Pain Management Group Research Articles

Intercostal Nerve Cryoablation in Lung Transplantation: A Single-Center, Propensity-Matched Analysis

ObjectiveAchieving adequate pain control after lung transplantation is an essential milestone in a patient’s recovery. We compared postoperative opioid use, clinical outcomes, and respiratory function in lung transplant recipients treated with intercostal nerve cryoablation (INC) vs standard pain management. MethodsWe reviewed all adult lung transplants performed at our center between January 2016 and December 2022. We excluded cases performed through median sternotomy , patients with prior thoracotomies, multiorgan transplants, and redo transplants. We performed a propensity matched analysis, comparing patients who received INC versus standard pain management The primary outcome was cumulative postoperative opioid use in morphine milligram equivalents (MME) by POD 14. Secondary outcomes included opioid use on POD5 and POD10, perioperative outcomes, 1-year survival and longitudinal measurement of respiratory function. ResultsPropensity matching resulted in 85 patients in each group. Compared to standard pain management, the INC group had a lower cumulative opioid use by POD 14 (509 vs 864 MME, p=0.032). In addition, the INC group had a lower opioid use at POD5, POD10, POD14, no difference in perioperative outcomes, and similar 1-year survival. The INC group had better respiratory function at 6 and 12-months posttransplant compared to the standard pain management group. ConclusionsIn our single center analysis, INC was associated with lower opioid use and improved respiratory function after lung transplant. This report adds to the growing literature supporting the use of INC in multimodal pain management strategies and enhanced recovery protocols in lung transplant.

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal.

As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy. Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B). Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate. Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

History and prospects for the use of morphine in clinical practice: literature review

The authors analyzed various studies on acute and chronic pain syndrome treatment. This review provides brief historical data on the discovery and use of morphine from ancient times to present. Morphine remains one of the most common painkillers worldwide and has a rich history dating back more than 200 years. Its basic properties, pharmacokinetics, pharmacodynamics, and principles of use are discussed. No drug has had such an impact on society as morphine because of its medical use as a pain reliever and its illicit use as a drug of addiction and abuse. This review includes the main modern recommendations for the treatment of acute and chronic pain, particularly from the World Health Organization for the treatment of chronic pain and the Procedure-Specific Postoperative Pain Management (PROSPECT) group for the treatment of postoperative pain in various surgical interventions. The types of opioids and their clinical use are described, and the authors’ opinion on the current use of morphine for treating acute and chronic pain syndrome is presented.

Cases, Prevalence and Treatment of Low Back Pain at Bandung Pain Rehab

Background: Low back pain (LBP) is one of the pain complaints that affects almost every aspect of a person's life, urging many patients to come for treatment. The incidence of LBP in Indonesia is estimated between 7,6% and 37%, but it is still precisely unknown. A clinician must be able to make an accurate diagnosis to treat patients according to the etiology. In this study, we aim to determine the distribution of prevalence, demographic data, and the success of LBP treatment in order to help clinicians in management of LBP to reduce the global burden.&#x0D; Methods: This was a descriptive analytic study with a cross-sectional design. This research was conducted at the Bandung Pain Rehab Center (BPRC) clinic from July 2019 to December 2021. We included all patients complaining of low back pain who came for treatment at the BPRC. The data of this study were taken from medical records. The success of therapy in the interventional pain management (IPM) and non-IPM groups was assessed by comparing the VAS values before and after treatment. Statistical analysis was performed using the IBM SPSS Statistics 23 program with the Wilcoxon test.&#x0D; Results: Of the 704 patients, the majority were female (59,2%), aged 51-60 years (23,6%), with obese body mass index (54,4%), and worked as housewives (35,5%). The most common etiology of LBP was piriformis syndrome (50,9%), followed by sacroiliac joint arthropathy (18,5%) and lumbar radiculopathy (14,8%). In the IPM and non-IPM groups, there was a significant decrease in pain intensity after therapy (p &lt;0,001).&#x0D; Conclusion: Our research shows that LBP is most common at the age of 51-60 years, female gender, with a body mass index classified as obese, and working as a housewife. Piriformis syndrome is the most common prevalent etiology of LBP. The use of therapy in both IPM and non-IPM showed significant improvements in alleviating pain experienced by the patients.&#x0D; Keywords: Low back pain, case, prevalence, IPM, non-IPM, VAS score

Feasibility of a Mindfulness and Pain Management Group in an Acute Rehabilitation Setting

<h3>Research Objectives</h3> To report the feasibility of a Mindfulness and Pain Management group for adults in acute inpatient rehabilitation, share details on the novel intervention, and the results of an exploratory analysis. <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> Inpatient rehabilitation facility. <h3>Participants</h3> Adults receiving rehabilitation after orthopedic, amputee, spinal cord injury, cancer, or stroke, who report pain. <h3>Interventions</h3> 45-minute, 4-part, Mindfulness and Pain Management group led by a clinical psychologist and physical therapist. <h3>Main Outcome Measures</h3> The Mindfulness and Pain Management Survey (MPMS) which assesses any prior knowledge/use of mindfulness and pain management strategies and the likelihood to utilize strategies learned. The Numerical Rating Scale of Pain (NRS) assesses pain levels on a 0-10 scale. The NRS was administered to participants pre and post the intervention. <h3>Results</h3> Over 6-months, 22 pain management groups took place, with 53 participants total. Recruitment was continuous. Of the 53, 57.8% were female, the mean age of the group was 65.45(14.75). The most common diagnostic group was the orthopedic population (54.7%) and the most common location of the pain was the leg (29.7%). The means and standard deviations were calculated for the NRS, both pre and post the group session. The pre-group NRS were 5.13(2.50) and the post-group NRS were 4.45(2.66). The paired samples t-test revealed a statistically significant average difference, t52=3.648, p <h3>Conclusions</h3> The findings demonstrate the feasibility of implementing a Mindfulness and Pain Management Group in an acute rehabilitation setting. Also, findings suggests potential effect on pain reduction, however we suggest more research to examine the efficacy of this group. <h3>Author(s) Disclosures</h3> All authors have nothing to disclose.

Compassion focused therapy for pain management: '3 systems approach' to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain.

This paper describes the development of an eight-week Compassion Focused Therapy for Pain Management (CFT-PM) group. This group was specifically designed for 'strivers' a sub-group of people with persistent pain who tend to engage in over-activity and resist making reasonable adjustments to their activity levels to accommodate their persistent pain. 'Strivers' tend to cope by ignoring their pain and pushing on through, in the shorter term leading to 'boom and bust' activity-related exacerbations of their pain. They also risk the development of additional persistent fatigue and burnout in the longer term. 117 people completed the CFT-PM group; The group was delivered in person (n = 84) but in online format from July 2020 (n = 33). 162 people started the CFT-PM group but 45 dropped-out (27.43%). There was a significant effect for time across all measures: significant improvement was found for depression, self-compassion, pain-related disability, pain-related anxiety and pain self-efficacy. Pain numeric rating scores were approaching significance. There was a significant main effect of diagnosis; post-hoc t-test analysis found significant improvement for all diagnoses on all measures with the exception of spinal. There was also a significant interaction between time and format: post-hoc t-test analysis found greater improvement for virtual format on self-compassion and pain-related anxiety. Findings suggests that CFT-PM may be a clinically effective group intervention with virtual format showing superior improvement. This approach might be less suitable for certain diagnoses; the spinal group may benefit more from traditional CBT-based PMPs. Limitations include the lack of random selection or allocation to treatment group. Future studies should adopt an experimental design to be able to draw firm conclusions regarding causation and efficacy. Despite these limitations, present findings suggest that CFT-PM may be an effective group intervention worthy of further investigation and clinical application.

The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery.

Background Due to the presence of multimorbidity and polypharmacy, patients aged 75 and older are at a higher risk for postoperative adverse events after lumbar fusion surgery. More effective enhanced recovery pathway is needed for these patients. Pain control is a crucial part of perioperative management. The objective of this study is to determine the impact of multimodal pain management on pain control, opioid consumption, and other outcomes. Methods This is a retrospective review of a prospective collected database. Consecutive patients who underwent elective posterior lumbar fusion surgery (PLF) from October 2017 to April 2021 in our hospital were reviewed. Perioperative multimodal pain management (PMPM) group (from January 2019 to April 2021) in which patients received multimodal analgesia was case-matched to the control group (from October 2017 to December 2018) in which patients were treated under the conventional patient-controlled analgesia (PCA) method. Postoperative visual analogue scale (VAS), opioid consumption, complications within 3 months, and other outcomes were collected and compared between groups. Results A total of 122 consecutive patients (aged 75 and older) were included in the PMPM group and compared with previous 122 patients. The PMPM group had a lower maximal VAS score (3.0 ± 1.7 vs. 3.7 ± 2.0, p < 0.001) and frequency of additional opioid consumption (6.6% vs. 19.7%, p=0.001) on POD3 than the control group. The rates of postoperative complications were lower in the PMPM group compared with the control group (25% vs. 49%, p=0.006) during a 3-month follow-up period. Conclusions This study demonstrates that the PMPM protocol is effective in pain control and reducing additional opioid consumption when compared with conventional analgesia, even for patients aged 75 and older. Moreover, these improvements occur with a lower incidence of postoperative complications within three months after PLF surgery.

Precise Analgesic Instructions Improve Narcotic Usage: A Randomized Trial.

Given the ongoing battle with opioid abuse and overuse in the United States, new strategies are consistently being implemented to reduce opioid utilization and overprescribing. The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken. Blinded randomized prospective study comparing a total of 110 (Group A = 55, Group B = 55) women who underwent elective outpatient bilateral breast reduction surgery by 2 different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain. Patients in Group B took on average 1.5 oxycodone (5 mg) and patients in Group A took on average 5.7 oxycodone (5 mg) (P < 0.01). Thirty-four patients in Group B took no oxycodone. Patients in Group B also had statistically significant lower subjective pain scores. Based on these results, it appears that standardizing how patients are instructed to treat their pain postoperatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

Editorial introductions.

Editorial introductions.

A mind-body program for pain and stress management in active duty service members and veterans.

The Mind-Body Medicine (MBM) program at the Naval Medical Center San Diego, created in collaboration with the Benson-Henry Institute for Mind Body Medicine and the Home Base Program at Massachusetts General Hospital, is a 7-week program designed to facilitate stress management habits into patient treatment plans. The aim of this study is to test the feasibility and acceptability of a mind-body program for service members and veterans. Participants (N = 239) were primarily active duty service members of the U.S. Navy and Marine Corps reporting significant perceived stress (Stress Resiliency (SR) group; n = 124), or meeting criteria for chronic pain (Pain Management (PM) group; n = 115). Participants completed measures at preprogram and post-program assessing for perceived stress, pain, functional impairment, quality of life, and psychological and somatic symptoms. Changes in self-reported psychological symptoms and knowledge and practice of mind-body principles were examined. Participants across groups had significant improvement in most outcomes (perceived stress, response to stressful experience, functional impairment, sleep disturbance, depression, PTSD, and anxiety symptoms; and each quality of life domain aside from social relationships), with p values < .0017 (Bonferroni corrected level of significance). The SR group demonstrated significant improvements in primary outcomes of perceived stress and response to stressful experience, and the PM group demonstrated significant improvement in pain severity, but not perceived stress. Significant change was observed in knowledge and practice of mind-body medicine principles, and high satisfaction was reported. Results suggest that a mind-body program may improve physical and psychological functioning for service members, including those facing significant perceived stress and chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in children with burns: a prospective randomized controlled study

Objective: To explore the effects of stepwise acute pain management on acute pain and post-traumatic stress disorder (PTSD) in children with burns. Methods: From November 2018 to December 2019, 196 children with burns who were admitted to West China Hospital of Sichuan University and met the inclusion criteria were enrolled in the prospective randomized controlled study. The children were divided into traditional pain management group (97 children, 51 males and 46 females, aged 1 to 6 years) and stepwise pain management group (96 children, 55 males and 41 females, aged 1 to 6 years) according to the random number table. Children in traditional pain management group were treated with traditional acute pain care, while the children in stepwise pain management group were treated with stepped acute pain management (moderate pain was treated with oral administration of acetaminophen sustained-release dry suspension at the dose of 10 to 15 mg/kg once every 4 to 6 hours, and severe pain was treated with morphine intravenous injection at the dose of 0.1 to 0.2 mg/kg once every 4 hours) on the basis of traditional acute pain care after admission. The COMFORT behavior scale was applied to compare the resting pain levels of children in the two groups within post injury day (PID) 3 (1, 9, and 17 o'clock each day). The adverse reactions of children in the stepwise pain management group during the treatment period were recorded. The occurrence of PTSD within one month after injury was evaluated in both groups by the revised PTSD scale. Data were statistically analyzed with independent sample t test, Bonferroni correction, analysis of variance for repeated measurement, chi-square test, Wilcoxon rank sum test, and Fisher's exact probability test. Results: The pain scores of children in stepwise pain management group were significantly lower than traditional pain management group at 1, 9, and 17 o'clock on PID 1, 1, 9, and 17 o'clock on PID 2, and 1, 9, and 17 o'clock on PID 3 (t=2.71, 3.44, 4.05, 4.18, 4.08, 4.19, 4.25, 3.69, 3.71, P<0.05 or P<0.01). The pain scores of children in both groups showed a decreasing trend over time. Of the 96 children in stepwise pain management group, 84 children were treated with oral administration of acetaminophen sustained-release dry suspension, and 12 children were treated with morphine intravenous injection. No adverse reaction occurred during the treatment period. The incidence of PTSD of children in stepwise pain management group within 1 month after injury was 3.12% (3/96), which was significantly lower than 14.43% (14/97) in traditional pain management group, P<0.05. Conclusions: The stepped acute pain management can relieve the acute pain and reduce the incidence of PTSD in children with burns.

Digital group developments in Acute Psychology Services

Dr Rachel Atherton,Consultant Clinical Psychologist Scottish National Residential Pain Management Programme (SNRPMP) &amp;Dr Ross Shearer,Consultant Clinical Psychologist Specialist Weight Management Service (SWMS) both with NHS Greater Glagsow &amp; Clyde share the practical aspects of moving a pain management group online.

Waiting in Pain II: An Updated Review of the Provision of Persistent Pain Services in Australia.

ObjectiveTo provide an update on Australian persistent pain services (number, structure, funding, wait times, activity).MethodsAn updated national search was conducted. Of those identified, 74 persistent pain services provided detailed responses between July 2016 and February 2018 (64 adult, seven pediatric, two pelvic pain, and one cancer pain). A similar structure to the original Waiting in Pain (WIP) survey was used, and participants chose online or telephone completion.ResultsPediatric pain services had more than doubled but remained limited. Adult services had also increased, with a concurrent decrease in median wait times and an increase in the number of new referrals seen each year. Despite this, some lengthy wait times (≥3 years) persisted. Wait times were longest at clinics using public or combined funding models and offering pain management group programs (PMGPs). Although clinical activity had increased, medical staffing had not, suggesting that clinics were operating differently. Privately funded clinics performed more procedures than publicly funded services. Use of PMGPs had increased, but program structure remained diverse.ConclusionsSpecialist pain services have expanded since the original WIP survey, facilitating treatment access for many. However, wait time range suggested that the most disadvantaged individuals still experienced the longest wait times, often far exceeding the recommended 6-month maximum wait. More needs to be done. Numerous developments (e.g., National Strategic Action Plan for Pain Management, health system changes as a result of the COVID-19 pandemic) will continue to influence the delivery of pain services in Australia, and repeated analysis of service structures and wait times will optimize our health system response to the management of this condition.

The effect of pain management group on chronic pain and pain related co-morbidities and symptoms. A stepped-wedge cluster randomized controlled trial. A study protocol

IntroductionIn primary care settings, pain-management group therapy is a tool potentially cost-effective but very much underused. MethodsOur purpose here is to provide useful scientific information on the effect of pain-management group participation on chronic pain and pain-related co-morbidities and symptoms, as well as practical information for primary and occupational health services to initiate pain-management group activity.This study will be carried out at primary care Occupational Health Helsinki (Helsinki city employees' occupational health services), with the Finnish Institute of Occupational Health as the research partner.This is a stepped-wedge cluster randomized controlled trial among both male and female municipal employees aged 18 to 65, all of whom had visited an occupational doctor, nurse, psychologist, or physiotherapist because of any chronic pain unrelated to malignant disease. An additional inclusion criterion is work disability risk being elevated, based on a short screening questionnaire (modified Örebro questionnaire). Each participant and each interviewer will be blinded at randomization. Three groups, 10 subjects in each, begin directly after recruitment with 6 weekly 2-h meetings and a follow-up meeting 6 months later. Three waiting-list groups begin 4 months later. Subjects complete self-administered questionnaires before and after the sixth meetings, also 6 months later. Primary outcomes are pain intensity, current work ability, pain self-efficacy, fear-avoidance beliefs, chronic pain acceptance, depressive symptoms, sleep problems, sickness absence days, and number of occupational health care contacts from OH's medical records. ResultsWe will publish our results in a peer-reviewed scientific journals.

The effect of pain management group on chronic pain and pain related co-morbidities and symptoms. A stepped-wedge cluster randomized controlled trial. A study protocol

IntroductionIn primary care settings, pain-management group therapy is a tool potentially cost-effective but very much underused. MethodsOur purpose here is to provide useful scientific information on the effect of pain-management group participation on chronic pain and pain-related co-morbidities and symptoms, as well as practical information for primary and occupational health services to initiate pain-management group activity.This study will be carried out at primary care Occupational Health Helsinki (Helsinki city employees' occupational health services), with the Finnish Institute of Occupational Health as the research partner.This is a stepped-wedge cluster randomized controlled trial among both male and female municipal employees aged 18 to 65, all of whom had visited an occupational doctor, nurse, psychologist, or physiotherapist because of any chronic pain unrelated to malignant disease. An additional inclusion criterion is work disability risk being elevated, based on a short screening questionnaire (modified Örebro questionnaire). Each participant and each interviewer will be blinded at randomization.Three groups, 10 subjects in each, begin directly after recruitment with 6 weekly 2-h meetings and a follow-up meeting 6 months later. Three waiting-list groups begin 4 months later. Subjects complete self-administered questionnaires before and after the sixth meetings, also 6 months later. Primary outcomes are pain intensity, current work ability, pain self-efficacy, fear-avoidance beliefs, chronic pain acceptance, depressive symptoms, sleep problems, sickness absence days, and number of occupational health care contacts from OH's medical records. ResultsWe will publish our results in a peer-reviewed scientific journals.

Pre-emptive pain management program is associated with reduction of opioid prescription after minimally invasive pulmonary resection.

BackgroundWe developed and implemented a pre-emptive pain management program wherein providers agreed to have non-opioid pain medication as a standard pain management strategy at discharge accompanied by patient education about the program.MethodsA retrospective case-control study of prospectively collected data of patients who underwent minimally invasive pulmonary resection. We compared the outcomes among patients who were managed with pre-emptive pain management program with enhanced recovery after surgery (Pre-emptive), enhanced recovery program after surgery alone (ERAS) and standard care (control).ResultsOf the 443 patients, 132 patients (30%) were in the pre-emptive pain management group, 90 (20%) patients were in the ERAS only group and 221 (50%) in the control group. There were significantly fewer complications (15.9% vs. 23.3% vs. 38%, P<0.001), shorter median length of hospital stay (2 vs. 3 vs. 3 days, P<0.001), lower 30-day readmission rates (2.3% vs. 3.3% vs. 11.3%, P=0.002), and fewer opioid prescriptions at discharge (17.4% vs. 76.7% vs. 83.7%, P<0.001) in the pre-emptive pain management group compared to the ERAS and control groups. Multivariate logistic regression analyses showed that the pre-emptive pain management program (OR 0.06; 95% CI, 0.03, 0.11, P<0.001) and robotic surgery (OR 0.52; 95% CI, 0.3, 0.88, P=0.02) were associated with lower odds of patients being discharged to home with opioid prescriptions. The median pain score in the pre-emptive pain group at 30 days after surgery was 1.5 on a pain scale of 1–10.ConclusionsThe pre-emptive pain management program was associated with a decrease in opioid prescriptions after elective pulmonary resections. Successful implementation of this program can lead to significant decreases in the amount of prescription opioids in the community.

Staff Experiences of Using Virtual Reality in a Pain Management Group

Staff Experiences of Using Virtual Reality in a Pain Management Group

PAIN SYNDROME AND PAIN MANAGEMENT AFTER LUMBAR SPINE SURGERY

Background. Multimodal analgesia (MMA) in spine surgery is in the beginning of implementation because of contradictions about the negative influence of NSAIDs on spinal fusion process. There is no agreement as to the influence of anesthesia method on postoperative pain after lumbar spine surgery. Aim of the study was to examine the influence of anesthesia type and postoperative pain management on narcotic consumption during lumbar spine surgery. Material and methods: 250 ASA I-II patients 18-65 y.o. during elective lumbar spine surgery on 1-2 segments were examined prospectively. Patients were divided into 4 groups: 1А (n=55) – spinal anesthesia (SA) and standard pain management, 1В (n=55) – SA and MMA, 2А (n=70) – intravenous anesthesia with propofol/fentanyl (TIVA) and standard pain management, 2В (n=70) – TIVA and ММА. Standard pain management included acetaminophen 1 g IV 3 times per day and morphine if VAS pain score was e” 4. For MMA we additionally included pregabalin 75 mg 12 hours before surgery and then two times per day during 3 days and parecoxib 40 mg IV twice per day for the first postoperative day. Results: in both MMA groups (1B and 2B) time of the first morphine requirement was significantly longer than in standard pain management groups (1A and 2A). Average dose of morphine during 24 postoperative hours was the biggest in 2A group (TIVA with standard pain management). In MMA patients the incidence of nausea was lower than in standard pain management patients. Dizziness occurred more frequently in TIVA patients with standard pain management. Conclusions: anesthesia type has an influence on the postoperative pain during the first 24 hours: the average morphine consumption is bigger in TIVA patients with standard pain management than in SA patients. MMA decreases narcotic consumption in any type of anesthesia and decreases postoperative nausea and dizziness

Online group pain management for chronic pain: Preliminary results of a novel treatment approach to teletherapy

Objective This pilot study was designed to determine the feasibility, tolerability, safety, and efficacy of group teletherapy for persons with chronic pain. The aim was to present preliminary outcomes of an open trial of group cognitive behavioural therapy (CBT) teletherapy compared with an in-person chronic pain patient group. Methods We recruited 47 chronic pain patients to participate in an 8-session, 2-hour-per-week, online, structured, CBT-oriented pain management group using WebEx and compared them with 46 subjects who participated in a parallel, content-matched, in-person, weekly group. Both groups included goal setting, skills training, relaxation exercises, group discussion, and practice assignments. All subjects completed baseline measures, which were repeated post-treatment. Those in the online group participated in weekly telephone interviews and rated the perceived helpfulness of the remote group. Results The average age of the online group participants was 54.5 ( ± 14.3) years and 70.2% were female, compared with 59.7 ( ± 13.0) years of age and 57.8% females among the in-person group members. On follow-up, both CBT groups showed modest improvements on the outcome measures. Results of this preliminary investigation comparing online teletherapy with in-person CBT suggest similar benefit. Many participants in the online group rated their experience as very helpful (62.5%; 7–10/10) and most would recommend this programme to others (93.7%; 7–10/10). Discussion Preliminary findings suggest that online group CBT may be as effective in improving coping among persons with chronic pain as in-person groups. More rigorous controlled trials are needed to adequately assess the outcome benefit of online teletherapy for chronic pain.

Nurse-led post-thoracic surgery pain management programme: its outcomes in a Nigerian Hospital.

The overarching aim of this study was to investigate the effects of a nurse-led pain management programme on pain intensity, side effects of treatment, shoulder range of motion and length of stay after thoracic surgery. Post-thoracic surgical pain is a major source of stress and distress for patients. It has profound effects ranging from increased risks in developing chronic post-thoracic surgery pain to an increased length of stay after surgery. The post-thoracic surgical pain management in the Nigerian context is based on the traditional approach that is dependent on the attending medical and nursing staff. The study was a quasi-experimental design (two-group post-test only). The study was conducted in a Nigerian hospital. Forty-two patients were recruited and consecutively assigned into either the usual pain management group or the intervention group after they had met the inclusion criteria. Data were collected utilizing the following: (1) the modified McGill Pain Questionnaire; (2) a Numeric Rating Scale; (3) the documentation form for thoracic surgery pain management outcomes and (4) a goniometer. The findings indicated that pain intensity, nausea and drowsiness were significantly reduced among the patients in the experimental group than the control group, while the duration of stay after surgery and the shoulder range of motion were not different between the groups. This study's results suggest that the intervention in question for patients undergoing thoracic surgery had a positive effect on reducing pain intensity, nausea and drowsiness but not the shoulder range of motion and length of stay after surgery. Nursing policymakers may need to give a serious consideration to the revision of policies related to the nursing education curriculum as well as the in-service training curriculum regarding pain management by nurses especially after surgery. Likewise, future research on other populations employing an improved methodology as well as utilizing up-to-date evidence by nurses across different hospitals may be necessary.