Pain Management Practices Research Articles

Analgesic practices for acute pain management by veterinarians in Africa

Analgesic practices for acute pain management by veterinarians in Africa

Prevalence and associated factors of acute postoperative pain in adult surgical patients: A prospective study

BackgroundPain, as defined by the International Association for the Study of Pain, is an unpleasant sensory and emotional experience associated with, or resembling, that is associated with actual or potential tissue damage. In Ethiopia, where healthcare facilities and offerings are expanding to handle countless patients requiring surgical intervention, managing acute postoperative pain is a serious concern. ObjectivesTo assess the prevalence of acute postoperative pain and associated factors after elective surgery among adult patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2023 MethodologyThis is an institution-based cross-sectional study. A structured data collection format was used to collect data from 219 participants. Bivariable and multivariable logistic regression analyses described the association between independent and dependent variables. ResultsOf 219 patients, 180 (82.2 %) had acute postoperative pain. The prevalence of moderate to severe pain was 34.24 %. Preoperative anxiety, the use of intraoperative analgesics, and duration of surgery were the main factors associated with the prevalence of acute postoperative pain. ConclusionOur study revealed that the overall prevalence of postoperative pain was relatively low in the study area. This suggests that the attention given to postoperative pain recognition and management is better than that in other areas. However, the finding of a significant gap in managing postoperative pain underscores the need for further improvements in pain management practices. This should motivate us to commit to change, particularly in the identified areas of concern, such as preoperative anxiety, use of intraoperative analgesics, and duration of surgery.

Postoperative Opioid Administration and Prescription Practices Following Hysterectomy in Two Tertiary Care Centres: A Comparative Cohort Study between Canada and Austria.

Background: In light of the opioid epidemic, opioid-prescribing modalities for postoperative pain management have been discussed controversially and show a wide variation across geographic regions. The aim of this study was to compare postoperative pain treatment regimes. Methods: We performed a matched cohort study of women undergoing hysterectomy in Austria (n = 200) and Canada (n = 200). We aimed to compare perioperative opioid medications, converted to morphine equivalent dose (MED) and doses of non-opioid analgesic (NOA) within the first 24 h after hysterectomy, and opioid prescriptions at discharge between the two cohorts. Results: The total MED received intraoperatively, in the post-anaesthesia care unit (PACU) and during the first 24 h after surgery, was similar in both cohorts (145.59 vs. 137.87; p = 0.17). Women in the Austrian cohort received a higher MED intraoperatively compared to the Canadian cohort (117.24 vs. 79.62; p < 0.001) but a lower MED in the PACU (25.96 vs. 30.42; p = 0.04). The primary outcome, MED within 24 h in the postoperative ward, was markedly lower in the Austrian compared to the Canadian cohort (2.36 vs. 27.98; p < 0.001). In a regression analysis, only the variables "Country" and "mode of hysterectomy" affected this outcome. A total of 98.5% in the Canadian cohort were given an opioid prescription at discharge vs. 0% in the Austrian cohort. Conclusions: Our analysis reveals marked differences between Austria and Canada regarding pain management practices following elective hysterectomy; the significantly higher intraoperative and significantly lower postoperative MED administration in the Austrian cohort compared to the Canadian cohort seems to be significantly affected by each country's cultural attitudes towards pain management; this may have significant public health consequences and warrants further research.

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

The evolving landscape of neuromodulation for pain care

Here, we present five different insights on the use of neuromodulation strategies for effective pain management in clinical practice. Experts briefly illustrate the various techniques available and the complexities involved in evaluating their effectiveness. Additionally, they highlight the challenges for widespread adoption in clinical practice and explore some future directions. These viewpoints underscore the evolving landscape of neuromodulation in pain management and the ongoing efforts to optimize these treatments for diverse patient needs.

PSLBI-23 Effects of peri-castration pain management strategies on feed and water intake, performance, and blood cortisol concentrations of weaned beef steers

Abstract Objectives of this study were to identify if pain management strategies at the time of castration impact feed and water intake, performance, or blood cortisol concentrations in weaned beef steers. Black Angus and Simmental Angus cross bulls [n = 30; average age = 8 ± 1 mo, average body weight (BW) = 272 ± 45.5 kg] were randomly assigned to 1 of 3 treatment groups: 1) Control (CON; n = 10 bulls), castrated via banding; 2) Analgesic (M; n = 10 bulls), received an analgesic (meloxicam; 1 mg/kg BW) immediately after banding; or 3) Anesthetic + analgesic (ML; n = 10 bulls), received an intra-scrotal and intra-cord anesthetic (total lidocaine 15 to 20 mL + 10% sodium bicarbonate) injection immediately prior to banding and an analgesic (meloxicam; 1 mg/kg BW) immediately after banding. Blood collections to measure blood cortisol concentrations were taken on d -7, -0, +0 (day of castration pre- and post-procedure, respectively), 1, and 8. Data were analyzed as repeated measures using the MIXED procedure of SAS with treatment, day, and their interaction as fixed effects and animal as a random effect. While administering analgesics or anesthetics may reduce discomfort, the results of this study showed that these pain management practices do not significantly impact (P ≥ 0.07) on feed (CON = 7.41 ± 0.27 kg; M = 7.72 ± 0.27 kg; ML = 8.06 ± 0.27 kg) and water intake (CON = 20.90 ± 0.69 kg; M = 23.04 ± 0.69 kg; ML = 22.58 ± 0.69 kg), performance (CON = 345.40 ± 12.09 kg; M = 356.97 ± 12.09 kg; ML = 331.93 ± 12.09 kg), or blood cortisol concentrations (CON = 1.01 ± 0.19 ug/Dl; M = 1.19 ± 0.19 ug/Dl; ML = 1.38 ± 0.19 ug/DL). These data indicate that peri-castration pain management strategies can be adopted at the producers’ managerial discretion.

Opioid Administration in the Trauma Bay for Minor Injuries Does Not Improve Disposition.

Opioid usage in the trauma bay is a common practice for pain management. We evaluated the administration of opioids to patients with minimal injury to determine disposition and factors for opioid administration. A retrospective study at a single institution was conducted utilizing records of trauma activations with an ISS of 3 or less between 1/1/2022 and 10/29/2022. Patients who are incarcerated, pregnant, or received an opioid prior to arrival were excluded. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed using t-tests. 557 patients met inclusion criteria. One in five patients were administered an opioid (22%). The majority of patients who received opioids were between the ages of 25 and 44 (OR 1.218 [.693, 2.141]), black (OR 3.077 [2.066, 4.584]), and had Medicaid insurance (OR 1.390 [.883, 2.187]). Patients who received an opioid reported a higher pain level (8 [6, 9] v 5 [2, 8], P = .0001), despite no difference in ISS. No significant difference was found in patient dispositions (P = .1759). When fentanyl was administered, doses greater than 50mcg were administered to highest activation level trauma patients (40% v 10% P = .0001). Opioid administration for patients with minor injuries does not improve patient disposition. The majority of patients with minor injuries being treated with opioids are young, black, and Medicaid patients. This research suggests consideration for establishing a non-opioid analgesic medication as first-line pain management for patients without evidence of significant injury on initial evaluation.

Artificial Intelligence in Pain Management: Advancing Translational Science in Digital Health Research from Bench to Bedside

Artificial Intelligence (AI) is rapidly transforming the landscape of healthcare, with particularly profound implications in the field of pain management. This chapter delves into the integration of AI-driven tools that revolutionize the way pain is assessed, monitored, and treated. Through the use of predictive modeling, real-time monitoring, and personalized treatment plans, AI significantly enhances the precision, efficiency, and effectiveness of pain management strategies. The discussion extends to various AI applications, shedding light on the ethical considerations that accompany these technological advancements, as well as outlining future research directions. Collectively, these insights underscore the immense potential of AI to not only improve pain management practices but also to significantly elevate patient outcomes. Central to this transformation is the role of translational science in bridging the gap between theoretical AI models and their practical, clinical applications. This "bench to bedside" approach ensures that innovations in AI are not merely confined to research environments but are actively integrated into real-world patient care. For instance, AI-powered predictive analytics in pain management, driven by sophisticated machine learning algorithms, have progressed from computational experiments to clinical trials, and ultimately, to widespread implementation in healthcare settings. These AI models are now being utilized in hospitals to assess patient pain levels in real-time, predict opioid requirements, and optimize pain management protocols. This progression exemplifies how translational science is facilitating a paradigm shift in healthcare, positioning AI as an indispensable tool in modern pain management.

Practice variation in the management of pediatric intussusception: a narrative review.

This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception. • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients. • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception.

Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa

Purpose Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers’ perspective on factors influencing the optimal management of chronic pain. Methods Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model. Results The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal). Conclusion Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Advances in Nurses’ Pain Management Practices: The Case of Long-Term Care

Advances in Nurses’ Pain Management Practices: The Case of Long-Term Care

Efficacy of perioperative pain management in paediatric cardiac surgery: a protocol for a network meta-analysis

IntroductionCongenital heart disease is a common birth defect, but advancements in diagnosis and treatment have improved survival rates. Enhanced recovery after surgery (ERAS) programmes have emerged in paediatric cardiac surgery....

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices.

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

The Effect Of Implementing A Bundle Of Evidence-Based Pain Management On Patient's Perception Of Pain And Clinical Outcomes

Background: Evidence-based practice in pain management has been shown to provide improvements in patient outcomes. Aim: this study aimed to determine the effect of implementing a bundle of evidence-based pain management to improve patients' perception of pain and clinical outcomes. Research design: A quasi-experimental research design was used. Setting: the study was conducted on 3 surgical units (general, orthopedics and oncology surgery in Sayed Galal Hospital Sampling: a purposive sample of 70 adult patients was included in the study. Tools of data collection: four tools were used, first tool: a structured interviewing questionnaire. Second tool: Physiological parameters data. Third tool: Pain assessment by using The McGill Pain Questionnaire. Fourth tool: Groningen Sleep quality Scale. Result: the main results revealed that there was a statistically significant improvement in BP, HR, RR and Pso2 in the study group after intervention. There was statistically significant reducing total pain severity in the study group as well compared to control group with p-value = (0.01*). There was a highly statistically significant improvement of sleep quality at 3rd day postoperatively, with a p-value of 0.001* among study group. Conclusion: the implementation of a bundle of evidence-based pain management had a positive effect on reducing pain intensity, improvement of physiological parameters and sleep quality among the study group compared to control group. Recommendations: this study recommended that, reduplication this study in a large probability sample, using a bundle of evidence-based pain management in a different-surgical-wards. Set pain assessment scale as a part of a routine measurement like a vital-signs in surgical units

Association Between English Proficiency and Postoperative Pain Management for Adult Patients Undergoing Gynecologic Surgery: A Retrospective Cohort Study

PurposeTo determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery. DesignA retrospective cohort study was performed. MethodsThe electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest. FindingsAll patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance. ConclusionsLanguage barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted.

Opioid and Cannabinoid Systems in Pain: Emerging Molecular Mechanisms and Use in Clinical Practice, Health, and Fitness.

Pain is an unpleasant sensory and emotional experience. Adequate pain control is often challenging, particularly in patients with chronic pain. Despite advances in pain management, drug addiction, overtreatment, or substance use disorders are not rare. Hence the need for further studies in the field. The substantial progress made over the last decade has revealed genes, signalling pathways, molecules, and neuronal networks in pain control thus opening new clinical perspectives in pain management. In this respect, data on the epigenetic modulation of opioid and cannabinoid receptors, key actors in the modulation of pain, offered new perspectives to preserve the activity of opioid and endocannabinoid systems to increase the analgesic efficacy of opioid- and cannabinoid-based drugs. Similarly, upcoming data on cannabidiol (CBD), a non-psychoactive cannabinoid in the marijuana plant Cannabis sativa, suggests analgesic, anti-inflammatory, antioxidant, anticonvulsivant and ansiolitic effects and supports its potential application in clinical contexts such as cancer, neurodegeneration, and autoimmune diseases but also in health and fitness with potential use in athletes. Hence, in this review article, we summarize the emerging epigenetic modifications of opioid and cannabinoid receptors and focus on CBD as an emerging non-psychoactive cannabinoid in pain management in clinical practice, health, and fitness.

Expression of concern: “Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019” [Int. J. Africa Nurs. Sci. 20 (2024) 100642]

Expression of concern: “Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019” [Int. J. Africa Nurs. Sci. 20 (2024) 100642]

Evaluating the Impact of Opioid-free Anesthesia Protocol on Provider Utilization: A Pilot Study at 2 Southeastern US Hospitals

Objective: Perioperative opioid medications are implicated as contributors to the opioid crisis and associated with significant negative side effects that complicate recovery, leading to increased hospitalization and healthcare costs. Implementation of opioid-free anesthesia (OFA) hospital protocols may be an effective strategy to familiarize healthcare providers with non-opioid strategies for treating perioperative pain. Methods: An exploratory, descriptive pilot study was conducted at 2 Southeastern US Hospitals with a preexisting OFA policy. An electronic survey was developed and distributed to the anesthesia departments with an OFA protocol for bariatric surgical procedures. The responses (n=14) were analyzed, and the qualitative data thematically categorized. Results: Two major and one minor theme emerged. Theme 1: utilizing an OFA protocol led to increased familiarity and a desire to utilize OFA in other surgical populations. Theme 2: implementation of regional anesthesia into a multimodal OFA plan improves pain management and perioperative team support. Minor Theme: opioid sparing may be preferable to OFA techniques among a minority of anesthesia providers. Conclusion: OFA protocol promoted familiarity and favorable attitude towards OFA techniques. Participants reported an increased willingness to utilize OFA beyond protocol requirements. Therefore, hospital protocol may be a useful tool to drive evidence-based anesthesia and pain management practice change.

Exploring pain management practices among nurses in a provincial city of Vietnam: A cross-sectional investigation of influential factors

Background &amp; Aim: There is limited evidence regarding pain management practice and its associated factors among nurses in Vietnam. Therefore, the study aimed 1) To examine the current state of pain management practices among nurses at Hai Duong Provincial General Hospital, Vietnam; and 2) to identify its associated factors. Methods &amp; Materials: A cross-sectional study design was performed on 200 nurses and 200 medical records needed to be reviewed to match the number of nursing samples. The data collection was conducted from May to June 2022. The modified Cancer Pain Practice Index included 13 evidence-based pain management Indicators applied to measure nurses’ pain management practice by reviewing medical records, and the Knowledge and Attitudes Survey Regarding Pain tool was used to assess the pain management knowledge and attitude of nurses by self-completed questionnaire. Results: A significant majority, comprising 146 nurses (73%), demonstrated inadequate pain management practices. Several crucial indicators of pain management were suboptimally performed by the majority of nurses. These included failure to document the execution of pain assessments for new patients, inadequate monitoring for side effects of opioid analgesics, and insufficient assessment and care for bowel status when opioids were prescribed. Additionally, participation in prior pain management training courses, along with knowledge and attitude toward pain management, emerged as significant variables associated with pain management practices (p&lt;0.001). Conclusion: The study highlighted widespread poor pain management practices among nurses. Participation in training courses and good knowledge and attitude correlate with better practices.

ASSESSMENT OF NEWBORN PAIN RELATED TO CARE

Pain in newborns is an issue we cannot ignore any longer. The health care providers should confirm that the baby is comfortable during any procedures as it is not only that it is ethically right for them to treat in pain the patients but can also have serious after-effects in newborns and can also lead to other diseases. This study aimed to evaluate pain induced by medical procedures, describe pain management practices, and improve pain management. Two surveys were conducted: the first one on the patients through the prospective descriptive observational study. This was carried out in the NICU in the department of neonatology in the CHU MOHAMED VI of Oujda over a period of 4 months, starting from February 26, 2024 until June 26, 2024. Pain was assessed by using the DAN scale in 98 newborns (female: 56%, sex ratio: 1.27, premature: 42%, and mean weight: 2538g). The median DAN score duringmedical procedures was 4.5, which dropped to 1 three minutes after the painful procedure. The second survey was conducted among a sample of 45 medical and paramedical workers of the neonatology department of the CHU MOHAMED VI Oujda. Eighteen percent of the medical and paramedical staff indicated that they had taken specific training in pain and palliative care. A specific training session was organized for enhancing pain management. Before the training, 44% of caregivers had never assessed the pain level of their patient whereas after the training 78% of them will always assess the pain, this improved significantly post training. Regarding pain management, before training, it was not done routinely, fifty-eight percent of caregivers reported that they rarely or never used any preventive strategies, whereas after training, 84% reported always or often using preventive measures. The majority of caregivers were against the presence of parents during invasive procedures.