Pain Management Services Research Articles

A Course on Acute Pain Management for Nurses: An Endeavour to Improve Acute Pain Relief in a Developing Country

This article was migrated. The article was marked as recommended. Introduction: Inadequate acute pain relief is a significant healthcare problem. In developing countries acute pain services are still few in number, mainly due to insufficient resources. Adequately trained nurses can play a pivotal role in provision of pain management services. Method: A 5-day course was conducted for 30 nurses involved in care of surgical patients at six tertiary care hospitals as a first step towards development of anaesthesia-supervised nurse-based acute pain services in the participating hospitals. Teaching methodologies included lectures, problem-based discussions, workshops, and practicums. Pre and post-tests were conducted. A telephonic interview of the participants was conducted one year after the course. Results: The overall rating given to the course was 4.35 on the scale of 5. All nurses affirmed that they experienced a change in their practice after attending the course. Pain assessment is now performed routinely by them while recording vital signs and they are able to assess and manage side effects of pain medication in a more effective manner. All participants are involved in informal teaching of their peers. Conclusion: Similar courses need to be conducted on a regular basis to strengthen the workforce and improve the effectiveness of acute pain management in developing countries.

Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

Combined fluoroscopic and ultrasound guided cervical nerve root injections.

To assess the technical feasibility, safety and initial clinical efficacy of a combined ultrasound and fluoroscopy imaging approach to cervical nerve root blocks. Fluoroscopic guided cervical transforaminal and selective nerve root injections are often used in the investigation or treatment of radicular symptoms, although rare but serious complications including death have been reported. We report a combined technique developed to increase safety of selective nerve root injections, including the safety and early efficacy of this novel technique in our initial patient cohort. We retrospectively reviewed a consecutive cohort of injections performed in 149 patients by a single consultant radiologist between December 2010 and August 2012. For all patients the outcome was assessed both immediately following the procedure and at sixweeks. Primary outcome was reduction in radicular symptom level. Duration of symptoms were also assessed and all complications were recorded. One hundredand forty nine patients underwent injection at either one or two cervical levels. No patients experienced any complications during the follow-up period, and 72% had an initial positive response to the injection. Of these, 42% were discharged to the care of their General Practitioner, 23% went on to have surgery, 18% were actively monitored in a specialist clinic, 10% were referred to our pain management service and 4% had the injection repeated after symptoms recurred. Using this combined image guided technique cervical nerve root blocks appear both safe and effective in the investigation and management of radicular symptoms from the cervical spine.

Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care. Recommendations • Palliative and supportive care must be multidisciplinary. (G) • All core team members should have training in advanced communication skills. (G) • Palliative surgery should be considered in selected cases. (R) • Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R) • All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G) • Pain relief should be based on the World Health Organization pain ladder. (R) • Specialist pain management service involvement should be considered early for those with refractory pain. (G) • Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G) • Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G) • Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R) • Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R) • 'Do not attempt cardiopulmonary resuscitation' orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G).

Development and Patient Satisfaction of a New Telemedicine Service for Pain Management at Massachusetts General Hospital to the Island of Martha's Vineyard.

Patients in remote areas lack access to specialist care and pain management services. In order to provide pain management care to patients remote from our center, we created a telemedicine pain clinic (telepain) at Massachusetts General Hospital (MGH) in Boston, MA to extend services to the Island of Martha's Vineyard. Over 13 months, 238 telepain video clinic evaluations were conducted. A pain physician visited the island 1-2 days per month and performed 121 interventions. Given the novelty of telemedicine clinics, we surveyed patients to gauge satisfaction and identify perceived weaknesses in our approach that could be addressed. Forty-nine consecutive patients answered a 14-question, 5-point balanced Likert-scale survey with 1 (no, definitely not) being most negative and 5 (yes, definitely) being most positive. Patients on Martha's Vineyard referred for pain management consultation services via telemedicine. Forty-nine consecutive patients evaluated via telemedicine. Likert-scale survey administered. Questions measured patient impressions of video-based visits with their doctor, convenience of the visit, concerns about privacy, and whether they would recommend such a visit, among other items. Mean respondent scores for each question were >4.3 indicating a favorable impression of the telepain clinic experience. Lowest mean scores were found when respondents were asked to compare the care they received by telepain versus an in-person visit, or whether they were able to develop a friendly relationship with the doctor. The results suggest an overall positive reception of telepain by patients, yet highlight the challenge of building a patient-physician relationship remotely.

The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study

BackgroundSelf-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients’ health outcome. Contemporary pain management theories and models also suggest that a good patient–professional partnership enhances patients’ ability to self-manage their condition. Objectives(1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient–professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain. Design and settingThis quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient–professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients’ health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients’ life situation. Patients were recruited following initial consultation and followed up three months later. ParticipantsA total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief. MethodsSelf-reported measures of HRQoL, patient–professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling. ResultsThere was no association between patients’ self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (−0.38, p<0.01). A patient–professional partnership was not found to be beneficial for patients’ HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (−19.09, p<0.01). ConclusionsThis study suggests that the increase in patients’ self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient–professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain.

Inequalities in access to a tertiary children's chronic pain service: a cross-sectional study

BackgroundPoor health, including chronic pain, has been consistently shown to be associated with lower socioeconomic status (SES).ObjectiveTo describe the SES of a clinical population of children with chronic pain referred...

Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

New approach for treatment of prolonged postoperative pain: APS Out-Patient Clinic

Background and aimsPersistent postoperative pain (PPP) is a significant clinical problem. Several patient-related risk factors for PPP have been identified, including a previous chronic pain problem, young age, female gender and psychological vulnerability. Intra- and postoperative risk factors include surgical complications such as infections, haematoma, nerve damage and repeated surgery. As the length of hospital stay has been shortened, some patients may be discharged despite ongoing pain and insufficient analgesic medication. The challenge is to identify patients at high risk of developing PPP and to create a targeted care pathway to ensure effective and safe pain treatment especially in the subacute postoperative phase at home. This observational study describes the first two years of the Acute Pain Service Out-Patient Clinic (APS-OPC) at the Helsinki University Hospital. MethodsPatient characteristics, known risk factors, and details of treatment of PPP for the first 200 patients referred to our APS-OPC were retrospectively collected from the medical records. The APS-OPC clinic functions in close collaboration with the Multidisciplinary Pain Clinic (MPC), and the number of patients in need of physiotherapist, psychologist or psychiatrist counselling was recorded, as well as the number of patients referred to the MPC for further PPP management. ResultsPatients were referred to the APS-OPC from different surgical specialities, the two most common being thoracic and orthopaedic surgery. Seventy per cent of the patients (139/200) presented symptoms indicating neuropathic postsurgical pain. The patients had, on average, five risk factors for PPP. The median time from surgery to the first contact to the APS-OPC was two months, and the median duration of follow-up was 2.8 months (0–16 months). The median number of contacts with APS-OPC was 3 (range 1–14). Every fourth patient needed only one contact to the APS-OPC. Nineteen per cent of the patients had an appointment with the physiotherapist and 20% with a psychologist or psychiatrist. At discharge after surgery, 54% of the patients were using weak opioids, 32% strong opioids and 71% gabapentinoids; at discharge from the APS-OPC, these numbers were 20%, 6% and 43%, respectively. Twenty-two per cent of the patients were referred to the MPC for further pain management. ConclusionsThe APS-OPC provides a fluent fast-track method of ensuring effective multimodal analgesia in the subacute recovery phase after surgery. Even strong opioids can be safely used after discharge and then tapered off in close supervision of the APS-OPC anaesthesiologist. As the APS-OPC was implemented in close collaboration with the MPC, the multidisciplinary resources are easily available during the course of the APS-OPC treatment. ImplicationsThe first two years of the APS-OPC have shown that a significant number of surgical patients benefit from continuing active pain management after discharge from hospital. This fast-track service provides physician-supervised titration of analgesics to improve pain relief in the subacute phase. An important task of the APS-OPC is to ensure that strong opioids are not inappropriately continued after recovery. Another goal of the APS-OPC is to identify patients in need of multidisciplinary pain management services to prevent chronification.

Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs.

This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services.

Protecting Workers from Step Voltage Hazards

Occupational accidents still occur, despite technical developments in the occupational safety field at large. The experience of being harmed at work can be devastating, with profound consequences for employees, their families, friends, and work colleagues. Many consequences cannot be measured directly, such as pain suffered. However, the economic burden can be estimated [1]?[4]. Wages lost depends on the duration of illness and the worker?s disability rate. The more that work disability reduces an affected worker?s actual income, and that income diverges from projected earnings trajectory prior to the injury, the larger the economic consequences. A significant impact?on workers? productivity also increases the risk of dismissal. A permanently incapacitated worker is no longer able to contribute to the community and has to be supported by the society in many cases. Occupational accidents worsen previously existing health problems. Some injuries cause permanent chronic pain, which means the worker will need pain management and counseling services. Even after physical recovery, the consequences of a workplace accident may not cease. Employees may show higher rates of psychological problems, drug abuse, sleep ?disorders, changes in food consumption and body weight, and marital difficulties. Some of these workers need psychiatric assistance to overcome their problems. They may become isolated, estranged from their community, and depressed. Isolation and estrangement can become permanent. Often injured workers feel they are not supported by their friends and family or by the company, the local authorities, and social services. Better support results in better rehabilitation outcomes and an easier return to work and community life.

Factors affecting receipt of invasive pain management among Medicaid beneficiaries with cancer.

7 Background: Previous studies have reported that a substantial proportion of cancer patients do not receive appropriate pain management. Inadequate pain management may be greater among Medicaid beneficiaries with cancer. However, it is unknown whether Medicaid policies or patient characteristics affect the likelihood of receiving pain management services. Methods: We used 2006-2008 Medicaid claims data for individuals diagnosed with breast or colon cancer to assess patient characteristics and state-level policy factors associated with receipt of invasive pain management (IPM). Generalized estimating equations (GEE) were used to examine factors influencing receipt of IPM, including patient age, race/ethnicity, comorbidities, Medicaid reimbursements, redetermination period for Medicaid eligibility, required patient co-payments. Separate analyses were performed for the breast and colon cancer study populations. Results: Overall, 3% of Medicaid beneficiaries in the study population with breast cancer and 6% with colon cancer received IPM. Among the breast cancer population, non-white patients were significantly less likely to receive IPM compared with white breast cancer patients (Odds Ratio (OR) = 0.88, p &lt; 0.0001). Increased comorbidity score was associated with significantly increased likelihood of IPM (OR = 1.27, p &lt; 0.0001). Among the colon cancer population, older age was associated with significantly increased likelihood of IPM (OR = 1.36 for 10 years of age, p = 0.02). Patients in states with a Medicaid eligibility re-determination period of 12 months were less likely to receive IPM compared to those in states with a period &lt; 12 months (OR = 0.60, p = 0.046). Conclusions: Patient characteristics and (for colon cancer patients) state Medicaid policies predict receipt of IPM among Medicaid beneficiaries with cancer. As many of these factors are not associated with the need for pain management, quality improvements in supportive care are needed for this underserved population.

Discovery of anatomic variant of saphenous nerve from human cadaver dissection

Abstract Introduction: Saphenous nerve is the longest and largest pure sensory nerve, supplying the medial side of the thigh, leg and foot. Materials and Methods: In the present case study, during routine cadaveric dissection of the antero-medial part of the thigh, an interesting anomalous pattern of saphenous nerve was seen in the right lower limb of a 62 years old embalmed male cadaver from the Department of Human Anatomy, Universiti Putra Malaysia (UPM). Results: This saphenous nerve can be recognised as an unusual anatomical variant in which it gives a motor branch to the sartorius muscle during traversing the adductor canal and it was accompanied by blood vessels at the same time. The nerve continues its usual course and pierces the fascia lata, between the tendon of sartorius and gracilis and becomes subcutaneous. Conclusion: Knowledge of the variant anatomy of the saphenous nerve is important to surgeon in avoiding nerve injuries during adductor canal nerve block, nerve entrapment surgery, reconstructive surgery, pain management services and knee surgery successfully.

Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting.

Background and Aims:Assessment of patient satisfaction is an important tool for monitoring the quality of care in hospitals. The aim of this survey was to develop a reliable tool to assess patient satisfaction with acute pain management service (APMS) and identify variables affecting this so that care can be improved.Methods:A questionnaire was developed and administered to patients after being discharged from APMS care by an unbiased person. Data collected from record included patient demographics, surgical procedure, analgesic modality, co-analgesics and dynamic and static pain scores. Questions included pain expected and pain experienced, APMS response time, quality of pain relief with treatment, professionalism of APMS team, overall experience of pain relief and choosing/suggesting same modality for themselves/family/friends again. Five-point Likert scale was used for most of the options. Statistical analysis was done using SPSS 19.Results:Frequency and percentages were computed for qualitative observation and presented on pie chart and histogram. Seventy-one per cent patients expected severe pain while 43% actually experienced it. About 79.4% would choose same analgesia modality in future for self/family/friends. Ninety-nine per cent found APMS staff courteous and professional. About 89% rated their experience of pain management as excellent to very good.Conclusion:The survey of patients’ satisfaction to monitor the quality of care provided by APMS provided positive inputs on its role. This also helps to identify areas requiring improvement in care and as a tool to gauge the quality of care.

Impact of a Pediatric Palliative Care Program on the Caregiver Experience

California’s pediatric palliative care program Partners for Children uses family-centered care coordination to offer hospice-like therapeutic, respite, and pain management services for children delivered concurrently with curative care and regardless of the child’s life expectancy. As an early implementer of concurrent care for children, the program provides evidence of the impact of concurrent care on children and their families. Program impact on caregivers’ perceptions of their levels of stress and worry was measured using random effect growth curve models that included survey wave, caregivers’ perceived family support, and the child’s age and disease severity. All other data were descriptive and subject to univariate analysis. Worry and stress improved in the overall study population between the baseline and follow-up surveys. Family support was predictive of reductions in stress and worry. Disease severity was predictive of stress. Family-centered care coordination is a promising tool to enhance care for children with life-threatening health conditions and reduce caregiver stress and worry. Program strategies, including individualized care planning, access to a 24/7 nurse line, and a focus on the entire family, can be a model for other states as the need for integration of pediatric palliative care for seriously ill children becomes a national public health priority.

Epilepsy and AED-induced decreased libido — The unasked psychosocial comorbidity

Therapeutic treatment for persons with epilepsy (PWE) should address seizure control and the broad spectrum of associated comorbidities. Since both epilepsy and antiepileptic drugs (AEDs) can induce decreased libido, sexual health assessment is an important aspect of quality care in PWE as well as other patients receiving AEDs. This paper presents findings from a pilot quality initiative conducted in the ambulatory care epilepsy, pain management, and psychiatric services (N=15 clinicians) which addressed two themes: 1) whether libido is routinely questioned with/without the electronic medical record (EMR) and 2) clinicians' knowledge that both epilepsy and AEDs can induce decreased libido. All clinicians used the EMR, 40% used the GU-ROS section, but only 1 clinician (6.67%) questioned patients regarding libido. Of the clinicians, 26.7% demonstrated knowledge that both AEDs and epilepsy can cause decreased libido. Our results suggest that a treatment gap for epilepsy-induced and AED-induced decreased libido may be related to systems issues (duration of clinical visit, billing codes, EMR template) and physician barriers including decreased knowledge. Further research in this field and replication of this pilot quality initiative are indicated.

Intractable Rectal Pain Secondary to Colonic Stent Placement in Patient With Advanced Pelvic Cancer Successfully Treated With Hypogastric Nerve Plexus Neurolysis

Introduction: Symptomatic treatment of advanced rectal cancer can prove sometimes difficult to manage. Untreated pain from cancerous origin can lead to decreased quality of life and increase in morbidity. Colonic stent placement is a tool to relieve bowel obstruction and improve quality of life. Complications with the hypogastric nerve with colonic stent placement is sometimes an unfortunate result. The technique of superior hypogastric nerve plexus neurolysis is a procedure that can be used to relieve pain from stent insertion in individuals suffering from cancers of pelvic origin. Case Report: A 59 year old Caucasian female presented to the pain clinic diagnosed with ovarian cancer stage IV status post debulking surgery, chemotherapy and radiotherapy. She was found to have recurrent cancer involving the rectum, liver and peritoneum. Uncovered self-expandable metallic colonic stent (25 mm x 120 mm) was placed at the rectosigmoid junction with distal end of the stent positional at 5 cm proximal to the anorectal junction to relieve bowel obstruction for better quality of life. The patient subsequently developed intractable rectal pain despite use of opioids. Diagnostic block of the superior hypogastric plexus followed by neurolysis was performed by pain management service under fluoroscopy to relieve this patient's pain. The pain relief was achieved after neuolysis. Conclusion: Significant rectal pain is a potential complication of post endoluminal colonic stent placement. The condition could be alleviated by hypogastric nerve plexus neurolysis when medical therapy failed.Figure 1Figure 2

Safety and Patient Acceptability of Stellate Ganglion Blockade as a Treatment Adjunct for Combat-Related Post-Traumatic Stress Disorder: A Quality Assurance Initiative.

OBJECTIVE: To perform a quality assurance and performance improvement project through review of our single center data on the safety and patient acceptability of the stellate ganglion blockade (SGB) procedure for the relief of symptoms related to chronic post-traumatic stress disorder.BACKGROUND: Our interventional pain management service has been offering trials of SGB therapy to assist with the management of the sympathetically mediated anxiety and hyperarousal symptoms of severe and treatment-refractory combat-related PTSD. There have been multiple case series in the literature describing the potential impact of this procedure for PTSD symptom management as well as the safety of image-guided procedures. We wished to ensure that we were performing this procedure safely and that patients were tolerating and accepting of this adjunctive treatment option.METHODS: We conducted a review of our quality assurance and performance improvement data over the past 18 months during which we performed 250 stellate ganglion blocks for the management of PTSD symptoms to detect any potential complications or unanticipated side effects. We also analyzed responses from an anonymous patient de-identified survey collected regarding the comfort and satisfaction associated with the procedure.RESULTS: We did not identify any immediate post-procedural complications or delayed complications from any of the 250 procedures performed from November 2013 to April 2015. Of the 110 surveys that were returned and tabulated, 100% of the patients surveyed were overall satisfied with our process and with the procedure, 100% said they would recommend the procedure to a friend, and 95% stated that they would be willing to undergo as many repeat procedures as necessary based on little discomfort and tolerable side effects.CONCLUSION: Our quality assurance assessment suggests that in our center the SGB procedure for PTSD is a safe, well-tolerated, and acceptable treatment adjunct in the management of severe symptoms associated with chronic treatment-refractory PTSD. Patient satisfaction responses are strongly suggestive of high therapeutic value, and further studies are indicated to determine the effectiveness, duration of action, and optimal treatment regimen.

Effectiveness of a community based nurse-pharmacist managed pain clinic: A mixed-methods study

BackgroundChronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain. ObjectivesTo evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist. DesignA mixed-methods design consisting of qualitative interviews embedded within a quasi-experimental study. SettingsA community-based nurse-pharmacist led pain clinic in the north of England. ParticipantsAdult chronic pain (non-malignant) patients referred to the pain clinic. MethodsPain intensity was the primary outcome. Questionnaires (the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, the SF-36 and the Chronic Pain Grade questionnaire) were administered at the baseline, on discharge and at 3-month post-discharge (Brief Pain Inventory and Hospital Anxiety and Depression Scale only). Patient satisfaction was explored using face-to-face, semi-structured qualitative interviews. ResultsSeventy-nine patients with a mean age of 46.5 years (SD±14.4) took part in the quasi-experimental study. Thirty-six and nine patients completed the discharge and 3-month follow-up questionnaires respectively. Compared to baseline, statistically significant reductions were noted for two of the outcome measures: pain intensity (P=0.02), and interference of pain with physical functioning (P=0.02) on discharge from the service. Nineteen patients participated in qualitative interviews. The patients were, in general, satisfied with the quality of service. Four contributing factors to patient satisfaction were identified: ample consultation time, in-depth specialised knowledge, listening and understanding to patients’ needs, and a holistic approach. ConclusionsNurse and pharmacist managed community-based pain clinics can effectively deliver quality pain management services as they offer an interdisciplinary holistic approach to pain management. Such services have the potential not only to reduce the burden on secondary care but also decrease long waiting times for referral to secondary care. Further research is required to support the development of evidence based referral guidelines to such services.

Using Social Media While Waiting in Pain: A Clinical 12-Week Longitudinal Pilot Study.

BackgroundChronic pain places an enormous burden on health care systems. Multidisciplinary pain management services are well documented as an effective means to improve patient outcomes. However, waiting lists to access these services are long and outcomes deteriorate. Innovative solutions such as social media are gaining attention as a way to decrease this burden and improve outcomes. It is a challenge to design research that demonstrates whether social media are acceptable to patients and clinically effective.ObjectiveThe aim was to conduct a longitudinal pilot study to understand what aspects of research design are key to the success of running a larger-scale study of social media use in the clinical management of chronic pain.MethodsA 12-week study examined social media use by patients on the waiting list for the Royal Melbourne Hospital Pain Management Service. Selected social media resources were suggested for use by patients waiting for an appointment at the clinic. Patients filled out measures for pain interference and pain self-efficacy before and after the study. Follow-up was conducted at monthly intervals via telephone semistructured interviews to discuss engagement and garner individual perceptions towards social media use. A social media-use instrument was also administered as part of the after-study questionnaire.ResultsTargeted recruitment refined 235 patient referrals to 138 (58.7%) suitable potential participants. Contact was made with 84 out of 138 (60.9%) patients. After a further exclusion of 54 out of 84 (64%) patients for various reasons, this left 30 out of 84 (36%) patients fitting the inclusion criteria and interested in study participation. A final study cohort of 17 out of 30 (57%) was obtained. Demographics of the 17 patients were mixed. Low back pain was the primary condition reported as leading to chronic pain. Semistructured interviews collected data from 16 out of 17 (94%) patients who started the trial, and at final follow-up 9 out of 17 (53%) patients completed questionnaires. Low specificity of the resources to one’s condition and time poorness may have been barriers to engagement.ConclusionsResults suggest that with refinements, this study design can be implemented successfully when conducting a larger social media study. At present, comment cannot be made on what effect using social media can have on patients on hospital waiting lists, nor whether those who use social media while waiting in pain achieve better outcomes from eventual participation in a chronic pain program. Long-term follow-up should be included in future studies to answer this. Future research should focus on multicenter randomized controlled trials, involving patients in the intervention design for improved participation and outcomes and for evidence to be sound.