Pain Society Research Articles

The effectiveness of pain management methods used at kakamega county teaching & refferal hospital, Kenya

Effective managing acute postoperative pain is a major challenge for practitioners, given that more than 80% of patients report pain after surgery, and 75% report the pain as moderate, severe, or even extreme .The American pain Society states that ‘In more than half of cases, patients report not receiving adequate pain management following their procedure’, which has raised concerns over the development of chronic pain. The objective of the study was to assess the effectiveness of pain management methods used at Kakamega County Teaching and Referral Hospital, Kenya (KCTRH). The study adopted a descriptive cross-sectional study which was carried out KCTRH. The participants in the study included all adult male and female patients who had undergone major surgical procedure within 24 hours post-operative.at KCTRH. The target population, (N) is 250. Purposive sampling method was used, meaning that only patients available during the data collection period and meets the inclusion criteria were included in the sample. Majority of the patients interviewed were aged between 31-40 years and most of the respondents were females accounting to 67(61%) of the respondents. All the respondents interviewed were Christians and worked in the informal sector. Most of the respondents 80(73%) reported that painkillers were given through intra-venous. 64(59%) of the respondents were given general anesthesia whereas 45(41%) were given regional block type of anesthesia.

Editorial introductions

Editorial introductions

Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society).

Three scientific societies, the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) developed the "2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia" (referred to as the "2015 consensus terminology").The terminology included 11 descriptors of vulvodynia. However, the definitions of the descriptors were not included in the 2015 consensus terminology publications. The objective of this article was to provide these definitions. The ISSVD led a discussion on the definitions for the 11 vulvodynia descriptors, with participation from the ISSWSH and IPPS. The definitions were created through a consensus process. The definitions are described and the rationale for their choice is elucidated. The definitions of vulvodynia descriptors were determined by a multistaged process of discussion among health care providers with expertise in the pathophysiology, evaluation, and treatment of vulvodynia. The definitions were approved by the ISSVD, ISSWSH, and IPPS. It is recommended that these definitions of vulvodynia descriptors as well as the 2015 consensus terminology be used for the classification of vulvodynia.

Perioperative use of metamizole and other nonopioid analgesics in children : Results of a survey

Nonopioid analgesics are frequently used for perioperative pain management in children. In many countries, the nonopioid metamizole (dipyrone) is administered as an alternative to paracetamol and traditional NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen and diclofenac; however, concerns over possible life-threatening adverse events (agranulocytosis) have prompted a debate over the use of metamizole. To investigate current practice and use of nonopioid analgesics, particularly of metamizole in children younger than 14years, in the perioperative setting. Furthermore, metamizole-related side effects, safety and approaches used to inform patients were addressed. Alink to an online questionnaire on the perioperative use of nonopioid analgesics in children, with a specific focus on dipyrone, was sent by e‑mail to members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and to members of the German Pain Society. Atotal of 2284 anesthesiologists filled out the questionnaire. Of these, 1476 were involved in the perioperative care of children younger than 14years. The majority of respondents worked in German hospitals (90.5%) but Austria, Switzerland and the Netherlands were also among the countries represented. Of the respondents, 99.1% reported using nonopioid analgesics in the perioperative setting. The NSAID, metamizole, paracetamol and COX-2 inhibitors were administered by 83.9%, 68.6%, 67.5% and 2% of the respondents, respectively. Intravenous metamizole was the preferred nonopioid analgesic during surgical procedures, but following surgery, NSAID, metamizole and paracetamol were given with the same frequency by anesthesiologists. Of the respondents, 49.3% reported using metamizole in combination with another nonopioid analgesic in cases of severe pain, 14.8% used it as the sole nonopioid analgesic, and 23.2% never used it at all. Nearly half of the respondents administered metamizole i.v. in doses of 15 mg/kg body weight or lower, whereas 26% administered doses of at least 16 mg/kg up to more than 20 mg/kg. Of the physicians, 298 (20.2%) restricted the duration of metamizole use, varying between one single administration (4.7%), administration for 1 day (27.5%), or for 1-2 weeks (29.2%). Of the anesthesiologists, 65.6% reported no metamizole-related adverse effects. Allergic reactions/anaphylaxis and adrop in blood pressure requiring intervention were observed by 3-4% of the respondents. No change in blood cell counts within the last 2 years was reported by 73.1% of the respondents, whereas 17anesthesiologists (1.3%) had observed children with altered blood cell counts, with 2 (0.14%) reporting agranulocytosis. In most cases these were incidental findings. No severe sequelae or deaths were reported. Few respondents (5.5%) performed routine blood cell counts to monitor metamizole therapy. Furthermore, only aminority always (3.5%) or sometimes (6.1%) informed achild's parents of possible side effects of treatment with metamizole. The survey confirmed that metamizole is frequently used in children in the perioperative setting. Intravenous metamizole is the preferred nonopioid analgesic administered intraoperatively for pain prophylaxis. Clinical symptoms of agranulocytosis should be monitored and patients should be better informed about metamizole-related side effects.

Perioperative use of gabapentinoids for the management of postoperative acute pain: protocol of a systematic review and meta-analysis

BackgroundOpioids are commonly used for the management of postoperative pain, but their use is limited by important adverse events, such as respiratory depression and the potential for addiction. Multimodal opioid-sparing analgesia regimens can be effectively employed to manage postoperative pain and reduce exposure to opioids. Gabapentinoids (pregabalin and gabapentin) represent an attractive class of drugs for use in multimodal regimens. The American Pain Society recommends the use of gabapentinoids during the perioperative period; however, evidence to inform such a recommendation is unclear.MethodsWe will conduct a systematic review and meta-analysis of randomized clinical trials evaluating the use of systemic gabapentinoids, in comparison to other analgesic regimens or placebo in adult patients undergoing surgery. We will search MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and ClinicalTrials.gov databases for relevant citations. Our primary outcome will be intensity of postoperative acute pain (12 h). Our secondary outcomes will be postoperative pain intensity at 6, 24, 48 h, and 72 h, cumulative dose of opioids administered within 24, 48, and 72 h following surgery, the length of stay, chronic pain, and adverse events. Two investigators will independently select trials and extract data. We will evaluate the risk of bias of included trials using the Cochrane risk of bias tools. We will represent pooled continuous data as weighted mean differences and pooled dichotomous data as risk ratios with a 95% confidence interval. We will use random effect models and assess statistical heterogeneity with the I2 index.DiscussionOur study will provide the best level of evidence to inform the effect of gabapentinoids in the management of postoperative acute pain.Systematic review registrationPROSPERO CRD42017067029

Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.

AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain

Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public–private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks–American Pain Society–American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. PerspectiveThis article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD.

AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders

Peripheral neuropathic pain is among the most prevalent types of neuropathic pain. No comprehensive peripheral neuropathic pain classification system that incorporates contemporary clinical, diagnostic, biological, and psychological information exists. To address this need, this article covers the taxonomy for 4 focal or segmental peripheral neuropathic pain disorders, as part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership and the American Pain Society (APS) collaborative to develop a standardized, evidence-based taxonomy initiative: the ACTTION-APS Pain Taxonomy (AAPT). The disorders—postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia—were selected because of their clinical and clinical research relevance. The multidimensional features of the taxonomy are suitable for clinical trials and can also facilitate hypothesis-driven case-control and cohort epidemiologic studies. PerspectiveThe AAPT peripheral neuropathic pain taxonomy subdivides the peripheral neuropathic pain disorders into those that are generalized and symmetric and those that are focal or segmental and asymmetric. In this article, we cover the focal and segmental disorders: postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia. The taxonomy is evidence-based and multidimensional, with the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.

Assessment and patient selection process for a pain management programme: a case study in specialty care.

The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service. The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used. About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensive residential programme (30.5%, with an additional 11.6% offered case management first), followed by the five session outpatient programme (8.1%) and a minority was offered individual treatment (2.5%); 44.7% of the patients were discharged following the assessment. The three most frequently used reasons for exclusion were: not ready to engage with the pain management approach (35%), complex psychological or other needs needing to be prioritised (29.5%) and the patient declining a programme (19.3%). Reviewing the use of inclusion/exclusion criteria revealed some challenges regarding patient selection. For example, a sizable proportion of patients were still seeking pain reduction and were not open to a self-management approach when this was the recommended treatment for them. Complex patients might need other treatment approaches before they can be considered for a programme. Having a range of pain management options of varying intensities available seems helpful in meeting individual patient need.

Evaluation of the quality of acute pain management in a pediatric surgical setting: Validation of a parent proxy modified version of the revised American Pain Society Patient Outcome Questionnaire.

Effective pain management involves a cycle of continual pain assessment, good pain control strategies, and assessment of a standard quality improvement measures. A validated questionnaire that focuses on the quality of postoperative pain management in pediatric surgical patients and parental satisfaction on pain treatment is lacking. We, therefore, modified the revised American Pain Society Patient Outcome Questionnaire to evaluate the quality of postoperative pain management in a pediatric surgical setting. The primary aim of this study was to validate the modified version of revised American Pain Society Patient Outcome Questionnaire. Parents whose children aged below 12years and were scheduled for elective surgery in a teaching hospital, were approached to participate in this survey. The reliability of the modified version of revised American Pain Society Patient Outcome Questionnaire was evaluated using Cronbach's alpha test, while the construct validity was assessed with a principal component analysis using a varimax rotation. The parental satisfaction with pain treatment received was measured. A total of 108 parents completed the questionnaire. The internal consistency of the questionnaire shows a Cronbach's alpha of 0.798. Principal component analysis revealed a four-factor structure of the 12 items which explained 69.7% of the total variance. The factors are "Interference of sleep and activity," "Pain severity and drowsiness," "Perception of care," and "Adverse effects," respectively. Our study showed that this questionnaire is a valid and reliable measure for "Interference of sleep and activity" and "Pain severity and drowsiness" factors, but not for "Perception of care" and "Adverse effects." The results for "Perception of care" and "Adverse effects," therefore, should be reported as individual items instead of total score. The parental satisfaction with pain treatment given was good (median 8.0; IQR 3.0). The modified version of revised American Pain Society Patient Outcome Questionnaire is a feasible and easy instrument to administer. The questionnaire can be used to obtain feedback from parents about the outcomes and experiences of pain management and is helpful in continuous quality evaluation and improvement in the postoperative care in a pediatric setting.

Psychometric evaluation of the Danish version of a modified Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-D) for patients hospitalized with acute abdominal pain.

Background and aims This paper forms part of a study evaluating the effect of patient-controlled oral analgesia for patients admitted to hospital with acute abdominal pain. Pain is a subjective experience, and a multifaceted evaluation tool concerning patient-reported outcome measures is needed to monitor, evaluate, and guide health care professionals in the quality of pain management. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) is a validated multifaceted evaluation tool for measuring patient-reported pain experiences to evaluate different pain management interventions. The aim of this study was to evaluate the psychometric properties of a modified Danish version of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-D) used during and after hospitalization for patients with acute abdominal pain. Methods The APS-POQ-R was translated into Danish and two slightly different questionnaires were formed. Questionnaire one had 39 items and the six subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), and patient-related barriers to pain management. The questionnaire focused on time during hospital stay and was to be completed at discharge. Questionnaire two included 25 items and the five subscales pain, satisfaction, activity, emotion, and safety and focused on time at home and was to be completed daily 1 week after discharge. The questionnaires were tested on 156 patients with acute abdominal pain. Internal consistency reliability and construct validity was examined. Results In both questionnaires, the results of correlations and tests for internal consistency reliability showed a Cronbach's alpha of >0.7 for the pain, activity, and emotion subscales, but the value was ≥0.69 for the satisfaction subscale. In questionnaire one, Cronbach's alpha was ≤0.64 for the safety subscale, but this was 0.73 when the item "itching" was deleted. In questionnaire two, Cronbach's alpha was ≤0.51 for the safety subscale. For the patient-barrier subscale in questionnaire one, Cronbach's alpha was ≤0.62 for any combination of the items in the subscale. The results of the construct validity and factor analysis showed a five-factor structure in questionnaire one and a three-factor structure in questionnaire two. In questionnaire one, items from the pain, activity, emotion, and safety subscales, except for the items "least pain" and "itching," loaded on factor one. In questionnaire two, all items from the pain, activity, and emotion subscales loaded on factor one. Conclusions The modified APS-POQ-R-D demonstrated adequate psychometric properties for the five subscales pain severity (pain), perception of care (satisfaction), pain interference with function (activity) and emotions (emotion), side effects of treatment (safety), but not for the patient-barrier subscale for patients hospitalized with acute abdominal pain. Consequently, the APS-POQ-R-D may be used without the patient-barrier subscale. Implications The clinical implications of this study may help clinicians with investigating how acute patients manage pain during and after hospital admission.

Editorial introductions

Editorial introductions

Effects of standardized management of cancer pain on quality of life and pain outcome in tumor patients

Objective To explore the effects of standardized management of cancer pain on the quality of life and pain outcome in tumor patients. Methods A total of 104 tumor patients admitted in the Department of Oncology of People's Hospital Affiliated to Hubei University of Medicine, from August 2016 to August 2017 were selected by convenient sampling and randomized divided into control group (n=52) and observation group (n=52) . The control group received conventional pain management, whereas the observation group received standardized management of cancer pain. The Quality of Life Questionnaire-Core 30 (QLQ-C30) and the American Pain Society Patient Outcome Questionnaire-Medified (APS-POQ-Medified) were used to evaluate the patients on the date of admission and 3 months post intervention. Results There was no significant difference in the QLQ-C30 and APS-POQ-Medified scores between the two groups (P>0.05) at admission. The observation group showed higher scores in the dimensions of function and overall quality of life while lower scores in the dimension of symptom than the control group (P<0.05) ; and the observation group showed better scores in terms of the four indicators of pain outcome than the control group (P<0.05) . Conclusions Standardized management of cancer pain can mitigate the pain of tumor patients, change their pain outcomes and improve their quality of life. Key words: Neoplasms; Pain; Quality of life; Pain outcome

Series 4. Wound pain, part 1. Understanding wound pain

British Journal of Healthcare AssistantsVol. 12, No. 9 ClinicalSeries 4. Wound pain, part 1. Understanding wound painMenna Lloyd JonesMenna Lloyd JonesSearch for more papers by this authorMenna Lloyd JonesPublished Online:11 Sep 2018https://doi.org/10.12968/bjha.2018.12.9.436AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Augustin M, Carville K, Clark M et al.. Optimising wellbeing in people living with a wound. An expert working group review. Wounds International. 2012. http://www.woundsinternational.com/consensus-documents/view/international-consensus-optimising-wellbeing-in-people-living-with-a-wound (accessed 16 August 2018) Google ScholarBowers K, Barrett S. Wound-related pain: features, assessment and treatment. Nurs Stand. 2009; 24(10):47–56 Google ScholarBritish Pain Society (BPS). What is pain? 2018. https://www.britishpainsociety.org/people-with-pain/frequently-asked-questions/#what-is-pain (accessed 16 August 2018) Google ScholarHaesler E, White W. Minimising wound-related pain: a discussion of traditional wound dressings and topical agents used in low-resource communities. Wound Practice and Research. 2017; 25(3):138–144 Google ScholarHealthcare Improvement Scotland. Best practice statement. Management of chronic pain in adults. 2006. http://www.healthcareimprovementscotland.org/previous_resources/best_practice_statement/management_of_chronic_pain_in_.aspx (accessed 30 August 2018). Google ScholarJohnson M. Physiology of pain. In: White RHarding K, eds. Trauma and wound pain in wound care. London: Wounds-UK Books; 2009 Google ScholarJones ML. Wound debridement, Part 1. British Journal of Healthcare Assistants. 2018a; 12(2):78–80 Google ScholarJones ML. Wound debridement, Part 2. British Journal of Healthcare Assistants. 2018b; 12(3):115–117 Link, Google ScholarInternational Association for the Study of Pain. 2014–2015 global year against neuropathic pain. 2018b. https://s3.amazonaws.com/rdcms-iasp/files/production/public/AM/Images/GYAP/What%20is%20Neuropathic%20Pain.pdf (accessed 16 August 2018) Google ScholarMudge E, Orsted H. Wound infection and pain management, made easy. 2010. http://www.woundsinternational.com/made-easys/view/wound-infection-and-pain-management-made-easy (accessed 16 August 2018) Google ScholarRoyal College of Nursing. The recognition and assessment of acute pain in children. Clinical practice guidelines. 2009. https://www.rcn.org.uk/professional-development/publications/pub-003542 (accessed 16 August 2018) Google ScholarWorld Union of Wound Healing Societies. Minimising pain at wound dressing-related procedures. A consensus document. 2004. http://www.woundsinternational.com/media/issues/79/files/content_39.pdf (accessed 16 August 2018) Google ScholarNational Association for the Study of Pain (IASP). IASP terminology. 2018a. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698 (accessed 16 August 2018) Google ScholarInternational Association for the Study of Pain. 2014–2015 global year against neuropathic pain. 2018b. https://s3.amazonaws.com/rdcms-iasp/files/production/public/AM/Images/GYAP/What%20is%20Neuropathic%20Pain.pdf (accessed 16 August 2018) Google ScholarMudge E, Orsted H. Wound infection and pain management, made easy. 2010. http://www.woundsinternational.com/made-easys/view/wound-infection-and-pain-management-made-easy (accessed 16 August 2018) Google ScholarRoyal College of Nursing. The recognition and assessment of acute pain in children. Clinical practice guidelines. 2009. https://www.rcn.org.uk/professional-development/publications/pub-003542 (accessed 16 August 2018) Google ScholarWorld Union of Wound Healing Societies. Minimising pain at wound dressing-related procedures. A consensus document. 2004. http://www.woundsinternational.com/media/issues/79/files/content_39.pdf (accessed 16 August 2018) Google Scholar FiguresReferencesRelatedDetails 2 September 2018Volume 12Issue 9ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 11 September 2018 Published in print 2 September 2018 Information© MA Healthcare LimitedPDF download

Literature review informs clinical guidelines for pain management during screening and laser photocoagulation for retinopathy of prematurity.

The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs). The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and used the Grading of Recommendations, Assessment, Development and Evaluation approach, to develop new guidelines on pain and ROP. The Society's pain experts assessed the full texts of 47 papers, including randomised or quasi-randomised controlled trials and case-control studies on nonpharmacological and pharmacological measures used in NICUs during the screening and laser photocoagulation of neonates for ROP. The literature suggested methods for reducing the stress and pain associated with ROP screening procedures. The panel concluded that the literature showed that it was feasible to provide laser photocoagulation for ROP in spontaneously breathing patients with adequate analgesia. This literature review on managing pain in infants with ROP in NICUs led to the development of national guidelines, which will help physicians and nurses to reduce the stress and pain experienced by premature newborn infants during unavoidable screening and treatment for ROP.

Improved Quality of Recovery from Ambulatory Shoulder Surgery After Implementation of a Multimodal Perioperative Pain Management Protocol.

Pain control after shoulder arthroscopy can be challenging, often relying on opioids. The study aims to measure the quality of recovery (QoR) before and after implementation of a "Multimodal Perioperative Pain Protocol" (MP3) in patients undergoing ambulatory shoulder arthroscopy. Prospective cohort study. Free-standing ambulatory surgery facility of a tertiary care academic center. Patients undergoing ambulatory shoulder arthroscopy. The primary end point of the study was the QoR-9 score at 24 hours, 48 hours, and one week after surgery. Secondary end points included 1) measuring the quality of pain management using the Revised American Pain Society Patient Oriented Questionnaire (APS-POQ-R) and 2) postoperative opioid requirements. Data from132 patients in the control group (pre-intervention) and 120 patients in the MP3 group were analyzed. The QoR-9 scores were significantly higher for the MP3 group at all time points, but only met the minimal clinical important difference threshold at 24 hours (13.4 vs 14.9, P < 0.05) and 48 hours (14.0 vs 15.0, P < 0.05) postoperatively. Patients reported better quality of pain management after implementation of the MP3 in the domains of pain intensity, pain interference with activity, and sleep, and they reported the presence of negative emotions up to two days after ambulatory shoulder surgery. In addition, this protocol significantly reduced opioid consumption up to three days after surgery. Implementation of the MP3 improved the overall QoR and many aspects of postoperative pain relief while reducing total opioid consumption in patients undergoing ambulatory shoulder surgery.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: a new look at imaging: 209. Low pressure lumbar provocation discography according to international association for the study of pain or spine intervention society standards does not cause accelerated progression of disc degeneration in symptomatic low back pain patients: a 7-year matched cohort study

BACKGROUND CONTEXT Study of subjects without clinically-significant low back pain (LBP) suggests that high-pressure lumbar provocation discography (PD) may cause accelerated disc degeneration. PURPOSE Determine if low-pressure PD, according to IASP/SIS standards,results in accelerated disc degeneration and disruption at long-term follow-up in patients with symptomatic LBP. STUDY DESIGN/SETTING This was a longitudinal matched cohort study conducted in a tertiary, academic spine center. PATIENT SAMPLE Patients with sympatomatic LBP. OUTCOME MEASURES The primary outcome was the proportion of discs that advanced in Pfirrmann score category (I–II, III–IV, and V). MRI T2-signal-intensity-to-CSF ratio, disc height, new disc herniation, new high intensity zones (HIZs), and new Type-1 Modic changes were also assessed. METHODS Consecutive patients with symptomatic LBP who underwent MRI, PD, and repeat MRI>7 years later, but no spinal fusion, were identified by EMR query. Punctured discs were matched at a 1:2-1:4 ratio to corresponding discs in a control cohort by age, BMI, Pfirrmann score (+/−1) and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by >7 years. RESULTS Baseline and follow-up MRIs were available for 66 discs exposed to PD, and 243 discs in the matched cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD cohort (17%, 95%CI 9%–28%) compared to the matched cohort (23%, 95%CI 18%–29%), p=0.13, or in punctured (36%, 95%CI 21%–53%) versus nonpunctured (36%, 95%CI 21%–53%) discs within the PD cohort, p=0.97. There were no differences in T2-signal-intensity-to-CSF ratio, disc height, new disc herniations, new HIZs, or new Type-1 Modic changes following puncture in the PD versus matched cohorts or the punctured versus nonpunctured discs within the PD cohort (p's>.05) CONCLUSIONS In patients with symptomatic LBP who underwent provocation discography according to IASP/SIS standards but no subsequent spinal fusion, accelerated progression of disc degeneration or disruption was not observed in comparison to un-punctured discs in a matched cohort or in un-punctured discs within the PD cohort. These results are notable given that PD was in symptomatic patients who were appropriate candidates for this procedure, rather than in patients without clinically-significant LBP who would not undergo PD in realistic clinical practice.

Validity Test of the Indonesia Version of Revised American Pain Society Outcome Questionnaire (APS-POQ-R) to Evaluate Postoperative Management Quality

The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) is the most commonly used instrument to assess the quality of pain management in many countries but the validity and reliability of this instrument has not been verified in Indonesia. This is a descriptive, cross-sectional psychometric study to test the validity and reliability of Indonesia version of APS-POQ-R instrument to evaluate postoperative pain management quality. The APS-POQ-R was translated into Bahasa Indonesia according to international guidelines. The translation result was tested in 102 patients who underwent elective surgery at Cipto Mangunkusumo Hospital from March to April 2017. Coefficient Aiken V formula was used for content validity test while factor analysis and corrected item total correlation were used for construction validity test. Reliability was tested using internal consistency (Chronbach α). Aiken V formula showed the Indonesian version of APS-POQ-R was valid with score of 0.8–1 (scale V was ≥0.5). Factor analysis generated five main factors out of 18 instrument questions: activity and sleep disturbances, impact of pain to emotion, side effects, pain management perception, and pain scale. Construction validity test with corrected item total correlation showed all questions has good correlation, which ranged between 0.244–0.799 (correlation ≥0.3). Correlation between each factors of the Indonesian version of APS-POQ-R ranged 0.319–0.407. Internal consistency test showed the Indonesian version of APS-POQ-R was reliable with score of 0.663 (α &gt; 0.5). The Indonesian version of APS-POQ-R is valid and reliable to measure postoperative pain management quality.

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group.

BackgroundEpidural corticosteroid injections are used frequently worldwide in the treatment of radicular pain. Concerns have arisen involving rare major neurologic injuries after this treatment. Recommendations to prevent these complications have been published, but local implementation is not always feasible due to local circumstances, necessitating local recommendations based on literature review.MethodsA work group of 4 stakeholder pain societies in Belgium, The Netherlands, and Luxembourg (Benelux) has reviewed the literature involving neurological complications after epidural corticosteroid injections and possible safety measures to prevent these major neurologic injuries.ResultsTwenty‐six considerations and recommendations were selected by the work group. These involve the use of imaging, injection equipment particulate and nonparticulate corticosteroids, epidural approach, and maximal volume to be injected.ConclusionRaising awareness about possible neurological complications and adoption of safety measures recommended by the work group aim at reducing the risks for these devastating events.

Emergency management of SCD pain crises: Current practices and playing variables

Introduction/ObjectivesAcute pain episode is a common reason for patients with sickle cell disease to present to the Emergency Room. This study is designed to assess the role of multiple factors that might affect the time from Emergency Department triage to the administration of the first opiate pain medication and its dosage, to compare current practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the Emergency Department. By identifying and recognizing some of the factors that delay or affect the proper dosing of the pain medications, we aim to implement suitable and plausible changes to ensure better emergency care for these sickle cell disease patients. MethodologyThis is a cross-sectional retrospective descriptive study that relied on collecting non-identifiable data from the local Electronic Medical Record to assess for possible relationship between the proposed set of factors/variables and the time to administration of the 1st pain medication and it's dosage. The population in question includes the entire sickle cell disease patients' population (HB-SS, HB-SC, HB-SD, HB-SB+ and HB-SB0) that are under the care of our Pediatric Hematology-Oncology clinic with the age range of 1 day–21 years. The factors include age, gender, pain assessment/scale, time of presentation, mode of arrival, presence or absence of IV access at presentation, and ESI acuity. ResultsThere were 259 patient Emergency Room visits with 148 unique patients. Mean (SD) age of the entire study population was 15.98 (±4.08) years and 61.8% of the patients were females. Average time to 1st opiate pain medication was 120.27 min (SD ± 78.4) and average doses of Morphine and Hydromorphone were 0.067 mg/kg and 0.053 mg/kg respectively. Longer waiting time to 1st opiate pain medication were found in females with a mean difference of 25.5 min (95% CI 20–80.5 P value 0.027), older patients and patients with least severity ESI score (correlation coefficient of 0.214 & 0.134 (p values of 0.001 and 0.031) respectively). On the other hand, there seems to be a negative correlation between the time to 1st opiate and the pain score with a negative correlation coefficient of −0.22 (p value of <0.001). ConclusionOverall, patients with acute SCD pain experienced significant delays when seeking pain relief in the Emergency Department. The following patients experienced the longest delays: those assigned a lower triage priority level, female patients, patients with lower pain score and older patients.