Pharmacological Pain Management Research Articles

Pain assessment and management in patients with dementia in Taiwan: a best practice implementation project.

The lack of a consistent and effective assessment tool for older adults with dementia in home care in Taiwan, and the inability of home care nurses to provide pharmacological and non-pharmacological pain management, may affect the quality of life of patients with dementia. The aim of this project was to promote evidence-based practices for pain assessment and management of patients with dementia living in the community. The project followed the JBI Evidence-based Healthcare Model and the seven-phase JBI Evidence Implementation Framework. Eight audit criteria were used, representing best practice recommendations. Through a Getting Research into Practice (GRiP) analysis, we identified three barriers to changing practice and implemented improvement strategies. A follow-up audit was conducted to measure changes in compliance. This project was conducted in five home care institutions. Fourteen home care nurses and 109 patients with dementia participated in the project. The follow-up audit showed that compliance rates had improved significantly. Specifically, the compliance rate increased from 14.29%, 1.83%, 1.83% to 100% for Criteria 1-3, respectively. For Criteria 4-8, compliance increased from 0% to 100%. In addition, the average score of the home care nurses' perceptions of pain care for patients with dementia increased from 44.29 points before the intervention to 82.86 points, and all 14 home care nurses achieved a score of 100 points in the Objective Structured Clinical Examination scenario-based exercises, which was a good learning outcome. Leadership, knowledge-sharing, learning-by-doing teaching strategies, and open communication were key factors in the successful implementation of this study. http://links.lww.com/IJEBH/A294.

Evaluation of a continuing education course on guideline-concordant management of acute dental pain

BackgroundThe purpose of the present study was to evaluate the use of a free online continuing education (CE) course that sought to address barriers of capability by training dental team members in the specific recommendations of the American Dental Association (ADA)-endorsed adult guideline for the pharmacologic management of acute dental pain, shared decision-making, and the adoption of the guideline into practice.MethodsIn 2022 and 2023, dentists completed an online, asynchronous CE course on the guideline-concordant pharmacologic management of acute dental pain. They completed 11-item knowledge tests before and after completing the course. Total scores on the pre- and post-tests were compared using a t-test.ResultsThe mean score increased from 7.68 (SD = 1.08) on the pretest to 8.79 (SD = 1.35) on the post-test (t(4468) = -27.34, p < .01), indicating that dentists gained knowledge from the CE course.ConclusionsWe found that the CE course increased knowledge with respect to the guideline recommendations and shared decision-making but not epidemiology or incorporating a guideline into practice. Future studies should evaluate whether the CE course increased guideline-concordant prescribing.

The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations

Background: Managing anxiety and behavior during pediatric dental procedures is challenging. This study examines the effects of combining ibuprofen with midazolam sedation using both behavioral management and clinical hypnosis to improve patient cooperation and reduce post-treatment pain. Methods: A retrospective cohort study of 311 children (mean age 74.2 months, standard deviation (SD) = 24.7) was conducted. Patients received either midazolam with ibuprofen (n = 156) or midazolam only (n = 155). Behavior was assessed using the Venham Behavior Rating Scale and anxiety with the Dental Subscale of Children’s Fear Survey Schedule (CFSS-DS) and the Inventory of Stressful Situations (ISS) questionnaires. Statistical analyses included Mann–Whitney U tests and correlation analyses. Results: Ibuprofen did not significantly improve behavior during procedures (drinking phase 0.61, SD 1.31, p = 0.13; before treatment 0.25, SD 0.93, p = 0.53, anesthesia 1.21, SD 1.55, p = 0.29; after treatment 0.51, SD 1.22, p = 0.68), indicating that pharmacological pain management alone is insufficient to address behavioral challenges. Ibuprofen significantly reduced post-treatment pain, with 7.2% of cases reporting pain in the non-ibuprofen group compared to none in the ibuprofen group (p &lt; 0.05). Conclusions: Ibuprofen had no effect on intraoperative behavior and only a limited effect on post-procedural pain, mainly for more invasive procedures. This study highlights the integration of sedation with behavioral strategies, such as clinical hypnosis, to manage anxiety and improve patient cooperation, aiming to enhance treatment outcomes using this integrative approach to pediatric dentistry. Further research is needed to optimize these strategies and verify them in a prospective setting.

Pharmacological Pain Treatment in Older Persons.

Pharmacological pain treatment in older persons is presented by a multi-disciplinary group of European pain experts. Drugs recommended for acute or chronic nociceptive pain, also for neuropathic pain and the routes of administration of choice are the same as those prescribed for younger persons but comorbidities and polypharmacy in older persons increase the risk of adverse effects and drug interactions. Not all drugs are available or authorised in all European countries. For mild-to-moderate pain, non-opioids including paracetamol and non-steroidal anti-inflammatory drugs are first-line treatments, followed by nefopam and metamizole. Codeine, dihydrocodeine and tramadol are prescribed for moderate to severe pain and 'strong' opioids, including morphine, hydromorphone, oxycodone, fentanyl, buprenorphine, methadone and tapentadol, for severe pain. Chronic neuropathic pain treatment relies on coanalgesics, including anti-epileptics (gabapentinoids) and anti-depressants with additional option of topical lidocaine and capsaicine. The choice of analgesic(s) and the route of administration should be guided by the pain characteristics, as well as by the patient's comorbidities, organ function and medications. Several directions have been highlighted to optimise pharmacological pain management in older individuals: (1) before starting pain treatment adequately detect and assess pain and always perform a full geriatric assessment, (2) consider kidney function systematically to adjust the doses of analgesics and avoid the risks of overdose, (3) start with the lowest dose of an analgesic and increase it gradually under the control of the effect, (4) involve the older persons and family in their treatment, (5) reevaluate pain regularly during treatment and (6) combine pharmacological treatment with non-pharmacological approaches.

Pharmacologic and Nonpharmacologic Management of Neuropathic Pain.

Disorders of the somatosensory nervous system that cause neuropathic pain are treated in a variety of ways. Herein, we introduce a stepwise approach to treating neuropathic pain. We then summarize the available data and guidelines for treating neuropathic pain, both with pharmacologic and nonpharmacologic methods, and provide a synthesized algorithm highlighting the similarities and differences between recent guidelines on the management of neuropathic pain. Pharmacologic treatments are primarily antiseizure medications (e.g., gabapentinoids, sodium channel blockers) and antidepressant medications (e.g., tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors), though other medications and interventional pharmacologic therapies can also be considered. There are a wide variety of nonpharmacologic treatments for neuropathic pain including neuromodulation, nerve stimulation, physiotherapy, movement therapies, lifestyle modification, nutritional supplements, acupuncture, and mind-body techniques.

Prescription pattern of usage of analgesics in pain relief in cancer patients at a tertiary care teaching hospital - An observational prospective study

Objective The World Health Organization has developed guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to healthcare providers on the adequate relief of pain associated with cancer. This prospective study was done to evaluate the prescription pattern of analgesics for the treatment of cancer pain. Material and Methods This prospective observational study was conducted in cancer patients attending the pain clinic of the Anesthesia and Radiotherapy Outpatient Department. Approval was obtained from the Institutional Human Ethics Committee. Inclusion criteria were age ≥18 years of either gender, willing to provide written informed consent, and patients undergoing radiotherapy, chemotherapy, or palliative treatment. Exclusion criteria were patients having psychiatric illness, not willing to provide written informed consent, patients having renal and or hepatic dysfunction, patients with comorbidities with chronic pain, and patients who underwent surgical intervention. Results A total of 100 participants were recruited during the study period of July 2022–April 2024 whose data were assessed. Participants were prescribed different classes of analgesic drugs, which included 30% participants on opioid analgesics, 30% on non-opioid analgesics, and 40% on combination therapy. Among opioid analgesics, morphine was the most commonly prescribed. Among non-opioid, paracetamol was the most commonly prescribed. Among combination therapy, tramadol was the most commonly prescribed. Pregabalin was most commonly used as an adjuvant analgesic. Conclusion This study also emphasizes on need for adequate treatment of cancer pain and vigilant monitoring of patients on opioids to prevent drug abuse, drug dependence, and adverse drug reactions.

Quality Indicators for Pain in Adults: A Review of Performance Measures by the American College of Physicians.

Pain is a debilitating symptom generally caused by injuries or various conditions. It can be acute, subacute, or chronic and can have a significant impact on a patient's quality of life. The goal of managing pain is to relieve or reduce suffering and improve patient functioning. Several performance measures that address the treatment of pain are used in payment, public reporting, or accountability programs. The American College of Physicians (ACP) embraces performance measurement as a means to improve quality of care. ACP believes that a performance measure must be methodologically sound and evidence-based to be considered for inclusion in payment, accountability, or reporting programs. However, a plethora of performance measures that provide minimal or no value to patient care have inundated physicians, practices, and systems with the burden of collecting and reporting data. ACP's Performance Measurement Committee (PMC) reviews performance measures using a validated process to recognize high-quality performance measures, address gaps and areas for improvement in performance measures, and help reduce reporting burden. There is a need for a higher standard for a performance measure when reputation and reimbursement are on the line. This paper aims to present a review of current performance measures for pain to inform physicians, payers, and policymakers in their selection and use of performance measures. The PMC reviewed 6 performance measures for pain relevant to internal medicine physicians, of which 3 were considered valid at their intended levels of attribution ("Use of Imaging for Low Back Pain," "Use of Opioids at High Dosage in Persons Without Cancer," and "Use of Opioids From Multiple Providers in Persons Without Cancer"). This paper also proposes a performance measure concept to address a quality-of-care gap based on the current clinical guideline from ACP and the American Academy of Family Physicians, "Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-low Back, Musculoskeletal Injuries in Adults."

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.

Knowledge and Attitudes of Nursing Students Regarding Children's Pain.

Although the occurrence of pain among hospitalized children is inevitable, the way to assess and detect the intensity of pain is still challenging to pediatric professionals and may lead to increased morbidity and mortality rates if left untreated. The knowledge base of nurses regarding both pharmacological and non-pharmacological pain management among children plays a significant role in managing and making a management plan. The purpose of this study was to assess nursing students' knowledge and attitudes toward pediatric painmanagement. This study used a cross-sectional design to investigate the knowledge and attitudes regarding pain and its management among undergraduate nursing students at a university. A convenience sample of students from all levels was obtained. The pediatric nurses knowledge and attitudes survey (PNKAS) regarding pain was used. Data were analyzed by IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, USA). In this study, 86.3% of participants (n = 69) scored within the satisfactory range on the PNKAS, suggesting adequate knowledge and attitudes about pediatric pain management. The results showed there was no significant relationship between age and a total score p-value of 0.740, as well as between academic levels and the same p-value of 0.397. This study highlights the importance of undergraduate nursing education in pediatric pain management. The findings suggest that students may benefit from additional training in pain assessment and pharmacological interventions.

Phenobarbital as an adjunctive agent for sedation in pediatric intensive care unit patients: A single-center, retrospective study from Colorado

Abstract Background: Pediatric patients require pharmacological management of pain and agitation associated with mechanical ventilation. Pain and agitation may be refractory to opioids and alpha-2 agonists, prompting the use of adjunctive analgesics and sedatives with alternative mechanisms. The purpose of this study was to describe the use of phenobarbital as an adjunctive agent for refractory agitation in critically ill, mechanically ventilated pediatric patients. Subjects and Methods: This was a single-center, retrospective chart review at a pediatric intensive care unit (PICU) at a pediatric academic medical center in America between 2016 and 2021. Children aged 2 months to 18 years old were admitted to the PICU were mechanically ventilated and received phenobarbital for adjunct sedation. Sixty-three patients had phenobarbital dosing data evaluated, and the 38 patients who were not receiving continuous neuromuscular blockade were included in the primary and secondary outcome analysis of time within the goal sedation score. Descriptive statistics was used to assess baseline characteristics and the primary outcome. Wilcoxon signed-rank tests were used to evaluate secondary outcomes. Results: Patients spent significantly more time within the goal sedation score range after phenobarbital compared to before phenobarbital. The median number of rescue sedative boluses, morphine equivalents (MEs), and benzodiazepine equivalents (BZDE) significantly decreased 2 days after the first phenobarbital dose compared to the 2 days before the first phenobarbital dose. Conclusions: The use of phenobarbital as an adjunct sedative was associated with a statistically significant increase in time spent in the goal sedation score range and decrease in ME, BZDE, and concomitant sedative boluses.

Improving Pain Management in the Intensive Care Unit by Assessment

PurposePatients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation. DesignQuantitative pre-post design. MethodsThe study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT). ResultsAfter implementation, a 38% adherence rate was found. The frequency of nurses’ pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01. ConclusionsImplementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses’ adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps. Clinical ImplicationsImplementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.

Witzenberg Women's experience of health care after a miscarriage: A descriptive qualitative study.

Although some evidence is available from low- and middle-income countries, no South African data are available on how women experience healthcare during treatment for an incomplete miscarriage. This study sets out to explore and describe the experiences of healthcare among women who suffered an incomplete spontaneous miscarriage in the Witzenberg subdistrict, a rural area in the Western Cape province of South Africa. Witzenberg subdistrict, Western Cape province, South Africa. This study used a descriptive exploratory qualitative study design. In-person interviews were held with women who experienced a miscarriage. Interviews followed a semi-structured format by a single interviewer to explore the various aspects involving experiences of healthcare. Eight interviews were conducted and analysed. The five themes that arose from transcribed data were: (1) a need for safety, (2) pain management, (3) moderating behaviours and attitudes, (4) disorienting healthcare systems and (5) abandonment. Several factors contributed to the loss of physical and emotional safety in the emergency centre environment. Timeous emotional and pharmacological pain management were found to be a gap while patients awaited care. Clear communication and staff attitude were found to be integral to the patient's experience and could avoid the perception of abandonment. There is a universal need for basic respectful, supportive and safe care in patients who attend an emergency centre for early pregnancy complications in rural South African. Specific focus should be given to clear communication and appropriate emotional support during and after the miscarriage.Contribution:This study can be used as a guide to improve services by ensuring respectful, transparent, informed, and appropriate continuity of care.

Recommendations for managing adults with chronic non-cancer pain in primary care: A systematic clinical guideline review.

Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence. To undertake a systematic review of CPGs that address the management of adults with CNCP, regardless of underlying condition type, in primary care. We systematically reviewed and synthesised current CPGs for managing adults with CNCP in primary care (2013-2023). We followed a stepwise systematic process to synthesise key CPG recommendations: extracted and analysed each recommendation, synthesised by compiling similar recommendations using a thematic analysis approach, and assessed the strength of CPG recommendations to create a final, unified set of recommendations. We focused on identifying CPGs containing recommendations on the following topics: (a) opioid pain management, (b) non-opioid pharmacological pain management, (c) non-pharmacological pain management, and (d) patient-centred communication around pain management, prevention, and organisation of care. We included 13 CPGs, 8 of which focused solely on use of opioids, emphasising the lack of long-term effectiveness and safety concerns, being mainly based on the expert consensus. As an exception, high-quality evidence recommended referring patients with suspected opioid use disorder to specialist addiction services for medication-assisted treatment. Recommendations for non-opioid pain management were often contradictory and based on the expert consensus. Patient-centred pain management combined with exercise-based interventions and psychological therapies are appropriate strategies for managing patients with CNCP. Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.

“…We never considered it important…”: a qualitative study on perceived barriers on use of non-pharmacological methods in management of labour pain by nurse-midwives in eastern Tanzania

BackgroundA significant number of women experience labour without effective pain management and thus suffer from unbearable labour pain to the extent they term labour as the most agonizing event in their lives. Unresolved labour pain can lead to stress, fear, and confusion, which may compromise placental perfusion and lead to birth asphyxia. Although various pharmacological and non-pharmacological labour pain management methods exist, the use of non-pharmacological methods (NPMs) to manage labour pain has remained low in low-resource settings. This paper explored the barriers for using NPMs to manage labour pain by nurse-midwives in eastern Tanzania.MethodsWe conducted an exploratory qualitative study with 18 nurse-midwives purposefully recruited from the labour wards of two selected district hospitals in eastern Tanzania. Qualitative content analysis guided the data analysis.ResultsTwo categories illustrating barriers to using NPMs were generated: individual-level and institutional-level barriers. Individual-level barriers include (i) limited competencies of nurse-midwives on the use of NPMs for managing labour pain, (ii) inadequate exposure to labour pain management practices, (iii) misconceptions about labour pain relief, and (iv) a lack of opportunities for knowledge acquisition. The institutional barriers include (i) a critical staff shortage amidst many clients and (ii) an unfavourable healthcare facility environment.ConclusionThe implementation of NPMs for labour pain management by nurse-midwives in eastern Tanzania faces several institutional and individual barriers. We recommend addressing both supply- and demand-side barriers. Strengthening nurse midwives’ competencies in NPMs adoption and use and improving the facility environment to ensure privacy during labour can be a starting point for addressing supply-side issues. We recommend dispelling myths and misconceptions through health promotion education to address demand-side barriers.

Efficacy of pain management strategies in adults with Amyotrophic Lateral Sclerosis (ALS): A Systematic Review.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive muscle weakness. Presence of pain in ALS patients is heterogeneously reported in studies, and mostly underrepresented in symptom scales. The aim of this study is to evaluate the efficacy of pharmacological and non-pharmacological therapeutic modalities for pain management in patients with ALS. A systematic review was conducted in four databases; PubMed, Scopus, Clinicaltrials.gov, and Cochrane-Ovid. Five randomized controlled clinical trials were included regarding pharmacological and non-pharmacological pain management interventions in adult patients with confirmed diagnosis of ALS in whom pain was objectively evaluated. Risk of bias assessment was evaluated using the RoB2.0 tool. Eligible studies were reported as a descriptive analysis. This systematic review was registered with PROSPERO ID: CRD42024495009. Five clinical trials regarding pain management strategies in ALS were eligible for analysis. Two out of five were non-pharmacological approaches whilst the remaining three provided pharmacological therapies. Of these, Mexiletine was efficient in terms of pain relief, particularly between 600 and 900mg per day, whereas Mecasin showed no pain relief at both, high and low doses. Non-pharmacological therapies, such as exercise and osteopathic manual treatment also lacked efficacy in regard to pain management. Clinical trials focusing on pain management strategies for ALS patients are limited. Medical professionals, understandably focused on immediate life-threatening aspects, may inadvertently sideline the nuanced and intricate dimension of pain experienced by patients with ALS.

Non-pharmacological Interventions for Muscle Cramps and Pain in Patients With Cirrhosis: A Systematic Review.

Despite the high prevalence of pain and challenges associated with traditional pharmacological pain management in patients with cirrhosis, little is known about the safety and effectiveness of non-pharmacological management of pain in this patient population. A systematic literature search of published studies was conducted in nine databases from inception through January 11, 2023, including any clinical trial, cohort, or case-control study of non-pharmacological pain interventions in adult patients with cirrhosis. Studies using nutritional supplements were included. The primary and secondary outcomes for this review were pain/analgesic effect and safety, respectively. Two reviewers independently performed data extraction and risk of bias assessment. Of the 4,087 studies initially screened, 11 studies representing 340 patients ultimately met inclusion criteria, including seven observational and four randomized controlled trials. Five studies reported muscle cramp severity, four reported muscle cramp frequency, and two reported non-cramp pain. Oral zinc sulfate, L-carnitine, and taurine were reported to decrease cramp frequency. Oral vitamin E, oral zinc sulfate, L-carnitine, taurine, and pickle juice decreased cramp severity. Curcumin supplementation, resistance training, and stretching and walking programs improved non-cramp pain. Mild adverse events were reported in four studies. The risk of bias was moderate to high for all studies, largely due to missing data, study design, and a lack of blinding of participants. Numerous nutritional and non-pharmacological interventions have been reported to be safe and effective for the treatment of pain and painful muscle cramps in patients with cirrhosis. However, further research is needed to better determine the efficacy, safety, and optimal frequency and dosage of interventions.

Nonpharmacological pain management approaches among U.S. construction workers: A cross-sectional pilot study.

U.S. construction workers experience high rates of injury that can lead to chronic pain. This pilot study examined nonpharmacological (without medication prescribed by healthcare provider) and pharmacological (e.g., prescription opioids) pain management approaches used by construction workers. A convenience sample of U.S. construction workers was surveyed, in partnership with the U.S. National Institute for Occupational Safety and Health (NIOSH) Construction Sector Program. Differences in familiarity and use of nonpharmacological and pharmacological pain management approaches, by demographics, were assessed using logistic regression models. A boosted regression tree model examined the most influential factors related to pharmacological pain management use, and potential reductions in use were counterfactually modeled. Of 166 (85%) of 195 participants reporting pain/discomfort in the last year, 72% reported using pharmacological pain management approaches, including 19% using opioids. There were significant differences in familiarity with nonpharmacological approaches by gender, education, work experience, and job title. Among 37 factors that predicted using pharmacological and non-pharmacological pain management approaches, training on the risks of opioids, job benefits for unpaid leave and paid disability, and familiarity with music therapy, meditation or mindful breathing, and body scans were among the most important predictors of potentially reducing use of pharmacological approaches. Providing these nonpharmacological approaches to workers could result in an estimated 23% (95% CI: 16%-30%) reduction in pharmacological pain management approaches. This pilot study suggests specific factors related to training, job benefits, and worker familiarity with nonpharmacological pain management approaches influence use of these approaches.

Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis

BackgroundThe number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to improve primary PC based on international recommendations and available scientific evidence.MethodsA descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs.ResultsPC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs.ConclusionsPC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs’ curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC.Trial registrationNot applicable.

A Brief Insight into Nanotherapeutic Approaches in the Management of Analgesia

Background: Growing public awareness of chronic pain resulting from illness and injury has prompted pharmaceutical researchers and drug corporations to create better, more targeted painkillers. For effective pain management, prolonged analgesic medication delivery at the intended areas continues to be a major problem such as addiction, tolerance and other serious side effects, which can prolong suffering and decrease painkiller effectiveness. Objective: The present paper focuses on review of current advances in the field of pain treatment by different nanoparticles formulations of various drugs, by enhancing their pharmacokinetic factors and diminishing associated adverse effects. Results: According to literature survey, usage of nano-carriers enables the delivery of these drugs to target locations with less systemic toxicity. Nanotechnology for varied therapeutic purposes, different analgesics have been loaded onto different nano carriers, including those that are natural, synthetic, and polymeric and proven to be beneficial in pain management. Conclusion: Overall, new nano based preparations and new ways to utilize existing medications in a variety of circumstances is a multimodal approach to pain relief, have resulted in recent advancements in the pharmacological management of pain.

Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study.

Within hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. The purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. In a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants' vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. The study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. This study will provide greater insight into how patients' perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. DERR1-10.2196/52649.