Role In Pain Management Research Articles

Evaluation of Knowledge, Attitude, and Practices of Nurses Regarding Pain Management

Background: Pain is the primary symptom that brings patients to seek health care and is considered a global health problem. Thus, pain control is a fundamental goal in the management of the hospitalized patients. Despite the development of analgesics and advancement in pain management, the pain remains undermanaged. The untreated pain has a detrimental effect on the patient's quality of life, affects their outcomes, delays recovery, and increases the hospital stay. Nurses play a significant role in pain management as they spend a considerable portion of their time with the patients and deal with all their complaints, including pain. One of the significant obstacles to effective pain management among nurses is their limited knowledge and negative attitudes towards pain management. The primary purpose of this study was to explore nurses' knowledge, attitude, and practices toward pain management. Methods: An online survey was conducted for 224 nurses of various departments to assess their knowledge, attitude, and practices regarding pain management using a 30-item questionnaire in Google Forms. Results: Our survey shows a deficiency in knowledge related to the basics of pain, opioid use, and pain management in the elderly and pediatric age group. Conclusions: It may be prudent to consider training programs regarding opioid use and pain management as a part of continuous education and nursing undergraduate curricula.

Effect of Ashwini Mudra as an adjuvant on pain in post-operative cases of ano-rectal diseases - An Ayurvedic management protocol

Ano-rectal disorders refer to the illness of the anal canal and rectum. Fissure in ano, Fistula in ano and haemorrhoids are among the most common ano-rectal conditions. In these cases, symptoms like pain, itching, burning, bleeding and swelling can significantly affect a patient's lifestyle. In Today’s Era, for pain management in post-operative cases of ano-rectal diseases, yoga plays an important role in pain management. Yoga is a way of living that aim towards a healthy mind in a healthy body. Ashwini mudra is a tantric practice used to generate and move prana (life force energy) upward along the spine, via the main energy channel of the subtle body known as sushumna nadi. The practice involves contracting the anal sphincter in a rhythmic way, thereby generating and containing intense energy within the lower body before pumping it upwards As the ano-rectal disease require long term conservative treatment and also surgical intervention. Due to this patients are suffering for long term problems. To minimize the side effects of medicine in post-operative cases, certain measures are needed. Yoga is a way of living that aims towards a healthy mind in a healthy body. Sushruta and Vagbhata have described that the total length of Guda is 4½ Angula only. Vagbhata had also told measurement of Guda as Atmapanitala (palm of hand) Ashwini mudra is very easy to perform and can be done during any time and by any age group.

Cognitive and Emotional Factors and Pain-Related Outcomes in Youth with Sickle Cell Disease

Children with sickle cell disease (SCD) experience acute episodes of pain that may require visits to emergency department (ED) or hospitalizations. SCD is associated with cognitive deficits that are particularly evident in domains of executive functioning (e.g., attention, working memory). Many patients/parents also report emotional concerns related to SCD. It is not known the degree to which these concerns impact disease self-management and healthcare utilization. This study investigated cognitive and emotional factors as contributors to pain-related healthcare utilization (visits to ED and hospitalizations) in children with SCD. The cohort included 112 youth with SCD (all genotypes) between ages 7-16 years who received care at Children's National Hospital in Washington, DC. Measures of socioeconomic status (e.g., parent education, family income, 1- vs. 2-parent households), cognitive abilities, and emotional functioning were extracted from an existing database of participants who had previously enrolled in the IRB approved study of computerized working memory training. Cognitive measures included the Wechsler Intelligence Scale for Children (WISC-V) Full Scale IQ and attention, working memory, and executive functioning tests from Cogstate, a computerized cognitive assessment. Emotional functioning was measured using the Worry 1 (i.e., anxiety about SCD) and Emotions (i.e., frustration and anger about SCD) domains of both the child- and parent-rated Pediatric Quality of Life Inventory Sickle Cell Disease Module. Healthcare utilization was measured through chart review, separated into ED visits for pain and hospitalizations for pain 1 year and 3 years after enrollment. The mean age of participants was 10.61 (SD=2.91) year with majority being females (n=65; 58%). Eighty-three (74%) had sickle cell anemia (HbSS or HbSβ0 thalassemia). The median number of ED visits for pain was 1 visit (IQR=2) across 1 year after enrollment and 3 visits (IQR=6) across 3 years after enrollment. The median number of hospital admissions for pain was 0 admissions (IQR=1) across 1 year after enrollment and 1 admission (IQR=4) across 3 years after enrollment (pain hospitalizations = 1; IQR=4). Linear regression models were applied to explore whether cognitive and emotional variables were predictive of healthcare utilization for pain. Variables included in the final model were selected by using the Akaike information criterion. Results indicated that attentional abilities were significantly associated with ED visits and hospitalizations for pain, both at 1 year and 3 years after enrollment (p's<.009), such that better performance on the Cogstate attention task was associated with fewer ED visits and hospitalizations. Child-rated emotional quality of life significantly predicted ED visits for pain over 1 year (b=-0.004, p=.049) and hospitalizations for pain over 3 years (b=-0.006, p=.013), such that higher emotional quality of life was predictive of fewer ED visits and hospitalizations. Parent-rated child emotional quality of life was also predictive of hospitalizations for pain over 3 years (b=-0.007, p=.020). Neither SCD genotype nor socioeconomic status significantly impacted healthcare utilization. Results demonstrate that children's cognitive and emotional functioning play an important role in pain management and should be an integral part of comprehensive pain management plans for children with SCD. Attentional abilities emerged as a reliable predictor of pain-related healthcare utilization and may signal that poor attention makes it difficult to implement strategies to distract from pain. It could also suggest that children with poor attention have greater difficulty with behavioral aspects of disease self-management (e.g., medication adherence, avoiding pain triggers). These are important considerations, given that youth with SCD are at risk for disease-related neurological sequelae including reduced attentional abilities. Emotional functioning (specifically, frustration and anger about SCD) also predicted healthcare utilization for pain, highlighting the potential impact of stress on pain onset and management. Clinicians and researchers should consider cognitive and emotional factors when evaluating risk for pain in SCD and incorporate these factors when developing strategies to reduce healthcare utilization and costs. Disclosures Darbari: Hilton Publishing: Consultancy, Other: Expert advisory board for developing gaming app for SCD; Global blood therapeutics: Consultancy, Honoraria, Other: participated in advisory board meeting ; Novartis: Consultancy, Honoraria, Other: steering committee for SPARTAN study .

Evaluation and Pain Management in Children with Cancer: About 48 Cases in Dakar

Introduction: Pain is ubiquitous in cancer and is the most dreaded symptom in children with cancer. It is a medical emergency. In Senegal, there is little data on the assessment and management of pain in children. The objective of this study is to evaluate the role of morphine in cancer pain management in children. Methodology: This is a prospective study carried out over a period of 4 and a half months (from April 15 to August 31, 2017). All children hospitalized at the pediatric Oncology Department and who used morphine as part of their treatment were included in this study. The hospital prevalence was 69.5%. The most common tumor pathologies found were acute leukemia, followed by nephroblastoma and Burkitt’s lymphoma. Results: Pain was present for an average of 30.3 days; It was abdominal in half of the cases. Nociceptive pain was present in 89.6% of cases. An average 40% reduction in pain intensity was observed following morphine administration on the first day. Analgesia was obtained on average after 6 days. Conclusion: Morphine has a crucial role in pain management in children with cancer. Efforts still need to be made in our unit to improve the quality of pain management in children.

Nurses' Behavior Regarding Pain Treatment in an Emergency Department: A Single-Center Observational Study.

PurposeThe aim of this prospective study was to assess the behavior of emergency department (ED) nurses with regard to pain and their role in pain management in a real-life clinical setting.MethodsA total of 509 consecutive patients were enrolled during a 6-week period. A case-report form was used to collect data on nurses’ approaches to pain, time to analgesia provision, and patient-perceived quality of analgesia.ResultsTriage nurses actively inquired about pain in almost every case, but they did not estimate pain intensity in a third of patients. In the majority of cases, triage nurses did not report pain-related findings to the physician, who was the only professional that could prescribe analgesia to patients. The assignment of the color-coding of triage by nurses appears to be related to the perceived severity of the clinical case and a more comprehensive evaluation of pain. More than half of patients were at least fairly satisfied with analgesia.ConclusionPain is increasingly screened during triage, but its comprehensive assessment and management still lack systematic application. We believe that further education and implementation of analgesia protocols may empower nurses to manage ED patients’ pain more effectively and in a more timely manner.

Magnesium and Pain.

In terms of antinociceptive action, the main mode of action of magnesium involves its antagonist action at the N-methyl-d-aspartate (NMDA) receptor, which prevents central sensitization and attenuates preexisting pain hypersensitivity. Given the pivotal function of NMDA receptors in pain transduction, magnesium has been investigated in a variety of pain conditions. The oral and parenteral administration of magnesium via the intravenous, intrathecal, or epidural route may alleviate pain and perioperative anesthetic and analgesic requirements. These beneficial effects of magnesium therapy have also been reported in patients with neuropathic pain, such as malignancy-related neurologic symptoms, diabetic neuropathy, postherpetic neuralgia, and chemotherapy-induced peripheral neuropathy. In addition, magnesium treatment is reportedly able to alleviate fibromyalgia, dysmenorrhea, headaches, and acute migraine attacks. Although magnesium plays an evolving role in pain management, better understanding of the mechanism underlying its antinociceptive action and additional clinical studies is required to clarify its role as an adjuvant analgesic.

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain-A Pilot Study.

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

The Relationship Between Parental Care and Pain in Children With Headache: A Narrative Review.

In migraine or primary headache in children, parents play a fundamental role in pain management. For this narrative review, PubMed, Google Scholar, and Psych Info were searched using the terms "parent headache", "mother/father headache", "parental impact headache", "alexithymia parents headache", "catastrophizing parent headache", "family headache", "children parent headache", and "quality of life family headache". Articles were chosen for inclusion based on their relevance in to the topic. Several parental and psychological characteristics can influence in children and adolescent headache, such as parental attitudes as oppressive or overprotective; punitive parenting styles; familial psychological symptoms, especially anxiety and depression; catastrophizing about their child's pain or excessive worry about their child's headache; inability to express emotions; and feelings that may lead to somatization problems. Parents' attitudes and behaviors toward their child's headache have a strong relation with the severity of headache attacks. Mothers seem to have more influence than fathers on children's pain and emotional regulation. We suggest that the presence of caregiver-child transmission of maladaptive coping strategies, arising from difficulties expressing emotion, may lead to incorrect management of headache pain, further facilitating headache chronification.

A Practical Approach to Using Adjuvant Analgesics in Older Adults.

The adjuvant analgesics are a large and diverse group of drugs that were developed for primary indications other than pain and are potentially useful analgesics for one or more painful conditions. The "adjuvant" designation reflects their early use as opioid co-analgesics for cancer pain. During the past 3 decades, their role in pain management has changed with the advent of many new entities, emerging data from numerous analgesic trials, and growing clinical experience. Many of these drugs are now used as primary analgesics for specific types of chronic pain. With proper patient selection and cautious administration, they can potentially contribute meaningfully to the management of chronic pain in older adults. A practical approach categorizes the many adjuvant analgesics by broad indications: multipurpose drugs and drugs that target neuropathic pain, musculoskeletal pain, and cancer pain, respectively. This article reviews the status of the evidence supporting the analgesic potential of the adjuvant analgesics and discusses best practices in terms of drug selection and dosing. J Am Geriatr Soc 68:691-698, 2020.

Nursing Students' Knowledge and Attitude toward Pain Management in Gaza Strip, Palestine

Pain is considered as one of the most common reasons that oblige people to seek medical care. Graduates in nursing have a vital role in administering medication and have an essential role in pain management. However, applying these roles require that nursing students attain an adequate knowledge and management toward pain. So, the present study was conducted to examine the level of nursing students' knowledge and attitude toward pain management in Gaza Strip.

The association between chronic pain and central sensitization following total knee replacement: A retrospective cohort study

Background: Pain still persists in 20% of patients who have had total knee replacement (TKR) surgery. It is important to investigate the reason for the persistent pain after surgery and related factors. This study aimed to elucidate any connection between central sensitization and ongoing pain after knee replacement surgery and other associated factors. Methods: The population was composed of 182 patients who had undergone TKR, and in follow-up visits from 1 mo to 2 yr after the operation, they were evaluated using the Pressure Pain Threshold (PPTs), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Central Sensitization Inventory (CSI), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Beck Depression Inventory (BDI), and the painDETECT test. Results: The mean follow-up period was 6.84±4.10 (1-24) months. According to the postoperative LANSS score, neuropathic mechanisms were responsible for pain in 48.4% (88/182) of the patients. CSI showed central sensitization in 41.2% (75/182) of the patients (CSI score ≥40). Patients whose pain was not associated with neuropathic mechanisms (LANSS score <12 or painDETECT score<19) saw more benefit from surgery (P<0.001). Additionally, pain relief after TKR was more prevalent in patients whose CSI score was <40 points (P<0.001). Conclusions: This study showed that neuropathic mechanisms and central sensitization are important sources of persistent pain in patients who have had total knee replacement. Evaluation of central sensitization and neuropathic mechanisms may play an important role in management of pain. Level of Evidence: Level III.

The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence.

Given the growing challenges in chronic pain management coupled with the ongoing consequences of the opioid epidemic, pain management practitioners are looking into more effective, innovative, and safer alternatives to treat pain. Cannabis-based medicine had been described for hundreds of years but only recently have we seen the more scientific, evidence-based approach to its use, and ongoing investigations continue to explore its potential medical benefits. While historically more attention has been paid to the psychoactive component of the cannabis plant Δ9-tetrahydrocannabinol (THC), there have been fewer scientific studies on the medical use of the cannabidiol (CBD) - a non-psychoactive component of the cannabis plant. By examining recent literature, we investigated the use of CBD and its potential role in pain management. Since there are currently no approved pharmaceutical products that contain CBD alone for the management of pain, this review focused on nabiximols (which is a combined product of THC/CBD in a 1:1 ratio) as the only pharmaceutical product available that contains CBD and is being used for the management of pain. It is difficult to definitely attribute the therapeutic properties to CBD alone since it is always administered with THC. Based on the available literature, it is difficult to make a recommendation for the use of CBD in chronic pain management. It is also important to note that there are many CBD products currently availableas supplements, but these products are non-pharmaceuticals and lack the appropriate clinicalstudies to support their efficacy claims.

Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists.

Background and Aims:Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy.Methods:One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia.Results:All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics.Conclusion:ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.

Is pain part of a systemic syndrome in head and neck cancer?

Head and neck cancers (HNC) represent 5% of all malignancies worldwide with about 180,000 cancer deaths per year. Patients with HNC are characterized by a systemic inflammatory state, generally associated with worse outcomes. Treatment-related toxicity is common among HNC patients and causes systemic consequences such as fatigue or cognitive dysfunction. The therapeutic treatments of HNC involve the release in circulation of inflammatory systemic mediators, whose effects trigger a vicious circle that may lead to functional and behavioral alterations. The areas of the head and neck are highly sensitive to pain. Literature data confirm that in HNC patients, pain is one of the most distressing symptoms across all the phases of treatment. Pain is associated with worse general conditions, depression, fatigue, impaired cognitive functions, and lower survival rate. The treatment of advanced HNC cases is multimodal and requires a multidisciplinary psycho-socio-pharmacological approach mediated by a team of experts. The pharmacological approach in management of HNC patients with pain is fundamental and involves the use of opioids, NSAIDs, steroids, or other drugs. Opioids in pain management therapy in patients with HNC could allow the pain level to be adequately monitored, thus improving quality of life. The integration of opioid and non-opioid therapy as well as non-pharmacological interventions is essential for the rehabilitation of physical, social, and psychological functions and to achieve pain control in patients with HNC. Opioid treatment is the mainstay for pain control, being used both for background and breakthrough cancer pain (BTcP) episodes. Fentanyl, easily absorbed and generally well tolerated, appears to be a possible choice due to its versatility. Non-pharmacological interventions, such as tailored yoga, physical exercise, and acupuncture, may have a role in pain management in patients with HNC.

The good death and the institutionalisation of dying: An interpretive analysis of the Austrian discourse

The institutionalisation of dying is recurrently assessed as adverse to a good death. However, a majority of people die in institutions such as hospitals or nursing homes and end-of-life care at home is more and more professionally supported. This article analyses how the discursive production of dying, the good death, and the issue of institutionalisation at the end of life are interrelated. The study empirically investigates a parliamentary enquiry on dying with dignity that took place in Austria between 2014 and 2015. It employs the Sociology of Knowledge Approach to Discourse to analyse parliamentary documents and minutes, written statements submitted by individuals and organisations, as well as newspaper articles. Data analysis shows a restrictive and a permissive normative position considering both killing on request and assisted suicide. Apart from their different political demands, they both reproduce a discourse constructing dying as a longer lasting and painful process striking old or ill people. In order to enable a good death, the dying person needs comprehensive support that the informal social environment is incapable to provide. Thereby, institutionalisation is associated with negative characteristics and at the same time identified as requirement for a good death considering its role in pain management and provision of care. The analysis interprets the call for institutionalisation in the context of medicalisation and the central role of physicians to alleviate pain. The article proposes a differentiated view on institutionalisation processes and practices in end-of-life care, also reflecting the potential of institutionalisation to obstruct fundamental societal transformation.

Relationships between patient-related attitudinal barriers, analgesic adherence and pain relief in Chinese cancer inpatients.

The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief. A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics. The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05). The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients' analgesic adherence. Conversely, patients' beliefs are more likely to be shaped by under treatment rather than as a cause.

Provider perceptions of the social work role in oncologic pain management.

214 Background: Best practices of cancer care delivery have shifted from medical models to interdisciplinary approaches aimed at holistic care. The social work profession has advanced itself by gaining competence in psycho-oncology, advance care planning, biopsychosocial assessment and intervention, and pain management. While Masters prepared Social Workers (MSW) are widely recognized as experts in most of these areas, it appears that they are underutilized in pain management. This study will examine provider and nursing perceptions about social work expertise and whether those perceptions may limit utilization of social work in multidisciplinary management of cancer pain. Methods: While review of psycho-oncology literature supports the role of social work in pain management, this was not clearly indicated within the medical oncology domain. A survey was created to ascertain the perception of the MSW role in pain management as a supplement to pharmacologic and medically-based care when identifying and treating multidimensional pain. The survey was completed by Physicians, Advanced Practice Providers, and Nurses in outpatient oncology practices in The US Oncology Network. Results: 139 medical professionals responded. As hypothesized, 88% reported they were comfortable with MSWs conducting Advance Care Planning, while 61% reported being comfortable with MSWs educating patients and families about pain management during palliative/end of life care. 95% believed unmet emotional, social, spiritual and existential needs can present as physiological pain, however only 55% indicated they would include Licensed Clinical Social Workers to provide therapeutic interventions as part of pain management. Conclusions: Under half of survey participants reported an understanding of the scope of social work practice, which aligns with the lack of awareness and under-utilization of social work as a vital contributor in oncologic pain management. MSWs have training in evidence-based interventions such as CBT, guided imagery, mindfulness and biofeedback techniques which may diminish the experience of pain. Further research is recommended to identify strategies to promote and integrate social work into multidisciplinary pain management.

Hospitalized patients\u2019 pain experience before and after the introduction of a nurse-based pain management programme: a separate sample pre and post study

BackgroundMany patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain management. Hence, a nurse-based pain management programme may influence how hospitalized patients experience pain. In this study we investigated hospitalized patients’ experience of pain before and after the introduction of a two-component nurse-based pain management programme.MethodsA quasi-experimental design with a separate sample pretest-posttest approach was conducted on a convenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four inpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at baseline, before the intervention six weeks after pain management education, and finally immediately after four months of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire.ResultsAll the samples had similar sociocultural backgrounds. The proportion of patients who reported average moderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to 48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were 53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the physical and emotional function was generally reduced across the surveys after the introduction of the nurse-based pain management programme. These reductions were statistically significant with p < 0.05.ConclusionsThough the survey findings must be taken with caution, they demonstrate that the nurse-based pain management programme positively influenced patient-reported pain intensity and functional interference at the university medical center. This shows the potential clinical importance of the programme for hospitalized patients.

Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain.

Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.

The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol.

The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.