Safety Of Pain Management Research Articles

Quality indicators for osteoarthritis pain management in the primary care setting

BackgroundDevelopment of valid and feasible quality indicators (QIs) is needed to track quality initiatives for osteoarthritis pain management in primary care settings.MethodsLiterature search identified published guidelines that were reviewed for QI extraction. A panel of 14 experts was assembled, including primary care physicians, rheumatologists, orthopedic surgeons, pain specialists, and outcomes research pharmacists. A screening survey excluded QIs that cannot be reliably extracted from the electronic health record or that are irrelevant for osteoarthritis in primary care settings. A validity screening survey used a 9-point Likert scale to rate the validity of each QI based on predefined criteria. During expert panel discussions, stakeholders revised QI wording, added new QIs, and voted to include or exclude each QI. A priority survey used a 9-point Likert scale to prioritize the included QIs.ResultsLiterature search identified 520 references published from January 2015 to March 2021 and 4 additional guidelines from professional/governmental websites. The study included 41 guidelines. Extraction of 741 recommendations yielded 115 candidate QIs. Feasibility screening excluded 28 QIs. Validity screening and expert panel discussion excluded 73 QIs and added 1 QI. The final set of 15 prioritized QIs focused on pain management safety, education, weight-management, psychological wellbeing, optimizing first-line medications, referral, and imaging.ConclusionThis multi-disciplinary expert panel established consensus on QIs for osteoarthritis pain management in primary care settings by combining scientific evidence with expert opinion. The resulting list of 15 prioritized, valid, and feasible QIs can be used to track quality initiatives for osteoarthritis pain management.

Pain Control with Regional Anesthesia in Patients at Risk of Acute Compartment Syndrome: Review of the Literature and Editorial View.

Acute compartment syndrome (ACS) is a devastating complication that can happen in almost every part of the human body, most noticeably after long bone fractures. The cardinal symptom of ACS is pain in excess of what would otherwise be expected from the underlying injury and unresponsive to routine analgesia treatment. There is paucity of literature on major analgesic management strategies including opioid analgesia, epidural anesthesia, and peripheral nerve blocks with regard to their differential efficacy and safety of pain management in patients at risk of developing ACS. The lack of quality data has led to recommendations that are perhaps more conservative than they should be, particularly when it comes to peripheral nerve blocks. In this review article, we attempt to make recommendations in favor of regional anesthesia in this vulnerable group of patients and strategies that will optimize adequate pain control and improve surgical outcome without jeopardizing patient safety.

Identifying Self-Management Support Needs for Pregnant Women With Opioid Misuse in Online Health Communities: Mixed Methods Analysis of Web Posts.

BackgroundThe current opioid crisis in the United States impacts broad population groups, including pregnant women. Opioid use during pregnancy can affect the health and wellness of both mothers and their infants. Understanding women’s efforts to self-manage opioid use or misuse in pregnancy is needed to identify intervention points for improving maternal outcomes.ObjectiveThis study aims to identify the characteristics of women in an online health community (OHC) with opioid use or misuse during pregnancy and the self-management support needs of these mothers.MethodsA total of 200 web posts by pregnant women with opioid use participating in an OHC were double coded. Concepts and their thematic connections were identified through an inductive process until theoretical saturation was reached. Statistical tests were performed to identify patterns.ResultsThe majority of pregnant women (150/200, 75.0%) in the OHC exhibited signs of misuse, and 62.5% (125/200) of the participants were either contemplating or pursuing dosage reduction. Self-managed withdrawal was more common (P<.001) than professional treatment among the population. A total of 5 themes of self-management support needs were identified as women sought information about the potential adverse effects of gestational opioid use, protocols for self-managed withdrawal, pain management safety during pregnancy, hospital policies and legal procedures related to child protection, and strategies for navigating offline support systems. In addition, 58.5% (117/200) of the pregnant women expressed negative emotions, of whom only 10.2% (12/117) sought to address their emotional needs with the help of the OHC.ConclusionsOHCs provide vital self-management support for pregnant women with opioid use or misuse. Women pursuing self-managed dosage reduction are prone to misinformation and repeated relapses, which can result in extreme measures to avoid testing positive for drug use at labor. The study findings provide evidence for public policy considerations, including universal screening of substance use for pregnant women, emphasis on treatment rather than legal punishment, and further expansion of the Drug Addiction Treatment Act waiver training program. The improvement of web-based platforms that can organize geo-relevant information, dispense clinically validated withdrawal schedules, and offer structured peer support is envisioned for harm reduction among pregnant women who opt for self-management of opioid misuse.

Pain management during bone marrow aspiration and biopsy in pediatric cancer patients

The pain associated with bone marrow aspiration and biopsy (BMAB) has an enormous impact on pediatric cancer patients and their families, but no specific reference standards for sedation and analgesia have been developed in Japan. To determine the problems associated with pain management during BMAB, a cross-sectional investigation was conducted. A survey was sent in October 2011 to data managers in institutions belonging to the Tokyo Children's Cancer Study Group, addressing the non-pharmacological and pharmacological pain management for BMAB performed on pediatric cancer inpatients between January 2010 and December 2010. The eligible response rate was 41 of 57 institutions (71.9%). Non-pharmacological pain intervention was provided in 68% of surveyed institutions. All institutions provided pharmacological pain management. In most institutions, sedation/analgesia was performed by pediatric oncologists in a treatment room in the ward. Standards for pain management were developed and utilized in only four institutions. Other means of pain management were provided in various settings. Twelve institutions reported insufficient sedation/analgesia. In total, 80% of institutions reported some adverse events. Two serious adverse events were reported in cases of underlying or complicated conditions. No serious long-term consequences were reported. Significant issues were identified regarding the efficacy and safety of pain management. Adverse events can occur in any institution. Children with underlying or complicated conditions are at high risk for serious adverse events. Therefore, adequate and systematic assessment, patient monitoring, preparation and treatment for adverse events, and cooperation with skilled specialists of pediatric oncology, anesthesiology, and intensive care are essential.

One size does not fit all: opioid dose range orders.

WITH THE INTRODUCTION of The Joint Commission (TJC) pain assessment standards 14 years ago, hospitals nationwide implemented initiatives to improve pain management. 1 Phillips D.M. JCAHO pain management standards are unveiled. JAMA. 2000; 284: 428-429 Crossref PubMed Scopus (454) Google Scholar The ongoing evaluation of pain management practices by TJC and Centers for Medicare and Medicaid (CMS) surveyors during hospital accreditation visits not only continues to fuel attempts to improve the way pain is managed in hospitals, but also has introduced unexpected and concerning consequences. The combination of a focus on reducing undertreated pain, obtaining pain intensity ratings as the primary (and sometimes only) method of pain assessment, and the prevalence of opioid-only pain treatment plans has resulted in an increase in life-threatening opioid-related adverse events. 2 Institute for Safe Medication Practices (ISMP) Pain Scales Don't Weigh Every Risk. Institute for Safe Medication Practices, 2002https://www.ismp.org/newsletters/acutecare/articles/20020724.asp Google Scholar , 3 Lucas C.E. Vlahos A.L. Ledgerwood A.M. Kindness kills: The negative impact of pain as the fifth vital sign. J Am Coll Surg. 2007; 205: 101-107 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 4 Pasero C. The perianesthesia nurse's role in the prevention of opioid-induced sentinel events. J Perianesth Nurs. 2013; 28: 31-37 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 5 Vila Jr., H. Smith R.A. Augustyniak M.J. et al. The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: Is patient safety compromised by treatment based solely on numerical pain ratings. Anesth Analg. 2005; 101: 474-480 Crossref PubMed Scopus (202) Google Scholar , 6 White P.F. Kehlet H. Improving pain management: Are we jumping from the frying pan into the fire?. Anesth Analg. 2007; 105: 10-12 Crossref PubMed Scopus (58) Google Scholar Chris Pasero, MS, RN-BC, FAAN, Pain Management Educator and Clinical Consultant in El Dorado Hills, CA

Preventing Opioid-Related Deaths in Children Undergoing Surgery

Tonsillectomy is one of the most commonly done surgical procedures in children. There are many unreported deaths following tonsillectomy in children due to opioids. Genetic variations in liver microenzyme, CYP2D6, had been associated with some of the deaths. Opioids metabolized by CYP2D6 include codeine, tramadol, hydrocodone, and oxycodone. Ultrarapid metabolizers and some extensive metabolizers of CYP2D6 relatively produce more active opioid metabolites resulting in life-threatening adverse effects, especially in young children. Young and obese children with history of sleep apnea are at higher risk of developing serious opioid-related respiratory depression. The adverse outcomes can be avoided and the safety of pain management can be improved by CYP2D6 genetic testing before prescribing these opioids or by using alternative analgesics.

The Efficacy and Safety of Pain Management Before and After Implementation of Hospital-wide Pain Management Standards

Survey of Anesthesiology: June 2006 - Volume 50 - Issue 3 - p 156-157 doi: 10.1097/01.sa.0000220757.13899.26

The Efficacy and Safety of Pain Management Before and After Implementation of Hospital-wide Pain Management Standards: Is Patient Safety Compromised by Treatment Based Solely on Numerical Pain Ratings?

The Efficacy and Safety of Pain Management Before and After Implementation of Hospital-wide Pain Management Standards: Is Patient Safety Compromised by Treatment Based Solely on Numerical Pain Ratings?

The Efficacy and Safety of Pain Management Before and After Implementation of Hospital-Wide Pain Management Standards: Is Patient Safety Compromised by Treatment Based Solely on Numerical Pain Ratings?

Inadequate analgesia in hospitalized patients prompted the Joint Commission on Accreditation of Healthcare Organizations in 2001 to introduce standards that require pain assessment and treatment. In response, many institutions implemented treatment guided by patient reports of pain intensity indexed with a numerical scale. Patient safety associated with treatment of pain guided by a numerical pain treatment algorithm (NPTA) has not been examined. We reviewed patient satisfaction with pain control and opioid-related adverse drug reactions before and after implementation of our NPTA. Patient satisfaction with pain management, measured on a 1-5 scale, significantly improved from 4.13 to 4.38 (P < 0.001) after implementation of an NPTA. The incidence of opioid over sedation adverse drug reactions per 100,000 inpatient hospital days increased from 11.0 pre-NPTA to 24.5 post-NPTA (P < 0.001). Of these patients, 94% had a documented decrease in their level of consciousness preceding the event. Although there was an improvement in patient satisfaction, we experienced a more than two-fold increase in the incidence of opioid over sedation adverse drug reactions in our hospital after the implementation of NPTA. Most adverse drug reactions were preceded by a documented decrease in the patient's level of consciousness, which emphasizes the importance of clinical assessment in managing pain. Although patient satisfaction with pain management has significantly improved since the adoption of pain management standards, adverse drug reactions have more than doubled. For the treatment of pain to be safe and effective, we must consider more than just a one-dimensional numerical assessment of pain.