Pain Medication Side Effects Research Articles

Chinese American Pain Experience Project (CAPE): Perceptions, Expectations, and Attitudes on Pain Management among Chinese American Postoperative Patients.

Chinese Americans are one of the fastest growing racial and ethnic groups and represent the largest subgroup of the Asian American population in the US and in New York City (NYC) where they number 573,528 in 2021. Despite their numbers, current pain perceptions, expectations, and attitudes of Chinese Americans remains poorly understood, especially as related to postoperative pain. A better understanding of pain experience among Chinese American patients is needed to inform strategies on improving pain management satisfaction. A total of 27 Chinese American postoperative patients from a NYC health system were recruited for face-to-face surveys and interviews with a trained bilingual and bicultural Community Health Worker. Questions from the Survey on Disparities in Quality of Healthcare and Kleinman's Explanatory Model of Illness were integrated into the survey and topic guide. Topics of discussion included satisfaction with healthcare and pain management during hospital stay and health beliefs and practices. More than half of participants experienced language challenges that made it difficult to communicate with healthcare staff. In general, high levels of satisfaction with pain management were reported; however, participants reported feeling less comfortable asking healthcare teams questions. Common themes across interviews included: (1) pain was an expected outcome of the procedure and was thus perceived as tolerable; (2) the wish to not be a burden to others; (3) concerns about side effects of pain medications; and (4) a cultural and language mismatch between healthcare teams and patients on words being used to elicit pain and discomfort. Our project findings can inform pain management strategies and tools to serve the Chinese American patient population.

Developing an Evidence-Based Patient Education Guide on Pain Management for Asian Patients on Hospice.

Asian Americans are the fastest-growing racial group in the United States. This article describes the development of a pain management assessment guide for Asian patients on hospice, their families, and their nurses. Thematic analysis was used to evaluate the applicability of research on pain, pain management, and barriers to pain management from primarily Asian countries to Asian patients on hospice in the United States. Thematic analysis of interviews with such patients concurs with research findings. Four themes emerged: enduring pain, preference for Chinese medicine remedies, fear of addiction, and concern about the side effects of pain medications. Interviews with experienced hospice nurses also aligned with these themes. Hospice nurses were asked to share their strategies for assessing and managing pain among their Asian hospice patients. Thematic analysis of their interviews revealed six strategies: focusing on treatment goals, involving family and caregivers, explaining the physiology of pain, explaining the progression of pain medications, addressing concerns about addiction, and managing the side effects of medications. The themes that emerged from patient and hospice nurse interviews were used to develop an evidence-based pain management assessment guide to support Asian patients on hospice, their family, and the nurses who care for them.

VIRTUAL-REALITY PAIN SCIENCE POSITIVELY IMPACTS PAIN AND FUNCTION, RETURN TO WORK, CUSTOMER EXPERIENCE AND RETURN ON INVESTMENT: A CASE STUDY

CASE SETTING 52-year-old male client referred for post-operative cervical-spine two-level fusion rehabilitation, two-years following a motor accident. History of prior motor accident five-years earlier with cervical-spine discectomy resolving symptoms. Referred under compensable insurance policy with 13-years claim benefit remaining. Referral objective to restore health and function for return-to-work (RTW). Experiencing intolerable neck pain with reduced left arm function, pain medication side effects, and low mood. Loss of hope resulting from significant pain post-operatively, whereas prior surgery resolved similar symptoms. Not working at referral. Pre-disability work was full-time self-employed barista. TREATMENT/REHABILITATION PROVIDED Six hours of EXPHYS BETTER Pain VR program, consisting of virtual-reality (VR) pain science coached by an exercise physiologist (AEP) over 10-weeks, face-to-face, within the pain mechanism and bio-psycho-social models. Learning consisted of VR modules and workbook with practical application of six key target pain concepts: pain is always real, doesn’t accurately measure tissue health, relies on context, is a protector, has a buffer zone, and can be retrained. Two functional goals of self-care and cooking were established, and RTW. RESULTS Validated inventories demonstrated self-reported improvements in; pain intensity: 11 item numerical pain rating scale, range: 0-10 points [8 referral; 1 closure]; and function; two 11-item patient-specific functional scale [self-care, cooking], range: 0-20 points) [2 referral; 16 closure]. Work mindset improved from pre-contemplation [referral] to maintenance [closure]. Work capacity improved from no capacity to full capacity. Work status improved from not working to working pre-disability hours and duties. Insurance claim closed. Direct return-on-investment of $300 for every $1 spent on the EXPHYS BETTER Pain VR Program. Client net promotor score (NPS) was promoter (10/10), and customer satisfaction (CSAT) was very satisfied (5/5). REFLECTIONS/LEARNINGS Virtual-reality pain science, delivered by an AEP within the pain mechanisms model, positively impacts pain and function, RTW, and customer experience, with demonstrated return-on-investment.

Small-Fiber Neuropathy

Small-fiber neuropathy (SFN) develops due to the impairment of fibers responsible for mediating temperature, pain, and autonomic functions. SFN complicates a number of common diseases such as diabetes mellitus, human immunodeficiency virus, and COVID-19, and is likely to be increasingly encountered. The associated pain contributes significantly to the morbidity of these diseases. Progression is slow, and most people affected by SFN do not develop large-fiber involvement over time. However, mixed polyneuropathies often start as SFN, and SFN often coexists with large fiber–predominant neuropathy. Symptoms of SFN, including painful paresthesia and dizziness, and sedative side effects of pain medications can negatively affect the quality of life. Standardized diagnostic criteria for SFN are not fully established, and skin biopsy remains the diagnostic test considered most reliable. Autonomic testing is useful when autonomic symptoms are present along with screening for associated conditions. Treatment should be individualized to control underlying causes and alleviate pain. Early diagnosis and individualized treatment are important for controlling SFN symptoms and optimizing daily functions. Here, we review the common but increasingly ignored condition, SFN, and discuss its diagnosis and management.

Parental knowledge and attitude of postoperative paediatric pain: stepwise linear regression analysis.

Despite the fact that mothers care for their children's pain in most cases, it has been noted that mothers have limited knowledge and attitude about paediatric pain. This study aims to assess parental knowledge and attitude of postoperative paediatric pain (POPP). This is institutional based cross sectional study conducted with 102 parents at Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH). A convenience sampling technique was used to select parents. This study has used a questionnaire (Parental Pain Expression Perception (PPEM), examine parents' attitudes and knowledge about how their children exhibit their pain and Medication Attitude Questioner (MAQs), focuses on how parents feel about giving their child analgesic medication to alleviate post-operative pain). Descriptive statistics were utilized to analyse the parent's response and presented with frequency and percentage. Factor analysis to analyze factor structure and stepwise linear regression analysis to examine the impact of socio-demographic factors in predicting parental knowledge and attitude about POPP were done. The statistical tests were performed at 95% confidence interval and 5% significance level. A total of 102 parents fulfilling the inclusion criteria were included. About 78% of parents agreed that children always express pain by crying or whining. The majority of parents (75.6%) believe children who are playing are not in pain. Regarding parental attitudes about pain medications, majority of parents (61%) believe that children should be given pain medication as little as possible because of its side effects. According to about 26.8% of parents, giving children pain medication for pain might teach them to use drugs for other issues. On the other hand, 63.4% of parents say that giving children pain medication as little as possible is the most effective way to manage their pain. Parents of younger children and parents from rural area are more likely to score higher in attention seeking sub-score of PPEP while parents from urban residence and those parents who are employed are more likely to perceive about the side effects of pain medications (Side effects factors). The overall knowledge and attitude of parents about postoperative pain and pain medications were poor.

Piloting a Mediterranean Ketogenic Nutrition Program to Address Pain in Older Adults with Mild Cognitive Impairment

AbstractBackgroundPain is a persistent problem in older adults associated with poorer quality of life, greater risk of falls, functional impairment, and risk for cognitive impairment. Psychosocial and lifestyle interventions may be especially important to consider in older populations who may be more susceptible to negative side effects of pain medications. Ketogenic nutrition (KN) is one promising option that may offer a nonpharmacologic pathway for treating pain; however, KN is also a relatively strict and complex diet associated with challenges in dissemination and long‐term adherence, especially in older adults with memory impairments.MethodThis pilot clinical trial (N = 58) evaluated a 6‐week Mediterranean KN program designed to evaluate adherence and preliminary effects of the program on pain in individuals with possible mild cognitive impairment (aged 60‐85). Participants completed daily at‐home urine ketone testing during the program, weekly evaluations of psychosocial and health characteristics, and three in‐person assessments of health, ketones, pain, and other relevant measures.ResultsAnalyses demonstrated significant improvement in pain intensity across the assessment period. Average daily urine ketone level and average self‐reported adherence across the 6‐week program were both positively correlated with improvements in pain‐related quality of life (ps<.05).ConclusionFindings offer preliminary evidence that a group, Mediterranean KN program and adherence to this type of nutrition may reduce the experience of pain and pain‐related outcomes for older adults.

P180 Impact of fibromyalgia on work: informing strategies for enablement

Abstract Background/Aims The Getting It Right First Time Report for Rheumatology recommends that care for patients with non-inflammatory painful MSK conditions such as fibromyalgia should be provided in primary and community care settings, and include reablement support. Employment that is safe, healthy, and gives individuals some control is good for physical and mental health and is of prime importance to patients with most MSK conditions. However, limited evidence exists about the impact of fibromyalgia on work ability and how to support this. We aimed to understand impacts of fibromyalgia on work ability in order to inform strategies for reablement. Methods Narrative qualitative interviews were undertaken with people with fibromyalgia across the UK. We explored views about care and treatment, and the impact fibromyalgia had on their wider lives, including work. Interviews were analysed thematically using an interpretive approach. Data management and initial analytic coding was supported by N*VIVO software. Results 31 people were interviewed; 26 female and 5 male. Participants were aged between 23 and 77 years (median 53 years). Time since diagnosis ranged from <1 year to > 20 years. Many people with fibromyalgia wanted to work and described its value. However, some described having to give up work or retire early because of their fibromyalgia. Those who remained in work reported often struggling mentally and physically with the demands of their job, mentioning: poor memory; brain fog; poor concentration; poor sleep and fatigue, along with side effects of pain medication. Committing to work was reportedly difficult due to the unpredictable nature of fibromyalgia causing concern about letting people down. Fibromyalgia was often described as an invisible illness, with colleagues and employers having little knowledge about fibromyalgia. Several people said that their employers were supportive; flexibility in how, when and where work tasks were done were highly valued e.g. flexible hours, additional rest breaks and home-working. Others felt they were perceived as a burden or ‘malingerer.’ Those without a formal diagnosis particularly struggled to access support. People often reported struggling to remain working for as long as possible before being unable to continue. Some actively made career choices that provided flexibility to remain at work e.g., changing career, becoming self-employed. Younger participants described disruption to school and university courses. Some reported completely re-thinking their intended career and described grief for the life and career to which they had aspired. There was a perceived lack of advice and support about working with fibromyalgia. Conclusion Work is an important part of rehabilitation and enablement for people with fibromyalgia. Services for fibromyalgia should facilitate early diagnosis and support for those who want to work, particularly for younger people as well as older adults who may find it harder to remain in the workplace. Disclosure R.J. Hollick: None. S. Doebl: None. Z. Skea: None. G. Macfarlane: None. L. Locock: None. K. Walker-Bone: None.

Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of \u2018very high\u2019 Human Development Index English-speaking countries

BackgroundRacial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups.MethodsMixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed.ResultsEighteen papers were included in the primary outcome analysis. Three papers were rated ‘High’ weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping.ConclusionsThere was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients’ pain management concerns.Trial registrationPROSPERO-CRD42020167890.

Exploring driving behaviour from the perspectives of individuals with chronic pain and health professionals

Chronic pain affects one in five Australians, and this could impact daily activities such as driving. Driving is a complex task, which requires the cognitive and physical ability to predict, identify, and respond to hazards to avoid crashing. However, research exploring the factors that influence safe driving behaviour for chronic pain individuals is limited. A qualitative study was conducted which involved semi-structured interviews with 23 people who had experienced persistent pain for at least three months and 17 health professionals who had experience working with individuals with chronic pain. The aim of this study was to obtain a deeper understanding of the experiences and challenges that people with chronic pain may have in their day-to-day driving. Participants were also asked about currently available driving assessments and strategies for individuals with chronic pain in the Australian healthcare system. The themes emerging from the interviews highlighted the need for clearer guidelines and educational materials regarding the impact of chronic pain on an individual's ability to drive. These themes included the physical and cognitive challenges resulting from chronic pain, as well as the potential side effects of pain medications. In addition, participants identified a number of self-regulation strategies and driving assessments currently available for monitoring safe driving behaviour in Australia. This study improves our understanding of how chronic pain affects driving behaviour, as reported by individuals experiencing the pain and relevant health professionals. Recommendations for improving the safety of drivers with chronic pain are discussed, including possible technological interventions and better public education.

Barriers and Facilitators of Pain Management in Persons With Dementia in Long-Term Care: A Scoping Review

Approximately 50% of individuals with dementia regularly experience moderate to severe pain, which is largely undermanaged. Several studies have explored the barriers and facilitators of pain management for persons with dementia; yet the evidence has not been systematically reviewed. This review aimed to synthesize current evidence on the barriers and facilitators of pain management in persons with dementia in long-term care. A PRISMA guided literature search was conducted in PubMed, CINAHL, and PsycINFO. Titles, abstracts, and full texts were screened. Included articles were original research examining the barriers or facilitators of pain assessment and treatment in individuals with dementia in long-term care. Quality assessment was conducted using the Risk of Bias tool and Johns Hopkins Level of Evidence. Ten studies were identified, including four quantitative studies, five qualitative studies, and one with both quantitative and qualitative research. Barriers of pain management identified include residents’ ability to self-report pain, pain medication side effects, need discrepancy among residents and their families, reluctance in administering analgesics, lack of pain assessment tools, lack of guidance in providing nonpharmacological interventions, and lack of clinical guidelines. Facilitators of pain management include clinicians with caring and enthusiastic characteristics, clinicians’ knowledge of residents, positive relationships among clinicians, good communication skills, using validated pain assessment tools, understanding pain indicators, clinical experience, and need-driven continuing education. These results can guide clinical practice in long-term care. Interventions should be developed to target these barriers and facilitators and improve pain management in persons with dementia.

Centralized pain and pain catastrophizing mediate the association between lifetime abuse history and self-reported pain medication side effects

BackgroundSelf-reported side effects of pain medication are important determinants of treatment course that can affect patient adherence, medication discontinuation and physician decisions. Yet, few studies have investigated patient-level predictors of...

A Pilot to Improve the Pain Medication Education Experience in Hospice.

Pain is one of the most feared symptoms experienced by patients at the end of life and one of the most difficult to manage. Families identify patient comfort as a priority in hospice, yet many have concerns regarding pain management and medication side effects. Timely, open, and ongoing communication with hospice teams can assuage concerns to improve care and outcomes relevant to pain medication use in hospice. A pilot project was undertaken to improve the patient and family/caregiver experience in end-of-life care relevant to communication regarding pain medication side effects and management within an inpatient hospice. A 5% improvement in the Consumer Assessment of Healthcare Providers & Services (CAHPS) Hospice quality indicator 18 (Understanding Side Effects) was sought. An evidence-based, interprofessional educational protocol and tool were designed and implemented to guide pertinent conversations. A 6.6% increase in favorable responses to the CAHPS Hospice target indicator occurred over the course of the pilot. Feedback from staff revealed positive responses to the tool with recommended expansion of use across hospice settings. Educational programming holds promise to support communication with hospice patients and families regarding pain medication side effects and management to improve experiential care quality as reflected in CAHPS Hospice surveys.

Willingness to Change Medications Linked to Increased Fall Risk: A Comparison between Age Groups.

To describe and compare two age groups' knowledge of medications linked to falls and willingness to change these medications to reduce their fall risk. We analyzed data from community-dwelling adults age 55 and older (n = 1812): 855 adults aged 55 to 64 years and 957 older adults (65 and older) who participated in the 2016 summer wave of the ConsumerStyles survey, an annual Web-based survey. The data are weighted to match the US Current Population Survey proportions on nine US Census Bureau demographic characteristics. Survey respondents were asked about medication use, knowledge of side effects, their willingness to change their medications to reduce fall risk, communication in the previous year about fall risk with their healthcare provider, and their comfort in discussing fall risk with their healthcare provider. All data were weighted to match the 2016 population estimates. Descriptive statistics and χ2 (p ≤ .05) were used to identify differences between the two age groups. About one-fifth of all respondents reported using at least one class of medication that increases fall risk. Older adults were less likely to report using medications for mood or sadness, less likely to report knowing the side effects of pain medications, and more willing to change their sleep medications compared with their younger counterparts. Among all respondents using these medication classes, less than one-third knew the potential fall-related side effects. However, most of them expressed willingness to change their medication if advised by their healthcare provider. Most older adults were unaware of potential fall risks associated with medications prescribed to address pain, difficulty sleeping, mood or sadness, and anxiety- or nervousness-related health issues. However, most were willing to change their medication if recommended by a healthcare provider. J Am Geriatr Soc 67:527-533, 2019.

Electronic medical records as a replacement for prospective research data collection in postoperative pain and opioid response studies

Background and aimMany clinical research studies claim to collect data that are also captured in the electronic medical record (EMR). We evaluate the potential for EMR data to replace prospective research data collection. MethodsUsing a dataset of 358 surgical patients enrolled in a prospective study, we examined the completeness and agreement of EMR and study entries for several variables, including the patient’s stay in the post-operative care unit (PACU), surgical pain relief and pain medication side effects. ResultsFor all variables with a completeness percentage, values were greater than 96%. For the adverse event variables, we found slight to substantial agreement (Cohen’s kappa), ranging from 0.19 (nausea) to 0.48 (respiratory depression) to 0.73 (emesis). ConclusionThe potential to use EMR data as a replacement for prospective research data collection shows promise, but for now, should be evaluated on a variable-by-variable basis.

Prevalence and Associated Factors of Regular Nonsteroidal Anti-inflammatory Drugs used in a Rural Community, Thailand

BACKGROUND: In Thailand, 67.2% of the population widely uses analgesics including nonsteroidal anti-inflammatory drugs (NSAIDs), which may lead to serious side effects. However, the information of regular NSAIDs used in Thailand is still limited.METHODS: A mixed method cross-sectional study was conducted. Quantitative data were collected using questionnaires to determine the prevalence and factors associated with regular NSAID use. The qualitative study was conducted using group and in-depth interviews to determine the knowledge, attitudes and practices of NSAID users.RESULTS: Of 771 participants, the prevalence of NSAID use was 31.1 and regular NSAID use was 7.4. Age, pain at the hips or thighs and pain score were independent factors associated with regular NSAID use. The qualitative study indicated that the use of NSAIDs was influenced by drug effectiveness, sources of NSAIDs and consideration of benefits and risks of the drugs.CONCLUSION: This was the first report on the prevalence and associated factors of regular NSAID use in Thailand. In this community, nonprescribed NSAIDs might cause some serious side effects and undesirable drug interaction. Information on side effects of pain medications should be disseminated to the public including guidelines on how to use pain medications.

Needs assessment of primary care physicians in the management of chronic pain in cancer survivors.

Cancer patients live longer with effective anti-cancer therapy and supportive care. About 30% of cancer survivors (non-palliative cancer patients who completed treatment) suffer from chronic pain, which will be managed by their primary care physician (PCP). The aim of this study was to assess practice patterns and treatment barriers in the management of chronic pain in cancer survivors among PCPs. A survey using a 16-item questionnaire was sent to PCPs across Canada. A total of 162 responses were collected. The majority of participants were in group (59%) or solo (33%) practice, with an average of 25years of clinical experience. Seventy-one percent of PCPs were practicing in communities of 10,000 to 100,000 people. Respondents were treating approximately 10 cancer survivors with chronic pain per month. The majority of PCPs (59%) reported having "little knowledge" or "some understanding" of chronic pain management in cancer survivors. They did not usually refer these patients to other specialists. Patient comorbidities (79%), pain medication side effects (78%), previous pain treatment (76%), effect of pain on daily functioning (75%), and drug interactions (71%) were identified as factors that guided PCP treatment choices. Major barriers included medication cost (54%), concerns about opioid abuse (51%), and patient non-compliance (46%). PCPs indicated that treatment guidelines (74%) and knowledge of pharmacological (64%) and non-pharmacological (62%) treatment options would help their chronic pain management. Most PCPs report a lack of knowledge in the management of chronic pain in cancer survivors but are keen to receive medical education on treatment options and clinical practice guidelines.

The Use of Marijuana and Hydroxyurea Among Sickle Cell Patients

ObjectiveSickle cell crises are a common, painful complication of sickle cell disease. These crises are treated in the emergency department with narcotic analgesia. However due to concerns about addiction, tolerance and side effects of pain medications, physicians specifically hematologists recommend the use of hydroxyurea as an alternative therapeutic medication for sickle cell patients. Hydroxyurea is the only FDA approved therapeutic medication proven to decrease the painful vasoocclusive process in sickle cell disease. Similarly, marijuana is being studied as an alternative in reducing pain in sickle cell disease. However, few have looked at the prevalence of hydroxyurea and marijuana use in sickle cell disease patients. We want to explore the prevalence of marijuana use among our hydroxyurea and non-hydroxyurea users.MethodWe developed a structured self-administered anonymous questionnaire that was provided to our adult sickle cell patients. One hundred and three (103) patients with HbSS, HbSC, HbSBetaThalassemia and HbSS disease with Alpha Thalassemia trait were consented and explained the purpose of the questionnaire. The questionnaire was administered in a private room in our clinic. The questionnaire focused on the following variables: (1) current regimen of their prescribed narcotic medication at steady state (2) current regimen of their prescribed narcotic medication during a moderate to severe pain crisis (3) use of Marijuana and Hydroxyurea during steady state and during a moderate to severe pain crisis (4) whether or not they were taking Hydroxyurea and the (5) physical effects of combining prescribed narcotic medication with illicit drug use. The questionnaire consisted of twenty-five (25) questions which took on average 10-15 minutes. The answers to the questionnaire were entered into REDCap (Research Electronic Data Capture). It is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources. The data was analyzed using SPSS 23.0 (IBM Corp. Armonk, NY). Chi-square or Fisher exact testing was used to test the association between variables on the prevalence of cannabis use for pain management and other symptom relief and its side effects during self-administration in patients with sickle cell disease.ResultsOur analysis showed that fifty-one (51%) percent of the participants were females while forty-nine (49%) percent were males. Thirty-six (36%) percent of patients were between 25-34 years of age and the median age was 30 years. Thirty-three percent (33%) had a college degree or higher. Sixty percent (60%) of participants admitted to using marijuana at least once. Fifty-six percent (56%) of patients used both hydroxyurea and marijuana while forty-four percent (44%) of patients did not use hydroxyurea but used marijuana. Thirty percent (30%) of participants stated they used marijuana within the last 12 months to relieve symptoms associated with sickle cell disease. The main reasons for use were to increase appetite, improve sleep, mood and concentration, relieve stress and anxiety and alleviate pain. Eighty percent (80%) of participants stated that marijuana was not as effective in managing their sickle-related pain as hydroxyurea. There was no significant difference (p= 0.173) between the use of marijuana among hydroxyurea users and non-hydroxyurea users. Five percent(5%) of participants reported combining marijuana with prescribed narcotic medications to alleviate their sickle-related pain.ConclusionIn summary, our data showed that within the groups of hydroxyurea users and non-hydroxyurea users, there was no significant difference in the use of marijuana. Both groups use marijuana as much as the general population. However, the use of marijuana among our sickle cell patients was not solely dependent on pain control. Further studies need to be conducted to show any significant results between hydroxyurea and non-hydroxyurea users. DisclosuresNo relevant conflicts of interest to declare.

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

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

Optimising pain management - An update

The key to optimal pain management is the ability to effectively monitor the patient to ensure pain relief, whilst minimising or managing the side-effects of pain medication. This will only be possible though the collaborative work of all healthcare professionals managing the patient. This article provides an overview of the requirements for optimising pharmacotherapeutic pain management.

Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

BackgroundBuruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.MethodologyA mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed.Principal FindingsIn 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.ConclusionsProfessionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.