Letter to the editor regarding Fukshansky M et al., The role of opioids in cancer pain management. Pain Practice 2005;5(1);43-54.
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Pain management. Pain as a motivator (Part I).
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Communication↗
Evaluation of the pain resource nurse role: a resource for improving pediatric pain management.
Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.
Attitude of Health Personnel↗
Family and caregiver involvement in pain management.
Pain management is a common concern of elderly patients with chronic cancer pain as well as many nonmalignant chronic illnesses. Family caregivers are central to pain management efforts, particularly in the home-care environment. Pain management is cited as an aspect of caregiving with both physical and emotional demands. Comfort for elderly patients in pain is enhanced by support from family caregivers. Education is necessary to dispel common misconceptions regarding pain and use of analgesics, and also to address the emotional aspects of relieving pain. This family education must be preceded by the education of professionals in geriatric care and to the extension of recent advances in pain management into the geriatric population. These advances can provide comfort to elderly patients as well as to the family members who care for them.
Aged↗
Measuring patient opinion of pain management.
Pain management has been increasingly recognized as an important indicator of quality patient care. In this article, we describe the development of a measure of patients' perception of pain management. Based upon the American Pain Society's guidelines, the six-item Patient Opinion of Pain Management (POPM) scale demonstrated promising internal consistency, reliability, and validity in a sample of 241 patients from 11 hospitals. The POPM is discussed in the context of previous research on the assessment of pain management.
Humans↗
Ethical issues for psychologists in pain management.
Pain management is relatively young as a specialty. Although increasing attention is being paid to issues such as pain at the end of life and pain in underserved populations, only recently has an open discussion of ethical issues in chronic pain treatment come to the fore. Psychologists specializing in pain management are faced with a myriad of ethical issues. Although many of these problems are similar to those faced by general clinical psychologists or other health psychologists, they are often made more complex by the multidisciplinary nature of pain management and by the psychologists' relationships to third-party payers (health maintenance organizations, workers' compensation), attorneys, or other agencies. An open forum exploring ethical issues is needed. This article outlines major ethical considerations faced by pain management psychologists, including patient autonomy and informed consent, confidentiality, reimbursement and dual relationships, patient abandonment, assessment for medical procedures, clinical research, and the interface of psychology and medicine. American Psychological Association ethical principles and principles of biomedical ethics need to be considered in ethical decision making. Further exploration and discussion of ethics for pain management psychologists are recommended.
Journal Article↗
[Barriers to effective cancer pain management].
Pain is one of the most feared consequences of cancer experienced by patients. Despite numerious education programs, intervention strategies and multidiciplinary pain societies, approximately 60% of patients with cancer are experiencing pain. Cancer-related pain may affect patient's life in every way, and therefore it has a great influence on the overall quality of life. Barriers to adequate pain management exist, including those related to health-care professionals, the health-care system, and the patients. The most common barriers to pain management include knowledge deficits, misconceptions about opioids and their side effects, inadequate assessment, and organizational issues. The purpose of this article is to provide information about barriers to effective cancer pain management.
Communication Barriers↗
Multiple meanings of pain and complexities of pain management.
Pain is a human experience with many different definitions and meanings. Under the influence of science these meanings multiplied and added complexity to the process of managing pain as a clinical problem. Over the last four decades nurses have made important contributions to pain knowledge and pain management through research and clinical innovation. Nurses are pivotal providers in the implementation of effective pain management programs and in fostering multidisciplinary efforts to improve the services currently available to cancer patients and their families.
Attitude to Health↗
The pharmacological basis of contemporary pain management.
Pain management has become an increasingly well researched area in medicine over recent years, and there have been advances in a number of areas. While opioids remain an integral part of pain-management strategies, there is now an emphasis on the use of adjuvant drugs, such as paracetamol and anti-inflammatory agents, which through physiological or pharmacological synergism, both enhance pain control and reduce opioid use. The management of neuropathic pain continues to be a challenge. Anti-epileptics and antidepressants, together with clonidine and ketamine, provide the foundations for treatment. Another area of interest has been the widespread use of patient-controlled analgesia and the administration of some drugs, especially opioids, by means other than traditional oral and parenteral routes. The number of new drugs that have reached the stage of clinical trials has been small, yet they offer exciting possibilities. The epibatidine analogue ABT-594 and zinconitide both offer novel approaches to the management of neuropathic pain states, while selective cyclo-oxygenase-2 inhibitors and nitroaspirins may see advances in the management of nociceptive pain states.
Analgesia↗
Contemporary pain management.
Pain management is a dynamic clinical area. Basic research is generating new drugs and new technologies for their delivery. Clinical research has demonstrated the important roles of psychological and environmental factors in the complaint of pain. Surgical strategies are improving. The recognition that the human brain plays a major role in pain perception and pain behaviours has led to the development of multidisciplinary teams that can bring a diversity of diagnostic and therapeutic skills to clinical medicine. The specialty of pain management is gaining momentum throughout the world. Australian health care delivery needs to respond to these developments to permit the citizens of this country to receive state-of-the-art care. Not only will this be more humane, but it will permit a reduction in the enormous financial costs of the poor management of both acute and chronic pain.
Acute Disease↗
How to achieve effective pain management.
Pain is a common problem in a wide range of conditions encountered by nurses in every setting. Despite the availability of knowledge about effective pharmacological and non-pharmacological approaches to pain management, patients still experience uncontrolled pain. This article, the first of six examining how pain control can be made more effective, explores how a basic misunderstanding of approaches to pain relief can lead to ineffective care. The author suggests that improved education and cooperation among professionals can lead to improved pain management.
Analgesics↗
Moving toward interdisciplinary pain management.
Pain is an unpleasant and emotional experience associated with actual or potential tissue damage. The current method of caring for a person with multiple issues and problems is a "multidisciplinary" approach; however, the disadvantages of a multidisciplinary approach are many. A more desirable alternative is an "interdisciplinary" approach. Interdisciplinary care is predicated on professionals communicating with one another about a single patient and designing care that is in the overall best interest of the patient. This paper describes the formation of the International Veterinary Academy of Pain Management, whose objective is to promote the interdisciplinary approach to animal pain management.
Animals↗
Barriers to managing pain in the nursing home: findings from a statewide survey.
OBJECTIVES: The objective of this study was to identify pain management demographics, perceived resources, and perceived barriers to adequately manage pain in the nursing home setting. DESIGN: Mailed survey. SETTING: All licensed Connecticut nursing homes. PARTICIPANTS: Directors of Nursing (DONs). MEASUREMENTS: Survey eliciting pain management demographics, perceived resources, and perceived barriers to adequately manage pain in respondents' nursing home. RESULTS: A total of 113 of 260 DONs (43%) responded to the survey. Respondents believed pain was suboptimally managed, particularly for residents with malignant and nonmalignant chronic pain. Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians' personal attitudes toward treating pain (eg, fear of addiction or overdose), lack of diagnostic precision in treating pain, and difficulty in choosing the right analgesic. Other barriers are also discussed, including low hospice enrollment of nursing home residents. CONCLUSION: Improving pain management in nursing homes requires improving provider knowledge and attitudes, enhancing diagnostic precision, standardizing pain treatment, and achieving an institutional commitment. Although responding DONs seemed aware of the need for improved pain management outcomes at their facilities, the required institutional commitment to accomplish this was not evidenced by these findings.
Analgesia↗
Barriers to managing pain in the nursing home: findings from a statewide survey.
OBJECTIVES: The objective of this study was to identify pain management demographics, perceived resources, and perceived barriers to adequately manage pain in the nursing home setting. DESIGN: Mailed survey. SETTING: All licensed Connecticut nursing homes. PARTICIPANTS: Directors of Nursing (DONs). MEASUREMENTS: Survey eliciting pain management demographics, perceived resources, and perceived barriers to adequately manage pain in respondents' nursing home. RESULTS: A total of 113 of 260 DONs (43%) responded to the survey. Respondents believed pain was suboptimally managed, particularly for residents with malignant and nonmalignant chronic pain. Perceived barriers to providing adequate pain management included lack of knowledge about pain management among nurses and physicians, lack of a standardized approach to treating pain, physicians' personal attitudes toward treating pain (eg, fear of addiction or overdose), lack of diagnostic precision in treating pain, and difficulty in choosing the right analgesic. Other barriers are also discussed, including low hospice enrollment of nursing home residents. CONCLUSION: Improving pain management in nursing homes requires improving provider knowledge and attitudes, enhancing diagnostic precision, standardizing pain treatment, and achieving an institutional commitment. Although responding DONs seemed aware of the need for improved pain management outcomes at their facilities, the required institutional commitment to accomplish this was not evidenced by these findings.
Aged↗
Making sense of ... pain management.
Pain is a common human fear. A sound knowledge of the nature of pain should inform nursing practice. This paper outlines basic pain physiology related to practical issues of pain management.
Central Nervous System↗
Interprofessional education to improve pain management.
Pain is a prevalent problem in community care and there is evidence that knowledge and understanding of pain management can be lacking among health professionals, leading to under-treatment. This mini-review aimed to assess the effectiveness of interprofessional education on health professionals' pain documentation and on the pain intensity reported by patients. A search of key databases identified two randomized controlled trials and two quasi-experimental studies. Two studies assessed change in pain documentation following interprofessional education; one revealed a statistically significant improvement and another indicated 29% increase in documentation of pain assessments. Two studies demonstrated no significant changes in patient outcomes, while the other revealed significant improvements. However, integration of the results was not possible because of the various methods of measurement used by the different researchers. Although broadly supportive of interprofessional education, the evidence is not helpful in determining the best way of improving pain management in the community.
Attitude to Health↗
Pearls, pitfalls, and updates for pain management.
Pain management is one of the most challenging areas we encounter as emergency physicians. However, many of us fail to adequately meet this challenge. This article discusses frequently encountered pain syndromes and pain management options.
Adult↗
Pain management.
Pain is a common problem encountered among elderly people in subacute and long-term care facilities. Pain often is underestimated and undertreated in these settings. Most pain problems can be improved by careful assessment and careful use of analgesic drugs and nondrug strategies. Subacute care and other long-term care facilities often present unique challenges to pain management. Clinicians who care for patients in these settings must help to establish a plan of care that is reasonable for the given resources and skills often available in these settings. Clinicians have an obligation to improve comfort and dignity for these patients, especially those near the end of life.
Acute Disease↗