Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.06.012
Gabriela Ortega BSN, RN , Alexa Lisenby BS , Tatiana Getz BS , Wenhui Zhang PhD, MS , Kenneth Mueller PharmD, BCPS , Mara L. Schenker MD, MBA, FACS , Sydney A. Axson PhD, MPH, RN , Nicholas A. Giordano PhD, RN, FAAN
Purpose
Opioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury.
Design
Secondary analysis of 86 clinical trial participants following orthopedic trauma.
Methods
Participants were assessed 2-weeks postoperatively with the following measures: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, past 24-hour average pain intensity captured on the numeric pain rating scale, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Linear regressions examined the association between PAC-SYM scores and both pain intensity and PROMIS T-scores while accounting for injury severity and opioid medication dosage.
Results
Most participants (69%) reported experiencing opioid-induced constipation symptoms and 7% reported moderate to severe symptoms. Compared to those without symptoms, participants reporting opioid-induced constipation symptoms were found to have a 3-point increase in PROMIS Pain Interference (95% Confidence Interval [CI]: 0.28-5.90; p = .032), a 3-point decline in PROMIS Physical Function (95% CI: -6.57 to -0.02; p = .049), and a 1.7-point increase in average pain scores (95% CI: 0.50-3.01; p = .007) at 2-weeks following surgery.
Conclusions
Opioid-induced constipation symptoms are common after orthopedic trauma and linked to increased pain interference and pain intensity as well as reduced physical function.
Clinical Implications
Nurse-led assessments of opioid-induced constipation can support the timely delivery of interventions to alleviate symptoms and potentially improve patient-reported outcomes after injury.
{"title":"Opioid-Induced Constipation and Associated Symptoms After Orthopedic Trauma","authors":"Gabriela Ortega BSN, RN , Alexa Lisenby BS , Tatiana Getz BS , Wenhui Zhang PhD, MS , Kenneth Mueller PharmD, BCPS , Mara L. Schenker MD, MBA, FACS , Sydney A. Axson PhD, MPH, RN , Nicholas A. Giordano PhD, RN, FAAN","doi":"10.1016/j.pmn.2024.06.012","DOIUrl":"10.1016/j.pmn.2024.06.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Opioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury.</div></div><div><h3>Design</h3><div>Secondary analysis of 86 clinical trial participants following orthopedic trauma.</div></div><div><h3>Methods</h3><div>Participants were assessed 2-weeks postoperatively with the following measures: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference, PROMIS Physical Function, past 24-hour average pain intensity captured on the numeric pain rating scale, and the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Linear regressions examined the association between PAC-SYM scores and both pain intensity and PROMIS T-scores while accounting for injury severity and opioid medication dosage.</div></div><div><h3>Results</h3><div>Most participants (69%) reported experiencing opioid-induced constipation symptoms and 7% reported moderate to severe symptoms. Compared to those without symptoms, participants reporting opioid-induced constipation symptoms were found to have a 3-point increase in PROMIS Pain Interference (95% Confidence Interval [CI]: 0.28-5.90; <em>p</em> = .032), a 3-point decline in PROMIS Physical Function (95% CI: -6.57 to -0.02; <em>p</em> = .049), and a 1.7-point increase in average pain scores (95% CI: 0.50-3.01; <em>p</em> = .007) at 2-weeks following surgery.</div></div><div><h3>Conclusions</h3><div>Opioid-induced constipation symptoms are common after orthopedic trauma and linked to increased pain interference and pain intensity as well as reduced physical function.</div></div><div><h3>Clinical Implications</h3><div>Nurse-led assessments of opioid-induced constipation can support the timely delivery of interventions to alleviate symptoms and potentially improve patient-reported outcomes after injury.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages 615-621"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.07.007
Njood Y. ALfaifi RN, ACNP-BC, Elizabeth J. Winokur PhD, RN, CEN
Objectives
This paper describes phantom limb pain (PLP), its impact on patients, and the various treatment options, including pharmacologic and complementary therapies. It investigates the efficacy of incorporating complementary and alternative therapies, both invasive and noninvasive, for amputees who have not achieved satisfactory results with pharmacologic treatments and suffer from adverse drug events. Furthermore, with the predicted increase in limb amputations, it is crucial for nurses, as frontline providers, to understand PLP, be prepared to manage persistent pain and associated psychological and functional issues and educate patients and families about alternative treatment options.
Approach
The review includes recent studies on pharmacologic interventions for PLP, case reports, and randomized clinical trials on non-pharmacologic complementary therapies, covering both invasive and noninvasive modalities. Studies from 2013 to 2022 were identified using the PubMed search engine with terms such as “Amputation,” “phantom limb pain,” “invasive therapies,” and “non-invasive therapies.”
Results and Conclusion
The pathogenesis of PLP remains unclear, complicating the identification of causes and the selection of targeted therapies for each patient. Uncontrolled PLP can severely impact the quality of life, causing psychological distress and loss of productivity. Traditional pharmacologic therapy often requires supplementation with other options due to PLP's refractory nature. A comprehensive, multimodal treatment plan, including non-pharmacologic therapies, can enhance rehabilitation and reduce complications. Incorporating these therapies can decrease reliance on medications, particularly opioids, and mitigate side effects. Although many potential PLP treatments exist, further clinical studies are needed to determine their effectiveness and establish protocols for optimizing patient outcomes.
{"title":"Integrating Complementary Therapies in Managing Phantom Limb Pain: A Case Review","authors":"Njood Y. ALfaifi RN, ACNP-BC, Elizabeth J. Winokur PhD, RN, CEN","doi":"10.1016/j.pmn.2024.07.007","DOIUrl":"10.1016/j.pmn.2024.07.007","url":null,"abstract":"<div><h3>Objectives</h3><div>This paper describes phantom limb pain (PLP), its impact on patients, and the various treatment options, including pharmacologic and complementary therapies. It investigates the efficacy of incorporating complementary and alternative therapies, both invasive and noninvasive, for amputees who have not achieved satisfactory results with pharmacologic treatments and suffer from adverse drug events. Furthermore, with the predicted increase in limb amputations, it is crucial for nurses, as frontline providers, to understand PLP, be prepared to manage persistent pain and associated psychological and functional issues and educate patients and families about alternative treatment options.</div></div><div><h3>Approach</h3><div>The review includes recent studies on pharmacologic interventions for PLP, case reports, and randomized clinical trials on non-pharmacologic complementary therapies, covering both invasive and noninvasive modalities. Studies from 2013 to 2022 were identified using the PubMed search engine with terms such as “Amputation,” “phantom limb pain,” “invasive therapies,” and “non-invasive therapies.”</div></div><div><h3>Results and Conclusion</h3><div>The pathogenesis of PLP remains unclear, complicating the identification of causes and the selection of targeted therapies for each patient. Uncontrolled PLP can severely impact the quality of life, causing psychological distress and loss of productivity. Traditional pharmacologic therapy often requires supplementation with other options due to PLP's refractory nature. A comprehensive, multimodal treatment plan, including non-pharmacologic therapies, can enhance rehabilitation and reduce complications. Incorporating these therapies can decrease reliance on medications, particularly opioids, and mitigate side effects. Although many potential PLP treatments exist, further clinical studies are needed to determine their effectiveness and establish protocols for optimizing patient outcomes.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages 659-665"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.07.002
Hui Lyu MD , Ling-Yan Wang MD , Rui-Xia Wang BD , Han Sheng MD , Jian-Mei Xia BS , Jun-Ya Cheng MD
Purpose
Pain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance.
Design and Methods
In this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model.
Results
A predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1.
Conclusions
The prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.
{"title":"Clinical Predictors of Medication Compliance in Patients With Acute Herpetic Neuralgia","authors":"Hui Lyu MD , Ling-Yan Wang MD , Rui-Xia Wang BD , Han Sheng MD , Jian-Mei Xia BS , Jun-Ya Cheng MD","doi":"10.1016/j.pmn.2024.07.002","DOIUrl":"10.1016/j.pmn.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Pain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance.</div></div><div><h3>Design and Methods</h3><div>In this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model.</div></div><div><h3>Results</h3><div>A predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1.</div></div><div><h3>Conclusions</h3><div>The prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages e479-e486"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/S1524-9042(24)00299-6
{"title":"You are invited to contribute to Pain Management Nursing","authors":"","doi":"10.1016/S1524-9042(24)00299-6","DOIUrl":"10.1016/S1524-9042(24)00299-6","url":null,"abstract":"","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Page A6"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143160405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.06.013
Reidun K.N.M. Sandvik PhD , Maida Mujakic MSc , Ingvild Haarklau MSc , Gosselin Emilie , Asgjerd L. Moi
Purpose
Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation.
Design
Quantitative pre-post design.
Methods
The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT).
Results
After implementation, a 38% adherence rate was found. The frequency of nurses’ pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01.
Conclusions
Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses’ adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps.
Clinical Implications
Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.
{"title":"Improving Pain Management in the Intensive Care Unit by Assessment","authors":"Reidun K.N.M. Sandvik PhD , Maida Mujakic MSc , Ingvild Haarklau MSc , Gosselin Emilie , Asgjerd L. Moi","doi":"10.1016/j.pmn.2024.06.013","DOIUrl":"10.1016/j.pmn.2024.06.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation.</div></div><div><h3>Design</h3><div>Quantitative pre-post design.</div></div><div><h3>Methods</h3><div>The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT).</div></div><div><h3>Results</h3><div>After implementation, a 38% adherence rate was found. The frequency of nurses’ pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (<em>p</em> = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at <em>p</em> < .01.</div></div><div><h3>Conclusions</h3><div>Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses’ adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps.</div></div><div><h3>Clinical Implications</h3><div>Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages 606-614"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.06.003
HwiKyung Kim MS, RN , Hanna Lee PhD, RN
Background
Patients undergoing laparoscopic cholecystectomy develop severe postoperative pain, and this acute pain often becomes chronic.
Objectives
This study determines the effects of preoperative education on patient-controlled analgesia (PCA) through smart learning in patients using PCA after undergoing laparoscopic cholecystectomies.
Design
We conducted a quasi-experimental study with a nonequivalent control group pretest–posttest design.
Participants
A total of 60 adult patients aged 20-65 years, admitted for laparoscopic cholecystectomy at a hospital in Korea, participated in a smart learning training program.
Methods
The concept of smart learning, which integrates learning content and solutions with the fourth industrial revolution using mobile devices such as smartphones and media tablets was applied in this study. This smart learning training program comprised three phases: (1) prebriefing, where patients accessed PCA knowledge via a program created by researchers and accessible using a mobile web device (e.g., smartphone or an iPad), with training covering pain characteristics, PCA effects, precautions, and usage methods; (2) simulation, where patients learned using PCA with a machine; (3) debriefing, where patients reviewed their knowledge and skills.
Results
Comparing the pain between the experimental and control groups, the pain decreased significantly in both the experimental (Z = –4.40, p < .001) and control groups (Z = –4.41, p < .001), with no significant difference between groups (Z = –1.00, p = .319). Preoperative knowledge significantly increased in both the experimental (Z = –4.74, p < .001) and control groups (Z = –3.55, p < .001), with a significant difference between groups (Z = –6.05, p < .001). Total satisfaction with pain control was higher in the experimental group than in the control group.
Conclusions
A structured educational program on PCA use is an effective nursing intervention. PCA educational programs using smart learning could help patients undergoing laparoscopic cholecystectomy understand postoperative pain, promote efficient PCA use, and enhance their satisfaction with pain control.
{"title":"Effects of a Preoperative Patient-Controlled Analgesia Education Program Using Smart Learning in Laparoscopic Cholecystectomy Patients","authors":"HwiKyung Kim MS, RN , Hanna Lee PhD, RN","doi":"10.1016/j.pmn.2024.06.003","DOIUrl":"10.1016/j.pmn.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing laparoscopic cholecystectomy develop severe postoperative pain, and this acute pain often becomes chronic.</div></div><div><h3>Objectives</h3><div>This study determines the effects of preoperative education on patient-controlled analgesia (PCA) through smart learning in patients using PCA after undergoing laparoscopic cholecystectomies.</div></div><div><h3>Design</h3><div>We conducted a quasi-experimental study with a nonequivalent control group pretest–posttest design.</div></div><div><h3>Participants</h3><div>A total of 60 adult patients aged 20-65 years, admitted for laparoscopic cholecystectomy at a hospital in Korea, participated in a smart learning training program.</div></div><div><h3>Methods</h3><div>The concept of smart learning, which integrates learning content and solutions with the fourth industrial revolution using mobile devices such as smartphones and media tablets was applied in this study. This smart learning training program comprised three phases: (1) prebriefing, where patients accessed PCA knowledge via a program created by researchers and accessible using a mobile web device (e.g., smartphone or an iPad), with training covering pain characteristics, PCA effects, precautions, and usage methods; (2) simulation, where patients learned using PCA with a machine; (3) debriefing, where patients reviewed their knowledge and skills.</div></div><div><h3>Results</h3><div>Comparing the pain between the experimental and control groups, the pain decreased significantly in both the experimental (<em>Z</em> = –4.40, <em>p</em> < .001) and control groups (<em>Z</em> = –4.41, <em>p</em> < .001), with no significant difference between groups (<em>Z</em> = –1.00, <em>p</em> = .319). Preoperative knowledge significantly increased in both the experimental (<em>Z</em> = –4.74, <em>p</em> < .001) and control groups (<em>Z</em> = –3.55, <em>p</em> < .001), with a significant difference between groups (<em>Z</em> = –6.05, <em>p</em> < .001). Total satisfaction with pain control was higher in the experimental group than in the control group.</div></div><div><h3>Conclusions</h3><div>A structured educational program on PCA use is an effective nursing intervention. PCA educational programs using smart learning could help patients undergoing laparoscopic cholecystectomy understand postoperative pain, promote efficient PCA use, and enhance their satisfaction with pain control.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages e428-e435"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.08.011
Angela Harless DNP, FNP-C , Patricia M. Vanhook PhD, FNP-BC , Sarah Shoemaker-Hunt PhD, PharmD , Nicole Keane MSN, RN , Ellen Childs PhD
Purpose
The authors describe a case study of a quality improvement initiative to implement the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain2 (“2016 CDC Guideline”) into nurse-led primary care practices in central Appalachia.
Design
In this controlled pre–post quality improvement study, a policy change, an electronic health record form, and supporting education were implemented. Knowledge change and quality improvement metrics were measured before and after implementation.
Data Sources
The data comprised pre- and post-knowledge survey and quality improvement metrics from the electronic health record.
Results
After the implementation of the chronic pain intake form and supporting training and education, marked improvements in documentation and completion of the 2016 CDC Guideline and Tennessee Clinical Practice Guideline-concordant activities were observed, suggesting an increase in compliance with guidelines.
Conclusions
Quality improvement efforts that focus on opioid management best practices may be effective at enhancing 2016 CDC Guideline-concordant care in clinics, including nurse-led ones. Similar strategies could be trialed to ensure the 2022 CDC Clinical Practice Guideline recommendations for opioid and pain management are adopted effectively.
Practice Implications
Interventions to improve opioid and pain management through quality improvement efforts require policy changes, clinician and patient education, and electronic record tools.
{"title":"Implementation of a Quality Improvement Learning Collaborative to Support Implementation of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: Case Study from Nurse-Led Clinics","authors":"Angela Harless DNP, FNP-C , Patricia M. Vanhook PhD, FNP-BC , Sarah Shoemaker-Hunt PhD, PharmD , Nicole Keane MSN, RN , Ellen Childs PhD","doi":"10.1016/j.pmn.2024.08.011","DOIUrl":"10.1016/j.pmn.2024.08.011","url":null,"abstract":"<div><h3>Purpose</h3><div>The authors describe a case study of a quality improvement initiative to implement the 2016 CDC <em>Guideline for Prescribing Opioids for Chronic Pain</em><span><span><sup>2</sup></span></span> (“2016 CDC Guideline”) into nurse-led primary care practices in central Appalachia.</div></div><div><h3>Design</h3><div>In this controlled pre–post quality improvement study, a policy change, an electronic health record form, and supporting education were implemented. Knowledge change and quality improvement metrics were measured before and after implementation.</div></div><div><h3>Data Sources</h3><div>The data comprised pre- and post-knowledge survey and quality improvement metrics from the electronic health record.</div></div><div><h3>Results</h3><div>After the implementation of the chronic pain intake form and supporting training and education, marked improvements in documentation and completion of the 2016 CDC Guideline and Tennessee Clinical Practice Guideline-concordant activities were observed, suggesting an increase in compliance with guidelines.</div></div><div><h3>Conclusions</h3><div>Quality improvement efforts that focus on opioid management best practices may be effective at enhancing 2016 CDC Guideline-concordant care in clinics, including nurse-led ones. Similar strategies could be trialed to ensure the 2022 CDC Clinical Practice Guideline recommendations for opioid and pain management are adopted effectively.</div></div><div><h3>Practice Implications</h3><div>Interventions to improve opioid and pain management through quality improvement efforts require policy changes, clinician and patient education, and electronic record tools.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages 638-644"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study was conducted as a descriptive study to determine the pain fears of patients undergoing surgery in the neurosurgery clinic.
Material and Method
The study was conducted with 151 patients hospitalized in the neurosurgery clinic who met the inclusion criteria. Data were collected with the patient information form and the fear of pain scale-III. Ethics committee approval, institutional permission, and written consent from individuals were obtained before the study.
Results
It was determined that the mean fear of pain score was 64.59 ± 18.43, 41.7% of the patient were fear of surgical incisional pain. Fear of surgical incisional pain is responsible for 22.0% and female gender is responsible for 29% of the change in fear of pain scores.
Conclusion
As a result, it was determined that the pain fear level of the patients in the pre-operative period was moderate. Increasing the practices to reduce the patients' fear of pain should be recommended.
{"title":"Patient Fear of Pain: The Pre-Operative Period in the Neurosurgery Clinic","authors":"Handan Topan PhD , Yeliz Sürme PhD , Özlem Ceyhan PhD","doi":"10.1016/j.pmn.2024.07.004","DOIUrl":"10.1016/j.pmn.2024.07.004","url":null,"abstract":"<div><h3>Purpose</h3><div>This study was conducted as a descriptive study to determine the pain fears of patients undergoing surgery in the neurosurgery clinic.</div></div><div><h3>Material and Method</h3><div>The study was conducted with 151 patients hospitalized in the neurosurgery clinic who met the inclusion criteria. Data were collected with the patient information form and the fear of pain scale-III. Ethics committee approval, institutional permission, and written consent from individuals were obtained before the study.</div></div><div><h3>Results</h3><div>It was determined that the mean fear of pain score was 64.59 ± 18.43, 41.7% of the patient were fear of surgical incisional pain. Fear of surgical incisional pain is responsible for 22.0% and female gender is responsible for 29% of the change in fear of pain scores.</div></div><div><h3>Conclusion</h3><div>As a result, it was determined that the pain fear level of the patients in the pre-operative period was moderate. Increasing the practices to reduce the patients' fear of pain should be recommended.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages e405-e410"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.07.012
Qizhen Lu MSN, RN, Deping Zhang MSN, RN, Li Li MSN, Hefan Sun MSN, RN, Yuqi Wu MSN, RN, Wanting Zhang MSN, RN
<div><h3>Purpose</h3><div>To investigate the current status and related influencing factors of self-management stages in older patients with chronic pain.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Methods</h3><div>A total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages.</div></div><div><h3>Results</h3><div>The self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain.</div></div><div><h3>Conclusions</h3><div>In this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages.</div></div><div><h3>Clinical Implications</h3><div>Nursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention
{"title":"Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study","authors":"Qizhen Lu MSN, RN, Deping Zhang MSN, RN, Li Li MSN, Hefan Sun MSN, RN, Yuqi Wu MSN, RN, Wanting Zhang MSN, RN","doi":"10.1016/j.pmn.2024.07.012","DOIUrl":"10.1016/j.pmn.2024.07.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the current status and related influencing factors of self-management stages in older patients with chronic pain.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Methods</h3><div>A total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages.</div></div><div><h3>Results</h3><div>The self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain.</div></div><div><h3>Conclusions</h3><div>In this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages.</div></div><div><h3>Clinical Implications</h3><div>Nursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages e411-e419"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.pmn.2024.06.014
Bárbara Brenda de Araújo Faria , Sabrina Gabrielle Gomes Fernandes Macêdo , Catherine M. Pirkle , Saionara M.A. Câmara
Issue
Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations.
Background
Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic.
Aim
We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women.
Methods
This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann–Whitney and Kruskal–Wallis tests compared depressive symptoms in relation to pain status.
Findings
Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to “deep pain with intercourse” (p = .09), “burning vaginal pain after sex” (p = .01), “pelvic pain lasting hours or days after intercourse” (p = .06), and “pain with urination” (p = .09). When stratified by age group, significant associations were found only for the adolescents.
Discussion
Our results suggest that women reporting pain in different daily situations have higher EPDS scores.
Conclusion
Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.
{"title":"Association Between Pain During Pregnancy and Postpartum Depressive Symptoms in Adolescent and Adult Women","authors":"Bárbara Brenda de Araújo Faria , Sabrina Gabrielle Gomes Fernandes Macêdo , Catherine M. Pirkle , Saionara M.A. Câmara","doi":"10.1016/j.pmn.2024.06.014","DOIUrl":"10.1016/j.pmn.2024.06.014","url":null,"abstract":"<div><h3>Issue</h3><div>Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations.</div></div><div><h3>Background</h3><div>Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic.</div></div><div><h3>Aim</h3><div>We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women.</div></div><div><h3>Methods</h3><div>This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann–Whitney and Kruskal–Wallis tests compared depressive symptoms in relation to pain status.</div></div><div><h3>Findings</h3><div>Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to “deep pain with intercourse” (<em>p</em> = .09), “burning vaginal pain after sex” (<em>p</em> = .01), “pelvic pain lasting hours or days after intercourse” (<em>p</em> = .06), and “pain with urination” (<em>p</em> = .09). When stratified by age group, significant associations were found only for the adolescents.</div></div><div><h3>Discussion</h3><div>Our results suggest that women reporting pain in different daily situations have higher EPDS scores.</div></div><div><h3>Conclusion</h3><div>Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"25 6","pages":"Pages e420-e427"},"PeriodicalIF":1.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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