Pain Management Nursing最新文献

Purpose: Disagreements between nurses and doctors regarding the assessment and management of existential suffering in terminally ill patients represent a critical challenge in palliative care, particularly in the context of inpatient adult hospices. This study aimed to explore nurses' decision-making processes for palliative sedation in cases of existential suffering in an inpatient adult hospice, providing a comparison with physicians' approaches.

Design: The study employed Charmaz's constructing grounded theory methodology.

Methods: Case-based guided interviews, incorporating a case vignette, were conducted with nurses in a German inpatient adult hospice. Data were analyzed using MAXQDA 22.8.0 following Charmaz's methodology.

Results: Five categories were identified: (1) enabling quality of life until death, (2) perceiving existential suffering, (3) making a decision, (4) performing palliative sedation, and (5) palliative sedation as a solution for existential suffering. In this article, we focus on the decision-making process.

Conclusions: The study highlights the limited involvement of nurses in decision-making processes regarding palliative sedation despite their critical insights into patients' existential suffering. The findings emphasize the need for interdisciplinary collaboration and the integration of nurses' perspectives to achieve more holistic and ethically sound care in inpatient hospices.

Clinical implications: The study emphasizes the need to strengthen nurses' role in palliative sedation to foster ethical practice and reduce moral distress. © 20XX by the American Society for Pain Management Nursing.

Purpose: Limited data are available on the validation or use of culturally and language-specific pediatric self-report pain scales in Sub-Saharan Africa despite the high burden of pain affecting children.

Design: An observational study was conducted to determine the discriminant and convergent validity of two self-report pain scales in Tanzania translated into Swahili: Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS).

Methods: Children aged 5-18 years in the outpatient clinic and inpatient wards at Bugando Medical Center in Mwanza, Tanzania, were eligible. The FPS-R and CAS were translated into Tanzanian Swahili. Discriminant validity was assessed before, during, and after venipuncture using analysis of variance. Convergent validity between the two scales and between parental and child reports was assessed using Spearman correlation.

Results: A total of 107 children were enrolled (56% male, median age 8 years, interquartile range = 6.5-11). A majority (73%) had sickle cell disease. Serial assessments around venipuncture were completed in 46 children, and 74 child-parent dyads were assessed for pain burden, caregiver correlation, and scale preference. Median scores before, during, and 5 and 30 minutes after venipuncture documented an expected increase and decrease in pain over time (p < .001) in both the FPS-R and CAS. The correlation between FPS-R and CAS was r = 0.972 and p < .001. The correlation between parent and child was r = 0.849 and p < .001. Most caregivers (85%) and children (92%) preferred the FPS-R.

Conclusions: The FPS-R was preferred and the parent pain report correlated with the child report.

Clinical implications: The Tanzanian Swahili FPS-R and CAS are valid pediatric pain assessment tools.

Purpose: Healthcare education programs often provide limited training in contemporary pain neuroscience, leaving future professionals ill-prepared to address the pervasive and biopsychosocial problem of chronic pain. Exploration of the level of understanding of contemporary pain neuroscience and the attitudes toward people in pain among university students may help educators identify appropriate roles for students in pain-related interprofessional education. This study assessed and compared knowledge of contemporary pain neuroscience and attitudes and beliefs toward individuals experiencing pain among university students.

Design: Cross-sectional observational study.

Methods: 284 undergraduate and graduate, healthcare and non-healthcare students completed the revised Neurophysiology of Pain Questionnaire and the Health Care Providers' Pain and Impairment Relationship Scale.

Results: Findings revealed a widespread lack of contemporary pain neuroscience knowledge and misinformed attitudes and beliefs about individuals in pain across most groups. Physical Therapy students demonstrated significantly greater contemporary pain neuroscience knowledge and more informed attitudes and beliefs compared to all non-physical therapy healthcare and non-healthcare students. Surprisingly, non-healthcare students displayed comparable contemporary pain neuroscience to healthcare undergraduate and non-physical therapy graduate students, further highlighting gaps in healthcare curricula. Attitudes and beliefs toward individuals in pain were deficient among non-physical therapy healthcare majors and non-healthcare students alike.

Conclusions: These results underscore the need for comprehensive, contemporary pain neuroscience education across healthcare disciplines.

Clinical implications: All universities should consider incorporating contemporary Pain Neuroscience Education into healthcare curricula. Improved knowledge and attitudes among physical therapy students highlight the potential for meaningful contributions to interprofessional pain education through leadership, collaboration, and shared learning.

Objectives: To evaluate the correlation between opioid administration, pupillary changes measured by pupillometry, and patient-reported pain levels in nonprocedural settings, and to assess the utility of pupillometry as an objective tool for pain assessment and opioid efficacy.

Design: Systematic review of published literature.

Data sources: A literature search was conducted in February 2022 using PubMed, CINAHL, Web of Science, and EMBASE to identify studies examining the relationship between opioids, pupillary responses, and pain.

Review/analysis methods: A total of 160 articles were screened, and 14 studies met inclusion criteria for final analysis. Studies were evaluated for associations between opioid administration, pupillary measurements, and pain levels, as well as for reported confounding factors influencing pupillary response.

Results: Most studies demonstrated a significant association between opioid administration and pupillary constriction or altered pupillary reflexes. Several studies also identified correlations between pupillary responses and reported pain levels. Age, intraoperative medications, and individual physiological variability were found to influence pupillary measurements and may act as confounders.

Conclusions: Pupillometry shows promise as an objective indicator of opioid effect and pain response, particularly in settings where subjective pain reporting may be limited or unreliable. However, its interpretation must account for patient-specific and clinical confounding factors.

Nursing practice implications: Pupillary measurement may serve as a useful adjunct to traditional pain assessment tools in outpatient and postoperative settings. Incorporating pupillometry alongside routine vital signs-such as blood pressure, respiratory rate, and temperature-may enhance pain evaluation and support safer opioid prescribing and monitoring practices. Further research is needed to guide clinical implementation and establish standardized protocols.

Purpose: Chronic pain and cognitive impairment share similar biopsychosocial risk factors; however, little work has directly explored how these factors influence the relationship between chronic pain and cognitive impairment. This review aimed toexamine and integrate available evidence on biopsychosocial factors that influence the relationship between chronic pain and cognitive impairment in adults and develop a framework that will guide future research on this topic.

Design: Integrative review.

Method: Guided by the Whittemore and Knafl (2005) framework, we conducted a search using PubMed, Embase, and CINAHL to identify peer-reviewed, English-language articles published between 2015 and February 2025 with available full text that examined biopsychosocial factors associated with cognitive impairment in adults with chronic pain.

Results: Thirty-one articles were included, revealing four themes: 1) nature and type of chronic pain, 2) biological aging processes, 3) psychological disturbances, and 4) socioenvironmental factors.

Conclusion: Biopsychosocial factors influence the relationship between chronic pain and cognitive impairment through various pathways. Individuals with multifocal chronic pain, which is intense and of long duration, may be at the highest risk for cognitive impairment. Markers of brain aging and epigenetic aging may mediate the relationship between chronic pain and cognitive impairment. Psychological disturbances and the stress response may further mediate cognitive outcomes. Socioenvironmental factors may act as moderators in the relationship such that individuals with low socioeconomic status experience worse cognitive outcomes.

Nursing practice implication: Cognitive assessments should be included in the routine care of individuals with chronic pain.

Purpose: High levels of stigma among patients with chronic pain contribute to negative psychological well-being. Existing measures have not focused on opioid stigma among individuals with chronic pain who may have legitimate need for opioid therapy.

Design: We developed a measure of opioid stigma that captures two constructs: perceived stigma (awareness of others' negative attitudes) and internalized stigma (application of stereotypes to oneself) among individuals with chronic pain.

Methods: We recruited 180 participants with chronic pain via the online platform CloudResearch to modify an existing stigma scale. We developed items related to perceived stigma (8 items) and internalized stigma (5 items). Concurrent and discriminant validity were evaluated using the Center for Epidemiologic Study Depression Scale-10, Rosenberg Self-Esteem and Brief Resilience Scales. Factor structure were based on Iterated principal factor analysis with Promax rotation.

Results: The final sample included 151 participants, primarily Caucasian (80%), between 30-39 years old (40%), with a history of opioid use (81%). A two-factor solution was identified (MSA = .90), representing perceived and internalized stigma (Eigenvalues 7.23, 2.53; inter-factor correlation = .45, alphas = .94, .94). Semi-partial item correlations ranged from .61-.78 for perceived stigma and .73-.82 for internalized stigma. Significant correlations were observed between perceived stigma and CESD-10 (0.19, p = 0.02), and internalized stigma and resilience (-0.26, p = .001).

Conclusion: The adapted 13-item measure demonstrates sound psychometric properties in evaluating awareness and agreement with stigmatizing attitudes, supporting its reliability and validity.

Clinical implications: Nurses are uniquely positioned to identify opioid stigma, develop interventions, and reduce its impact for individuals with chronic pain.

Background: Cancer-related pain is one of the most common and challenging symptoms affecting cancer patients, impacting their physical and mental health. The involvement of families in the management of cancer patients' symptoms has gradually become a trend.

Aims: The purpose of this study is to collect the real experiences of patients participating in family meetings focused on pain management from the patients' perspective.

Methods: A descriptive qualitative design was adopted, using phenomenological methods. Ten patients were interviewed using semi-structured interviews to clarify their real experiences of participating in family meetings focused on pain.

Results: The real experiences were divided into four major themes: obstacles in pain management, the effectiveness of family meetings in pain management, changes in participation in family meetings, and views on participating in family meetings. Specifically, family meetings can enable cancer patients to move from isolation to sharing, improving their self-management efficacy of pain.

Conclusions: Family meeting intervention is a positive experience. Family meetings enhance the knowledge and skills of patients and family members in pain management, increase their participation in pain care, and improve their emotional communication. When implementing pain management and family meeting intervention measures, the influence of different cultures should be considered.

Background: Since pain varies in patients with Parkinson's disease (PD), it is crucial to use an appropriate PD-specific pain scale to assess and manage pain. This study aimed to verify the reliability and validity of the Korean version of the King's Parkinson's Disease Pain Scale (KPPS).

Methods: Two hundred-thirty nine participants with Parkinson's Disease recruited from a tertiary medical center in Republic of Korea. Reliability was assessed through internal consistency and test-retest. For validity, the convergent and known-group validities were analyzed.

Results: Among the 239 PD participants, 205 (85.8%) experienced pain, measured by the Korean version of KPPS. For reliability, the Cronbach's α was .69, and test-retest reliability using intraclass correlation coefficient was .81. For convergent validity, the scale had statistically significant positive correlations with other pain characteristics, modified Hoehn and Yahr stage, activities of daily living, and nonmotor symptom. In addition, the scale was correlated with quality of life including EuroQol-5D and Parkinson's Disease Questionnaire-8. For known-group validity, the Korean version of the KPPS score was higher in women and in the group with higher modified Hoehn and Yahr stage. In addition, the scale was associated with motor fluctuation and dyskinesia.

Conclusion: The reliability and convergent and known-group validities of the Korean version of the KPPS were established. The use of this scale could contribute to the effective evaluation and management of pain in patients with PD in both research and clinical settings.