Pain Management Nursing最新文献

Background: Sleep problems, pain, and depression are common issues in fibromyalgia. However, studies on sleep hygiene education to address these problems are limited in the literature. Therefore, there is a need to investigate the effects of sleep hygiene education given to individuals with fibromyalgia on their sleep quality, pain, and depression levels.

Purpose: This experimental study was conducted to determine the effects of sleep hygiene education on sleep quality, pain, and depression in individuals with fibromyalgia.

Design: This study was carried out using an experimental pretest-posttest design with a control group.

Methods: Seventy individuals with fibromyalgia (35 experimental, 35 control) were included in the study. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), the Visual Analog Scale (VAS), and the Beck Depression Inventory (BDI). The experimental group received sleep hygiene education, while the control group did not undergo any intervention.

Results: The participants in the experimental group had lower PSQI, VAS, and BDI scores after the intervention. In the inter-group comparisons, there were statistically significant differences between sleep quality and pain scores of the groups after the intervention.

Conclusions: Sleep hygiene education was found to be effective in improving sleep quality and alleviating pain and depression in individuals with fibromyalgia.

Clinical implications: Sleep hygiene education, which has been neglected in improving sleep quality and pain in the care of fibromyalgia, should be used in clinical settings.

Background: Living liver donors are known to experience many physical symptoms such as pain in the postoperative period.

Aim: This qualitative study was conducted to examine pain experiences and coping methods of living liver donors experiencing postoperative chronic pain.

Methods: The study sample consisted of 16 living liver donors. Data were collected using a personal information form and a semi-structured questionnaire. Quantitative data were analyzed as number, mean, standard deviation, and percentage. Qualitative data were analyzed within the framework of thematic and content analysis methods.

Results: The mean postoperative chronic pain rate of living liver donors was 4.5. Eight of these people reported experiencing sudden, pinprick-like pain after liver transplantation. Living liver donors stated that the greatest factor that increased their pain was exertion/spontaneous movement. Half of them stated that the pain they experienced after transplantation had no impact on their daily life activities. Most of the living liver donors stated that the pain they experienced had no impact on their social lives; however, it caused sadness and psychological deterioration. The most preferred method to cope with pain was the use of medication.

Conclusions: Living liver donors experienced moderate postoperative chronic pain, and a significant proportion of them reported psychological symptoms related to the pain they experienced. A multidisciplinary pain team can help with pain management by providing training conducted in transplant centers.

Objectives: To examine the pain conditions that have been studied using transcutaneous auricular vagus nerve stimulation (taVNS), the various methods and dosage configurations used, as well as identify current gaps in the literature.

Design: Scoping review with the literature search and reporting guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement-extension for scoping reviews.

Review methods: A systematic search was conducted across four databases-Pubmed/Medline (n = 24), PsycInfo (n = 218), CINAHL (n = 114), and Scopus (n = 52)-comprising a total of 408 publications from peer-reviewed journals. The MeSH terms used for the search were: "transcutaneous nerve stimulation AND vagus nerve stimulation" along with "transcutaneous vagus nerve stimulation OR taVNS AND pain" with filters placed for clinical trials published between 2014 to March 2024.

Results: A total of 26 publications met eligibility for inclusion in this scoping review. The most common types of pain that have been used to evaluate the efficacy of taVNS include episodic migraine without aura, rheumatoid arthritis, fibromyalgia, irritable bowel syndrome, and chronic low back pain. The device type and settings, dosage, and placement of electrodes varied across studies. Identified research gaps include the need to determine optimal dosage for the pain condition under study, inclusion of measures to evaluate intervention fidelity, long-term outcomes and symptoms that co-occur with pain, and subanalyses to examine outcomes among various sociodemographic variables.

Conclusions: There is increasing evidence supporting the potential of taVNS in pain management. Further research is necessary to comprehensively evaluate its efficacy, underlying mechanisms, and to optimize its clinical application.

Nursing practice implications: The findings indicate a growing body of evidence for effective use of taVNS for pain management, along with reducing co-occurring symptoms, such as depression. Nurses should be knowledgeable about this treatment option and collaborate with other healthcare professionals to develop best practices for the use of this technology in practice.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) can cause chemotherapy dose reductions and impact patients' quality of life. Few proven treatments exist, with generally modest analgesic effects and possible side effects. Small studies show the beneficial effects of topical capsaicin 8% on pain.

Aim: To investigate capsaicin's effects on pain, neurotoxicity, and mood in patients with CIPN.

Design: Prospective data collection in patients treated with capsaicin 8% for painful CIPN.

Methods: In 17 patients, data was collected before (t0) and directly (t1), 2 weeks (t2), and 8 weeks (t3) after capsaicin 8% treatment. Differences between t0-t2 and t0-3 were assessed for pain (Numeric Rating Scale [NRS]; acceptability), neurotoxicity symptoms (20-item questionnaire [CIPN20]; mechanical detection [MDT] and pain [MPT] thresholds), and mood (Hospital Anxiety and Depression Score [HADS]).

Results: For 9 patients (53%), pain became "acceptable" at t2 and t3, with a significant reduction (pain intensity difference [PID]_t0-2: -1.72, PID_t0-3: -2.47, both p < .001), whereas average NRS did not change significantly for patients scoring "unacceptable." HADS anxiety scores remained unchanged, whereas depression scores decreased from baseline (t_0-2: -1.47, p = .014; t_0-3: -1.36, p = .021). CIPN20 decreased from baseline (t_0-2: -1.87, p = .004; t_0-3: -3.32 p = .002). MPT was significantly lower post-treatment and MDT did not change.

Conclusions: Capsaicin 8% can have a beneficial analgesic effect in patients with CIPN-related pain but with a marked "on-off" effect. Mood changes were marginal. Quantitative sensory testing findings do not support earlier findings on nerve degeneration after capsaicin treatment, although the study size was small for definitive conclusions.

Objective: The main objective of this review is to demonstrate the use of Peripheral Percutaneous Electrical Nerve Stimulation (PENS), together with its most up-to-date protocols, for the treatment of neuropathies.

Design: We conducted a systematic search for randomised clinical trials evaluating the effectiveness of PENS on pain intensity, sleep quality, oral analgesic intake and depression in patients with neuropathic pain.

Data sources: The search was performed in Pubmed, PEDro and Cochrane databases.

Analysis methods: The meta-analysis was conducted using RevMan 5.4 software. The mean difference was applied for variables with the same measurement scale, while the standardized mean difference was used for different scales. The inverse variance method was employed for statistical analysis, with heterogeneity assessed using the I² and Cochrane Q statistics.

Results: Four articles that met the search requirements were included. After qualitative and quantitative synthesis, the results obtained were an improvement in pain intensity (-3.57 [-4.01, -3.13]; p < .05) and sleep quality (2.48 [1.96, 3.00]; p < .05) and a reduction in medication intake (-2.37 [-4.26, -0.47]; p < .05) and depressive behaviours (-1.10 [-1.55, -0.66]; p < .05). The overall methodological quality was rated as moderate and the risk of bias as unclear.

Conclusions: The scientific evidence found is still limited for the use of PENS in neuropathies. However, this study suggests an encouraging future for the use of this therapy as a treatment tool in physiotherapy.

Nursing practice implications: PENS requires nurse education on electrode/needle placement and patient instruction, with documentation of key parameters. This review emphasizes the need for further research to establish standardized protocols and optimal application parameters for different neuropathic pain conditions.

Background: Historically, postoperative pain management of children in hospitals has been inadequate, despite advancements in pain physiology and management. Postoperative pain correlates with increased complications, psychological harm, and parental stress, leading to inefficiencies in resource utilization and prolonged hospital stays. Effective pain management relies on organizational, collaborative, and individual efforts, with interprofessional communication and cooperation being crucial.

Aim: This study aims to explore healthcare professionals' experiences with barriers to effective pediatric postoperative pain management through interprofessional focus group interviews, aiming to address gaps in understanding and improve care.

Methods: Data collection was performed using focus group interviews with twelve healthcare professionals from four surgical wards. Interviews were audio-recorded and transcribed verbatim. Transcriptions were coded and analyzed using reflexive thematic analysis by two researchers independently.

Results: Our study aligns with prior research on barriers, revealing issues such as lack of competence among physicians and nurses, limited availability of skilled personnel, heavy workloads, and absence of standardized protocols. These barriers largely reflect resource limitations and resonate with existing literature. Additionally, our findings highlight differences in perceptions between nurses and physicians regarding opioid use and standardized pain assessment tools, underscoring potential barriers to optimal pediatric postoperative pain management.

Conclusions: Our study underscores the importance of adhering to standardized, evidence-based pain management protocols, revealing a link to inadequate leadership at the hospital and department levels. Noncompliance may stem from professional inexperience and lack of trust between healthcare professionals, necessitating interprofessional dialogues facilitated by leaders to foster a culture of evidence-based pediatric care.

Clinical implications: Establishing best practices and ensuring adherence is a leadership responsibility. Furthermore, a lack of adherence to established routines of pain management might be a consequence of professional inexperience and lack of competence, as well as a symptom of lack of trust between professions and professionals. It is important that leaders of both nurses and physicians facilitate arenas for discussing these topics. A culture of evidence-based PPPM needs to be interprofessional and inclusive of different perspectives and facilitate open discussions.

Purpose: The aim was to examine nurses' experiences and opinions regarding using their professional autonomy in nonpharmacologic pain management.

Design: A qualitative descriptive approach was used in the study.

Methods: The study was conducted in the acute care services of a public hospital between December 10, 2022, and March 2023. It was completed with 29 nurses using the purposive sampling method. Data were collected using an ``Interview Guide'' consisting of semi-structured open-ended questions and analyzed using the content analysis method.

Results: Four main categories emerged. (1) Individual qualities behind independent actions, (2) physician influence in professional autonomy, (3) establishing a positive therapeutic relationship in professional autonomy, and (4) recognizing barriers to professional autonomy. Nurses perceive that they enhance their professional autonomy in nonpharmacologic pain management by making independent decisions and selecting the nonpharmacologic intervention that will optimally benefit the patient. This is achieved by making the most beneficial nonpharmacologic application for the patient, having professional competencies, and realizing physician-nurse collaboration.

Conclusions: Nurses can improve their professional autonomy in nonpharmacologic pain management by gaining knowledge, skills, expertise, and leadership skills, participating in joint decision-making processes with physicians, and considering patient preferences and needs. Discussions regarding complete professional autonomy among nurses were limited by the patients' conditions, physicians' opinions, and management's decisions. Nurse managers can use their experience to offer additional details on care, protocols and practices.

Clinical implications: Nurse managers can support nurses in their units and use their expertise to develop care, practices, and processes. At the organizational level, they can create a working environment in which nurses can better participate in multiprofessional working groups. Supportive management can have a significant positive impact on nurses' professional autonomy. It creates a work culture in the organization where there is an opportunity for shared decision-making and development of daily work without hierarchy and where employees feel trusted and valued.

Chronic pain affects 1.9 billion people worldwide and wait times for interprofessional pain management programs can be extensive. The existing wait times provide an opportunity to introduce internet-based interventions that enhance self-management ability.

Purpose: The purpose of this study was to examine the feasibility, acceptability, engagement, and meaningfulness of an online program designed to enhance the readiness for change and self-management.

Design: Participants (N = 61) waiting for interprofessional chronic pain care at two centers were assigned to engage in either a series of eight self-directed web-based modules or engage in the modules with the addition of four one-on-one sessions delivered by coaches trained in motivational interviewing techniques.

Methods: We collected participant demographics, feasibility and engagement metrics, and pre and post intervention questionnaires. A subset of participants from each group participated in an interview (n = 22).

Results: The use of online modules was found to be feasible and acceptable for participants and engagement varied depending on individual preference and between modules. Participants noted that the content and approach were relevant and meaningful, influencing changes in thinking and behaviour around pain self-management. Exploratory analyses were performed and supported improvement in self-efficacy and chronic pain acceptance outcomes in both groups. Coaching did not augment improvements in any of our outcomes.

Conclusions and clinical implications: The use of a self-directed web-based chronic pain and motivational empowerment program appears to be a promising option to support people waiting for specialist care and may influence readiness for interprofessional care.

Background: The Pain Relief Motivation Scale (PRMS) was administered to chronic pain sufferers and predicts their psychological well-being. However, the Chinese version of the PRMS has not undergone psychometric validation.

Objectives: The PRMS will be psychometrically validated in patients with neuropathic pain-induced chronic pain from mainland China.

Methods: This cross-sectional study involved 340 patients with neuropathic chronic pain from China. The measurability of the Chinese version of the PRMS was determined by the critical ratio between items, and reliability was confirmed by Cronbach's alpha coefficient. The study also examined the validity of the construction and criterion validity of the Chinese PRMS.

Results: The Chinese version of the PRMS had critical ratio (CR) values ranging from 4.044 to 15.977 (p < 0.05). The Cronbach's alpha coefficient for the scale was 0.821, and the Cronbach's alpha coefficients for the subscales ranged from 0.663 to 0.961. Exploratory Factor Analysis (EFA) showed that five variables accounted for 77.73% of the total variance. The results of the Confirmatory Factor Analysis (CFA) supported the framework for the assessment of the 21-item PRMS. The Chinese version of the PRMS was positively correlated with the General Self-Efficacy Scale in the correlation validity analyses (r = 0.458, p < .001).

Conclusion: The Chinese version of the PRMS has powerful validity and reliability and can be used to assess the level of the motivation for pain alleviation in people with pain, serving as a reference for the development of intervention programs for healthcare providers.