Pain Management Nursing最新文献

Chronic pain is highly prevalent among Veterans and contributes to poor surgical recovery. This pilot quality improvement project evaluated a structured postoperative ketamine infusion program at a Veterans Affairs medical center. Veterans with chronic pain undergoing complex surgery received low-dose ketamine infusions (0.2 mg/kg/hr) for 24-72 hours postoperatively. The Quality of Recovery-15 (QoR-15), a validated patient-reported measure, was collected on postoperative days 2, 7, and 30. A minimal clinically important difference (MCID) of six points was used to define meaningful improvement. Among 21 participants, 80% achieved clinically meaningful recovery, with mean scores rising from 84 (poor recovery) on day 2-124 (good recovery) by day 30. No ketamine-related adverse events were reported. The program was successfully implemented across multiple postoperative and inpatient settings with structured nursing education and standardized monitoring procedures. This project is novel in demonstrating the feasibility of a standardized ketamine infusion protocol delivered outside intensive care within a Veterans Affairs hospital. Findings suggest that ketamine infusions were associated with safe, sustained improvements in postoperative recovery among Veterans with chronic pain. Results underscore the importance of nursing-led implementation strategies and highlight ketamine's potential role as a scalable, multimodal pain management intervention for high-risk surgical populations.

Background: Inequities in access to psychologically based therapies for chronic pain management include inadequate numbers of qualified professionals in needed locations and cost. To extend reach, skilled nurses trained in delivery of evidence-based treatments could disseminate effective options and ease disparities for people experiencing pain.

Objectives: This randomized controlled trial investigated the effects of Empowered Relief®(ER), a one-session pain relief skills intervention, on chronic pain outcomes when delivered via videoconference by registered nurse (RN) and advanced practice nurse (APN) members of the American Society for Pain Management Nursing (ASPMN). Feasibility and acceptability of ER were also assessed.

Methods: Participants were recruited from health organizations and clinics known to serve populations with mixed-etiology chronic pain. U.S. adults (N = 150) aged ≥18 years with self-reported pain lasting at least three months were randomized 1:1 to ER (n = 74) or wait-list control (WLC; n = 76) between November 2023 and October 2024. Electronic surveys captured data on primary and secondary outcomes at 2-, 4-, and 8-weeks posttreatment. The primary outcome was pain catastrophizing, with pain intensity, pain interference, depression, anger, pain self-efficacy, anxiety, fatigue, pain bothersomeness, sleep disturbance, satisfaction with social roles, and physical function as secondary outcomes. The mixed-effects model for repeated measures was used to compare the 8-week change in primary and secondary outcomes between ER and WLC. ER feasibility was assessed by session attendance and completion while a satisfaction survey measured acceptability.

Results: At 8-weeks follow-up, pain catastrophizing (primary outcome) was significantly improved (p < .001), as well as secondary outcomes for pain intensity, depression, pain self-efficacy, anxiety, fatigue, and satisfaction with social roles (p < .05). Attendance and treatment appraisal ratings were high and supported feasibility and acceptability.

Conclusion: ER-certified nurses can effectively deliver a single-session, psychology-based, online pain intervention that improves self-reported outcomes in adults with chronic pain.

Purpose: Chronic pain in America has reached a tipping point, utilization of effective therapies is needed in primary care. This quality improvement project evaluated the impact of adding group hypnotherapy to the chronic pain treatment plan, on pain interference, global health, and pain intensity in primary care patients.

Design: Using a pre-test/post-test survey to compare the effectiveness of adding group hypnotherapy to the pain regimen, participants were invited to undergo one session of group hypnotherapy lasting two hours either in person or virtually METHODS: Three data points were evaluated to assess the impact of chronic pain on participants: pain interference (PEG), pain intensity (NRS), and global health (PROMIS). All measures were self-reported and statistically analyzed using Microsoft Data Toolkit. The percentage change in each measure was evaluated from pre-intervention to post-intervention.

Results: There were 65 participants who were mostly female (83%). African-Americans represented 77% of the group and 72% of participants experienced chronic pain for more than five years. Pain intensity and pain interference were reduced following hypnotherapy by 24% and 23%, respectively. Global health was directly impacted by audio recording adherence, with a notable 19% improvement at follow-up.

Conclusions: The inclusion of one group hypnotherapy session into chronic pain management can reduce the overall pain experience with reduced pain intensity and interference.

Clinical implications: Chronic pain management in primary care needs to shift to a tailored approach. Collaborating with alternative medicine practitioners for a comprehensive pain management approach is needed. The development of multidisciplinary teams, including hypnotherapists for chronic pain management, has potential to efficaciously address chronic pain.

Introduction: Current pain scoring systems are being replaced by sensor-derived physiological parameters responding to autonomic changes (i.e., autonomic parameters such as heart rate variability and pupillary diameter) that quantify pain intensity at a specific moment. However, evidence supporting their use in postoperative patients is scarce. This review aims to analyze the correlation between autonomic parameters and self-reported pain intensity.

Methods: PubMed/Medline, Embase, Scopus, and Google Scholar were inquired for studies evaluating autonomic parameters in the assessment of acute postoperative pain in the postanesthesia care unit and measuring the correlation between these and pain intensity. The keywords used were related to heart rate variability, photoplethysmography (PPG), electrodermal activity, pupillary reflexes, postoperative pain, and pain measurement.

Results: Out of 3,204 studies, 23 fulfilled the eligibility criteria. PPG features and indices had the strongest correlations with pain scoring systems, with correlation coefficients of -0.738 and 0.778 for the ratio of alternating current and direct current and perfusion index in obese patients, respectively. In addition, the variant coefficient of pupillary diameter and the analgesia nociception index had the highest sensitivity, while the pupillary light reflex amplitude had the highest specificity.

Conclusions: PPG and pupillary features are promising candidates for the objective assessment of postoperative pain. Studying these variables and the addition of machine learning algorithms for feature extraction will provide supporting data for their translation into the clinical setting.

Purpose: The study aimed to explore the experiences of burn patients who used virtual reality (VR) headsets during burn dressing procedures, focusing on their perceptions of pain, comfort, and interaction with nurses.

Design: A qualitative descriptive study was conducted using descriptive content analysis to explore patients' experiences with VR during burn care.

Methods: Ten adult burn patients participated in the study. They were mostly male, with a mean age of 42 years, and had seconddegree burns covering 10%-18% of their total body surface area. Semi-structured interviews were conducted after dressing procedures, and data were analyzed using descriptive content analysis to identify key themes and patterns.

Results: Three main themes emerged: attention diversion, nurse-patient relationship, and user experience. Most participants reported that VR distracted them from pain and made the dressing process more tolerable. They expressed high satisfaction and a desire to use VR in future dressings. However, some disadvantages were noted, including reduced communication with nurses, limited visual awareness, and discomfort from headset use (e.g., dizziness, headache, pressure around the head). Ergonomic and adjustable headset designs were perceived to enhance comfort and usability.

Conclusions: VR use during burn dressing procedures can provide effective distraction and pain control. Despite minor discomforts and communication challenges, patients' overall experiences were positive.

Clinical implications: Integrating VR into burn dressing care may improve patient comfort and satisfaction. Optimizing headset design and maintaining effective nurse-patient communication can enhance the therapeutic benefits of VR in clinical burn management.

Aim: This randomized controlled experimental study was conducted to investigate the effects of listening to music during mammography screening on pain perception, anxiety level, and overall satisfaction with the procedure.

Design: This is a randomized controlled trial.

Methods: This study was conducted with 74 women who underwent mammography at the Cancer Early Diagnosis, Screening and Education Center (KETEM) between February and April 2024. Participants were randomly assigned to an intervention group (listened to music during the procedure) and a control group (received routine care). Data were collected using a Demographic Information Form, State-Trait Anxiety Inventory (STAI-I), visual analog scale (VAS) for pain assessment, and satisfaction questionnaires. The intervention group listened to Evgeny Grinko's Valse via Bluetooth speakers during the procedure. Data were analyzed using SPSS 26 with Mann-Whitney U, Kruskal-Wallis, analysis of covariance, and Spearman's correlation tests.

Results: Women in the music intervention group reported significantly lower levels of anxiety and pain (VAS scores) compared to the control group. A weak positive correlation was found between anxiety (STAI-I) and pain (VAS) after the procedure, while a weak negative correlation was observed between anxiety and satisfaction with the procedure.

Conclusions: The findings suggest that listening to music during mammography may help reduce pain and anxiety levels and may increase procedure satisfaction in women.

Clinical implications: Music therapy may be a potentially effective nonpharmacological approach for managing procedure-related discomfort and anxiety in the specific participant population studied. As such, it could be considered a feasible, accessible, and cost-effective intervention to be supported and potentially integrated into nursing practice for mammography screening.

Purpose: This study aimed to determine the effect of a video-based educational intervention on postoperative pain and anxiety in patients undergoing total knee replacement surgery.

Design: A quasi-experimental design with nonrandomized intervention and control groups was used.

Methods: This study was conducted in the orthopedics and traumatology clinic of a hospital in Karaman province in Türkiye between April and October 2022. Data were collected using the State-Trait Anxiety Inventory-State form and the Visual Analog Scale. In the intervention group (n = 40) patients received video-based education in addition to routine care. In the control group (n = 40), only standard preoperative care was provided, with no additional intervention. The pain levels were measured at 6th and 12th postoperative hours, while both pain and anxiety levels were assessed at the 24th hour.

Results: Postoperative State-Trait Anxiety Inventory-State form scores were significantly lower in the intervention group compared to the control group (p < .05). However, the mean Visual Analog Scale pain scores did not differ significantly between the groups (p > .05).

Conclusions: Preoperative video-based education related to the operating room environment did not significantly affect postoperative pain levels in total knee replacement patients but did lead to a significant reduction in anxiety levels.

Clinical implications: Video-based education may support psychological preparation and could indirectly influence the perception of postoperative pain. Nurses play a pivotal role in preparing patients for surgery, and the use of video-based educational strategies may serve as a practical and effective tool to reduce preoperative anxiety, particularly in patients undergoing orthopedic procedures.

Purpose: To determine the prevalence of chronic pain, describe characteristics of chronic pain, and examine the impact of chronic pain on quality-of-life in United States adults with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Design: Secondary analysis of cross-sectional data from the 2023 National Health Interview Survey.

Methods: Survey weights and variance estimation variables were employed. Pain duration over the past 3 months was used to determine whether individuals with CFS/ME were experiencing chronic pain. Rao-Scott chi-square test examined group-based differences between those with CFS/ME and chronic pain to those with chronic pain without CFS/ME across pain characteristics (intensity, location, limitations) and three quality-of-life domains (psychological health, general health, life satisfaction).

Results: The proportion of United States adults who reported having CFS/ME was 1.4% (weighted). Of those with CFS/ME, 70.7% (weighted) met study criteria for chronic pain. Pain was common across multiple body locations among those with comorbid CFS/ME and chronic pain, and impacted multiple domains of functioning, including life/work activities and family relationships. Relative to those with chronic pain without CFS/ME, individuals with CFS/ME and chronic pain were significantly more likely to have positive results on depression and anxiety screeners, and report fair/poor general health and life dissatisfaction (ps < .05).

Conclusions: Chronic pain is common among individuals with CFS/ME and is associated with diminished quality-of-life. Although not all individuals with CFS/ME experience chronic pain, a prominent proportion do.

Clinical implications: For those with comorbid CFS/ME and chronic pain, interventions targeting the management of multiple symptoms may be particularly important.