Opioid Prescribing Practices in Chronic Pain Management: Guidelines Do Not Sufficiently Influence Clinical Practice

2009 ◽  
Vol 10 (10) ◽  
pp. 1051-1057 ◽  
Author(s):  
Timothy W. Victor ◽  
Nancy A. Alvarez ◽  
Errol Gould
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Management ◽  
Chronic Pain Management ◽  
Prescribing Practices ◽  
Management Guidelines ◽  
Opioid Prescribing

Hypnosis and relaxation

2013 ◽  
pp. 560-568 ◽  
Author(s):  
Christina Liossi ◽  
Leora Kuttner ◽  
Chantal Wood ◽  
Lonnie K. Zeltzer
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Management ◽  
Research Evidence ◽  
Research Literature ◽  
Current Understanding ◽  
Relaxation Techniques ◽  
Chronic Pain Management ◽  
Future Studies ◽  
Hypnotic Analgesia

This chapter discusses the current research literature and clinical practice regarding the use of hypnosis in paediatric pain management, first defining hypnosis and discussing theoretical conceptualizations. Next it presents our current understanding of the mechanisms of hypnotic analgesia, along with the research evidence for the efficacy of hypnosis in the control of acute and chronic paediatric pain; in both sections relevant clinical techniques are discussed. It also includes a description and discussion of different relaxation techniques and the evidence for their efficacy in acute and chronic pain management, and concludes with an attempt to summarize and evaluate the existing literature and make suggestions for future studies and clinical practice.

scholarly journals Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

2017 ◽  
Vol Volume 10 ◽  
pp. 1395-1400 ◽  
Author(s):  
Amy Pearson ◽  
Rajat Moman ◽  
Susan Moeschler ◽  
Jason Eldrige ◽  
W. Michael Hooten
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Opioid Therapy ◽  
Chronic Pain Management ◽  
Opioid Prescribing ◽  
Provider Survey

scholarly journals Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review

2021 ◽  
Vol 121 (3) ◽  
pp. 307-317
Author(s):  
Megan Franzetti ◽  
Emily Dries ◽  
Brady Stevens ◽  
Lisa Berkowitz ◽  
Sheldon C. Yao
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Functional Status ◽  
Secondary Outcome ◽  
Osteopathic Manipulative Treatment ◽  
Chronic Pain Management ◽  
Medication Usage ◽  
Management Guidelines ◽  
Comparator Group ◽  
Chronic Pain Conditions

Abstract Context Osteopathic manipulative treatment (OMT) is used to treat chronic pain conditions. However, few guidelines focusing on chronic pain management include recommendations for OMT. Objectives To evaluate previous literature on the use of OMT for improving chronic pain. Methods A literature search was conducted on MEDLINE/PubMed and ScienceDirect on August 26–27, 2019, using the terms “osteopathic,” “chronic,” and “pain,” yielding a total of 312 MEDLINE/PubMed articles and 515 ScienceDirect articles. Eligibility criteria required that studies investigate pain, functional status, or medication usage through an experimental design, focusing on human subjects with chronic pain who had various forms of OMT administered by osteopathically trained individuals in which the comparator group received no intervention, a sham or placebo, or conventional care. Three authors independently performed literature searches and methodically settled disagreements over article selection. Results In the 22 articles included in our study that examined OMT use in chronic pain conditions, we evaluated primary outcomes of pain (22; 100%) and functional status (20; 90.9%), and the secondary outcome of medication usage (3; 13.6%). The majority of articles showed that OMT resulted in a significant decrease in pain levels as compared to baseline pain levels or the control group (20; 90.9%) and that OMT resulted in an improvement in functional status (17; 77.3%). In articles that did not find a significant difference in pain (2; 9.1%) or functional status (3; 13.6%), there were overall outcomes improvements noted. All articles that investigated medication usage (3; 13.6%) showed that OMT was effective in decreasing patients’ medication usage. Our study was limited by its small sample size and multimodal comparator group exclusion. Conclusions OMT provides an evidence-based management option to reduce pain levels, improve functional status, and decrease medication usage in chronic pain conditions, especially low back pain (LBP). Pain management guidelines should include OMT as a resource to alleviate chronic pain.

Erector spinae plane block in chronic pain management: a scoping review

2021 ◽  
pp. 030089162098593
Author(s):  
Dmitriy Viderman ◽  
Antonio Sarria-Santamera
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Management ◽  
Scoping Review ◽  
Case Series ◽  
Erector Spinae ◽  
Chronic Pain Management ◽  
Efficacy And Safety ◽  
Erector Spinae Plane Block

Chronic pain is reaching epidemic levels. Chronic pain represents a significant burden for patients, healthcare systems, and society, given its impact on quality of life, increased disability, and risk of hospitalization and mortality. Unmet needs of chronic pain management are also significant as only a small percentage of patients respond to medical (drug) therapy. Erector spinae plane block (ESPB) was rapidly adapted in clinical practice and numerous cases have been published assessing its effectiveness, but no systematic review of evidence on ESPB in chronic pain management is available. The purpose of this scoping review is to perform a comprehensive overview of existing evidence on ESPB in chronic pain management. We analyzed cases and case series reporting 43 patients. ESPB was performed in patients with severe pain and in all cases resulted in some degree of pain relief. However, because there was heterogeneity in mechanisms and underlying causes of chronic pain, preprocedural analgesic therapy, and pain assessment in reporting the cases, with the information currently available (case reports) we cannot make a definitive conclusion regarding efficacy and safety of ESPB in chronic pain management. Lack of homogeneity was present in medication use before the procedure, indicating a significant variation in how patients with chronic pain are managed. Variation in clinical practice can indicate the need to improve the quality of care to alleviate the chronic pain burden. Randomized controlled clinical trials are warranted to establish efficacy and safety of ESPB in chronic pain management.

scholarly journals Pain Management Strategies and Lessons from the Military: A Narrative Review

2015 ◽  
Vol 20 (5) ◽  
pp. 261-268 ◽  
Author(s):  
April Hazard Vallerand ◽  
Patricia Cosler ◽  
Jack E. Henningfield ◽  
Pam Galassini
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
General Population ◽  
Management Strategies ◽  
The United States ◽  
Narrative Review ◽  
Chronic Pain Management ◽  
Management Guidelines ◽  
Us Military ◽  
The Us

BACKGROUND: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings.OBJECTIVE: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population.METHODS: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population.DISCUSSION: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes.

scholarly journals Prescribers or Multidisciplinarians? An Evaluation of Brief Education for General Practitioners on Chronic Pain Management

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Simon Mark Holliday ◽  
Chris Hayes ◽  
Lester Edmund Jones ◽  
Jill Gordon ◽  
Catherine Fraser ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sensitivity Analysis ◽  
Pain Management ◽  
General Practitioners ◽  
Chronic Pain Management ◽  
Primary Analysis ◽  
Opioid Prescribing ◽  
Cohen’S D ◽  
Educational Package ◽  
Post Test

Purpose Active pain self-management (PSM) for patients with chronic pain is assumed to require multidisciplinary care, leaving prescribing analgesics the most accessible option for general practitioners (GPs). We sought to upskill GPs in multimodalPSM with a harm minimisation approach for any opioid prescribing. Design and Methodology Having developed an educational training resource, a multidisciplinary team delivered the program to attendees at a GP conference in 2017. The educational package comprised pre-readings, a 6-hour interactive, skills-based workshop, and post-workshop resources. The single-group intervention was evaluated with an original and unvalidated pre/post-test (three months) survey of four domains: knowledge; attitudes; utilisation of strategies involving PSM and opioid harm minimization. Paired t-tests were conducted on each domain score and overall, with effect sizes assessed with Cohen’s d. A sensitivity analysis was performed on the data lacking a post-test survey response. Post-survey scores were imputed via chained regression equations, then paired t-tests analyses were conducted on imputed datasets using Rubin's method to pool estimates. FindingsOf 99 participants, 33 returned both surveys for primary analysis. These were combined in the sensitivity analysis with 60 unpaired surveys. Internal consistency was modest (Cronbach’s alpha 0.736). Primary analysis demonstrated significant self-reported improvements in each educational domain with overall score increasing 10.54 points out of 130 (p<0.001 Cohen’s d 1.11). Improvements were similar in a sensitivity analysis. Discussion, Limitations and Conclusions This study found that a brief GP educational package may be a viable intervention for facilitating PSM and promoting safer prescribing strategies. Outcomes at three months, from this unvalidated survey instrument, suggest improvements in knowledge, attitudes and self-reported facilitation of PSM and opioid prescribing. As this study did not measure clinician behaviour or patient outcomes objectively, further educational research is indicated to confirm these findings and identify how best to deliver chronic pain management training.

Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners

Pain ◽  
2017 ◽  
Vol 158 (2) ◽  
pp. 278-288 ◽  
Author(s):  
Simon Mark Holliday ◽  
Chris Hayes ◽  
Adrian J. Dunlop ◽  
Simon Morgan ◽  
Amanda Tapley ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
General Practitioners ◽  
Management Education ◽  
Pragmatic Trial ◽  
Early Career ◽  
Chronic Pain Management ◽  
Opioid Prescribing ◽  
Education Change
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