The Impact of Technology on the Analgesic Gap and Quality of Acute Pain Management

195 Background: Radiotherapy (RT) effectively palliates bone metastases, but relief may take weeks, frequently necessitating acute pain management (APM). NCCN Guidelines for Adult Cancer Pain (V2.2015) recommend initiation/titration of analgesics for patients with pain scale value (PSV) ≥ 4. We sought to evaluate how often symptomatic patients have analgesic regimens assessed and intervened upon at radiation oncology (RO) consult for bone metastases, and the impact of a dedicated palliative RO service on APM. Methods: We reviewed consult notes for 217 bone metastases patients treated with RT at Dana Farber Cancer Institute/Brigham & Women’s Hospital (DFCI/BWH) and University of California, San Francisco (UCSF) during June-July 2008, Jan-Feb 2010, Jan-Feb 2013, and June-July 2014, time periods before and after implementation in 2011 of a dedicated palliative RO service at DFCI/BWH. For symptomatic patients, rate of assessment of analgesic regimen was recorded. Among patients with PSV ≥ 4, rate of pain intervention was recorded. The impact of a palliative RO service on these rates was evaluated. Results: Median age was 63 and median KPS was 70. Median PSV for painful bone metastases was 5 (IQR 2-7); 51% had PSV ≥ 4. Among symptomatic patients, analgesic regimen was assessed for 44.5% (51.7% at DFCI/BWH and 28.1% at UCSF). Among patients with PSV ≥ 4, pain intervention occurred for 17.2% (20.5% for DFCI/BWH, 0% for UCSF). At DFCI/BWH, consultation by a dedicated palliative RO provider was associated with higher rate of assessment of analgesic regimen (82.4% vs 47.7%, p = 0.007). At DFCI/BWH, consultation by a palliative RO provider was associated with higher rate of pain intervention (31.2% vs 7.9%, p = 0.012). There was no difference in analgesic regimen assessment or intervention between non-dedicated palliative RO providers at DFCI/BWH and UCSF (p = 0.07 and 0.09, respectively). Conclusions: At two cancer centers, half of bone metastases patients seen for RT have PSV ≥ 4, yet a minority have analgesic assessment and intervention, indicating need for APM quality improvement in RO. An integrated palliative RO service was associated with improved assessment and management of acute pain per NCCN guidelines.

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Acute pain management in principle

10.1093/med/9780199234721.003.0004 ◽

2011 ◽

Author(s):

Jeremy N. Cashman

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Clinical Practice Guidelines ◽

Acute Pain ◽

Practice Guidelines ◽

Oral Route ◽

Acute Pain Management ◽

Post Operative Pain ◽

Pain Services

Pain measurement is essential in evaluating response to analgesic therapy. The oral route is the route of choice for analgesics in non-fasting patients. Administering opioids by the neuraxial route provides superior analgesia to the same drug administered by parenteral routes. Clinical practice guidelines may be useful in acute pain management. Acute Pain Services improve the quality of post-operative pain management.

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Evaluation of the quality of acute pain management in a pediatric surgical setting: Validation of a parent proxy modified version of the revised American Pain Society Patient Outcome Questionnaire

Pediatric Anesthesia ◽

10.1111/pan.13528 ◽

2018 ◽

Vol 29 (1) ◽

pp. 68-76 ◽

Cited By ~ 1

Author(s):

SookHui Chaw ◽

YokeLin Lo ◽

Ina I. Shariffuddin ◽

JiaWing Wong ◽

JiaYin Lee ◽

...

Keyword(s):

Patient Outcome ◽

Pain Management ◽

Acute Pain ◽

Outcome Questionnaire ◽

Acute Pain Management ◽

American Pain Society ◽

Surgical Setting ◽

Parent Proxy

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Assessment of patient satisfaction with acute pain management service: Monitoring quality of care in clinical setting

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.179450 ◽

2016 ◽

Vol 60 (4) ◽

pp. 248 ◽

Cited By ~ 8

Author(s):

Robyna Khan ◽

Fizzah Farooq ◽

Aliya Ahmed

Keyword(s):

Patient Satisfaction ◽

Quality Of Care ◽

Pain Management ◽

Acute Pain ◽

Clinical Setting ◽

Management Service ◽

Acute Pain Management ◽

Service Monitoring ◽

Monitoring Quality

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Evaluation of the Impact of an Online Opioid Education Program for Acute Pain Management

Pain Medicine ◽

10.1093/pm/pny300 ◽

2019 ◽

Vol 21 (1) ◽

pp. 55-60 ◽

Cited By ~ 1

Author(s):

Dale J Langford ◽

Jacob B Gross ◽

Ardith Z Doorenbos ◽

David J Tauben ◽

John D Loeser ◽

...

Keyword(s):

Pain Management ◽

Online Education ◽

Acute Pain ◽

Monitoring Program ◽

Perceived Competence ◽

Learning Activity ◽

Clinical Practices ◽

Acute Pain Management ◽

Opioid Prescribing ◽

The Impact

Abstract Objective The University of Washington instituted a policy requiring all credentialed clinicians who prescribe opioids to complete a one-time education activity about safe and responsible opioid prescribing. A scenario-based, interactive online learning module was developed for opioid management of acute pain in hospitalized adults. This study examined the impact of the education module on learners’ knowledge, perceived competence, and use of guideline-adherent practices. Methods Clinicians who completed the education module participated in a voluntary de-identified online survey approximately six months after the learning activity. Survey questions were related to 1) the perception of improved knowledge; 2) impact on learner’s use of three guideline-adherent practices; and 3) perceived competence in managing opioids for acute pain. Descriptive statistics were generated, and multiple linear regression models were used for analysis. Results Clinicians (N = 167) reported improvement in knowledge and perceived competence. Controlling for other aspects of knowledge evaluated, learning to construct a safe opioid taper plan for acute pain, distinguishing between short- and long-acting opioids, and safely initiating opioids for acute pain were significantly associated with increased self-reported likelihood of incorporating the Washington state Prescription Monitoring Program (P = 0.003), using multimodal analgesia (P = 0.022), and reducing the duration of opioids prescribed (P = 0.016). Only improvement in knowledge of how to construct a safe opioid taper plan was significantly associated with increased perceived competence (P = 0.002). Conclusions Our findings suggest that this online education module about safe opioid prescribing for acute pain management was effective at improving knowledge, increasing the likelihood of using guideline-adherent clinical practices, and increasing perceived competence.

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Acute pain in haematological disorders

10.1093/med/9780199234721.003.0014 ◽

2011 ◽

Author(s):

Ali Mofeez ◽

Upal Hossain

Keyword(s):

Pain Management ◽

Acute Pain ◽

Specific Treatment ◽

Opioid Therapy ◽

Acute Pain Management ◽

Haematological Patients ◽

Strong Opioids ◽

Multidisciplinary Pain Management

The use of painkillers ranging from simple analgesics to strong opioids is a common feature in the acute pain management of haematological conditions. However, each disease also has its own specific aetiological factors for pain, requiring specific treatment. Haematological patients with chronic pain on long-term opioid therapy may require multidisciplinary pain management to improve quality of life and prevent chronic escalation of opioid doses. Intramuscular injections should be avoided in all patients. The use of pethidine (meperidine) is not recommended.

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