scholarly journals Exploring patient experiences of a pain management centre: A qualitative study

2017 ◽  
Vol 17 (1) ◽  
pp. 378-381 ◽  
Author(s):  
Manasi M. Mittinty ◽  
John Lee ◽  
Amanda C. de C. Williams ◽  
Natasha Curran
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Control ◽  
Waiting Times ◽  
Management Strategies ◽  
Clinical Team ◽  
Large Hospital ◽  
Personalized Care ◽  
Chronic Pain Patients ◽  
Pain Patients

AbstractBackground and aimsTo improve care and management of patients with chronic pain it is important to understand patients’ experiences of treatment, and of the people and the environment involved. As chronic pain patients often have long relationships with medical clinics and pain management centres, the team and team interactions with the patients could impact the treatment outcome. The aim of this study was to elicit as honest as possible an account of chronic pain patients’ experiences associated with their care and feed this information back to the clinical team as motivation for improvement.MethodsThe research was conducted at a large hospital-based pain management centre. One hundred consecutive patients aged 18 years and above, who had visited the centre at least once before, were invited to participate. Seventy patients agreed and were asked to write a letter, as if to a friend, describing the centre. On completion of the study, all letters were transcribed into NVivo software and a thematic analysis performed.ResultsSix key themes were identified: (i) staff attitude and behaviour; (ii) interactions with the physician; (iii) importance of a dedicated pain management centre; (iv) personalized care; (v) benefits beyond pain control; (vi) recommending the pain management centre.ConclusionThe findings suggest that the main reasons that patients recommended the centre were: (i) support and validation provided by the staff; (ii) provision of detailed information about the treatment choices available; (iii) personalized management plan and strategies to improve overall quality of life alongside pain control. None of the letters criticized the care provided, but eight of seventy reported long waiting times for the first appointment as a problem.ImplicationsPatient views are central to improving care. However, satisfaction questionnaires or checklists can be intimidating, and restrictive in their content, not allowing patients to offer spontaneous feedback. We used a novel approach of writing a letter to a friend, which encouraged reporting of uncensored views. The results of the study have encouraged the clinical team to pursue their patient management strategies and work to reduce the waiting time for a first appointment.

scholarly journals Clinical Challenges and Considerations in Management of Chronic Pain Patients During a COVID-19 Pandemic

2020 ◽  
Vol 49 (9) ◽  
pp. 669-673
Author(s):  
Diana XH Chan ◽  
Xu Feng Lin ◽  
Jane Mary George ◽  
Christopher W Liu
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Practices ◽  
Management Strategies ◽  
Chronic Pain Patient ◽  
Control Measures ◽  
Pain Patient ◽  
Chronic Pain Patients ◽  
Pain Patients

Since the coronavirus disease 2019 (COVID-19) was deemed a pandemic on 11 March 2020, we have seen exponential increases in the number of cases and deaths worldwide. The rapidly evolving COVID-19 situation requires revisions to clinical practice to defer non-essential clinical services to allocate scarce medical resources to the care of the COVID-19 patient and reduce risk to healthcare workers. Chronic pain patients require long-term multidisciplinary management even during a pandemic. Fear of abandonment, anxiety and depression may increase during this period of social isolation and aggravate pain conditions.Whilst physical consults for chronic pain patients were reduced, considerations including continuity of support and analgesia, telemedicine, allied health support and prioritising necessary pain services and interventions, were also taken to ensure biopsychosocial care for them. Chronic pain patients are mostly elderly with multiple comorbidities, and are more susceptible to morbidity and mortality from COVID-19. It is imperative to review pain management practices during the COVID-19 era with respect to infection control measures, re-allocation of healthcare resources, community collaborations, and analgesic use and pain interventions. The chronic pain patient faces a potential risk of functional and emotional decline during a pandemic, increasing healthcare burden in the long term. Clinical decisions on pain management strategies should be based on balancing the risks and benefits to the individual patient. In this commentary, we aim to discuss the basis behind some of the decisions and safeguards that were made at our tertiary pain centre over the last 6 months during the COVID-19 outbreak.

CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3199-3204 ◽  
Author(s):  
Chrysanthi Batistaki ◽  
Eleni Chrona ◽  
Andreas Kostroglou ◽  
Georgia Kostopanagiotou ◽  
Maria Gazouli
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cyp2d6 Genotype ◽  
Chronic Pain Patients ◽  
Reduction Of Pain ◽  
Pain Patients ◽  
Numeric Rating

Abstract Objective To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. Design Prospective cohort study. Setting General hospital, pain management unit. Subjects Patients with chronic pain, treated with codeine or tramadol. Methods Patients’ pain was assessed at baseline (numeric rating scale [NRS]; 0–10). Prescription of codeine or tramadol was selected randomly. The assessment of patients’ response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients’ blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). Results Seventy-six consecutive patients were studied (20 males, 56 females), aged 21–85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). Conclusions Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

scholarly journals Triaging Interventional Pain Procedures During COVID-19 or Related Elective Surgery Restrictions: Evidence-Informed Guidance from the American Society of Interventional Pain Physicians (ASIPP)

2020 ◽  
Vol 4S;23 (8;4S) ◽  
pp. E183-S204
Author(s):  
Christopher Gharibo
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Surgical Procedures ◽  
Task Force ◽  
Elective Surgery ◽  
Interventional Techniques ◽  
Elective Surgical Procedures ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Pain Patients

Background: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of “elective” interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures. Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. Objectives: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. Methods: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. Results: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included emergent, urgent, and elective procedures. Examples of emergent and urgent procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, urgent procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. Limitations: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. Conclusion: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus. Key words: Coronavirus, COVID-19, interventional pain management, COVID risk factors, elective surgeries, interventional techniques, chronic pain, immunosuppression

Characterization of complex chronic pain patients

2015 ◽  
Vol 8 (1) ◽  
pp. 49-50
Author(s):  
E.-B. Hysing ◽  
T. Gordh ◽  
R. Karlsten ◽  
L. Smith
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Intensity ◽  
Ordinal Scale ◽  
Ethical Review ◽  
Pain Patient ◽  
High Dose ◽  
Severe Problem ◽  
Chronic Pain Patients ◽  
Pain Patients

AbstractAimsTreatment of the most complex chronic pain patients, often not accepted in regular pain management programs, remains a challenge.To beable todesign interventions for these patients we must know what characterize them. The aim of this study was to characterize a subgroup of pain patients, treated in our in-patient rehabilitation programme, organized at the University Hospital in Uppsala, the only tertiary treatment for pain patients in Sweden.MethodsThe study was approved by the Regional Ethical Review Board in Uppsala (Dnr 2010/182). Seventy-two patients, consecutive new referrals seen at the rehabilitation program in 2008–2010 were enrolled and examined with a 41-item questionnaire of symptoms other than pain. The 41 symptoms were listed on an ordinal scale from 0–10, with 0–no problems and 10–severe problem. The mean pain intensity within the preceding 24-h was assessed using an 11-point NRS, numeric rating scale from 0–no problems to 10–severe problems. Information about drug-consumption was obtained from the medical record. The opioid medication was translated to morphine-equivalents dos using EAPC (European Association for Palliative Care) conversion table.ResultsSeventy-two patients were enrolled and screened, 39% men and 61% woman. Median age 45 years (range 20–70). Seventy-four percent of patients were treated with opioids, 15 patients with more than one opioid. They all reported high pain intensity, the four patients with doses over 150 mg MEq reported pain 5–8. There was no correlation between the dose of opioids and pain intensity. The patients reported 22 symptoms (median) other than pain. The number of symptoms reported using this scaleina normal population is three–four. The most common symptoms reported were lethargy, tiredness, concentration difficulties and headache reported by over 80%. Sleeping disorders and tiredness were considered as the two most problematic symptom to deal with. We found no correlation between the degree of pain and presence and severity of symptoms reported. Number of symptoms reported diminished when the dose of opioids increased.ConclusionsThe pain patient considered too complex for regular pain-management programs are characterized by reporting many symptoms other than pain. High pain intensity or high opioid-dose does not correlate to presence or severity of other symptoms, and high dose of opioids does not have a connection to low pain intensity. Many of the symptoms commonly reported – lethargy, tiredness, concentration difficulties and headache are real obstacles for successful rehabilitation, and have to be dealt with to achieve successful results.

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