The importance of nonspecific factors in pain management: Lessons learned from open versus hidden medical treatments.

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

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Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from the impacts of the COVID‐19 pandemic on pain management care

PM&R ◽

10.1002/pmrj.12615 ◽

2021 ◽

Vol 13 (6) ◽

pp. 579-588

Author(s):

Ameet S. Nagpal ◽

Ai Mukai ◽

Saloni Sharma

Keyword(s):

Health Care ◽

Pain Management ◽

Vital Role ◽

Lessons Learned ◽

Care Continuum

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Use of the Pain Assessment Screening Tool and Outcomes Registry in an Army Interdisciplinary Pain Management Center, Lessons Learned and Future Implications of a 10-Month Beta Test

Military Medicine ◽

10.7205/milmed-d-16-00212 ◽

2017 ◽

Vol 182 (S1) ◽

pp. 167-174 ◽

Cited By ~ 2

Author(s):

Diane M. Flynn ◽

Karon Cook ◽

Michael Kallen ◽

Chester Buckenmaier ◽

Ricke Weickum ◽

...

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Screening Tool ◽

Lessons Learned ◽

Interdisciplinary Pain Management ◽

Beta Test

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004 Lessons learned from pain management research in dairy cattle

Journal of Animal Science ◽

10.2527/asasmw.2017.004 ◽

2017 ◽

Vol 95 (suppl_2) ◽

pp. 2-2

Author(s):

T. F. Duffield

Keyword(s):

Pain Management ◽

Dairy Cattle ◽

Lessons Learned ◽

Management Research

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Strategy for addressing research-site overlap in pragmatic clinical trials: lessons learned from the NIH-DOD-VA Pain Management Collaboratory (PMC)

Trials ◽

10.1186/s13063-020-04941-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Mary Geda ◽

◽

Steven Z. George ◽

Diana J. Burgess ◽

Dylan V. Scarton ◽

...

Keyword(s):

Clinical Trials ◽

Pain Management ◽

Research Effort ◽

Health Care Systems ◽

Lessons Learned ◽

Exclusion Criteria ◽

Eligibility Criteria ◽

Recruitment Methods ◽

Research Site ◽

Pragmatic Clinical Trials

Abstract Background The Pain Management Collaboratory (PMC) is a multi-site network of pragmatic clinical trials (PCTs) focused on nonpharmacological approaches to pain management, conducted in health care systems of the US Department of Defense (DoD) and Department of Veterans Affairs (VA) and co-funded by the National Institutes of Health (NIH). Concerns about potential research-site overlap prompted the PMC investigator community to consider strategies to avert this problem that could negatively affect recruitment and contaminate interventions and thus pose a threat to trial integrity. Methods We developed a two-step strategy to identify and remediate research-site overlap by obtaining detailed recruitment plans across all PMC PCTs that addressed eligibility criteria, recruitment methods, trial settings, and timeframes. The first, information-gathering phase consisted of a 2-month period for data collection from PIs, stakeholders, and ClinicalTrials.gov. The second, remediation phase consisted of a series of moderated conference calls over a 1-month time period to develop plans to address overlap. Remediation efforts focused on exclusion criteria and recruitment strategies, and they involved collaboration with sponsors and stakeholder groups such as the Military Treatment Facility Engagement Committee (MTFEC). The MTFEC is comprised of collaborating DoD and university-affiliated PIs, clinicians, and educators devoted to facilitating successful pragmatic trials in DoD settings. Results Of 61 recruitment sites for the 11 PMC PCTs, 17 (28%) overlapped. Four PCTs had five overlapping Military Treatment Facilities (MTFs), and eight PCTs had 12 overlapping VA Medical Centers (VAMCs). We developed three general strategies to avoid research-site overlap: (i) modify exclusion criteria, (ii) coordinate recruitment efforts, and/or (iii) replace or avoid any overlapping sites. Potential overlap from competing studies outside of the PMC was apparent at 26 sites, but we were not able to confirm them as true conflicts. Conclusion Proactive strategies can be used to resolve the issue of overlapping research sites in the PMC. These strategies, combined with open and impartial mediation approaches that include researchers, sponsors, and stakeholders, provide lessons learned from this large and complex pragmatic research effort.

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Translation of policy and guidelines into practice: lessons learned from implementation of the Cancer Pain Management Guideline

Journal of Hospital Management and Health Policy ◽

10.21037/jhmhp.2020.02.01 ◽

2020 ◽

Vol 4 ◽

pp. 12-12

Author(s):

Miran Kim ◽

Sarah Jeong ◽

Margaret McMillan ◽

Isabel Higgins

Keyword(s):

Pain Management ◽

Cancer Pain ◽

Lessons Learned ◽

Cancer Pain Management ◽

Management Guideline

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Five lessons learned about long-term pain management in adults with sickle cell disease

Hematology ◽

10.1182/asheducation-2017.1.406 ◽

2017 ◽

Vol 2017 (1) ◽

pp. 406-411 ◽

Cited By ~ 4

Author(s):

Joshua J. Field

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Lessons Learned ◽

Cell Disease ◽

Prescribing Practices ◽

Blood Institute ◽

Pain Syndromes ◽

National Heart Lung

AbstractChronic pain affects one-half of adults with sickle cell disease (SCD). Despite the prevalence of chronic pain, few studies have been performed to determine the best practices for this patient population. Although the pathophysiology of chronic pain in SCD may be different from other chronic pain syndromes, many of the guidelines outlined in the pain literature and elsewhere are applicable; some were consensus-adopted in the 2014 National Heart, Lung, and Blood Institute SCD Guidelines. Recommended practices, such as controlled substance agreements and monitoring of urine, may seem unnecessary or counterproductive to hematologists. After all, SCD is a severe pain disorder with a clear indication for opioids, and mistrust is already a major issue. The problem, however, is not with a particular disease but with the medicines, leading many US states to pass broad legislation in attempts to curb opioid misuse. These regulations and other key tenets of chronic pain management are not meant to deprive adults with SCD of appropriate therapies, and their implementation into hematology clinics should not affect patient-provider relationships. They simply encourage prudent prescribing practices and discourage misuse, and should be seen as an opportunity to more effectively manage our patient’s pain in the safest manner possible. In line with guideline recommendations as well as newer legislation, we present five lessons learned. These lessons form the basis for our model to manage chronic pain in adults with SCD.

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Improving pediatric experience of pain during vaccinations: a quality improvement project

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-07-2018-0185 ◽

2019 ◽

Vol 32 (6) ◽

pp. 1034-1040

Author(s):

Terri MacDougall ◽

Shawna Cunningham ◽

Leeann Whitney ◽

Monakshi Sawhney

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Pain Management ◽

Practice Guidelines ◽

Pediatric Population ◽

Lessons Learned ◽

Pediatric Pain ◽

Topical Anesthetic ◽

Content Type ◽

Pain Scores

Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

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