International survey: real-world pain management strategies

Abstract Background Pain is a nearly universal experience, but little is known about how people treat pain. This international survey assessed real-world pain management strategies. Methods From 13-31 January, 2020, an online survey funded by GSK Consumer Healthcare was conducted in local languages in Australia, Brazil, Canada, China, Colombia, France, Germany, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Poland, Russia, Spain, Sweden, UK, and USA. Adults were recruited from online panels of people who agreed to participate in surveys. Quotas ensured nationally representative online populations based on age, gender, and region. Results Of 19,000 people (1000/country) who completed the survey, 18,602 (98%) had ever experienced physical pain; 76% said they would like to control their pain better. Presented with 17 pain-management strategies and asked to select the ones they use in the order of use, respondents chose an average of 4 strategies each. The most commonly selected strategies were pain medication (65%), rest/sleep (54%), consult a doctor (31%), physical therapy (31%), and nonpharmacologic action (eg, heat/cold application; 29%). Of those who use pain medication, 56% take some other action first. Only 36% of those who treat pain do so immediately; 56% first wait to see if it will resolve spontaneously. Top reasons for waiting include a desire to avoid medication (37%); willingness to tolerate less severe pain (33%); concerns about side effects (21%) or dependency (21%); and wanting to avoid a doctor's visit unless pain is severe or persistent (21%). Nearly half (42%) of those who take action to control pain have visited ≥1 healthcare professional (doctor 31%; pharmacist 18%; other 17%) about pain. Conclusions This large global survey shows that people employ a range of strategies to manage pain but still wish for better pain control. Although pain medication is the most commonly used strategy, many people postpone or avoid its use. Key messages More than three-quarters (76%) of respondents across countries seek better pain control. Pain medication and rest/sleep consultation are the most common pain management strategies. More than half of respondents (56%) wait to see if pain will resolve spontaneously before taking any action, and 56% of those who use pain medication try some other approach first.

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Pain management practice patterns after hip arthroscopy: an international survey

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa050 ◽

2020 ◽

Author(s):

Flávio L Garcia ◽

Brady T Williams ◽

Bhargavi Maheshwer ◽

Asheesh Bedi ◽

Ivan H Wong ◽

...

Keyword(s):

Pain Management ◽

Hip Arthroscopy ◽

Pain Control ◽

Sports Medicine ◽

Management Practice ◽

Professional Organizations ◽

International Survey ◽

Nerve Blocks ◽

Optimal Approach ◽

Answer Choice

Abstract Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy. It was hypothesized that a lack of agreement would be present in the majority of the surgeons’ responses. A 25-question multiple-choice survey was designed and distributed to members of multiple orthopedic professional organizations related to sports medicine and hip arthroscopy. Clinical agreement was defined as > 80% of respondents selecting a single answer choice, while general agreement was defined as >60% of a given answer choice. Two hundred and fifteen surgeons completed the survey. Clinical agreement was only evident in the use of oral non-steroidal anti-inflammatory drugs (NSAIDs) for pain management after hip arthroscopy. A significant number of respondents (15.8%) had to readmit a patient to the hospital for pain control in the first 30 days after hip arthroscopy in the past year. There is significant variability in pain management practice after hip arthroscopy. The use of oral NSAIDs in the post-operative period was the only practice that reached a clinical agreement. As the field of hip preservation surgery continues to evolve and expand rapidly, further research on pain management after hip arthroscopy is clearly needed to establish evidence-based guidelines and improve clinical practice.

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Effecting Superior Pain Management Strategies by Combining Technology With Tradition

Chronic Illness and Long-Term Care ◽

10.4018/978-1-5225-7122-3.ch031 ◽

2019 ◽

pp. 631-641

Author(s):

CK Foo

Keyword(s):

Pain Management ◽

Management Strategies ◽

Psychosocial Interventions ◽

Modern Medicine ◽

Modern Technology ◽

Significant Rise ◽

The Public ◽

Physical Disorders ◽

Control Pain ◽

Traditional Approaches

Today we are witnessing a significant rise in chronic diseases and chronic pain. Modern medicine appears not to be sufficient to relieve symptoms and reduce or eliminate discomfort. The following proffers the need to look at alternate strategies. In particular, it suggests that a solution might lie if we combine modern technology with ancient wisdom and traditional approaches. This chapter serves to highlight strategies for prudent pain management. “Pain is not just from physical disorders but also from combinations of physiological, pathological, emotional, psychological, cognitive, environmental, and social factors. The keys to successful pain control are the mechanisms that initiate and maintain pain.” “Now, the public and health professionals expect to control pain by using preventive and active strategies, including drugs and physical and psychosocial interventions.” (Holdcroft & Power, 2003).

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No Access and Still in Pain

Pediatric Palliative Care ◽

10.1093/med/9780190051853.003.0016 ◽

2020 ◽

pp. 101-108

Author(s):

Lindsay B. Ragsdale

Keyword(s):

Gastrointestinal Tract ◽

Pain Control ◽

Medication Administration ◽

Pain Medication ◽

Intravenous Access ◽

Skin Integrity ◽

Dosing Strategies ◽

Integrative Therapies ◽

Control Pain ◽

Selection Of

Pain management for children can be intimidating for providers unfamiliar with pediatric practice. Finding the correct dose can involve weight-based dosing and calculations of suspensions, which are overall more involved than adult dosing strategies. When there is a lack of intravenous access or the inability to use the gastrointestinal tract, finding the correct route of pain medication for children can be challenging. However, following simple strategies can help find the best option for pain relief. The least invasive route of medication administration should be selected first, and nonpharmacologic strategies should be layered in to enhance pain control. Pain should be assessed regularly, and therapy should be escalated when indicated. The pain medication should be matched with the type of pain and anticipated duration of painful stimulus. Skin integrity, weight-based dosing limitations, and prognosis should be considered in the selection of agents. Comfort position, supportive caregiver, and distraction and integrative therapies depending on age should be integrated into any treatment regimen.

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Interventional Therapies for Cancer Pain Management: Important Adjuvants to Systemic Analgesics

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2007.0075 ◽

2007 ◽

Vol 5 (8) ◽

pp. 851-858 ◽

Cited By ~ 12

Author(s):

Anthony Eidelman ◽

Traci White ◽

Robert A. Swarm

Keyword(s):

Pain Management ◽

Adverse Effects ◽

Cancer Pain ◽

Pain Control ◽

Analgesic Efficacy ◽

Cancer Pain Management ◽

Patients With Cancer ◽

Inflammatory Drugs ◽

Control Pain ◽

Interventional Therapies

Optimized use of systemic analgesics fails to adequately control pain in some patients with cancer. Commonly used analgesics, including opioids, nonopioids (acetaminophen and non-steroidal anti-inflammatory drugs), and adjuvant analgesics (anticonvulsants and antidepressants), have limited analgesic efficacy, and their use is often associated with adverse effects. Without adequate pain control, patients with cancer not only experience the anguish of poorly controlled pain but also have greatly diminished quality of life and may even have reduced life expectancy. Interventional pain therapies are a diverse set of procedural techniques for controlling pain that may be useful when systemic analgesics fail to provide adequate control of cancer pain or when the adverse effects of systemic analgesics cannot be managed reasonably. Commonly used interventional therapies for cancer pain include neurolytic neural blockade, spinal administration of analgesics, and vertebroplasty. Compared with systemic analgesics, which generally have broad indications for control of pain, individual interventional therapies generally have specific, narrow indications. When appropriately selected and implemented, interventional pain therapies are important components of broad, multimodal cancer pain management that significantly increases the proportion of patients able to experience adequate pain control.

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Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00006 ◽

2019 ◽

Vol 4 (2) ◽

pp. 2473011419S0000

Author(s):

Laura E. Sokil ◽

Elizabeth McDonald ◽

Ryan G. Rogero ◽

Daniel J. Fuchs ◽

Steven M. Raikin ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Control ◽

Pain Threshold ◽

Postoperative Pain Management ◽

Pain Medication ◽

Pain Tolerance ◽

Foot And Ankle ◽

Ankle Surgery ◽

Perceived Pain

Category: Pain Management Introduction/Purpose: The opioid epidemic in the United States continues to take lives. As one of the top prescribing groups, orthopaedic surgeons must tailor post-surgical pain control to minimize the potential for harm from prescription opioid use. Patients often reference their own pain threshold as a benchmark for how they will tolerate the pain of surgery, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual threshold for heat stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self- reported pain tolerance and their actual prescription narcotic medication usage after foot and ankle surgery. Methods: This was a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a large, multispecialty orthopaedic practice over a one year period. Demographic data, procedural details and anesthesia type were collected. Narcotic usage data including number of pills dispensed and pill counts performed at the first postoperative visit were obtained. Patients were contacted via email or telephone between 7-19 months postoperatively, and asked to respond to the validated statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients scored their pain threshold on a scale of 1- 100 with 0 being “pain intolerant” and 100 a ”high pain threshold" and ranked their expectations of the pain after surgery and satisfaction with pain management on respective five-point Likert scales. Data was analyzed using a Spearman’s correlation. Results: Of the 486 patients who completed surveys, average age was 51.24 years, 32.1% were male and 7.82% current smokers. After controlling for age and anesthesia type, both agreement with the validated statement and higher pain tolerance score had a weak negative correlation with pills taken (r=-0.13, p=0.004 and r=-0.14, p=0.002, respectively); patients with higher perceived pain thresholds took fewer opioid pills after surgery (Table 1). Correlation between high expectations of postoperative pain and pills taken was weakly negative (r=-0.28, p=<0.001) (Table 1). Patients who found surgery more painful than they expected took less pain medication. There was a small, positive correlation between pain tolerance and satisfaction with pain management (r=0.12, p=0.008), indicating that patients with a relatively high pain tolerance had more satisfaction (Table 1). Conclusion: Assessment of both subjective description and quantitative score of a patient’s pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control regimens. Unexpectedly, patients who found surgery less painful than expected actually took a greater number of opioid pills. This may highlight an educational opportunity regarding postoperative pain management in order to reduce narcotic requirement. Setting expectations on safe utilization of prescribed pain medications may also increase satisfaction. This study provides useful information for surgeons to customize pain management regimens and to perform effective preoperative education and counseling regarding postoperative pain management. [Table: see text]

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Procedural Sedation and Pain Management

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0048 ◽

2020 ◽

pp. 588-602

Author(s):

Rosalia Holzman ◽

Jennifer Mitzman

Keyword(s):

Pain Management ◽

Pain Control ◽

Procedural Sedation ◽

Nerve Blocks ◽

Administration Routes ◽

Wide Range ◽

Age Appropriate ◽

Control Pain ◽

And Control ◽

Pharmacologic Agents

There are many conditions in the emergency department that require pain management or procedural sedation due to significant pain or complexity. There are also a number of procedures and conditions that will require pain control or anxiolysis in children due to developmental and behavioral factors. Pain control and procedural sedation in pediatric patients can be challenging. A variety of pharmacologic agents can be utilized to minimize anxiety and control pain. These have a wide range of administration routes, including topical, oral, intravenous, intramuscular, intranasal, and regional pain control via nerve blocks. In addition, many non-pharmacologic adjuncts can be coupled with age-appropriate interaction tips to decrease the medications required. This chapter discusses pharmacologic intervention, including narcotic and non-narcotic medications, non-pharmacologic interventions, procedural sedation, and nerve blocks.

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Effecting Superior Pain Management Strategies by Combining Technology with Tradition

Handbook of Research on Healthcare Administration and Management - Advances in Healthcare Information Systems and Administration ◽

10.4018/978-1-5225-0920-2.ch023 ◽

2017 ◽

pp. 407-417

Author(s):

CK Foo

Keyword(s):

Pain Management ◽

Management Strategies ◽

Psychosocial Interventions ◽

Modern Medicine ◽

Modern Technology ◽

Significant Rise ◽

The Public ◽

Physical Disorders ◽

Control Pain ◽

Traditional Approaches

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

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.017 ◽

2017 ◽

Vol 17 (1) ◽

pp. 378-381 ◽

Cited By ~ 1

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.

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65 Pain Management Practices in the Elderly Patient with Burn Injury

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.069 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S46-S47

Author(s):

Ciara Hutchison ◽

Rita Gayed ◽

Rohit Mittal

Keyword(s):

Pain Management ◽

Pain Control ◽

Management Practices ◽

Burn Injury ◽

Management Strategies ◽

Total Body Surface Area ◽

Operative Therapy ◽

The Elderly ◽

Burn Patients ◽

Opioid Use

Abstract Introduction Opioids are key to pain management in burns but have increased side effects like falls and delirium in the elderly. However, comorbidities prevalent in this population (e.g., chronic kidney disease) limit use of non-opioid adjuncts, making pain control for these patients a difficult balance. Little data exists regarding pain control practices in elderly burn patients. We aim to retrospectively characterize pain management strategies (including opioids and non-opioid adjuncts) in this patient population. Methods This is a retrospective cohort of patients age >65 with burns < 20% total body surface area (TBSA) admitted to the burn stepdown unit from 2014 to 2019. The primary outcome was to quantify opioid use inpatient and at discharge in morphine milligram equivalents (MME). Secondary outcomes included percent of patients receiving opioids and adjunct analgesics at these timepoints. Mean MME inpatient vs. at discharge were compared using paired t-test. Percent of patients receiving opioids and non-opioid adjuncts were compared using McNemar’s test. Results One hundred elderly patients (mean age 73.9, SD 6.7) with mean TBSA of 5.6% (SD 4.5) were included. Fifty-two percent required autografting; the remainder received porcine or non-operative therapy. Mean daily inpatient MME was 18.0 (SD 20.8) and mean discharge MME was 28.0 (SD 20.5) (p=.001), equivalent to 12mg and 18.5mg of oral oxycodone. Inpatient, 72% of patients received opioids vs. 83% at discharge (p=.041). Acetaminophen was the most commonly prescribed non-opioid adjunct inpatient and at discharge; other adjuncts like non-steroidal anti-inflammatories (NSAIDs) and gabanoids were infrequently used. Conclusions Elderly burn patients are discharged with more opioids than utilized while inpatient. Aside from acetaminophen, non-opioid adjuncts used commonly in younger patients such as NSAIDs and gabanoid medications are under-utilized, presumably due to concern for comorbidities.

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EXPRESS: Pediatric Subcutaneous Treprostinil Site Maintenance and Pain Control Strategies from the Pediatric Pulmonary Hypertension Network (PPHNet)

Pulmonary Circulation ◽

10.1177/2045894021994450 ◽

2021 ◽

pp. 204589402199445

Author(s):

Emma Olson Jackson ◽

Anna Brown ◽

Julia McSweeney ◽

Claire Parker

Keyword(s):

Pulmonary Hypertension ◽

Pain Management ◽

Pain Control ◽

Control Strategies ◽

Management Strategies ◽

Venous Catheter ◽

Perceived Effectiveness ◽

Central Venous ◽

Life Threatening ◽

Pulmonary Arterial

Pulmonary arterial hypertension (PAH) is a chronic, progressive and life-threatening disease in children with diverse causes of PAH. The most severe cases of PAH require aggressive treatments with systemic administration of continuous prostacyclin therapy, including treprostinil and epoprostenol. The successful use of continuous subcutaneous (SubQ) treprostinil therapy eliminates the need for an indwelling central venous catheter and its associated risks. However, pain at the SubQ infusion site, an expected side effect of this therapy, is often a deterrent to its widespread use. Effective SubQ treprostinil site maintenance and pain management is essential to achieve success with this therapy, but strategies surrounding site maintenance and pain control vary significantly between pediatric pulmonary hypertension (PH) treatment centers. In an attempt to standardize practice, a survey on the use of SubQ treprostinil and site maintenance and pain management strategies, as well as its perceived effectiveness, was disseminated to 13 pediatric PH centers of the Pediatric Pulmonary Hypertension Network (PPHNet). Responses to the survey were collected and analyzed and were developed into a set of formalized strategies to facilitate knowledge sharing and standardization of practice.

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