Barriers to Optimal Pain Management in the General Surgery Population

2018 ◽  
Author(s):  
Anand C. Thakur
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
Pain Perception ◽  
Evidence Based ◽  
Multimodal Approach ◽  
Short List ◽  
Acute Pain Management ◽  
Physiological Factors ◽  
Physician Knowledge ◽  
Perception Management

Barriers to the implementation of adequate pain control are multifactorial and encompass all caregivers. A complete list of barriers to adequate pain control would involve biopsychosocial factors, physiological factors, pharmacological concerns, and medical legal concerns. A short list of barriers to adequate pain control can be separated into physician knowledge, expectations and perceptions, nurses’ and other ancillary providers’ knowledge, expectations and perceptions, patient expectations and perception, management of acute pain, management of chronic pain, discrepancies of pain perception and different population groups, and both regulatory and formulary issues. To have an understanding of up-to-date recommendations and standards regarding evidence-based pain management requires a multimodal approach with a team of physicians.

scholarly journals A Pain Control Optimization Pathway to Reduce Acute Postoperative Pain and Opioid Consumption Postoperatively: An Approach to Battling the Opioid Epidemic

2020 ◽  
Author(s):  
◽  
Holly Franson
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Control ◽  
Opioid Consumption ◽  
Care Process ◽  
Management Technique ◽  
Evidence Based ◽  
Post Intervention ◽  
Acute Pain Management ◽  
Control Optimization

Practice Problem: Healthcare providers worldwide are working to battle the opioid epidemic and reduce opioid-related harm to patients. Utilizing evidence-based acute pain management methods to reduce opioid consumption is critical to combat the problem. PICOT: The PICOT question that guided this project was: In opioid-naïve adult patients undergoing general anesthesia for out-patient, minimally invasive abdominal wall hernia surgery, how does the implementation of an evidence-based, preventative Pain Control Optimization Pathway (POP) using a multimodal, opioid-sparing acute pain management technique and standardized procedure-specific opioid prescribing, compared to standard treatment, affect postoperative pain scores and opioid consumption, upon discharge from the recovery room and 72 hours postoperative? Evidence: Evidence supported utilizing a multimodal, opioid-sparing acute pain management technique, patient counseling, and opioid prescribing guidelines to improve outcomes among opioid-naïve patients undergoing abdominal surgeries. Intervention: In this pre- and post-intervention evaluation, N = 28 patients received the POP care process during the perioperative period. Outcome: Results showed the mean pain score at discharge from the recovery room decreased from 4.8 to 2.82 on the 10-point Numeric Rating Scale post-intervention (p< 0.001). Also, provider compliance with prescribing a procedure-specific opioid prescription increased from 73% to 100%, thus reducing opioid exposure and access. Conclusion: This project provided evidence that utilization of the innovative POP care process provided optimal pain control and decreased opioid consumption, consequently reducing the risk of new persistent opioid use.

Craniotomy

2019 ◽  
pp. 221-245
Author(s):  
Roxana Grasu ◽  
Sally Raty
Keyword(s):  
Risk Factors ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Pain Control ◽  
Sensory Nerves ◽  
Current Evidence ◽  
Multimodal Approach ◽  
Perivascular Nerves ◽  
Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

Acute pain management in morbid obesity – an evidence based clinical update

2017 ◽  
Vol 13 (3) ◽  
pp. 523-532 ◽  
Author(s):  
Adele Sandra Budiansky ◽  
Michael P Margarson ◽  
Naveen Eipe
Keyword(s):  
Morbid Obesity ◽  
Pain Management ◽  
Acute Pain ◽  
Evidence Based ◽  
Acute Pain Management

scholarly journals Non-Allopathic Interventions for the Management of Acute and Chronic Pain: A Brief Review

2020 ◽  
Vol 25 (2) ◽  
Author(s):  
Linda Cole
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Control ◽  
Nursing Practice ◽  
Healthcare Providers ◽  
Allopathic Medicine ◽  
Management Approach ◽  
Historical Overview ◽  
Multimodal Approach ◽  
Effective Interventions

With increased regulation and scrutiny, healthcare providers may be reluctant to prescribe medications, especially opioids, for patients with pain, and particularly chronic pain. However, nurses, as the frontline resource for patients, must advocate for effective interventions to address pain. Sound knowledge of non-allopathic approaches (including non-conventional, complementary, alternative, and integrative strategies) for acute, chronic, and cancer-related pain control supports a holistic pain management approach for patient care. In this article I discuss the clinical relevance of pain management and provide an historical overview of non-allopathic medicine. The discussion considers the five domains of non-allopathic medicine along with negative aspects associated with these interventions and the need for a multimodal approach. The article conclusion offers implications for nursing practice that include resources for non-allopathic pain management for both providers and patients.

Postoperative Management and Radiography

2015 ◽  
Author(s):  
John Goodfellow ◽  
John O'Connor ◽  
Hemant Pandit ◽  
Christopher Dodd ◽  
David Murray
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Pain Control ◽  
Postoperative Management ◽  
Early Postoperative Period ◽  
Multimodal Approach ◽  
Invasive Approach ◽  
Opiate Use ◽  
Total Knee ◽  
Good Pain Control

In the early postoperative period, good pain control is essential. Regimes of pain management appropriate for total knee arthroplasty may not be suited to the very rapid mobilisation that is possible after UKA through a minimally invasive approach. A multimodal approach is best with minimal opiate use. Different regimes are used successfully in different institutions.

scholarly journals Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults

2017 ◽  
Vol 40 (12) ◽  
pp. 1749-1764 ◽  
Author(s):  
Clayton J. Shuman ◽  
Xian-Jin Xie ◽  
Keela A. Herr ◽  
Marita G. Titler
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Pain Intensity ◽  
Acute Pain ◽  
Management Practices ◽  
Cluster Randomized Trial ◽  
Evidence Based ◽  
Acute Pain Management ◽  
Factors Affecting ◽  
Hospitalized Older Adults

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

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