Pain management

2019 ◽  
pp. 549-568
Author(s):  
John Curtin
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Rating Scales ◽  
Interdisciplinary Approach ◽  
Opioid Analgesics ◽  
Brief Pain Inventory ◽  
Assessment Tools ◽  
World Health ◽  
Numerical Rating ◽  
Strong Opioids

Pain is described as being whatever the experiencing person says it is, and their perception of pain is determined by their mood and morale and the meaning of the pain for them. Cancer pain is common, and prevalence is related to the stage of the illness: 59% in patients undergoing treatment, and 64% in those with advanced disease. Pain is multi-causal and multidimensional, and a holistic, interdisciplinary approach to assessment is necessary, encompassing physical, psychological, social, and spiritual aspects of pain (together are ‘total pain’). A narrative approach to pain assessment is helpful, keeping the focus on the patient and their experience. Pain assessment tools can also be used to identify where pain is and how much it hurts. These include: pain body map, visual analogue scales (VAS), verbal rating scales (VRS), numerical rating scales (NRS), and Brief Pain Inventory (BPI). Classifications of pain include acute and chronic pain, nociceptive pain caused by the stimulation of nerve endings, and neuropathic pain caused by nerve dysfunction or compression. Analgesic drugs may be given according to the World Health Organization's pain relief ladder: step 1, non-opioid analgesics such as paracetamol and non-steroidal anti-inflammatory drugs; step 2, mild opioids like codeine with or without non-opioid analgesics; and step 3, strong opioids like morphine with or without non-opioid analgesics. Non-pharmacological interventions for pain management include transcutaneous electrical nerve stimulation (TENS), massage, distraction, relaxation, breathing exercises, comfort measures, and presence of the nurse. Effective communication at all stages of management is essential.

scholarly journals Cancer pain assessment and management in ambulatory patients at a tertiary hospital in Ghana

2017 ◽  
Vol 4 (6) ◽  
pp. 1793
Author(s):  
Akua A. Abruquah ◽  
Robert P. Biney ◽  
Ernest B. Osei-Bonsu ◽  
Kofi M. Boamah ◽  
Eric Woode
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Cancer Pain ◽  
Pain Assessment ◽  
Brief Pain Inventory ◽  
Tertiary Hospital ◽  
Assessment Tools ◽  
Cancer Pain Management ◽  
Cross Sectional ◽  
Pain Medications

Background: Adequate cancer pain assessment using valid and reliable pain assessment tools is essential for effective cancer pain management. This study evaluated the common types, effectiveness as well as adherence to prescribed analgesics in oncology outpatients in a tertiary oncology centre in Ghana.Methods: This descriptive cross-sectional study involved 204 oncology outpatients with different confirmed cancer diagnosis attending clinic at the Oncology Directorate of a Tertiary Hospital in Ghana. The research instruments used were the medical folders of patients, a hospital-based electronic drug database system; hospital administration management systems (HAMS) and the Brief Pain Inventory Long-Form (BPI-LF).Results: More than half (63.7%) of the participants reported moderate pain, 37.8% received opioid analgesics: 31.4% strong opioids and 6.4% weak opioids. Less than one-fourth (21.6%) had complete pain relief and 18.1% felt they needed a stronger pain medication. A little more than one-fourth (28.4%) of participants took their pain medications 1-2 times per day. Almost half (45.6%) of participants did not experience side effects from taking pain medications and 27.9% needed more information about their pain medications.Conclusions: Enhancing effective cancer symptom management approaches in healthcare practitioners and incorporating existing knowledge and guidelines on cancer pain management into routine clinical practice should be done to enhance efficient pain relief. 

scholarly journals Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3056
Author(s):  
Ada Holak ◽  
Michał Czapla ◽  
Marzena Zielińska
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Pain Assessment ◽  
Rating Scales ◽  
Rating Scale ◽  
Low Frequency ◽  
Numeric Rating Scale ◽  
Health Concern ◽  
School Age Children ◽  
Medical Teams

Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

2021 ◽  
Vol 24 (1) ◽  
pp. 4-30
Author(s):  
Paulo V Steagall ◽  
Sheilah Robertson ◽  
Bradley Simon ◽  
Leon N Warne ◽  
Yael Shilo-Benjamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Multimodal Analgesia ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Assessment Tools ◽  
Mental Wellbeing ◽  
Team Approach ◽  
Analgesic Drugs

Practical relevance: Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer. Clinical challenges: Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management. Evidence base: These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors’ experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

Acute Pain Management

2018 ◽  
Author(s):  
Nihar Patel
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Treatment Options ◽  
Postoperative Pain Management ◽  
Assessment Tools ◽  
Age Appropriate ◽  
Short And Long Term ◽  
Inflammatory Drugs ◽  
Postoperative Setting

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Pain in children should be routinely and regularly assessed, documented, treated and reassessed with clear documentation. Poor pain management in the acute and postoperative setting can result in both short- and long-term consequences. The most effective analgesia plans are multimodal. This chapter focuses on the variety of treatment options for pain in the acute setting. Topics covered include age-appropriate pain assessment tools for children; the basics of age-appropriate pain management in children; as well as the role of opioids, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia in acute and postoperative pain management in children.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

scholarly journals Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

2022 ◽  
Vol 9 ◽  
pp. 237437352110496
Author(s):  
Jenni Hämäläinen ◽  
Tarja Kvist ◽  
Päivi Kankkunen
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numerical Rating ◽  
Emergency Department Patients ◽  
Pain At Rest ◽  
Patients Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

scholarly journals Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Kald Beshir Tuem ◽  
Leake Gebremeskel ◽  
Kibrom Hiluf ◽  
Kbrom Arko ◽  
Haftom Gebregergs Hailu
Keyword(s):  
Pain Management ◽  
Assessment Tool ◽  
Negative Impact ◽  
Short Form ◽  
Brief Pain Inventory ◽  
Cross Sectional Study ◽  
Self Report ◽  
Cross Sectional ◽  
Specialized Hospital ◽  
Strong Opioids

Background. Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers. Purpose. To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21. Result. Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18–45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients’ self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association. Conclusion. This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

Self-report: the primary source in assessment after infancy

2013 ◽  
pp. 370-378 ◽  
Author(s):  
Carl L. von Baeyer
Keyword(s):  
Pain Management ◽  
Rating Scales ◽  
Primary Source ◽  
Self Report ◽  
New Developments ◽  
Pain Scores ◽  
Self Reports ◽  
Numerical Rating ◽  
Source Of Information

Self-report is the primary source of information for assessment of pain and measurement of its intensity in children age 3 years and older. This chapter provides an overview of the variables addressed in assessment, specific tools used to obtain self-reports, and interpretation of pain scores. Challenges include establishing whether children are able to understand and use self-report scales and interpreting self-reported pain scores when they conflict with clinicians’ observation. New developments in self-report assessment are introduced, such as new support for the use of numerical rating scales and development of computer and smartphone self-report tools. Recommendations are provided supporting integration of self-report of pain in pain management.

Mechanistic, translational, quantitative pain assessment tools in profiling of pain patients and for development of new analgesic compounds

2013 ◽  
Vol 4 (4) ◽  
pp. 226-230 ◽  
Author(s):  
Lars Arendt-Nielsen ◽  
Michele Curatolo
Keyword(s):  
Pain Management ◽  
Drug Development ◽  
Healthy Volunteers ◽  
Success Rate ◽  
Pain Assessment ◽  
Development Process ◽  
Experimental Pain ◽  
Assessment Tools ◽  
Pain Mechanisms ◽  
Pain Patients

AbstractBackgroundMechanistic, translational, human experimental pain assessment technologies (pain bio markers) can be used for: (1) profiling the responsiveness of various pain mechanisms and pathways in healthy volunteers and pain patients, and (2) profiling the effect of new or existing analgesic drugs or pain management procedures. Translational models, which may link mechanisms in animals to humans, are important to understand pain mechanisms involved in pain patients and as tools for drug development. This is urgently needed as many drugs which are effective in animal models fail to be efficient in patients as neither the mechanisms involved in patients nor the drugs’ mechanistic actions are known.AimThe aim of the present topical review is to provide the basis for how to use mechanistic human experimental pain assessment tools (pain bio markers) in the development of new analgesics and to characterise and diagnose pain patients. The future aim will be to develop such approaches into individualised pain management regimes.MethodExperimental pain bio markers can tease out mechanistically which pain pathways and mechanisms are modulated in a given patient, and how a given compound modulates them. In addition, pain bio markers may be used to assess pain from different structures (skin, muscle and viscera) and provoke semi-pathophysiological conditions (e.g. hyperalgesia, allodynia and after-sensation) in healthy volunteers using surrogate pain models.ResultsWith this multi-modal, multi-tissue, multi-mechanism pain assessment regime approach, new opportunities have emerged for profiling pain patients and optimising drug development. In this context these technologies may help to validate targets (proof-of-concept), provide dose-response relationships, predicting which patient population/characteristics will respond to a given treatment (individualised pain management), and hence provide better understanding of the underlying cause for responders versus non-responders to a given treatment.ConclusionIn recent years, pain bio markers have been substantially developed to have now a role to play in early drug development, providing valuable mechanistic understanding of the drug action and used to characterise/profile pain patients. In drug development phase I safety volunteer studies, pain bio marker scan provide indication of efficacy and later if feasible be included in clinical phase II, III, and IV studies to substantiate mode-of-action.ImplicationsRefining and optimizing the drug development process ensures a higher success rate, i.e. not discarding drugs that may be efficient and not push non-efficient drugs too far in the costly development process. Mechanism-based pain bio markers can help to qualify the development programmes and at the same time help qualifying them by pain profiling (phenotyping) and recognising the right patients for specific trials. The success rate from preclinical data to clinical outcome may be further facilitated by using specific translational pain bio-markers. As human pain bio markers are getting more and more advanced it could be expected that FDA and EMA in the future will pay more attention to such mechanism-related measures in the approval phase as proof-of-action.

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