Implementation of an Electronic Pain Management Order Set and the Effect on Postpartum Pain Control [16L]

Background Adequate pain control is critical after outpatient surgery where patients are not as closely monitored. A multimodal pain management regimen was compared to a conventional pain management method in patients undergoing operative fixation for distal radius fractures. We hypothesized that there would be a decrease in the amount of narcotics used by the multimodal group compared to the conventional pain management group, and that there would be no difference in bone healing postoperatively. Methods Forty-two patients were randomized into 2 groups based on pain protocols. Group 1, the control, received a regional block, acetaminophen, and oxycodone. Group 2 received a multimodal pain regimen consisting of daily doses of pregabalin, celecoxib, and acetaminophen up until postoperative day (POD) #3. They also received a regional block with oxycodone for breakthrough pain. Results From POD#3 to week 1, there was a significant increase in oxycodone use in the study group correlating with the point in time when the multimodal regimen was discontinued. The shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) scores taken at 2 weeks postoperation showed a significantly lower average score in the study group compared to the control. There was no difference in bone healing. Conclusions The 2 regimens yielded similar pain control after surgery. The rebound increase in narcotic use after the multimodal regimen was discontinued, and significant difference in QuickDASH scores seen at 2 weeks postoperatively supported that multimodal regimens may not necessarily lead to decreased narcotic use in outpatient upper extremity surgery, but in the short term are shown to improve functional status.

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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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International survey: real-world pain management strategies

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1183 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Hagen ◽

A Georgescu

Keyword(s):

Pain Management ◽

Real World ◽

Pain Control ◽

Online Survey ◽

Management Strategies ◽

Pain Medication ◽

International Survey ◽

Nationally Representative ◽

Online Panels ◽

Control Pain

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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Analysis of a Standardized Perioperative Pain Management Order Set in Highly Opioid-Tolerant Patients

Journal of Patient Safety ◽

10.1097/pts.0000000000000247 ◽

2019 ◽

Vol 15 (2) ◽

pp. 105-110

Author(s):

Alex N. Isaacs ◽

Kellie L. Knight ◽

Sarah A. Nisly

Keyword(s):

Pain Management ◽

Perioperative Pain ◽

Perioperative Pain Management ◽

Order Set

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Factors that affect opioid use for postpartum pain control in women with opioid use disorder

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.235 ◽

2022 ◽

Vol 226 (1) ◽

pp. S133-S134

Author(s):

Omar Abuzeid ◽

Cassandra Heiselman ◽

Anna Fuchs ◽

Lama R. Noureddine ◽

Mia A. Heiligenstein ◽

...

Keyword(s):

Pain Control ◽

Opioid Use Disorder ◽

Opioid Use ◽

Postpartum Pain

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Pain Management in the Cancer Patient

Journal of Pharmacy Practice ◽

10.1177/089719009801100506 ◽

1998 ◽

Vol 11 (5) ◽

pp. 349-373 ◽

Cited By ~ 1

Author(s):

Kristi L. Lenz ◽

Eileen M. Marley

Keyword(s):

Pain Management ◽

Cancer Patient ◽

Cancer Pain ◽

Pain Control ◽

Cancer Pain Management ◽

Basic Principles ◽

Adequate Pain Management

Of the over one million patients diagnosed with cancer each year, 30 percent will have pain at diagnosis and up to 85 percent will have pain as their disease progresses. Adequate pain management continues to be hindered by multiple patient-and clinician-related barriers; however, with increased awareness and knowledge, the pharmacy practitioner can play a key role in facilitating pain management. This review will focus on the mechanisms of cancer pain, the role of non-opioids, opioids, and adjuvant agents in the treatment of cancer pain, and the basic principles of cancer pain management that allow 70 to 90 percent of patients to achieve excellent pain control.

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Pain Control: How Aging Affects Pain Management

AJN American Journal of Nursing ◽

10.2307/3471738 ◽

1998 ◽

Vol 98 (6) ◽

pp. 12

Author(s):

Christine L. Pasero ◽

Barbara Reed ◽

Margo McCaffery

Keyword(s):

Pain Management ◽

Pain Control

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Opioid Reduction Through Postoperative Pain Management in Pediatric Orthopedic Surgery

PEDIATRICS ◽

10.1542/peds.2020-001487 ◽

2021 ◽

Author(s):

Kerwyn Jones ◽

Laurie Engler ◽

Elizabeth Fonte ◽

Ibrahim Farid ◽

Michael T. Bigham

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Control Charts ◽

Postoperative Pain Management ◽

Prescribing Practices ◽

Opioid Prescription ◽

Orthopedic Surgical Procedures ◽

Pediatric Orthopedic ◽

Over Time ◽

Order Set

OBJECTIVES Our goal with this initiative was to reduce discharge opioid prescriptions while maintaining optimal pain management through the use of standardized pain prescribing guidelines for pediatric patients after orthopedic surgical procedures. METHODS Through analysis of established yet inconsistent prescribing practices, we created a 4-tiered guideline for pediatric orthopedic postoperative pain management prescription ordering. Following the Model for Improvement methodology including iterative plan-do-study-act cycles, the team created an electronic medical record order set to be used at discharge from the hospital. The provider compliance with this order set was monitored and analyzed over time by using provider-level and aggregate control charts. A secondary measure of opioid prescriptions (morphine milligram Eq [MME] dosage per patient) was tracked over time. The balancing measure was the analysis of unanticipated opioid prescription refills. RESULTS Greater than 90% compliance with the guidelines was achieved and sustained for 20 months. This resulted in a 54% reduction in opioids prescribed during the improvement period (baseline = 71 MME per patient; postintervention = 33 MME per patient) and has been sustained for 12 months. The percentage of unanticipated opioid prescription refills did not significantly change from the period before the institution of the guidelines and after institution of the guidelines (2017 = 3%; 2019 = 3%). CONCLUSIONS The creation of these guidelines has led to a significant reduction in the number of opioids prescribed while maintaining effective postoperative pain management.

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The experience of pain among cancer patients at the University of the Philippines: Philippine General Hospital Cancer Institute—A cross-sectional study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24078 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24078-e24078

Author(s):

Harold Nathan C. Tan ◽

Rogelio Nona Velasco ◽

Lance Isidore Garcenila Catedral ◽

Michael Ducusin San Juan ◽

Corazon Ngelangel ◽

...

Keyword(s):

Pain Management ◽

Cancer Patients ◽

Pain Control ◽

Severe Pain ◽

Cross Sectional Study ◽

The Philippines ◽

Pain Interference ◽

Cancer Center ◽

Cross Sectional ◽

Adequate Pain Management

e24078 Background: Pain is one of the most common and dreaded sequelae of cancer, occurring in approximately 55% of patients. The experience of pain takes a toll on the patients’ quality of life. However, many patients do not receive adequate pain management. This study aimed to determine the prevalence of pain, its severity, and the adequacy of pain management among cancer patients in the Philippines. Methods: A cross-sectional study was conducted at a representative cancer center in the Philippines, enrolling 351 cancer patients. Pain severity was assessed using the Brief Pain Inventory-Short Form (BPI-SF) Filipino. The BPI evaluates pain severity and its impact on daily functioning (pain interference). To ascertain the adequacy of pain control, the pain management index (PMI) was calculated by subtracting the subtracting the severity of pain reported by the patient from the type of analgesic treatment received. Logistic regression analysis was conducted to evaluate the factors associated with worst pain and adequacy of pain management. Data were analyzed using Stata version 16.0, with statistical significance set at p < 0.05. Results: Three hundred three cancer patients (86.3%) experienced pain. Approximately 3 out of 5 patients (n = 208) did not receive adequate pain control, and one-third of patients experienced severe pain (n = 121). Patients who reported severe pain interference (n = 110) had three times greater odds to experience severe pain (OR 3.2, 95% CI 1.82-5.61, p < 0.001). Those patients who had regular follow up were 65% less likely to experience severe pain (OR 0.35, 95% CI 0.16 – 0.78, p = 0.01). Patients who used pain medications (n = 196) were 14 times more likely to experience adequate pain management (OR 14.19, 95% CI 6.53 – 30.83, p < 0.001). Patients who were referred to pain service (n = 25) were seven times more likely to report adequate pain control (OR 6.62, 95% CI 2.50 – 17.56, p < 0.001). Conversely, those patients who reported a severe rating on total pain interference were 75% less likely to experience adequate pain management (OR 0.25, 95% CI 0.17 – 0.35, p < 0.001). Conclusions: Unexpectedly, there was a high prevalence of pain among cancer patients at a representative cancer center in the Philippines. Pain exerts a heavy toll on patients, affecting daily functioning. The undertreatment of pain discovered in this study (59% of cancer patients) is alarming. Timely pain evaluation can help identify the presence of pain and the need for appropriate use of analgesics. The assessment and management of pain is a critical component of cancer care that should not be neglected.

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