scholarly journals The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Emilie Paul-Savoie ◽  
Patricia Bourgault ◽  
Stéphane Potvin ◽  
Emilie Gosselin ◽  
Sylvie Lafrenaye
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Clinical Experience ◽  
Patient Centered Care ◽  
Chronic Pain Management ◽  
Patient Centered ◽  
Chronic Pain Patients ◽  
Centered Care ◽  
The Impact ◽  
Pain Patients

Objectives. The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver’s patient-centered and empathetic behaviours in chronic pain context. Methods. A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer’s assessment using a video of real patients with chronic pain. Results. The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler–Danlos syndrome and fibromyalgia) (p<0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience. Discussion. The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.

scholarly journals Patient Assessment and Chronic Pain Self-Management in Ethnomedicine: Seasonal and Ecosystemic Embodiment in Ayurvedic Patient-Centered Care

2020 ◽  
Vol 17 (8) ◽  
pp. 2842
Author(s):  
Vinita Agarwal
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Patient Centered Care ◽  
Self Management ◽  
Seasonal Cycles ◽  
Chronic Pain Management ◽  
Patient Assessment ◽  
Patient Centered ◽  
Centered Care ◽  
The Individual

Background: Ayurveda’s preventive focus complements its strength with the interventionist approach of the biomedical in chronic pain self-management. Patient-centered care (PCC) using ethnomedicine promises greater patient self-management; however, few studies have examined environmental relationships and PCC in self-management of chronic pain through Ayurveda. Objective: To examine how Ayurveda’s philosophical focus on whole system frameworks describes the integration of the individual and the ecological in tailoring an integrative patient-centered diagnostic and prognostic approach to chronic pain management. Methods: This qualitative case study conducted in-depth semi-structured interviews of Ayurvedic physicians from India (N = 10) and a qualitative inductive content analytic approach. Findings: The diagnostic and interpretational framework of the doshas supports the integration of the individual and the ecological through (a) the circadian and seasonal cycles relating mind-body awareness with diet, lifestyle (e.g., yoga), and breath (e.g., pranayama), and (b) biogeographical and ecosystemic regions relating the biogeographical and the ecological (e.g., desh) with the regulatory principle of pain and its physiological and anatomical perception (vata) in an approach that goes beyond treating pain etiology to a whole person PCC approach. Conclusions: The study highlights how circadian and seasonal cycles and evolutionary spatial-temporal factors of biogeographical and ecological regions are employed in patient assessment and self-management to support patient involvement. Recommendations for PCC in integrative chronic pain management include supporting patient ownership of their care through the dosha framework that relates the individual and the ecological in the patient’s own life-context and supports co-creation of a collaborative plan of care using an ethnomedical framework.

scholarly journals Impact of the COVID-19 pandemic on chronic pain management

2021 ◽  
Vol 2 (3) ◽  
pp. 197-212
Author(s):  
Andrew Auyeung ◽  
Hank Wang ◽  
Iulia Pirvulescu ◽  
Nebojša Knežević
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Chronic Pain Management ◽  
Steroid Use ◽  
Chronic Pain Patients ◽  
Interventional Pain Management ◽  
Tools And Techniques ◽  
Pain Patients

Introduction: The COVID-19 pandemic has generated considerable turmoil in the interventional pain management (IPM) community. Due to IPM being classified as 'elective', numerous pain practices across the United States were forced to close during the pandemic, leaving chronic pain patients untreated for indefinite periods, and IPM physicians with increased stress and burnout. Results: In response to these detrimental effects, various re-opening tools and techniques have been created to facilitate a cautious resumption of in-person interventional pain practice. Due to their ability to minimize person-to-person contact, telehealth and pharmacotherapy played a more significant role in IPM during the pandemic, but their increased utilization has also led to the exacerbation of substance abuse and the opioid epidemic. The interplay between steroid use and its immunosuppressive effects, in relation to the COVID-19 infection and the COVID-19 vaccine, has also arisen as an issue of concern. Conclusion: As practices begin to safely re-open throughout the United States, the effects felt by chronic pain patients during the pandemic must be emphasized and not ignored. This review emphasizes the struggles pain patients have had to face during the pandemic and the need to update and redefine regulations regarding interventional and chronic pain management.

scholarly journals Differences in Swedish and Australian medical student attitudes and beliefs about chronic pain, its management, and the way it is taught

2018 ◽  
Vol 18 (3) ◽  
pp. 533-544 ◽  
Author(s):  
Linda Rankin ◽  
Britt-Marie Stålnacke ◽  
Christopher J. Fowler ◽  
Gisselle Gallego
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Medical Students ◽  
Clinical Guidelines ◽  
Management Education ◽  
Attitudes And Beliefs ◽  
Chronic Pain Management ◽  
Chronic Pain Patients ◽  
Swedish Medical ◽  
Pain Patients

Abstract Background and aims Medical students receive training in the management of chronic pain, but the training is often suboptimal. Considering that the basis for physician’s knowledge is their medical education, it is important to explore the attitudes and beliefs of medical students with respect both to chronic pain management and to their views on current pain education. Therefore, the aim of this study was to compare Swedish and Australian medical student’s attitudes and beliefs about patients with chronic pain, and their perceptions regarding their chronic pain management education. Methods An online survey was conducted with final year Australian and Swedish medical students from two different universities between December 2016 and February 2017. Attitudes and beliefs towards chronic pain patients were measured using the Health Care Providers’ Pain and Impairment Scale (HC-PAIRS). A thematic analysis was conducted on open end questions regarding their views on their education and important skills for chronic pain management. Results A total of 57 Swedish and 26 Australian medical students completed the HC-PAIRS scale. The Swedish medical students showed statistically significantly lower total mean HC-PAIRS scores compared to Australian medical students (46 and 51, respectively). Australian students had statistically significantly higher scores than the Swedish students for two of four factors: functional expectations and need for cure, whereas no significant differences were seen for the factors social expectations or for projected cognition. From the open end questions it was evident that final year medical students are knowledgeable about key chronic pain items described in clinical guidelines. However, both cohorts described their chronic pain training as poor and in need of improvement in several areas such as more focus on the biopsychosocial model, working in multidisciplinary teams, seeing chronic pain patients and pharmacological training. Conclusions Attitudes and beliefs are formed during medical education, and our study exploring attitudes of medical students towards chronic pain and how it is taught have provided valuable information. Our survey provided detailed and cohesive suggestions for education improvement that also are in line with current clinical guidelines. This study indicates that the Swedish final year students have a more positive attitude towards chronic pain patients compared to their Australian counterparts. The majority of students in both cohorts perceived chronic pain management education in need of improvement. Implications This study highlights several areas of interest that warrant further investigation, for example, the impact of a changed medical curriculum in alignment with these clinical guidelines requested by students in this survey, and correspondingly if their attitudes towards chronic pain patients can be improved through education. Further, we conclude that it would be valuable to align the implementation of the HC-PAIRS instrument in order to achieve comparable results between future studies.

scholarly journals Perioperative management of opioid-tolerant chronic pain patients

2006 ◽  
Vol 2 (6) ◽  
pp. 353 ◽  
Author(s):  
Dima Rozen, MD ◽  
Noah P. DeGaetano, MD
Keyword(s):  
Chronic Pain ◽  
Personal Experience ◽  
Clinical Utility ◽  
Perioperative Management ◽  
Anesthetic Management ◽  
Chronic Pain Management ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
The Impact ◽  
Pain Patients

Opioids occupy a position of unsurpassed clinical utility in the treatment of many types of painful conditions. In recent years there has been a noticeable shift regarding the use of opioids for the treatment of both benign and malignancy-related pain. As acceptance of the prescribing of opioids for chronically painful conditions has grown, many more opioid-tolerant patients are presenting for surgical procedures. It is therefore imperative that practicing anesthesiologists become familiar with currently available opioid formulations, including data regarding drug interactions and side effects, in order to better plan for patients’ perioperative anesthetic needs and management. Unfortunately, there is a lack of scientifically rigorous studies in this important area, and most information must be derived from anecdotal reports and the personal experience of anesthesiologists working in this field. In this review, we shall discuss current chronic pain management and the impact of opioid use and tolerance on perioperative anesthetic management.

scholarly journals Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain:

2020 ◽  
Vol 52 (3) ◽  
pp. 189-197
Author(s):  
Ann Marie Chiasson ◽  
Audrey J. Brooks ◽  
Mari Ricker ◽  
Patricia Lebensohn ◽  
Mei-Kuang Chen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Family Medicine ◽  
Self Efficacy ◽  
Medical Knowledge ◽  
Primary Care Providers ◽  
Control Group ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Patients

Background and Objectives: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management. Methods: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion. Results: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P&lt;.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%). Conclusions: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.

CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3199-3204 ◽  
Author(s):  
Chrysanthi Batistaki ◽  
Eleni Chrona ◽  
Andreas Kostroglou ◽  
Georgia Kostopanagiotou ◽  
Maria Gazouli
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cyp2d6 Genotype ◽  
Chronic Pain Patients ◽  
Reduction Of Pain ◽  
Pain Patients ◽  
Numeric Rating

Abstract Objective To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. Design Prospective cohort study. Setting General hospital, pain management unit. Subjects Patients with chronic pain, treated with codeine or tramadol. Methods Patients’ pain was assessed at baseline (numeric rating scale [NRS]; 0–10). Prescription of codeine or tramadol was selected randomly. The assessment of patients’ response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of &gt;50% or an NRS &lt;4 was considered a positive response. Patients’ blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). Results Seventy-six consecutive patients were studied (20 males, 56 females), aged 21–85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). Conclusions Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

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