Evaluating Pain, Opioids, and Delirium in Critically Ill Older Adults

2020 ◽  
pp. 105477382097312
Author(s):  
Kara J. Pavone ◽  
Juliane Jablonski ◽  
Pamela Z. Cacchione ◽  
Rosemary C. Polomano ◽  
Peggy Compton
Keyword(s):  
Pain Management ◽  
Estimating Equation ◽  
Equation Model ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Chi Square ◽  
Opioid Administration ◽  
Management Approaches ◽  
Pain Patients

Untreated pain and pain management with opioids are independent precipitating factors for delirium. This retrospective study evaluated the relationships among pain severity, its management with opioids, and the onset of delirium in older adult patients admitted to the surgical intensive care unit (SICU). Consecutive patients aged 65 or greater admitted to the SICU over a 5-month period were examined ( n = 172). When assessed using a multivariable general estimating equation model, opioids (chi-square [χ2], 12.34, p = .0004), but not pain (χ2, 3.31, p = .0688) were significant in predicting next-day delirium status. Controlling for pain, patients exposed to opioids were 2.5 times more likely to develop delirium than patients not exposed (95% Confidence Interval: 1.44–4.36). Our data shows that opioid administration predicted the onset of next-day delirium. In an effort to prevent delirium, future research should focus on opioid-sparing pain management approaches to mitigate pain and delirium.

46: SURGICAL INTENSIVE CARE UNIT PAIN MANAGEMENT IN THE ERA OF INTRAVENOUS OPIOID SHORTAGES

2020 ◽  
Vol 48 (1) ◽  
pp. 23-23
Author(s):  
Allison Bouwma ◽  
Mark Mlynarek ◽  
Michael Peters ◽  
Vincent Procopio ◽  
Carolyn Martz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

scholarly journals Comparative Analysis of Different Methods of Pain Management for Elderly Patients in the Surgical Intensive Care Unit

2017 ◽  
Vol 11 (3) ◽  
pp. 186-190
Author(s):  
Becki Wan-Yu Huang ◽  
Benjamin Ing-Tiau Kuo ◽  
Chien-Chuan Chen ◽  
Wen-Han Chang ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Comparative Analysis ◽  
Pain Management ◽  
Elderly Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

MULTIDISCIPLINARY PROVIDER ASSESSMENT OF PAIN MANAGEMENT IN A SURGICAL INTENSIVE CARE UNIT.

2006 ◽  
Vol 34 ◽  
pp. A83
Author(s):  
Daniel R Brown ◽  
Amy Henderson ◽  
Becky Krueger ◽  
Deborah Mangan ◽  
Joseph Pletta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Long-term follow-up of ICU patients

1992 ◽  
Vol 1 (2) ◽  
pp. 115-117 ◽  
Author(s):  
BC Friedman ◽  
W Boyce ◽  
CE Bekes
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Practical Method ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Long Term Follow Up

Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.

scholarly journals Association between self-esteem and efficacy and mental health in people with disabilities

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257943
Author(s):  
Jong Youn Moon ◽  
Jae-Hyun Kim
Keyword(s):  
Mental Health ◽  
Perceived Stress ◽  
Self Efficacy ◽  
People With Disabilities ◽  
Inverse Correlation ◽  
Estimating Equation ◽  
Self Esteem ◽  
Equation Model ◽  
Self Report ◽  
Future Research

This study aimed to investigate the association among self-evaluations—such as self-esteem and self-efficacy—self report of depression, and perceived stress among Korean individuals with disabilities. Data from the second wave of the Panel Survey of Employment for the Disabled (collected from 2016–2018) were used. In 2016 and the follow-up in 2018, 4,033 participants were included. We estimated the annual change in both independent variables and the probability of self-report of depression and stress. Generalized estimating equation model and chi-square test were used. Compared with those whose self-esteem and self-efficacy scores were ≥30, those with scores ≤19 were, respectively, 5.825 (95% Confidence Interval [CI]: 4.235–8.011; p < .0001) and 1.494 times (95% CI: 1.233–1.810; p < .0001) more likely to have self-report of depression. The perceived stress of those with self-esteem scores ≤19 or ranging from 20–24 were, respectively, 2.036 (95% CI: 1.510–2.747; p < .0001) and 1.451 times higher (95% CI: 1.269–1.659; p < .0001) than those with self-esteem scores ≥30. There exists an inverse correlation between self-evaluations, such as self-efficacy and self-esteem, and mental health in people with disabilities. The results of this study can be used as a basis for developing interventional strategies and training and intervention programs for people with disabilities. Future research is needed to investigate potential mediating factors among Korean individuals.

Pilot study of eDOL, a new mHealth application and web platform for medical follow-up of chronic pain patients (Preprint)

2021 ◽  
Author(s):  
NICOLAS KERCKHOVE ◽  
Noémie Delage ◽  
Sébastien Cambier ◽  
Nathalie Cantagrel ◽  
Eric Serra ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Real Life ◽  
Basic Research ◽  
High Rate ◽  
Future Research ◽  
Chronic Pain Patients ◽  
Pain Patients

BACKGROUND The pharmacopoeia of analgesics is old, their effectiveness is limited, with undesirable effects and little progress has been made in recent years. Thus, innovation is limited despite prolific basic research. Better characterization of patients could help to identify the predictors of successful treatments through research programs, and therefore enable physicians to carry out better decision-making in the initial choice of treatment and in the follow-up of their patients. Nevertheless, the current assessment of chronic pain patients provides only fragmentary data on their painful daily experiences. Thus, it is essential to modify the temporality in which patients’ sensations are assessed, with real-life monitoring of different parameters, i.e. subjective and objective markers of chronic pain. Consequently, recent studies have highlighted the urgent need to develop self-management and chronic pain management programs through e-health programs, and enhance their therapeutic value. OBJECTIVE We hypothesize that regular patient self-monitoring using an mHealth application would lead physicians to obtain deeper knowledge and a new vision of chronic pain patients, while for patients it would play a positive therapeutic role, as they become active in their own management and benefit from online advice. Such an assessment would not only contribute to better patient characterization and help in the choice of the most appropriate treatment, but could also improve adherence to treatment. To address this issue, we evaluated the feasibility and acceptability, by patients and physicians, of a new mHealth application called eDOL. METHODS An observational study assessing the feasibility and acceptability of the eDOL tool was conducted. Patients completed several questionnaires via eDOL over a period of 2 weeks, and then repeatedly over a period of 3 months. Physicians saw their patients at a follow-up visit that took place at least 3-months after the inclusion visit. The primary endpoint, a composite criterion reflecting the acceptability of eDOL and the feasibility of its use, was assessed using satisfaction questionnaires for both patients and physicians after the completion of study. RESULTS One hundred and thirty-three patients were included of whom 105 were analyzable. Our results showed a rate of adherence of approximately 60% of patients after 3 months of using eDOL, a median acceptability score around 7/10 for both patients and physicians, a high rate of completion of the baseline questionnaires / meters, and a low rate for follow-up questionnaires / meters and forms. We were also able to characterize subgroups of patients and determine a profile of those who adhered to eDOL. CONCLUSIONS This work demonstrates that eDOL is highly feasible and acceptable for both chronic pain patients and their physicians. It also shows that such a tool can integrate many parameters to ensure the detailed characterization of patients for future research works and pain management. CLINICALTRIAL NCT03931694

Recruiting patients with advanced cancer to participate in a non-opioid intervention for chronic pain management.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14085-e14085
Author(s):  
Preethi Selvan ◽  
Katherine Myers-Coffman ◽  
Karolina Bryl ◽  
Jasmine Tenpa Lama ◽  
Brigette Sutton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Music Therapy ◽  
Advanced Cancer ◽  
Research Participation ◽  
Future Research ◽  
Control Group ◽  
Pharmacological Interventions ◽  
Chi Square ◽  
Recruitment Methods

e14085 Background: Chronic pain related to advanced cancer is difficult to treat. In addition to traditional analgesics, non-pharmacological interventions, such as music therapy, may help alleviate pain in this population. Research studies to test the efficacy of these non-pharmacological interventions are necessary and important. However, recruiting patients with advanced cancer to participate in such interventions can be challenging. Identifying effective sources of referrals and barriers to participation may help increase recruitment rates in the future. Methods: We recruited patients with advanced cancer (stage III or IV) with chronic pain from two major hospital systems to participate in a pain management interventional study. The experimental group received individualized music therapy, while the control group received talk therapy. Participants attended six weekly sessions at the hospital and were compensated for time and travel. Recruitment methods included referrals from care teams, advertisement through flyers and posters, EMR chart reviews, and in-person recruitment at multiple infusion centers. Missing data was excluded from analyses. Chi-square tests assessed significant differences between groups. Results: Of 594 patients that were referred to the study, 7% enrolled (n = 40), 35% declined (n = 208), and 58% were ineligible (n = 346). Forty-seven percent (n = 19) of enrolled participants were female; race/ethnic distributions were the following: African American/Black (55%; n = 22), Caucasian/White (28%; n = 11), or other (17%; n = 7). The most effective recruitment method was through self-referral; of the 40 patients enrolled in the study, 9 (23%) were enrolled through this method. There were no statistically significant differences between referral source and enrollment. The top three reasons patients declined to participate included lack of interest (32%; n = 67), lack of time and/or energy (28%; n = 59), and lack of transportation (16%, n = 34). Conclusions: Although there were no differences in referral sources, more patients were enrolled through self-referral or in-person recruitment, showing the power of personal motivation and personal touch. While lack of participation due to interest, time, or energy are hard to overcome, future research should consider campaigns to reach patients who are motivated to participate. In addition to referrals, resources for in-person recruitment and transportation to help alleviate barriers to research participation should be considered.

scholarly journals Attitudes and Perceptions Toward Authorized Deception: A Pilot Comparison of Healthy Controls and Fibromyalgia Patients

Pain Medicine ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 794-802
Author(s):  
Susan J Goo ◽  
Eleni Frangos ◽  
Emily A Richards ◽  
Marta Ceko ◽  
Brenda L Justement ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Future Research ◽  
Healthy Controls ◽  
Willingness To Participate ◽  
Chi Square ◽  
Cross Sectional ◽  
Perceptions And Attitudes ◽  
Attitudes And Perceptions ◽  
First Time ◽  
Pain Patients

Abstract Objective Little is known about the perceptions and attitudes of participants who volunteer in studies involving authorized deception. Thus, this cross-sectional pilot study measured, for the first time, the perceptions about participation in an authorized-deception placebo analgesia study in chronic pain patients with fibromyalgia and assessed whether their perceptions differed from healthy controls. Methods An anonymous survey with questions about trust in research and willingness to participate in future research involving deception was mailed to participants in both groups after completion of the parent study. Statistical analyses were performed using the Mann-Whitney U and chi-square tests (31 controls and 16 fibromyalgia patients were included in the analyses). Results The majority of participants expressed little or no concern about the deception, still trusted the scientific process, and found the debriefing procedure helpful and worthwhile. Group differences were found in willingness to 1) participate in the parent study had the deceptive element been disclosed in advance (controls = definitely, fibromyalgia patients = probably, U = 341.5, P = 0.01) and 2) participate in future studies (controls = definitely, fibromyalgia patients = probably, U = 373, P &lt; 0.001). Conclusions Despite slightly less favorable responses of fibromyalgia patients and the relatively small size of the study, these findings suggest that attitudes and perceptions about participating in an authorized placebo study remain positive in both healthy and chronic pain populations.

scholarly journals ‘The Doctor doesn’t need to see you now’: reduction in general practice appointments following group pain management

2018 ◽  
Vol 13 (2) ◽  
pp. 121-129
Author(s):  
Ajay Clare ◽  
Sarah MacNeil ◽  
Tamzin Bunton ◽  
Stephanie Jarrett
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pain Management ◽  
Clinical Effectiveness ◽  
Self Management ◽  
Future Research ◽  
Before And After ◽  
Gp Services ◽  
Management Techniques ◽  
Pain Patients

Background: Patients living with chronic, non-malignant, musculoskeletal pain are frequent visitors to general practice (GP) services, placing a large burden on resources. Pain management programmes (PMPs) are recommended for chronic pain patients and aim to teach self-management techniques. While there is evidence for their clinical effectiveness, few studies have explored whether there is a reduction in primary care healthcare use after attending a PMP. Aim: This study sought to address this by gathering data on pain-related primary care appointments before and after attending a PMP. Design and setting: Medical records of 50 patients attending a group outpatient PMP were obtained to determine whether the number of pain-related GP appointments differed 1 year after attending the programme compared with the year beforehand. Robust data were obtained from GP appointment systems and a retrospective observational design was utilised. Results: The results indicated a 43.9% decrease in the number of GP appointments in the year following a PMP, a change that was statistically significant. Conclusion: The findings of the study show that there are fewer pain-related appointments in primary care in the year following a group outpatient PMP compared with the preceding year. It is possible that the self-management techniques taught on the programme lead to a reduction in patient’s need to consult their GP as frequently about their pain. However, limitations in the current research mean that the reduction in appointments cannot be definitively attributed to PMP attendance and suggestions for future research are discussed.

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