Undertreated pain: Trends over time for older adults with and without cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 15-15 ◽  
Author(s):  
Carolyn J Presley ◽  
Jennifer Kapo ◽  
Shi-Yi Wang ◽  
Maureen Canavan ◽  
Ella Sheinfeld ◽  
...  
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Low Income ◽  
Severe Pain ◽  
Opioid Analgesics ◽  
Total Sample ◽  
Pain Interference ◽  
Moderate Pain ◽  
Care Needs ◽  
Part D

15 Background: Concerns about the adequacy of pain management among older adults are increasing. We examined calendar year (CY) trends in prescription medication (Rx) use by older adults with and without cancer who reported pain interference with normal activities. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims data, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis or without cancer history. We used Rx claims to characterize use of opioids, non-opioid analgesics, local anesthetics and anti-epileptics during the 90 days post survey. Participant reported pain-related activity limitations within the past 30 days (pain interference) were summarized as severe, moderate, or none. We applied multivariable logistic regression to determine associations of Rx use with CY, cancer status, and pain interference, controlling for socio-demographics, chronic conditions, plan type and Part D Low Income Subsidy. Adjusted outcome levels were predicted based on the regression coefficients. Results: In the total sample (N = 15,624), pain Rx was used by 30%, with 20% receiving opioids. Severe or moderate pain interference with activities was reported by 23% and 46%, respectively. Among respondents with cancer (N = 9,105), 49% reporting severe (28% moderate) pain interference received any pain Rx; 37% & 18% used opioids, respectively. For those without cancer, adjusted pain Rx use rates were significantly lower in all categories. Pain Rx increased over CY for cancer respondents with moderate pain (25% in 2008 to 31% in 2012; p = .017), but not for those reporting severe pain interference. In addition, pain Rx increased over CY for the cohort without cancer with no pain interference (11% in 2008 to 14% in 2012; p = .027). Conclusions: Despite increased focus on symptom management, the majority of older adults who experienced moderate or severe pain interference did not have Rx for pain management. Efforts to identify and target unmet supportive care needs for Medicare beneficiaries, with and without cancer, are necessary to further improve quality of life.

scholarly journals Muscle pain

2017 ◽  
Vol 59 (3) ◽  
pp. 24-32 ◽  
Author(s):  
Omphile Mogole ◽  
Ralph Kandiwa ◽  
Oyetola Babarinde ◽  
Halima Ismail ◽  
Nokuthula Dlamini ◽  
...  
Keyword(s):  
Pain Management ◽  
Adenosine Triphosphate ◽  
Muscle Pain ◽  
Severe Pain ◽  
Viral Infections ◽  
Opioid Analgesics ◽  
Nerve Endings ◽  
Moderate Pain ◽  
Endogenous Substance ◽  
Inflammatory Drugs

Muscle pain, also known as myalgia, is most commonly associated with sprains or strains. It frequently presents as redness at the site of injury, tenderness, swelling and fever. Muscle pain may occur as a result of excitation of the muscle nociceptor due to overuse of the muscle, viral infections or trauma. The most important endogenous substance released in response to the damaged tissues or nociceptor nerve endings in regards with muscle pain is adenosine triphosphate (ATP). Optimal pain management involves a combination of non-opioid, opioid analgesics, adjuvants, as well as non-pharmacologic strategies. Non-opiod analgesics include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which are indicated for mild to moderate pain. Whereas moderate to severe pain acquires opiod analgesics. This article provides an overview of muscle pain, the management and treatment thereof.

scholarly journals Pain management after lung surgery

2014 ◽  
Vol 4 (1) ◽  
Author(s):  
Maria Frödin ◽  
Margareta Warrén Stomberg
Keyword(s):  
Quality Of Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Lung Surgery ◽  
Moderate Pain ◽  
Number Of Patients ◽  
Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

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

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.

Dendritic cell vaccine as an alternative to opioid analgesia in patients with advanced cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18022-e18022
Author(s):  
Anna P. Menshenina ◽  
Oleg I. Kit ◽  
Elena M. Frantsiyants ◽  
Tatiana I. Moiseenko ◽  
Ekaterina V. Verenikina ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pain Relief ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Dendritic Cell Vaccine ◽  
Cell Vaccine ◽  
Advanced Cervical Cancer ◽  
Moderate Pain ◽  
Intense Pain

e18022 Background: Locally advanced and progressive cervical cancer is always accompanied by the pain syndrome. The common analgesics include non-steroidal anti-inflammatory drugs and opioids. The purpose of the study was to assess allogeneic dendritic cell vaccine (DCV) as an alternative analgesic in patients with advanced cervical cancer. Methods: The pain syndrome dynamics was assessed in 20 patients with advanced T3-4N1M0-1 cervical cancer receiving subcutaneous paravertebral injections of allogeneic DCV in a total alternating dose of 5-10 million cells every 2 weeks. Patients received DCV for one year, with a total of 24 vaccine therapy sessions and a total dosage of 180 million dendritic cells. The pain intensity was assessed on a verbal rating scale: 0 – no pain; 1 – mild pain; 2 – moderate pain; 3 – severe pain; 4 – extremely intense pain. Results: Prior to the therapy, 15 patients (75%) had severe pain; 2 (10%) - moderate pain; 3 (15%) - extremely intense pain. After 4-6 DCV injections, the pain intensity decreased, patients refused opioid analgesics. After 10-12 DCV sessions, 19 (95%) (p < 0.05) women had no pain at all, patients denied additional pain relief with non-opioid analgesics. Unrelieved pain was registered only in one cervical cancer patient. Conclusions: DCV injections in patients with advanced cervical cancer provide pain relief thereby improving their quality of life.

scholarly journals ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study

2020 ◽  
Vol 57 ◽  
pp. 004695802093522
Author(s):  
Melissa McInerney ◽  
Ruth Winecoff ◽  
Padmaja Ayyagari ◽  
Kosali Simon ◽  
M. Kate Bundorf
Keyword(s):  
Older Adults ◽  
Metabolic Syndrome ◽  
Health Insurance ◽  
Low Income ◽  
Well Being ◽  
Health And Retirement Study ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Care Needs ◽  
Retirement Study

The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.

scholarly journals The Relationship Between Pain and Psychological Distress During the COVID-19 Pandemic: Is Social Technology Use Protective?

Pain Medicine ◽  
2021 ◽  
Author(s):  
Yulin Yang ◽  
Hanna Grol-Prokopczyk ◽  
M Carrington Reid ◽  
Karl Pillemer
Keyword(s):  
Older Adults ◽  
Psychological Distress ◽  
Technology Use ◽  
Severe Pain ◽  
Well Being ◽  
Pain Severity ◽  
Social Technology ◽  
Moderate Pain ◽  
Social Technologies ◽  
The Relationship

Abstract Objectives The COVID-19 pandemic and resulting shelter-in-place orders have profoundly changed the everyday social environment. This study examines the relationship between pain and psychological distress (depression, anxiety, and loneliness) among U.S. adults ages 54 and older during the pandemic. We also test whether use of technology for social purposes moderates the association between pain severity and psychological distress. Methods Using cross-sectional data on 1,014 adults ages 54 and older (pain free, n = 637; mild pain, n = 106; moderate pain, n = 227; and severe pain, n = 64) from the 2020 Health and Retirement Study COVID-19 Project (Early, Version 1.0), we conducted regression analyses to test the association between pain severity and psychological outcomes and to assess social technology use frequency as a moderator. Results Compared with their pain-free peers, participants with mild-to-moderate pain reported more depressive symptoms and greater loneliness; those with severe pain reported higher levels of depression, anxiety, and loneliness. Social technology use was associated with lower levels of depression and loneliness. However, interaction analyses show that social technology use predicted an increase in depression for individuals with pain but a decrease in depression among pain-free individuals. For anxiety and loneliness, no significant effects of social technology use were observed. Conclusion Older adults with pain are at high risk of depression, anxiety, and loneliness during the pandemic. Although social technologies have become a common alternative to face-to-face interactions during the COVID-19 crisis, and overall they can provide mental health benefits, our results suggest that social technologies can be detrimental to psychological well-being among people with pain. These findings can inform technology-based interventions aiming to promote well-being among older adults with pain.

scholarly journals Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 328-329
Author(s):  
Lisa Rauch ◽  
Toby Adelman ◽  
Daryl Canham ◽  
Nancy Dudley
Keyword(s):  
Older Adults ◽  
Community Health ◽  
Low Income ◽  
Independent Living ◽  
Complex Care ◽  
Care Needs ◽  
Term Care ◽  
Undergraduate Nursing ◽  
Complex Care Needs ◽  
The Impact

Abstract Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.

Pain score, analgesic utilization, and patient satisfaction among cancer patients at a community cancer center.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 203-203
Author(s):  
Dylan Michael Zylla ◽  
Jim Fulbright ◽  
Pamala A. Pawloski ◽  
Lisa Illig ◽  
Adina Peck ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Cancer Patients ◽  
Severe Pain ◽  
Opioid Analgesics ◽  
Brief Pain Inventory ◽  
Patient Survey ◽  
Management Plan ◽  
Cancer Center ◽  
Long Acting

203 Background: Cancer-related pain is common, negatively impacts quality of life and survival, and often requires opioid analgesics. Patient level data describing the incidence and severity of pain, medication utilization, and patient satisfaction associated with care are lacking. An understanding of cancer pain prevalence and analgesic utilization is needed to initiate quality improvement (QI) interventions. Methods: We analyzed 2 months of outpatient oncology clinic encounters from the electronic medical record (EMR) and conducted a patient survey of 163 cancer patients to obtain baseline data on pain levels, opioid and non-opioid treatments, and patient satisfaction. Our survey incorporated questions from the Brief Pain Inventory to validate EMR reports and obtain patient satisfaction data. Results: Moderate to severe pain is reported in nearly 1 of every 9 cancer patient encounters (Table 1). On average, we achieved a personal pain goal (PPG) in 83.5 % of all patients (n=109). Among patients receiving opioids, a PPG was achieved in 16 of 29 patients (55.2%). Of the 13 opioid-consuming patients not achieving a PPG, 12 were not on a long-acting opioid, and 5 had never discussed a pain management plan with their physician. Oxycodone CR is the most commonly prescribed long-acting opioid (40.4% versus morphine SR (26.1%), methadone (23.0%), and fentanyl transdermal (10.6%)). Conclusions: Moderate to severe pain is commonly encountered among patients receiving cancer care in the clinic setting. Increasing the proportion of patients achieving a PPG is a critical quality and patient satisfaction goal, and may be improved by creating a pain plan incorporating a long-acting opioid. Our QI intervention aims to improve pain assessment documented in the EMR and educate both patients and staff regarding appropriate pain management. [Table: see text]

scholarly journals Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care

2018 ◽  
Vol 36 (4) ◽  
pp. 333-338
Author(s):  
Hannah Major-Monfried ◽  
Linda V. DeCherrie ◽  
Ania Wajnberg ◽  
Meng Zhang ◽  
Amy S. Kelley ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Pain Management ◽  
Severe Pain ◽  
Psychosocial Care ◽  
Symptom Burden ◽  
Chronically Ill ◽  
Assessment System ◽  
Home Based ◽  
Study Population

Background: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound. Objective: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program. Design/Measurements: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment. Results: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period. Conclusions: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.

scholarly journals Cancer-Related Pain Management and the Optimal Use of Opioids

2015 ◽  
Vol 28 (3) ◽  
pp. 376 ◽  
Author(s):  
Paulo Reis-Pina ◽  
Peter G. Lawlor ◽  
António Barbosa
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Medical Management ◽  
Pain Control ◽  
Severe Pain ◽  
Malignant Disease ◽  
Healthcare Professionals ◽  
Medical Practitioner ◽  
Opioid Analgesics ◽  
Clinical Recommendations

<p>Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics – by a registered medical practitioner for absolute pain control – is a legitimate practice. In this article we look at patients’ fears and physicians’ general<br />hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.</p>

Sign in / Sign up

Export Citation Format

Share Document