scholarly journals An Interprofessional Approach to Chronic Pain Management and Education

2022 ◽  
Vol 54 (1) ◽  
pp. 47-53
Author(s):  
Nida S. Awadallah ◽  
Vanessa Rollins ◽  
Alvin B. Oung ◽  
Miriam Dickinson ◽  
Dionisia de la Cerda ◽  
...  

Background and Objectives: The opioid epidemic highlights the importance of evidence-based practices in the management of chronic pain and the need for improved resident education focused on chronic pain treatment and controlled substance use. We present the development, implementation, and outcomes of a novel, long-standing interprofessional safe prescribing committee (SPC) and resulting policy, protocol, and longitudinal curriculum to address patient care and educational gaps in chronic pain management for residents in training. Methods: The SPC developed and implemented an opioid prescribing policy, protocol, and longitudinal curriculum in a single, community-based residency program. We conducted a postcurriculum survey for resident graduates to assess impact of knowledge gained. We conducted a retrospective chart review for patients on chronic opioid therapy to assess change in morphine equivalent dosing (MED) and pain scores pre- and postintervention. Results: A postcurriculum survey was completed by 20/26 (77%) graduates; 18/20 (90%) felt well-equipped to manage chronic pain based on their residency training experience. We completed a retrospective chart review on 57 patients. We found a significant decrease in MED (-20.34 [SE 5.12], P<.0001) at intervention visit with MED reductions maintained through the postintervention period (-9.43 per year additional decrease [SE 5.25], P=.073). We observed improvement in postintervention pain scores (P=.017). Conclusions: Our study illustrates the effectiveness of an interprofessional committee in lowering prescribed opioid doses and enhancing chronic pain education in a community-based residency setting.

2021 ◽  
pp. 084456212110477
Author(s):  
Jodi Wilding ◽  
Hailey Scott ◽  
Victoria Suwalska ◽  
Zarina Geddes ◽  
Carolina Lavin Venegas ◽  
...  

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. Methods Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) – post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. Results At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. Conclusion No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.


PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S290-S291
Author(s):  
Phuong Q. Tien ◽  
Ake Evans ◽  
Matt Root ◽  
Francis P. Lagattuta ◽  
Winston F. Montero ◽  
...  

2019 ◽  
Author(s):  
Jason Wilhelm

Pain after surgery is one of greatest complaints patients have in the surgical process. It is important to decrease pain after surgery to promote a quicker recovery and minimize complications. Opioids alone have been used to manage post-operative pain in cardiac surgery; However, recently multimodal approaches to pain management are now being explored. This approach involves using multiple medications with varying mechanisms of action for pain relief in addition to decreased adverse effects. Ofirmev (IV acetaminophen) is a relatively new medication for use in cardiac surgery that has few contraindications and side effects. The purpose of this study was to investigate if utilizing the current pain management approach in addition to Ofirmev impacted pain scores in post-operative cardiothoracic patients in a non-experimental retrospective chart review. A two group comparative chart review was conducted for a total of 30 charts to meet inclusion criteria. Group 1 (n=15) received opioid only for pain management were compared to Group 2 (n=15) who received Ofirmev and opioids for pain management after cardiac surgery. Results showed that pain scores at hour 6 and 24 showed significance in favor of Group 2, the Ofirmev group. Results also showed Group 2, the Ofirmev group, consumed less morphine on average than Group 1, opioid only. Unexpectedly, length of stay was on average longer for the Ofirmev group than the non- ofirmev group. The research supports the need to utilize multimodal pain management and alternative techniques to manage pain. This study shows there is a need for further research for pain management with a multimodal approach in cardiac surgery.


2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 405-412
Author(s):  
Alaa Abd-Elsayed

Background: This study describes the use of transversus abdominis plane (TAP) blocks to treat and manage chronic abdominal pain (CAP) in patients who have exhausted other treatment options. Typically, this is a procedure prescribed for treating acute abdominal pain following abdominal surgery. Here we evaluate the use of TAP blocks for longer relief from CAP. Objectives: To assess the efficacy of TAP blocks for pain control in patients with CAP. Study Design: This was a retrospective chart review and analysis of TAP blocks performed over 5 years. This project qualified for institutional review board exemption. Setting: This study was completed at an academic institution. Methods: We reviewed the charts of 92 patients who received TAP blocks for CAP after previous treatment was ineffective. Some patients underwent multiple TAP blocks, with a total of 163 individual procedures identified. For most blocks, a solution of 0.25% bupivacaine and triamcinolone was injected into the TAP. Efficacy of the injection was measured using pain scores, percent improvement, and duration of relief from pain. Results: TAP blocks were associated with a statistically significant (P ≤ 0.05) improvement in abdominal pain scores in 81.9% of procedures. Improvement was 50.3% ± 39.0% with an average duration of 108 days after procedures with ongoing pain relief at time of follow-up were removed. There was a significant reduction in emergency department visits for abdominal pain before and after the procedure (P ≤ 0.05). Limitations: This was a retrospective chart review with lack of a control group. Conclusions: TAP blocks can be extrapolated for treating abdominal pain beyond acute settings. TAP injections can be considered as a treatment option for patients with somatosensory CAP refractory to other forms of pain management. Key words: Abdominal pain, transversus abdominis plane block, chronic pain, chronic abdominal pain, pain management, somatosensory pain, transversus abdominis plane, steroid injection


2019 ◽  
Vol 2 (1) ◽  
pp. 102-104
Author(s):  
Bigen Man Shakya ◽  
Ninadini Shrestha ◽  
Binita Acharya ◽  
Anil Shrestha ◽  
Renu Gurung ◽  
...  

Erector Spinae Block is a paraspinal musculofascial plane block where we inject local anesthetics superficial to the tip of the transverse processes and deep to the erector spinae muscle .It works at the origin of spinal nerves based on cadaveric and contrast study. It is effective and safe regional anesthetic technique. It has a wide variety of applications ranging from acute postoperative pain treatment to chronic pain management. In this series, we report a series of two cases, which include postoperative pain management in Partial Nephrectomy and chronic pain management in Post Herpetic Neuralgia. Keywords: Analgesia; erector spinae block; regional.


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