scholarly journals Evaluation of Prescribing and Administering As-Needed Pain Medications Based on Pain Severity Scores

2021 ◽  
Vol 12 (3) ◽  
pp. 19
Author(s):  
Jenna Stearns ◽  
Christine Cortese ◽  
Jennifer Remington ◽  
Nirav Patil
Keyword(s):  
Pain Management ◽  
Management Practices ◽  
General Medicine ◽  
Pain Severity ◽  
Common Symptom ◽  
Chi Square ◽  
Pain Medications ◽  
Severity Scores ◽  
Significant Difference ◽  
Patient Reported

Pain is a common symptom reported by patients admitted to hospitals in both medical and surgical units. Due to the subjective and multidimensional nature of pain, it should be assessed regularly to ensure patient pain control. Suboptimal prescribing of opioids and other pain medications contribute to the inadequate treatment of pain. To combat the wide variability and response to pain medications, many providers prescribe as-needed range orders of pain medications to cover each pain severity. These range orders enable necessary and safe adjustments in dose based on individual responses to treatment. Currently, there are no studies analyzing the prescribing of pain medications based on pain severity, leaving a gap in literature in inpatient pain management. The purpose of this retrospective cohort study was to evaluate the appropriateness of prescribing as-needed pain medications based on the patient’s pain severity scores throughout their hospital stay at a 125-bed community hospital in Northeast Ohio on the general medicine floor. Secondarily, this study also evaluated the administration of pain medications by nursing staff based on patient-reported pain severity scores. Statistical analyses including Chi-square tests, t-tests, Fisher’s Exact tests and descriptive statistics were utilized to determine the significance of the data collected. This study found that there was a statistically significant difference between appropriately (47.4%) and inappropriately (52.6%) prescribed pain medications (P<0.001). There was also a statistically significant difference between appropriately (40.5%) and inappropriately (59.5%) administered pain medications (P<0.001). Pharmacists hope to improve pain management practices by providing education to both providers and nurses to prevent poor patient outcomes and uncontrolled pain.

scholarly journals The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
pp. 205435812199399
Author(s):  
Sara N. Davison ◽  
Sarah Rathwell ◽  
Sunita Ghosh ◽  
Chelsy George ◽  
Ted Pfister ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Chronic Pain ◽  
Pain Management ◽  
Meta Analysis ◽  
Pain Severity ◽  
Chronic Pain Management ◽  
Dialysis Patients ◽  
Severity Scores ◽  
The Mean

Background: Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD. Objectives: To determine the prevalence and severity of chronic pain in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported. Results: Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates. Limitations: Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain. Conclusions: Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided. Trial registration: PROSPERO Registration number CRD42020166965

scholarly journals Interpreting the Meaning of Pain Severity Scores

2002 ◽  
Vol 7 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Marilyn J Hodgins
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Health Care Professionals ◽  
Pain Measurement ◽  
Management Practices ◽  
Care Organization ◽  
Treatment Goals ◽  
Severity Scores ◽  
Measurement Tools ◽  
The Impact

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.

scholarly journals Prevalence and Management of Dysmenorrhea Among Secondary School Adolescents in Enugu State, Nigeria

2020 ◽  
Author(s):  
Amaka Onu ◽  
Deborah Aluh ◽  
Michael Ikehi
Keyword(s):  
Management Practices ◽  
Common Symptom ◽  
Management Options ◽  
Cross Sectional ◽  
Gynecological Disorders ◽  
Menstrual Symptoms ◽  
Significant Difference ◽  
The Mean ◽  
Enugu State ◽  
Descriptive Survey

Abstract Background: Dysmenorrhea is reported to be among the most common gynecological disorders worldwide. The current study aimed to determine the prevalence and management practices for dysmenorrhea among adolescent school girls in Nigeria. The study also aimed to determine the predictors for choosing a management option for dysmenorrhea.Methods: The study was a cross-sectional descriptive survey conducted in five conveniently selected secondary schools (high schools) in Enugu State. A 12-item questionnaire including a Visual Analog Scale was used to collect data. All data were analyzed using SPSS with significance set at p<0.05.Results: A total of 1,486 survey questionnaires were completed (88.45% response rate). The mean age of the study respondents was 15.26±1.517. The prevalence of dysmenorrhea was 51.1%. There was a significant difference (t =-6.299, p < 0.001) between the ages of the dysmenorrheic girls (15.50±1.466) and the ages of girls who were not dysmenorrheic (15.01±1.529). The mean age of Menarche was 12.64±1.450. Pain in the waist was the most common symptom reported among the respondents (57.4%, n = 853). More than one-third of the respondents reported that they take OTC medications for menstrual symptoms (31.8%, n = 472). Age and severity of dysmenorrhea significantly predicted the likelihood of taking a pharmacological agent for dysmenorrhea.Conclusion: Younger females were more likely to do nothing about menstrual pain. There is a need for adolescents to be educated on the safety and efficacy of different management options for dysmenorrhea early.

scholarly journals The Effectiveness of Dialectical Behavior Therapy on Sleep Quality and Pain Management in Multiple Sclerosis

2020 ◽  
Vol 6 (4) ◽  
pp. 205-213
Author(s):  
Marie Abdolghaderi ◽  
◽  
Mohammad Narimani ◽  
Akbar Atadokht ◽  
Abbas Abolghasemi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pain Management ◽  
Sleep Quality ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Common Symptom ◽  
Significant Difference ◽  
And Control

Background: Pain can interfere with the daily functioning of patients with Multiple Sclerosis (MS). Furthermore, sleep disturbance is a common symptom of MS. The dialectical behavior therapy program is presented as a detailed structured treatment program that was demonstrated that has effects on the treatment of psychosomatic disorders such as pain and sleep disorders. Objectives: To investigate the effectiveness of dialectical behavior therapy on sleep quality and pain management in patients with MS. Materials & Methods: This research has been carried out as a quasi-experimental with pretest, posttest, and a control group. A total of 24 people were selected through a convenient sampling method from the patients of the MS-Society of Guilan Province, Iran. Then, they are randomly divided into 2 equal groups (experimental and control). The study data were collected through Pittsburgh sleep quality scale and pain self-efficacy questionnaires. The intervention process was performed for the experimental group as 8 training sessions of 90 minutes long. The obtained data were analyzed by univariate analysis of covariance and multivariate analysis of covariance in SPSS v. 24. Results: The results showed a significant difference between the experimental and control groups in terms of pain management (F=4.04) and sleep quality (F=5.64) (P<0.05) and dialectical behavior therapy had a significant statistical effect on sleep quality and pain management. Conclusion: Based on these findings, dialectical behavior therapy can be used to improve the quality of sleep and manage pain in patients with MS.

scholarly journals LO33: External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomized controlled non-inferiority trial

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S19
Author(s):  
A. Ballard ◽  
C. Khadra ◽  
S. Adler ◽  
E. Parent ◽  
E. D. Trottier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Management Practices ◽  
Mean Difference ◽  
Procedural Pain ◽  
Topical Anesthetic ◽  
Promising Alternative ◽  
Require Time ◽  
Randomized Controlled ◽  
Significant Difference

Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery

2020 ◽  
pp. 019459982095280
Author(s):  
Amarbir S. Gill ◽  
Farrukh R. Virani ◽  
Joshua C. Hwang ◽  
Machelle D. Wilson ◽  
Angela M. Beliveau ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Wilcoxon Test ◽  
Opioid Use ◽  
Chi Square ◽  
Vas Score ◽  
Significant Difference ◽  
Patient Reported ◽  
Chi Square Test ◽  
Sinonasal Outcome Test ◽  
The Mean

Objective To determine the efficacy of preoperative gabapentin on patient-reported pain levels and postoperative opioid requirements following sinonasal surgery. Study Design Retrospective review. Setting Academic institution. Methods Patients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi-square test and Wilcoxon test were used for data analysis. Results Fifty-seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test–22 scores between the groups. The total MED, postoperative day (POD) 1-2 MED, POD 3-4 MED, and POD 5-6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups ( P = .98, .25, .16, .44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups ( P = .81). The mean daily VAS score decreased significantly in both groups with each successive POD ( P = .004). Conclusion Preoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.

Abstract 3: Association of Video- vs. Text-Based Informed Consent With Multicenter Registry Enrollment

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Alexander C Fanaroff ◽  
Shuang Li ◽  
Vincent Miller ◽  
Laura Webb ◽  
Ann Marie Navar ◽  
...  
Keyword(s):  
Informed Consent ◽  
Management Practices ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Chi Square ◽  
Lipid Management ◽  
Significant Difference ◽  
Activation Times ◽  
Multicenter Registry

Background: Low patient participation in clinical research undermines the generalizability of findings. Conducting informed consent by video rather than a traditional text format may enhance the appeal of research and break down barriers to participation. Methods: The Patient and Provider Assessment of Lipid Management (PALM) Registry enrolled patients at U.S. cardiology, endocrinology, and primary care clinics to evaluate cholesterol management practices. PALM investigators developed an iPad-based video informed consent tool that included video segments totaling 8 minutes which patients navigated though a “game-ified” interface. At sites whose IRB did not approve the video tool, participants read a 6-page text consent form on the iPad. Characteristics of sites and site activation times were compared between sites that did and did not use the video consent tool using Pearson’s chi-square test for categorical variables and Wilcoxon’s signed rank test for continuous variables. Results: Of 140 sites that enrolled 7904 patients in PALM, 60 (42.9%) used the video informed consent tool. Compared with sites using text consent, sites using the video consent tool were more often rural (16.7 vs. 3.8%, p = 0.01) and used a central IRB (91.7 vs. 80.0%, p = 0.06). Sites using video consent enrolled a greater proportion of patients who were ≥ 75 years old (27.5 vs. 23.6%, p < 0.001) or non-white (17.7 vs. 14.2%, p < 0.001). Sites using video consent had shorter times from site approach to first patient enrollment ( Figure ). Median (IQR) enrollment was 33 (12, 98) patients at sites using video consent versus 24 (12, 86) at sites using text consent only (p = 0.54); there was also no significant difference in median weekly enrollment rate (2.9 [1.1, 7.5] vs. 2.8 [1.3, 6.6], p = 0.73). Conclusions: In this early experience with video consent in a multicenter registry, availability of video informed consent was associated with greater enrollment of older and non-white patients, faster speed to first patient enrolled, and numerically but not significantly more rapid enrollment compared with text informed consent.

scholarly journals Prevalence of Neuropathic Pain and Related Characteristics in Hidradenitis Suppurativa: A Cross-Sectional Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4046
Author(s):  
Simone Garcovich ◽  
Simona Muratori ◽  
Chiara Moltrasio ◽  
Agata Alba Buscemi ◽  
Giulia Giovanardi ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Hidradenitis Suppurativa ◽  
Specific Treatment ◽  
Cross Sectional Study ◽  
Pain Severity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Patient Reported ◽  
Reported Data

Background: Pain is a core symptom of hidradenitis suppurativa (HS) and is of complex, multifactorial origin. HS patients frequently report typical neuropathic pain qualities, but its prevalence has been poorly described. Methods: In this cross-sectional study, we examine the prevalence of neuropathic pain (NP) component and related pain-characteristics of a hospital-based cohort of patients with symptomatic HS. We administered the pain-DETECT tool (PDQ), a validated screening tool for NP, collecting clinical and patient-reported data on pain, pruritus and pain-management. We obtained 110 complete datasets from symptomatic HS patients (49.1% females; Hurley I (27.3%])–II (45.5%)–III (27.3%)). According to the PDQ tool, 30% of patients were classified with a high probability (>90%) of neuropathic pain (LNP). LNP status was significantly associated with increased pain severity, disease activity, pruritus intensity and use of pain medication. Regression analysis showed a significant impact of the PDQ score on patient-reported outcomes, including pain severity and the dimensions of activity and affective pain interference. HS patients may present a mixed chronic pain phenotype with a neuropathic component, thus requiring additional pain-assessments. A multi-modal approach to pain management, in combination with disease-specific treatment, should be implemented in future interventional studies.

scholarly journals Survey of pain etiology, management practices and patient satisfaction in two urban emergency departments

CJEM ◽  
2002 ◽  
Vol 4 (04) ◽  
pp. 252-256 ◽  
Author(s):  
Knox H. Todd ◽  
Edward P. Sloan ◽  
Connie Chen ◽  
Stephen Eder ◽  
Kyle Wamstad
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Emergency Departments ◽  
Severe Pain ◽  
Management Practices ◽  
Rating Scale ◽  
Pain Severity ◽  
Pain Experiences ◽  
Median Rating ◽  
Analgesic Administration

ABSTRACT: Objective: The underuse of analgesics, or “oligoanalgesia,” is common in emergency departments (EDs). To improve care we must understand our patients’ pain experiences as well as our clinical practice patterns. To this end, we examined pain etiology, pain management practices and patient satisfaction in 2 urban EDs. Methods: We conducted a cross-sectional study using structured interviews and chart reviews for patients with pain who presented to either of 2 university-affiliated EDs. We assessed pain etiologies, patient pain experiences, pain management practices, and patient satisfaction with pain management. Results: The 525 study subjects reported high pain intensity levels on presentation, with a median rating of 8 on a 10-point numerical rating scale (NRS). At discharge, pain severity had decreased to a median rating of 4; however, 48% of patients were discharged from the ED in moderate to severe pain (NRS 5–10). Subjects reported spending 57% of their ED stay in moderate to severe pain. Analgesics were administered to only 50% of patients. The mean time to analgesic administration was almost 2 hours. Despite high levels of reported pain at discharge and low rates of analgesic administration, subjects reported high satisfaction with pain management. Conclusions: In the 2 EDs studied, we found high levels of pain severity for our patients, as well as low levels of analgesic use. When used, analgesic administration was often delayed. Despite these findings, patient satisfaction remained high. Despite recent efforts to improve pain management practice; oligoanalgesia remains a problem for our specialty.

Content Analysis of Single-dose Analgesics Dispensed by Attendants in Retail Drug Outlets in Obiaruku ,Delta State , Nigeria : A Surrogate-type Approach

2017 ◽  
Vol 3 (1) ◽  
pp. 20
Author(s):  
Adje U D ◽  
Eniojukan F J ◽  
Akpovwovwo E ◽  
Okinedo C P
Keyword(s):  
Single Dose ◽  
Pain Management ◽  
Management Practices ◽  
Ferrous Sulphate ◽  
Vitamin B ◽  
Cross Sectional ◽  
Significant Difference ◽  
Retail Outlets ◽  
Drug Therapy Problems ◽  
Patent Medicine

Abstract   Background Medicines can be potentially dangerous when used wrongly. This work examined drug combinations in pain management among attendants in retail drug outlets in  Obiaruku, Delta State, Nigeria.       Objectives The objective of this study was to describe drug combination in the management of pains by attendants working in community pharmacies and patent medicine shops (PMSs)         Method This was a cross-sectional descriptive study using the ‘’surrogate shopper’’ approach to explore the real day-to-day practices and extract required information in twelve retail drug outlets located in the study area. Conversations were tape recorded and thereafter composition of   single doses of pain relievers   recommended by attendants   were analyzed. Results A total of 12 retail outlets were visited. The average number of pills contained in a single dose pain reliever was 6.80±2.35 (for pharmacy outlets) and 5.33±1.32 (for PMSs), p>0.05. Piroxicam (14, 73.7%)   was   most frequently used NSAID. More than half,   63.2% of the attendants included single tablet of Prednisolone, 5mg in their pain relief combination. Other drugs not indicated for analgesia were included in the single dose combo. This includes Vitamin B complex (2, 10.5%), cod liver oil,   Sulfadoxine – pyrimetamine (1, 5.3%), Salbutamol and Ferrous sulphate (1, 5.3%) and multivitamin (12, 63.2%).There was no   significant difference in pain management practices between Pharmacies and Patent medicine stores (PMSs)   (p>0.05). Conclusion Polypharmacy and irrational use of NSAIDs was   a common practice among shop attendants in retail drug outlets, resulting in avoidable drug therapy problems and posing serious risk to public health.

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