scholarly journals How to think about pain with the whole person in mind

2022 ◽  
Vol 9 (1) ◽  
pp. 38-39
Author(s):  
Timothy H. Wideman ◽  
Peter Stilwell

Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience. This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.

2011 ◽  
Vol 97 (1) ◽  
pp. 10-15 ◽  
Author(s):  
Gretchen P. Kenagy ◽  
Barbara S. Schneidman ◽  
Barbara Barzansky ◽  
Claudette E. Dalton ◽  
Carl A. Sirio ◽  
...  

ABSTRACT Physician reentry to clinical practice is fast becoming recognized as an issue of central importance in discussions about the physician workforce. While there are few empirical studies, existing data show that increasing numbers of physicians take a leave of absence from practice at some point during their careers; this trend is expected to continue. The process of returning to clinical practice is coming under scrutiny due to the public's increasing demand for transparency regarding physician competence. Criteria for medical licensure often do not include an expectation of ongoing clinical activity. Physicians who maintain a license but do not practice for a period of time, therefore, may be reentering the workforce with unknown competency to practice. This paper: (1) presents survey data on current physician reentry policies of state medical boards; (2) discusses the findings from the survey within the context of regulatory challenges that impact physician-reentry; and (3) offers recommendations to facilitate the development of comprehensive, coordinated regulatory policies on physician reentry.


2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vanitha Arumugam ◽  
Joy C. MacDermid ◽  
Dave Walton ◽  
Ruby Grewal

Abstract Introduction PAIN+ and PubMed are two electronic databases with two different mechanisms of evidence retrieval. PubMed is used to “Pull” evidence where clinicians can enter search terms to find answers while PAIN+ is a newly developed evidence repository where along with “Pull” service there is a “Push” service that alerts users about new research and the associated quality ratings, based on the individual preferences for content and altering criteria. Purpose The primary purpose of the study was to compare yield and usefulness of PubMed and PAIN+ in retrieving evidence to address clinical research questions on pain management. The secondary purpose of the study was to identify what search terms and methods were used by clinicians to target pain research. Study design Two-phase double blinded randomized crossover trial. Methods Clinicians (n = 76) who were exposed to PAIN+ for at least 1 year took part in this study. Participants were required to search for evidence 2 clinical question scenarios independently. The first clinical question was provided to all participants and thus, was multi-disciplinary. Participants were randomly assigned to search for evidence on their clinical question using either PAIN+ or PubMed through the electronic interface. Upon completion of the search with one search engine, they were crossed over to the other search engine. A similar process was done for a second scenario that was discipline-specific. The yield was calculated using number of retrieved articles presented to participants and usefulness was evaluated using a series of Likert scale questions embedded in the testing. Results Multidisciplinary scenario: Overall, the participants had an overall one-page yield of 715 articles for PAIN+ and 1135 articles for PubMed. The topmost article retrieved by PAIN+ was rated as more useful (p = 0.001). While, the topmost article retrieved by PubMed was rated as consistent with current clinical practice (p = 0.02). PubMed (48%) was preferred over PAIN+ (39%) to perform multidisciplinary search (p = 0.02). Discipline specific scenario: The participants had an overall one-page yield of 1046 articles for PAIN+ and 1398 articles for PubMed. The topmost article retrieved by PAIN+ was rated as more useful (p = 0.001) and consistent with current clinical practice (p = 0.02) than the articles retrieved by PubMed. PAIN+ (52%) was preferred over PubMed (29%) to perform discipline specific search. Conclusion Clinicians from different disciplines find both PAIN+ and PubMed useful for retrieving research studies to address clinical questions about pain management. Greater preferences and perceived usefulness of the top 3 retrieved papers was observed for PAIN+, but other dimensions of usefulness did not consistently favor either search engine. Trial registration Registered with ClinicalTrials.gov Identifier: NCT01348802, Date: May 5, 2011.


Author(s):  
Martha Mherekumombe ◽  
John J. Collins

Persistent pain in childhood and medical illness can be challenging to manage. The chapter has been revised to give a brief overview of the approach to pain management in some childhood diseases. Better understanding of the etiology of pain mechanisms guide the management of pain. In addition, an understanding of the pathophysiology of the underlying processes and utilizing a stepwise assessment and treatment approach is important. Discussion around the multifaceted approach to childhood pain management incorporating the understanding of the role and place of analgesics in managing these medical illnesses is outline. In addition, appropriate medication or analgesia prescription and the role of nonpharmacological approaches has been considered in this revision.


Author(s):  
Francisco A. Loaiciga ◽  
Suresh Reddy

Pain has been a major concern in both inpatient and outpatient settings, particularly in patients with advanced diseases. In recent years, considerable progress has been made in the understanding of both acute and chronic pain mechanisms. The bio psychosocial experience of pain, whether it is a mixture or a single presentation of it’s different components, physical, psychological, social, or spiritual, may present a real challenge to both the patient and the treating team, and thus a clear understanding of it’s complexity, is of prime importance. Effective pain management involves an interdisciplinary approach using multimodal techniques, with the goal being to relieve the patient’s suffering. This chapter discusses basic concepts related to pain and its approach in routine palliative care practice.


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