scholarly journals An Overview of Pain Management

2005 ◽  
Vol 91 (2) ◽  
pp. 20-30
Author(s):  
June L. Dahl
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Public Health Problem ◽  
The United States ◽  
Basic Knowledge ◽  
Rational Approach ◽  
Major Public Health Problem ◽  
Pharmacologic Treatments ◽  
Control Pain

ABSTRACT In spite of major advances in pain management practices, the undertreatment of pain remains a major public health problem in the United States. A basic knowledge of pain assessment and management is critical to removing the barriers that are responsible for poor pain control. Pain assessment is the essential first step in the management of any type of pain as it guides the development of a rational approach to treatment. Pharmacologic therapies are often essential to successful pain management. Three major classes of pain medications are available: non-opioids, opioids, and adjuvant analgesics for special pain problems. This paper provides an overview of the various drugs in each of these classes as well as recommendations to guide their use. The goal of therapy is to reduce pain and improve function. A comprehensive approach to pain management should be based on the use of multimodal therapy, rational combinations of pharmacologic and non-pharmacologic treatments.

Bronchopulmonary Dysplasia: Pharmacologic Treatments and Prediction of Outcome

1991 ◽  
Vol 7 (S1) ◽  
pp. 61-65
Author(s):  
William E. Truog
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Newborn Infants ◽  
Public Health Problem ◽  
The United States ◽  
Major Public Health Problem ◽  
Prediction Of Outcome ◽  
Live Births ◽  
Pharmacologic Treatments ◽  
Progressive Disorder

Bronchopulmonary dysplasia (BPD) is a progressive disorder of the lungs of newborn infants initially involving distal airways, but followed in weeks by the development of abnormalities in all parts of the lung architecture. BPD develops primarily but not exclusively in premature infants. The incidence in the general population has never been assessed accurately in a prospective manner. One retrospectively calculated incidence figure is 1.2 infants per 1,000 total live births per year in the United States (17). With approximately 4 million births annually in North America, there are about 5,000 babies each year who develop BPD. The additional weeks, months, and, in some cases, years of hospitalization, the frequent rehospitalizations, and the mortality of 20–50% beyond 1 month of age (17) underscore the disproportionate financial and emotional toll of BPD not only on patients and families but caregivers as well. The glacial rates of improvement in the illness, the frequent setbacks, and the profound disruption to family life all support the contention that BPD is a major public health problem.

scholarly journals Deadly Gun Violence, Neighborhood Collective Efficacy, and Adolescent Neurobehavioral Outcomes

2021 ◽  
Author(s):  
Arianna M Gard ◽  
Jeanne Brooks-Gunn ◽  
Sara McLanahan ◽  
Colter Mitchell ◽  
Christopher S. Monk ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Stress Responses ◽  
Social Ties ◽  
Physiological Stress ◽  
Public Health Problem ◽  
The United States ◽  
Gun Violence ◽  
Major Public Health Problem ◽  
Community Factors ◽  
Neighborhood Collective Efficacy

Gun violence is a major public health problem and costs the United States $280 billion annually (1). Although adolescents are disproportionately impacted (e.g., via premature death), we know little about how close adolescents live to deadly gun violence incidents and whether such proximity impacts their socioemotional development (2–4). Moreover, gun violence is likely to shape youth developmental outcomes through biological processes – including functional connectivity within regions of the brain that support emotion processing, salience detection, and physiological stress responses – though little work has examined this hypothesis. Lastly, it is unclear if strong neighborhood social ties can buffer youth from the neurobehavioral effects of gun violence. Within a nationwide birth cohort of 3,444 youth (56% Black, 24% Hispanic) born in large U.S. cities, every additional exposure to a deadly gun violence incident within 500 meters of home in the prior year increased behavioral problems by 7.7%, even after accounting for area-level crime and socioeconomic resources. Incidents that occurred closer to a child’s home exerted larger effects, and stronger neighborhood social ties offset these associations. In a neuroimaging subsample (N = 164) of the larger cohort, exposure to more incidents of gun violence and weaker social ties were associated with weaker amygdala-prefrontal functional connectivity during socioemotional processing, a pattern previously linked to less effective emotion regulation. Results provide spatially-sensitive evidence for gun violence effects on adolescent behavior, a potential mechanism through which risk is biologically-embedded, and ways in which positive community factors offset ecological risk.

scholarly journals Postoperative Pain and Opioid Use Following Surgical Treatment of Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Matthew Pate ◽  
Jacob Hall ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Ankle Fracture ◽  
Management Practices ◽  
Opioid Analgesic ◽  
The United States ◽  
Ankle Fractures ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Opioid Medication

Category: Ankle, Bunion, Trauma Introduction/Purpose: Chronic opioid abuse is one of the greatest public health challenges in the United States. The most common first exposure to opioids comes from acute care prescriptions, such as those after surgery. Moreover, opioids are often prescribed excessively, with current estimates suggesting ˜75% of the pills prescribed are unused. Ankle fractures are the most common operatively treated fracture in orthopaedic surgery, and management of acute pain following surgery is challenging. The optimal perioperative pain regimen is still a point of controversy, as there is limited data available regarding appropriate amount of opioid to prescribe. This study evaluates opioid prescribing techniques of multiple foot and ankle surgeons, and associated patient outcomes. We aim to help surgeons improve their pain management practices and to limit opioid overprescription. Methods: Chart review and phone survey were performed on forty two adult patients within three to six months of ankle fracture fixation at our institution. These patients were offered to voluntarily participate in a standardized questionnaire regarding pain scores, opioid use, non-opioid analgesic use, pain management satisfaction, and patient prescription education. Results: 57% of patients reported that they were given “more” or ”much more” opioid medication than needed, 38% stated that they were given the “right amount”, and 5% reported that they were given ”less” or “much less” than needed. 40.0% were on opioids prior to operation. 53.5% did not require refill of discharge opioid prescriptions, 30.2% of patients did not fill any posteroperative opioid prescription. 16.3% of patients filled their discharge prescription and at least one additionall refill (mean refill = 2.22). Mean number of reported opioid pills taken after surgery was 17.4. Mean satisfaction with overall pain management at phone follow up was 8.6/10. Conclusion: While postoperative pain and management vary substantially, a majority of patients feel that they are given more opioid medication than necessary following ankle fracture repair, and a majority of opioid prescriptions are not completely used. Going forward, it is likely that a majority of patients could experience the same beneficial results with less prescription opioid pain medication, which would reduce overpresciption and potential misuse.

scholarly journals 302 Current pain mitigation practices in beef and dairy cattle in the United States

2019 ◽  
Vol 97 (Supplement_3) ◽  
pp. 2-2
Author(s):  
Elizabeth C Johnstone ◽  
Johann Coetzee ◽  
Lily Edwards-Callaway ◽  
Pablo Pinedo
Keyword(s):  
United States ◽  
Pain Management ◽  
Management Practices ◽  
The United States ◽  
Management Options ◽  
Adult Cattle ◽  
Analgesic Drugs ◽  
On Line ◽  
Analgesic Use ◽  
Pain Mitigation

Abstract The lack of FDA-approved analgesic drugs for use in cattle in the United States offers limited pain management options to cattle veterinarians and producers. An on-line survey was developed to investigate current use of pain mitigation by cattle veterinarians and producers. The survey was distributed electronically to multiple listservs in Summer 2018 (BEEF Magazine, American Association of Bovine Practitioners, National Milk Producers Federation Farmers Assuring Responsible Management evaluators, Dairy Moms and Dairy Girls Facebook groups; n = 46,577). A total of 1,187 (2.5%) surveys were received; 41.9% of respondents identified as producers, 47.9% as veterinarians, and 10.2% as both. Multivariate logistic regression was used for analysis. Veterinarians [OR (95% CI) = 10.2 (7.21–14.4)] and both veterinarians and producers [OR (95% CI) = 3.30 (2.02–5.39)] had significantly greater odds of using analgesia than producers in all cattle ages. Summary statistics indicate that analgesic use increased with cattle age; 57.6% of respondents used pain management in calves < 2 months of age, while 71.6% of respondents used pain management in adult cattle (>12 months of age). Respondents agreed that “cattle benefit from receiving analgesic drugs” (76.6%) and that “US/USDA/FDA regulations limit my ability to use analgesic drugs in cattle” (64.01%). Fifty-eight percent of respondents indicated their use of pain management had increased in the last 10 years. Data identify impediments to improving pain management practices in cattle. Results indicate the need for education and communication between veterinarians and producers on the necessity of pain management.

Approaches Used by Employee Assistance Programs to Address Perpetration of Intimate Partner Violence

2012 ◽  
Vol 27 (2) ◽  
pp. 135-147 ◽  
Author(s):  
Jennifer L. Hardison Walters ◽  
Keshia M. Pollack ◽  
Monique Clinton-Sherrod ◽  
Christine H. Lindquist ◽  
Tasseli McKay ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Work Performance ◽  
Public Health Problem ◽  
The United States ◽  
Intimate Partner ◽  
Employee Assistance Programs ◽  
Major Public Health Problem ◽  
Employee Assistance ◽  
Assistance Programs

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs—even when interacting with employees who present with issues known to correlate with IPV—are missing a potential opportunity to assess and intervene with IPV perpetrators.

scholarly journals Barriers perceived by nurses in the optimal treatment of postoperative pain

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 239-246 ◽  
Author(s):  
Wioletta Medrzycka-Dabrowka ◽  
Sebastian Dąbrowski ◽  
Aleksandra Gutysz-Wojnicka ◽  
Aleksandra Gawroska-Krzemińska ◽  
Dorota Ozga
Keyword(s):  
Pain Management ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Management Practices ◽  
National Level ◽  
University Hospital ◽  
Municipal Hospital ◽  
Post Operative Pain ◽  
Polish Version ◽  
The University

AbstractIt is currently estimated that the lack of adequate pain management affects 80% of the global population and the phenomenon poses a serious problem in more than 150 countries. On a national level, the greatest burden of inadequate treatment is borne, among others, by elderly patients. The purpose of the paper was to compare the prevalence of barriers to optimum post-operative pain management in elderly patients, observed by nurses in a clinical, provincial and municipal hospital in Poland. The research project was a multi-center one and took over a year. The study was questionnaire-based. It used the Polish version of the Nurses’ Perceived Obstacles to Pain Assessment and Management Practices questionnaire. The study included a total of 1602 nurses working at a clinical, provincial and municipal hospital.In the university hospital, difficulties in pain assessment related to the healthcare system occurred statistically significantly more often.

Technologies to Detect Concealed Weapons: Fourth Amendment Limits on a New Public Health and Law Enforcement Tool

2003 ◽  
Vol 31 (4) ◽  
pp. 567-579 ◽  
Author(s):  
Jon S. Vernick ◽  
Matthew W. Pierce ◽  
Daniel W. Webster ◽  
Sara B. Johnson ◽  
Shannon Frattaroli
Keyword(s):  
Public Health ◽  
United States ◽  
Public Health Problem ◽  
The United States ◽  
Major Public Health Problem ◽  
Public Places ◽  
New Public Health ◽  
Gun Carrying ◽  
New Public ◽  
The Social

Firearm violence is a major public health problem in the United States. In 2000, firearms were used in 10,801 homicides – two-thirds of all homicides in the U.S. – and 533,470 non-fatal criminal victimizations including rapes, robberies, and assaults. The social costs of gun violence in the United States are also staggering, and have been estimated to be on the order of $100 billion per year.Illegal gun carrying, usually concealed, in public places is an important risk factor for firearm-related crime. In the 1980s and 1990s, police departments across the country began to develop and implement strategies to address illegal weapons carrying. Often these strategies have involved aggressive efforts to identify and physically search individuals suspected of illegally carrying a firearm.

scholarly journals Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

2012 ◽  
Vol 17 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Lisa M Zhu ◽  
Jennifer Stinson ◽  
Lori Palozzi ◽  
Kevin Weingarten ◽  
Mary-Ellen Hogan ◽  
...  
Keyword(s):  
Pain Management ◽  
Knowledge Translation ◽  
Clinical Outcomes ◽  
Pain Assessment ◽  
Management Practices ◽  
Audit And Feedback ◽  
Opioid Administration ◽  
Pain Outcomes ◽  
Pain Prevalence ◽  
The Impact

BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.OBJECTIVES: To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.METHODS: Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.RESULTS: Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.CONCLUSIONS: Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.

scholarly journals Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Cross-Sectional Study

2020 ◽  
Author(s):  
Godfred Boakye ◽  
Adam Gyedu ◽  
Melissa Stewart ◽  
Peter Donkor ◽  
Charles Mock ◽  
...  
Keyword(s):  
Supply Chain ◽  
Resource Availability ◽  
Trauma Care ◽  
Management Practices ◽  
Low Cost ◽  
The United States ◽  
Major Public Health Problem ◽  
Stock Management ◽  
Low Resource ◽  
High Resource

Abstract Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, we study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care.Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability.Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34).Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals

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