Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

BMC Emergency Medicine ◽

10.1186/s12873-019-0260-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Pain Management ◽

Cross Sectional ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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The Relationship between Mental Health with the Level of Empathy Among Medical Students in Southern Thailand: A University-Based Cross- Sectional Study

Siriraj Medical Journal ◽

10.33192/smj.2021.108 ◽

2021 ◽

Vol 73 (12) ◽

pp. 832-840

Author(s):

Katti Sathaporn ◽

Jarurin Pitanupong

Keyword(s):

Mental Health ◽

Medical Students ◽

Protective Factor ◽

Cross Sectional Study ◽

Clinical Group ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Significant Difference ◽

High Level

Objective: To determine the level of and factors associated with empathy among medical students.Materials and Methods: This cross-sectional study surveyed all first- to sixth-year medical students at the Facultyof Medicines, Prince of Songkla University, at the end of the 2020 academic year. The questionnaires consisted of:1) The personal and demographic information questionnaire, 2) The Toronto Empathy Questionnaire, and 3) ThaiMental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathylevel were assessed via chi-square and logistic regression analyses.Results: There were 1010 participants with response rate of 94%. Most of them were female (59%). More than half(54.9%) reported a high level of empathy. There was a statistically significant difference in empathy levels betweenpre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). The assessment ofemotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic respondingscores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicatedthat female gender, pre-clinical training level, and minor specialty preference were factors associated with empathylevel. The protective factor that significantly improved the level of empathy was having fair to good mental health.Conclusion: More than half of the surveyed medical students reported a high level of empathy. The protective factorthat improved the level of empathy was good mental health. However, future qualitative methods, longitudinalsurveillance, or long-term follow-up designs are required to ensure the trustworthiness of these findings.

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Chronic pain among children with cerebral palsy attending a Ugandan tertiary hospital: a cross-sectional study

BMC Pediatrics ◽

10.1186/s12887-021-02928-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emma Nsalazi Bambi ◽

Angelina Kakooza Mwesige ◽

Hervé Monka Lekuya ◽

Philip Kasirye ◽

Richard Idro

Keyword(s):

Chronic Pain ◽

Cerebral Palsy ◽

Pain Management ◽

Classification System ◽

Behavioral Problem ◽

Cross Sectional Study ◽

Mulago Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Children With Cerebral Palsy

Abstract Background Children with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments. Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated. Methods A cross-sectional study of children with CP, aged 2–12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale. Results A total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were co- morbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFCS level IV & V, CFCS level IV & V, EDACS level IV & V, female children, and caretaker aged more than 30 years. Conclusions Two-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.

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Chronic pain among children with cerebral palsy attending a Ugandan hospital: a cross-sectional study

10.21203/rs.3.rs-256229/v1 ◽

2021 ◽

Author(s):

Emma Nsalazi Bambi ◽

Angelina Kakooza Mwesige ◽

Hervé Monka Lekuya ◽

Philip Kasirye ◽

Richard Idro

Keyword(s):

Chronic Pain ◽

Cerebral Palsy ◽

Pain Management ◽

Classification System ◽

Behavioral Problem ◽

Cross Sectional Study ◽

System Level ◽

Sectional Study ◽

Cross Sectional ◽

Children With Cerebral Palsy

Abstract Background: Children with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments.Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated.Methods: A cross-sectional study of children with CP, aged 2 – 12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale.Results: A total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were comorbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFC system level 4 & 5, CFCS level 4 & 5, EDACS level 4 & 5, female children, and caretaker aged more than 30 years.Conclusion: Two-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.

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Mental and Physical Health Correlates of Pain Treatment Utilization Among Veterans With Chronic Pain: A Cross-sectional Study

Military Medicine ◽

10.1093/milmed/usy235 ◽

2018 ◽

Vol 184 (3-4) ◽

pp. e127-e134 ◽

Cited By ~ 3

Author(s):

Kaitlin Harding ◽

Melissa A Day ◽

Dawn M Ehde ◽

Amanda E Wood ◽

Alisha McCall ◽

...

Keyword(s):

Chronic Pain ◽

Physical Health ◽

Pain Treatment ◽

Cross Sectional Study ◽

Treatment Utilization ◽

Sectional Study ◽

Cross Sectional ◽

Mental And Physical Health

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to pain management at the emergency department: a multicenter cross-sectional study

10.21203/rs.2.10155/v1 ◽

2019 ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Level Of Knowledge ◽

Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We carried out a prospective analytic cross-sectional study over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a 30-item structured questionnaire, data on the knowledge, attitudes, and practices of pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

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Knowledge, attitudes, and practices of Cameroonian physicians with regards to acute pain management in the emergency department: a multicenter cross-sectional study

10.21203/rs.2.10155/v2 ◽

2019 ◽

Author(s):

Paul Owono Etoundi ◽

Junette Arlette Metogo Mbengono ◽

Ferdinand Ndom Ntock ◽

Joel Noutakdie Tochie ◽

Dominique Christelle Anaba Ndom ◽

...

Keyword(s):

Emergency Department ◽

Pain Management ◽

Acute Pain ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Pain Management ◽

Cross Sectional ◽

Attitudes And Practices ◽

Level Of Knowledge ◽

Knowledge Attitudes And Practices

Abstract Introduction: Pain is the most frequent presenting complaint in patients consulting or admitted to the emergency department (ED). Thus, its acute management is often done by physicians working in the ED. These practitioners are often general practitioners and not emergency medicine physicians in resource-poor settings. Hence, a mastery of pain management by these physicians may be important in relieving acute pain. We aimed to assess the knowledge, to determine the attitudes and practices of physicians in the management of pain in EDs of Cameroon. Methods: We cross-sectional study carried out prospectively over four months in the year 2018. We enrolled all consenting physicians who were neither emergency medicine doctors nor anesthesiologists working at the EDs of five tertiary hospitals of Cameroon. Using a validated and pretested structured questionnaire, data on the knowledge, attitudes, and practices of acute pain management at the ED by these clinicians were studied. We used an externally validated score to assess the knowledge as either poor, insufficient, moderate or good. Results: A total of 58 physicians were included; 18 interns and 39 general practitioners. Their mean age was 28.6 ± 3 years and their average number of years of practice was 2.9 years. The level of knowledge was rated “poor” in 77.6% of physicians. Being a general practitioner was significantly associated with a poor level of knowledge (p=0.02; OR=5.1). We found a negative and significant correlation between knowledge and years of practice (p=0.04; r2= 0.06). More than three-quarter (82.8%) of participants used a pain scale to evaluate the severity of pain. The most used scale being the Visual Analog scale (56.9%). The most frequently used analgesic was paracetamol (98.3%), although only 3.5% of physicians correctly knew its half-life, delay of onset of action and duration of action. Conclusion: These findings suggest that physicians in EDs of Cameroon have poor knowledge and suboptimal practices in pain management. General practice and a greater number of professional experience seemed to favour these attitudes. Overall, there is an urgent need for refresher courses in acute pain management for physicians working in these resource-limited EDs.

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Predictors of effective management of acute pain in children within a UK ambulance service: a cross-sectional study

British Paramedic Journal ◽

10.29045/14784726.2019.12.4.3.58 ◽

2019 ◽

Vol 4 (3) ◽

pp. 58-59

Author(s):

Gregory Adam Whitley ◽

Pippa Hemingway ◽

Graham Richard Law ◽

Caitlin Wilson ◽

A. Niroshan Siriwardena

Keyword(s):

Pain Management ◽

Acute Pain ◽

Rating Scale ◽

Cross Sectional Study ◽

Ambulance Service ◽

Effective Management ◽

Sectional Study ◽

Cross Sectional ◽

Second Pain ◽

Clinical Records

Introduction: Pre-hospital pain management in children is poor, with very few children in pain receiving analgesia. Without effective pain treatment, children may suffer long-term changes in stress hormone responses and pain perception and are at risk of developing posttraumatic stress disorder. We aimed to identify predictors of effective management of acute pain in children in the pre-hospital setting.Methods: A retrospective cross-sectional study using electronic clinical records from one large UK ambulance service between 1 October 2017 and 30 September 2018 was performed using multi-variable logistic regression. We included all children < 18 years suffering acute pain. Children with a Glasgow Coma Scale of < 15, no documented pain or without a second pain score were excluded. The outcome measure was effective pain management (abolition or reduction of pain by ≥ 2 out of 10 using the numeric pain rating scale, Wong and Baker FACES® scale or Face, Legs, Activity, Crying and Consolability (FLACC) scale).Results: A total of 2312 patients were included for analysis. Median (IQR) age was 13 (9‐16), 54% were male and the cause of pain was trauma in 66% of cases. Predictors of effective pain management include children who were younger (0‐5 years) compared to older (12‐17 years) (adjusted odds ratio (AOR) 1.57; 95% confidence interval (CI) 1.21‐2.03), administered analgesia (AOR 2.35; CI 1.94‐2.84), attended by a paramedic (AOR 1.39; CI 1.13‐1.70) or living in an area of medium deprivation (index of multiple deprivation (IMD) 4‐7) compared to children in an area of high deprivation (IMD 1‐3) (AOR 1.41; CI 1.10‐1.79). Child gender, type of pain, transport time and clinician experience were not significant.Conclusion: These predictors highlight disparity in effective pre-hospital management of acute pain in children. Qualitative research is needed to help explain these findings.

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Knowledge in Pain and Palliative Care in Medical Students From 2 Universities in Mozambique: A Cross Sectional Study

10.21203/rs.3.rs-44900/v1 ◽

2020 ◽

Author(s):

Emília Pinto ◽

Teresa Schwalbach ◽

Ferraz Gonçalves ◽

Jahit Sacarlal ◽

Luisa Castro ◽

...

Keyword(s):

Palliative Care ◽

Pain Management ◽

Medical Students ◽

Medical Training ◽

Medical Schools ◽

Cross Sectional Study ◽

World Health ◽

Sectional Study ◽

Cross Sectional ◽

Exact Test

Abstract Background: Palliative Care (PC) needs have been increasing in low- and middle-income countries. The education of its contents avoids the patients and families´ suffering and therapeutic futility. Aim: to assess the pain and palliative care´s knowledge in Mozambican medical students of the fifth and sixth years. Methods: A cross–sectional study was conducted between August 2018 and July 2019. Data was collected by applying a self-administered survey directed to students from 2 medical schools in Mozambique. Comparison of answer’s frequencies between hospitals was performed using chi-square and Fisher’s exact test. Results: From the 146 participants, 52.7% were female and the median age was 24 years old. Regarding general knowledge: 90.1% think they need to improve their knowledge on pain management, 50.3% of the participants did not know the palliative care World Health Organization´s (WHO) definition. Concerning to therapeutic approach, 36.4% did not have knowledge in control of symptoms, 43.7% did not know the WHO pain management scale, 65.3% did not know how to initiate analgesia for cancer pain. There are significant differences between universities in training related to medical posture on communication to bad news to patients and family as well as training in terminally ill patients. Conclusion: Results show that students from these 2 medical schools have gaps in pain and palliative care knowledge. There is a need to introduce palliative care education in medical training in Mozambique.

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