Cultural Considerations in the Management of Chronic Pain

Cultural competency within health care helps eliminate racial and ethnic health disparities. When assessing and treating patients with chronic pain, practitioners should feel confident in using information regarding a patient’s individual cultural beliefs due to their significant impact on the pain experience. Culture impacts perception, outlook, and communication of pain, as well as coping mechanisms. These are aspects of subjective history that influence important decisions regarding the management of chronic pain. Becoming more aware of what to look for and which questions to ask can allow naturopathic doctors and other health-care providers to continue improving therapeutic relationships and patient outcomes.

Improving Quality of Care via Effective Pain Management

Pain is neither a vital sign nor a normal part of aging. Yet, older adults frequently experience pain chronically or from an acute event. Pain was identified as a gap per the Centers for Medicare & Medicaid Services Quality Measures report (2019). The purpose of this quality improvement project was to improve the assessment of pain at a skilled nursing facility (SNF) by using a standardized tool. The Comprehensive Pain Assessment Tool for the Cognitively Intact evaluates the complex sensation and emotional reaction of the pain experience. Nurse managers (N=7) received 1:1 education on pain, pain assessment, use of the pain assessment tool, and took a post-test. Chart audits were conducted to identify tool use and evaluate the patient response. Additional data were collected from nurse managers via a questionnaire. All nurse managers received education and completed the post-test. Pain assessments and care plans were completed for 100% of the SNF residents in the cohort (N=22). Follow-up assessments were completed on only 75% of the cohort. Of the cohort, 95% demonstrated improved physical ability and functioning in activities of daily living as their pain experience improved. Only 4.5% of the cohort participated in the anticipated level of minutes of therapy as a result of facility infection control limitations due to the COVID-19 pandemic. This project demonstrated improved pain management through use of a tool to comprehensively assess pain. An organizational policy to comprehensively assess pain at this SNF could promote a higher level of independence and functioning for older adults.

Keep Your Hopes Up: An Examination of Racial Differences in the Association Between Hope and Pain

Hope has been associated with increased pain tolerance (Snyder et al., 2005) and has been incorporated in interventions targeting chronic pain (Howell et al., 2015; Katsimigos et al., 2020). Research suggests that African Americans with osteoarthritis (OA) pain experience greater pain severity and disability compared to non-Hispanic White individuals (Vaughn et al., 2019). Although the literature is limited, there is some evidence to suggest racial/ethnic differences in hope (Chang & Banks, 2007). The current study examined race as a moderator of the association between hope and pain in a sample of older adults. Experience sampling (ESM) data was used from a multi-site study examining non-Hispanic White and African American individuals with knee osteoarthritis (OA). Participants completed the Adult Hope Scale (Snyder et al., 1991) during baseline interviews and self-reported momentary pain during 28 ESM calls. Multilevel models revealed a significant interaction between hope and race (p = .04). Specifically, greater hope was associated with decreased momentary pain, and this association was stronger for African American compared to non-Hispanic White individuals. Results suggest that high levels of hope may be particularly protective for African American chronic pain patients. These findings can help inform existing and future interventions focused on enhancing hope in chronic pain populations. (Supported by AG041655, P. Parmelee and D. Smith, Co-PIs)

Future pain as present concern

Pain is multidimensional, complex; it affects the ontological structures of the human being and exceeds spatio-temporal boundaries. Therefore, it is universally felt with an impact in the past, moving to the present, and projecting to the future. There are efforts to ease or completely eliminate the impact of pain, however, a good understanding of its biological and anthropological dimensions is necessary for proper orientation of such undertakings. This article identifies some social, cultural, medical-scientific, and individual factors that account for the changes in modes of experiencing and managing pain. It posits that there is a general unpreparedness on the physical, psychological, and spiritual levels for continued pain in the future. It thus analyses factors that need to be learnt in order to promote favourable alterations in mental attitudes, pain sensitivity, and tolerance to pain. Preparing for a future of pain requires interdisciplinary reflection on the bodily, emotional, and spiritual components that constitute the pain experience so as to re-direct its trajectory.

The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

Background Both chewed aspirin and sublingual nitroglycerin are fast acting medications and reach therapeutic levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS. Methods From the large National Emergency Medical Services Information System (NEMSIS) 2017 Version database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding) that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received aspirin first were further stratified based on the time between administration of aspirin and the first dose of nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified. Results In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7% decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to nitroglycerin-first group. Conclusion In patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.

The Survey of Knee Osteoarthritis in the Population over Age 50 Visited in the Health Bus in Kermanshah, Iran

Along with an aging population worldwide, knee osteoarthritis (KOA), which is the main cause of musculoskeletal pain and disability in the elderly and decreases the quality of life, is prevalent, and their impact is widespread. This study aimed to evaluate the knee osteoarthritis status among the population over age 50 in Kermanshah, Iran. The research community consisted of the population who has been visited in the health bus in Kermanshah in 2016-2017, of which 589 were chosen by an available sampling method. A WOMAC questionnaire was used to determine the prevalence of knee osteoarthritis. The prevalence of knee stiffness rate after sitting, lying down, or resting during the day among women and men were 40.7% and 20.5%, respectively. According to the findings, the highest prevalence rate of knee pain was in subjects with a BMI higher than 30 (31.6%) and BMI 25–30 (24.5%). 39.2% of the subjects never experienced knee pain, 16.6% monthly, 13.4% once a week, 20.4% daily, and 10.4% of them had prolonged knee pain experience. The prevalence of gender-based knee pain was 60.5% among women and 38.6% among men. 30.5% of women and 61.4% of men never experienced knee pain.