Testing the impact of a multimedia video CD of patient-controlled analgesia on pain knowledge and pain relief in patients receiving surgery (original) (raw)

9.Pain and the Patient Experience-1.pdf

With the continuing opioid epidemic, there is an urgent call for alternatives to narcotics and other addictive medications. Historically, pain theories have moved through the many stages of medicine, predating the scientific method and following through past Descartes declaration that the mind and the body do not influence each other. This article reviews pain theories and practices moving into the era of the Patient Experience, multi-modal strategies for mitigating suffering, and the impact of the patient's environment and social/cultural milieu informing and supporting the patient's own capacity to cope and manage pain. Methods: A broad review was done of studies and critiques that bring together the historic and current attitudes and beliefs about pain, social-ethnic-racial assumptions, to evaluate the state of pain management as medication-driven solutions begin to fail as first options. In addition, the dominant role of mean-making and caregiver beliefs is discussed as they become more relevant in seeking alternatives to opioids. Conclusion: I). The debate regarding what exactly pain is continues to be between the physical or biochemical domain and the mental-emotionalcognitive domain that brings meaning to the experience. II) The Patient Experience of pain is lived rather than theorized, and is known fully only by the patient and is a private experience informed by the unique circumstances and history of each patient. III) The merging of neurological and psychological factors in pain management is well documented but not optimized in strategizing effective pain control methods. IV) Additional studies are needed to better understand the balance between psychological-social-and-clinical factors to arrive at more effective strategic processes in pain reduction.

Assessment, Physiological Monitoring, and Consequences of Inadequately Treated Acute Pain

Journal of PeriAnesthesia Nursing, 2008

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for interindividual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychologic and emotional distress and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiologic changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient monitoring practices.

Perspective on Pain Management in the 21st Century

Journal of PeriAnesthesia Nursing, 2008

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiologic, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients. Thus, techniques for effective acute pain management (APM) represent unmet educational needs. The significance of this unmet need is reflected in the number of journal and textbook publications dedicated to disseminating research, evidence-based guidelines, and clinical information. Acknowledging the importance of APM, health care accrediting agencies and professional societies have become increasingly focused on ensuring that patients receive prompt and acceptable pain relief.

Identifying Opportunities to Improve Pain Among Patients with Serious Illness (S712)

Context. Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. Objective. Identify characteristics associated with pain and pain improvement among inpatients referred to PC. Methods. Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. Results. Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR ¼ 2.9, P < 0.0001) and dyspnea (OR ¼ 1.4, P ¼ 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P ¼ 0.003). Conclusion. Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement.