Safe and competent opioid prescribing education: Increasing dissemination with a train-the-trainer program.

PubMed

Zisblatt, Lara; Hayes, Sean M; Lazure, Patrice; Hardesty, Ilana; White, Julie L; Alford, Daniel P

2017-01-01

Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing education based on an FDA curricular Blueprint. This paper describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) train-the-trainer program and its impact on (1) disseminating the SCOPE of Pain curriculum and (2) knowledge, confidence, attitudes, and performance of the participants of trainer-led compared with expert-led meetings. SCOPE of Pain is a 3-hour ER/LA opioid REMS education. In addition to expert-led live statewide meetings, a 2-hour train-the-trainer (TTT) workshop was developed to increase dissemination nationally. The trainers were expected to conduct SCOPE of Pain meetings at their institutions. Participants of both the trainer-led and expert-led SCOPE of Pain programs were surveyed immediately post and 2 months post meetings to assess improvements in knowledge, confidence, attitudes, and self-reported safe opioid prescribing practices. During 9 months (May 2013 to February 2014), 89 trainers were trained during 9 TTT workshops in 9 states. Over 24 months (May 2013 to April 2015), 33% of the trainers conducted at least 1 SCOPE of Pain training, with a total of 79 meetings that educated 1419 participants. The average number of meetings of those who conducted at least 1 meeting was 2.8 (range: 1-19). The participants of the trainer-led programs were significantly more likely to be practicing in rural settings than those who participated in the expert-led meetings (39% vs. 26%, P < .001). At 2 months post training, there were no significant differences in improvements in participant knowledge, confidence, attitudes, and performance between expert-led and trainer-led meetings. The SCOPE of Pain TTT program holds promise as an effective dissemination strategy to increase guideline-based safe opioid prescribing knowledge, confidence, attitudes, and self-reported practices.

Interview with David Tauben: University of Washington, Chief of the Division of Pain Medicine.

PubMed

Tauben, David

2017-07-01

Dr Tauben is Clinical Professor jointly appointed in the Departments of Medicine and Anesthesia & Pain Medicine, and is the Hughes M & Katherine G Blake Endowed Professor, board certified in both Internal Medicine and Pain Medicine. He is also University of Washington (UW) Director of Medical Student and Resident Education in Pain Medicine, and Medical Director of UW TelePain, a tele-video-conferencing program intended to provide innovative pain education and consultative support to a five-state northwest regional primary care providers. He served as a member of the NIH National Pain Strategy task force on pain education and is principal investigator for the UW's prestigious NIH Pain Consortium Center of Excellence for Pain Education, leading curriculum development to extend the pain proficiency qualifications of interprofessional primary care providers. Dr Tauben is a member of the American Pain Society and the International Association for the Study of Pain special interest study groups on Pain Education. He is a founding member of the State of Washington Agency Medical Directors panel of medical experts developing opioid prescription guidelines for the state, and a regular clinical and content expert for regulatory and legislative bodies involved in public policy regarding pain medicine practice and standards. He speaks as a clinical expert in medical management of chronic pain, especially as it applies to primary care practices. Dr Tauben served as an expert for several US Centers for Disease Control clinical outreach programs and policy reviews advising primary care providers on how to prescribe opioids for chronic noncancer pain. He is annually recognized by his peers as recipient of regional awards in care of pain patients, and brings decades of clinical experience of best practice medication management of acute and chronic pain. Dr Tauben received his bachelors degree in philosophy from Yale University, medical degree from Tufts University School of Medicine and completed his residency training at the UW, in Seattle. He is a fellow of the American College of Physicians.

Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial.

PubMed

Bodes Pardo, Gema; Lluch Girbés, Enrique; Roussel, Nathalie A; Gallego Izquierdo, Tomás; Jiménez Penick, Virginia; Pecos Martín, Daniel

2018-02-01

To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP). Single-blind randomized controlled trial. Private clinic and university. Patients with CLBP for ≥6 months (N=56). Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants. The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change. At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: -2.2; -2.93 to -1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures. Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Nursing

PubMed Central

Herr, Keela; St. Marie, Barbara; Gordon, Debra B.; Paice, Judith A.; Watt-Watson, Judy; Stevens, Bonnie J.; Bakerjian, Debra; Young, Heather M.

2015-01-01

Background Ineffective assessment and management of pain is a significant problem. A gap in prelicensure health science program pain content has been identified for the improvement of pain care in the United States. Method Through consensus processes, an expert panel of nurses, who participated in the interdisciplinary development of core competencies in pain management for prelicensure health professional education, developed recommendations to address the gap in nursing curricula. Results Challenges and incentives for implementation of pain competencies in nursing education are discussed, and specific recommendations for how to incorporate the competencies into entry-level nursing curricula are provided. Conclusion Embedding pain management core competencies into prelicensure nursing education is crucial to ensure that nurses have the essential knowledge and skills to effectively manage pain and to serve as a foundation on which clinical practice skills can be later honed. PMID:26057425

Teddy and I Get a Check-Up: A Pilot Educational Intervention Teaching Children Coping Strategies for Managing Procedure-Related Pain and Fear

PubMed Central

Dalley, Jessica S.; McMurtry, C. Meghan

2016-01-01

Background. Pediatric medical information provision literature focuses on hospitalization and surgical procedures, but children would also benefit from an educational program regarding more commonly experienced medical procedures (e.g., needles, general check-up). Objective. To determine whether an evidence-based educational program reduced children's ratings of fear of and expected pain from medical stimuli and increased their knowledge of procedural coping strategies. Methods. An educational, interactive, developmentally appropriate Teddy Bear Clinic Tour was developed and delivered at a veterinary clinic. During this tour, 71 5–10-year-old children (Mage = 6.62 years, SD = 1.19) were taught about medical equipment, procedures, and coping strategies through modelling and rehearsal. In a single-group, pretest posttest design, participants reported their fear of and expected pain from medical and nonmedical stimuli. Children were also asked to report strategies they would use to cope with procedural fear. Results. Children's ratings for expected pain during a needle procedure were reduced following the intervention. No significant change occurred in children's fear of needles. Children reported more intervention-taught coping strategies at Time 2. Conclusions. The results of this study suggest that an evidence-based, interactive educational program can reduce young children's expectations of needle pain and may help teach them procedural coping strategies. PMID:27445612

Evaluation of a Pain Management Education Program and Operational Guideline on Nursing Practice, Attitudes, and Pain Management.

PubMed

Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A

2018-04-01

Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.

Take Charge of Pain: evaluating a community-targeted self-management education program for people with musculoskeletal pain.

PubMed

Hoon, Elizabeth; Smith, Karen; Black, Julie; Burnet, Simon; Hill, Catherine; Gill, Tiffany K

2017-03-01

Issue addressed Musculoskeletal conditions are highly prevalent, affecting 28% of the Australian population. Given the persistent nature of many musculoskeletal conditions self-management is recognised as an important aspect of effective disease management. However, participant recruitment and retention for formal self-management programs is a challenge. Methods Arthritis SA (Arthritis Foundation of South Australia, a non-profit community health organisation) redesigned a shorter, community-orientated self-management education program delivered by health professionals. The program utilises aspects of the Stanford model of chronic disease self-management and motivational interviewing as well as principles of adult learning to create an effective learning environment. The program aims to guide participants to learn and practise a range of pain management strategies that are known to be effective in improving quality of life. This study used a pre- and post-test (at 6 weeks) design to determine whether this program achieved benefits in self-reported health outcomes. Outcomes that were measured included pain, fatigue, health distress, self-efficacy and communication. Results A response rate of 47% (n=102) was achieved and small but statistically significant improvements in mean [s.d.] pain scores (6.1 [2.3] to 5.4 [2.4], P=0.001), health distress (2.3 [1.3] to 2.0 [1.3], P=0.002) and self-efficacy (6.2 [2.1] to 6.8 [2.2], P=0.002) were found. Conclusion Community-based participants of this shorter, focused program recorded small but significant improvements in self-reported pain, health distress and self-efficacy. For those who completed the current program, Arthritis SA is currently exploring the potential of developing a booster session to promote sustainable positive health outcomes. So what? Supporting self-management through education is recognised as important but also as a key challenge for effective management of musculoskeletal conditions. Using a pre-post evaluation design, this study demonstrated effectiveness (short-term improvements for self-reported pain, health distress and self-efficacy) for a redesigned and shortened community-targeted program focusing on musculoskeletal pain.

SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program

PubMed Central

Zisblatt, Lara; Ng, Pamela; Hayes, Sean M.; Peloquin, Sophie; Hardesty, Ilana; White, Julie L.

2016-01-01

Objective. Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Method. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. Subjects. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Results. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. Conclusions. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. PMID:26304703

Pain education in North American medical schools.

PubMed

Mezei, Lina; Murinson, Beth B

2011-12-01

Knowledgeable and compassionate care regarding pain is a core responsibility of health professionals associated with better medical outcomes, improved quality of life, and lower healthcare costs. Education is an essential part of training healthcare providers to deliver conscientious pain care but little is known about whether medical school curricula meet educational needs. Using a novel systematic approach to assess educational content, we examined the curricula of Liaison Committee on Medical Education-accredited medical schools between August 2009 and February 2010. Our intent was to establish important benchmark values regarding pain education of future physicians during primary professional training. External validation was performed. Inclusion criteria required evidence of substantive participation in the curriculum management database of the Association of American Medical Colleges. A total of 117 U.S. and Canadian medical schools were included in the study. Approximately 80% of U.S. medical schools require 1 or more pain sessions. Among Canadian medical schools, 92% require pain sessions. Pain sessions are typically presented as part of general required courses. Median hours of instruction on pain topics for Canadian schools was twice the U.S. median. Many topics included in the International Association for the Study of Pain core curriculum received little or no coverage. There were no correlations between the types of pain education offered and school characteristics (eg, private versus public). We conclude that pain education for North American medical students is limited, variable, and often fragmentary. There is a need for innovative approaches and better integration of pain topics into medical school curricula. This study assessed the scope and scale of pain education programs in U.S. and Canadian medical schools. Significant gaps between recommended pain curricula and documented educational content were identified. In short, pain education was limited and fragmentary. Innovative and integrated pain education in primary medical education is needed. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

[Medical educational evaluation of the German Pain Congress 2012. In the context of the CanMEDS physician competency framework].

PubMed

Dusch, M; Bräscher, A-K; Kopf, A; Treede, R D; Benrath, J

2014-10-01

Professionals in the medical field are expected to participate in continuing medical education in the sense of lifelong learning. The authors took this occasion to evaluate the most important national convention in pain medicine concerning its role in medical education. The participants of the 37th German Pain Congress (17-20 October 2012 in Mannheim) were asked to complete a questionnaire concerning content and design of the convention. The aim of this study was to analyze the distribution of different physician competencies in the program. For this purpose the congress program was analyzed with respect to the various medical role models as defined in the Canadian medical education directions for specialists (CanMEDS) framework. The participants considered the quality of the different sessions of the German Pain Congress to be good. The poster sessions were considered to be the second most important educational format in the congress following the live sessions. Concerning the content of the congress the participants wished more emphasis on the role of interprofessional partners, such as nursing and psychotherapy. The CanMEDS physician roles of manager, communicator, health advisor and professional paragon were underrepresented in the congress program in this study. Regarding content and educational value, the congress design could benefit from additional Praktikerseminaren (practical seminars). The role of interprofessional partners should be more emphasized. In addition the program could become more attractive through a more balanced distribution of the CanMEDS roles.

SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program.

PubMed

Alford, Daniel P; Zisblatt, Lara; Ng, Pamela; Hayes, Sean M; Peloquin, Sophie; Hardesty, Ilana; White, Julie L

2016-01-01

Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

PubMed

Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

2008-01-01

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The effectiveness of back pain and injury prevention programs in the workplace.

PubMed

Gatty, Carolyn M; Turner, Mynde; Buitendorp, Dinice J; Batman, Heather

2003-01-01

Musculoskeletal disorders in the workplace cause thousands of injuries and cost industry billions of dollars yearly. Work injury prevention programs have been developed and implemented as a means for cost containment. A variety of preventive strategies have been investigated in primary research. The purpose of this review article is to examine the effectiveness of back injury and pain prevention programs in the workplace. Nine studies published between 1995 and 2000 were reviewed and analyzed. Studies used primarily one of three types of preventive strategies: 1) back belts, 2) education and task modification, and 3) education and task modification with workstation redesign. The effectiveness of back belts to prevent back pain and injury remains inconclusive. Positive outcomes were associated with studies reporting high compliance that used job-specific and individualized/small group education and training approaches. Themes that arose following a critical review of primary research studies are discussed.

Comparison of pain neurophysiology knowledge among health sciences students: a cross-sectional study.

PubMed

Adillón, Cristina; Lozano, Èrik; Salvat, Isabel

2015-10-22

A key tool for use in approaching chronic pain treatment is educating patients to reconceptualize pain. Thus, health professionals are fundamental to the transmission of pain information to patients. Because their understanding of pain is acquired during the educational process, the aim of this study was to compare the knowledge about pain neurophysiology in first and final-year students from three different health science programs at a single University to determine their gain in knowledge using a well-known questionnaire designed to evaluate the understanding of pain. The Neurophysiology of Pain Questionnaire (19 closed-ended questions) was administered to students in their first and final years of study in Medicine, Physiotherapy, or Nutrition. The percentage of correct responses was determined and comparisons of the results were analyzed between the programs as well as between the first and final years of study within each program. For all tests, p-values were two-sided, and results with p-values below 0.05 were considered statistically significant. The participation rate was greater than 51% (n = 285). The mean percentage of correct responses, reported as mean (SD), among the first year students was 42.14 (12.23), without significant statistical differences detected between the programs. The mean percentages of correct responses for students in their final year were as follows: Medicine, 54.38 (13.87); Physiotherapy, 68.92 (16.22); Nutrition, 42.34 (10.11). We found statistically significant differences among all three programs and between the first and final years in Medicine and Physiotherapy. A question-by-question analysis showed that the percentage of correct responses for questions related to the biopsychosocial aspects of pain was higher for students in Physiotherapy than those in Medicine. Students in their final years of Medicine and Physiotherapy programs know more about the neurophysiology of pain than students in their first years of these programs, however there are some questions where first years students have better results. Physiotherapy students have greater knowledge of neurophysiology of pain than Medicine students, especially the biopsychosocial aspects. Even so, their understanding may not be sufficient and does not guarantee an approach to chronic pain that will help patients reconceptualize their pain.

A Blueprint of Pain Curriculum across Prelicensure Health Sciences Programs: One NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) Experience

PubMed Central

Doorenbos, AZ; Gordon, DB; Tauben, D; Palisoc, J; Drangsholt, M; Lindhorst, T; Danielson, J; Spector, J; Ballweg, R; Vorvick, L; Loeser, JD

2013-01-01

To improve U.S. pain education and promote inter-institutional and inter-professional collaborations, the NIH Pain Consortium has funded 12 sites to develop Centers of Excellence in Pain Education (CoEPE). Each site was given the tasks of development, evaluation, integration, and promotion of pain management curriculum resources, including case studies that will be shared nationally. Collaborations among schools of medicine, dentistry, nursing, pharmacy, and others were encouraged. The John D. Loeser CoEPE is unique in that it represents extensive regionalization of health science education, in this case in the region covering the states of Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI). This paper describes a blueprint of pain content and teaching methods across the University of Washington’s six health sciences schools and provides recommendations for improvement in pain education at the prelicensure level. The Schools of Dentistry and Physician Assistant provide the highest percentage of total required curriculum hours devoted to pain compared with the Schools of Medicine, Nursing, Pharmacy, and Social Work. The findings confirm paucity of pain content in health sciences curricula, missing International Association for the Study of Pain (IASP) curriculum topics, and limited use of innovative teaching methods such as problem-based and team-based learning. PMID:24094694

[Effects of a yoga-focused prenatal program on stress, anxiety, self confidence and labor pain in pregnant women with in vitro fertilization treatment].

PubMed

Shim, Chung Sin; Lee, Young-Sook

2012-06-01

The purpose of this study was to identify the effects of a Yoga-focused prenatal program on the stress, anxiety, self confidence and labor pain of pregnant women who had in vitro fertilization (IVF) treatment. A quasi experimental study with a non-equivalent control group pretest-posttest design was used. The data collection period and meditation program were between January 9 and August 31, 2009. Forty-six women who were pregnant following IVF, and were between 12-20 weeks gestation, participated in the study (23 experimental group, 23 control group). Data were analyzed using Chi-square test, Mann-Whitney U Test, ANCOVA, and Cronbach's alpha coefficients with the SPSS 12.0 for Windows Program. Although the sample size was limited, women who participated in the program showed statistically significant improvements in stress, anxiety, labor pain, and labor confidence for women pregnant after IVF. The result indicate that this 12-week Yoga-focused educational program can be utilized for women pregnant following IVF to reduce their stress, anxiety, and labor pain, and to increase delivery confidence. It is suggested that the Yoga-focused educational program be offered to every pregnant woman.

Aspiring Pain Practitioners in India: Assessing Challenges and Building Opportunities.

PubMed

Bhatnagar, Sushma; Patel, Anuradha; Raja, Srinivasa N

2018-01-01

Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty. The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers. Face-to-face interactive sessions were held with 60 aspiring pain physicians of India who were chosen as registrants to an International Association for the Study of Pain-Indian Society for Study of Pain multidisciplinary evidence-based pain management program conducted at Delhi and Mumbai. The available opportunities, practical issues and the hurdles in becoming a pain specialist were analyzed and summarized in this commentary. The major barriers identified were: (1) Inadequate knowledge and absence of structured, educational and training courses, (2) bureaucratic hurdles, and (3) concerns of opioid misuse and addiction. The opportunities for personal growth and that of the specialty that could be utilized include the creation of a pain resource team, increasing community awareness, changing attitudes of other physicians toward pain specialty, and research and evidence building of the effectiveness of pain management strategies. India needs a structured teaching and training program in the area of pain medicine that is affiliated by the Medical Council of India or other reputed boards of medical education and certification. There is an urgent need to include pain management in the undergraduate and postgraduate medical curriculum. Enhancing community level awareness by public health education campaigns, developing networks of pain physicians, and appropriate marketing of the specialty is needed to make pain medicine recognized and utilized as a valuable specialty.

Chronic pain self-management support with pain science education and exercise (COMMENCE): study protocol for a randomized controlled trial.

PubMed

Miller, Jordan; MacDermid, Joy C; Walton, David M; Richardson, Julie

2015-10-14

Previous research suggests that self-management programs for people with chronic pain improve knowledge and self-efficacy but result in negligible effects on function. This study will investigate the effectiveness self-management support with pain science education and exercise on improving function for people with chronic pain in comparison to a wait-list control. A secondary objective is to determine which variables help to predict response to the intervention. This study will be an unblinded, randomized controlled trial with 110 participants comparing a 6-week program that includes self-management support, pain science education and exercise to a wait-list control. The primary outcome will be function measured by the Short Musculoskeletal Function Assessment - Dysfunction Index. Secondary outcomes will include pain intensity measured by a numeric pain rating scale, pain interference measured by the eight-item PROMIS pain interference item-bank, how much patients are bothered by functional problems measured by the Short Musculoskeletal Function Assessment - Bother Index, catastrophic thinking measured by the Pain Catastrophizing Scale, fear of movement/re-injury measured by the 11-item Tampa Scale of Kinesiophobia, sense of perceived injustice measured by the Injustice Experience Questionnaire, self-efficacy measured by the Pain Self-Efficacy Questionnaire, pain sensitivity measured by pressure pain threshold and cold sensitivity testing, fatigue measured by a numeric fatigue rating scale, pain neurophysiology knowledge measured by the Neurophysiology of Pain Questionnaire, healthcare utilization measured by number of visits to a healthcare provider, and work status. Assessments will be completed at baseline, 7 and 18 weeks. After the 18-week assessment, the groups will crossover; however, we anticipate carry-over effects with the treatment. Therefore, data from after the crossover will be used to estimate within-group changes and to determine predictors of response that are not for direct between-group comparisons. Mixed effects modelling will be used to determine between-group differences for all primary and secondary outcomes. A series of multiple regression models will be used to determine predictors of treatment response. This study has the potential to inform future self-management programming through evaluation of a self-management program that aims to improve function as the primary outcome. ClinicalTrials.gov NCT02422459 , registered on 13 April 2015.

Pain and Pain Management Among University Students: Online Survey and Web-Based Education.

PubMed

Tse, Mimi Mun Yee; Tang, Angel; Budnick, Andrea; Ng, Shamay Sheung Mei; Yeung, Suey Shuk Yu

2017-05-01

Pain is common among university students. Unrelieved pain has adverse impacts on their quality of life. In this study, a pain management Web site was developed to distribute an online survey and provide Web-based pain education to university students. Participants were recruited from eight universities in Hong Kong using snowball sampling. The online survey included 37 items examining pain situations, pain management strategies, knowledge about self-medication, and demographic data of the participants. A total of 387 students participated and over 90 percent of them reported pain in the past 6 months. Around one-third of participants did not take any action to manage their pain. Pharmacological method was the most common strategy for students to relieve pain (37.2 percent). The use of over-the-counter (OTC) drug for pain relief was high (n = 214). However, OTC drug knowledge score was significantly higher among health-related group than nonhealth-related group (p < 0.001). There were 188 students who also read the Web-based pain education and completed the evaluation on its usefulness. Nonhealth-related students reported significantly higher scores of self-perceived usefulness for the online education than the health-related students (p < 0.001). Findings suggested the need to consider the service users' background when developing online education program in the future.

A Randomized Controlled Trial of the Effects of Online Pain Management Education on Primary Care Providers.

PubMed

Trudeau, Kimberlee J; Hildebrand, Cristina; Garg, Priyanka; Chiauzzi, Emil; Zacharoff, Kevin L

2017-04-01

To improve pain management practices, we developed an online interactive continuing education (CE) program for primary care providers (PCPs). This program follows the flow of clinical decision-making through simulated cases at critical pain treatment points along the pain treatment continuum. A randomized controlled trial was conducted to test the efficacy of this program. Participants were randomized to either the experimental condition or the control condition (online, text-based CE program). A total of 238 primary care providers were recruited through hospitals, professional newsletters, and pain conferences. Participants in both conditions reported significantly improved scores on knowledge (KNOW-PAIN 50), attitudes (CAOS), and pain practice behaviors (PPBS) scales over the four-month study. The experimental condition showed significantly greater change over time on the tamper-resistant formulations (TRFs) of opioids and dosing CAOS subscale compared with the control condition. Post hoc comparisons suggested that participants in the experimental condition were less likely to endorse use of opioid TRFs over time compared with the control condition. Exploratory analyses for potential moderators indicated a significant three-way interaction with time, condition, and discipline (i.e., physician vs other) for the impediments and concerns attitudes subscale and the early refill behaviors subscale. Post hoc comparisons indicated that physicians in the experimental condition exhibited the greatest change in attitudes and the nonphysicians exhibited the greatest change in reported behaviors in response to requests for early refills. Findings suggest online CE programs may positively impact PCPs' knowledge, attitudes, and pain practice behaviors but provide minimal evidence for the value of including interactivity. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Position paper: appropriate use of pharmacotherapeutic agents by the orofacial pain dentist.

PubMed

Heir, Gary M; Haddox, J David; Crandall, Jeffrey; Eliav, Eli; Radford, Steven Graff; Schwartz, Anthony; Jaeger, Bernadette; Ganzberg, Steven; Aquino, Carlos M; Benoliel, Rafael

2011-01-01

Orofacial Pain Dentistry is concerned with the prevention, evaluation, diagnosis, treatment, and management of persistent and recurrent orofacial pain disorders. The American Dental Association, through the Commission on Dental Accreditation (CODA), now recognizes Orofacial Pain as an area of advanced education in Dentistry. It is mandated by CODA that postgraduate orofacial pain programs be designed to provide advanced knowledge and skills beyond those of the standard curriculum leading to the DDS or DMD degrees. Postgraduate programs in orofacial pain must include specific curricular content to comply with CODA standards. The intent of CODA standards is to assure that training programs develop specific educational goals and objectives that describe the student/resident’s expected knowledge and skills upon successful completion of the program. A standardized core curriculum, required for accreditation of dental orofacial pain training programs, has now been adopted.Among the various topics mandated in the curriculum are pharmacology and, specifically, pharmacotherapeutics. The American Academy of Orofacial Pain (AAOP) recommends, and the American Board of Orofacial Pain (ABOP) requires, that the minimally competent orofacial pain dentist* be knowledgeable in the management of orofacial pain conditions using medications when indicated. Basic knowledge of the appropriate use of pharmacotherapeutics is essential for the orofacial pain dentist and, therefore, constitutes part of the examination specifications of the ABOP. The minimally competent orofacial pain clinician must demonstrate knowledge, diagnostic skills, and treatment expertise in many areas, such as musculoskeletal, neurovascular, and neuropathic pain syndromes; sleep disorders related to orofacial pain; orofacial dystonias; and intraoral, intracranial, extracranial, and systemic disorders that cause orofacial pain or dysfunction. The orofacial pain dentist has the responsibility to diagnose and treat patients in pain that is often chronic, multifactorial, and complex. Failure to understand pain mechanisms can lead to inaccurate diagnoses and ineffective, delayed, or harmful treatment. It is the responsibility of the orofacial pain dentist to accurately diagnose the cause(s) of the pain and decide if treatment should be dentally, medically, or psychologically oriented, or if optimal management requires a combination of all three treatment approaches. Management may consist of a number of interdisciplinary modalities including, eg, physical medicine, behavioral medicine, and pharmacology or, in rare instances, surgical interventions. Among the essential armamentarium is the knowledge and proper use of pharmacologic agents.

Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

PubMed Central

2011-01-01

Background Effective strategies for the primary prevention of low back pain (LBP) remain elusive with few large-scale clinical trials investigating exercise and education approaches. The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise. Methods The Prevention of Low Back Pain in the Military study was a cluster randomized clinical study with four intervention arms and a two-year follow-up. Participants were recruited from a military training setting from 2007 to 2008. Soldiers in 20 consecutive companies were considered for eligibility (n = 7,616). Of those, 1,741 were ineligible and 1,550 were eligible but refused participation. For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years (SD = 4.2) and there were 3,082 males (71.3%). Companies were randomly assigned to receive traditional lumbar exercise, traditional lumbar exercise with psychosocial education, core stabilization exercise, or core stabilization with psychosocial education, The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks. The primary outcome for this trial was incidence of low back pain resulting in the seeking of health care. Results There were no adverse events reported. Evaluable patient analysis (4,147/4,325 provided data) indicated no differences in low back incidence resulting in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs. However, brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach, resulting in a 3.3% (95% CI: 1.1 to 5.5%) decrease over two years (numbers needed to treat (NNT) = 30.3, 95% CI = 18.2 to 90.9). Conclusions Core stabilization has been advocated as preventative, but offered no such benefit when compared to traditional lumbar exercise in this trial. Instead, a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain resulting in the seeking of health care. Since this trial was conducted in a military setting, future studies are necessary to determine if these findings can be translated into civilian populations. Trial Registration NCT00373009 at ClinicalTrials.gov - http://clinicaltrials.gov/ PMID:22126534

Pain medicine--a new credential in Canada.

PubMed

Morley-Forster, Patricia; Karpinski, Jolanta

2015-06-01

In 2010, Pain Medicine was formally recognized as a subspecialty in Canada by the Royal College of Physicians and Surgeons of Canada, a national organization with oversight of the medical education of specialists in Canada. The first trainees began their training at the Western University, London, Canada in July, 2014. This article traces the process of Pain Medicine's development as a discipline in Canada and outlines its multiple entry routes, 2-year curriculum, and assessment procedures. The application for specialty status was initiated in 2007 with the understanding that while Anesthesiology would be the parent specialty, the curriculum would train clinicians in a multidisciplinary setting. To receive recognition as a Royal College subspecialty, Pain Medicine had to successfully pass through three phases, each stage requiring formal approval by the Committee on Specialties. The multiple entry routes to this 2-year subspecialty program are described in this article as are the objectives of training, the curriculum, assessment of competency and the practice-eligibility route to certification. The process of accreditation of new training programs across Canada is also discussed. The new Pain Medicine training program in Canada will train experts in the prevention, diagnosis, treatment and rehabilitation of the spectrum of acute pain, cancer pain and non-cancer pain problems. These physicians will become leaders in education, research, advocacy and administration of this emerging field. Wiley Periodicals, Inc.

The state of chronic pain education in geriatric medicine fellowship training programs: results of a national survey.

PubMed

Weiner, Debra K; Turner, Gregory H; Hennon, John G; Perera, Subashan; Hartmann, Susanne

2005-10-01

A survey of U.S. geriatric medicine fellowship training programs was performed to assess the status of teaching about chronic pain evaluation and management and identify opportunities for improvement. After an initial e-mail query, 43 of 96 programs agreed to participate. A self-administered questionnaire, with items adapted from a 2002 consensus panel statement, was mailed to their 171 fellows-in-training and 43 fellowship directors. Thirty-two programs (33% of nationwide sample) including 79 fellows (30% of nationwide sample) and 25 directors (26% of nationwide sample) returned surveys; 21 institutions returned both faculty and fellow surveys. Overall, directors endorsed the 19 items identified by the consensus panel as essential components of fellowship training, but fellows identified deficiencies, both before and during fellowship training. Specific areas of undereducation included comprehensive musculoskeletal assessment, neuropathic pain evaluation, indications for low back pain imaging, the role of multidisciplinary pain clinics and nonpharmacological modalities, the effect of physical and psychosocial comorbidities in formulating treatment goals, and the effect of aging on analgesic metabolism and prescription. Both groups were generally positive about fellows' abilities to implement pain-related clinical skills. Discrepancies existed between fellowship directors' ratings of importance of teaching individual items and the degree to which teaching was actually done, as well as faculty versus fellow assessments of whether some of the 19 items were taught. Primary care training programs (e.g., internal medicine, family medicine, geriatric medicine) should pay more systematic attention to educating trainees about chronic pain to optimize patient care, decrease suffering, and diminish healthcare expenditures.

Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program.

PubMed

Miquelutti, Maria Amélia; Cecatti, José Guilherme; Makuch, Maria Yolanda

2015-04-01

To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804. The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings.

Effects of a cognitive-behavioral pain-management program.

PubMed

Johansson, C; Dahl, J; Jannert, M; Melin, L; Andersson, G

1998-10-01

A cognitive behavioral multidisciplinary pain management program was evaluated in two separate outcome studies; one controlled study (study I) and one study conducted on a consecutive sample with a long-term follow-up (study II). The 4-week inpatient treatment program included education sessions, goal setting, graded activity training, pacing, applied relaxation, cognitive techniques, social skills training, drug reduction methods, contingency management of pain behaviors, and planning of work return. The outcome of study I showed significant between-group differences in favor of the treatment group on measures of occupational training at 1-month follow-up, activity level in the sparetime at post-treatment and at follow-up, and decreased catastrophizing and pain behaviors at post-treatment. In study II significant improvements over time were found on measures of sick leave, pain intensity, pain interference, life control, affective distress, activity level in the sparetime, physical fitness and use of analgetics at 2-month follow-up and at 1-year follow-up. The results of the two outcome studies reported show that cognitive behavioral multidisciplinary pain management programs can successfully be applied to Swedish musculoskeletal pain patients.

Enhancing cancer pain control regimens through patient education.

PubMed

Rimer, B; Levy, M H; Keintz, M K; Fox, L; Engstrom, P F; MacElwee, N

1987-12-01

The problem of cancer-related pain afflicts millions of people annually. The study described here was aimed at improving cancer patients' pain control through a planned patient education program. A randomized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed materials. The sample included 230 cancer patients. One month later, patients in the experimental group were more likely to have taken their pain medicine on the correct schedule and to have taken the correct dosage. The experimental group also was significantly less likely to report stopping the medicine when they felt better. In addition, they were significantly less worried about tolerance and addiction to pain medicines. Forty-four percent of the experimental group compared to 24% of the control group reported no or mild pain at the posttest.

Happy Despite Pain: A Randomized Controlled Trial of an 8-Week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients With Chronic Pain.

PubMed

Peters, Madelon L; Smeets, Elke; Feijge, Marion; van Breukelen, Gerard; Andersson, Gerhard; Buhrman, Monica; Linton, Steven J

2017-11-01

There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive-behavioral program. A randomized controlled trial was carried out with 3 conditions: an internet-delivered positive psychology program, an internet-delivered cognitive-behavioral program and waitlist control. A total of 276 patients were randomized to 1 of the 3 conditions and posttreatment data were obtained from 206 patients. Primary outcomes were happiness, depression, and physical impairments at posttreatment and at 6-month follow-up. Intention-to-treat analyses were carried out using mixed regression analyses. Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared with waitlist. Improvements in happiness and depression were maintained until 6-month follow-up. There were no overall differences in the efficacy of the 2 active interventions but effects seemed to be moderated by education. Patients with a higher level of education profited slightly more from the positive psychology intervention than from the cognitive-behavioral program. The results suggest that an internet-based positive psychology and cognitive-behavioral self-help interventions for the management of chronic pain are clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.

Self-management of chronic low back pain and osteoarthritis.

PubMed

May, Stephen

2010-04-01

Chronic low back pain and osteoarthritis are two musculoskeletal problems that are highly prevalent in the general population, are frequently episodic and persistent, and are associated with high costs to society, both direct and indirect. This epidemiological picture provides the background that justifies the use of self-management strategies in managing these problems. For this Review, relevant systematic reviews were included that related to effectiveness; other study designs were included that addressed other aspects of the topic. The accepted definition of self-management includes liaison between health professionals and individuals with these problems, as well as independent health-promotion activities. Independent self-management strategies, such as exercise and self-medication, are practiced by individuals in the general population. Consistent evidence shows that self-management programs for osteoarthritis are effective in addressing pain and function, but effect sizes are small and might be clinically negligible. Educational programs for patients with back pain are effective in an occupational setting and if combined with an exercise program. Exercise is an effective strategy in the management of both chronic low back pain and osteoarthritis, although it is unclear what the optimum exercise is. Exercise, supported by advice and education, should be at the core of self-management strategies for chronic low back pain and osteoarthritis.

Pain medicine: The case for an independent medical specialty and training programs.

PubMed

Dubois, Michel Y; Follett, Kenneth A

2014-06-01

Over the last 30 years, pain has become one of the most dynamic areas of medicine and a public health issue. According to a recent Institute of Medicine report, pain affects approximately 100 million Americans at an estimated annual economic cost of $560 to $635 billion and is poorly treated overall. The American Board of Medical Specialties (ABMS) recognizes a pain subspecialty, but pain care delivery has struggled with increasing demand and developed in an inconsistent and uncoordinated fashion. Pain education is insufficient and highly variable. Multiple pain professional organizations have led to fragmentation of the field and lack of interdisciplinary agreement, resulting in confusion regarding who speaks for pain medicine. In this Perspective, the authors argue that ABMS recognition of pain medicine as an independent medical specialty would provide much needed structure and oversight for the field and would generate credibility for the specialty and its providers among medical peers, payers, regulatory and legislative agencies, and the public at large. The existing system, managed by three ABMS boards, largely excludes other specialties that contribute to pain care, fails to provide leadership from a single professional organization, provides suboptimal training exposure to pain medicine, and lengthens training, which results in inefficient use of time and educational resources. The creation of a primary ABMS conjoint board in pain medicine with its own residency programs and departments would provide better coordinated training, ensure the highest degree of competence of pain medicine specialists, and improve the quality of pain care and patient safety.

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims.

PubMed

Melhorn, J M

1999-02-01

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.

Happy Despite Pain

PubMed Central

Smeets, Elke; Feijge, Marion; van Breukelen, Gerard; Andersson, Gerhard; Buhrman, Monica; Linton, Steven J.

2017-01-01

Objectives: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive-behavioral program. Materials and Methods: A randomized controlled trial was carried out with 3 conditions: an internet-delivered positive psychology program, an internet-delivered cognitive-behavioral program and waitlist control. A total of 276 patients were randomized to 1 of the 3 conditions and posttreatment data were obtained from 206 patients. Primary outcomes were happiness, depression, and physical impairments at posttreatment and at 6-month follow-up. Intention-to-treat analyses were carried out using mixed regression analyses. Results: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared with waitlist. Improvements in happiness and depression were maintained until 6-month follow-up. There were no overall differences in the efficacy of the 2 active interventions but effects seemed to be moderated by education. Patients with a higher level of education profited slightly more from the positive psychology intervention than from the cognitive-behavioral program. Discussion: The results suggest that an internet-based positive psychology and cognitive-behavioral self-help interventions for the management of chronic pain are clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs. PMID:28379873

Educating Patient Educators: Enhancing Instructional Effectiveness in Physical Therapy for Low Back Pain Patients.

ERIC Educational Resources Information Center

Kerssens, Jan J.; Sluijs, Emmy M.; Verhaak, Peter F. M.; Knibbe, Hanneke J.; Hermans, Irma M. J.

1999-01-01

Examines the effectiveness of a training program designed for physical therapists (N=19) to aid them in the enhancement of patient education. Five therapist-skills were tested. After the training only a minority of the trained skills appeared to have improved. Results show that the training program was not very effective. (Author/MKA)

Arthritic pain among Latinos: results from a community-based survey.

PubMed

Cheriel, Chad; Huguet, Nathalie; Gupta, Shalini; McClure, Heather; Leman, Richard F; Ngo, Duyen L

2009-11-15

To examine factors associated with pain among Latinos with arthritis, identify common coping strategies and potentially effective interventions, and determine whether pain levels affect the level of interest in potentially useful programs. Using a convenience sampling approach and a combination of face-to-face and telephone surveys, 588 Latino adults in Oregon with arthritis were interviewed. The intensity of pain during a typical day was assessed using a scale ranging from 0 (no pain) to 10 (worst pain). A score of >or=7 was defined as severe pain. More than 60% of Latinos reported severe pain. Results from an ordinary least square regression indicated that among Latinos with arthritis, women, those with lower levels of education, and those reporting poor or fair self-rated health and functional limitations had higher levels of pain, after controlling for confounders. Those with severe pain were more likely than those with lower levels of pain to use over the counter medicine and home remedies to manage their arthritis. In addition, Latinos with greater pain were more likely to be interested in arthritis management programs. These findings have important implications for public health policy. The strong interest of Latinos in various arthritis and joint pain management programs could prove to be an important avenue for supporting a population with high levels of arthritic pain and lack of health insurance. These pain management programs are all the more appealing, given the availability of a number of evidence-based, low-cost interventions.

Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial.

PubMed

Crossley, K M; Vicenzino, B; Lentzos, J; Schache, A G; Pandy, M G; Ozturk, H; Hinman, R S

2015-09-01

Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA. A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS). 81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: -15.2 mm, 95% CI -27.0 to -3.4). No significant effects on ADL were observed (5.8; 95% CI -0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI -22.7 to 1.8) or ADL (3.0, 95% CI -3.7 to 9.7). Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent. Australian New Zealand Clinical Trials Registry (ACTRN12608000288325): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82878. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

A cognitive-behavioural program for adolescents with chronic pain-a pilot study.

PubMed

Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; van Suijlekom-Smit, Lisette W A; Koes, Bart W; Passchier, Jan

2005-11-01

The purpose of this pilot study is to evaluate the feasibility of a cognitive-behavioural training program for adolescents with chronic pain irrespective of pain localisation. A secondary aim was to give an impression of the effect of the program on pain and quality of life. Eight adolescents (14-18 years) with chronic non-organic pain recruited from the general population (and their parents) participated in this pilot study. The intervention included five group meetings alternated with four telephone contacts (during the self-management weeks) over a period of 9 weeks. The training aimed to change pain behaviour through pain education, relaxation strategies, problem-solving techniques, assertiveness training, cognitive restructuring and by stimulating the adolescent's physical activity level. The training further addresses the social context of pain by inviting parents to attend two meetings for the parents only, and by asking the adolescents to bring a peer to one of the meetings. Adolescents and their parents were positive about the program. Adolescents felt they were more in control of their pain and parents valued the support they experienced in helping their children to master the pain. The training was considered to be feasible in daily life. Further, the preliminary data showed an effect on pain and quality of life in the expected direction. The results underline the need for a definitive study with a larger sample size and a random controlled design.

Effectiveness of knowledge translation interventions to improve cancer pain management.

PubMed

Cummings, Greta G; Olivo, Susan Armijo; Biondo, Patricia D; Stiles, Carla R; Yurtseven, Ozden; Fainsinger, Robin L; Hagen, Neil A

2011-05-01

Cancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined. To examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes. A systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients. Twenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design. Trials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

A New Program in pain medicine for medical students: Integrating core curriculum knowledge with emotional and reflective development

PubMed Central

Murinson, Beth B.; Nenortas, Elizabeth; Mayer, R. Sam; Mezei, Lina; Kozachik, Sharon; Nesbit, Suzanne; Haythornthwaite, Jennifer A.; Campbell, James N.

2010-01-01

Objective Improvements in clinical pain care have not matched advances in scientific knowledge, and innovations in medical education are needed. Several streams of evidence indicate that pain education needs to address both the affective and cognitive dimensions of pain. Our aim was to design and deliver a new course in pain establishing foundation-level knowledge while comprehensively addressing the emotional development needs in this area. Setting 118 first year medical students at Johns Hopkins School of Medicine. Outcome measures Performance was measured by multiple choice tests of pain knowledge, attendance, reflective pain portfolios and satisfaction measures. Results Domains of competence in pain knowledge included central and peripheral pain signaling, pharmacological management of pain with standard analgesic medications, neuromodulating agents and opioids; cancer pain, musculoskeletal pain, nociceptive, inflammatory, neuropathic, geriatric, and pediatric pain. Socio-emotional development (portfolio) work focused on increasing awareness of pain affect in self and others and enhancing the commitment to excellence in pain care. Reflections included observations on a brief pain experience (cold pressor test), the multi-dimensionality of pain, the role of empathy and compassion in medical care, the positive characteristics of pain-care role models, the complex feelings engendered by pain and addiction including frustration and disappointment, and aspirations and commitments in clinical medicine. The students completing feedback expressed high levels of interest in pain medicine as a result of the course. Discussion We conclude that a four-day pain course incorporating sessions with pain- specialists, pain medicine knowledge, and design-built elements to strengthen emotional skills is an effective educational approach. PMID:21276187

Effectiveness of an Educational Physiotherapy and Therapeutic Exercise Program in Adult Patients With Hemophilia: A Randomized Controlled Trial.

PubMed

Cuesta-Barriuso, Rubén; Torres-Ortuño, Ana; Nieto-Munuera, Joaquín; López-Pina, José Antonio

2017-05-01

To assess the efficacy of an educational physiotherapy home exercise intervention for physical improvement, pain perception, quality of life, and illness behavior in patients with hemophilic arthropathy. Single-blind randomized controlled trial. Home. Patients with hemophilia (N=20) were randomly allocated to an educational intervention group or to a control group. The educational intervention was performed every 2 weeks over a 15-week period, and home exercises were carried out once a day, 6 days a week, over the same period. Joint status was evaluated using the Gilbert scale; pain was assessed using the visual analog scale; illness behavior was evaluated using the Illness Behavior Questionnaire; and the perception of the quality of life was evaluated using the A36 Hemophilia-QoL questionnaire. We observed significant differences in the intervention group and the control group for both quality of life and illness behavior. There was no significant improvement in joint status; however, an improvement was noted in terms of perception of pain in the ankle. A physiotherapy program based on educational sessions and home exercises can improve the perception of pain in patients with hemophilic arthropathy of the ankle. It improves some variables in the perception of the quality of life and illness behavior. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.

PubMed

Archer, Kristin R; Devin, Clinton J; Vanston, Susan W; Koyama, Tatsuki; Phillips, Sharon E; George, Steven Z; McGirt, Matthew J; Spengler, Dan M; Aaronson, Oran S; Cheng, Joseph S; Wegener, Stephen T

2016-01-01

The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Preclinic group education sessions reduce waiting times and costs at public pain medicine units.

PubMed

Davies, Stephanie; Quintner, John; Parsons, Richard; Parkitny, Luke; Knight, Paul; Forrester, Elizabeth; Roberts, Mary; Graham, Carl; Visser, Eric; Antill, Tracy; Packer, Tanya; Schug, Stephan A

2011-01-01

To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from $1,805 Australian Dollars (AUD) to AUD$541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction. Wiley Periodicals, Inc.

Cognitive-behavioral based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

PubMed Central

Archer, Kristin R.; Devin, Clinton J.; Vanston, Susan W.; Koyama, Tatsuki; Phillips, Sharon; George, Steven Z.; McGirt, Matthew J.; Spengler, Dan M.; Aaronson, Oran S.; Cheng, Joseph S.; Wegener, Stephen T.

2015-01-01

The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared to the Education group at 3 month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at-risk for poor recovery following spine surgery. PMID:26476267

Adapting principles of chronic pain self-management to the workplace.

PubMed

Shaw, William S; Tveito, Torill H; Geehern-Lavoie, Mary; Huang, Yueng-Hsiang; Nicholas, Michael K; Reme, Silje E; Wagner, Gregory; Pransky, Glenn

2012-01-01

To evaluate the extent to which the principles of chronic pain or illness self-management (SM) programs might be adapted to focus on the workplace concerns of adults with persistent or recurrent pain and lead to new workplace intervention opportunities. Eight SM programs were selected as representative evidence-based programs and then compared to extract common instructional elements. Elements were analyzed for potential application to four workplace problem domains identified by workers with pain: activity interference, negative self-perceptions, interpersonal challenges, and the inflexibility of work. Of 24 instructional elements, 17 were shared by at least half of the SM programs. Instructional elements judged to be best suited for dealing with workplace concerns included those focused on reducing pain and discomfort, making informed decisions, communicating effectively, and dealing with thoughts and feelings. However, aspects of the workplace that may alter the feasibility or effectiveness of SM strategies include the level of physical demands and limitations, job leeway, and the nature of workplace roles and relationships. Principles and methods of SM intervention programs are generally well suited to address pain-related problems in the workplace, but tailoring of messages may be necessary to incorporate the unique organizational, physical, and social aspects of work into psycho-educational programs.

Effects of a two-school-year multifactorial back education program in elementary schoolchildren.

PubMed

Geldhof, Elisabeth; Cardon, Greet; De Bourdeaudhuij, Ilse; De Clercq, Dirk

2006-08-01

A quasi-experimental pre/post design. To investigate effects of a 2-school-year multifactorial back education program on back posture knowledge and postural behavior in elementary schoolchildren. Additionally, self-reported back or neck pain and fear-avoidance beliefs were evaluated. Epidemiologic studies report mounting nonspecific back pain prevalence among youngsters, characterized by multifactorial risk factors. Study findings of school-based interventions are promising. Furthermore, biomechanical discomfort is found in the school environment. The study sample included 193 intervention children and 172 controls (baseline, 9-to-11-year-olds). The multifactorial intervention consisted of a back education program and the stimulation of postural dynamism in the class through support and environmental changes. Evaluation consisted of a questionnaire, an observation of postural behavior in the classroom, and an observation of material handling during a movement session. The intervention resulted in increased back posture knowledge (P < 0.001), improved postural behavior during material handling (P < 0.001), and decreased duration of trunk flexion (P < 0.05) and neck torsion (P < 0.05) during lesson time. The intervention did not change fear-avoidance beliefs. There was a trend for decreased pain reports in boys of the intervention group (P < 0.09). The intervention resulted in improved postural aspects related to spinal loading. The long-term effect of improved postural behavior at young age on back pain prevalence later in life is of interest for future research.

Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program

PubMed Central

Syazwan, AI; Azhar, MN Mohamad; Anita, AR; Azizan, HS; Shaharuddin, MS; Hanafiah, J Muhamad; Muhaimin, AA; Nizar, AM; Rafee, B Mohd; Ibthisham, A Mohd; Kasani, Adam

2011-01-01

Objectives The purpose of this study was to evaluate a multidisciplinary, interventional, ergonomic education program designed to reduce the risk of musculoskeletal problems by reducing schoolbag weight and correcting poor sitting posture. Methods Data were collected twice before and twice following intervention using the Standardized Nordic Body Map Questionnaire, a rapid upper limb assessment for posture evaluation, and schoolbag weight measurement in children aged 8 and 11 years attending two schools within the central region of Malaysia. Results Students who received the ergonomic intervention reported significant improvements in their sitting posture in a classroom environment and reduction of schoolbag weight as compared with the controls. Conclusion A single-session, early intervention, group ergonomics education program for children aged 8 and 11 years is appropriate and effective, and should be considered as a strategy to reduce musculoskeletal pain among schoolchildren in this age group. PMID:22003301

U.S. Army Medical Department Journal, January-March 2006

DTIC Science & Technology

2006-03-01

Commission of Dental available. In 2004, the first Army resident went to the Accreditation (CODA) in association with the Orofacial Pain Fellowship at...the Orofacial Pain American Dental Association (ADA). Advanced Center, Naval Postgraduate Dental School, National training in general dentistry is...presented by orofacial pain patients. Year Advanced Education in General Dentistry Program. DODI 6000.13 notes that "while internship Another

Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions.

PubMed

Boschen, Kathryn A; Robinson, Edward; Campbell, Kent A; Muir, Sarah; Oey, Elvina; Janes, Kristen; Fashler, Samantha R; Katz, Joel

2016-01-01

Background. Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT) and physical exercise (PE) are empirically supported treatments that can reduce pain and improve quality of life. Objectives. To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario. Methods. The pain management group (PMG) consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning. Results. From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Paired t -tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men. Discussion. The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.

Development of a Guided Internet-based Psycho-education Intervention Using Cognitive Behavioral Therapy and Self-Management for Individuals with Chronic Pain.

PubMed

Perry, Jennifer; VanDenKerkhof, Elizabeth G; Wilson, Rosemary; Tripp, Dean A

2017-04-01

Evidence-based chronic pain treatment includes nonpharmacologic therapies. When addressing barriers to treatment, there is a need to deliver these therapies in a way that is accessible to all individuals who may benefit. To develop a guided Internet-based intervention for individuals with chronic pain, program content and sequence of evidence-based treatments for chronic pain, traditionally delivered via in-person sessions, were identified to be adapted for Internet delivery. With consideration to historical barriers to treatment, and through use of a concept map, therapeutic components and educational material were situated, in an ordered sequence, into six modules. An Internet-based chronic pain intervention was constructed to improve access to evidence-based chronic pain therapies. Research using this intervention, in the form of a pilot study for intervention refinement, was conducted, and a large-scale study to assess effectiveness is necessary prior to implementation. As clients may face barriers to multimodal treatment for chronic pain, nurses could introduce components of education, cognitive behavioral therapy and self-management to clients and prepare them for the "work" of managing chronic pain, through use of this Internet-based intervention. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Effects of exercise, patient education, and resource support on women with fibromyalgia: An extended long-term study.

PubMed

Karper, William B

2016-01-01

This research examined whether a long-term, multi-component program positively affected physical fitness, pain and fatigue in seven women with fibromyalgia syndrome. These women lived independently in the community. They attended a university-based program 3 days per week, 1 hour per session, year-around for many years. They were evaluated periodically with a fitness test and rating scale regarding pain and fatigue. Results from when they began the program versus most recently are provided. All of these women showed various positive results from participation in the program.

[Therapeutic education in oncology: involving patient in the management of cancer].

PubMed

Pérol, David; Toutenu, Pauline; Lefranc, Anne; Régnier, Véronique; Chvetzoff, Gisèle; Saltel, Pierre; Chauvin, Franck

2007-03-01

The notion of therapeutic education was only recently introduced in cancer. Although the term is commonly used, no standard definition exists for the concept and principles of therapeutic education and its efficacy remains to be assessed. Therapeutic education is complementary to the healthcare approach and aims to get the patients more involved in their disease and the treatment decision-making process. This discipline, placed at the interface of human and social sciences, was first developed for the management of chronic diseases (diabetes, asthma). It derives from the principle that involving patients in their own care and management can help them better adjust to life with a chronic disease. The lengthening survival time of cancer patients, which contributes to making cancer a chronic disease, as well as changes in the patient-caregiver relationship contribute to the development of therapeutic education in cancer. Pilot studies, conducted principally in the United States, evaluating the side effects of chemotherapy and the management of pain, have demonstrated that such educational programs could improve patient quality of life and decrease the side effects of treatments. The success of these programs depends on several parameters: taking into account patient's opinion in the elaboration and preparation of the programs; involving skilled multidisciplinary teams engaged in iterative educational actions; having recourse to methodological tools to evaluate the impact of implemented programs. Consistent with the World Health Organization guidelines, research should be conducted in France in order to elaborate and implement cancer-specific education programs and evaluate their potential benefit. Patient education programs on pain, fatigue, nutrition and treatment compliance are currently being developed at Saint-Etienne Regional Resource Centre for cancer information, prevention and education, within the framework of the Canceropole Lyon Auvergne Rhône-Alpes.

[Chronic noncancer pain and patient education: a place for e-learning?].

PubMed

Braillard, Olivia; Cedraschi, Christine; Jesaimani, Ameena; Piguet, Valérie

2015-06-24

Chronic non cancerous pain considerably limits the patients' quality of life. Yet, chronic non cancerous pain has a prevalence as high as 25% to 35%, Therapeutic education allows to work on the knowledge and know-how about the disease, the treatment, the management of health resources and health behaviors. E-learning uses new technologies of communication to improve the quality of learning by facilitating access to the resources and favoring the interactivity. It is attractive by its wide accessibility and its limited logistic needs. The level of proof of its efficacy is weak, mainly because of methodological limitations. Some good quality studies are promising, with a positive effect of e-learning programs on pain intensity, disability, autonomy and medication misuse.

The efficacy of patient education in whiplash associated disorders: a systematic review.

PubMed

Meeus, Mira; Nijs, Jo; Hamers, Veronique; Ickmans, Kelly; Oosterwijck, Jessica Van

2012-01-01

Until now, there is no firm evidence for conservative therapy in patients with chronic Whiplash Associated Disorders (WAD). While chronic WAD is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. This systematic literature study aimed at providing an overview of the literature regarding the currently existing educative treatments for patients with whiplash or WAD and their evidence. Systematic review of the literature. A systematic literature search was conducted in the following databases: Pubmed, Springerlink, and Web of Science using different keyword combinations. We included randomized controlled clinical trials (RCT) that encompass the effectiveness of education for patients with WAD. The included articles were evaluated on their methodological quality. Ten RCT's of moderate to good quality remained after screening. Both oral and written advice, education integrated in exercise programs and behavioral programs appear effective interventions for reducing pain and disability and enhancing recovery and mobility in patients with WAD. In acute WAD, a simple oral education session will suffice. In subacute or chronic patients broader (multidisciplinary) programs including education which tend to modulate pain behavior and activate patients seems necessary. Because of limited studies and the broad range of different formats and contents of education and different outcome measures, further research is needed before solid conclusions can be drawn regarding the use and the modalities of these educational interventions in clinical practice. Based on this systematic literature study is seems appropriate for the pain physician to provide education as part of a biopsychosocial approach of patients with whiplash. Such education should target removing therapy barriers, enhancing therapy compliance and preventing and treating chronicity. Still, more studies are required to provide firm evidence for the type, duration, format, and efficacy of education in the different types of whiplash patients.

A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT.

PubMed

Tekur, P; Nagarathna, R; Chametcha, S; Hankey, Alex; Nagendra, H R

2012-06-01

Previously, outpatient Yoga programs for patients with chronic low back pain (CLBP) lasting several months have been found to reduce pain, analgesic requirement and disability, and improve spinal mobility. This study evaluated changes in pain, anxiety, depression and spinal mobility for CLBP patients on short-term, residential Yoga and physical exercise programs, including comprehensive yoga lifestyle modifications. A seven day randomized control single blind active study in an residential Holistic Health Centre in Bangalore, India, assigned 80 patients (37 female, 43 male) with CLBP to yoga and physical exercise groups. The Yoga program consisted of specific asanas and pranayamas for back pain, meditation, yogic counselling, and lectures on yoga philosophy. The control group program included physical therapy exercises for back pain, and matching counselling and education sessions. Group×time interactions (p<0.05) and between group differences (p<0.05) were significant in all variables. Both groups' scores on the numerical rating scale for pain reduced significantly, 49% in Yoga (p<0.001, ES=1.62), 17.5% in controls (p=0.005, ES=0.67). State anxiety (STAI) reduced 20.4% (p<0.001, ES=0.72) and trait anxiety 16% (p<0.001, ES=1.09) in the yoga group. Depression (BDI) decreased in both groups, 47% in yoga (p<0.001, ES=0.96,) and 19.9% in controls (p<0.001, ES=0.59). Spinal mobility ('Sit and Reach' instrument) improved in both groups, 50%, in yoga (p<0.001, ES=2.99) and 34.6% in controls (p<0.001, ES=0.81). Seven days intensive residential Yoga program reduces pain, anxiety, and depression, and improves spinal mobility in patients with CLBP more effectively than physiotherapy exercises. Copyright © 2012 Elsevier Ltd. All rights reserved.

Acute Pain Medicine in the United States: A Status Report

PubMed Central

Tighe, Patrick; Buckenmaier, Chester C.; Boezaart, Andre P.; Carr, Daniel B.; Clark, Laura L.; Herring, Andrew A.; Kent, Michael; Mackey, Sean; Mariano, Edward R.; Polomano, Rosemary C.; Reisfield, Gary M.

2015-01-01

Background Consensus indicates that a comprehensive, multimodal, holistic approach is foundational to the practice of acute pain medicine (APM), but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service, which is often unavailable or inconsistently applied. This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. Methods A multidisciplinary panel was nominated through the Acute Pain Medicine Shared Interest Group (APMSIG) of the American Academy of Pain Medicine (AAPM). The panel met in Chicago, Illinois, in July 2014, to identify gaps and set priorities in APM research and education. Results The panel identified 3 areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of APM. Conclusion This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain. PMID:26535424

Computer Simulation for Pain Management Education: A Pilot Study.

PubMed

Allred, Kelly; Gerardi, Nicole

2017-10-01

Effective pain management is an elusive concept in acute care. Inadequate knowledge has been identified as a barrier to providing optimal pain management. This study aimed to determine student perceptions of an interactive computer simulation as a potential method for learning pain management, as a motivator to read and learn more about pain management, preference over traditional lecture, and its potential to change nursing practice. A post-computer simulation survey with a mixed-methods descriptive design was used in this study. A college of nursing in a large metropolitan university in the Southeast United States. A convenience sample of 30 nursing students in a Bachelor of Science nursing program. An interactive computer simulation was developed as a potential alternative method of teaching pain management to nursing students. Increases in educational gain as well as its potential to change practice were explored. Each participant was asked to complete a survey consisting of 10 standard 5-point Likert scale items and 5 open-ended questions. The survey was used to evaluate the students' perception of the simulation, specifically related to educational benefit, preference compared with traditional teaching methods, and perceived potential to change nursing practice. Data provided descriptive statistics for initial evaluation of the computer simulation. The responses on the survey suggest nursing students perceive the computer simulation to be entertaining, fun, educational, occasionally preferred over regular lecture, and with potential to change practice. Preliminary data support the use of computer simulation in educating nursing students about pain management. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Acute pain in the emergency department: Effect of an educational intervention.

PubMed

Friesgaard, Kristian Dahl; Paltved, Charlotte; Nikolajsen, Lone

2017-04-01

Pain management is often inadequate in emergency departments (ED) despite the availability of effective analgesics. Interventions to change professional behavior may therefore help to improve the management of pain within the ED. We hypothesized that a 2-h educational intervention combining e-learning and simulation would result in improved pain treatment of ED patients with pain. Data were collected at the ED of Horsens Regional Hospital during a 3-week study period in March 2015. Pain intensity (NRS, 0-10) and analgesic administration were recorded 24h a day for all patients who were admitted to the ED during the first and third study weeks. Fifty-three ED nurses and 14 ED residents participated in the educational intervention, which took place in the second study week. In total, 247 of 796 patients had pain >3 on the NRS at the admission to the ED and were included in the data analysis. The theoretical knowledge of pain management among nurses and residents increased as assessed by a multiple choice test performed before and after the educational intervention (P=0.001), but no change in clinical practice could be observed: The administration for analgesics [OR: 1.79 (0.97-3.33)] and for opioids [2.02 (0.79-5.18)] were similar before and after the educational intervention, as was the rate of clinically meaningful pain reduction (NRS >2) during the ED stay [OR: 0.81 (CI 0.45-1.44)]. Conduction of a 2-h educational intervention combining interactive case-based e-learning with simulation-based training in an ED setting was feasible with a high participation rate of nurses and residents. Their knowledge of pain management increased after completion of the program, but transfer of the new knowledge into clinical practice could not be found. Future research should explore the effects of repeated education of healthcare providers on pain management. It is essential for nurses and residents in emergency departments to have the basic theoretical and practical skills to treat acute pain properly. A modern approach including e-learning and simulation lead to increased knowledge of acute pain management. Further studies are needed to show how this increased knowledge is transferred into clinical practice. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Targeting practitioners: A review of guidelines, training, and policy in pain management

PubMed Central

Barth, Kelly S.; Guille, Constance; McCauley, Jenna; Brady, Kathleen T.

2017-01-01

This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders. PMID:28363316

Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial

PubMed Central

Erhart-Hledik, Jennifer C; Perez, Daniel A; Hunter, Simon

2018-01-01

Background Chronic knee pain, most commonly caused by knee osteoarthritis, is a prevalent condition which in most cases can be effectively treated through conservative, non-surgical care involving exercise therapy, education, psychosocial support, and weight loss. However, most people living with chronic knee pain do not receive adequate care, leading to unnecessary use of opiates and surgical procedures. Objective Assess the efficacy of a remotely delivered digital care program for chronic knee pain. Methods We enrolled 162 participants into a randomized controlled trial between January and March 2017. Participants were recruited from participating employers using questionnaires for self-assessment of their knee pain, and randomized into treatment (n=101) and control (n=61) groups. Participants in the treatment group were enrolled in the Hinge Health digital care program for chronic knee pain. This is a remotely delivered, home-based 12-week intervention that includes sensor-guided exercise therapy, education, cognitive behavioral therapy, weight loss, and psychosocial support through a personal coach and team-based interactions. The control group received three education pieces regarding self-care for chronic knee pain. Both groups had access to treatment-as-usual. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale and KOOS Physical Function Shortform (KOOS-PS). Secondary outcomes were visual analog scales (VAS) for pain and stiffness respectively, surgery intent, and self-reported understanding of the condition and treatment options. Outcome measures were analyzed by intention to treat (excluding 7 control participants who received the digital care program due to administrative error) and per protocol. Results In an intent-to-treat analysis the digital care program group had a significantly greater reduction in KOOS Pain compared to the control group at the end of the program (greater reduction of 7.7, 95% CI 3.0 to 12.3, P=.002), as well as a significantly greater improvement in physical function (7.2, 95% CI 3.0 to 11.5, P=.001). This was also reflected in the secondary outcomes VAS pain (12.3, 95% CI 5.4 to 19.1, P<.001) and VAS stiffness (13.4, 95% CI 5.6 to 21.1, P=.001). Participants’ self-reported likelihood (from 0% to 100%) of having surgery also reduced more strongly in the digital care program group compared to the control group over the next 1 year (–9.4 percentage points, pp, 95% CI –16.6 to –2.2, P=.01), 2 years (–11.3 pp, 95% CI –20.1 to –2.5, P=.01), and 5 years (–14.6 pp, 95% CI –23.6 to –5.5, P=.002). Interest in surgery (from 0 to 10) also reduced more so in the digital care program compared to control group (–1.0, 95% CI –1.7 to –0.2, P=.01). Participants’ understanding of the condition and treatment options (on a scale from 0 to 4) increased more substantially for participants in the digital care program than those in the control group (0.9, 95% CI 0.6 to 1.3, P<.001). In an analysis on participants that completed the intervention (per protocol analysis) all primary and secondary outcomes remained significant at greater effect magnitudes compared to intention to treat, with those completing the program showing a 61% (95% CI 48 to 74) reduction in VAS pain compared to 21% (95% CI 5 to 38) in the control group (P<.001). Accounting for the cost of administering the program, we estimate net cost savings on surgery alone of US $4340 over 1 year and $7900 over 5 years for those participants completing the digital care program compared to those in the control group receiving treatment-as-usual. In an exploratory subgroup analysis including only participants exhibiting clinical symptoms of osteoarthritis the program proved equally effective. Conclusions This trial provides strong evidence that a comprehensive 12-week digital care program for chronic knee pain, including osteoarthritis, yields significantly improved outcomes for pain, physical function, stiffness, surgery risk, and understanding of the condition, compared to a control group. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 13307390; http://www.isrctn.com/ISRCTN13307390 (Archived by WebCite at http://www.webcitation.org/6ycwjGL73) PMID:29695370

Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial.

PubMed

Mecklenburg, Gabriel; Smittenaar, Peter; Erhart-Hledik, Jennifer C; Perez, Daniel A; Hunter, Simon

2018-04-25

Chronic knee pain, most commonly caused by knee osteoarthritis, is a prevalent condition which in most cases can be effectively treated through conservative, non-surgical care involving exercise therapy, education, psychosocial support, and weight loss. However, most people living with chronic knee pain do not receive adequate care, leading to unnecessary use of opiates and surgical procedures. Assess the efficacy of a remotely delivered digital care program for chronic knee pain. We enrolled 162 participants into a randomized controlled trial between January and March 2017. Participants were recruited from participating employers using questionnaires for self-assessment of their knee pain, and randomized into treatment (n=101) and control (n=61) groups. Participants in the treatment group were enrolled in the Hinge Health digital care program for chronic knee pain. This is a remotely delivered, home-based 12-week intervention that includes sensor-guided exercise therapy, education, cognitive behavioral therapy, weight loss, and psychosocial support through a personal coach and team-based interactions. The control group received three education pieces regarding self-care for chronic knee pain. Both groups had access to treatment-as-usual. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale and KOOS Physical Function Shortform (KOOS-PS). Secondary outcomes were visual analog scales (VAS) for pain and stiffness respectively, surgery intent, and self-reported understanding of the condition and treatment options. Outcome measures were analyzed by intention to treat (excluding 7 control participants who received the digital care program due to administrative error) and per protocol. In an intent-to-treat analysis the digital care program group had a significantly greater reduction in KOOS Pain compared to the control group at the end of the program (greater reduction of 7.7, 95% CI 3.0 to 12.3, P=.002), as well as a significantly greater improvement in physical function (7.2, 95% CI 3.0 to 11.5, P=.001). This was also reflected in the secondary outcomes VAS pain (12.3, 95% CI 5.4 to 19.1, P<.001) and VAS stiffness (13.4, 95% CI 5.6 to 21.1, P=.001). Participants' self-reported likelihood (from 0% to 100%) of having surgery also reduced more strongly in the digital care program group compared to the control group over the next 1 year (-9.4 percentage points, pp, 95% CI -16.6 to -2.2, P=.01), 2 years (-11.3 pp, 95% CI -20.1 to -2.5, P=.01), and 5 years (-14.6 pp, 95% CI -23.6 to -5.5, P=.002). Interest in surgery (from 0 to 10) also reduced more so in the digital care program compared to control group (-1.0, 95% CI -1.7 to -0.2, P=.01). Participants' understanding of the condition and treatment options (on a scale from 0 to 4) increased more substantially for participants in the digital care program than those in the control group (0.9, 95% CI 0.6 to 1.3, P<.001). In an analysis on participants that completed the intervention (per protocol analysis) all primary and secondary outcomes remained significant at greater effect magnitudes compared to intention to treat, with those completing the program showing a 61% (95% CI 48 to 74) reduction in VAS pain compared to 21% (95% CI 5 to 38) in the control group (P<.001). Accounting for the cost of administering the program, we estimate net cost savings on surgery alone of US $4340 over 1 year and $7900 over 5 years for those participants completing the digital care program compared to those in the control group receiving treatment-as-usual. In an exploratory subgroup analysis including only participants exhibiting clinical symptoms of osteoarthritis the program proved equally effective. This trial provides strong evidence that a comprehensive 12-week digital care program for chronic knee pain, including osteoarthritis, yields significantly improved outcomes for pain, physical function, stiffness, surgery risk, and understanding of the condition, compared to a control group. International Standard Randomized Controlled Trial Number (ISRCTN) 13307390; http://www.isrctn.com/ISRCTN13307390 (Archived by WebCite at http://www.webcitation.org/6ycwjGL73). ©Gabriel Mecklenburg, Peter Smittenaar, Jennifer C Erhart-Hledik, Daniel A Perez, Simon Hunter. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.04.2018.

Clinical effectiveness of behavioral signs for screening chronic low-back pain patients in a work-oriented physical rehabilitation program.

PubMed

Werneke, M W; Harris, D E; Lichter, R L

1993-12-01

This prospective study investigated the relationship between behavioral sign scores (from Waddell) and the return to work status of chronic low-back pain patients who completed a work-oriented physical rehabilitation program without formal facility-related psychologic or social services. Further, the authors monitored the effect of this program on changing these scores. The program consisted of physical reconditioning through resistive exercises, flexibility and aerobic training, posture and body mechanics education, and progressive work simulation tasks and activities of daily living. One hundred eighty-three nonworking or partially disabled low-back pain patients with an average duration of 8.7 months' disability were included in the study. The presence of each of eight behavioral signs was tested for on entry and again on completion of the program. Analysis showed a significant drop in behavioral sign scores for patients who successfully returned to work. There was no significant reduction in scores for patients who did not return to work. The results suggest these signs may predict the effectiveness of treating chronic low-back pain patients in a return-to-work physical rehabilitation program. Conversely, screening for behavioral signs may identify low-back pain patients who would benefit from intensive behavioral and psychiatric testing and intervention efforts.

Effects of internet-based pain coping skills training prior to home exercise for individuals with hip osteoarthritis (HOPE trial): a randomised controlled trial.

PubMed

Bennell, Kim L; Nelligan, Rachel K; Rini, Christine; Keefe, Francis J; Kasza, Jessica; French, Simon; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Harris, Anthony; Vicenzino, Bill; Hodges, Paul W; Hinman, Rana S

2018-05-22

This assessor-, therapist- and participant-blinded randomised controlled trial evaluated the effects of an automated internet-based pain coping skills training (PCST) program prior to home exercise for people with clinically-diagnosed hip osteoarthritis (OA). 144 people were randomised to either the PCST group or the comparator group. In the first 8 weeks, the PCST group received online education and PCST while the comparison group received online education only. From weeks 8-24, both groups visited a physiotherapist 5 times for home exercise prescription. Assessments were performed at baseline, 8, 24 and 52 weeks. Primary outcomes were hip pain on walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) at 24 weeks. Secondary outcomes were other measures of pain, quality-of-life, global change, self-efficacy, pain coping, pain catastrophizing, depression, anxiety, stress, physical activity and adverse events. Primary outcomes were completed by 137 (95%), 131 (91%) and 127 (88%) participants at 8, 24 and 52 weeks, respectively. There were no significant between-group differences in primary outcomes at week 24 (change in: walking pain (mean difference 0.5 units; 95%CI, -0.3 to 1.3) and function (-0.9 units; 95%CI, -4.8 to 2.9)), with both groups showing clinically-relevant improvements. At week 8, the PCST group had greater improvements in function, pain coping and global improvement than comparison. Greater pain coping improvements persisted at 24 and 52 weeks. In summary, online PCST immediately improved pain coping and function but did not confer additional benefits to a subsequent exercise program, despite sustained pain coping improvements.

Guidelines for fellowship training in Regional Anesthesiology and Acute Pain Medicine: Second Edition, 2010.

PubMed

2011-01-01

The Regional Anesthesiology and Acute Pain Medicine Fellowship Directors Group develops and maintains guidelines for fellowship training in the subspecialty. These guidelines update the original guidelines that were published in 2005. The guidelines address 3 major topic areas: organization and resources, the educational program, and the evaluation process.

A phase III randomized three-arm trial of physical therapist delivered pain coping skills training for patients with total knee arthroplasty: the KASTPain protocol

PubMed Central

2012-01-01

Background Approximately 20% of patients report persistent and disabling pain following total knee arthroplasty (TKA) despite an apparently normally functioning prosthesis. One potential risk factor for unexplained persistent pain is high levels of pain catastrophizing. We designed a three-arm trial to determine if a pain coping skills training program, delivered prior to TKA, effectively reduces function-limiting pain following the procedure in patients with high levels of pain catastrophizing. Methods/design The trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated. Discussion The trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated. Trial Registration NCT01620983 PMID:22906061

Feasibility of a Telehealth Educational Program on Self-Management of Pain and Fatigue in Adult Cancer Patients.

PubMed

Rocque, Gabrielle B; Halilova, Karina I; Varley, Allyson L; Williams, Courtney P; Taylor, Richard A; Masom, David G; Wright, William J; Partridge, Edward E; Kvale, Elizabeth A

2017-06-01

Pain and fatigue are common symptoms among cancer patients and often lead to substantial distress. Innovative self-management programs for pain and fatigue are needed. The primary objective was to assess the feasibility of a telehealth pain and fatigue self-management program among adult cancer patients. Secondary objectives included assessment of differences in patient characteristics, recruitment, and retention of patients based on two screening strategies: 1) navigator-collected, patient-reported pain or fatigue and 2) in-clinic, physician-identified pain or fatigue. This prospective, nonrandomized, pre-post evaluation assessed feasibility, which was defined as 50% of eligible patients choosing to participate and completing the intervention. Patient demographics and patient-reported outcomes (patient activation, distress, symptoms, and quality of life) were collected at baseline and study completion. Differences in baseline characteristics were compared between cohorts and for patients who did vs. did not graduate from the program. The program did not meet feasibility requirements because of only 34% of eligible patients choosing to participate. However, 50% of patients starting the program graduated. Differences in baseline characteristics and retention rates were noted by recruitment strategy. At baseline, 27.3% of navigated patients were at the highest activation level compared with 7.1% in the physician-referred, non-navigated patients (P = 0.17); more than 15% of non-completers were at the lowest activation level compared with 9% of completers (P = 0.85). Telehealth self-management program for pain and fatigue may be better accepted among selected segments of cancer patients. Larger scale studies are needed to assess the efficacy of this program in a more selective activated population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Preventing Advanced Carious Lesions with Caries Atraumatic Restorative Technique.

PubMed

Byrd, Tammi O

2016-06-01

An alternative approach to controlling dental caries and preventing the associated pain, called atraumatic restorative technique (ART), is described for populations in need, where dental hygienists restore decayed teeth with glass ionomer restorations without prior removal of all decayed tooth structure. There are populations whose decay needs are not adequately being met within the current oral health care delivery system. These include those in poverty conditions, vulnerable children, and the elderly who are often in long-term care facilities without adequate resources or opportunities for traditional dentistry. ART provides a viable option for controlling caries and relieving the pain of untreated decay. The purpose of this article is to suggest that the evidence surrounding ART be viewed objectively and that dental hygienists, with additional education in this approach, can contribute to relieving the pain of untreated dental decay. Evidence suggests that teeth can be effectively restored with ART. Dental hygienists represent an appropriate workforce to provide ART with their current background and education combined plus a brief training program; it is suggested that dental hygiene educational programs include ART within the curriculum. Along with dental sealants and fluoride varnish application, ART can be an important component of a comprehensive preventive program to address the unmet needs of vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

iCanCope with Pain™: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs

PubMed Central

Stinson, Jennifer N; Lalloo, Chitra; Harris, Lauren; Isaac, Lisa; Campbell, Fiona; Brown, Stephen; Ruskin, Danielle; Gordon, Allan; Galonski, Marilyn; Pink, Leah R; Buckley, Norman; Henry, James L; White, Meghan; Karim, Allia

2014-01-01

BACKGROUND: While there are emerging web-based self-management programs for children and adolescents with chronic pain, there is currently not an integrated web- and smartphone-based app that specifically addresses the needs of adolescents with chronic pain. OBJECTIVES: To conduct a needs assessment to inform the development of an online chronic pain self-management program for adolescents, called iCanCope with Pain™. METHODS: A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7). RESULTS: Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear/anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory-based functionalities of: symptom self-monitoring; personalized goal setting; pain coping skills training; peer-based social support; and chronic pain education. CONCLUSIONS: The proposed iCanCope with Pain™ program aims to address the self-management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support. PMID:25000507

Palliative care and palliative radiation therapy education in radiation oncology: A survey of US radiation oncology program directors.

PubMed

Wei, Randy L; Colbert, Lauren E; Jones, Joshua; Racsa, Margarita; Kane, Gabrielle; Lutz, Steve; Vapiwala, Neha; Dharmarajan, Kavita V

The purpose of this study was to assess the state of palliative and supportive care (PSC) and palliative radiation therapy (RT) educational curricula in radiation oncology residency programs in the United States. We surveyed 87 program directors of radiation oncology residency programs in the United States between September 2015 and November 2015. An electronic survey on PSC and palliative RT education during residency was sent to all program directors. The survey consisted of questions on (1) perceived relevance of PSC and palliative RT to radiation oncology training, (2) formal didactic sessions on domains of PSC and palliative RT, (3) effective teaching formats for PSC and palliative RT education, and (4) perceived barriers for integrating PSC and palliative RT into the residency curriculum. A total of 57 responses (63%) was received. Most program directors agreed or strongly agreed that PSC (93%) and palliative radiation therapy (99%) are important competencies for radiation oncology residents and fellows; however, only 67% of residency programs had formal educational activities in principles and practice of PSC. Most programs had 1 or more hours of formal didactics on management of pain (67%), management of neuropathic pain (65%), and management of nausea and vomiting (63%); however, only 35%, 33%, and 30% had dedicated lectures on initial management of fatigue, assessing role of spirituality, and discussing advance care directives, respectively. Last, 85% of programs reported having a formal curriculum on palliative RT. Programs were most likely to have education on palliative radiation to brain, bone, and spine, but less likely on visceral, or skin, metastasis. Residency program directors believe that PSC and palliative RT are important competencies for their trainees and support increasing education in these 2 educational domains. Many residency programs have structured curricula on PSC and palliative radiation education, but room for improvement exists in management of fatigue, assessing role of spirituality, and discussion regarding advance care planning. Copyright © 2016 American Society of Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

PubMed

Corizzo, C C; Baker, M C; Henkelmann, G C

2000-09-01

To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

From the Ouchless Place to Comfort Central: the evolution of a concept.

PubMed

Schechter, Neil L

2008-11-01

Although the past 20 years have yielded an outpouring of research on pain management in children, this information is often not applied uniformly to children in the hospital. To address this deficiency, we developed a systematic institution-wide program to reduce pain in all children in the hospital. Our goal was to create a setting in which attention to pain control and comfort measures would be inherent in all inpatient encounters. We labeled the inpatient unit in which this concept evolved as the "Ouchless Place" and described the program and its development in a 1997 Pediatrics article. In this article we describe the further evolution of that concept in light of the broader changes that have occurred in the field of pain management and in our community. The development of a new children's hospital allowed us to examine what we had learned from our previous experience and modify our program on the basis of that review. This new initiative was renamed "Comfort Central," recognizing that although no inpatient experience could be entirely "ouchless," we could still pledge to families that we were attentive to pain and would provide the most comfort that we could. Specific changes that were put in place in our model included the acquisition of administrative authority to mandate change; the extension of our program to the laboratory, outpatient clinics, and physician offices; the incorporation of newer, more active educational models; increased emphasis on collaboration with other services; increased visibility of pain-relief efforts; and development of an ongoing quality improvement program that monitors the efficacy of pain-relief initiatives in the institution. The elements of this program may be applicable to other health care systems that desire to develop a more cohesive system-wide approach to pain reduction in those for whom they provide care.

Rationale, design, and protocol for the prevention of low back pain in the military (POLM) trial (NCT00373009)

PubMed Central

George, Steven Z; Childs, John D; Teyhen, Deydre S; Wu, Samuel S; Wright, Alison C; Dugan, Jessica L; Robinson, Michael E

2007-01-01

Background There are few effective strategies reported for the primary prevention of low back pain (LBP). Core stabilization exercises targeting the deep abdominal and trunk musculature and psychosocial education programs addressing patient beliefs and coping styles represent the current best evidence for secondary prevention of low back pain. However, these programs have not been widely tested to determine if they are effective at preventing the primary onset and/or severity of LBP. The purpose of this cluster randomized clinical trial is to determine if a combined core stabilization exercise and education program is effective in preventing the onset and/or severity of LBP. The effect of the combined program will be compared to three other standard programs. Methods/Design Consecutive Soldiers participating in advanced individual training (AIT) will be screened for eligibility requirements and consented to study participation, as appropriate. Companies of Soldiers will be randomly assigned to receive the following standard prevention programs; a core stabilization exercise program (CSEP) alone, a CSEP with a psychosocial education (PSEP), a traditional exercise (TEP), or a TEP with a PSEP. Proximal outcome measures will be assessed at the conclusion of AIT (a 12 week training period) and include imaging of deep lumbar musculature using real-time ultrasound imaging and beliefs about LBP by self-report questionnaire. We are hypothesizing that Soldiers receiving the CSEP will have improved thickness of selected deep lumbar musculature (transversus abdominus, multifidi, and erector spinae muscles). We are also hypothesizing that Soldiers receiving the PSEP will have improved beliefs about the management of LBP. After AIT, Soldiers will be followed monthly to measure the distal outcomes of LBP occurrence and severity. This information will be collected during the subsequent 2 years following completion of AIT using a web-based data entry system. Soldiers will receive a monthly email that queries whether any LBP was experienced in the previous calendar month. Soldiers reporting LBP will enter episode-specific data related to pain intensity, pain-related disability, fear-avoidance beliefs, and pain catastrophizing. We are hypothesizing that Soldiers receiving the CSEP and PSEP will report the longest duration to first episode of LBP, the lowest frequency of LBP, and the lowest severity of LBP episodes. Statistical comparisons will be made between each of the randomly assigned prevention programs to test our hypotheses related to determining which of the 4 programs is most effective. Discussion We have presented the design and protocol for the POLM trial. Completion of this trial will provide important information on how to effectively train Soldiers for the prevention of LBP. Trial registration NCT00373009 PMID:17868436

Internet-mediated physiotherapy and pain coping skills training for people with persistent knee pain (IMPACT - knee pain): a randomised controlled trial protocol.

PubMed

Dobson, Fiona; Hinman, Rana S; French, Simon; Rini, Christine; Keefe, Francis; Nelligan, Rachel; Abbott, J Haxby; Bryant, Christina; Staples, Margaret P; Dalwood, Andrew; Bennell, Kim L

2014-08-13

Persistent knee pain in people over 50 years of age is often attributable to knee osteoarthritis (OA), a common joint condition that causes physical and psychological dysfunction. Exercise and pain coping skills training (PCST) can help reduce the impact of persistent knee pain, however, access to health professionals who deliver these services can be challenging. With increasing access to the Internet, remotely delivered Internet-based treatment approaches may provide alternatives for healthcare delivery. This pragmatic randomised controlled trial will investigate whether an Internet-delivered intervention that combines PCST and physiotherapist-guided exercise (PCST + Ex) is more effective than online educational material (educational control) in people with persistent knee pain. We will recruit 148 people over 50 years of age with self-reported persistent knee pain consistent with knee OA from the Australian community. Following completion of baseline questionnaires, participants will be randomly allocated to access a 3-month intervention of either (i) online educational material, or (ii) the same online material plus an 8-module (once per week) Internet-based PCST program and seven Internet-delivered physiotherapy sessions with a home exercise programs to be performed 3 times per week. Outcomes will be measured at baseline, 3 months and 9 months with the primary time point at 3 months. Primary outcomes are average knee pain on walking (11-point numeric rating scale) and self-reported physical function (Western Ontario and McMaster Universities Osteoarthritis Index subscale). Secondary outcomes include additional measures of knee pain, health-related quality-of-life, perceived global change in symptoms, and potential moderators and mediators of outcomes including self-efficacy for pain management and function, pain coping attempts and pain catastrophising. Other measures of adherence, adverse events, harms, use of health services/co-interventions, and process measures including appropriateness and satisfaction of the intervention, will be collected at 3, 6 and 9 months. The findings will help determine the effectiveness and acceptability of Internet access to a combination of interventions that are known to be beneficial to people with persistent knee pain. This study has the potential to guide clinical practice towards innovative modes of healthcare provision. Australian New Zealand Clinical Trials Registry reference: ACTRN12614000243617.

Multidimensional Patient Impression of Change Following Interdisciplinary Pain Management.

PubMed

Gagnon, Christine M; Scholten, Paul; Atchison, James

2018-04-20

To assess patient impression of change following interdisciplinary pain management utilizing a newly developed Multidimensional Patient Impression of Change (MPIC) questionnaire. A heterogeneous group of chronic pain patients (N = 601) participated in an interdisciplinary treatment program. Programs included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, patient education and medical management). Patients completed measures of pain, mood, coping, physical functioning and pain acceptance both prior to and at completion of their treatment programs. The newly developed MPIC is an expansion to the Patient Global Impression of Change (PGIC) including seven additional domains (Pain, Mood, Sleep, Physical Functioning, Cope with Pain, Manage Pain Flare-ups, and Medication Effectiveness). The MPIC was administered to the patients post-treatment. There were statistically significant pre- to post-treatment improvements found on all outcome measures. The majority of these improvements were significantly correlated with all domains of the MPIC. The original PGIC item was significantly associated with all of the new MPIC domains and the domains were significantly associated with each other; but there were variations in the distribution of responses highlighting variation of perceived improvements among the domains. Our results support the use of the MPIC as a quick and easy post-treatment assessment screening tool. Future research is needed to examine relevant correlates to Medication Effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Effectiveness of cognitive behavioral therapy based on the pain sustainment/exacerbation model in patients with tension-type headache: a pilot study.

PubMed

Motoya, Ryo; Oda, Keiko; Ito, Eiji; Ichikawa, Masahiro; Sato, Taku; Watanabe, Tadashi; Sakuma, Jun; Saito, Kiyoshi; Niwa, Shin-Ichi; Yabe, Hirooki

2014-01-01

The purpose of this study was to carry out a program of Cognitive Behavioral Therapy (CBT) based on the pain sustainment/exacerbation model for tension-type headache (TTH) patients and to examine the effectiveness as a pilot study. The participants were 4 TTH patients who consulted the outpatient clinic of a university hospital. It consisted of 4 individualized sessions as CBT program (including psychological education, self-monitoring, relaxation technique, cognitive restricting and exposure), and a follow-up examination was carried out 1 month after its completion. The sessions, each of which was 60 minutes long, were executed at weekly intervals. As a result, the score of the Pain Catastrophizing Scale (PCS) decreased after program compared with before program in all patients. The score of escape/avoidance was also reduced at the post-program and follow-up (1 month later) compared with the score of pre-program in patients except Case 2, in whom the score was 0 throughout the study. The degree of the Headache Impact Test (HIT-6) improved by program and changed to "mild" or "none" in all participants. These findings show that in patients with TTH this short CBT program has effect on pain catastrophizing, escape/avoidance and daily disability.

Effectiveness of Cognitive-behavioral Program on Pain and Fear in School-aged Children Undergoing Intravenous Placement.

PubMed

Hsieh, Yi-Chuan; Cheng, Su-Fen; Tsay, Pei-Kwei; Su, Wen-Jen; Cho, Yen-Hua; Chen, Chi-Wen

2017-12-01

This study aimed to evaluate the effects of cognitive-behavioral program on pain and medical fear in hospitalized school-aged children receiving intravenous (IV) placement. This study used an quasi-experimental design. Thirty-five participants were assigned to the experimental group and 33 to the control group in the acute internal medicine ward of a children's hospital. The cognitive-behavioral program entailed having the patients read an educational photo book about IV placement before the procedure and having them watch their favorite music video during the procedure. The outcome measures were numeric rating scales for pain intensity and fear during the procedure. After applying the cognitive-behavioral program, the mean scores on pain and fear decreased in the experimental group. However, the difference in pain intensity between these two groups was nonsignificant. The intensity of fear in the experimental group was significantly lower than that in the control group. In this study, the cognitive-behavioral program used with school-aged hospitalized children promoted less fear during IV placement. The results of this study can serve as a reference for empirical nursing care and as care guidance for clinical IV injections involving children. Copyright © 2017. Published by Elsevier B.V.

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol

PubMed Central

Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Haxby Abbott, J.; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S.

2015-01-01

Background Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. Objective The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist–instructed home exercise leads to greater reductions in pain and improvements in function. Design An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. Setting The study will be conducted in a community setting. Participants The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Intervention Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Measurements Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. Limitations A self-reported diagnosis of persistent hip pain will be used. Conclusions The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist–instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. PMID:26023213

Effects of Adding an Internet-Based Pain Coping Skills Training Protocol to a Standardized Education and Exercise Program for People With Persistent Hip Pain (HOPE Trial): Randomized Controlled Trial Protocol.

PubMed

Bennell, Kim L; Rini, Christine; Keefe, Francis; French, Simon; Nelligan, Rachel; Kasza, Jessica; Forbes, Andrew; Dobson, Fiona; Abbott, J Haxby; Dalwood, Andrew; Vicenzino, Bill; Harris, Anthony; Hinman, Rana S

2015-10-01

Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction. The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function. An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted. The study will be conducted in a community setting. The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA. Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention. Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks. A self-reported diagnosis of persistent hip pain will be used. The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision. © 2015 American Physical Therapy Association.

State of the field survey: spinal cord stimulator use by academic pain medicine practices.

PubMed

Gharibo, Christopher; Laux, Gary; Forzani, Brian R; Sellars, Christopher; Kim, Eric; Zou, Shengping

2014-02-01

The concept of neuromodulation via the use of spinal cord stimulators (SCS) was first established over forty years ago. Since then, its popularity has grown as numerous studies have demonstrated its utility to reduce chronic pain, improve patient function, and reduce long-term health care costs. The aim of this study was to update the pain medicine community on the evolution of SCS practice trends in academic centers. Ninety-three pain medicine fellowship programs in the United States were identified from the Accreditation Council for Graduate Medical Education Website and were contacted to participate in an internet survey. A 37-item questionnaire was inspired by a previous study performed by Fanciullo et al. Questions focused on three main themes regarding SCS clinical application, namely demographics, education, and technical matters. Completed surveys were received from 50 institutions, all of which reported performing SCS interventions. Annual implants ranged from 0 to 150. Fellowship training was cited as the most valuable modality for learning implantation. Nearly all programs reported manufacturer representative participation during SCS procedures, with a minority of program directors discouraging their involvement in fellow education. SCS trials were performed exclusively on an outpatient basis. The average length for trials was 4-7 days. The most common indication for SCS implantation was failed back surgery syndrome, which also had the highest 2-year success rate. Post procedure, patients generally were followed up every 2-4 weeks for device reprogramming, which was performed by company representatives 92% of the time. Standardized SCS training is imperative as the implementation of neuromodulation therapy continues to increase. Wiley Periodicals, Inc.

Back schools in Brazil: a review of the intervention methodology, assessment tools, and results.

PubMed

Noll, Matias; Vieira, Adriane; Darski, Caroline; Candotti, Cláudia Tarragô

2014-01-01

The Back School is characterized as an educational program aimed at individuals who have chronic pain in spine. In Brazil, a growing number of research studies on the effects of such programs have been observed in the last decades. Thus, the purpose of this systematic review was to identify studies on Back Schools carried out in Brazil with a population of adults and elderlies, and to compare their intervention methodologies, data collection tools, and results. A search for scientific articles and Master's and doctoral theses in several databases was conducted. The keywords used in that search were Postural Program; Postural School; Back School; Back Care Education; Back Education, as well as the respective terms in Portuguese. Eighteen studies were found, being fourteen quantitative and four qualitative studies.The studies showed many differences between them, in both the interventions proposed and the methodological design. However, the use of similar tools for assessing pain intensity, functional capacity, and quality of life between the quantitative studies allowed a partial comparison of the efficacy of those programs.The studies included in this systematic review demonstrated, in general, the immediate efficacy in reducing pain and improving functional capacity and quality of life after the Back School. Results, however, are still conflicting regarding the efficacy in the medium and long terms. Thus, it becomes necessary to conduct further studies that include follow-up assessments in the medium and long terms in order to obtain more accurate conclusions about the efficacy of Back Schools.

[ACTUAL QUESTIONS OF TEACHING PALLIATIVE CARE IN A SYSTEM OF FURTHER PROFESSIONAL EDUCATION.

PubMed

Sizova, Zh M; Nevzorova, D V; Beloborodova, A V; Abuzarova, G R; Sonkina, A A; Tyazhelnikov, A A; Zakharova, V L

2016-07-01

In response to the introduction ofpalliative care as a new kind of medical care in Russian Federation (Federal law No.323 from 21.11.2011), Russian Federation Health Ministry has taskedfurther educational institutions with teaching doctors about this new kind of care. I.M Sechenov First Moscow State Medical University has answered this plea in 2015 by introducing a new course focused on palliative care. The program of education was prepared in accordance with rec- ommendations of World Health Organization (WHO) and European Association for Palliative Care (EAPC). A special attention was paid to the pain relief communication skills and organization ofpalliative care for adults in ambulatory and stationary treatment. The program integrates different teaching methods including eLearning, trainings on pain relief and practical trainings on communication skills for interaction with palliative patients and their relatives using the technology of .

Enhancing knowledge and attitudes in pain management: a pain management education program for nursing home staff.

PubMed

Tse, Mimi Mun Yee; Ho, Suki S K

2014-03-01

The aim of the study was to examine the effectiveness of a pain management program (PMP) in enhancing the knowledge and attitudes of health care workers in pain management. Many nursing home residents suffer from pain, and treatment of pain is often inadequate. Failure of health care workers to assess pain and their insufficient knowledge of pain management are barriers to adequate treatment. It was a quasiexperimental pretest and posttest study. Four nursing homes were approached, and 88 staff joined the 8-week PMP. Demographics and the knowledge and attitudes regarding pain were collected with the use of the Nurse's Knowledge and Attitudes Survey Regarding Pain-Chinese version (NKASRP-C) before and after the PMP. A deficit in knowledge and attitudes related to pain management was prominent before the PMP, and there was a significant increase in pain knowledge and attitudes from 7.9 ± SD 3.52 to 19.2 ± SD4.4 (p < .05) after the 8-week PMP. A PMP can improve the knowledge and attitudes of nursing staff and enable them to provide adequate and appropriate care to older persons in pain. PMPs for nurses and all health care professionals are important in enhancing care for older adults and to inform policy on the provision of pain management. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Is appreciation of written education about pain neurophysiology related to changes in illness perceptions and health status in patients with fibromyalgia?

PubMed

van Ittersum, M W; van Wilgen, C P; Groothoff, J W; van der Schans, C P

2011-11-01

To investigate the appreciation of written education about pain neurophysiology in patients with fibromyalgia (FM) and its effects on illness perceptions and perceived health status. A booklet explaining pain neurophysiology was sent to participants with FM. Appreciation was assessed with 10 questions addressing relevance (0-30) and reassurance (0-30). Illness perceptions, catastrophizing and health status were measured with the Revised Illness Perception Questionnaire (IPQ-R), the Pain Catastrophizing Scale (PCS) and the Fibromyalgia Impact Questionnaire (FIQ) at baseline (T0), after a 2-week control period (T1) and 6 weeks after the intervention (T2). Forty-one patients participated. Mean (SD) scores for relevance and reassurance were 21.6 (5.6) and 18.7 (5.7), respectively. Only illness coherence, emotional representations, pain and fatigue changed significantly between T0 and T2. Correlations between appreciation and changes in outcomes ranged between r=0.00 and r=0.34. Although a majority of subjects appreciated the written information, it did not have clinically relevant effects on illness perceptions, catastrophizing or impact of FM on daily life. Written education about pain neurophysiology is inadequate toward changing illness perceptions, catastrophizing or perceived health status of participants with FM; education should be incorporated into a broader multidisciplinary self-management program. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Nursing knowledge and beliefs regarding patient-controlled oral analgesia (PCOA).

PubMed

Sawhney, Monakshi; Maeda, Eri

2013-12-01

Patient-controlled oral analgesia (PCOA) allows patients to self-administer oral opioids for pain management. Advantages of PCOA include improved pain control with lower doses of opioids, decreased length of stay, increased patient satisfaction, and better functional outcomes than conventional nurse-administered oral analgesia. Sucessful PCOA programs are well described in the literature. However, nurses have concerns about allowing patients to self-administer opioids. The purpose of this study was to identify nurses' knowledge and beliefs regarding PCOA. Nurses who work at the Holland Orthopaedic and Arthritic Centre were asked to complete a survey exploring their beliefs regarding PCOA. The nurses were asked to complete the same survey twice: before an education program in February 2010, and 3 months after implementation of PCOA in June 2010. In February 2010, 74 nurses and in June 2010, 32 nurses participated in the survey. Some nurses (18%) had previous experience with PCOA. At both the pre-education and the postimplementation times, nurses thought that the PCOA program reduced wait times for analgesics and improved patient satisfaction with pain management. Before program implementation, negative beliefs included that patients on the PCOA program would lose their analgesics, would give their analgesics to visitors or other patients, and were at risk for having their analgesics stolen and that the nurse was liable if the patient's analgesics were lost or stolen. After program implementation, no nurse believed that patients would lose their analgesics or give their analgesics to visitors or other patients or that they were liable for lost or stolen analgesics. However, nurses continued to think that patients were at risk for having their analgesics stolen. We found that nurses were concerned that analgesics could be lost, misused, or stolen and that they would be liable for lost analgesics. These findings were consistent with literature discussing patients' outcomes regarding PCOA. However, after education and experience these concerns decreased or resolved. It is important to address these concerns before PCOA program implementation. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Medical cannabis use among patients with chronic pain in an interdisciplinary pain rehabilitation program: Characterization and treatment outcomes.

PubMed

Shah, Arya; Craner, Julia; Cunningham, Julie L

2017-06-01

Cannabis is increasingly being used in the treatment of chronic pain. However, there is a lack of available research in the population of patients with chronic pain who are using cannabis. The current study examines clinical and treatment characteristics for patients who are admitted to a 3-week outpatient interdisciplinary chronic pain rehabilitation program. Participants (N=48) included patients with a positive urine drug screen for 9-carboxy-tetrahydrocannabinol (THC(+); n=24) and a matched comparison sample of patients with a negative screen (THC(-); n=24). Participants were matched for age, gender, race, education, and current prescription opioid use. Measures of pain, functioning, and quality of life were completed at admission and discharge. Medical chart review was conducted to assess medication and substance use history. Participants with a positive screen for THC were more likely to report a past history of illicit substance use, alcohol abuse, and current tobacco use. Cannabis use was not associated with a significantly lower morphine equivalence level for participants using prescription opioids (n=14). Both groups of participants reported significant improvement in pain severity, pain interference, depressive symptoms, and pain catastrophizing. There were no group- or treatment-related differences in these outcome variables. Results provide preliminary evidence that patients with chronic pain using cannabis may benefit from an interdisciplinary chronic pain program. Patients with chronic pain using cannabis may be at higher risk for substance-related negative outcomes, although more research is needed to understand this relationship. Copyright © 2017 Elsevier Inc. All rights reserved.

Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial.

PubMed

Téllez-García, Mario; de-la-Llave-Rincón, Ana I; Salom-Moreno, Jaime; Palacios-Ceña, Maria; Ortega-Santiago, Ricardo; Fernández-de-Las-Peñas, César

2015-07-01

The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN + EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline and 1-week after the intervention. Patients treated with TrP-DN + EDU experienced a significantly greater reduction of kinesiophobia (P = 0.008) and greater increases in PPT over the transverse process of L3 (P = 0.049) than those patients treated only with TrP-DN. Both groups experienced similar decreases in pain, ODI and RMQ, and similar increases in PPT over the C5/C6 joint, second metacarpal, and tibialis anterior after the intervention (all, P > 0.05). The results suggest that TrP-DN was effective for improving pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical LBP at short-term. The inclusion of a neuroscience educational program resulted in a greater improvement in kinesiophobia. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Crossover Trial Evaluating an Educational-Behavioral Joint Protection Programme for People with Rheumatoid Arthritis.

ERIC Educational Resources Information Center

Hammond, A.; Lincoln, N.; Sutcliffe, L.

1999-01-01

Joint protection, a self-management technique taught to people with rheumatoid arthritis, was used in a group education program. A crossover trial (N=35) was conducted. No significant changes in measures of pain, functional disability, grip strength, self-efficacy or helplessness occurred post-education, although this may have been due to the…

A bio-psycho-social exercise program (RÜCKGEWINN) for chronic low back pain in rehabilitation aftercare--study protocol for a randomised controlled trial.

PubMed

Hentschke, Christian; Hofmann, Jana; Pfeifer, Klaus

2010-11-17

There is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours). Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent. This study aims to examine the efficacy of a specially developed bio-psycho-social chronic back pain specific aftercare intervention (RÜCKGEWINN) in comparison to the current usual aftercare (IRENA) and a control group that is given an educational booklet addressing pain-conditioned functional ability and back pain episodes. Overall rehabilitation effects as well as predictors for compliance to the aftercare programs are analysed. Therefore, a multicenter prospective 3-armed randomised controlled trial is conducted. 456 participants will be consecutively enrolled in inpatient and outpatient rehabilitation and assigned to either one of the three study arms. Outcomes are measured before and after rehabilitation. Aftercare programs are assessed at ten month follow up after dismissal form rehabilitation. Special methodological and logistic challenges are to be mastered in this trial, which accrue from the interconnection of aftercare interventions to their residential district and the fact that the proportion of patients who take part in aftercare programs is low. The usability of the aftercare program is based on the transference into the routine care and is also reinforced by developed manuals with structured contents, media and material for organisation assistance as well as training manuals for therapists in the aftercare.

The effectiveness of noninvasive interventions for musculoskeletal thoracic spine and chest wall pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

PubMed

Southerst, Danielle; Marchand, Andrée-Anne; Côté, Pierre; Shearer, Heather M; Wong, Jessica J; Varatharajan, Sharanya; Randhawa, Kristi; Sutton, Deborah; Yu, Hainan; Gross, Douglas P; Jacobs, Craig; Goldgrub, Rachel; Stupar, Maja; Mior, Silvano; Carroll, Linda J; Taylor-Vaisey, Anne

2015-09-01

The purpose of this study was to critically appraise and synthesize evidence on the effectiveness of noninvasive interventions, excluding pharmacological treatments, for musculoskeletal thoracic pain. Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of noninvasive interventions were eligible. We searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text accessed through EBSCOhost from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were synthesized following best evidence synthesis principles. We screened 6988 articles and critically appraised 2 studies. Both studies had a low risk of bias and were included in our synthesis. One RCT compared thoracic spinal manipulation, needle acupuncture, and placebo electrotherapy for recent thoracic spine pain. There were statistically significant but clinically nonimportant short-term reductions in pain favoring manipulation. There were no differences between acupuncture and placebo electrotherapy. Another RCT compared a multimodal program of care and a session of education for recent musculoskeletal chest wall pain. The multimodal care resulted in statistically significant but clinically nonimportant short-term reductions in pain over education. However, participants receiving multimodal care were more likely to report important improvements in chest pain. Quality evidence on the management of musculoskeletal thoracic pain is sparse. The current evidence suggests that compared to placebo, spinal manipulation is associated with a small and clinically nonimportant reduction in pain intensity and that acupuncture leads to similar outcomes as placebo. Furthermore, a multimodal program of care (ie, manual therapy, soft tissue therapy, exercises, heat/ice, and advice) and a single education session lead to similar pain reduction for recent-onset musculoskeletal chest wall pain. However, patients who receive multimodal care are more likely to report pain improvements. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

The origins of the modern pain clinic at the Mayo Clinic.

PubMed

Weingarten, Toby N; Martin, David P; Bacon, Douglas R

2011-07-01

In the 1970s the practice of pain management evolved from the isolated anesthesiologist practicing pain "on the side" to a multi-disciplinary model. The impetus behind this change remains obscure. To understand how this national trend occurred locally and to examine national institutional challenges which should be reflected at the Mayo Clinic that stimulated the establishment of a modern academic pain practice, we interviewed appropriate staff members and reviewed relevant departmental meeting notes. Following the 1959 departure of Dr. John Lundy from Mayo, Dr. Robert Jones became the primary practitioner of pain procedures in addition to his anesthesiology practice. In 1973, close to his retirement, Jones wrote a letter to the department chairman, Dr. Richard Theye, expressing frustration because this divided practice hindered patient care, education, and research opportunities. In 1974 Dr. Lee Nauss joined Mayo upon residency completion at Virginia Mason where he received training in regional anesthesia and met Dr. John Bonica. Nauss introduced epidural steroid injections, which became in such great demand that other anesthesiologists needed to cover his rooms. Within two months, Theye asked Nauss to create a stand-alone pain clinic. Nauss recruited Dr. Tony Wang and opened the clinic that year. This pain clinic increased patient access, improved resident education, allowed for the establishment of a fellowship program, and produced ground-breaking research (e.g., the human administration of intrathecal morphine). The establishment of the pain clinic addressed the deficiencies of a mixed pain and anesthesia practice. The pain specialist could now focus attention on and provide better access for pain patients, keep current with clinical practice, engage in research, and educate future pain specialists.

Back posture education in elementary schoolchildren: stability of two-year intervention effects.

PubMed

Geldhof, E; Cardon, G; De Bourdeaudhuij, I; De Clercq, D

2007-09-01

The study's first objective was to evaluate class teachers' efforts to promote good body mechanics after a structured back education program was finished and to evaluate whether their support during follow-up resulted in better intervention effects at 1-year follow-up. Secondary, the stability of intervention effects on children's back posture knowledge, fear-avoidance beliefs and back pain reports following a 2-school-year multi-factorial back education program was evaluated at 1-year follow-up. An additional focus was put on what young children learned about good body mechanics in the obligatory school curriculum compared to intensive back posture promotion. The quasi-experimental study included at baseline 398 elementary schoolchildren aged 8-11 years. The back education program consisted of 13 h back education and the stimulation of postural dynamism in the class through support and environmental changes lasting 2 school-years. Controls received the obligatory curriculum, not including back education. Evaluation consisted of a questionnaire, which was filled out by 121 intervention children and 124 controls at baseline, post-test and follow-up. Teachers were interviewed at the end of the follow-up school-year. Teachers continued with initiatives to increase postural dynamism in the class when they had been instructed about that matter. However, teachers' efforts to continue the promotion of good body mechanics showed no additional effect on children's knowledge. Improved back posture knowledge demonstrated stability at 1-year follow-up. Whereas the obligatory curriculum provided children with fundamental postural knowledge, the back posture program added important aspects. Fear-avoidance beliefs and self-reported pain were not increased at 1-year follow-up. The stable intervention effects point out that intensive implementation of a structured multifactorial back education program in the elementary school curriculum is effective.

Antenatal education and the birthing experience of Brazilian women: a qualitative study

PubMed Central

2013-01-01

Background Information is still scarce on the birthing experience of women who participate in antenatal systematic education programs. The objective of the study was to report the experience of labor as described by nulliparous women who participated and who did not in a systematic Birth Preparation Program (BPP). Method A qualitative study was conducted with eleven women who participated in a BPP and ten women attending routine prenatal care selected through purposeful sampling. The BPP consisted of systematized antenatal group meetings structured to provide physical exercise and information on pain prevention during pregnancy, the role of the pelvic floor muscles, the physiology of labor, and pain relief techniques. A single, semi-structured interview was conducted with each participant. All interviews were recorded, transcribed verbatim and thematic analyses performed. The relevant themes were organized in the following categories of analysis: control of labor, positions adopted during labor, and satisfaction with labor. Results Women who participated in the systematic educational activities of the BPP reported they maintained self-control during labor and used breathing exercises, exercises on the ball, massage, baths and vertical positions to control pain. Also they reported satisfaction with their birthing experience. Women who did not participate in systematic educational activities referred to difficulties in maintaining control during labor and almost half of them reported lack of control. Also they were more likely to report dissatisfaction with labor. Conclusions Women who participated in the BPP reported self-control during labor and used non-pharmacological techniques to control pain and facilitate labor and expressed satisfaction with the birthing experience. PMID:24007540

The importance and impact of patients' health literacy on low back pain management: a systematic review of literature.

PubMed

Edward, Jean; Carreon, Leah Yacat; Williams, Mark V; Glassman, Steven; Li, Jing

2018-02-01

Health literacy (HL) and the overall ability of patients to seek, understand, and apply health information play an important role in the management of chronic pain conditions. Awareness of how patients' HL skills influence their pain experience and how their ability to understand the treatment regimen and to manage chronic pain may allow physicians to adjust clinical treatment accordingly. Despite the prevalence and the substantial economic impact of chronic low back pain (LBP), little is known about the relationship between HL and the treatment and management of this common disease entity. The purpose of this systematic review of published research was to examine the importance and the implications of HL in the treatment and management of LBP. A literature search was performed in Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo using medical subject heading (MeSH) terms related to LBP, HL, and patient education, which yielded only three studies that directly addressed HL among patients suffering from LBP. We identified only a limited number of studies that focused specifically on HL in the LBP population that were included in this review. The majority of studies excluded from this review focused on patient levels of educational attainment and patient education programs without addressing patients' HL levels and their impact on adherence to educational programs, self-care management, and rehabilitation, among other factors. The three studies that are critically reviewed in this review either use a direct measure of HL or make an effort to address HL in their programs. All three studies emphasize the importance of considering the HL of patients in the treatment and management of LBP. Building on these studies and the narrative review of other relevant literature, we identified significant gaps in current research addressing HL in the treatment and management of LBP. We developed recommendations for future research based on an assessment of strengths and limitations of available evidence-based studies. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

Chen, Hsing-Hsia; Yeh, Mei-Ling; Yang, Hui-Ju

2005-07-01

This study aimed to develop a multimedia video CD (VCD) of patient-controlled analgesia (PCA) and test its effects on pain knowledge and pain relief in patients receiving surgery. This multimedia VCD of PCA was created to convey fundamental knowledge to both patients and their family members and help patients properly utilize PCA devices to relieve pain and improve recovery. The content of multimedia VCD of PCA included pre-admission pain education, introduction of PCA, nursing care procedures, and questions and answers. This study used a quasi-experimental research design to test effects of the multimedia education program in the experimental group of 30 subjects compared to the control subjects of equal number (without the multimedia VCD of PCA). (1) The intervention of multimedia VCD of PCA resulted in a statistically significant difference in pain knowledge between the experimental and control groups. (2) Subjects in the experimental group obtained a better outcome of pain relief compared to control subjects. (3) Subjects in the experimental group indicated that the multimedia VCD of PCA indeed helped them effectively operate their PCA devices to relieve surgery pain. The clinical application of the multimedia VCD of PCA could help patients improve knowledge on pain, learn how to use PCA devices, achieve proper pain relief, and increase effectiveness of recovery activities.

Effects of a postural education program on school backpack habits related to low back pain in children.

PubMed

Vidal, Josep; Borràs, Pere A; Ponseti, Francisco J; Cantallops, Jaume; Ortega, Francisco B; Palou, Pere

2013-04-01

Population based studies have demonstrated that children and adolescents often complain of low back pain. A group-randomized controlled trial was carried out to investigate the effects of a postural education program on school backpack habits related to low back pain in children aged 10-12 year. The study sample included 137 children aged 10.7 years (SD = 0.672). Six classes from two primary schools were randomly allocated into experimental group (EG) (N = 63) or control group (CG) (N = 74). The EG received a postural education program over 6 weeks consisting of six sessions, while the CG followed the usual school curriculum. A questionnaire was fulfilled by the participants at pre-test, post-test, and 3 months after the intervention finished. The outcomes collected were: (1) try to load the minimum weight possible, (2) carry school backpack on two shoulders, (3) belief that school backpack weight does not affect to the back, and (4) the use of locker or something similar at school. A sum score was computed from the four items. Single healthy items mostly improved after the intervention and remained improved after 3-month follow-up in EG, while no substantial changes were observed in the CG. Healthy backpack use habits score was significantly increased at post-test compared to baseline in the EG (P < 0.000), and remained significantly increased after 3-month, compared to baseline (P = 0.001). No significant changes were observed in the CG (P > 0.2). The present study findings confirm that children are able to learn healthy backpack habits which might prevent future low back pain.

Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents: a randomized controlled trial.

PubMed

Stein, C M; Griffin, M R; Taylor, J A; Pichert, J W; Brandt, K D; Ray, W A

2001-05-01

The risk for serious gastrointestinal complications due to nonsteroidal anti-inflammatory drugs (NSAIDs) is high in the elderly. Acetaminophen-based regimens are safer and may be as effective as NSAIDs for the treatment of osteoarthritis in many patients. To determine the effects of an educational program on NSAID use and clinical outcomes in nursing homes. Randomized controlled study. Ten pairs of Tennessee nursing homes with > or = 8% of residents receiving NSAIDs were randomized to intervention or control. Nursing home residents (intervention n = 76 and control n = 71) aged 65 years and older taking NSAIDs regularly. An educational program for physicians and nursing home staff that included the risks and benefits of NSAIDs in the elderly and an algorithm that substituted acetaminophen, topical agents, and nonpharmacologic measures for the treatment of noninflammatory musculoskeletal pain. Intervention and control subjects were assessed at baseline and 3 months later. Differences in NSAID and acetaminophen use, and pain, function, and disability scores in intervention and control nursing home subjects. The intervention was effective resulting in markedly decreased NSAID use and increased acetaminophen use. Mean number of days of NSAID use in the 7 day periods before the baseline and 3 month assessments decreased from 7.0 to 1.9 days in intervention home subjects compared with a decrease from 7.0 to 6.2 days in control homes (P = 0.0001). Acetaminophen use in the 7 days immediately before the 3 month assessment increased by 3.1 days in intervention home subjects compared with 0.31 days in control homes (P = 0.0001). A similar proportion of subjects in control (32.5%) and intervention (35.4%) groups had worsening of their arthritis pain score (P = 0.81). An educational intervention effectively reduced NSAID use in nursing homes without worsening of arthritis pain.

Educational achievement and chronic pain disability: mediating role of pain-related cognitions.

PubMed

Roth, Randy S; Geisser, Michael E

2002-01-01

This study examined the relation between level of educational achievement (LOE) and the clinical morbidity associated with chronic pain. a multidisciplinary pain rehabilitation program located within a university hospital. Two hundred ninety-nine consecutive patients with chronic spinal pain, average age 39.6 years (SD = 10.7) and with an average duration of pain of 41.9 months (SD = 51.6). Age, duration of pain, sex, and compensation and litigation status were controlled for in the statistical analysis because each was found to be significantly associated with LOE. Pain intensity was assessed by the McGill Pain Questionnaire. Affective distress was assessed by the Global Severity Index from the Brief Symptom Inventory. Severity of depressive symptoms was derived from scores from the Center for Epidemiological Studies-Depression Scale. Pain beliefs and pain coping strategies were assessed by the Survey of Pain Attitudes and the Coping Strategies Questionnaire, respectively. Finally, self-report of pain-related disability was assessed by the Pain Disability Index. After controlling for relevant covariates, LOE was unrelated to pain intensity, severity of depressive symptoms, or affective distress, but was inversely related to self-reported disability. Persons with lower LOEs possessed a greater belief that pain is a "signal of harm," unrelated to emotional experience, disabling and uncontrollable. They also endorsed more passive and maladaptive coping strategies, including a tendency to catastrophize about their pain. Path analysis indicated that, after controlling for the influence of both the belief that pain is a "signal of harm" and catastrophizing on the association between LOE and disability, this relation loses statistical significance. These results suggest that pain-related cognitions mediate the relation between LOE and pain disability and that persons with lower LOEs are more likely to develop maladaptive pain beliefs and coping strategies.

Under-treatment of cancer pain.

PubMed

Fairchild, Alysa

2010-03-01

Cancer pain remains inadequately treated, despite internationally accepted management guidelines and a myriad of treatment options. Risk factors for undertreatment are reviewed, along with possible explanations. Recent studies documenting the scope of the problem as well as investigating solutions are discussed with clinical-practice recommendations outlined. Women over 65 years of age representative of a cultural minority, with earlier stage disease, cared for at home, and with high-school education or less are at highest risk of having uncontrolled cancer pain. Optimal treatment is impeded by patients' maladaptive beliefs, nonadherence, underreporting or miscommunication with caregivers; from a healthcare provider perspective, it may be due to inadequate assessment, documentation, knowledge, and communication. Emerging data support the vital influence of lay caregivers on appropriate pain management. Although home-education programs may decrease pain and improve quality of life, there are also less intensive approaches deliverable by individuals to holistically address pain. Prospective study of barriers to both delivery and receipt of adequate pain management is needed, as the majority of published literature is based on survey studies. Treatment must be individualized based on clinical circumstances and patient wishes, with the goal of maximizing function and quality of life.

The ethics of Canadian entry-to-practice pain competencies: how are we doing?

PubMed

Watt-Watson, Judy; Peter, Elizabeth; Clark, A John; Dewar, Anne; Hadjistavropoulos, Thomas; Morley-Forster, Pat; O'Leary, Christine; Raman-Wilms, Lalitha; Unruh, Anita; Webber, Karen; Campbell-Yeo, Marsha

2013-01-01

Although unrelieved pain continues to represent a significant problem, prelicensure educational programs tend to include little content related to pain. Standards for professional competence strongly influence curricula and have the potential to ensure that health science students have the knowledge and skill to manage pain in a way that also allows them to meet professional ethical standards. To perform a systematic, comprehensive examination to determine the entry-to-practice competencies related to pain required for Canadian health science and veterinary students, and to examine how the presence and absence of pain competencies relate to key competencies of an ethical nature. Entry-to-practice competency requirements related to pain knowledge, skill and judgment were surveyed from national, provincial and territorial documents for dentistry, medicine, nursing, pharmacy, occupational therapy, physiotherapy, psychology and veterinary medicine. Dentistry included two and nursing included nine specific pain competencies. No references to competencies related to pain were found in the remaining health science documents. In contrast, the national competency requirements for veterinary medicine, surveyed as a comparison, included nine pain competencies. All documents included competencies pertaining to ethics. The lack of competencies related to pain has implications for advancing skillful and ethical practice. The lack of attention to pain competencies limits the capacity of health care professionals to alleviate suffering, foster autonomy and use resources justly. Influencing professional bodies to increase the number of required entry-to-practice pain competencies may ultimately have the greatest impact on education and practice.

Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial.

PubMed

Saper, Robert B; Lemaster, Chelsey; Delitto, Anthony; Sherman, Karen J; Herman, Patricia M; Sadikova, Ekaterina; Stevans, Joel; Keosaian, Julia E; Cerrada, Christian J; Femia, Alexandra L; Roseen, Eric J; Gardiner, Paula; Gergen Barnett, Katherine; Faulkner, Carol; Weinberg, Janice

2017-07-18

Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain. To determine whether yoga is noninferior to PT for cLBP. 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927). Academic safety-net hospital and 7 affiliated community health centers. 320 predominantly low-income, racially diverse adults with nonspecific cLBP. Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life. One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up. A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. National Center for Complementary and Integrative Health of the National Institutes of Health.

Improvement of pain-related self-management for cancer patients through a modular transitional nursing intervention: a cluster-randomized multicenter trial.

PubMed

Jahn, Patrick; Kuss, Oliver; Schmidt, Heike; Bauer, Alexander; Kitzmantel, Maria; Jordan, Karin; Krasemann, Susann; Landenberger, Margarete

2014-04-01

Patients' self-management skills are affected by their knowledge, activities, and attitudes toward pain management. This trial aimed to test the Self Care Improvement through Oncology Nursing (SCION)-PAIN program, a multimodular structured intervention to reduce patients' barriers to self-management of cancer pain. Two hundred sixty-three patients with diagnosed malignancy, pain>3 days, and average pain > or = 3/10 participated in a cluster-randomized trial on 18 wards in 2 German university hospitals. Patients on the intervention wards received, in addition to standard pain treatment, the SCION-PAIN program consisting of 3 modules: pharmacologic, nonpharmacologic pain management, and discharge management. The intervention was conducted by specially trained cancer nurses and included components of patient education, skills training, and counseling. Starting with admission, patients received booster sessions every third day and one follow-up telephone counseling session within 2 to 3 days after discharge. Patients in the control group received standard care. Primary end point was the group difference in patient-related barriers to self-management of cancer pain (Barriers Questionnaire-BQ II) 7 days after discharge. The SCION-PAIN program resulted in a significant reduction of patient-related barriers to pain management 1 week after discharge from the hospital: mean difference on BQ II was -0.49 points (95% confidence interval -0.87 points to -0.12 points; P=0.02). Furthermore, patients showed improved adherence to pain medication; odds ratio 8.58 (95% confidence interval 1.66-44.40; P=0.02). A post hoc analysis indicated reduced average and worst pain intensity as well as improved quality of life. This trial reveals the positive impact of a nursing intervention to improve patients' self-management of cancer pain. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Blended-Learning Pain Neuroscience Education for People With Chronic Spinal Pain: Randomized Controlled Multicenter Trial.

PubMed

Malfliet, Anneleen; Kregel, Jeroen; Meeus, Mira; Roussel, Nathalie; Danneels, Lieven; Cagnie, Barbara; Dolphens, Mieke; Nijs, Jo

2018-05-01

Available evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated. The study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions. This study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked). The study took place at university hospitals in Ghent and Brussels, Belgium. Participants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain). The intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology). Measurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire). None of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86). Effect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies. Blended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.

Adherence to Analgesics in Oncology Outpatients: Focus on Taking Analgesics on Time.

PubMed

Oldenmenger, Wendy H; Sillevis Smitt, Peter A E; de Raaf, Pleun J; van der Rijt, Carin C D

2017-06-01

Inadequate adherence to prescribed analgesics may be one of the reasons why patients with cancer experience unrelieved pain. Adherence is directly influenced by patients' barriers about pain management. Patient pain education programs (PEPs) have been developed to reduce patients' barriers and increase patients' adherence to their analgesics. The purpose of this article was to evaluate patients' adherence in patients receiving a pain consult and patient pain education in comparison with patients receiving standard pain treatment (standard care [SC]), to better explore the difficulties in medication adherence in cancer-related pain and the effects of PEP. In 54 adult outpatients with cancer-related pain, patients' adherence to the prescribed around-the-clock analgesics was measured with a Medication Event Monitoring System, in the following time intervals: weeks 1 and 2, weeks 3 and 4, and weeks 7 and 8 after randomization. Adherence was differentiated into taking adherence, taking the correct dose, and taking analgesics at the right time intervals. Taking adherence increased in the intervention group compared to baseline (from 91% to 93%) and decreased in the SC group (from 85% to 78%; P < 0.05). At the end of the study, more patients in the intervention group took their analgesics at the right intervals (78%) than did patients in the SC group (64%, P < 0.05). During the study, patients were more adherent to opioids than to World Health Organization step 1 analgesics. The combined intervention can increase adherence. The true problem in pain management is that patients do not take their prescribed analgesics at the right time intervals. With the detailed adherence information from this study, it is possible to further tailor patient education to the individual patient. © 2016 World Institute of Pain.

State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows

PubMed Central

Kim, Hyung Tae; Kim, Sae Young; Byun, Gyung Jo; Shin, Byung Chul; Lee, Jin Young; Choi, Eun Joo; Choi, Jong Bum; Hong, Ji Hee; Choi, Seung Won

2017-01-01

Background Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05). Conclusions Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management. PMID:29123624

Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.

PubMed

Bhattarai, Priyanka; Newton-John, T R O; Phillips, Jane L

2018-03-01

To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain. A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.

Work-related back discomfort and associated factors among automotive maintenance mechanics in Eastern Nigeria: A cross sectional study.

PubMed

Abaraogu, Ukachukwu Okoroafor; Ezema, Charles Ikechukwu; Igwe, S E; Egwuonwu, Afamefuna Victor; Okafor, Udoka Chris

2016-02-15

Back pain has been identified as a common cause of disability in the working population. Automotive mechanics habitually use awkward back posture in their course of manual activity and hence may be at risk of work-related back pain. To investigate the prevalence, pattern and severity of back pain among automotive maintenance mechanics, as well as the personal and job variables associated with or predicting occurrence of back pain. Using a cross-sectional design, information about self-reported back pain and the associated variables were collected among 684 randomly recruited automotive mechanics. Prevalence of back pain was 76.02%; with the majority experiencing low back pain. 63.3% of the workers reported they limited their activity due to the back pain. Older workers (>50 years), daily work lasting ≥5 hours duration, no more than primary education, being normal weight, frequent use of kneeling and sustained postures, and lack of knowledge of ergonomic postures were associated with increased prevalence of back pain. Lack of job autonomy, inadequate task clarity, heavy physical work load, manual material handling, strenuous posture, noisy environment, vibrations, work schedule and inadequate auxiliary support were also associated with increased prevalence of back pain among the mechanics. Work-related back pain is prevalent among automotive maintenance mechanics. Work-related back pain is high among automotive maintenance mechanics. Workstation policy and legislation on reduction of risks with combined health literacy and ergonomic education programs in this occupational group are imperative.

Provoked vestibulodynia-women's experience of participating in a multidisciplinary vulvodynia program.

PubMed

Sadownik, Leslie A; Seal, Brooke N; Brotto, Lori A

2012-04-01

Provoked Vestibulodynia (PVD) is the most common cause of pain with intercourse that affects reproductively aged women. The treatment outcome literature suggests that existing treatments, when administered individually, may have only limited benefits for improving pain, and that multidisciplinary approaches may be more effective for reducing pain and pain-associated distress. A program that offers education, group cognitive behavioral therapy, pelvic floor physiotherapy, and medical appointments was developed and implemented at our hospital site. To explore the experiences of women who participated in the Multidisciplinary Vulvodynia Program (MVP) in order to identify the perceived benefits of this program. Qualitative retrospective study. A semi-structured interview format was used to interview graduates of the MVP. Nineteen women, mean age 30.8 (20-54 years), participated in a one-on-one in-depth interview with a trained interviewer. The key question asked was "What has been the impact of the mvp on your life?" interviews were audio-recorded, transcribed, and qualitatively analyzed for major themes. Content analysis of interview transcripts. Five main themes emerged and included: increased knowledge, gained tools/skills, perceived improved mood/psychological well-being, a sense of validation and support, and an enhanced sense of empowerment. Overall, a multidisciplinary vulvodynia program was perceived as being beneficial for women with PVD. © 2012 International Society for Sexual Medicine.

The effect of a mandibular advancement appliance on cervical lordosis in patients with TMD and cervical pain.

PubMed

Santander, Hugo; Zúñiga, Claudia; Miralles, Rodolfo; Valenzuela, Saúl; Santander, Montserrat Carolina; Gutiérrez, Mario Felipe; Córdova, Rosa

2014-10-01

A preliminary study to compare cervical lordosis by means of cervical cephalometric analysis, before and after six months of continuous mandibular advancement appliance (MAA) use, and to show how physical therapy posture re-education would improve the cervical lordosis angle. Twenty-two female patients with temporomandibular disorders (TMD) and cervical pain with lordosis <20° were included. Patients had to have a muscle pain history for at least six months, and with an intensity ⩾6, measured by means of a visual analog scale (a horizontal 0-10 numeric rating scale with 0 labeled as 'no pain' and 10 as 'worst imaginable pain'). Patients had to present the angle formed by the posterior tangents to C2 and C7 of equal or less than 20°. Cephalometric and clinical diagnostics were performed initially (baseline) and at the end of the study period (six months). During the third month with MAA treatment, a physical therapist evaluated the postural deficit and performed a program of postural re-education. Angular and linear dimension data presented a normal distribution (P>0·05; Shapiro Wilk Test), so the paired comparison of the cephalometric measurements was made by t-test for dependent samples. Angle 1 (OPT/7CVT); angle 3 (CVT/EVT) and angle 4 (2CL/7CL) showed a significant increase in the cervical lordosis. Angle 2 (MGP/OP), angle 5 (HOR/CVT) and the distances C0-C2 and Pt-VER, presented no significant changes. The increase in cervical lordosis implies that six months of continuous MAA use, together with a program of postural re-education, promotes the homeostasis of the craniocervical system.

Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers

NASA Technical Reports Server (NTRS)

Bautch, J. C.; Malone, D. G.; Vailas, A. C.

1997-01-01

OBJECTIVE: To determine the effects of low intensity weight-bearing exercise on osteoarthritis (OA) of the knee. METHODS: Synovial fluid keratan sulfate (KS) and hydroxyproline were measured as markers of cartilage degradation. The Arthritis Impact Measurement Scales (AIMS) were used to measure health status, and a visual analog scale for pain assessment was used before and after intervention. An exercise (EX) group (n = 15) received a thrice-weekly 12-week low intensity exercise program and a weekly educational program, and a minimal treatment (Min RX) group (n = 15) received only the education program. RESULTS: Pain levels declined in the EX group, and the Min RX group showed improvement on the AIMS. Synovial fluid was obtained in 11 subjects before and after the intervention. Levels of KS and hydroxyproline did not change. CONCLUSION: Further study of exercise effects should include both clinical and biologic parameters to examine the outcome of exercise as a therapeutic intervention in OA of the knee.

Attitudes of Italian general practitioners in the treatment of cancer pain. The Committee of the Associazione Italiana di Oncologia Medica (AIOM).

PubMed

Minotti, V; Betti, M

1997-01-01

The attitude of Italian general practitioners in prescribing practices for patients with cancer pain was assessed by means of a questionnaire. The results indicated that among most of the doctors who completed the questionnaire the basic principles of pain treatment in cancer patients are largely understood. Oral morphine emerged as the most commonly used opioid (60%) and controlled-release morphine as the preferred preparation. Non-steroidal anti-inflammatory drugs were the most commonly used minor analgesics. Fear of side effects and restrictive prescribing regulations emerged as the most important barrier against adequate pain management. The survey emphasised the need for continued efforts in implementing specific educational programming for improvement in cancer pain management.

Informing the development of an Internet-based chronic pain self-management program.

PubMed

Gogovor, Amédé; Visca, Regina; Auger, Claudine; Bouvrette-Leblanc, Lucie; Symeonidis, Iphigenia; Poissant, Lise; Ware, Mark A; Shir, Yoram; Viens, Natacha; Ahmed, Sara

2017-01-01

Self-management can optimize health outcomes for individuals with chronic pain (CP), an increasing fiscal and social burden in Canada. However, self-management is rarely integrated into the regular care (team activities and medical treatment) patients receive. Health information technology offers an opportunity to provide regular monitoring and exchange of information between patient and care team. To identify information needs and gaps in chronic pain management as well as technology features to inform the development of an Internet-based self-management program. Two methods were used. First was a structured literature review: electronic databases were searched up to 2015 with combinations of MeSH terms and text-words such as chronic pain, self-management, self-efficacy, technology, Internet-based, patient portal, and e-health. A narrative synthesis of the characteristics and content of Internet-based pain management programs emerging from the literature review and how they relate to gaps in chronic pain management were completed. Second, four audiotaped focus group sessions were conducted with individuals with chronic pain and caregivers (n=9) and health professionals (n=7) recruited from three multidisciplinary tertiary and rehabilitation centres. A thematic analysis of the focus group transcripts was conducted. Thirty-nine primary articles related to 20 patient-oriented Internet-based programs were selected. Gaps in CP management included lack of knowledge, limited access to health care, suboptimal care, and lack of self-management support. Overall, 14 themes related to information needs and gaps in care were identified by both health professionals and patients, three were exclusive to patients and five to health professionals. Common themes from the focus groups included patient education on chronic pain care, attitude-belief-culture, financial and legal issues, end-of-program crash, and motivational content. Internet-based programs contain automated, communication and decision support features that can address information and care gaps reported by patients and clinicians. However, focus groups identified functionalities not reported in the literature, non-medical and condition- and context-specific information, integration of personal health records, and the role of the different health professionals in chronic pain management were not identified. These gaps need to be considered in the future development of Internet-based programs. While the association between the mechanisms of Internet-based programs' features and outcomes is not clearly established, the results of this study indicate that interactivity, personalization and tailored messages, combined with therapist contact will maximize the effectiveness of an Internet-based chronic pain program in enhancing self-management. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Clinical outcomes of multidisciplinary pain rehabilitation among african american compared with caucasian patients with chronic pain.

PubMed

Hooten, W Michael; Knight-Brown, Miranda; Townsend, Cynthia O; Laures, Heidi J

2012-11-01

The primary aim of this study was to determine if the immediate outcomes of multidisciplinary pain rehabilitation were different for African Americans compared with Caucasians. A retrospective repeated measures design was used, and all analyses were adjusted for marital and employment status, years of education, and pain duration. Multidisciplinary pain rehabilitation center. Each African American (N = 40) consecutively admitted to a multidisciplinary pain rehabilitation program was matched with three Caucasians (N = 120) on age, sex, and treatment dates. A 3-week outpatient multidisciplinary pain rehabilitation program. The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, and Pain Catastrophizing Scale were administered at admission and dismissal.  At baseline, African Americans had greater pain severity (P < 0.001) and poorer physical function compared with Caucasians (P < 0.001). At program completion, African Americans had greater pain severity (P < 0.001) and poorer measures of life interference (P = 0.004), perceived control (P = 0.013), affective distress (P < 0.001), role physical (P = 0.001) and role emotional function (P = 0.001), physical (P < 0.001) and social function (P = 0.002), general health (P = 0.005), depression (P < 0.001), and pain catastrophizing (P < 0.001). A repeated measures analysis demonstrated a time by race interaction effect for pain interference (P = 0.038), affective distress (P = 0.019), role physical function (P = 0.007), social function (P = 0.029), and depression (P = 0.004), indicating African Americans experienced less improvement compared with Caucasians. The results of this study highlight an under-recognized health disparity which provides the basis for developing targeted interventions aimed at improving the clinical outcomes of African Americans with chronic pain. Wiley Periodicals, Inc.

Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.

PubMed

Childs, John D; Wu, Samuel S; Teyhen, Deydre S; Robinson, Michael E; George, Steven Z

2014-04-01

Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing total health care costs. Had the 1,995 soldiers in the PSEP group not received PSEP, we would estimate that 16.7% of them would incur an adjusted median LBP-related health care cost of $517 compared with the current 15.0% soldiers incurring an adjusted median cost of $399, which translates into an actual LBP-related health care cost savings of $52,846 during the POLM trial. However, it is likely that the unaccounted for direct and indirect costs might erase even these small cost savings. The results of this study will help to inform policy- and decision-making regarding the feasibility of implementing psychosocial education in military training environments across the services. It would be interesting to explore in future research whether cost savings from psychosocial education could be enhanced given a more individualized delivery method tailored to an individual's specific psychosocial risk factors. Published by Elsevier Inc.

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study.

PubMed

Lee, Minyoung; Kim, Minhee; Oh, Sejun; Choi, Yoon-Jin; Lee, Dongshin; Lee, Sang Heon; Yoon, BumChul

2017-09-01

To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting. An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase. Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) "awareness of the effectiveness"; 2) "a sense of duty to perform the exercise"; 3) "obedience to expert instruction"; and 4) "lack of friendship." These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.

What is important in transdisciplinary pain neuroscience education? A qualitative study.

PubMed

Wijma, Amarins J; Speksnijder, Caroline M; Crom-Ottens, Astrid F; Knulst-Verlaan, J M Corine; Keizer, Doeke; Nijs, Jo; van Wilgen, C Paul

2017-05-19

The main focus of Pain Neuroscience Education is around changing patients' pain perceptions and minimizing further medical care. Even though Pain Neuroscience Education has been studied extensively, the experiences of patients regarding the Pain Neuroscience Education process remain to be explored. Therefore, the aim of this study was to explore the experiences in patients with non-specific chronic pain. Fifteen patients with non-specific chronic pain from a transdisciplinary treatment centre were in-depth interviewed. Data collection and analysis were performed according to Grounded Theory. Five interacting topics emerged: (1) "the pre-Pain Neuroscience Education phase", involving the primary needs to provide Pain Neuroscience Education, with subthemes containing (a) "a broad intake" and (b) "the healthcare professionals"; (2) "a comprehensible Pain Neuroscience Education" containing (a) "understandable explanation" and (b) "interaction between the physiotherapist and psychologist"; (3) "outcomes of Pain Neuroscience Education" including (a) "awareness", b) "finding peace of mind", and (c) "fewer symptoms"; 4) "scepticism" containing (a) "doubt towards the diagnosis and Pain Neuroscience Education", (b) "disagreement with the diagnosis and Pain Neuroscience Education", and (c) "Pain Neuroscience Education can be confronting". This is the first study providing insight into the constructs contributing to the Pain Neuroscience Education experience of patients with non-specific chronic pain. The results reveal the importance of the therapeutic alliance between the patient and caregiver, taking time, listening, providing a clear explanation, and the possible outcomes when doing so. The findings from this study can be used to facilitate healthcare professionals in providing Pain Neuroscience Education to patients with non-specific chronic pain. Implications for Rehabilitation An extensive biopsychosocial patient centred intake is crucial prior to providing Pain Neuroscience Education. Repetitions of Pain Neuroscience Education, in different forms (verbal and written information, examples, drawings, etc.) help patients to understand the theory of neurophysiology. Pain Neuroscience Education induces insight into the patient's complaints, improved coping with complaints, improved self-control, and induces in some cases peace of mind. Healthcare professionals providing Pain Neuroscience Education should be aware of the possible confronting nature of the contributing factors.

Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report.

PubMed

Louw, Adriaan; Puentedura, Emilio J; Diener, Ina; Peoples, Randal R

2015-01-01

Therapeutic neuroscience education (TNE) has been shown to be effective in the treatment of mainly chronic musculoskeletal pain conditions. This case study aims to describe the changes in brain activation on functional magnetic resonance imaging (fMRI) scanning, before and after the application of a newly-designed preoperative TNE program. A 30-year-old female with a current acute episode of low back pain (LBP) and radiculopathy participated in a single preoperative TNE session. She completed pre- and post-education measures including visual analog scale (VAS) for LBP and leg pain; Oswestry Disability Index (ODI); Fear Avoidance Beliefs Questionnaire (FABQ); Pain Catastrophizing Scale (PCS) and a series of Likert-scale questions regarding beliefs and attitudes to lumbar surgery (LS). After a 30-minute TNE session, ODI decreased by 10%, PCS decreased by 10 points and her beliefs and attitudes shifted positively regarding LS. Immediately following TNE straight leg raise increased by 7° and forward flexion by 8 cm. fMRI testing following TNE revealed 3 marked differences compared to pre-education scanning: (1) deactivation of the periaqueductal gray area; (2) deactivation of the cerebellum; and (3) increased activation of the motor cortex. The immediate positive fMRI, psychometric and physical movement changes may indicate a cortical mechanism of TNE for patients scheduled for LS.

Impact of poor oral health on children's school attendance and performance.

PubMed

Jackson, Stephanie L; Vann, William F; Kotch, Jonathan B; Pahel, Bhavna T; Lee, Jessica Y

2011-10-01

We examined school days missed for routine dental care versus dental pain or infection to determine the relationship between children's oral health status and school attendance and performance. We used 2008 data from the North Carolina Child Health Assessment and Monitoring Program. The study sample, weighted to reflect the state's population, included 2183 schoolchildren. Variables assessed included school absences and performance, oral health status, parental education, health insurance coverage, race, and gender. Children with poor oral health status were nearly 3 times more likely (odds ratio = 3.89; 95% confidence interval = 1.96, 7.75) than were their counterparts to miss school as a result of dental pain. Absences caused by pain were associated with poorer school performance (P < .05), but absences for routine care were not. Mediation analyses revealed that oral health status was associated with performance independent of absence for pain. Children with poorer oral health status were more likely to experience dental pain, miss school, and perform poorly in school. These findings suggest that improving children's oral health status may be a vehicle to enhancing their educational experience.

Impact of Poor Oral Health on Children's School Attendance and Performance

PubMed Central

Vann, William F.; Kotch, Jonathan B.; Pahel, Bhavna T.; Lee, Jessica Y.

2011-01-01

Objectives. We examined school days missed for routine dental care versus dental pain or infection to determine the relationship between children's oral health status and school attendance and performance. Methods. We used 2008 data from the North Carolina Child Health Assessment and Monitoring Program. The study sample, weighted to reflect the state's population, included 2183 schoolchildren. Variables assessed included school absences and performance, oral health status, parental education, health insurance coverage, race, and gender. Results. Children with poor oral health status were nearly 3 times more likely (odds ratio = 3.89; 95% confidence interval = 1.96, 7.75) than were their counterparts to miss school as a result of dental pain. Absences caused by pain were associated with poorer school performance (P < .05), but absences for routine care were not. Mediation analyses revealed that oral health status was associated with performance independent of absence for pain. Conclusions. Children with poorer oral health status were more likely to experience dental pain, miss school, and perform poorly in school. These findings suggest that improving children's oral health status may be a vehicle to enhancing their educational experience. PMID:21330579

Effects of a Peer-Led Pain Management Program for Nursing Home Residents with Chronic Pain: A Pilot Study.

PubMed

Tse, Mimi Mun Yee; Yeung, Suey Shuk Yu; Lee, Paul Hong; Ng, Shamay Sheung Mei

2016-09-01

OBJECTIVES : To examine the feasibility of a peer-led pain management program among nursing home residents. DESIGN : A quasi-experimental design. SETTING : Two nursing homes. SUBJECTS : Fifty nursing home residents. METHODS : The experimental group (n = 32) was given a 12-week group-based peer-led pain management program. There were two 1-hour sessions per week. Education in pain and demonstrations of nonpharmacological pain management strategies were provided. The research team and 12 trained peers led the sessions. The control group (n = 18) received one 1-hour session of pain management program each week over 12 weeks from the research team only. Outcome measures for the participants were collected at baseline (P1) and at week 12 (P2). Data from peer volunteers were collected prior to training (V1) and at week 12 (V2). T-tests were used to compare the differences in outcome measures collected at two time points. RESULTS : There was a significant reduction in pain intensity from 5.8 ± 2.6 (P1) to 3.4 ± 2.5 (P2) for the experimental group (p = 0.003) and from 6.3 ± 3.0 (P1) to 3.1 ± 2.4 (P2) for the control group (p = 0.001). Activities of daily living significantly improved for both the experimental group (p = 0.008) and the control group (p = 0.014). There was an enhancement in happiness level for the experimental group (p < 0.001), while the loneliness level dropped significantly for the experimental group (p < 0.001) and the control group (p = 0.031). The peer volunteers showed a significant increase in self-rated pain management knowledge (2.9 ± 2.6 to 8.1 ± 1.2, p < 0.001) and self-efficacy in volunteering (5.8 ± 2.9 to 8.3 ± 1.5, p = 0.032). CONCLUSION : The peer-led pain management program was feasible and has potential in relieving chronic pain and enhancing the physical and psychological health of nursing home residents. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pain trajectory and exercise-induced pain flares during 8 weeks of neuromuscular exercise in individuals with knee and hip pain.

PubMed

Sandal, L F; Roos, E M; Bøgesvang, S J; Thorlund, J B

2016-04-01

Patients considering or engaged in exercise as treatment may expect or experience transient increases in joint pain, causing fear of exercise and influencing compliance. This study investigated the pain trajectory during an 8-week neuromuscular exercise (NEMEX) program together with acute exercise-induced pain flares in persons with knee or hip pain. Individuals above 35 years self-reporting persistent knee or hip pain for the past 3 months were offered 8 weeks of supervised NEMEX, performed in groups twice weekly. The program consisted of 11 exercises focusing on joint stability and neuromuscular control. Participants self-reported joint pain on a 0-10 numerical rating scale (NRS) at baseline and 8-weeks follow-up. NRS pain ratings were also collected before and immediately after every attended exercise session. Joint pain was reduced from baseline (NRS 3.6; 95% CI 3.2-4.1) to 8-weeks follow-up (2.6; 95% CI 2.1-3.1), (P < 0.01). Pain decreased 0.04 NRS (95% CI 0.02-0.05, P < 0.01) on average per exercise session and pre- to post-exercise pain decreased 0.04 NRS (95% CI 0.03-0.05, P < 0.01) on average per session, approaching no acute exercise-induced pain in the last weeks. This study found a clear decrease in size of acute exercise-induced pain flares with increasing number of exercise sessions. In parallel, pain ratings decreased over the 8 weeks exercise period. Our findings provide helpful information for clinicians, which can be used to educate and balance patient expectation when starting supervised neuromuscular exercise. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Effectiveness of aquatic exercises compared to patient-education on health status in individuals with knee osteoarthritis: a randomized controlled trial.

PubMed

Taglietti, Marcelo; Facci, Ligia Maria; Trelha, Celita Salmaso; de Melo, Fernanda Cristiane; da Silva, Daniela Wosiack; Sawczuk, Geovane; Ruivo, Thamires Marques; de Souza, Thaisley Barbosa; Sforza, Chiarella; Cardoso, Jefferson Rosa

2018-06-01

To compare the effectiveness of aquatic exercises with patient-education in individuals with knee osteoarthritis. Randomized controlled trial with blinded assessor and intention-to-treat analysis. Aquatic Physiotherapy Centre and Primary Health Care Unit. A total of 60 patients, aged 68.3 (SD = 4.8) with clinical symptoms and radiographic grading (Kellgren-Lawrence 1-4) of knee osteoarthritis were included. An eight-week treatment protocol of aquatic exercise ( n = 31) (16 individual sessions, twice a week) and an educational program (group sessions, once a week) ( n = 29). Before, after eight-week intervention, and a three-month follow-up with results for the following outcome measures: pain, function, quality of life, functional mobility, and depression. At the end of treatment, the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) functional capacity values reduced in favour of the aquatic exercise group for both the total score MD (mean difference) = -14.2; 95% CI (confidence interval) (-18; -10.5), P = 0.04 and the pain domain MD = -3.8 points; 95% CI (-8.71; -1), P = 0.021. The total score also reduced in the follow-up: MD = -12.3 points; 95% CI (-24.7; -6.1), P = 0.017. No differences were found for the outcomes functional mobility or depression. Aquatic exercise improved pain and function after eight weeks, and function at the three-month follow-up compared to the patient-education program.

Effectiveness and Cost-Effectiveness of Different Weekly Frequencies of Pilates for Chronic Low Back Pain: Randomized Controlled Trial.

PubMed

Miyamoto, Gisela Cristiane; Moura, Katherinne Ferro; Franco, Yuri Rafael dos Santos; Oliveira, Naiane Teixeira Bastos de; Amaral, Diego Diulgeroglo Vicco; Branco, Amanda Nery Castelo; Silva, Maria Liliane da; Lin, Christine; Cabral, Cristina Maria Nunes

2016-03-01

The Pilates method has been recommended to patients with low back pain, but the evidence on effectiveness is inconclusive. In addition, there is still no evidence for the cost-effectiveness of this method or for the ideal number of sessions to achieve the highest effectiveness. The aim of this study will be to investigate the effectiveness and cost-effectiveness of the Pilates method with different weekly frequencies in the treatment of patients with nonspecific low back pain. This is a randomized controlled trial with blinded assessor. This study will be conducted at a physical therapy clinic in São Paulo, Brazil. Two hundred ninety-six patients with nonspecific low back pain between the ages of 18 and 80 years will be assessed and randomly allocated to 4 groups (n=74 patients per group). All groups will receive an educational booklet. The booklet group will not receive additional exercises. Pilates group 1 will follow a Pilates-based program once a week, Pilates group 2 will follow the same program twice a week, and Pilates group 3 will follow the same program 3 times a week. The intervention will last 6 weeks. A blinded assessor will evaluate pain, quality-adjusted life-years, general and specific disability, kinesiophobia, pain catastrophizing, and global perceived effect 6 weeks, 6 months, and 12 months after randomization. Therapists and patients will not be blinded. This will be the first study to investigate different weekly frequencies of treatment sessions for nonspecific low back pain. The results of this study will contribute to a better definition of treatment programs for this population. © 2016 American Physical Therapy Association.

Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial.

PubMed

Lawford, Belinda J; Hinman, Rana S; Kasza, Jessica; Nelligan, Rachel; Keefe, Francis; Rini, Christine; Bennell, Kim L

2018-05-09

Internet-delivered exercise, education, and pain coping skills training is effective for people with knee osteoarthritis, yet it is not clear whether this treatment is better suited to particular subgroups of patients. The aim was to explore demographic and clinical moderators of the effect of an internet-delivered intervention on changes in pain and physical function in people with knee osteoarthritis. Exploratory analysis of data from 148 people with knee osteoarthritis who participated in a randomized controlled trial comparing internet-delivered exercise, education, and pain coping skills training to internet-delivered education alone. Primary outcomes were changes in knee pain while walking (11-point Numerical Rating Scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index function subscale) at 3 and 9 months. Separate regression models were fit with moderator variables (age, gender, expectations of outcomes, self-efficacy [pain], education, employment status, pain catastrophizing, body mass index) and study group as covariates, including an interaction between the two. Participants in the intervention group who were currently employed had significantly greater reductions in pain at 3 months than similar participants in the control group (between-group difference: mean 2.38, 95% CI 1.52-3.23 Numerical Rating Scale units; interaction P=.02). Additionally, within the intervention group, pain at 3 months reduced by mean 0.53 (95% CI 0.28-0.78) Numerical Rating Scale units per unit increase in baseline self-efficacy for managing pain compared to mean 0.11 Numerical Rating Scale units (95% CI -0.13 to 0.35; interaction P=.02) for the control group. People who were employed and had higher self-efficacy at baseline were more likely to experience greater improvements in pain at 3 months after an internet-delivered exercise, education, and pain coping skills training program. There was no evidence of a difference in the effect across gender, educational level, expectation of treatment outcome, or across age, body mass index, or tendency to catastrophize pain. Findings support the effectiveness of internet-delivered care for a wide range of people with knee osteoarthritis, but future confirmatory research is needed. Australian New Zealand Clinical Trials Registry ACTRN12614000243617; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365812&isReview=true (Archived by WebCite at http://www.webcitation.org/6z466oTPs). ©Belinda J Lawford, Rana S Hinman, Jessica Kasza, Rachel Nelligan, Francis Keefe, Christine Rini, Kim L Bennell. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.05.2018.

Review of pain content in three-year preregistration pediatric nursing courses in the United Kingdom.

PubMed

Twycross, Alison; Roderique, Lynda

2013-12-01

The results of several studies suggest that gaps remain in nurses' knowledge about pain in children, and particularly regarding pain assessment, analgesic drugs, and nondrug methods, suggesting a need to explore the pain content of preregistration nursing curricula. Over the past decade, the way nurse education is delivered has changed with the advent of the internet and the use of virtual learning environments. This study, therefore, explored the depth and breadth of pain content in 3-year preregistration pediatric nursing courses across the U.K. as well as ascertaining how this content is delivered. The leads for pediatric nursing at all 56 U.K. higher education institutions running the 3-year preregistration pediatric nursing course were e-mailed a questionnaire. Participants were asked to indicate whether topics are covered in the program, and if so how it was delivered. Results suggest that preregistration pediatric nursing courses in the U.K. do not always equip students to manage pain effectively in clinical practice. There appears to be limited content on pain in nursing curricula, with several institutions not covering key topics. Most teaching is delivered face to face with limited workbooks and virtual learning activities. Further research is needed in this area to ascertain the impact of this on the quality of care provided. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.

PubMed

Bennell, Kim L; Egerton, Thorlene; Pua, Yong-Hao; Abbott, J Haxby; Sims, Kevin; Metcalf, Ben; McManus, Fiona; Wrigley, Tim V; Forbes, Andrew; Harris, Anthony; Buchbinder, Rachelle

2010-10-14

Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.

Exploring effect of pain education on chronic pain patients' expectation of recovery and pain intensity.

PubMed

Mittinty, Manasi M; Vanlint, Simon; Stocks, Nigel; Mittinty, Murthy N; Moseley, G Lorimer

2018-04-25

Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving individuals with chronic pain examined their perspectives on pain education; did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery. The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants' expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data. Five hundred and seventy three people participated; full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The results from this study highlight the importance of effective pain education focused on reconceptualization of pain and its management.

Prevalence and treatment of cancer pain in Italian oncological wards centres: a cross-sectional survey.

PubMed

Mercadante, Sebastiano; Roila, Fausto; Berretto, Oscar; Labianca, Roberto; Casilini, Stefania

2008-11-01

The aim of this national cross-sectional survey was to draw information on pain prevalence and intensity from a large sample of patients who were admitted to oncologic centres for different reasons and to evaluate the pain treatment and possible influencing factors. A total of 2,655 patients completed the study. Nine hundred and one patients (34%) reported pain. Higher pain levels were observed in inpatients, in the presence of bone metastases, and with low levels of Eastern Cooperative Oncology Group status. The number of patients receiving strong opioids increased with the highest levels of pain. However, a significant part of patients with moderate-severe pain were not receiving appropriate medication, patients being predominantly administered non-opioid drugs. General practitioners' attitudes did not negatively influence the opioid prescription. The results of this survey indicate a need for continuing educational and informative program in pain management for oncologists and more generally for any physician dealing with cancer patients.

Predictors of nurses' knowledge and attitudes toward postoperative pain in Greece.

PubMed

Kiekkas, Panagiotis; Gardeli, Panagiota; Bakalis, Nick; Stefanopoulos, Nikolaos; Adamopoulou, Katerina; Avdulla, Christos; Tzourala, Georgia; Konstantinou, Evangelos

2015-02-01

Undertreatment of postoperative pain can aggravate patient outcomes and is associated with attending nurses' knowledge deficits or negative attitudes toward pain. The aim of this study was to investigate knowledge and attitudes toward postoperative pain of surgical department nurses and to identify predictors of their knowledge and attitudes. This was a descriptive, cross-sectional survey that took place in the departments of general surgery, orthopedics, neurosurgery, ear-nose-throat surgery, and obstetrics/gynecology at five Greek hospitals. Participants were a convenience sample of registered and assistant nurses. Nurses were asked to complete a three-section questionnaire, which included demographics, a Knowledge and Attitudes Survey Regarding Pain (KASRP) tool modified for postoperative pain, and seven questions capturing personal characteristics, working conditions, and feelings about work. One hundred eighty-two questionnaires were completed. Average scores were 45.35% for modified KASRP tool; 28.57% for pain assessment; 55.44% for general pain management; and 47.13% for use of analgesics. Four of the five most commonly missed items referred to use of analgesics. More previous personal experience of postoperative pain (p = .002) and being a registered nurse (p = .015) predicted higher modified KASRP tool score. Participation in continuing education programs and department of employment were also associated with differences in the modified tool score. The knowledge deficits and negative attitudes of the nurses toward postoperative pain highlight the role of pregraduate and continuing education, appropriately specialized for each surgical department, in the development of empathy toward patients in pain and of clinical competency regarding pain assessment and administration of analgesics. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Impact of a joint labor-management ergonomics program on upper extremity musculoskeletal symptoms among garment workers.

PubMed

Herbert, R; Dropkin, J; Warren, N; Sivin, D; Doucette, J; Kellogg, L; Bardin, J; Kass, D; Zoloth, S

2001-10-01

This study evaluated the effect of an ergonomics intervention program on the prevalence and intensity of symptoms of upper extremity work-related musculoskeletal disorders among 36 garment workers performing an operation called spooling. Adjustable chairs were introduced and workers were trained in their use. Symptom surveys were administered prior to and 6 months after introduction of adjustable chairs. Quantitative pre- and post-intervention measurement of joint position was performed utilizing videotapes among a subgroup of nineteen. Eighty nine percent of the cohort reported pain in either the neck or at least one upper extremity anatomic site prior to the adjustable chair intervention. Among subjects reporting pain at baseline, there were significantly decreased pain levels in 10 of 11 anatomic sites after the intervention. Among all subjects, the proportion reporting pain decreased for each anatomic site following the intervention, with statistically significant decreases in 3 sites. However, there were only modest declines in awkward posture among the videotaped subgroup. This study suggests that introduction of an ergonomics program focused on education and introduction of an adjustable chair may diminish musculoskeletal symptomatology in apparel manufacturing workers.

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care.

PubMed

Von Korff, M; Moore, J E; Lorig, K; Cherkin, D C; Saunders, K; González, V M; Laurent, D; Rutter, C; Comite, F

1998-12-01

Randomized, controlled trial. To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.

Survey of international regional anesthesia fellowship directors

PubMed Central

Lansdown, Andrew K; McHardy, Paul G; Patel, Sanjiv C; Nix, Catherine M; McCartney, Colin JL

2013-01-01

Background The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results The survey response rate was 66% (45/68). Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. PMID:23900350

Physicians' Practice, Attitudes Toward, and Knowledge of Cancer Pain Management in China.

PubMed

Zhang, Qiongwen; Yu, Chunhua; Feng, Shijian; Yao, Wenxiu; Shi, Huashan; Zhao, Yuwei; Wang, Yongsheng

2015-11-01

To evaluate physicians' current practice, attitudes toward, and knowledge of cancer pain management in China. We conducted a face-to-face survey of physicians (oncologists, internists, hematologists) who are responsible for the care of cancer patient of 11 general hospitals in Sichuan, China between December 2011 and December 2013. Statistical analyses were performed using SPSS (SPSS, Chicago, IL) software. A 23-item questionnaire was designed and distributed to 550 physicians in 11 medical facilities in China. Five hundred (90.90%) physicians responded. About one-third (32.6%) of physicians assessed patients' pain rarely, and 85.5% never or occasionally treated patients' cancer pain together with psychologists. More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently cited barriers to physicians' pain management. Physicians' positive attitudes toward cancer pain management need to be encouraged, and active professional analgesic education programs are needed to improve pain management in China. Wiley Periodicals, Inc.

Army Back Complaint Program

DTIC Science & Technology

1988-05-13

installation of ABC Programs. It is designed to be an educational tool to prevent injuries to the back, shoulder, or neck areas primarily as a result of...third of all costs are the result of back complaints. Wh)ther the problem stems from traumatic injury or aggravation of a long-term illness, back pain...within a matter of days. The Army Back Complaint (ABC) Program has been developed to prevent back complaints and injuries and to return workers with

Impact of the Arthritis Foundation’s Walk With Ease Program on Arthritis Symptoms in African Americans

PubMed Central

Wyatt, Brooke; Mingo, Chivon A.; Waterman, Mary B.; White, Patience; Cleveland, Rebecca J.

2014-01-01

Introduction Inadequate program design and lack of access to evidence-based programs are major barriers to the management of chronic diseases such as arthritis, particularly for African Americans. This study evaluates the effectiveness of the Arthritis Foundation’s Walk With Ease Program (WWE) in a subsample of African Americans who were part of a larger study that established evidence of the program’s efficacy. Methods Participants were African Americans (N = 117) with self-reported arthritis who chose to participate in either a self-directed (n = 68) or group (n = 49) 6-week WWE program. Arthritis-related symptoms (ie, pain, fatigue, stiffness; measured using visual analog scales) were assessed at baseline, 6 weeks, and 1 year. Independent samples t tests were conducted to examine group differences (ie, self-directed vs group) in arthritis-related symptoms at baseline, and paired sample t tests were conducted to examine differences over time (ie, baseline to 6 weeks and baseline to 1 year) in symptoms. Satisfaction was examined by descriptive statistics. Results Younger, more educated individuals chose the self-directed format (P < .001, P = .008; respectively). After the 6-week intervention, participants reported a decrease in pain (P < .001), fatigue (P = .002), and stiffness (P < .001). At 1 year, the decrease in pain (P = .04) and stiffness (P = .002) remained constant. Overall, participants were satisfied with both program formats. Conclusion The individualized and group formats of the WWE program improved arthritis-related pain, fatigue, and stiffness in African Americans. Culturally appealing arthritis interventions ultimately may increase the use of existing arthritis interventions. PMID:25393747

Influence of educational attainment on pain intensity and disability in patients with lumbar spinal stenosis: mediation effect of pain catastrophizing.

PubMed

Kim, Ho-Joong; Kim, Sung-Chan; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

2014-05-01

Level IV, prospective case series. To investigate the influence of educational attainment on the level of pain intensity and disability in patients with lumbar spinal stenosis (LSS) and determine how coping behavior, such as catastrophizing, may mediate the association between educational attainment and clinical impairments. Educational attainment has been thought to influence disability caused by chronic painful disease, mediated by pain behavior or a coping strategy such as catastrophizing. Nevertheless, little is known about the role of educational attainment on pain intensity or disability related with LSS. A total of 155 patients who were diagnosed as degenerative LSS participated in the study. Data on detailed medical history, physical examination, and series of questionnaires were collected, including pain catastrophizing scale, Oswestry Disability Index, and visual analogue pain scale for back and leg pain. For measures of socioeconomic status, educational attainment and occupation were assessed. Radiological analysis was performed using magnetic resonance images and computed tomographic scans. After adjustment of covariates, multivariate regression analysis was used to assess each component of the proposed mediation models among visual analogue pain scale for back/leg pain, Oswestry Disability Index, the level of education, occupation and pain catastrophizing scale. Mediation was also assessed by the bootstrapping technique. Educational attainment was negatively correlated with pain intensity, disability, and catastrophizing. Pain catastrophizing were also significantly correlated with disability and pain intensity for back/leg pain in the patients with LSS. In the relationship among variables, the mediation analysis with bootstrapping clearly showed the role of catastrophizing in the mediation between visual analogue pain scale for back pain/leg pain, Oswestry Disability Index, and the level of education. This study demonstrated that lower educational attainment was associated with increased pain intensity and disability in patients with LSS, which was mediated by the coping mechanism, catastrophizing.

[Functional restoration--it depends on an adequate mixture of treatment].

PubMed

Pfingsten, M

2001-12-01

In the last 50 years conventional treatments have not been able to slow down the expanding chronic low back pain problem. However, nowadays health care has changed according to a broad biopsychosocial model of health, the positive effect of activity on health and healing, emphasis on function rather than pain or impairment, and reliance upon clinical evidence. In search for new solutions "functional restoration" (FR) programs have been developed. They include multidisciplinary treatment of patients in groups, consisting of 6-8 h of treatment a day, lasting 3 to 6 weeks and usually integrating intense physical and ergonomic training, psychological (behavioral) therapy, patient education, and instruction in social- and work-related issues. FR programs have yet to demonstrate their effectiveness in several countries. Controlled studies in the USA were very positive regarding the return-to-work rate, whereas studies in Scandinavian countries did not demonstrate similar results. Possible reasons for the different results concerning back-to-work ratios might be that study design, patient population, content of the program, and other external factors are different and studies as well as effects are therefore not directly comparable. According to several well-controlled studies, the most probable reason for this different effect may be that social and security (health care) systems and cultures differ among countries and that patients with chronic low back pain respond differently to this combination. Sick absenteeism and inability to work may be influenced by many factors besides pain that cannot be addressed by intervention or prevention programs, e.g., job satisfaction, education level, and the compensation systems. It may be that the lower economic benefit during sick leave in the United States leads to favorable results from functional restoration programs. Concerning the prediction of success, several studies have shown that medical background, diagnosis and physical impairment as well as physical variables (mobility, strength) have limited predictive value. Return to work and pain reduction are much better predicted by length of absence from work, application for pension, and the patients' disability in daily-life activities. In the last five years another important variable of success has been identified: avoidance behavior has been suspected to be a major contributor to the initiation and maintenance of chronic low back pain. The perpetuation of avoidance behavior beyond normal healing time subsequently leads to negative consequences such as "disuse syndrome", which is associated with physical deconditioning, sick role behavior, psychosocial withdrawal and negative affect. Accordingly, fear-avoidance beliefs were strongly related to absenteeism from work due to back pain and were the best predictors of therapy outcome in 300 acute low back pain patients. In a prospective study on 87 patients with chronic low back pain (CLBP) we demonstrated that fear-avoidance beliefs were the strongest predictors of return to work after a functional restoration treatment program. Although nonspecific mechanisms such as emotional disturbance, helplessness, pain anticipation, disability, and job circumstances could be identified as influencing the chronic pain process, we have to remember that long-lasting experience of pain is usually a very individual process in which several conditions may work together in a unique combination. Treatment procedures must consider this variability by focusing on general mechanisms, as well as on individual conditions and deficits. FR treatment strongly depends on behavioral principles that rule the whole therapeutic process: Adequate information is necessary to overcome unhelpful beliefs; information has to be related to the patients' daily experiences and their mental capability to understand them. Pacing, goal-setting, graded exposure with exercise quotas and permanent feedback as well as contingent motivation characterize the training procedures. Training procedures must incorporate the patients' daily activities early on. The patients' efficacy expectations are the most potent determinants of change in the training process. Exacerbation of pain is not taken as a failure of the therapeutic concept, but as a challenge to self-management. However, the important principle in managing chronic low back pain is "treating patients rather than spines."

Learning To Use Scientific Knowledge in Education and Practice Settings: An Evaluation of the Contribution of the Biological Behavioural and Social Sciences to Pre-Registration Nursing and Midwifery Programmes. Researching Professional Education. Research Reports Series Number 3.

ERIC Educational Resources Information Center

Eraut, Michael; And Others

A research project evaluated the contribution of biological, behavioral, and social sciences to nursing and midwifery education programs in Britain. The study of scientific knowledge relevant to recently qualified nurses and midwives was confined to six topics: fluids, electrolytes, and renal systems; nutrition; acute pain; shock; stress; and…

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

PubMed Central

Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

2012-01-01

Background Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). Methods To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 =  nil and 5 =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Results Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  = −5.6±8.2, p<0.0001; 95% confidence interval: −7.6 to −3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. Conclusion An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice. PMID:22662264

A policy-into-practice intervention to increase the uptake of evidence-based management of low back pain in primary care: a prospective cohort study.

PubMed

Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

2012-01-01

Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1  =  nil and 5  =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  =  -5.6±8.2, p<0.0001; 95% confidence interval: -7.6 to -3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention. An interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice.

Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life

PubMed Central

Rod, Kevin

2016-01-01

Background. Chronic pain is prevalent, disabling, costly, and undertreated. There is clearly a need to improve patient understanding of ways to manage their pain. Internet-based programs are continually being developed to facilitate mental health improvement, providing tailored content for patients to manage their pain, anxiety, and depression. Objective. To evaluate the impact of Internet-based patient self-management education and activities on patients' pain, anxiety, and quality of life in patients who could not access multidisciplinary pain management. Design. Observational study. Subjects. Two hundred (200) patients (61% females, 39% males, between 18 and 75 years old) from one community pain clinic in Toronto, Canada (Toronto Poly Clinic), participated. Patients had moderate to severe pain, depression, and anxiety. These patients committed to study from a group of 515 patients with chronic noncancer pain of different origins who were stable on their levels of pain, anxiety, and depression for 12 consecutive months before start of study and could not afford noninsured treatment modalities like physiotherapy, psychology, nutrition, or exercise therapy consultation. Methods. Patients were encouraged to visit two Internet sites (a blog and Twitter postings) for educational postings written by the author about exercise, nutrition, mindfulness meditation, disease management methods, evidence-based supplements, daily relaxation exercises, and overall self-management methods 15 minutes per day for six months. Patients were also encouraged to share their ideas and comments on a blog. Activity logs were kept by patients and reviewed by physician at follow-up visits. Compliance was encouraged via weekly email reminders and phone calls during the observation period. Results. Modest improvements were noted in pain, anxiety, depression, and quality of life. Of the patients with moderate or severe pain before treatment, 45% reported mild levels of pain after treatment, with a reduction of severe pain from 40% before treatment to 25% after treatment (p value 0.0184). Conclusion. Self-management support interventions, such as Internet-based educational tools, can be considered to help patients manage their chronic pain, depression, and anxiety and may be helpful to improve the treatment outcome in patients who could not otherwise afford noninsured services. PMID:27445632

Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life.

PubMed

Rod, Kevin

2016-01-01

Background. Chronic pain is prevalent, disabling, costly, and undertreated. There is clearly a need to improve patient understanding of ways to manage their pain. Internet-based programs are continually being developed to facilitate mental health improvement, providing tailored content for patients to manage their pain, anxiety, and depression. Objective. To evaluate the impact of Internet-based patient self-management education and activities on patients' pain, anxiety, and quality of life in patients who could not access multidisciplinary pain management. Design. Observational study. Subjects. Two hundred (200) patients (61% females, 39% males, between 18 and 75 years old) from one community pain clinic in Toronto, Canada (Toronto Poly Clinic), participated. Patients had moderate to severe pain, depression, and anxiety. These patients committed to study from a group of 515 patients with chronic noncancer pain of different origins who were stable on their levels of pain, anxiety, and depression for 12 consecutive months before start of study and could not afford noninsured treatment modalities like physiotherapy, psychology, nutrition, or exercise therapy consultation. Methods. Patients were encouraged to visit two Internet sites (a blog and Twitter postings) for educational postings written by the author about exercise, nutrition, mindfulness meditation, disease management methods, evidence-based supplements, daily relaxation exercises, and overall self-management methods 15 minutes per day for six months. Patients were also encouraged to share their ideas and comments on a blog. Activity logs were kept by patients and reviewed by physician at follow-up visits. Compliance was encouraged via weekly email reminders and phone calls during the observation period. Results. Modest improvements were noted in pain, anxiety, depression, and quality of life. Of the patients with moderate or severe pain before treatment, 45% reported mild levels of pain after treatment, with a reduction of severe pain from 40% before treatment to 25% after treatment (p value 0.0184). Conclusion. Self-management support interventions, such as Internet-based educational tools, can be considered to help patients manage their chronic pain, depression, and anxiety and may be helpful to improve the treatment outcome in patients who could not otherwise afford noninsured services.

Endometriosis education in schools: A New Zealand model examining the impact of an education program in schools on early recognition of symptoms suggesting endometriosis.

PubMed

Bush, Deborah; Brick, Emily; East, Michael C; Johnson, Neil

2017-08-01

Menstrual morbidity plays a significant role in adolescent females' lives. There are no studies to date reporting such data from menstrual health education programs in schools. The aim of our study was to report results from an audit of a menstrual health and endometriosis education program in secondary schools and observe age patterns of young women presenting for menstrual morbidity care. Audit data from education in secondary schools and audit data of patients from an Endometriosis and Pelvic Pain Coaching clinic operating in a private endometriosis specialised centre are reported. In a region of consistent delivery of the education program, student awareness of endometriosis was 32% in 2015. Overall in 2015, 13% of students experienced distressing menstrual symptoms and 27% of students sometimes or always missed school due to menstrual symptoms. Further, in one region of consistent delivery of the menstrual health education program, data show an increase in younger patients attending for specialised endometriosis care. There is strong suggestive evidence that consistent delivery of a menstrual health education program in schools increases adolescent student awareness of endometriosis. In addition, there is suggestive evidence that in a geographical area of consistent delivery of the program, a shift in earlier presentation of young women to a specialised health service is observed. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

PubMed Central

2010-01-01

Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044 PMID:20946621

Back posture education in elementary schoolchildren: a 2-year follow-up study.

PubMed

Geldhof, Elisabeth; Cardon, Greet; De Bourdeaudhuij, Ilse; De Clercq, Dirk

2007-06-01

Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13-14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters' lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 +/- 0.8 years) and 101 controls (mean age 13.2 +/- 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential.

Back posture education in elementary schoolchildren: a 2-year follow-up study

PubMed Central

Geldhof, Elisabeth; De Bourdeaudhuij, Ilse; De Clercq, Dirk

2006-01-01

Within the scope of primary prevention regarding back functioning in children, research on the stability of intervention effects is indispensable. Along this line, the transition from childhood to adolescence is an important phase to evaluate the potential stability of intervention effects because of the typically mechanical and psychological demands related to adolescence. The main aim of the current study was to investigate the effects of a back education program at 2-year follow-up, in youngsters aged 13–14 years, on back posture knowledge, fear-avoidance beliefs and self-reported pain. An additional purpose was to evaluate which aspects of postural behavior were integrated in youngsters’ lifestyles. At 2-year follow-up, the study sample included 94 secondary schoolchildren in the intervention group (mean age 13.3 ± 0.8 years) and 101 controls (mean age 13.2 ± 0.7 years). The back posture program that had been implemented for two school years consisted of back education and the stimulation of postural dynamism in the class through support and environmental changes. A questionnaire was completed comparable to the pretest, posttest and follow-up evaluations. The current study demonstrated at 2-year follow-up stability of the improved general (F = 1.590, ns) and specific (F = 0.049, ns) back posture knowledge in children who had received early back posture education. Back posture education did not result in increased fear-avoidance beliefs (F = 1.163, ns) or mounting back and/or neck pain reports (F = 0.001, ns). Based on self-reports for postural behavior, youngsters who had received the back posture program in the elementary school curriculum integrated crucial sitting and lifting principles conform to biomechanical favorable postural behavior. The steady intervention effects 2-year post-intervention demonstrated that intensive back posture education through the elementary school curriculum is effective till adolescence. Future research on the impact of early school-based back posture promotion in relation to the integration of back posture principles according to a biomechanical favorable lifestyle and back pain prevalence later in life is essential. PMID:17013655

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care.

PubMed

Cano-García, Francisco J; González-Ortega, María Del Carmen; Sanduvete-Chaves, Susana; Chacón-Moscoso, Salvador; Moreno-Borrego, Roberto

2017-01-01

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13-14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program.

Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care

PubMed Central

Cano-García, Francisco J.; González-Ortega, María del Carmen; Sanduvete-Chaves, Susana; Chacón-Moscoso, Salvador; Moreno-Borrego, Roberto

2017-01-01

According to evidence from recent decades, multicomponent programs of psychological intervention in people with chronic pain have reached the highest levels of efficacy. However, there are still many questions left to answer since efficacy has mainly been shown among upper-middle class patients in English-speaking countries and in controlled studies, with expert professionals guiding the intervention and with a limited number of domains of painful experience evaluated. For this study, a program of multicomponent psychological intervention was implemented: (a) based on techniques with empirical evidence, but developed in Spain; (b) at a public primary care center; (c) among patients with limited financial resources and lower education; (d) by a novice psychologist; and (e) evaluating all domains of painful experience using the instruments recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The aim of this study was to evaluate this program. We selected a consecutive sample of 40 patients treated for chronic non-cancer pain at a primary care center in Utrera (Seville, Spain), adults who were not in any employment dispute, not suffering from psychopathology, and not receiving psychological treatment. The patients participated in 10 psychological intervention sessions, one per week, in groups of 13–14 people, which addressed psychoeducation for pain; breathing and relaxation; attention management; cognitive restructuring; problem-solving; emotional management; social skills; life values and goal setting; time organization and behavioral activation; physical exercise promotion; postural and sleep hygiene; and relapse prevention. In addition to the initial assessment, measures were taken after the intervention and at a 6-month follow-up. We assessed the program throughout the process: before, during and after the implementation. Results were analyzed statistically (significance and effect size) and from a clinical perspective (clinical significance according to IMMPACT standards). According to this analysis, the intervention was successful, although improvement tended to decline at follow-up, and the detailed design gave the program assessment a high degree of standardization and specification. Finally, suggestions for improvement are presented for upcoming applications of the program. PMID:28386242

A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial.

PubMed

Morone, Natalia E; Greco, Carol M; Moore, Charity G; Rollman, Bruce L; Lane, Bridget; Morrow, Lisa A; Glynn, Nancy W; Weiner, Debra K

2016-03-01

Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed. To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP. This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015. The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the "10 Keys" to Healthy Aging. Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted. Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional -1.1 (mean, 12.1 vs 13.1) points at 8 weeks and -0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, -0.23 and -0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional -1.8 points (95% CI, -3.1 to -0.05 points; effect size, -0.33) and -1.0 points (95% CI, -2.1 to 0.2 points; effect size, -0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (-0.1 [95% CI, -1.1 to 1.0] at 8 weeks and -1.1 [95% CI, -2.2 to -0.01] at 6 months; effect size, -0.01 and -0.22, respectively). A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability. clinicaltrials.gov Identifier: NCT01405716.

Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial.

PubMed

van Ittersum, Miriam W; van Wilgen, C Paul; van der Schans, Cees P; Lambrecht, Luc; Groothoff, Johan W; Nijs, Jo

2014-11-01

Mounting evidence supports the use of face-to-face pain neuroscience education for the treatment of chronic pain patients. This study aimed at examining whether written education about pain neuroscience improves illness perceptions, catastrophizing, and health status in patients with fibromyalgia. A double-blind, multicenter randomized controlled clinical trial with 6-month follow-up was conducted. Patients with FM (n = 114) that consented to participate were randomly allocated to receive either written pain neuroscience education or written relaxation training. Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties; the relaxation group received a booklet with relaxation education and a telephone call. The revised illness perception questionnaire, Pain Catastrophizing Scale, and fibromyalgia impact questionnaire were used as outcome measures. Both patients and assessors were blinded. Repeated-measures analyses with last observation carried forward principle were performed. Cohen's d effect sizes (ES) were calculated for all within-group changes and between-group differences. The results reveal that written pain neuroscience education does not change the impact of FM on daily life, catastrophizing, or perceived symptoms of patients with FM. Compared with written relaxation training, written pain neuroscience education improved beliefs in a chronic timeline of FM (P = 0.03; ES = 0.50), but it does not impact upon other domains of illness perceptions. Compared with written relaxation training, written pain neuroscience education slightly improved illness perceptions of patients with FM, but it did not impart clinically meaningful effects on pain, catastrophizing, or the impact of FM on daily life. Face-to-face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM. © 2013 World Institute of Pain.

The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series

PubMed Central

Louw, Adriaan; Diener, Ina

2015-01-01

Background Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. Methods A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. Results Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. Conclusions The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS. PMID:26056626

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran.

PubMed

Shojaei, Sarallah; Tavafian, Sedigheh Sadat; Jamshidi, Ahmad Reza; Wagner, Joan

2017-06-01

Interventional research with a 6-month follow-up period. We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group ( p <0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups ( p =0.07). We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals.

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison.

PubMed

Duncan, Larissa G; Cohn, Michael A; Chao, Maria T; Cook, Joseph G; Riccobono, Jane; Bardacke, Nancy

2017-05-12

Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected. In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women's childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls. This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects. The ClinicalTrials.gov identifier for the PEARLS  study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

[Optimizing post-operative pain management in Latin America].

PubMed

Garcia, João Batista Santos; Bonilla, Patricia; Kraychete, Durval Campos; Flores, Fernando Cantú; Valtolina, Elizabeth Diaz Perez de; Guerrero, Carlos

Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis.

PubMed

Geneen, Louise J; Martin, Denis J; Adams, Nicola; Clarke, Clare; Dunbar, Martin; Jones, Derek; McNamee, Paul; Schofield, Pat; Smith, Blair H

2015-10-01

Chronic pain can contribute to disability, depression, anxiety, sleep disturbances, poor quality of life and increased health care costs, with close to 20 % of the adult population in Europe reporting chronic pain. To empower the person to self-manage, it is advocated that education and training about the nature of pain and its effects and how to live with pain is provided. The objective of this review is to determine the level of evidence for education to facilitate knowledge about chronic pain, delivered as a stand-alone intervention for adults, to reduce pain and disability. We identified randomised controlled trials of educational intervention for chronic pain by searching CENTRAL, MEDLINE, EMBASE and ongoing trials registries (inception to December 2013). Main inclusion criteria were (1) pain >3 months; (2) study design that allowed isolation of effects of education and (3) measures of pain or disability. Two reviewers independently screened and appraised each study. Nine studies were analysed. Pooled data from five studies, where the comparator group was usual care, showed no improvement in pain or disability. In the other four studies, comparing different types of education, there was no evidence for an improvement in pain; although, there was evidence (from one study) of a decrease in disability with a particular form of education-pain neurophysiology education (PNE). Post-hoc analysis of psychosocial outcomes reported in the studies showed evidence of a reduction in catastrophising and an increase of knowledge about pain following PNE. The evidence base is limited by the small numbers of studies, their relatively small sample sizes, and the diversity in types of education studied. From that limited evidence, the only support for this type of education is for PNE, though it is insufficiently strong to recommend conclusively that PNE should be delivered as a stand-alone intervention. It therefore remains sensible to recommend that education be delivered in conjunction with other pain management approaches as we cannot confidently conclude that education alone is effective in reducing pain intensity or related disability in chronic pain in adults.

Relationship of Musculoskeletal Disorder Pain to Patterns of Clinical Care in California Dental Hygienists.

PubMed

Humann, Pamela; Rowe, Dorothy J

2015-10-01

To relate self-reported levels of musculoskeletal disorder (MSD) pain and patterns of clinical care among members of the California Dental Hygienists' Association (CDHA), using a web-based survey. The 24-item survey consisted of questions on patterns of clinical care, health habits, experience with MSD pain and demographic information. Recruitment information, including survey link and consent form, was emailed to the CDHA for distribution to its members. Descriptive analysis and cross tabulations were conducted using the online software program Qualtrics™. A Chi-square test determined statistical significant differences between the responses of the no/mild pain and moderate/severe pain groups. The response rate was 19% (500/2,700). Ninety-six percent of all respondents reported some level of MSD pain, causing nearly 25% of the respondents to miss work. Respondents, who reported moderate/severe pain, treated more patients per day (p=0.007) and on average treated greater numbers of moderate to heavy calculus patients (p=0.017) than those respondents reporting no/mild pain. Forty percent of the respondents in the moderate/severe group treated more than 8 patients per day. A higher percentage of respondents (p=0.000) in the moderate/severe pain group than in the no/mild group reported using proper posture less than 50% of treatment time. Using proper posture more than 50% of treatment time was more frequent in respondents who had practiced more than (p=0.012), compared with less than, 5 years. Workload and ergonomics are related to MSD pain. Educational programs need to emphasize the importance of these factors in the development and reduction of MSD pain. Copyright © 2015 The American Dental Hygienists’ Association.

Education: The Heart of the Matter.

PubMed

Morriss, Wayne W; Milenovic, Miodrag S; Evans, Faye M

2018-04-01

There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program. In some countries, nonuniversity programs may be appropriate for training providers.(2) It is essential to train local teachers-a number of short courses provide teacher training. Overseas attachments may also play an important role in developing leadership and teaching capacity.(3) Interactive teaching techniques, such as small-group discussions and simulation, have been incorporated into many educational programs. Computer learning and videoconferencing offer additional educational possibilities.(4) Subspecialty education in areas such as obstetric anesthesia, pediatric anesthesia, and pain management are needed to develop leadership and increase capacity in subspecialty areas of practice. Examples include short subspecialty courses and clinical fellowships.(5) Collaboration and coordination are vital. Anesthesiologists need to work with ministries of health and other organizations to develop plans that are matched to need. External organizations can play an important role.(6) Excellent education is required at all levels. Training guidelines could help to standardize and improve training. Resources should be available for research, as well as monitoring and evaluation of educational programs.

Training Physicians in Palliative Care.

ERIC Educational Resources Information Center

Muir, J. Cameron; Krammer, Lisa M.; von Gunten, Charles F.

1999-01-01

Describes the elements of a program in hospice and palliative medicine that may serve as a model of an effective system of physician education. Topics for the palliative-care curriculum include hospice medicine, breaking bad news, pain management, the process of dying, and managing personal stress. (JOW)

Modifying beliefs about back pain: A pilot study among healthcare professionals.

PubMed

Monnin, Dominique; Courvoisier, Delphine S; Genevay, Stéphane

2016-04-01

This study aimed to explore whether a preventive intervention based on the non-injury model and the biopsychosocial model of back pain succeeded in shifting beliefs toward less negative representations and in decreasing fear-avoidance beliefs related to back pain. One hundred and one healthcare professionals took part in a 10-h educational program held over 2 consecutive days, based on the key messages of the "Back Book." Baseline values were measured 6 weeks before the intervention and when it started. Follow-up was performed at the end of the intervention and six months later. No significant changes were observed between baseline values and values measured at the beginning of the intervention, but participants' beliefs about LBP changed significantly after the program. The benefit remained at 6 months follow-up. A prevention program based on the non-injury and bio-psychosocial models of LBP, introducing empowerment and problem-solving strategies, significantly reduced fear-avoidance and negative beliefs about LBP. The change was clinically relevant and thus could decrease direct and indirect healthcare costs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effectiveness of a standardised exercise programme for recurrent neck and low back pain: a multicentre, randomised, two-arm, parallel group trial across 34 fitness clubs in Finland.

PubMed

Suni, Jaana H; Rinne, Marjo; Tokola, Kari; Mänttäri, Ari; Vasankari, Tommi

2017-01-01

Neck and low back pain (LBP) are common in office workers. Exercise trials to reduce neck and LBP conducted in sport sector are lacking. We investigated the effectiveness of the standardised Fustra20Neck&Back exercise program for reducing pain and increasing fitness in office workers with recurrent non-specific neck and/or LBP. Volunteers were recruited through newspaper and Facebook. The design is a multi-centre randomised, two-arm, parallel group trial across 34 fitness clubs in Finland. Eligibility was determined by structured telephone interview. Instructors were specially educated professionals. Neuromuscular exercise was individually guided twice weekly for 10 weeks. Webropol survey, and objective measurements of fitness, physical activity, and sedentary behavior were conducted at baseline, and at 3 and 12 months. Mean differences between study groups (Exercise vs Control) were analysed using a general linear mixed model according to the intention-to-treat principle. At least moderate intensity pain (≥40 mm) in both the neck and back was detected in 44% of participants at baseline. Exercise compliance was excellent: 92% participated 15-20 times out of 20 possible. Intensity and frequency of neck pain, and strain in neck/shoulders decreased significantly in the Exercise group compared with the Control group. No differences in LBP and strain were detected. Neck/shoulder and trunk flexibility improved, as did quality of life in terms of pain and physical functioning. The Fustra20Neck&Back exercise program was effective for reducing neck/shoulder pain and strain, but not LBP. Evidence-based exercise programs of sports clubs have potential to prevent persistent, disabling musculoskeletal problems.

Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain: a prospective randomized controlled trial.

PubMed

Ozdemir, Serpil; Bebis, Hatice; Ortabag, Tulay; Acikel, Cengizhan

2015-08-01

To evaluate the effect of exercise programs on pregnant women with pregnancy-related low back and pelvic pain. Low back and pelvic pain during pregnancy is a major health problem due to its frequent occurrence and such pain can limit pregnant women in many of their daily activities. A randomized trial with a control group (n = 48) and an intervention group (n = 48). Trial registration number NCT02189356. Department of Obstetrics and Gynecology, between December 2011-May 2012, an Education and Research Hospital in Turkey. Based on the intention-to-treat principle, all pregnant women were analysed according to the group they were assigned to, regardless of whether they received the intervention or not. Participants in the intervention group received health counselling and exercised regarding low back and pelvic pain for four weeks. The pregnant women in the control group received usual care, comprised of routine clinical practice for pregnancy-related low back and pelvic pain. According to Mann-Whitney U test analysis results, there was a statistically significant difference between the control and intervention groups' Visual Analogue Scale during relaxation scores and Visual Analogue Scale during activity scores at the end of the study. According to Mann-Whitney U test analysis results, the change in the mean Oswestry Disability Index score for the intervention group and the difference in the mean scores between the two groups was statistically significant. A four-week exercise program including individualized health counselling to relieve low back and pelvic pain improved the functional status in pregnant women. © 2015 John Wiley & Sons Ltd.

Can an intensive diet and exercise program prevent knee pain among overweight adults at high risk?

PubMed

White, Daniel K; Neogi, Tuhina; Rejeski, W Jack; Walkup, Michael P; Lewis, Cora E; Nevitt, Michael C; Foy, Capri G; Felson, David T

2015-07-01

It is unclear whether an intensive program of weight loss combined with exercise prevents the onset of knee pain among those at high risk. We examined whether an intensive lifestyle intervention (ILI) prevents incident knee pain compared with a diabetes mellitus support and education (DSE) comparison group among overweight adults with diabetes mellitus. We conducted a secondary analysis of the Action for Health in Diabetes (Look AHEAD) study, which is a randomized intervention trial of adults who were obese and had type 2 diabetes mellitus starting in 2001. We studied a subcohort of 2,889 subjects who reported no knee pain at baseline but were at high risk due to obesity. Risk ratios (RRs) were calculated to examine the association of ILI versus DSE with incident knee pain at year 1 and year 4. All analyses were adjusted for potential confounders. Age, sex, and body mass index were similar among ILI and DSE participants with no knee pain at baseline. At year 1, ILI participants were 15% less likely to develop knee pain compared with DSE participants (RR 0.85, 95% confidence interval 0.74-0.98). At year 4, this difference decreased to 5% and was no longer statistically significant. An ILI of diet and exercise may prevent the development of knee pain among those at high risk in the short term. Health care providers may consider recommending diet and exercise as a means to prevent the development of knee pain among those at high risk. © 2015, American College of Rheumatology.

Change in Musculoskeletal Pain in Patients With Work-Related Musculoskeletal Disorder After Tailored Rehabilitation Education: A One-Year Follow-Up Survey.

PubMed

Lee, Dong Hun; Kang, Boram; Choi, Seungyoung; Kim, Taikon; Jang, Seong Ho; Lee, Kyu Hoon; Kim, Mi Jung; Park, Si-Bog; Han, Seung Hoon

2015-10-01

To apply tailored rehabilitation education to video display terminal (VDT) workers with musculoskeletal pain and to assess changes in musculoskeletal pain after rehabilitation education. A total of 8,828 VDT workers were screened for musculoskeletal disorders using a self-report questionnaire. Six hundred twenty-six VDT workers selected based on their questionnaires were enrolled in musculoskeletal rehabilitation education, which consisted of education on VDT syndrome and confirmed diseases, exercise therapy including self-stretching and strengthening, and posture correction. One year later, a follow-up screening survey was performed on 316 VDT workers, and the results were compared with the previous data. Compared with the initial survey, pain intensity was significantly decreased in the neck area; pain duration and frequency were significantly decreased in the low back area; and pain duration, intensity, and frequency were significantly decreased in the shoulder and wrist after tailored rehabilitation education. In addition, pain duration, intensity, and frequency showed a greater significant decrease after tailored rehabilitation education in the mild pain group than in the severe pain group. This study found that work-related musculoskeletal pain was reduced after tailored rehabilitation education, especially in the shoulder, wrist, and low back.

Recruiting seniors with chronic low back pain for a randomized controlled trial of a self-management program.

PubMed

Groupp, Elyse; Haas, Mitchell; Fairweather, Alisa; Ganger, Bonnie; Attwood, Michael

2005-02-01

To identify recruitment challenges and elucidate specific strategies that enabled recruitment of seniors for a randomized trial on low back pain comparing the Chronic Disease Self-management Program of the Stanford University to a 6-month wait-list control group. Recruitment for a randomized controlled trial. Community-based program offered at 12 locations. Community-dwelling seniors 60 years and older with chronic low back pain of mechanical origin. Passive recruitment strategies included advertisement in local and senior newspapers, in senior e-mail newsletters and listservs, in local community centers and businesses. Active strategies included meeting seniors at health fairs, lectures to the public and organizational meetings, and the help of trusted professionals in the community. A total of 100 white and 20 African American seniors were recruited. The program seemed to have the most appeal to white, middle-class older adults, educated through high school level. Advertisement failed to attract any participants to the program. Successful strategies included interaction with seniors at health fairs and lectures on health care, especially when the program was endorsed by a trusted community professional. Generating interest in the self-management program required keen communication skills because the idea of "self-management" was met with a myriad of responses, ranging from disinterest to disbelief. Generating interest also required active participation within the communities. Initial contacts had to be established with trusted professionals, whose endorsement enabled the project managers to present the concept of self-management to the seniors. More complex recruitment strategies were required for this study involving the self-management approach to back pain than for studies involving treatment.

Pain Neuroscience Education: State of the Art and Application in Pediatrics.

PubMed

Robins, Hannah; Perron, Victoria; Heathcote, Lauren C; Simons, Laura E

2016-12-21

Chronic pain is a widespread problem in the field of pediatrics. Many interventions to ameliorate pain-related dysfunction have a biobehavioral focus. As treatments for chronic pain (e.g., increased movement) often stand in stark contrast to treatments for an acute injury (e.g., rest), providing a solid rationale for treatment is necessary to gain patient and parent buy-in. Most pain treatment interventions incorporate psychoeducation, or pain neuroscience education (PNE), as an essential component, and in some cases, as a stand-alone approach. The current topical review focuses on the state of pain neuroscience education and its application to pediatric chronic pain. As very little research has examined pain neuroscience education in pediatrics, we aim to describe this emerging area and catalyze further work on this important topic. As the present literature has generally focused on adults with chronic pain, pain neuroscience education merits further attention in the realm of pediatric pain in order to be tailored and implemented in this population.

Pain Neuroscience Education: State of the Art and Application in Pediatrics

PubMed Central

Robins, Hannah; Perron, Victoria; Heathcote, Lauren C.; Simons, Laura E.

2016-01-01

Chronic pain is a widespread problem in the field of pediatrics. Many interventions to ameliorate pain-related dysfunction have a biobehavioral focus. As treatments for chronic pain (e.g., increased movement) often stand in stark contrast to treatments for an acute injury (e.g., rest), providing a solid rationale for treatment is necessary to gain patient and parent buy-in. Most pain treatment interventions incorporate psychoeducation, or pain neuroscience education (PNE), as an essential component, and in some cases, as a stand-alone approach. The current topical review focuses on the state of pain neuroscience education and its application to pediatric chronic pain. As very little research has examined pain neuroscience education in pediatrics, we aim to describe this emerging area and catalyze further work on this important topic. As the present literature has generally focused on adults with chronic pain, pain neuroscience education merits further attention in the realm of pediatric pain in order to be tailored and implemented in this population. PMID:28009822

Cancer Pain Management Education Rectifies Patients' Misconceptions of Cancer Pain, Reduces Pain, and Improves Quality of Life.

PubMed

Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil

2018-03-26

More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.

Pain management strategies and lessons from the military: A narrative review

PubMed Central

Vallerand, April Hazard; Cosler, Patricia; Henningfield, Jack E; Galassini, Pam

2015-01-01

BACKGROUND: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings. OBJECTIVE: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population. METHODS: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population. DISCUSSION: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes. PMID:26448972

Psychosocial Interventions for Children and Adolescents with Sickle Cell Disease (SCD).

ERIC Educational Resources Information Center

Collins, Marietta; Kaslow, Nadine; Doepke, Karla; Eckman, James; Johnson, Marjorie

1998-01-01

Reviews the existing literature on psychosocial interventions for children and adolescents with sickle cell disease and suggests some developmentally appropriate modifications for approaches designed for adults. Particular attention is paid to nonpharmacological pain management strategies that include coping skill training, educational programs,…

A cognitive-behavioral program for parents of children with chronic musculoskeletal pain; A feasibility study.

PubMed

Wiertz, C; Goossens, M; Spek, E M; Verbunt, J A

2017-10-01

The purpose of the study is to evaluate the feasibility of a newly developed parent program for parents of children with non-specific chronic musculoskeletal pain. This program is part of the child's interdisciplinary outpatient pain rehabilitation treatment. The goal of the parent program is to change parent's thoughts/behaviour regarding pain with the ultimate intention to further improve their child's functioning. There were two main objectives in the study: First, to evaluate the feasibility of the parent program. Second, to evaluate changing in parental behavioral factors pre- and posttreatment. Participants were parents of adolescents, who underwent a interdisciplinary outpatient pain program for non-specific chronic musculoskeletal pain. Parents participated in a parent program as part of their child's treatment. Adolescents reported their level of disability, pain intensity, fear of pain and pain catastrophizing by filling out questionnaires. Parents reported catastrophic thinking about their child's pain, fear of pain and disabilities of their child. In addition, they evaluated the parent program. Sixty five parents (36 mothers and 29 fathers) of 44 adolescents filled in the baseline questionnaires. Result showed significant and clinically relevant improvements for both parents as well for adolescents. Parents were positive about the content of the parent program, they evaluated the program as supportive and informative. Adding a parent program to a interdisciplinary outpatient pain program for adolescent with chronic musculoskeletal pain, seems to be feasible in daily life of the parents and results in positive behavioural changes for both parents and adolescents. A parent program, designed to change cognition and behaviour of parents of children with chronic musculoskeletal pain is feasible. © 2017 European Pain Federation - EFIC®.

Pain relief, spiritual needs, and family support: three central areas in intercultural palliative care.

PubMed

Hanssen, Ingrid; Pedersen, Gry

2013-12-01

The purpose of this study was to draw out and coalesce the topic-specific information found in research literature regarding the provision of culturally sensitive palliative practice. This was a literature study and Gadamerian hermeneutic text analysis. It is more difficult to assess the level of pain in ethnic minority patients, and healthcare providers may become frustrated and interpret pain symptoms as fabrication. These patients are more likely to receive inadequate pain medication. Physical symptom management has become the priority in palliative care, but pain must also be viewed from the perspective of its social, cultural, and spiritual significance. Collectivist values may lead to an other-reliant and dependent coping style. This and religious demands may cause the family to rally around the patient. Many dying patients wish to be cared for at home by their families, but as the patient often has complex needs, the family may not be able to cope with the patient's care. Formal education and in-service programs are needed for healthcare providers, together with empirical studies regarding how to achieve more culturally appropriate care in intercultural palliative practice. The immigrant population needs to be educated about cancer and the various kinds of palliative and hospice care offered in the society in which they now live.

A Survey of Knowledge and Attitudes of Nurses About Pain Management in End-Stage Liver Disease in a Geriatric Palliative Care Unit.

PubMed

Perri, Giulia-Anna; Yeung, Herman; Green, Yoel; Bezant, Abby; Lee, Carman; Berall, Anna; Karuza, Jurgis; Khosravani, Houman

2018-01-01

Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD. A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the "Nurses Knowledge and Attitudes Survey Regarding Pain" (NKASRP) tool. Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level. The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.

Marital quality and self-efficacy: influence on disease management among individuals with rheumatoid arthritis.

PubMed

Tewary, Sweta; Farber, Naomi

2014-01-01

Individuals with rheumatoid arthritis (RA) struggle to maintain improved functional ability and reduced pain levels. Health education emphasizing self-efficacy helps individuals to adjust with the disease outcome and progression. As a basis to develop comprehensive evidence-based patient education programs, the aim of the study was to examine the role of marriage as a predictor of pain and functional self-efficacy among individuals with RA. Review of the regression analysis did not provide support for the relationships between marital quality and self-efficacy. Relationships were not observed between marital quality, length of marriage, and self-efficacy as predicted by the first hypothesis. Additional regression analysis examination found that marital quality, length of marriage, pain, and health assessment together reported significant variance in self-efficacy. However, only health assessment significantly predicted self-efficacy. Other nonexamined variables could have influenced the independent marital quality effects. Future longitudinal studies with larger sample sizes can further validate the current findings.

Video education for critical care nurses to assess pain with a behavioural pain assessment tool: A descriptive comparative study.

PubMed

Björn, Annika; Pudas-Tähkä, Sanna-Mari; Salanterä, Sanna; Axelin, Anna

2017-10-01

To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education. Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis. The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction. Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of strong opioids for chronic pain in osteoarthritis: an insight into the Latin American reality.

PubMed

Ruiz Iban, Miguel Angel; Benavides, Javier; Forero, Juan Pablo; Bittelman, Sacha; Martinez, Rafael; Mite, Miguel Angel; Diaz Heredia, Jorge; Ulloa, Sergio; Lizárraga Ferrand, Mauro Marcelo

2018-01-01

Osteoarthritis is the most common cause of arthritis and one of the main causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids. Areas covered: In this article we review the epidemiology of osteoarthritis, its socioeconomic burden, its impact as a chronic pain cause and the pharmacological treatment options, giving emphasis to the role of strong opioids, their safety and efficacy, especially in Latin American countries, where restrictions regulate their usage. Expert commentary: Usage of strong opioids is safe and effective in the short-term management of osteoarthritis with moderate to severe pain, when other pharmacological treatments are inadequate and surgery is contraindicated, provided their use adheres to existing guidelines. Educational programs for patients and physicians and further research on treating chronic pain with opioids should be implemented to reduce adverse effects and improve care quality.

Nonnarcotic analgesics and tricyclic antidepressants for the treatment of chronic nonmalignant pain.

PubMed

Richlin, D M

1991-05-01

Chronic nonmalignant pain is often characterized by multiple treatment failures, a pattern of maladaptive behavior, and depression. Often there is a history of inappropriate and excessive use of medications for pain. Prior and ongoing use of narcotics and sedatives acts to compound and aggravate the chronic pain syndrome. A first step in treatment is controlled withdrawal of these agents. Nonnarcotic analgesics, NSAIDs, and tricyclic antidepressants are commonly employed in patients with chronic pain. Effective use of these agents requires understanding of their pharmacokinetic and pharmacodynamic properties. Use of a fixed-time schedule is necessary to achieve an effective, sustained therapeutic response. Careful patient education and monitoring for side effects and toxicity are necessary, particularly in the elderly and patients with coexisting medical disorders. Incidence of side effects and toxicity may be reduced by choice of drug and modification of dosing regimen. Nonnarcotic analgesics, TCAs, and NSAIDs are seldom effective by themselves in resolving the pain and distress of patients with chronic nonmalignant pain. This is particularly true when maladaptive behavior coexists. A comprehensive multimodal pain management program encompassing additional pain-relieving strategies and behavior-modifying techniques should be considered and utilized in conjunction with medication.

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules.

PubMed

Madaus, Stacy M; Lim, Lionel S

2016-10-01

Chronic pain is an international healthcare crisis that affects an estimated 1.5 billion individuals worldwide, but pain management is not emphasized in the medical school curriculum, and thus supplemental education is essential. The Portal of Geriatric Online Education (POGOe) is a free repository of teaching modules for use by geriatric educators and learners. This article highlights three teaching modules available on this site: It's My Old Back Again: An Approach to Diagnosing and Managing Back Pain in the Older Adult (POGOe ID: 21670), Computer Based Learning Workbook, Third Edition module on Pain Management (POGOe ID: 21036), and Aging Q3 Curriculum on Pain Management of Older Adult Patients (POGOe ID: 21187). These modules were chosen based on their ability to address the major topics that the International Association for the Study of Pain proposes should be included in medical school curricula: mulitdimensional nature of pain, pain assessment and measurement, management of pain, and clinical conditions resulting in pain in older adults. They were also selected for their ability to be adapted for interprofessional education and how well they integrate basic science and clinical principles. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A survey to assess the educational-level interference on self-evaluation of acute pain.

PubMed

Labronici, Pedro José; Pires, Robinson Esteves Santos; Bastos Filho, Ricardo Pinheiro dos Santos; Pires-e-Albuquerque, Rodrigo Sattamini; Palma, Idemar Monteiro de; Giordano, Vincenzo; Franco, José Sérgio

2015-08-01

The present study aimed to evaluate whether patient education level interferes in the percentage of pain relief or increase using visual analogue scale (VAS) and subjective pain perception. Ninety-five patients presenting acute shoulder pain due to enthesitis were evaluated. They were asked to quantify the pain using VAS before steroid articular infiltration. One week later, patients reevaluated the pain using VAS and orally stated the percentage of perceived pain increase or relief. The information gathered was then compared among three patient educational levels (elementary, high school, and university). Percentages of improvement stated orally and utilizing VAS presented no statistically significant differences among the three educational status levels (p = 0.804). Patient educational status caused no impact in the results of acute pain self-assessment with VAS and oral evaluation.

Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study.

PubMed

Van Oosterwijck, Jessica; Nijs, Jo; Meeus, Mira; Truijen, Steven; Craps, Julie; Van den Keybus, Nick; Paul, Lorna

2011-01-01

Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli, maladaptive illness beliefs, inappropriate attitudes, and movement dysfunctions. Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance. This single-case study (A-B-C design) with six patients with chronic whiplash associated disorders (WAD) was aimed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms, daily functioning, pain beliefs, and behavior. Periods A and C represented assessment periods, while period B consisted of the intervention (pain neurophysiology education). Results showed a significant decrease in kinesiophobia (Tampa Scale for Kinesiophobia), the passive coping strategy of resting (Pain Coping Inventory), self-rated disability (Neck Disability Index), and photophobia (WAD Symptom List). At the same time, significantly increased pain pressure thresholds and improved pain-free movement performance (visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test) were established. Although the current results need to be verified in a randomized, controlled trial, they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD.

The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

PubMed

Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

2012-01-01

The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

Improving undergraduate medical education about pain assessment and management: A qualitative descriptive study of stakeholders’ perceptions

PubMed Central

Tellier, Pierre-Paul; Bélanger, Emmanuelle; Rodríguez, Charo; Ware, Mark A; Posel, Nancy

2013-01-01

BACKGROUND Pain is one of the most common reasons for individuals to seek medical advice, yet it remains poorly managed. One of the main reasons that poor pain management persists is the lack of adequate knowledge and skills of practicing clinicians, which stems from a perceived lack of pain education during the training of undergraduate medical students. OBJECTIVE: To identify gaps in knowledge with respect to pain management as perceived by students, patients and educators. METHODS: A qualitative descriptive study was conducted. Data were generated through six focus groups with second- and fourth-year medical students, four focus groups with patients and individual semistructured interviews with nine educators. All interviews were audiotaped and an inductive thematic analysis was performed. RESULTS: A total of 70 individuals participated in the present study. Five main themes were identified: assessment of physical and psychosocial aspects of pain; clinical management of pain with pharmacology and alternative therapies; communication and the development of a good therapeutic relationship; ethical considerations surrounding pain; and institutional context of medical education about pain. CONCLUSION: Participating patients, students and pain experts recognized a need for additional medical education about pain assessment and management. Educational approaches need to teach students to gather appropriate information about pain, to acquire knowledge of a broad spectrum of therapeutic options, to develop a mutual, trusting relationship with patients and to become aware of their own biases and prejudice toward patients with pain. The results of the present study should be used to develop and enhance existing pain curricula content. PMID:23985579

A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community-Dwelling Older Adults With Lower Extremity Osteoarthritis

PubMed Central

Park, Juyoung; McCaffrey, Ruth; Newman, David; Liehr, Patricia; Ouslander, Joseph G.

2016-01-01

Objectives To determine effects of Sit ‘N’ Fit Chair Yoga, compared to a Health Education program (HEP), on pain and physical function in older adults with lower extremity osteoarthritis (OA) who could not participate in standing exercise Design Two-arm randomized controlled trial Setting One HUD senior housing facility and one day senior center in south Florida Participants Community-dwelling older adults (N = 131) were randomly assigned to chair yoga (n = 66) or HEP (n = 65). Thirteen dropped after assignment but prior to the intervention; 6 dropped during the intervention; 106 of 112 completed at least 12 of 16 sessions (95% retention rate). Interventions Participants attended either chair yoga or HEP. Both interventions consisted of twice-weekly 45-minute sessions for 8 weeks. Measurements Primary: pain, pain interference; secondary: balance, gait speed, fatigue, functional ability measured at baseline, after 4 weeks of intervention, at the end of the 8-week intervention, and post-intervention (1 and 3 months). Results The chair yoga group showed greater reduction in pain interference during the intervention (p = .01), sustained through 3 months (p = .022). WOMAC pain (p = .048), gait speed (p = .024), and fatigue (p = .037) were improved in the yoga group during the intervention (p = .048) but improvements were not sustained post intervention. Chair yoga had no effect on balance. Conclusion An 8-week chair yoga program was associated with reduction in pain, pain interference, and fatigue, and improvement in gait speed, but only the effects on pain interference were sustained 3 months post intervention. Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities. Trial Registration ClinicalTrials.gov: NCT02113410 PMID:28008603

"I've Actually Changed How I Live"-Patients' Long-Term Perceptions of a Cognitive Behavioral Pain Management Program.

PubMed

Egan, Aine; Lennon, Olive; Power, Camillus K; Fullen, Brona M

2017-02-01

To determine patients’ perceptions regarding cognitive behavioral pain management programs, and to determine what, if any, strategies learned on the program patients continue to use long-term to manage their pain. A qualitative, focus-group based study. An outpatient multidisciplinary pain management program in a university teaching hospital. Patients with chronic pain who had previously completed a 4-week cognitive behavioral pain management program (2001–2014). Sixteen patients attended one of four focus groups. A battery of semi-structured questions explored their perceptions of the cognitive behavioral program, and which strategies they found useful and continued to use long-term to manage their pain. Six key themes emerged: 1) universal long-term positive feedback on the utility of the program; 2) the program facilitated long-term changes in daily life; 3) participants now considered themselves as the “new me”; 4) request for more updates on emerging new treatments/pain knowledge; 5) recognizing that the key to maximizing gain from the program was to be open, to listen, and accept; and 6) participants sharing pain management knowledge with others in pain. There was universal positive feedback for the pain management program. Despite the years since they participated in one, patients continue to use key strategies to effectively manage their pain (pacing, relaxation), embedding them in their daily lives to maximize their quality of life.

Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial.

PubMed

Van Oosterwijck, Jessica; Meeus, Mira; Paul, Lorna; De Schryver, Mieke; Pascal, Aurelie; Lambrecht, Luc; Nijs, Jo

2013-10-01

There is evidence that education on pain physiology can have positive effects on pain, disability, and catastrophization in patients with chronic musculoskeletal pain disorders. A double-blind randomized controlled trial (RCT) was performed to examine whether intensive pain physiology education is also effective in fibromyalgia (FM) patients, and whether it is able to influence the impaired endogenous pain inhibition of these patients. Thirty FM patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education). The primary outcome was the efficacy of the pain inhibitory mechanisms, which was evaluated by spatially accumulating thermal nociceptive stimuli. Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status. Assessments were performed at baseline, 2 weeks, and 3 months follow-up. Repeated measures ANOVAS were used to reveal possible therapy effects and effect sizes were calculated. After the intervention the experimental group had improved knowledge of pain neurophysiology (P<0.001). Patients from this group worried less about their pain in the short term (P=0.004). Long-term improvements in physical functioning (P=0.046), vitality (P=0.047), mental health (P<0.001), and general health perceptions (P<0.001) were observed. In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition (P=0.041) compared with the control group. These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

Using a quasi-experimental research design to assess knowledge in continuing medical education programs.

PubMed

Markert, Ronald J; O'Neill, Sally C; Bhatia, Subhash C

2003-01-01

The objectives of continuing medical education (CME) programs include knowledge acquisition, skill development, clinical reasoning and decision making, and health care outcomes. We conducted a year-long medical education research study in which knowledge acquisition in our CME programs was assessed. A randomized separate-sample pretest/past-test design, a quasi-experimental technique, was used. Nine CME programs with a sufficient number of participants were identified a priori. Knowledge acquisition was compared between the control group and the intervention group for the nine individual programs and for the combined programs. A total of 667 physicians, nurses, and other health professionals participated. Significant gain in knowledge was found for six programs: Perinatology, Pain Management, Fertility Care 2, Pediatrics, Colorectal Diseases, and Alzheimer's Disease (each p < .001). Also, the intervention group differed from the control group when the nine programs were combined (p < .001), with an effect size of .84. The use of sound quasi-experimental research methodology (separate-sample pretest/post-test design), the inclusion of a representative sample of CME programs, and the analysis of nearly 700 subjects led us to have confidence in concluding that our CME participants acquired a meaningful amount of new knowledge.

An Integrative Review of Pain Resource Nurse Programs.

PubMed

Crawford, Cecelia L; Boller, Jan; Jadalla, Ahlam; Cuenca, Emma

2016-01-01

Mismanaged pain challenges health care systems. In the early 1990s, pain resource nurse programs were developed by Ferrell and colleagues. Variations of the model have existed for more than 20 years. While results of these programs have been disseminated, conclusive evidence has not been examined via a synthesis of the literature. A structured systematic search using multiple databases was conducted for research studies published 2005-2012. The search identified 11 studies on effective use of a pain resource nurse and/or a pain resource nurse program. The results revealed wide variations existing in program design, research methodology, practice settings, and reported outcomes. Overall, the strength of the evidence on pain resource nurse programs was determined to range from low to moderate quality for making generalizable conclusions. However, 4 key elements were identified as integral to effective pain resource nurse programs and useful for the program design and development: leadership commitment and active involvement in embedding a culture of effective pain management throughout the organization; addressing staff-related and organization-related challenges and barriers to pain management; a combination of strategies to overcome these barriers; and collaborative multidisciplinary teamwork and communication. Specific recommendations are provided for program implementation. Although the evidence was inconclusive, useful information exists to create the design of effective pain resource nurse programs. Collaborative multisite studies on the long-term effects of pain resource nurse programs are recommended.

The Integration of Technology into Treatment Programs to Aid in the Reduction of Chronic Pain.

PubMed

Eckard, Chad; Asbury, Caitlyn; Bolduc, Brandon; Camerlengo, Chelsea; Gotthardt, Julia; Healy, Lauren; Waialae, Laura; Zeigler, Ceirra; Childers, Jennifer; Horzempa, Joseph

2016-01-01

In the United States, roughly $600 billion is spent on pain management - usually in the form of addictive opioid drugs. Due to the dangers associated with long-term opiate-based pain medication, the development of additional strategies for chronic pain management is warranted. The advent of smartphones and associated technology has provided healthcare providers with a unique opportunity to provide pain management support. This review summarizes of the use of technology to supplement chronic pain management regimens. Smartphone and internet-based applications that employ online journals facilitate improved communication between patient and clinician and allow for more personalized care and improved pain management. For instance, the e-Ouch application provides a platform for pain logs as well as feedback and coaching to patients via Twitter postings and blogs. Other applications provide online resources and blogs to improve patient education, which has shown to relieve patient symptoms through lifestyle modification. Internet-delivered cognitive behavioral therapy (CBT) focuses on the psychological coping mechanisms. The application of technology and smartphone apps toward pain management shows promise toward reducing the use of opioids in pain management, but has yet to be incorporated as a standard practice. More robust studies critically evaluating the efficacy of these technology-based therapies need to be conducted before standardization and insurance coverage can become reality.

A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals.

PubMed

Coleman, Sophie; Briffa, N Kathryn; Carroll, Graeme; Inderjeeth, Charles; Cook, Nicola; McQuade, Jean

2012-01-27

Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis (OA) of the knee (the Osteoarthritis of the Knee Self-Management Program (OAK)) implemented by health care professionals would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group. Medical practitioners referred 146 primary care patients with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded. Randomisation was to either a control group or the OAK group. The OAK group completed a 6-week self-management program. The control group had a 6-month waiting period before entering the OAK program. Assessments were taken at baseline, 8 weeks and 6 months. The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales on the Short Form 36 version 1 questionnaire (SF-36) Secondary outcomes were Visual Analogue Scale (VAS) pain, Timed Up & Go Test (TUG), knee range of motion and quadriceps and hamstring strength-isometric contraction. Responses to treatment (responders) and minimal clinically important improvements (MCIIs) were determined. In the OAK group, VAS pain improved from baseline to week 8 from mean (SEM) 5.21 (0.30) to 3.65 (0.29) (P ≤ 0.001). During this period, improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes: WOMAC Pain, Physical Function and Total dimensions, as well as SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains. In addition, from baseline to week 8, the proportion of MCIIs was greater among the OAK group than the control group for all outcomes. For the period between baseline and month 6, WOMAC Pain, Physical Function and Total dimensions significantly improved in the OAK group compared to the control group, as did the SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains, as well as hamstring strength in both legs. During the same period, the TUG Test, range of motion extension and left-knee flexion improved compared with the control group, although these improvements had little clinical relevance. We recorded statistically significant improvements compared with a control group with regard to pain, quality of life and function for participants in the OAK program on the basis of WOMAC and SF-36 measures taken 8 weeks and 6 months from baseline.

De-educate to re-educate: aging and low back pain.

PubMed

Louw, Adriaan; Zimney, Kory; Johnson, Eldon A; Kraemer, Chris; Fesler, Justin; Burcham, Tyler

2017-12-01

Patients' beliefs about their condition have been shown to play a significant role in their pain experience and response to treatment, especially when a patient sees their tissue health as vulnerable or aged. Educational can alter these beliefs. Prior to new information, patients often have to be de-educated regarding common misbeliefs to undergo re-education. To determine if a brief de-education session regarding aging and low back pain (LBP) can shift pain ratings, fear-avoidance beliefs, beliefs regarding aging and LBP, and limited active trunk flexion. Fifty adults ranging from 50 to 93 years of age (SD = 10.73) with a 15.1 years of LBP were education on the poor correlation between aging and LBP. Prior to and immediately after the education pain ratings for LBP and leg pain (numeric pain rating scale-NPRS), fear-avoidance (fear avoidance beliefs questionnaire-FABQ), beliefs regarding aging and LBP (Likert scale) and active trunk flexion were measured. Significant changes were found in positive shifts with LBP (p = 0.002), leg pain (p = 0.042), FABQ-physical activity subscale (p = 0.004) and active trunk forward flexion (p < 0.001). The results show that education aimed at altering beliefs regarding LBP and aging result in a positive shift in pain, fear avoidance related to physical activity and active trunk flexion. Prior to providing patients with new healthcare information, de-educating them regarding poor beliefs may be helpful in shifting them towards new, healthier paradigms associated with their condition.

Knowledge and attitudes of pain management among nursing faculty.

PubMed

Voshall, Barbara; Dunn, Karen S; Shelestak, Debra

2013-12-01

A descriptive correlational design was used in this study to examine nursing faculty knowledge and attitudes in pain management. Relationships between age, education level, pain management preparation, length of time practicing as a nurse, length of time teaching nursing, time teaching pain management in the classroom, taught pain guidelines in the classroom, and additional continuing education about pain management were explored. Ninety-six nursing faculty participated from 16 schools of nursing in one Midwestern U.S. region. Findings identified that most of the nursing faculty recalled being taught about pain management in their basic education, but less than one-half felt adequately prepared. Most respondents said that they taught pain management, yet fewer than one-half identified that they used specific pain management guidelines. Faculty demonstrated adequate knowledge of pain assessment, spiritual/cultural issues, and pathophysiology. Areas of weakness were found in medications, interventions, and addiction. Faculty that reported teaching pain management in the classroom and reported more continuing education missed fewer items. Older nursing faculty reported more years of practice, more years of teaching, and more continuing education in pain management than younger faculty. Younger nursing faculty remembered being taught pain management in nursing school and felt more adequately prepared than older nursing faculty. Faculty that reported practicing for longer periods of time felt less prepared in pain management than faculty who practiced for shorter periods of time. More continuing education in pain management may be needed for older nurses to meet the recommendations of the Institute of Medicines' report on relieving pain in the U.S. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).

PubMed

Schleyer, Anneliese M; Best, Jennifer A; McIntyre, Lisa K; Ehrmantraut, Ross; Calver, Patty; Goss, J Richard

2013-01-01

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

A quality improvement approach to reducing use of meperidine.

PubMed

Gordon, D B; Jones, H D; Goshman, L M; Foley, D K; Bland, S E

2000-12-01

In 1991 the University of Wisconsin Hospital and Clinics formed a pain management QI team whose goal was to improve pain management through education, outcome monitoring, and the development of programs intended to improve clinical practice. Longitudinal monitoring mechanisms were established to audit medical records and survey patients to examine both staff practice patterns and patient outcomes. The QI team targeted use of meperidine, one of the most widely used opioid analgesics for the treatment of moderate to severe pain, which is now discouraged as a first-line agent for most painful conditions. A QI process was implemented using a traditional plan-do-check-act (PDCA) model, resulting in a successful and sustained reduction of inappropriate meperidine use. A cause-and-effect diagram helped highlight the multiple factors contributing to the drug's overuse and was used to prioritize targets for action. A flow chart helped to uncover some of the interrelationships between the myths about meperidine and the resultant customary prescribing and administration practices. While most of the strategies were implemented in 1996 (formulary guideline release, change in stock supply and physician orders, staff education and feedback), a significant impact in practice was not seen until late 1997. Ongoing tracking and feedback loops were established to ensure continued low use of meperidine. Use of a QI approach in pain management has been shown to affect the visibility of pain as a clinical priority, enhance interdisciplinary collaboration, facilitate the implementation of clinical guidelines at the bedside, and improve the quality of care for patients.

Feasibility and Effectiveness of a Pilot Health Promotion Program for Adults With Type 2 Diabetes

PubMed Central

Kluding, Patricia M.; Singh, Rupali; Goetz, Jeanine; Rucker, Jason; Bracciano, Sarah; Curry, Natasha

2013-01-01

Purpose The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness. Methods Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 ± 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (α = .05). Results Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy. Conclusions A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy. PMID:20530663

Evidence-based pain management: is the concept of integrative medicine applicable?

PubMed Central

2012-01-01

This article is dedicated to the concept of predictive, preventive, and personalized (integrative) medicine beneficial and applicable to advance pain management, overviews recent insights, and discusses novel minimally invasive tools, performed under ultrasound guidance, enhanced by model-guided approach in the field of musculoskeletal pain and neuromuscular diseases. The complexity of pain emergence and regression demands intellectual-, image-guided techniques personally specified to the patient. For personalized approach, the combination of the modalities of ultrasound, EMG, MRI, PET, and SPECT gives new opportunities to experimental and clinical studies. Neuromuscular imaging should be crucial for emergence of studies concerning advanced neuroimaging technologies to predict movement disorders, postural imbalance with integrated application of imaging, and functional modalities for rehabilitation and pain management. Scientific results should initiate evidence-based preventive movement programs in sport medicine rehabilitation. Traditional medicine and mathematical analytical approaches and education challenges are discussed in this review. The physiological management of exactly assessed pathological condition, particularly in movement disorders, requires participative medical approach to gain harmonized and sustainable effect. PMID:23088743

Developing a pain management program through continuous improvement strategies.

PubMed

Woodward, Dora

2005-01-01

Pain affects more than one third of cancer patients in the early stages of their disease, dramatically rising above 70% in the advanced stages. Numerous studies have been conducted in the pursuit of cancer pain relief, yet the prevalence of pain persists. This article focuses on a pain management program, developed by a performance improvement team, which addressed the inadequacies of current pain management. Performance improvement activities are described through the process of assessment, planning, implementation, and evaluation of the pain management program. This pain management program is uniquely derived from a unit core value that all staff is responsible and accountable for pain management.

Effects of a Distance Learning Program on Physicians' Opioid- and Benzodiazepine-Prescribing Skills

ERIC Educational Resources Information Center

Midmer, Deana; Kahan, Meldon; Marlow, Bernard

2006-01-01

Introduction: Opioid misuse is common among patients with chronic nonmalignant pain. There is a pressing need for physicians to increase their confidence and competence in managing these patients. Methods: A randomized controlled trial of family physicians (N = 88) attending 1 of 4 continuing medical education events helped to determine the…

An Oral Health Education Program for Latino Immigrant Parents

ERIC Educational Resources Information Center

Brown, Ruth M.; Canham, Daryl; Cureton, Virginia Young

2005-01-01

A high prevalence of dental caries in the pediatric population is a major health problem. At highest risk are low-income minority groups, including refugee and immigrant populations. Consequences of oral disease include pain, difficulty eating and speaking, poor school performance, and poor self-esteem. Parent involvement in oral health education…

Managing chronic back pain: impact of an interdisciplinary team approach.

PubMed

Flavell, H A; Carrafa, G P; Thomas, C H; Disler, P B

1996-09-02

To evaluate the effectiveness of a six-week outpatient program in pain management for patients with chronic back pain. Retrospective review. Rehabilitation Clinical Business Unit, Essendon campus of the Royal Melbourne Hospital. 138 consecutive patients who participated in the unit's Chronic Back Pain Programme between 1991 and 1993. Multidisciplinary program that promoted pain management rather than "cure", with two six-hour group sessions per week for six weeks. Patient assessments before the program and at program completion and at three months' follow-up, with the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) and a four-minute walk test. At program completion, the WHYMPI showed significant decreases in the amount pain interfered with life and significant increases in patient sense of control and activity level. However, severity of pain remained the same. All these effects were maintained three months later. A brief outpatient program was effective in improving pain management in a group of chronic back pain sufferers. This seems a useful and relatively inexpensive option in managing this problematic group of patients.

Back school or brain school for patients undergoing surgery for lumbar radiculopathy? Protocol for a randomised, controlled trial.

PubMed

Ickmans, Kelly; Moens, Maarten; Putman, Koen; Buyl, Ronald; Goudman, Lisa; Huysmans, Eva; Diener, Ina; Logghe, Tine; Louw, Adriaan; Nijs, Jo

2016-07-01

Despite scientific progress with regard to pain neuroscience, perioperative education tends to stick to the biomedical model. This may involve, for example, explaining the surgical procedure or 'back school' (education that focuses on biomechanics of the lumbar spine and ergonomics). Current perioperative education strategies that are based on the biomedical model are not only ineffective, they can even increase anxiety and fear in patients undergoing spinal surgery. Therefore, perioperative pain neuroscience education is proposed as a dramatic shift in educating patients prior to and following surgery for lumbar radiculopathy. Rather than focusing on the surgical procedure, ergonomics or lumbar biomechanics, perioperative pain neuroscience education teaches people about the underlying mechanisms of pain, including the pain they will feel following surgery. The primary objective of the study is to examine whether perioperative pain neuroscience education ('brain school') is more effective than classic back school in reducing pain and improving pain inhibition in patients undergoing surgery for spinal radiculopathy. A secondary objective is to examine whether perioperative pain neuroscience education is more effective than classic back school in: reducing postoperative healthcare expenditure, improving functioning in daily life, increasing return to work, and improving surgical experience (ie, being better prepared for surgery, reducing incongruence between the expected and actual experience) in patients undergoing surgery for spinal radiculopathy. A multi-centre, two-arm (1:1) randomised, controlled trial with 2-year follow-up. People undergoing surgery for lumbar radiculopathy (n=86) in two Flemish hospitals (one tertiary care, university-based hospital and one regional, secondary care hospital) will be recruited for the study. All participants will receive usual preoperative and postoperative care related to the surgery for lumbar radiculopathy. The experimental group will also receive perioperative pain neuroscience education comprising one preoperative and one postoperative individual educational session plus an educational booklet. Participants in the control group will receive perioperative back school on top of usual preoperative and postoperative care, comprising one preoperative and one postoperative individual educational session plus an educational booklet. Self-reported pain and endogenous pain modulation (including measurements of simultaneous cortical activation via electroencephalography) will be the primary outcome measures. Secondary outcome measures will include daily functioning, return to work, postoperative healthcare utilisation and surgical experience/satisfaction. Psychological factors will be measured as possible treatment mediators. All assessments will take place in the week preceding surgery (baseline), and at 3 days and 6 weeks after surgery. Intermediate and long-term follow-up assessments will take place at 6, 12 and 24 months after surgery. All data analyses will be based on the intention-to-treat principle. Repeated measures AN(C)OVA analyses will be used to evaluate and compare treatment effects. Baseline data, treatment centre, age and gender will be included as covariates. Statistical, as well as clinically, significant differences will be evaluated and effect sizes will be determined. In addition, the numbers needed to treat will be calculated. This study will determine whether pain neuroscience education is worthwhile for patients undergoing surgery for lumbar radiculopathy. It is expected that participants who receive perioperative pain neuroscience education will report less pain and have improved endogenous pain modulation, lower postoperative healthcare costs and improved surgical experience. Lower pain and improved endogenous pain modulation after surgery may reduce the risk of developing postoperative chronic pain. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Certified nursing assistants' perspectives of nursing home residents' pain experience: communication patterns, cultural context, and the role of empathy.

PubMed

Dobbs, Debra; Baker, Tamara; Carrion, Iraida V; Vongxaiburana, Elizabeth; Hyer, Kathryn

2014-03-01

This study explored the following issues related to pain management among nursing home (NH) residents: 1) communication patterns between NH residents and certified nursing assistants (CNAs) about pain; 2) how race and ethnicity influence NH residents' pain experiences; and 3) CNAs' personal experiences with pain that may affect their empathy toward the resident's pain experience. The study consisted of a convenience sample of four focus groups (n = 28) from a NH in central Florida. A content analysis approach was used. Data were analyzed with the use of Atlas.ti version 6.2. The content analysis identified four main themes: 1) attitudes as barriers to communication about resident pain care; 2) cultural, religious, and gender influences of resident pain care by CNAs; 3) the role of empathy in CNAs care of residents with pain; and 4) worker strategies to detect pain. Attitudes among CNAs about resident cognitive status and perceived resident burden need to be recognized as barriers to the detection and reporting of pain by CNAs and should be addressed. In addition, NHs should consider a person-centered approach to pain that is culturally competent given the cultural influences of both residents and staff. Finally, educational programs for CNAs that include empathy-inducing scenarios could potentially improve the care provided by CNAs when dealing with residents' pain. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran

PubMed Central

Shojaei, Sarallah; Jamshidi, Ahmad Reza; Wagner, Joan

2017-01-01

Study Design Interventional research with a 6-month follow-up period. Purpose We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. Overview of Literature WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. Methods We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. Results The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07). Conclusions We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals. PMID:28670410

The Evaluation of Undergraduate Nursing Students' Knowledge of Post-op Pain Management after Participation in Simulation.

PubMed

Evans, Cecile B; Mixon, Diana K

2015-12-01

The purpose of this paper was to assess undergraduate nursing students' pain knowledge after participation in a simulation scenario. The Knowledge and Attitudes of Survey Regarding Pain (KASRP) was used to assess pain knowledge. In addition, reflective questions related to the simulation were examined. Student preferences for education method and reactions to the simulation (SIM) were described. Undergraduate nursing students' knowledge of pain management is reported as inadequate. An emerging pedagogy used to educate undergraduate nurses in a safe, controlled environment is simulation. Literature reports of simulation to educate students' about pain management are limited. As part of the undergraduate nursing student clinical coursework, a post-operative pain management simulation, the SIM was developed. Students were required to assess pain levels and then manage the pain for a late adolescent male whose mother's fear of addiction was a barrier to pain management. The students completed an anonymous written survey that included selected questions from the KASRP and an evaluation of the SIM experience. The students' mean KASRP percent correct was 70.4% ± 8.6%. Students scored the best on items specific to pain assessment and worst on items specific to opiate equivalents and decisions on PRN orders. The students' overall KASRP score post simulation was slightly better than previous studies of nursing students. These results suggest that educators should consider simulations to educate about pain assessment and patient/family education. Future pain simulations should include more opportunities for students to choose appropriate pain medications when provided PRN orders. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs

PubMed Central

Cox, Terry; Louw, Adriaan; Puentedura, Emilio J.

2017-01-01

Objective To determine if a 3-hour therapeutic neuroscience education session alters physical therapy student’s knowledge of pain and effects their attitudes and beliefs regarding treating chronic pain. Methods Seventy-seven entry-level doctoral physical therapy students participated in the study. Following consent, demographic data were obtained and then the subjects completed the Neuroscience of Pain Questionnaire, the Health Care Provider’s Pain and Impairment Relationship Scale and an additional questionnaire designed by the researchers. The subjects then received a 3-hour educational session developed by the researchers, focusing on the neurobiology and physiology of pain. The questionnaires were re-administered immediately after the educational session and at 6 months post-education. Results Seventy-seven subjects (mean age = 24.7 years, 57.1% female and 81.8% white) completed the questionnaires pre- and post-educational session with 75 completing the questionnaires at 6 months. To assess the effect of the education on the scores of the questionnaires, a repeated measures ANOVA was conducted. Students demonstrated significantly higher scores on the neuroscience of pain questionnaire (p < 0.001) with no significant effect found on the attitudes and beliefs questionnaire at any of the time points. There were significant differences found on some of the individual questions that were part of the additional questionnaire. Discussion An educational session on the neuroscience of pain is beneficial for educating entry-level doctoral physical therapy students immediately post-education and at 6 months. This educational session had no effect on the student’s attitudes and beliefs regarding treating the chronic pain population. There were additional significant findings regarding individual questions posed to the subjects.

An educational intervention to reduce pain and improve pain management for Malawian people living with HIV/AIDS and their family carers: study protocol for a randomised controlled trial.

PubMed

Nkhoma, Kennedy; Seymour, Jane; Arthur, Antony

2013-07-13

Many HIV/AIDS patients experience pain often due to advanced HIV/AIDS infection and side effects of treatment. In sub-Saharan Africa, pain management for people with HIV/AIDS is suboptimal. With survival extended as a direct consequence of improved access to antiretroviral therapy, the prevalence of HIV/AIDS related pain is increasing. As most care is provided at home, the management of pain requires patient and family involvement. Pain education is an important aspect in the management of pain in HIV/AIDS patients. Studies of the effectiveness of pain education interventions for people with HIV/AIDS have been conducted almost exclusively in western countries. A randomised controlled trial is being conducted at the HIV and palliative care clinics of two public hospitals in Malawi. To be eligible, patient participants must have a diagnosis of HIV/AIDS (stage III or IV). Carer participants must be the individual most involved in the patient's unpaid care. Eligible participants are randomised to either: (1) a 30-minute face-to-face educational intervention covering pain assessment and management, augmented by a leaflet and follow-up telephone call at two weeks; or (2) usual care. Those allocated to the usual care group receive the educational intervention after follow-up assessments have been conducted (wait-list control group). The primary outcome is pain severity measured by the Brief Pain Inventory. Secondary outcomes are pain interference, patient knowledge of pain management, patient quality of life, carer knowledge of pain management, caregiver motivation and carer quality of life. Follow-up assessments are conducted eight weeks after randomisation by palliative care nurses blind to allocation. This randomised controlled trial conducted in sub-Saharan Africa among people living with HIV/AIDS and their carers will assess whether a pain education intervention is effective in reducing pain and improving pain management, quality of life and carer motivation. Current Controlled Trials ISRCTN72861423.

An empowerment health education program for children undergoing surgery for congenital heart diseases.

PubMed

Ni, Zhihong; Chao, Yannfen; Xue, Xiaoling

2016-09-01

Since the surgery for congenital heart disease (CHD) is considered highly risky, appropriate postoperative care is crucial. After the surgery, children are often discharged with unhealed wounds, incomplete recovery, and continuing pain. Health education programs based on empowerment education model can assist clients to develop skills in self-management. This study aimed to evaluate the effectiveness of an empowerment health education program for improving caregiving knowledge, caring behaviors, and self-efficacy of parents caring for children after corrective surgery for CHD. This prospective clinical trial enrolled pediatric patients undergoing surgical correction for CHD. Patients were divided into two groups: the control group (n = 42), which received the standard education program, and the intervention group (n = 44), which participated in the empowerment theory-based education program. We collected data on left ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2); New York Heart Association classification of the patients; and the parents' caregiving knowledge, caring behaviors, and self-efficacy before surgery and one month and three months after surgery. At one month and three months after surgery, the intervention group scored higher than the control group in caregiving knowledge, caring behavior, and self-efficacy. By the third month after surgery, the intervention group had significantly higher values of LVEF and SpO2 than the control group. © The Author(s) 2015.

Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial.

PubMed

Pires, Diogo; Cruz, Eduardo Brazete; Caeiro, Carmen

2015-06-01

The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients. Single-blind randomized controlled trial. Outpatient clinic. Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme. The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia). Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: -25.4± 26.7 vs -6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01-2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time. This study's findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise. © The Author(s) 2014.

Using education and support strategies to improve the way nurses assess regular and transient pain - A quality improvement study of three hospitals.

PubMed

Peterson, Anna; Carlfjord, Siw; Schaller, Anne; Gerdle, Björn; Larsson, Britt

2017-07-01

Systematic and regular pain assessment has been shown to improve pain management. Well-functioning pain assessments require using strategies informed by well-established theory. This study evaluates documented pain assessments reported in medical records and by patients, including reassessment using a Numeric Rating Scale (NRS) after patients receive rescue medication. Documentation surveys (DS) and patient surveys (PS) were performed at baseline (BL), after six months, and after 12 months in 44 in-patient wards at the three hospitals in Östergötland County, Sweden. Nurses and nurse assistants received training on pain assessment and support. The Knowledge to Action Framework guided the implementation of new routines. According to DS pain assessment using NRS, pain assessment increased significantly: from 7% at baseline to 36% at 12 months (p<0.001). For PS, corresponding numbers were 33% and 50% (p<0.001). According to the PS, the proportion of patients who received rescue medication and who had been reassessed increased from 73% to 86% (p=0.003). The use of NRS to document pain assessment after patients received rescue medication increased significantly (4% vs. 17%; p<0.001). After implementing education and support strategies, systematic pain assessment increased, an encouraging finding considering the complex contexts of in-patient facilities. However, the achieved assessment levels and especially reassessments related to rescue medication were clinically unsatisfactory. Future studies should include nursing staff and physicians and increase interactivity such as providing online education support. A discrepancy between documented and reported reassessment in association with given rescue medication might indicate that nurses need better ways to provide pain relief. The fairly low level of patient-reported pain via NRS and documented use of NRS before and 12 months after the educational programme stresses the need for education on pain management in nursing education. Implementations differing from traditional educational attempts such as interactive implementations might complement educational programmes given at the work place. Standardized routines for pain management that include the possibility for nurses to deliver pain medication within well-defined margins might improve pain management and increase the use of pain assessments. Further research is needed that examines the large discrepancy between patient-reported pain management and documentation in the medical recording system of transient pain. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

[Non-randomised trial of an educational intervention based on cognitive-behavioural principles for patients with chronic low back pain attended in Primary Care Physiotherapy].

PubMed

Díaz-Cerrillo, Juan Luis; Rondón-Ramos, Antonio; Pérez-González, Rita; Clavero-Cano, Susana

2016-01-01

To assess the influence of an educational intervention in reducing «fear-avoidance» (FA) and «pain catastrophising» (CAT) in a population with unspecific chronic low back pain (UCLBP), attending physiotherapy in Primary Health Care. A pragmatic quasi-experimental study was conducted in Health Centres of a Costa del Sol Health District. Quasi-experimental study. Primary Health Care physiotherapy Back Schools in Health Centres of a Costa del Sol Health District. The selection criteria were: UCLBP; 18-65years; understanding of the Spanish language; absence of parallel educational interventions; absence of red flags; not showing cognitive impairment or fibromyalgia; absence of thoracic-lumbar surgery, and exercise tolerance. The control group received the usual Back Schools program. The experimental group also received a written document for home reading, plus the subsequent sharing, clarifying doubts, and beliefs and goals restructuring during the development of the sessions. Both interventions lasted about 280minutes (7 sessions×40min). The main variables included FA and CAT. Pain and disability were also assessed. Some «demographic» and «related disorder» variables were considered in the analysis. Statistically significant differences were observed in the experimental group versus control, in the variation of FA -14 (-25.5; 0) vs -4 (-13; 0) (P=.009), and CAT -9 (-18; -4) vs -4,5 (-8.25; 0) (P=.000), were observed. Also differences in disability (P=.046), but not in pain (P=.280). These results should be considered in light of possible limits imposed by the study. Its pragmatic nature would allow a potential transfer to usual care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

[Risk factors for the spine: nursing assessment and care].

PubMed

Bringuente, M E; de Castro, I S; de Jesus, J C; Luciano, L dos S

1997-01-01

The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.

The Impact of a Cognitive Behavioral Pain Management Program on Sleep in Patients with Chronic Pain: Results of a Pilot Study.

PubMed

Blake, Catherine; Cunningham, Jennifer; Power, Camillus K; Horan, Sheila; Spencer, Orla; Fullen, Brona M

2016-02-01

To determine the impact of a cognitive behavioral pain management program on sleep in patients with chronic pain. Prospective nonrandomized controlled pilot study with evaluations at baseline and 12 weeks. Out-patient multidisciplinary cognitive behavioral pain management program in a university teaching hospital. Patients with chronic pain who fulfilled the criteria for participation in a cognitive behavioral pain management program. Patients assigned to the intervention group (n = 24) completed a 4 week cognitive behavioral pain management program, and were compared with a waiting list control group (n = 22). Assessments for both groups occurred at baseline and two months post cognitive behavioral pain management program. Outcome measures included self-report (Pittsburgh Sleep Quality Index) and objective (actigraphy) sleep measures, pain and quality of life measures. Both groups were comparable at baseline, and all had sleep disturbance. The Pittsburgh Sleep Quality Index correlated with only two of the seven objective sleep measures (fragmentation index r = 0.34, P = 0.02, and sleep efficiency percentage r = -0.31, P = 0.04). There was a large treatment effect for cognitive behavioral pain management program group in mean number of wake bouts (d = 0.76), where a significant group*time interaction was also found (P = 0.016), showing that the CBT-PMP group improved significantly more than controls in this sleep variable. Patients attending a cognitive behavioral pain management program have high prevalence of sleep disturbance, and actigraphy technology was well tolerated by the patients. Preliminary analysis of the impact of a cognitive behavioral pain management program on sleep is promising, and warrants further investigation.

Preparing to implement a self-management program for back pain in new york city senior centers: what do prospective consumers think?

PubMed

Townley, Sarah; Papaleontiou, Maria; Amanfo, Leslie; Henderson, Charles R; Pillemer, Karl; Beissner, Katherine; Reid, M C

2010-03-01

Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers' prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program, and 3) ascertain perceived barriers/facilitators to program participation. Cross-sectional survey. Six senior centers located in New York City. We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (P = 0.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success.

Spellings Campaign Runs Low on Time, and on the Power to Persuade

ERIC Educational Resources Information Center

Basken, Paul

2008-01-01

This article reports on Education Secretary Margaret Spellings' attempt to convince colleges that they risk painful government interventions if they do not improve the quality of their programs and help more students evaluate and afford them. As the Bush administration nears an end, Ms. Spellings tries to persuade colleges to adopt the measures…

Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee osteoarthritis awaiting joint replacement surgery--a systematic review and meta-analysis.

PubMed

Wallis, Jason A; Taylor, Nicholas F

2011-12-01

To determine if pre-operative interventions for hip and knee osteoarthritis provide benefit before and after joint replacement. Systematic review with meta-analysis of randomised controlled trials (RCTs) of pre-operative interventions for people with hip or knee osteoarthritis awaiting joint replacement surgery. Standardised mean differences (SMD) were calculated for pain, musculoskeletal impairment, activity limitation, quality of life, and health service utilisation (length of stay and discharge destination). The GRADE approach was used to determine the quality of the evidence. Twenty-three RCTs involving 1461 participants awaiting hip or knee replacement surgery were identified. Meta-analysis provided moderate quality evidence that pre-operative exercise interventions for knee osteoarthritis reduced pain prior to knee replacement surgery (SMD (95% CI)=0.43 [0.13, 0.73]). None of the other meta-analyses investigating pre-operative interventions for knee osteoarthritis demonstrated any effect. Meta-analyses provided low to moderate quality evidence that exercise interventions for hip osteoarthritis reduced pain (SMD (95% CI)=0.52 [0.04, 1.01]) and improved activity (SMD (95% CI)=0.47 [0.11, 0.83]) prior to hip replacement surgery. Meta-analyses provided low quality evidence that exercise with education programs improved activity after hip replacement with reduced time to reach functional milestones during hospital stay (e.g., SMD (95% CI)=0.50 [0.10, 0.90] for first day walking). Low to moderate evidence from mostly small RCTs demonstrated that pre-operative interventions, particularly exercise, reduce pain for patients with hip and knee osteoarthritis prior to joint replacement, and exercise with education programs may improve activity after hip replacement. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom.

PubMed

Mackintosh-Franklin, Carolyn

2017-01-01

Pain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering. Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management. A three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool. The word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes. In spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Continuing medical education-driven skills acquisition and impact on improved patient outcomes in family practice setting.

PubMed

Bellamy, N; Goldstein, L D; Tekanoff, R A

2000-01-01

An abundance of educational theory, design, and delivery of continuing medical education (CME) learning interventions, including their impact on learners, are described in the health and social sciences literature. However, establishing a direct correlation between the acquisition of new skills by learners and patient outcomes as a result of a planned CME learning intervention has been difficult to demonstrate. The learning intervention described here tested the impact of an injection skills-acquisition program for family physicians treating osteoarthritis of the knee by measuring patient outcomes using the pain and function subscales of the Western Ontario and McMaster (WOMAC) 3.0 osteoarthritis index, a standardized and fully validated patient-centered outcome measurement. It was hypothesized that patients of family physicians who participated in this skills-acquisition CME program would benefit from treatment administered by their physician during the time between injection skills acquisition to 6 weeks post-injection. Inclusion of a validated health status measure administered pre- and post-injection in addition to more traditional faculty and participant program evaluations was deemed necessary to test this hypothesis. Rheumatology, orthopedic surgery, and family medicine specialists from across Canada were invited to contribute to the planning, curriculum elaboration, and delivery of the viscosupplement injector preceptorship (VIP) program. Thirty-nine orthopedic and rheumatology specialists agreed to serve as expert faculty and participated in training 474 Canadian family and general practitioners over 8 months. The learning intervention involved a review of pertinent literature by a local preceptor and a summary of recommendations of the planning committee, followed by demonstration of injector skills and then supervised practice with patients, who received hylan G-F 20 (Synvisc, Ridgefield, NJ) usually in the offices of the family physicians. The pain and function subscales of the WOMAC 3.0 questionnaire were self-administered to each patient in their physician's office, prior to receiving their joint injection and again at or near 6-weeks post-injection. Data were analyzed in the Department of Epidemiology and Biostatistics at The University of Western Ontario, London, ON. Clinically important statistically significant improvements in pain and physical function were noted in patients who received viscosupplementation treatment from family physicians who had recently acquired the necessary injection skills. Approximately three-quarters of the patients experienced a reduction in pain and an improvement in physical function of at least 20%. These results suggest a positive relationship between acquisition of a new skill by learners and improved patient outcomes as a result of this planned CME learning intervention.

Learned helplessness and responses to nerve blocks in chronic low back pain patients.

PubMed

Chapman, S L; Brena, S F

1982-01-01

In a double-blind study, 67 chronic low back pain patients received 4 lumbar sympathetic nerve blocks, two given with bupivacaine and two given with saline. It was hypothesized that patients showing evidence of 'learned helplessness,' as measured by dependence on habit-forming medications for the pain, low activity levels, and elevated MMPI scores on Hypochondriasis, Depression and Hysteria would show the least reduction in subjective pain intensity following injections with both bupivacaine and saline. It also was hypothesized that placebo responses would be greatest in patients who had a high educational level, were divorced, and had no pending disability claims. Responses 30 min following nerve blocks failed to correlate with these variables. However, decreases in subjective pain intensity 24 h following both types of nerve blocks were greater in patients who showed low levels of pain behavior, who were divorced, and who had no pending disability claims. Decreased pain 24 h following saline injections was significantly related to low scores on the Lie, Defensiveness, Hypochondriasis, and Hysteria scales of the MMPI and to reduced subjective pain intensity following a 6 week comprehensive outpatient pain rehabilitation program. It was concluded that chronic pain patients who are fixed in their focus on pain, high in pain-related behaviors, and low in responsibilities are less likely to respond favorably to nerve blocks and that medical treatment for them needs to be paired with therapies designed to reduce their helplessness.

The Feasibility of Hypnotic Analgesia in Ameliorating Pain and Anxiety Among Adults Undergoing Needle Electromyography

PubMed Central

Slack, David; Nelson, Lonnie; Patterson, David; Burns, Stephen; Hakimi, Kevin; Robinson, Lawrence

2017-01-01

Objective Our hypothesis was that hypnotic analgesia reduces pain and anxiety during electromyography [EMG]. Design Prospective randomized controlled clinical trial at outpatient electrodiagnostic clinics in teaching hospitals. Just prior to EMG, 26 subjects were randomized to one of three 20 minute audio programs: (EDU) education about EMG (n=8); (HYP-C) hypnotic induction without analgesic suggestion (n=10) or; (HYP-ANLG) hypnotic induction with analgesic suggestion (n=8). The blinded electromyographer provided a post-hypnotic suggestion at the start of EMG. After EMG, subjects rated worst and average pain, and anxiety using visual analog scales. Results Mean values for the EDU, HYP-C and HYP-ANLG groups were not significantly different (mean ± sd): worst pain 67 ± 25, 42 ± 18, 49 ± 30: average pain 35 ± 26, 27 ± 14, 25 ± 22; anxiety 44 ± 41, 42 ± 23, 22 ± 24. When hypnosis groups were merged [n=18] and compared with the EDU condition [n=8], average and worst pain and anxiety were less for the hypnosis group than EDU, but this was statistically significant only for worst pain [hypnosis - 46 ± 24 vs. EDU - 67 ± 35, p=0.049] with a 31% average reduction. Conclusions A short hypnotic induction appears to reduce worst pain during EMG. PMID:18971768

Rehabilitation of patient with brachial plexus lesion and break in axillary artery. Case study.

PubMed

Bajuk, S; Jelnikar, T; Ortar, M

1996-01-01

This paper describes the physiotherapy and occupational therapy used in treating a 74-year-old woman with a left brachial plexus lesion, a break in the axillary artery, dislocation of the acromioclavicular joint, a broken scapula and clavicula, serial left rib fractures, and lacerations on the upper and lower arm. After testing the patient, the following goals were set: reduce pain, soften scar tissue, and improve joint motion, muscle strength, and functionality of the hand. A 12-month outpatient program was used. Various analgesics were used to reduce pain, and a special aid was made to unweight the shoulder and elbow joints. Physiotherapy included kinesiotherapy, audiovisual biofeedback, electrical stimulation, friction massage, and lymph drainage. Occupational therapy included active functional exercises and re-education. As a result of this program, the patient no longer had pain, passive range of motion was close to normal, active motion where present was improved, swelling was reduced, and the hand became functional again. Complex physiotherapy, occupational therapy, and the patient's motivation resulted in the rehabilitation of severe trauma of the hand.

Understanding factors that facilitate the inclusion of pain education in undergraduate curricula: Perspectives from a UK survey.

PubMed

Carr, Eloise Cj; Briggs, Emma V; Briggs, Michelle; Allcock, Nick; Black, Pauline; Jones, Derek

2016-05-01

Studies in Europe, North America and Australasia suggest that one in five adults suffer from pain. There is increasing recognition that pain, particularly chronic pain, represents a global health burden. Many studies, including two national surveys exploring the content of undergraduate curricula for pain education, identify that documented pain education in curricula was limited and fragmentary. The study design used a questionnaire which included an open text comment box for respondents to add 'further comments' as part of larger study previously published. The sample consisted of 19 UK universities that offered 108 undergraduate programmes in the following: dentistry, medicine, midwifery, nursing (adult, child, learning disabilities and mental health branches), occupational therapy (OT), pharmacy, physiotherapy and veterinary science. An inductive content analysis was performed, and the data were managed using NVivo 10 software for data management. A total of 57 participants across seven disciplines (dentistry, medicine, midwifery, nursing, pharmacy, physiotherapy and OT) completed the open text comment box (none were received from veterinary science). Analysis revealed two major themes of successes and challenges. Successes included expansion (extending coverage and/or increased student access), multidimensional curriculum content and diversity of teaching methods. Challenges included difficulties in identifying where pain is taught in the curriculum, biomedical versus biopsychosocial definitions of pain, perceived importance, time, resources and staff knowledge, and finally a diffusion of responsibility for pain education. This study identifies new insights of the factors attributed to successful implementation of pain education in undergraduate education. Many of the challenges previously reported were also identified. This is one of the first studies to identify a broad range of approaches, for pain education, that could be deemed as 'successful' across a range of health disciplines.

A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients

PubMed Central

Sherman, Christy A.; Mist, Scott D.; Carson, James W.; Bennett, Robert M.; Li, Fuzhong

2017-01-01

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p=0.0002), BPI pain severity (1.2 vs. 0.4, p=0.0008), BPI pain interference (2.1 vs. 0.6, p=0.0000), sleep (2.0 vs. −0.03, p=0.0003), and self-efficacy for pain control (9.2 vs. −1.5, p=0.0001). Functional mobility variables including timed get up and go (−.9 vs. −.3, p=0.0001), static balance (7.5 vs. −0.3, p= 0.0001), and dynamic balance (1.6 vs. 0.3, p=0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients. (ClinicalTrials.gov Identifier, NCT01311427) PMID:22581278

A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients.

PubMed

Jones, Kim D; Sherman, Christy A; Mist, Scott D; Carson, James W; Bennett, Robert M; Li, Fuzhong

2012-08-01

Previous researchers have found that 10-form Tai chi yields symptomatic benefit in patients with fibromyalgia (FM). The purpose of this study was to further investigate earlier findings and add a focus on functional mobility. We conducted a parallel-group randomized controlled trial FM-modified 8-form Yang-style Tai chi program compared to an education control. Participants met in small groups twice weekly for 90 min over 12 weeks. The primary endpoint was symptom reduction and improvement in self-report physical function, as measured by the Fibromyalgia Impact Questionnaire (FIQ), from baseline to 12 weeks. Secondary endpoints included pain severity and interference (Brief Pain Inventory (BPI), sleep (Pittsburg sleep Inventory), self-efficacy, and functional mobility. Of the 101 randomly assigned subjects (mean age 54 years, 93 % female), those in the Tai chi condition compared with the education condition demonstrated clinically and statistically significant improvements in FIQ scores (16.5 vs. 3.1, p = 0.0002), BPI pain severity (1.2 vs. 0.4, p = 0.0008), BPI pain interference (2.1 vs. 0.6, p = 0.0000), sleep (2.0 vs. -0.03, p = 0.0003), and self-efficacy for pain control (9.2 vs. -1.5, p = 0.0001). Functional mobility variables including timed get up and go (-.9 vs. -.3, p = 0.0001), static balance (7.5 vs. -0.3, p    0.0001), and dynamic balance (1.6 vs. 0.3, p = 0.0001) were significantly improved with Tai chi compared with education control. No adverse events were noted. Twelve weeks of Tai chi, practice twice weekly, provided worthwhile improvement in common FM symptoms including pain and physical function including mobility. Tai chi appears to be a safe and an acceptable exercise modality that may be useful as adjunctive therapy in the management of FM patients. (ClinicalTrials.gov Identifier, NCT01311427).

Neuromuscular adaptations after a rehabilitation program in patients with chronic low back pain: case series (uncontrolled longitudinal study)

PubMed Central

2013-01-01

Background To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations. Methods Case series (uncontrolled longitudinal study). Thirty chronic patients with LBP (21 women and 19 men, mean age 42.6 ± 8.6 years, mean weight 73 ± 14 kg, mean height 174 ± 10 cm) were included. The intervention consisted in a 5-day program including therapeutic education sessions (360 min), supervised abdominal and back muscle strength exercises (240 min), general aerobic training (150 min), stretching (150 min), postural education (150 min) and aqua therapy (150 min). Feedforward activation level and reflex amplitude determined by surface electromyographic activity triggered by postural perturbations were recorded from abdominal and paraspinal muscles in unexpected and expected conditions. Subjects were tested before, just after and again one month after the rehabilitation program. Results No main intervention effect was found on feedforward activation levels and reflex amplitudes underlining the absence of changes in the way patients with LBP reacted across perturbation conditions. However, we observed a shift in the behavioral strategy between conditions, in fact feedforward activation (similar in both conditions before the program) decreased in the unexpected condition after the program, whereas reflex amplitudes became similar in both conditions. Conclusions The results suggest that a short-term rehabilitation program modifies trunk behavioral strategies during postural perturbations. These results can be useful to clinicians for explaining to patients how to adapt to daily life activities before and after rehabilitation. PMID:24063646

One-on-one care management and procurement of Naloxone for ambulatory use.

PubMed

Whittington, Richard; Whittington, Kathleen; Whittington, John; Porter, Joel; Zimmermann, Karla; Case, Holly; Berg, Stacey

2018-02-16

Morbidity and mortality from prescription opioids has reached unprecedented levels. Opioids remain part of chronic pain treatment in primary care. This study was designed to determine whether one-on-one care management increases procurement of Naloxone, an opioid antagonist shown to reduce morbidity and mortality in opioid overdoses. Participants included all patients ≥18 years enrolled in a primary care-based chronic pain management program and who were prescribed a daily dose of opioids for treatment of chronic pain. In total, 153 patients chose to participate. Each had a 1 h one-on-one education meeting with a registered nurse. Among the enrolled, eight patients (5.2%) had procured Naloxone prior to intervention. Overall, 31 additional patients (20.2%) procured Naloxone after intervention, a 288% relative improvement in the attainment of Naloxone (P < 0.0001) (χ2 = 29.032 with 1 degree freedom). Of the 114 participants who never procured Naloxone, 69.3% believed it was unnecessary, 20% forgot about Naloxone, 8% said it was cost prohibitive, 3.5% had access concerns and 0.9% had concerns about side effects. Direct one-on-one nurse care management sessions were associated with an increased procurement of Naloxone in a primary care-based pain management program. A significant number of patients believed Naloxone was unnecessary after the intervention.

Preparing to Implement a Self-Management Program for Back Pain in New York City Senior Centers: What Do Prospective Consumers Think?

PubMed Central

Townley, Sarah; Amanfo, Leslie; Papaleontiou, Maria; Henderson, Charles R.; Pillemer, Karl; Beissner, Katherine; Reid, M.C.

2013-01-01

Objective Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers’ prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program; and 3) ascertain perceived barriers/facilitators to program participation. Design Cross-sectional survey. Setting Six senior centers located in New York City. Participants We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. Results While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (p=.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. Conclusions These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success. PMID:20088858

Getting Back to Living: Further Evidence for the Efficacy of an Interdisciplinary Pediatric Pain Treatment Program.

PubMed

Bruce, Barbara K; Ale, Chelsea M; Harrison, Tracy E; Bee, Susan; Luedtke, Connie; Geske, Jennifer; Weiss, Karen E

2017-06-01

This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up. Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up. This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.

Physical Therapists' Views and Experiences of Pregnancy-Related Low Back Pain and the Role of Acupuncture: Qualitative Exploration

PubMed Central

Bartlam, Bernadette; Bishop, Annette; Holden, Melanie A.; Barlas, Panos; Foster, Nadine E.

2015-01-01

Background Low back pain is often accepted as a “normal” part of pregnancy. Despite research suggesting that quality of life for women who are pregnant is adversely affected, most are advised to self-manage. Although the use of acupuncture for the management of persistent nonspecific low back pain has been recommended in recent UK national guidelines, its use in the management of pregnancy-related low back pain remains limited. Objectives This study aimed to explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain with the objective of informing the pretrial training program for a pilot randomized trial (Evaluating Acupuncture and Standard care for pregnant womEn with Back pain [EASE Back]). Design A qualitative phenomenological method with purposive sampling was used in the study. Methods Three focus groups and 3 individual semistructured interviews were undertaken, and an iterative exploratory thematic analysis was performed. To ensure transparency of the research process and the decisions made, an audit trail was created. Results Twenty-one physical therapists participated, and emergent issues included: a lack of experience in treating pregnancy-related complaints, mixed messages from previous acupuncture education, a mistrust of the current evidence for acupuncture safety and effectiveness, and personal and professional fear of causing harm. Conclusions The findings suggest that UK physical therapists are reluctant to use acupuncture in the management of pregnancy-related low back pain. The explanations for these findings include perceived lack of knowledge and confidence, as well as a pervasive professional culture of caution, particularly fears of inducing early labor and of litigation. These findings have been key to informing the content of the training program for physical therapists delivering acupuncture within the pilot EASE Back trial. PMID:25929530

Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility

NASA Astrophysics Data System (ADS)

Musumeci, Alfredo; Pranovi, Giulia; Masiero, Stefano

2018-05-01

Nowadays, some spa centers are suitable for providing rehabilitative and preventive treatment in association with traditional spa therapy. This study aims to evaluate the feasibility and the effectiveness of an intensive rehabilitation program after hip arthroplasty in an Italian spa center. Early after total hip arthroplasty for severe osteoarthritis (≤ 10 days after the intervention), 12 consecutive patients (5 males and 7 females) aged between 50 and 85 years were enrolled for this study. All the patients performed a 2-week thermal multimodal rehabilitation program, which consisted of education and physical rehabilitative measures. Patients had 2-h and half/day session of land-based and hydrokinesitherapy (aquatic therapy) consisted in active and passive joint mobilization, respiratory and functional re-education exercises, gait and balance training, resistance exercise, and power training mainly for the upper limb associated to physical therapy modalities (electrotherapy and low-level laser therapy). An educational program was performed to both patients and families. Both before and after the rehabilitation treatment, patients underwent clinical evaluation, hip flexion/abduction range of motion, and Numeric Pain Rating Scale. Harris Hip Score (HHS) and SF-12 questionnaires (physical—PCS-12—and mental health component—MCS-12) were also administered. After the 2-week thermal spa treatment, hip flexion/abduction improved significantly (p < 0.05), but there was no statistically significant reduction in pain (p = 0.350). The HHS score improved significantly from 62.6 ± 12.8 to 82.15 ± 12.7 (p < 0.05), and the PCS-12 score from 36.37 ± 8.4 to 43.61 ± 8.95 (p < 0.05). There was no adverse event during spa treatment. After total hip arthroplasty, patients who underwent an intensive post-acute multimodal rehabilitation program showed an improvement in motor and functional recovery and a positive impact on quality of life. Therefore, we believe that the thermal setting is a suitable place for providing intensive rehabilitative treatment in orthopedic musculoskeletal disability.

Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning (APPEAL) study.

PubMed

Briggs, Emma V; Battelli, Daniele; Gordon, David; Kopf, Andreas; Ribeiro, Sofia; Puig, Margarita M; Kress, Hans G

2015-08-10

Unrelieved pain is a substantial public health concern necessitating improvements in medical education. The Advancing the Provision of Pain Education and Learning (APPEAL) study aimed to determine current levels and methods of undergraduate pain medicine education in Europe. Using a cross-sectional design, publicly available curriculum information was sought from all medical schools in 15 representative European countries in 2012-2013. Descriptive analyses were performed on: the provision of pain teaching in dedicated pain modules, other modules or within the broader curriculum; whether pain teaching was compulsory or elective; the number of hours/credits spent teaching pain; pain topics; and teaching and assessment methods. Curriculum elements were publicly available from 242 of 249 identified schools (97%). In 55% (133/242) of schools, pain was taught only within compulsory non-pain-specific modules. The next most common approaches were for pain teaching to be provided wholly or in part via a dedicated pain module (74/242; 31%) or via a vertical or integrated approach to teaching through the broader curriculum, rather than within any specific module (17/242; 7%). The curricula of 17/242 schools (7%) showed no evidence of any pain teaching. Dedicated pain modules were most common in France (27/31 schools; 87%). Excluding France, only 22% (47/211 schools) provided a dedicated pain module and in only 9% (18/211) was this compulsory. Overall, the median number of hours spent teaching pain was 12.0 (range 4-56.0 h; IQR: 12.0) for compulsory dedicated pain modules and 9.0 (range 1.0-60.0 h; IQR: 10.5) for other compulsory (non-pain specific) modules. Pain medicine was principally taught in classrooms and assessed by conventional examinations. There was substantial international variation throughout. Documented pain teaching in many European medical schools falls far short of what might be expected given the prevalence and public health burden of pain. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community-Dwelling Older Adults With Lower Extremity Osteoarthritis.

PubMed

Park, Juyoung; McCaffrey, Ruth; Newman, David; Liehr, Patricia; Ouslander, Joseph G

2017-03-01

To determine effects of Sit 'N' Fit Chair Yoga, compared to a Health Education program (HEP), on pain and physical function in older adults with lower extremity osteoarthritis (OA) who could not participate in standing exercise. Two-arm randomized controlled trial. One HUD senior housing facility and one day senior center in south Florida. Community-dwelling older adults (N = 131) were randomly assigned to chair yoga (n = 66) or HEP (n = 65). Thirteen dropped after assignment but prior to the intervention; six dropped during the intervention; 106 of 112 completed at least 12 of 16 sessions (95% retention rate). Participants attended either chair yoga or HEP. Both interventions consisted of twice-weekly 45-minute sessions for 8 weeks. Primary: pain, pain interference; secondary: balance, gait speed, fatigue, functional ability measured at baseline, after 4 weeks of intervention, at the end of the 8-week intervention, and post-intervention (1 and 3 months). The chair yoga group showed greater reduction in pain interference during the intervention (P = .01), sustained through 3 months (P = .022). WOMAC pain (P = .048), gait speed (P = .024), and fatigue (P = .037) were improved in the yoga group during the intervention (P = .048) but improvements were not sustained post intervention. Chair yoga had no effect on balance. An 8-week chair yoga program was associated with reduction in pain, pain interference, and fatigue, and improvement in gait speed, but only the effects on pain interference were sustained 3 months post intervention. Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities. ClinicalTrials.gov: NCT02113410. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Effects of topical essential oil on exercise volume after a 12-week exercise program for women with fibromyalgia: a pilot study.

PubMed

Rutledge, Dana N; Jones, C Jessie

2007-12-01

We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. SETTINGS included community sites in southern California. The study included 20 women randomized to 024 oil, 23 to sham oil. Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.

The Impact of Educational Status on the Postoperative Perception of Pain

PubMed Central

Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-01-01

Background Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old. PMID:26495081

The Impact of Educational Status on the Postoperative Perception of Pain.

PubMed

Lanitis, Sophocles; Mimigianni, Christina; Raptis, Demetris; Sourtse, Gionous; Sgourakis, George; Karaliotas, Constantine

2015-10-01

Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1(st) PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2(nd) to the 6(th)). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.

Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors.

PubMed

Kraus, Chadd K; Greenberg, Marna R; Ray, Daniel E; Dy, Sydney Morss

2016-05-01

Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. To assess PC competency education in EM residency programs. This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training. Response rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn, and 59% reported that they teach7 PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents' skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for management of the dying child, withdrawal/withholding of nonbeneficial interventions, and ethical/legal issues. There are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, nonbeneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial.

PubMed

Nkhoma, Kennedy; Seymour, Jane; Arthur, Antony

2015-07-01

Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P < 0.001). A short pain education intervention is effective in reducing pain and improving pain management for Malawian people living with HIV/AIDS and their family carers. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Opioid Analgesics.

PubMed

Jamison, Robert N; Mao, Jianren

2015-07-01

Chronic pain is an international health issue of immense importance that is influenced by both physical and psychological factors. Opioids are useful in treating chronic pain but have accompanying complications. It is important for clinicians to understand the basics of opioid pharmacology, the benefits and adverse effects of opioids, and related problematic issues of tolerance, dependence, and opioid-induced hyperalgesia. In this article, the role of psychiatric comorbidity and the use of validated assessment tools to identify individuals who are at the greatest risk for opioid misuse are discussed. Additionally, interventional treatment strategies for patients with chronic pain who are at risk for opioid misuse are presented. Specific behavioral interventions designed to improve adherence with prescription opioids among persons treated for chronic pain, such as frequent monitoring, periodic urine screens, opioid therapy agreements, opioid checklists, and motivational counseling, are also reviewed. Use of state-sponsored prescription drug monitoring programs is also encouraged. Areas requiring additional investigation are identified, and the future role of abuse-deterrent opioids and innovative technology in addressing issues of opioid therapy and pain are presented. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain.

PubMed

Chao, Maria T; Abercrombie, Priscilla D; Santana, Trilce; Duncan, Larissa G

2015-12-01

The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study.

PubMed

Fletcher, Claire; Bradnam, Lynley; Barr, Christopher

2016-05-01

Chronic pain is prevalent in the western world; however fear of pain often has a greater impact than the degree of initial injury. The aim of this study was to explore the relationship between knowledge of the neurophysiology of pain and fear avoidance in individuals diagnosed with chronic pain. Twenty-nine people with chronic musculoskeletal pain were recruited and completed questionnaires to determine their understanding of pain neurophysiology and the degree of their fear avoidance beliefs. There was an inverse relationship between knowledge of pain neurophysiology and the level of fear avoidance. Patients with higher pain knowledge reported less fear avoidance and lower perceived disability due to pain. There was no relationship with the educational level or compensable status for either variable. The findings suggest that fear avoidance is positively influenced by neurophysiology of pain education, so that a higher level of pain knowledge is associated with less activity-related fear. The clinical implication is that reducing fear avoidance/kinesiophobia using neurophysiology of pain education in people with chronic pain may provide an effective strategy to help manage fear avoidance and related disability in the chronic pain population in order to improve treatment outcomes.

Searching for pain information, education, and support on the Internet.

PubMed

Colón, Yvette

2013-03-01

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are searching for pain information, education, support, and providers on the Internet and evaluating online information.

A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

PubMed

Arbour, Richard

2003-01-01

Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.

An exploration of the extent and nature of reconceptualisation of pain following pain neurophysiology education: A qualitative study of experiences of people with chronic musculoskeletal pain.

PubMed

King, Rick; Robinson, Victoria; Ryan, Cormac G; Martin, Denis J

2016-08-01

Pain neurophysiology education (PNE), a method of pain education, purports to work by helping patients reconceptualise their pain, shifting from a tissue injury model towards a biopsychosocial understanding related to neural sensitivity. Better understanding of pain reconceptualisation following PNE is needed to improve the delivery of this educational approach to enhance its effectiveness. This study aimed to investigate the extent and nature of reconceptualisation following PNE. In a qualitative design, based on Interpretive Phenomenological Analysis, thematic analysis was carried out on individual interviews with 7 adults before and three weeks after receiving PNE at a pain clinic. Three themes emerged describing variable degrees of reconceptualisation; prior beliefs as facilitators and barriers to reconceptualisation; and the influence of reconceptualisation on clinical benefits of PNE. The results lend support to claims that reconceptualisation is an important mechanism in PNE and justify further investigation of this phenomenon. When delivering PNE to patients with chronic pain helping patients to reconceptualise their pain may be key to enhancing the clinical benefits of the intervention. Understanding prior beliefs may be an important step in facilitating reconceptualisation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain

PubMed Central

Webster, Fiona; Bremner, Samantha; Oosenbrug, Eric; Durant, Steve; McCartney, Colin J.; Katz, Joel

2017-01-01

Abstract Background. Chronic pain is a significant health problem strongly associated with a wide range of physical and mental health problems, including addiction. The widespread prevalence of pain and the increasing rate of opioid prescriptions have led to a focus on how physicians are educated about chronic pain. This critical scoping review describes the current literature in this important area, identifying gaps and suggesting avenues for further research starting from patients’ standpoint. Methods. A search of the ERIC, MEDLINE, and Social Sciences Abstracts databases, as well as 10 journals related to medical education, was conducted to identify studies of the training of medical students, residents, and fellows in chronic noncancer pain. Results. The database and hand-searches identified 545 articles; of these, 39 articles met inclusion criteria and underwent full review. Findings were classified into four inter-related themes. We found that managing chronic pain has been described as stressful by trainees, but few studies have investigated implications for their well-being or ability to provide empathetic care. Even fewer studies have investigated how educational strategies impact patient care. We also note that the literature generally focuses on opioids and gives less attention to education in nonpharmacological approaches as well as nonopioid medications. Discussion. The findings highlight significant discrepancies between the prevalence of chronic pain in society and the low priority assigned to educating future physicians about the complexities of pain and the social context of those afflicted. This suggests the need for better pain education as well as attention to the “hidden curriculum.” PMID:28371881

Effect of pain neurophysiology education on physiotherapy students' understanding of chronic pain, clinical recommendations and attitudes towards people with chronic pain: a randomised controlled trial.

PubMed

Colleary, G; O'Sullivan, K; Griffin, D; Ryan, C G; Martin, D J

2017-12-01

To investigate the effect of pain neurophysiology education (PNE) on student physiotherapists': (1) knowledge of chronic pain; (2) attitudes towards patients with chronic pain; and (3) clinical recommendations for patients with chronic pain. Multicentre single-blind randomised controlled trial. One UK and one Irish university. Seventy-two student physiotherapists. Participants received either PNE (intervention) or a control education. Both were delivered in a 70-minute group lecture. (1) The Revised Pain Neurophysiology Quiz to assess knowledge; (2) the Health Care Pain Attitudes and Impairment Relationship Scale (HC-PAIRS) to assess attitudes; and (3) a case vignette to assess the appropriateness of clinical recommendations. Post education, the PNE group had a greater increase in pain neurophysiology knowledge [mean difference 4.0 (95% confidence interval 3.2 to 4.7), P<0.01] and more improved attitudes [-17.5 (95% confidence interval -22.1 to -12.9), P<0.01] compared with the control group. Post education, students in the PNE group were more likely to make appropriate recommendations regarding work (94% vs 56%), exercise (92% vs 56%), activity (94% vs 67%) and bed rest (69% vs 33%) compared with those in the control group (P<0.05). The improvements in knowledge, attitudes and recommendations for pain management show that PNE is a potentially valuable part of the education of physiotherapy students, and could be used on a more widespread basis. There is a need to investigate whether these findings can be replicated in other healthcare professions, and how well these reported changes lead to changes in actual clinical behaviour and the clinical outcomes of patients. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

The Postoperative Pain Assessment Skills pilot trial.

PubMed

McGillion, Michael; Dubrowski, Adam; Stremler, Robyn; Watt-Watson, Judy; Campbell, Fiona; McCartney, Colin; Victor, Charles; Wiseman, Jeffrey; Snell, Linda; Costello, Judy; Robb, Anja; Nelson, Sioban; Stinson, Jennifer; Hunter, Judith; Dao, Thuan; Promislow, Sara; McNaughton, Nancy; White, Scott; Shobbrook, Cindy; Jeffs, Lianne; Mauch, Kianda; Leegaard, Marit; Beattie, W Scott; Schreiber, Martin; Silver, Ivan

2011-01-01

BACKGROUND⁄ Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills. Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student's t tests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores. DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups. These pilot data suggest that DPS is an effective simulation alternative for HCPs' education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.

The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population.

PubMed

Newman, Andrea K; Van Dyke, Benjamin P; Torres, Calia A; Baxter, Jacob W; Eyer, Joshua C; Kapoor, Shweta; Thorn, Beverly E

2017-09-01

Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.

Can a theory-based educational intervention change nurses' knowledge and attitudes concerning cancer pain management? A quasi-experimental design.

PubMed

Gustafsson, Markus; Borglin, Gunilla

2013-08-19

Registered Nurses (RNs) play an important role in caring for patients suffering from cancer pain. A lack of knowledge regarding pain management and the RNs' own perception of cancer pain could act as barriers to effective pain management. Educational interventions that target RNs' knowledge and attitudes have proved promising. However, an intervention consisting of evidence-based practice is a multifaceted process and demands behavioural and cognitive changes to sustain the effects of the intervention. Therefore, our study aimed to investigate if a theory-based educational intervention could change RNs' knowledge and attitudes to cancer pain and pain management, both four and 12 weeks after the start of the intervention. A quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses' Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention's educational curriculum was based on the principles of Ajzen's Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN's own experiences from cancer pain management were used in the learning process. The theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward. The findings of this study, suggest that a theory-based educational intervention focused at RNs can be effective in changing RN's knowledge and attitudes regarding cancer pain management. However, the high number of dropouts between baseline and four weeks needs to be taken into account when evaluating our findings. Finally, this kind of theory-based educational intervention with interactive learning activities has been sparsely researched and needs to be evaluated further in larger projects. Clinical Trials. Gov: NCT01313234.

Meeting the public health challenge of pain in later life: what role can senior centers play?

PubMed

Tobias, Karen R; Lama, Sonam D; Parker, Samantha J; Henderson, Charles R; Nickerson, Allison J; Reid, M Carrington

2014-12-01

Interest in nonpharmacologic approaches for managing pain continues to grow. The aim of this study was to determine the types of pain-relevant programs offered by senior centers and whether the programs varied by clients' race/ethnicity status and center size. A telephone survey was conducted. Respondents were presented with a list of 15 programs and the option to choose "other" and asked (1) whether the activity was offered and, if so, how often; (2) if they believed the programs had value for seniors with pain; and (3) whether the classes were advertised as a means of achieving pain relief. Of 204 center staff contacted, 195 (95.6%) participated. The most common programs offered were movement-based, including exercise (by 91.8% of the centers), dance (72.3%), walking clubs (71.8%), yoga (65.6%), and Tai Chi (53.3%) classes. Creative arts programs were also frequently offered, including music (58.5%) and fine arts (47.7%). Programs such as stress management (27%) and relaxation (26%) classes were less commonly offered. Most respondents identified movement-based programs as helpful for seniors with pain, but few identified creative arts classes as potentially beneficial. The programs/classes offered were infrequently advertised as a means of helping seniors manage pain and varied by clients' race/ethnicity status and center size. Programs that have potential utility for older adults with pain are commonly offered by senior centers. Future research should determine optimal strategies for engaging older adults in these programs in the senior center setting. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Transforming long-term care pain management in north america: the policy-clinical interface.

PubMed

Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

2009-04-01

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

An evaluation of a pain education programme for physiotherapists in clinical practice.

PubMed

Monaghan, Jenni; Adams, Nicola; Fothergill, Melissa

2018-03-01

The present study evaluated the implementation and acceptability of a pain education programme delivered to physiotherapists in clinical practice. A pre-test/post-test design with 10 physiotherapists was employed. Descriptive and inferential statistics were used for outcome measure data. Focus groups were carried out with seven physiotherapists within 1 month post-intervention. These data were analysed using the framework approach. Ten musculoskeletal physiotherapists were recruited. It was possible to develop and deliver the intervention and this was found to be acceptable to physiotherapists within clinical practice. The study explored trends within outcome measures, and one was considered appropriate. The focus groups yielded three interlinked themes, which related to the impact of the programme: "providing a context for pain education", "influence on aspects of the patient-therapist encounter" and "logistics of the education programme in clinical practice". A pain education programme delivered to physiotherapists in clinical practice was both possible to deliver and acceptable to participants. A key strength of the programme was the applicability to real-life practice, which was valued by physiotherapists. While physiotherapists felt that pain neurophysiology education was important, they reported lacking confidence in implementing their pain neurophysiology knowledge with patients. Thus, more time is needed to focus on pain neurophysiology education, with the aim of increasing confidence with the application of this approach in clinical practice. Copyright © 2017 John Wiley & Sons, Ltd.

The importance of communication in the management of postoperative pain.

PubMed

Sugai, Daniel Y; Deptula, Peter L; Parsa, Alan A; Don Parsa, Fereydoun

2013-06-01

This study investigates the importance of communication in surgery and how delivering preoperative patient education can lead to better health outcomes postoperatively, via promoting tolerable pain scores and minimizing the use of narcotics after surgery. Patients who underwent outpatient surgery were randomly divided into groups to compare the pain scores of those who received preoperative patient education, the experimental group, and those who did not receive any form of patient education, the control group. Two weeks before surgery, the experimental group subjects received oral and written forms of patient education consisting of how the body responds to pain, and how endorphins cause natural analgesia. Moreover, patients were educated on the negative effects narcotics have on endorphin production and activity, as well as mechanisms of non-opioid analgesics. Of the 69 patients in the experimental group, 90% declined a prescription for hydrocodone after receiving preoperative education two weeks prior to surgery. The control group consisted of 66 patients who did not receive preoperative patient education and 100% filled their hydrocodone prescriptions. Patients in both groups were offered and received gabapentin and celecoxib preoperatively for prophylaxis of postoperative pain unless they declined. The control groups were found to have average pain scores significantly greater (P <.05) than the experimental groups and also a significantly longer (P <.005) duration of pain. This study illustrates the power of patient education via oral, written and visual communication, which can serve as an effective means to minimize narcotic analgesia after surgery.

[Effectiveness of education based on neuroscience in the treatment of musculoskeletal chronic pain].

PubMed

Cuenda-Gago, J D; Espejo-Antunez, L

2017-07-01

Chronic pain is one of the most frequent health, economic and social problems. Given this, numerous approaches have been described, one of which is pain neuroscience education. To examine the effectiveness of pain neuroscience education in the treatment of musculoskeletal disorders with chronic pain and to explore the impact of specific aspects of the technique on its effectiveness. Relevant studies published between 2000 and 2015 were identified by searching PubMed, Scopus and Web of Science. Studies identified by electronic searches were screened against a set of pre-defined inclusion criteria. PEDro and SIGN scales were used to evaluate the methodological quality of the included studies. Ten studies were included in this systematic review. The main outcomes that were measured were pain, disability, neurophysiology pain test, attitudes and beliefs, fear-avoidance beliefs, self-care, kinesiophobia, quality of life and algometry. The results suggest that pain neuroscience education is effective in the short term and medium/long term for pain relief, either alone or combined with multimodal treatment. It was also effective in normalizing cognitions about pain, fear-avoidance beliefs, and self-care. Despite some evidence for a positive effect in the short and medium/long term, the heterogeneity in the technical aspects used does not allow the obtaining of conclusive results.

Implementation and evaluation of a multisite drug usage evaluation program across Australian hospitals - a quality improvement initiative

PubMed Central

2011-01-01

Background With the use of medicines being a broad and extensive part of health management, mechanisms to ensure quality use of medicines are essential. Drug usage evaluation (DUE) is an evidence-based quality improvement methodology, designed to improve the quality, safety and cost-effectiveness of drug use. The purpose of this paper is to describe a national DUE methodology used to improve health care delivery across the continuum through multi-faceted intervention involving audit and feedback, academic detailing and system change, and a qualitative assessment of the methodology, as illustrated by the Acute Postoperative Pain Management (APOP) project. Methods An established methodology, consisting of a baseline audit of inpatient medical records, structured patient interviews and general practitioner surveys, followed by an educational intervention and follow-up audit, is used. Australian hospitals, including private, public, metropolitan and regional, are invited to participate on a voluntary basis. De-identified data collected by hospitals are collated and evaluated nationally to provide descriptive comparative analyses. Hospitals benchmark their practices against state and national results to facilitate change. The educational intervention consists of academic detailing, group education, audit and feedback, point-of-prescribing prompts and system changes. A repeat data collection is undertaken to assess changes in practice. An online qualitative survey was undertaken to evaluate the APOP program. Qualitative assessment of hospitals' perceptions of the effectiveness of the overall DUE methodology and changes in procedure/prescribing/policy/clinical practice which resulted from participation were elicited. Results 62 hospitals participated in the APOP project. Among 23 respondents to the evaluation survey, 18 (78%) reported improvements in the documentation of pain scores at their hospital. 15 (65%) strongly agreed or agreed that participation in APOP directly resulted in increased prescribing of multimodal analgesia for pain relief in postoperative patients. Conclusions This national DUE program has facilitated the engagement and participation of a number of acute health care facilities to address issues relating to quality use of medicine. This approach has been perceived to be effective in helping them achieve improvements in patient care. PMID:21871132

Implementation and evaluation of a multisite drug usage evaluation program across Australian hospitals - a quality improvement initiative.

PubMed

Pulver, Lisa K; Wai, Angela; Maxwell, David J; Robertson, Marion B; Riddell, Steven

2011-08-29

With the use of medicines being a broad and extensive part of health management, mechanisms to ensure quality use of medicines are essential. Drug usage evaluation (DUE) is an evidence-based quality improvement methodology, designed to improve the quality, safety and cost-effectiveness of drug use. The purpose of this paper is to describe a national DUE methodology used to improve health care delivery across the continuum through multi-faceted intervention involving audit and feedback, academic detailing and system change, and a qualitative assessment of the methodology, as illustrated by the Acute Postoperative Pain Management (APOP) project. An established methodology, consisting of a baseline audit of inpatient medical records, structured patient interviews and general practitioner surveys, followed by an educational intervention and follow-up audit, is used. Australian hospitals, including private, public, metropolitan and regional, are invited to participate on a voluntary basis. De-identified data collected by hospitals are collated and evaluated nationally to provide descriptive comparative analyses. Hospitals benchmark their practices against state and national results to facilitate change. The educational intervention consists of academic detailing, group education, audit and feedback, point-of-prescribing prompts and system changes. A repeat data collection is undertaken to assess changes in practice.An online qualitative survey was undertaken to evaluate the APOP program. Qualitative assessment of hospitals' perceptions of the effectiveness of the overall DUE methodology and changes in procedure/prescribing/policy/clinical practice which resulted from participation were elicited. 62 hospitals participated in the APOP project. Among 23 respondents to the evaluation survey, 18 (78%) reported improvements in the documentation of pain scores at their hospital. 15 (65%) strongly agreed or agreed that participation in APOP directly resulted in increased prescribing of multimodal analgesia for pain relief in postoperative patients. This national DUE program has facilitated the engagement and participation of a number of acute health care facilities to address issues relating to quality use of medicine. This approach has been perceived to be effective in helping them achieve improvements in patient care.

Living and doing with chronic pain: narratives of pain program participants.

PubMed

Van Huet, Helen; Innes, Ev; Whiteford, Gail

2009-01-01

This study aimed to explore factors which predicated successful long-term pain management for people who had attended a cognitive-behavioural-based pain management program (PMP) in regional Australia. This study used qualitative methods based on analysis of narratives. Fifteen people (11 women and four men), who attended the PMP in 2002 and 2003, agreed to participate in two in-depth interviews with a narrative focus in 2005. Their ages ranged from 30-65 years. Interview transcripts were analysed thematically. Themes that emerged from the interviews were the meanings and beliefs participants had attributed to their pain at the time of the program and after program completion (i.e. being ready to do the program and acceptance or non-acceptance of the long term nature of their pain). It also identified the strategies that some participants used and continued to apply in their daily lives (i.e. using pacing strategies and re-engaging in valued routines and tasks). The findings suggested that the ability to adopt positive meaning attributes and use a variety of strategies was related to those participants who were successful in their ongoing pain management. The importance of these factors should be considered for those attending chronic pain programs.

Short-term effect of back school based on cognitive behavioral therapy involving multidisciplinary collaboration.

PubMed

Motoya, Ryo; Otani, Koji; Nikaido, Takuya; Ono, Yoko; Matsumoto, Takatomo; Yamagishi, Ryohei; Yabuki, Shoji; Konno, Shin-Ichi; Niwa, Shin-Ichi; Yabe, Hirooki

2017-08-09

ObjectivesThe purpose of this study was to develop a comprehensive back school program that included elements of CBT (Cognitive Behavioral Therapy), implement this through multidisciplinary collaboration, and ascertain its effectiveness as a pilot study. DesignThis school was implemented in the form of five 90-minute group sessions held every other week.MethodsParticipants comprised 7 chronic low back pain patients with poor improvement in the usual treatment. Practitioners were orthopaedic surgeon, physical therapist, and a clinical psychologist. This school contents were patient education, self-monitoring, back exercise, relaxation, stress management, cognitive restructuring, activity pacing, and exposure. ResultsFrom the Wilcoxon signed-rank test, each score of four scales or items (sense of control, PCS (pain catastrophizing), PASS-20 (escape/avoidance), FFD (finger-floor distance)) after this program significantly improved. Results of calculating the effect size, sense of control (d=0.55) is 'moderate', the PCS (d=1.12) and the PASS-20 (d=1.64) were 'large'.ConclusionsThis back school may be useful for physical function and psychological variables which much related to pain management and daily disabilities in patients with poor respond to standard orthopaedic treatment.

The relationship between subjective oral health and dental fear in Korean adolescents

PubMed Central

2017-01-01

Background This study is aimed to evaluate the level of fear and to reduce the overall fear, thereby enabling patients to receive treatment via timely visits. Methods In a survey conducted by 460 South Korean middle school students, we used 453 data that faithfully responded to the survey. Multiple regression analysis was conducted to investigate the factors influencing subjective oral health and dental fear. The significance level used for statistical significance was α = 0.05. Results The level of fear was higher for upper grade, female students. The factors affecting dental fear were higher for gingival bleeding and dental pain. Regarding factors for dental fear affecting subjective oral health, lower fear of puncture needle and tooth removal tool resulted in higher subjective oral health. Conclusion The study found that adolescents had higher fear of dental care when they had gingival bleeding and tooth pain. Gingival bleeding is a symptom of early gingival disease and dental pain is likely due to advanced dental caries. These results suggested that it is necessary to have a program to reduce dental fear and anxiety as well as a program to prevent dental diseases through regular periodic screening and education. PMID:29349351

Understanding how pain education causes changes in pain and disability: protocol for a causal mediation analysis of the PREVENT trial.

PubMed

Lee, Hopin; Moseley, G Lorimer; Hübscher, Markus; Kamper, Steven J; Traeger, Adrian C; Skinner, Ian W; McAuley, James H

2015-07-01

Pain education is a complex intervention developed to help clinicians manage low back pain. Although complex interventions are usually evaluated by their effects on outcomes, such as pain or disability, most do not directly target these outcomes; instead, they target intermediate factors that are presumed to be associated with the outcomes. The mechanisms underlying treatment effects, or the effect of an intervention on an intermediate factor and its subsequent effect on outcome, are rarely investigated in clinical trials. This leaves a gap in the evidence for understanding how treatments exert their effects on outcomes. Mediation analysis provides a method for identifying and quantifying the mechanisms that underlie interventions. To determine whether the effect of pain education on pain and disability is mediated by changes in self-efficacy, catastrophisation and back pain beliefs. Causal mediation analysis of the PREVENT randomised controlled trial. Two hundred and two participants with acute low back pain from primary care clinics in the Sydney metropolitan area. Participants will be randomised to receive either 'pain education' (intervention group) or 'sham education' (control group). All outcome measures (including patient characteristics), primary outcome measures (pain and disability), and putative mediating variables (self-efficacy, catastrophisation and back pain beliefs) will be measured prior to randomisation. Putative mediators and primary outcome measures will be measured 1 week after the intervention, and primary outcome measures will be measured 3 months after the onset of low back pain. Causal mediation analysis under the potential outcomes framework will be used to test single and multiple mediator models. A sensitivity analysis will be conducted to evaluate the robustness of the estimated mediation effects on the influence of violating sequential ignorability--a critical assumption for causal inference. Mediation analysis of clinical trials can estimate how much the total effect of the treatment on the outcome is carried through an indirect path. Using mediation analysis to understand these mechanisms can generate evidence that can be used to tailor treatments and optimise treatment effects. In this study, the causal mediation effects of a pain education intervention for acute non-specific low back pain will be estimated. This knowledge is critical for further development and refinement of interventions for conditions such as low back pain. Copyright © 2015 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Prescription drug abuse: problem, policies, and implications.

PubMed

Phillips, Janice

2013-01-01

This article provides an overview on prescription drug abuse and highlights a number of related legislative bills introduced during the 112th Congress in response to this growing epidemic. Prescription drug abuse has emerged as the nation's fastest growing drug problem. Although prescription drugs have been used effectively and appropriately for decades, deaths from prescription pain medicine in particular have reached epidemic proportions. Bills related to prescription drug abuse introduced during the 112th Congress focus on strengthening provider and consumer education, tracking and monitoring prescription drug abuse, improving data collection on drug overdose fatalities, combating fraud and abuse in Medicare and Medicaid programs, reclassifying drugs to make them more difficult to prescribe and obtain, and enforcing stricter penalties for individuals who operate scam pain clinics and sell pain pills illegitimately. This article underscores the importance of a multifaceted approach to combating prescription drug abuse and concludes with implications for nursing. Copyright © 2013. Published by Mosby, Inc.

Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program

PubMed Central

Erhart-Hledik, Jennifer C; Kinsella, Rose; Hunter, Simon; Mecklenburg, Gabriel; Perez, Daniel

2017-01-01

Background Chronic knee pain (CKP) affects a large number of adults, many of whom do not receive best-practice care and are at high risk for unnecessary surgery. Objective The aim of this study was to investigate the effect of the Hinge Health 12-week digital care program (DCP) for CKP on knee pain and function, with secondary outcomes of surgery interest and satisfaction, at 12 weeks and 6 months after starting the program. Methods Individuals with CKP were recruited onto the 12-week program, comprising sensor-guided physical exercises, weekly education, activity tracking, and psychosocial support such as personal coaching and cognitive behavioral therapy (CBT). We used a single-arm design with assessment of outcomes at baseline, 12 weeks, and 6 months after starting the program. We used a linear mixed effects model with Tukey contrasts to compare timepoints and report intention-to-treat statistics with last observation carried forward. Results The cohort consisted of 41 individuals (32 female, mean age 52 years, SD 9 years). Between baseline and week 12, participants reported clinically significant improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) function scales of 16 points (95% CI 12-21, P<.001) and 10 points (95% CI 6-14, P<.001), respectively. Significant reductions of 57% (mean difference 30, 95% CI 21-38, P<.001) and 51% (mean difference 25, 95% CI 16-33, P<.001) in visual analog scale (VAS) knee pain and stiffness, respectively, were observed at 12 weeks, as well as a 67% reduction in surgery interest (mean reduction 2.3 out of 10, 95% CI 1.5-3.1, P<.001). Average satisfaction at week 12 was 9.2 out of 10. Critically, all improvements were maintained at 6 months at similar or greater magnitude. Conclusions Participants on the Hinge Health DCP for CKP showed substantial clinical improvements that were maintained 6 months after enrolling in the program. This shows that DCPs carry strong potential to deliver evidence-based, cost-effective care to those suffering from CKP. PMID:28582253

Meeting the Public Health Challenge of Pain in Later Life: What Role Can Senior Centers Play?

PubMed Central

Tobias, Karen R.; Lama, Sonam D.; Parker, Samantha J.; Henderson, Charles R.; Nickerson, Allison J.; Reid, M.C.

2013-01-01

Background Interest in nonpharmacologic approaches for managing pain continues to grow. Aim To determine the types of pain-relevant programs offered by senior centers and whether the programs varied by clients' race/ethnicity status and center size. Design and methods We conducted a telephone survey. Respondents were presented with a list of 15 programs (plus other) and asked: (1) whether the activity was offered and if so how often; (2) if they believed the programs had value for seniors with pain; and (3) whether the classes were advertised as a means of achieving pain relief. Setting New York City. Participants/Subjects Senior center agency staff, i.e., center directors, activity program coordinators. Results Of 204 center staff contacted, 195 (95.6%) participated. The most common programs offered were movement-based, including exercise (by 91.8% of the centers), dance (72.3%), walking clubs (71.8%), yoga (65.6%), and Tai Chi (53.3%) classes. Creative arts programs were also frequently offered, including music (58.5%) and fine arts (47.7%). Programs such as stress management (27%) and relaxation (26%) classes were less commonly offered. Most respondents identified movement-based programs as helpful for seniors with pain, while few identified creative arts classes as potentially beneficial. The programs/classes offered were infrequently advertised as a means of helping seniors manage pain, and varied by clients' race/ethnicity status and center size. Conclusion Programs that have potential utility for older adults with pain are commonly offered by senior centers. Future research should determine optimal strategies for engaging older adults in these programs in the senior center setting. PMID:24144569

A Framework for Fibromyalgia Management for Primary Care Providers

PubMed Central

Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.

2012-01-01

Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. PMID:22560527

Yoga for Youth in Pain

PubMed Central

Evans, Subhadra; Moieni, Mona; Sternlieb, Beth; Tsao, Jennie C.I; Zeltzer, Lonnie K.

2012-01-01

Children, adolescents, and young adults do not typically feature in clinics, studies, and mainstream notions of chronic pain. Yet many young people experience debilitating pain for extended periods of time. Chronic pain in these formative years may be especially important to treat in order for young patients to maintain life tasks and to prevent protracted disability. The Pediatric Pain Program at the University of California, Los Angeles, is a multidisciplinary treatment program designed for young people with chronic pain and their families. We offer both conventional and complementary medicine to treat the whole individual. This article describes the work undertaken in the clinic and our newly developed Yoga for Youth Research Program. The clinical and research programs fill a critical need to provide service to youth with chronic pain and to scientifically study one of the more popular complementary treatments we offer, Iyengar yoga. PMID:22864296

Effects of a postpartum back pain relief program for Korean women.

PubMed

Oh, Hyun-Ei; Lee, Young-Sook; Shim, Mi-Jung; Kim, Jin-Sun

2007-03-01

Despite the high prevalence of back pain and its subsequent effects in post-partum women, intervention programs are scarce. The purpose of this study was to test the effects of a back-pain-reducing program on post-partum women who experienced low-back pain during pregnancy. A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended a hospital for prenatal check-ups and experienced back pain participated in an intervention program (n=27), and the results were compared with women in a control group from another hospital (n=25). At 8 weeks post-partum, the pain intensity, functional limitations were lower in the intervention group than in the control group. However, differences in mean change of the pain intensity and functional limitations between 36 and 39 weeks of gestation and at 8 weeks post-partum were not statistically significant between the groups. Moreover, the flexibility, post-partum functional status, and post-partum depression did not differ significantly between the groups. A back-pain-relief program in this study was not effective to reduce the back-pain intensity in post-partum women and to decrease the associated functional limitations. The implications for nursing practice and directions for future research are discussed.

Effects of a self-care education program on quality of life of patients with gastric cancer after gastrectomy.

PubMed

Davoodi, Arefeh; Gholizadeh, Leila; Rezazadeh, Hassan; Sheikalipour, Zahra; Lakdizaji, Sima; Mirinajad, Kazem; Rahmani, Azad

2015-09-01

Gastrectomy affects different aspects of functionality and impacts on the quality of life (QoL) of patients with gastric cancer. The importance of appropriate assessment of QoL in cancer patients is well established, yet strategies that help improve this important patient outcome are relatively scarce. To examine the effectiveness of a brief self-care education program to improve QoL of gastric cancer patients after gastrectomy. Using a randomized controlled trial, 59 patients with gastric cancer and candidate for gastrectomy were randomly assigned either to an intervention group (n = 31) to participate in a brief self-care education program or to a usual-care group (n = 28). Data were collected on patient demographics, and QoL was measured by the QLQ-C30 and the QLQ-STO22 at baseline and 1 month after gastrectomy. There were no statistically significant between-group differences in any subscales of the QLQ-C30 and the QLQ-STO22. However, participants in the brief self-care education program showed significant improvements from baseline in the global health status-QoL scale (t = 2.243, < .05), experience of pain (t = 2.508, < .05), constipation (t = 2.773, < .05), and the experience of dysphagia at the follow-up assessment. This study is likely to be underpowered to show differences between the groups. A brief self-care education program was not sufficient to significantly improve the quality of life patients with gastric cancer after gastrectomy. ©2015 Frontline Medical Communications.

Impact of a novel online learning module on specialist palliative care nurses' pain assessment competencies and patients' reports of pain: Results from a quasi-experimental pilot study.

PubMed

Phillips, Jane L; Heneka, Nicole; Hickman, Louise; Lam, Lawrence; Shaw, Tim

2014-06-01

Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain. To test the impact of an online pain assessment learning module on specialist palliative care nurses' pain assessment competencies, and to determine whether this education impacted positively on palliative care patients' reported pain ratings. A quasi-experimental pain assessment education pilot study utilising 'Qstream © ', an online methodology to deliver 11 case-based pain assessment learning scenarios, developed by an interdisciplinary expert panel and delivered to participants' work emails over a 28-day period in mid-2012. The 'Self-Perceived Pain Assessment Competencies' survey and chart audit data, including patient-reported pain intensity ratings, were collected pre-intervention (T1) and post-intervention (T2) and analysed using inferential statistics to determine key outcomes. Nurses working at two Australian inpatient specialist palliative care services in 2012. The results reported conform to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines. Participants who completed the education intervention ( n = 34) increased their pain assessment knowledge, assessment tool knowledge and confidence to undertake a pain assessment ( p < 0.001). Participants were more likely to document pain intensity scores in patients' medical records than non-participants (95% confidence interval = 7.3%-22.7%, p = 0.021). There was also a significant reduction in the mean patient-reported pain ratings between the admission and audit date at post-test of 1.5 (95% confidence interval = 0.7-2.3) units in pain score. This pilot confers confidence of the education interventions capacity to improve specialist palliative care nurses' pain assessment practices and to reduce patient-rated pain intensity scores.

Horticultural therapy for patients with chronic musculoskeletal pain: results of a pilot study.

PubMed

Verra, M L; Verra, Martin L; Angst, Felix; Beck, Trudi; Lehmann, Susanne; Brioschi, Roberto; Schneiter, Renata; Aeschlimann, Andre

2012-01-01

Therapists can use horticultural therapy as an adjuvant therapy in a non threatening context, with the intent of bringing about positive effects in physical health, mental health, and social interaction. Very few experimental studies exist that test its clinical effectiveness. To determine whether the addition of horticultural therapy to a pain-management program improved physical function, mental health, and ability to cope with pain. The research team designed a prospective, nonrandomized, controlled cohort study, enrolling all patients consecutively referred to the Zurzach Interdisciplinary Pain Program (ZISP) who met the studys criteria. The team divided them into two cohorts based on when medical professionals referred them: before (control group) or after (intervention group) introduction of a horticultural therapy program. The setting was the rehabilitation clinic (RehaClinic) in Bad Zurzach, Switzerland. Seventy-nine patients with chronic musculoskeletal pain (fibromyalgia or chronic, nonspecific back pain) participated in the study. The research team compared a 4-week, inpatient, interdisciplinary pain-management program with horticultural therapy (intervention, n = 37) with a pain-management program without horticultural therapy (control, n = 42). The horticultural therapy program consisted of seven sessions of group therapy, each of 1-hour duration. The research team assessed the outcome using the Medical Outcome Study Short Form-36 (SF-36), the West Haven-Yale Multidimensional Pain Inventory (MPI), the Hospital Anxiety and Depression Scale (HADS), the Coping Strategies Questionnaire (CSQ ), and two functional performance tests. The team tested participants on entry to and discharge from the 4-week pain-management program. Between-group differences in sociodemographic and outcome variables were not significant on participants entry to the pain-management program. On discharge, the research team measured small to moderate outcome effects (effect size [ES] up to 0.71) within both groups. The study found significantly larger improvements for the horticultural therapy group vs the control group in SF-36 role physical (ES = 0.71 vs 0.22; P = .018); SF-36 mental health (ES = 0.46 vs 0.16; P = .027); HADS anxiety (ES = 0.26 vs 0.03; P = .043); and CSQ pain behavior (ES = 0.30 vs -0.05; P = .032). The addition of horticultural therapy to a pain management program improved participants' physical and mental health and their coping ability with respect to chronic musculoskeletal pain.

Innovation and design of a web-based pain education interprofessional resource.

PubMed

Lax, Leila; Watt-Watson, Judy; Lui, Michelle; Dubrowski, Adam; McGillion, Michael; Hunter, Judith; Maclennan, Cameron; Knickle, Kerry; Robb, Anja; Lapeyre, Jaime

2011-01-01

The present article describes educational innovation processes and design of a web-based pain interprofessional resource for prelicensure health science students in universities across Canada. Operationalization of educational theory in design coupled with formative evaluation of design are discussed, along with strategies that support collaborative innovation. Educational design was driven by content, theory and evaluation. Pain misbeliefs and teaching points along the continuum from acute to persistent pain were identified. Knowledge-building theory, situated learning, reflection and novel designs for cognitive scaffolding were then employed. Design research principles were incorporated to inform iterative and ongoing design. An authentic patient case was constructed, situated in interprofessional complex care to highlight learning objectives related to pre-operative, postoperative and treatment up to one year, for a surgical cancer patient. Pain mechanisms, assessment and management framed content creation. Knowledge building scaffolds were used, which included video simulations, embedded resources, concurrent feedback, practice-based reflective exercises and commentaries. Scaffolds were refined to specifically support knowledge translation. Illustrative commentaries were designed to explicate pain misbeliefs and best practices. Architecture of the resource was mapped; a multimedia, interactive prototype was created. This pain education resource was developed primarily for individual use, with extensions for interprofessional collective discourse. Translation of curricular content scripts into representation maps supported the collaborative design process by establishing a common visual language. The web-based prototype will be formatively and summatively evaluated to assess pedagogic design, knowledge-translation scaffolds, pain knowledge gains, relevance, feasibility and fidelity of this educational innovation.

Exploring psychological mechanisms of clinical response to an internet-delivered psychological pain management program.

PubMed

Gandy, M; Karin, E; Jones, M P; McDonald, S; Sharpe, L; Titov, N; Dear, B F

2018-05-13

The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. A large sample (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms. © 2018 European Pain Federation - EFIC®.

Pharmacological, psychological, and patient education interventions for patients with neck pain: results of an international survey.

PubMed

Carlesso, Lisa C; Gross, Anita R; MacDermid, Joy C; Walton, David M; Santaguida, P Lina

2015-01-01

Examination of practice patterns compared to existing evidence identifies knowledge to practice gaps. To describe the utilization of pharmacological, patient education, primary psychological interventions and relaxation therapies in patients with neck pain by clinicians. An international cross-sectional survey was conducted to determine the use of these interventions amongst 326 clinicians treating patients with neck pain. Nineteen countries participated. Results were analyzed by usage amongst physical therapists (39%) and chiropractors (35%), as they were the predominant respondents. Patient education (95%) and relaxation therapies (59%) were the most utilized interventions. Tests of subgroup differences determined that physical therapists used patient education significantly more than chiropractors. Use of medications and primary psychological interventions were reported by most to be outside of scope of practice. The high rate of patient education is consistent with supporting evidence. However, usage of relaxation therapies is contrary to evidence suggesting no benefit for improved pain or function for chronic neck pain. This survey indicates that patient education and relaxation therapies are common treatments provided by chiropractors and physical therapists for patients with neck pain. Future research should address gaps associated with variable practice patterns and knowledge translation to reduce usage of interventions shown to be ineffective.

[Education for patients with fibromyalgia. A systematic review of randomised clinical trials].

PubMed

Elizagaray-Garcia, Ignacio; Muriente-Gonzalez, Jorge; Gil-Martinez, Alfonso

2016-01-16

To analyse the effectiveness of education about pain, quality of life and functionality in patients with fibromyalgia. The search for articles was carried out in electronic databases. Eligibility criteria were: controlled randomised clinical trials (RCT), published in English and Spanish, that had been conducted on patients with fibromyalgia, in which the therapeutic procedure was based on patient education. Two independent reviewers analysed the methodological quality using the PEDro scale. Five RCT were selected, of which four offered good methodological quality. In three of the studies, patient education, in combination with another intervention based on therapeutic exercise, improved the outcomes in the variables assessing pain and quality of life as compared with the same procedures performed separately. Moreover, an RCT with a high quality methodology showed that patient education activated inhibitory neural pathways capable of lowering the level of pain. The quantitative analysis yields strong-moderate evidence that patient education, in combination with other therapeutic exercise procedures, offers positive results in the variables pain, quality of life and functionality. Patient education in itself has not proved to be effective for pain, quality of life or functionality in patients with fibromyalgia. There is strong evidence, however, of the effectiveness of combining patient education with exercise and active strategies for coping with pain, quality of life and functionality in the short, medium and long term in patients with fibromyalgia.

Postoperative pain: knowledge and beliefs of patients and nurses.

PubMed

van Dijk, Jacqueline Fm; Schuurmans, Marieke J; Alblas, Eva E; Kalkman, Cor J; van Wijck, Albert Jm

2017-11-01

To describe patients' and nurses' knowledge and beliefs regarding pain management. Moreover, to explore the effect of information and education on patients' and nurses' knowledge and beliefs regarding pain management. In the treatment of postoperative pain, patients' and nurses' inadequate knowledge and erroneous beliefs may hamper the appropriate use of analgesics. A randomised controlled trial and a cross-sectional study. In 2013, half of 760 preoperative patients were allocated to the intervention group and received written information about the complications of postoperative pain. The knowledge and beliefs of 1184 nurses were studied in 2014 in a cross-sectional study. All data were collected with the same questionnaires. In the intervention group, patients' knowledge level was significant higher than in the control group, while no differences were found in beliefs. Nurses had higher knowledge and more positive beliefs towards pain management compared with both patient groups. Nurses with additional pain education scored better than nurses without additional pain education. Nurses were also asked what percentage of pain scores matched their impression of the patient's pain, and the mean was found to be 63%. Written information was effective for increasing patients' knowledge. However, it was not effective for changing beliefs about analgesics and patients and nurses had erroneous beliefs about analgesics. It is necessary to continue to inform patients and nurses about the need for analgesics after surgery. Such education could also emphasise that a discrepancy between a patient's reported pain score and the nurse's own assessment of the patient's pain should prompt a discussion with the patient about his/her pain. © 2017 John Wiley & Sons Ltd.

Low back pain at school: unique risk deriving from unsatisfactory grade in maths and school-type recommendation.

PubMed

Erne, Cordula; Elfering, Achim

2011-12-01

Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils' back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4 weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.

Pain management for older persons living in nursing homes: a pilot study.

PubMed

Tse, Mimi M Y; Ho, Suki S K

2013-06-01

Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Manual Physical Therapists' Use of Biopsychosocial History Taking in the Management of Patients with Back or Neck Pain in Clinical Practice

PubMed Central

Oostendorp, Rob A. B.; Elvers, Hans; Mikołajewska, Emilia; Laekeman, Marjan; van Trijffel, Emiel; Samwel, Han; Duquet, William

2015-01-01

Objective. To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain. Methods. The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice. Results. Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%). Conclusion. MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy. PMID:25945358

Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review.

PubMed

Xu, Melody J; Su, David; Deboer, Rebecca; Garcia, Michael; Tahir, Peggy; Anderson, Wendy; Kinderman, Anne; Braunstein, Steve; Sherertz, Tracy

2017-12-20

Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial.

PubMed

Magalhães, Mauricio Oliveira; Muzi, Luzilauri Harumi; Comachio, Josielli; Burke, Thomaz Nogueira; Renovato França, Fabio Jorge; Vidal Ramos, Luiz Armando; Leão Almeida, Gabriel Peixoto; de Moura Campos Carvalho-e-Silva, Ana Paula; Marques, Amélia Pasqual

2015-08-01

Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain. to compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain. A total of 66 patients with chronic nonspecific low back pain were randomized to perform either graded activity (moderate intensity treadmill walking, brief education and strength exercises) or physiotherapy (strengthening, stretching and motor control). These patients received individual sessions twice a week for six weeks. The primary measures were intensity of pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire). After six weeks, significant improvements have been observed in all outcome measures of both groups, with a non-significant difference between the groups. For intensity of pain (mean difference = 0.1 points, 95% confidence interval [CI] = -1.1-1.3) and disability (mean difference = 0.8 points, 95% confidence interval [CI] = -2.6-4.2). No differences were found in the remaining outcomes. The results of this study suggest that graded activity and physiotherapy showed to be effective and have similar effects for patients with chronic nonspecific low back pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effect of three ergonomics training programs on the prevalence of low-back pain among workers of an Iranian automobile factory: a randomized clinical trial.

PubMed

Aghilinejad, M; Bahrami-Ahmadi, A; Kabir-Mokamelkhah, E; Sarebanha, S; Hosseini, H R; Sadeghi, Z

2014-04-01

Many workers suffer from low-back pain. Type and severity of spinal complaints have relationship with work load. Lack of adherence to ergonomics recommendations among the important causes of low-back pain. To assess the effect of 3 ergonomics training programs on the prevalence of lowback pain among workers of an Iranian automobile factory. In a parallel-design 4-arm randomized clinical trial, 760 active workers of an automobile factory were studied. 503 workers were found eligible and randomized into 3 intervention groups (n=252), and a control group (n=251). The intervention groups consisted of 3 arms: 84 workers were educated by pamphlet, 84 by lectures, and 84 by workshop. Nordic questionnaire was used to determine the prevalence of spinal complaint before and 1-year after the interventions. The trial is registered with the Iranian Randomized Clinical Trial Registry, number IRCT2013061213182N2. Out of 503 workers, 52 lost to follow-up leaving 451 workers for analyses. The prevalence of low-back pain at the baseline was not significantly different among the studied arms. 1-year after the interventions, the prevalence did not change significantly from the baseline values for the lecture and pamphlet group. However, the prevalence of LBP experienced during the last year significantly (p=0.036) decreased from 42% to 23% in participant took part in the workshop. Training of automobile factory workers in ergonomics is more effective by running workshop than giving lecture or disseminating pamphlet.

Position Statement of the Israeli Society for Musculoskeletal Medicine on Intramuscular Stimulation for Myofascial Pain Syndrome-A Delphi Process.

PubMed

Ratmansky, Motti; Minerbi, Amir; Kalichman, Leonid; Kent, John; Wende, Osnat; Finestone, Aharon S; Vulfsons, Simon

2017-04-01

To develop consensus on a position paper on the use of intramuscular stimulation (IMS) for the treatment of myofascial pain syndrome (MPS) by physicians in Israel. The Israeli Society of Musculoskeletal Medicine ran a modified Delphi process to gather opinions from a multidisciplinary expert panel. Eight experts in the treatment of MPS were chosen and asked to participate, and six participated. The position paper was iterated three times. After three iterations, general consensus was reached by all six experts. The general statement that was agreed on was: "IMS is one of the preferred treatments for myofascial pain syndrome. The treatment is evidence-based, effective, safe, and inexpensive. The position of the Israeli Society of Musculoskeletal Medicine is that the treatment should be taught and used by all primary care physicians and those physicians in other areas of medicine who deal with pain in their work." The position paper is a basis for clinical work and education programs for physicians interested in a better understanding and ability to treat patients with a musculoskeletal complaint or manifestation of disease. © 2016 World Institute of Pain.

Can a theory-based educational intervention change nurses’ knowledge and attitudes concerning cancer pain management? A quasi-experimental design

PubMed Central

2013-01-01

Background Registered Nurses (RNs) play an important role in caring for patients suffering from cancer pain. A lack of knowledge regarding pain management and the RNs’ own perception of cancer pain could act as barriers to effective pain management. Educational interventions that target RNs’ knowledge and attitudes have proved promising. However, an intervention consisting of evidence-based practice is a multifaceted process and demands behavioural and cognitive changes to sustain the effects of the intervention. Therefore, our study aimed to investigate if a theory-based educational intervention could change RNs’ knowledge and attitudes to cancer pain and pain management, both four and 12 weeks after the start of the intervention. Methods A quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention’s educational curriculum was based on the principles of Ajzen’s Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN’s own experiences from cancer pain management were used in the learning process. Results The theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward. Conclusions The findings of this study, suggest that a theory-based educational intervention focused at RNs can be effective in changing RN’s knowledge and attitudes regarding cancer pain management. However, the high number of dropouts between baseline and four weeks needs to be taken into account when evaluating our findings. Finally, this kind of theory-based educational intervention with interactive learning activities has been sparsely researched and needs to be evaluated further in larger projects. Trial registration Clinical Trials. Gov: NCT01313234 PMID:23958335

Listening is therapy: Patient interviewing from a pain science perspective.

PubMed

Diener, Ina; Kargela, Mark; Louw, Adriaan

2016-07-01

The interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient's pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than "just" collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.

Convalescence care for seniors of lower Manhattan: an interdisciplinary outreach, rehabilitation, and education model.

PubMed

Moroz, Alex; Schoeb, Veronika; Fan, Grace; Vitale, Kenneth; Lee, Mathew

2004-03-01

The purpose of this study was to test the efficacy of an interdisciplinary geriatric outreach, rehabilitation, and education program for seniors. Community-dwelling Chinese seniors in lower Manhattan were recruited through outreach activities (17 educational workshops, three community health fairs, media interviews) and community physician referrals to offer rehabilitation services. The instrument administered at entry and exit included questions about pain intensity, quality of life, activities of daily living (ADLs), and an assessment of a variety of intrinsic and extrinsic barriers to life participation. The sample included 70 seniors (53 women) with a mean age of 70.5 +/- 7.48 years (range 60-93 years old) of whom 86% were Cantonese-speaking Chinese. The barriers-to-life participation assessment revealed cultural, communication, transportation, and physical environmental barriers as well as insufficient financial resources. Thirty-four patients who completed the program showed a significant improvement in quality of life. Patients' reports reflected a high degree of satisfaction with the program. Interdisciplinary team-oriented patient care, including a physiatrist, social worker, and rehabilitation staff, may result in good outcomes and high patient satisfaction in ambulatory community seniors.

Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital.

PubMed

Brenn, B Randall; Choudhry, Dinesh K; Sacks, Karen; Como-Fluehr, Sandra; Strain, Robert

2016-09-01

Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity. Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database. There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention. An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

Evaluation of a self-management patient education program for patients with fibromyalgia syndrome: study protocol of a cluster randomized controlled trial.

PubMed

Musekamp, Gunda; Gerlich, Christian; Ehlebracht-König, Inge; Faller, Hermann; Reusch, Andrea

2016-02-03

Fibromyalgia syndrome (FMS) is a complex chronic condition that makes high demands on patients' self-management skills. Thus, patient education is considered an important component of multimodal therapy, although evidence regarding its effectiveness is scarce. The main objective of this study is to assess the effectiveness of an advanced self-management patient education program for patients with FMS as compared to usual care in the context of inpatient rehabilitation. We conducted a multicenter cluster randomized controlled trial in 3 rehabilitation clinics. Clusters are groups of patients with FMS consecutively recruited within one week after admission. Patients of the intervention group receive the advanced multidisciplinary self-management patient education program (considering new knowledge on FMS, with a focus on transfer into everyday life), whereas patients in the control group receive standard patient education programs including information on FMS and coping with pain. A total of 566 patients are assessed at admission, at discharge and after 6 and 12 months, using patient reported questionnaires. Primary outcomes are patients' disease- and treatment-specific knowledge at discharge and self-management skills after 6 months. Secondary outcomes include satisfaction, attitudes and coping competences, health-promoting behavior, psychological distress, health impairment and participation. Treatment effects between groups are evaluated using multilevel regression analysis adjusting for baseline values. The study evaluates the effectiveness of a self-management patient education program for patients with FMS in the context of inpatient rehabilitation in a cluster randomized trial. Study results will show whether self-management patient education is beneficial for this group of patients. German Clinical Trials Register, DRKS00008782 , Registered 8 July 2015.

Patients' views toward knee osteoarthritis exercise therapy and factors influencing adherence - a survey in China.

PubMed

Zhou, Zhiwei; Hou, Yunfei; Lin, Jianhao; Wang, Kai; Liu, Qiang

2018-05-01

To understand the views toward exercise therapy for knee osteoarthritis (KOA) in China and to analyze factors affecting treatment adherence. A survey-based study, which included multiple choice and open-ended questions on knee OA exercise therapy was conducted in a Chinese population. The content included the respondents' attitudes and beliefs, willingness to receive treatment, and reasons why they could or could not adhere to the treatment. We used Chi-squared tests to compare cognitive differences between the patients and non-patient groups. A total of 1,069 people responded to the questionnaire, and the response rate was 81.8%. A total of 93.6% of the patients thought that they could adhere to the exercise treatment if they received professional advice and prescriptions. The following questionnaire items achieved consensus: 'Increasing the strength of the muscles around the knee stops the knee pain from getting worse,' 'It is the person's own responsibility to continue doing their exercise program,' 'How helpful the exercise program will be determines how well a person sticks to it,' 'Health professionals should educate patients with knee pain about how to change their lifestyle for the better,' and 'Exercise for knee pain is most helpful when it is designed for each person, to suit their own particular needs.' Patient adherence was affected by multiple factors, and some negative factors included 'forgetfulness,' 'getting joint symptoms improved after therapy,' 'professional guidance, subsequent monitoring and supervision,' 'willing to enhance overall health and quality of life,' 'having no time,' 'occupational factors,' 'considering that the pain would worsen while/after exercise,' and 'family factors.' A general Chinese population accepted exercise therapy for treating KOA in our survey. Education is necessary because patients were uncertain and had misunderstandings regarding the potential benefits of exercise therapy. Some factors related to treatment adherence were also analyzed.

Experiences of Rehabilitation Professionals with the Implementation of a Back School for Patients with Chronic Low Back Pain: A Qualitative Study.

PubMed

Peters, Stefan; Faller, Hermann; Pfeifer, Klaus; Meng, Karin

2016-01-01

A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) "back school as a common thread," (b) "theory versus practice," and (c) "participation and patient-centeredness." The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools.

The effect of a multimedia health educational program on the postoperative recovery of patients undergoing laparoscopic cholecystectomy.

PubMed

Stergiopoulou, Antonia; Birbas, Konstantinos; Katostaras, Theophanis; Diomidous, Mariana; Mantas, John

2006-01-01

Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program (MHEP) on patients undergoing elective Laparoscopic Cholecystectomy (LC) for cholelithiasis, preoperative anxiety and postoperative pain and nausea. Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial. Patients were assigned randomly to four groups: Group A included 15 patients, preoperatively informed regarding LC through the MHEP presented by a Registered Nurse (RN). Group B included 15 patients preoperatively informed through a leaflet (designed and developed using the exact contents of the MHEP). In Group C, there were 15 patients who were being informed verbally from the RN. Finally, the control Group D included 15 patients, who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, C. Preoperative assessment of patient's knowledge about cholelithiasis and LC was performed after informative session, and was based on a specifically developed "closed, true-false" questionnaire. Preliminary results suggest that conventional information provided by the attending surgeon (Group D) is inadequate. Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain, in patients undergoing elective LC.

Joining forces: collaborating internationally to deliver high-quality, online postgraduate education in pain management.

PubMed

Devonshire, Elizabeth; Siddall, Philip

2011-01-01

The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.

Joining forces: Collaborating internationally to deliver high-quality, online postgraduate education in pain management

PubMed Central

Devonshire, Elizabeth; Siddall, Philip J

2011-01-01

The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives. PMID:22184549

Common Functional Gastroenterological Disorders Associated With Abdominal Pain.

PubMed

Bharucha, Adil E; Chakraborty, Subhankar; Sletten, Christopher D

2016-08-01

Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Use of multimedia in patient and caregiver education for cancer pain management: a literature review.

PubMed

Lam, Michael; Choi, Matthew; Lam, Helen R; Agarwal, Arnav; Chow, Ronald; Chow, Selina; Rowbottom, Leigha; McDonald, Rachel; Lam, Henry; Chan, Stephanie; Chow, Edward; Henry, Blair

2017-01-01

Pain is one of the most prominent symptoms faced by cancer patients. It is known that patient and caregiver-targeted educational interventions addressing the proper use of pain management may provide significant clinical value. This review examines the literature surrounding the use of multimedia interventions for patient and caregiver education (PCE) on pain management compared to traditional educational interventions. A literature search was conducted in Ovid MEDLINE (1946-July Week 2, 2016), Ovid Embase (1947-2016 Week 29), and Ovid Cochrane Central Register of Controlled Trials (up to June 2016). Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and cohort studies evaluating one or more multimedia-based PCE interventions focused on cancer pain and pain management and targeting patients and/or caregivers. Findings were extracted by paired reviewers and synthesized qualitatively. Of the 68 full-text papers assessed, 7 were deemed relevant, of which 5 were RCTs and 2 were observational studies. We found limited but convincing quantitative data to suggest that the use of multimedia use in pain management education for patients/caregivers has greater value-added benefit compared to standard education. While there is evidence suggesting a positive effect on pain-related outcomes with the use of multimedia-based patient and caregiver-targeted interventions, it is limited to a small number of lower-quality studies. More robust and large-scale studies are needed to supplement existing evidence and provide more insight regarding the usability and user-friendliness of these tools in practice.

Innovation and design of a web-based pain education interprofessional resource

PubMed Central

Lax, Leila; Watt-Watson, Judy; Lui, Michelle; Dubrowski, Adam; McGillion, Michael; Hunter, Judith; MacLennan, Cameron; Knickle, Kerry; Robb, Anja; Lapeyre, Jaime

2011-01-01

INTRODUCTION: The present article describes educational innovation processes and design of a web-based pain interprofessional resource for prelicensure health science students in universities across Canada. Operationalization of educational theory in design coupled with formative evaluation of design are discussed, along with strategies that support collaborative innovation. METHODS: Educational design was driven by content, theory and evaluation. Pain misbeliefs and teaching points along the continuum from acute to persistent pain were identified. Knowledge-building theory, situated learning, reflection and novel designs for cognitive scaffolding were then employed. Design research principles were incorporated to inform iterative and ongoing design. RESULTS: An authentic patient case was constructed, situated in inter-professional complex care to highlight learning objectives related to pre-operative, postoperative and treatment up to one year, for a surgical cancer patient. Pain mechanisms, assessment and management framed content creation. Knowledge building scaffolds were used, which included video simulations, embedded resources, concurrent feedback, practice-based reflective exercises and commentaries. Scaffolds were refined to specifically support knowledge translation. Illustrative commentaries were designed to explicate pain misbeliefs and best practices. Architecture of the resource was mapped; a multimedia, interactive prototype was created. This pain education resource was developed primarily for individual use, with extensions for interprofessional collective discourse. DISCUSSION: Translation of curricular content scripts into representation maps supported the collaborative design process by establishing a common visual language. The web-based prototype will be formatively and summatively evaluated to assess pedagogic design, knowledge-translation scaffolds, pain knowledge gains, relevance, feasibility and fidelity of this educational innovation. PMID:22184552

Achieved Competencies and Satisfaction in Temporomandibular Disorders and Orofacial Pain Education.

PubMed

Nordin, Sara; Dawson, Andreas; Ekberg, Ewa Carin

2016-01-01

To assess dental students' achieved competencies and perceived satisfaction with their temporomandibular disorders (TMD) and orofacial pain education and to compare these with the results of their final examination in TMD and orofacial pain. Dental students from two consecutive classes (2011/2012 and 2012/2013) at the Department of Orofacial Pain and Jaw Function at the dental school in Malmö, Sweden completed two self-evaluations, one at the beginning of semester seven and one at the end of semester eight. The questionnaire that they were given concerned achieved competencies and satisfaction with education in TMD and orofacial pain. Items focused on anatomy, physiology, and clinical training. Students estimated their competence and satisfaction on a numeric rating scale and described their idea of treating TMD and orofacial pain patients on a verbal rating scale. Outcome variables were tested with paired samples t test for differences over time and independent samples t test for between-class comparisons; both were adjusted for multiple testing with Bonferroni correction. Significant improvement in all items was observed for achieved competencies and satisfaction in both classes between semester seven and semester eight (P < .05). No differences in competencies or satisfaction occurred between classes at the end of the clinical course in semester eight (P > .05). This study has shown that expansion in undergraduate TMD and orofacial pain education at the dental school in Malmö has allowed all students to develop the same level of competence, independent of prior experience. The study also pointed out that continuous evaluation and enhancement of TMD and orofacial pain education in undergraduate dental education is beneficial.

Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial.

PubMed

Bennell, Kim L; Campbell, Penny K; Egerton, Thorlene; Metcalf, Ben; Kasza, Jessica; Forbes, Andrew; Bills, Caroline; Gale, Janette; Harris, Anthony; Kolt, Gregory S; Bunker, Stephen J; Hunter, David J; Brand, Caroline A; Hinman, Rana S

2017-01-01

To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n = 84) or PT-only (n = 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) -0.4, 1.3]) and in WOMAC function (1.8 [95% CI -1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program. © 2016, American College of Rheumatology.

Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention.

PubMed

Holliday, Simon; Hayes, Chris; Dunlop, Adrian; Morgan, Simon; Tapley, Amanda; Henderson, Kim; Larance, Briony; Magin, Parker

2017-12-01

Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes. This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test. Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001). Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Nurses' knowledge and barriers regarding pain management in intensive care units.

PubMed

Wang, Hsiang-Ling; Tsai, Yun-Fang

2010-11-01

To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.

Current Practices in Lumbar Surgery Perioperative Rehabilitation: A Scoping Review.

PubMed

Marchand, Andrée-Anne; O'Shaughnessy, Julie; Châtillon, Claude-Édouard; Sorra, Karin; Descarreaux, Martin

The objective of this review was to identify current practices and relevant patient-reported and objective outcome measures with regard to rehabilitation protocols directed at the lumbar spine in perioperative procedure settings in order to inform clinical practice and future research. A literature search was performed in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Central Register of Controlled Trials, PEDro (Physiotherapy Evidence Database), and PubMed using terms relevant to surgical interventions, rehabilitation, and the lumbar spine. Twenty-nine studies met the inclusion criteria, and 28 investigated postoperative forms of rehabilitation. Patient-reported outcomes typically used were pain and disability, although a wide range of objective measures based on physical capacities were often reported. Rehabilitation programs, for the most part, included some form of strengthening exercises alone or in combination with stabilization exercises, aerobic conditioning, stretching, or education. Despite most studies reporting statistically significant results between intervention groups, considering clinically significant improvement within intervention groups yielded a different portrait. A wide range of objective and subjective outcomes is used to document changes after active rehabilitation. Program components include both active and assisted interventions combined with various means of education and discussion. Multimodal rehabilitation protocols after lumbar surgery may be used to improve patient-reported and objective outcome measures such as pain, disability, and physical function. Further research should be conducted on the effects of preoperative rehabilitation programs. Copyright © 2016. Published by Elsevier Inc.

Acute care to prevent back disability. Ten years of progress.

PubMed

Bigos, S J; Battié, M C

1987-08-01

Efforts to curb back problems through preemployment screening, safety measures, and educational programs have had little effect on this most expensive musculoskeletal malady. Present knowledge raises doubts about the possibility of preventing back pain. However, recent scientific investigations indicate that chronic back pain disability, which accounts for 80% of the costs for back problems, can be prevented. In Gothenburg, Sweden, the collective use of proven treatment methods during the acute stage of back symptoms markedly reduced the period of time patients were disabled from back problems. Effective early intervention centers around: teaching patients about back care, including how to control symptoms through improved body mechanics; applying these educational principles, specifically to the patient's livelihood; avoiding the debilitation that results from overusing bed rest and medication; recommendations to increase cardiovascular fitness; and the judicious use of orthopedic surgery. This approach targets the few patients who tend to be disabled the longest, suffer the most, and become the most costly to society.

Pain management knowledge and attitudes of baccalaureate nursing students and faculty.

PubMed

Duke, Gloria; Haas, Barbara K; Yarbrough, Susan; Northam, Sally

2013-03-01

Pain affects approximately 76 million adults in the US. Though pain management has been targeted as a top priority, it continues to be inadequately addressed. Nursing faculty are in a unique position to significantly address the problem through facilitating the acquisition and utilization of knowledge by student nurses. The purpose of this study was to determine the knowledge of and attitudes toward pain in baccalaureate nursing students and faculty to establish a foundation for a systematic and comprehensive integration of pain content in the curricula. The descriptive design included a sample of 162 junior and senior students enrolled in a baccalaureate nursing program in Texas and 16 nursing faculty. The Knowledge and Attitudes Survey Regarding Pain (KASRP) was used to measure knowledge and attitudes toward pain. A direct correlation was found between the level of education and the percentage correct score. Differences found in knowledge and attitudes among the three levels of students and faculty were significant (df = 3.173; F = 14.07, p < .001). Senior students nearing graduation scored only 68% (SD = 6.8) with faculty scoring only slightly better with a mean of 71% (SD = 13). Significant differences also were found in assessment of pain through case scenarios of a patient who was smiling and talking as compared to a patient who was lying quietly and grimacing (X2 = 37.13, p < .05 (df = 24). Reevaluation of the way pain assessment and treatment are taught is indicated. Further studies are needed to assess changes in knowledge and attitudes toward pain as curricular revisions are made. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

An 8-week multimodal treatment program improves symptoms of knee osteoarthritis: a real-world multicenter experience

PubMed Central

Miller, Larry E; Block, Jon E

2013-01-01

Purpose To report outcomes from a 5-year real-world clinical experience with a multimodal treatment program in patients with symptomatic knee osteoarthritis (OA). Methods Patients with symptomatic, radiographically confirmed knee OA resistant to traditional conservative treatments underwent a supervised 8-week multimodal treatment program consisting of low-impact aerobic exercise, muscle flexibility exercises, joint mobilization, physical therapy modalities, muscle strengthening and functional training, patient education, and a series of 3 or 5 weekly hyaluronic acid injections. Patients were evaluated at admission, 4 weeks, and 8 weeks. Patient-reported outcomes included knee pain severity using an 11-point (0–10) numerical scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Results A total of 3,569 patients completed an 8-week treatment course between January 2008 and April 2013 at 66 dedicated treatment centers in the United States. Knee pain severity assessed on a numeric scale decreased 59% on average, from 5.4±2.9 to 2.2±2.2 (P<0.001). Western Ontario and McMaster Universities Osteoarthritis Index subscores decreased by 44% to 51% (all P<0.001) during the 8-week program. The percentage of patients achieving the threshold for Western Ontario and McMaster Universities Osteoarthritis Index minimally perceptible clinical improvement was 79% for the Pain subscale, 75% for Function, and 76% for Stiffness. Favorable patient outcomes were reported in all subgroups, regardless of age, sex, body mass index, disease severity, or number of treatment cycles. Discussion A real-world 8-week multimodal treatment program results in clinically meaningful improvements in knee OA symptoms, with excellent generalizability across a broad range of patient characteristics. PMID:27774023

The influence of the systematic birth preparation program on childbirth satisfaction.

PubMed

Akca, Aysu; Corbacioglu Esmer, Aytul; Ozyurek, Eser Sefik; Aydin, Arife; Korkmaz, Nazli; Gorgen, Husnu; Akbayir, Ozgur

2017-05-01

The primary purpose of this study was to assess the influence of a systematic multidisciplinary birth preparation program on satisfaction with childbirth experience. A secondary aim was to detect factors that affect the childbirth satisfaction. In this prospective study, 77 pregnant women who completed the 4-month birth preparation program (Group 1) and 75 women in the control group (Group 2) were asked to fill out two questionnaires with face-to-face interviews within 48 h after labor. One of the questionnaires was the translated form of Salmon's Item List German (SIL-Ger), and SIL-Ger scores ≥70 was accepted as a satisfactory experience. There was no statistically significant difference between the groups in terms of sociocultural and intrapartum characteristics, and obstetric outcome parameters. The women who received antenatal education experienced significantly less pain (p = 0.01), had a better communication with midwife or obstetrician during delivery (p = 0.001), and participated more actively in decision-making before, during, and after childbirth (p < 0.001 for all). SIL score was significantly higher in Group 1 (105.7 ± 2.2 vs 80 ± 2.5, p < 0.01), and significantly more women had a SIL score ≥70 (96.1 vs 73.3%, p < 0.01). In multivariate logistic regression model, attending the birth preparation program and the level of pain perceived during labor were found to have a significant effect on the birth satisfaction. Systematic birth preparation program improves satisfaction with childbirth experience by enabling women to communicate better with healthcare providers and to participate in decision-making during labor, as well as by decreasing the perception of labor pain.

Using e-learning to enhance nursing students' pain management education.

PubMed

Keefe, Gemma; Wharrad, Heather J

2012-11-01

Absence of standardised pain curricula has led to wide diversity in the understanding and awareness of pain by healthcare students. Indeed pain management is frequently under-prioritised in nursing education, providing potential to negatively impact upon patient care. Yet the recent addition of Pain to the UK National Health Service's Essence of Care Benchmarks has highlighted the need to address this issue, and in response pain educators have called for the development of high quality, globally accessible e-learning resources in pain management. This study will determine the effectiveness of an e-learning intervention on pain management developed for nursing students. Two variants of an e-learning resource on pain management were developed, each containing the same core content but one with a section focusing on pain assessment and the other on pharmacological management. Nursing students (n=42) were randomly assigned to trial one resource, after which they undertook a questionnaire adapted (to ensure alignment with the content of the e-learning resources) from Ferrell and McCaffrey's Nurses Knowledge and Attitudes Towards Pain Survey. Scores were analysed for each resource and year of study, and compared with scores from a standard non-intervention group completing the questionnaire only (n=164). Scores averaged 19.2% higher for students undertaking the e-learning resources (p<0.005). Specifically, undertaking the assessment resource improved assessment knowledge more, whilst assignment to the treatment resource particularly enhanced pharmacological knowledge (p<0.005). Correlation was found between year of study and pain knowledge. Results support the effectiveness of the resources independent of voluntary-response bias. Conclusions recommend that introducing e-learning has substantial benefit to enhance pain education in nursing. Copyright © 2012 Elsevier Ltd. All rights reserved.

Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility.

PubMed

Musumeci, Alfredo; Pranovi, Giulia; Masiero, Stefano

2018-05-11

Nowadays, some spa centers are suitable for providing rehabilitative and preventive treatment in association with traditional spa therapy. This study aims to evaluate the feasibility and the effectiveness of an intensive rehabilitation program after hip arthroplasty in an Italian spa center. Early after total hip arthroplasty for severe osteoarthritis (≤ 10 days after the intervention), 12 consecutive patients (5 males and 7 females) aged between 50 and 85 years were enrolled for this study. All the patients performed a 2-week thermal multimodal rehabilitation program, which consisted of education and physical rehabilitative measures. Patients had 2-h and half/day session of land-based and hydrokinesitherapy (aquatic therapy) consisted in active and passive joint mobilization, respiratory and functional re-education exercises, gait and balance training, resistance exercise, and power training mainly for the upper limb associated to physical therapy modalities (electrotherapy and low-level laser therapy). An educational program was performed to both patients and families. Both before and after the rehabilitation treatment, patients underwent clinical evaluation, hip flexion/abduction range of motion, and Numeric Pain Rating Scale. Harris Hip Score (HHS) and SF-12 questionnaires (physical-PCS-12-and mental health component-MCS-12) were also administered. After the 2-week thermal spa treatment, hip flexion/abduction improved significantly (p < 0.05), but there was no statistically significant reduction in pain (p = 0.350). The HHS score improved significantly from 62.6 ± 12.8 to 82.15 ± 12.7 (p < 0.05), and the PCS-12 score from 36.37 ± 8.4 to 43.61 ± 8.95 (p < 0.05). There was no adverse event during spa treatment. After total hip arthroplasty, patients who underwent an intensive post-acute multimodal rehabilitation program showed an improvement in motor and functional recovery and a positive impact on quality of life. Therefore, we believe that the thermal setting is a suitable place for providing intensive rehabilitative treatment in orthopedic musculoskeletal disability.

Effects of Combining a Brief Cognitive Intervention with Transcranial Direct Current Stimulation on Pain Tolerance: A Randomized Controlled Pilot Study.

PubMed

Powers, Abigail; Madan, Alok; Hilbert, Megan; Reeves, Scott T; George, Mark; Nash, Michael R; Borckardt, Jeffrey J

2018-04-01

Cognitive behavioral therapy has been shown to be effective for treating chronic pain, and a growing literature shows the potential analgesic effects of minimally invasive brain stimulation. However, few studies have systematically investigated the potential benefits associated with combining approaches. The goal of this pilot laboratory study was to investigate the combination of a brief cognitive restructuring intervention and transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex in affecting pain tolerance. Randomized, double-blind, placebo-controlled laboratory pilot. Medical University of South Carolina. A total of 79 healthy adult volunteers. Subjects were randomized into one of six groups: 1) anodal tDCS plus a brief cognitive intervention (BCI); 2) anodal tDCS plus pain education; 3) cathodal tDCS plus BCI; 4) cathodal tDCS plus pain education; 5) sham tDCS plus BCI; and 6) sham tDCS plus pain education. Participants underwent thermal pain tolerance testing pre- and postintervention using the Method of Limits. A significant main effect for time (pre-post intervention) was found, as well as for baseline thermal pain tolerance (covariate) in the model. A significant time × group interaction effect was found on thermal pain tolerance. Each of the five groups that received at least one active intervention outperformed the group receiving sham tDCS and pain education only (i.e., control group), with the exception of the anodal tDCS + education-only group. Cathodal tDCS combined with the BCI produced the largest analgesic effect. Combining cathodal tDCS with BCI yielded the largest analgesic effect of all the conditions tested. Future research might find stronger interactive effects of combined tDCS and a cognitive intervention with larger doses of each intervention. Because this controlled laboratory pilot employed an acute pain analogue and the cognitive intervention did not authentically represent cognitive behavioral therapy per se, the implications of the findings on chronic pain management remain unclear.

Pain management: evaluating the effectiveness of an educational programme for surgical nursing staff.

PubMed

Lin, Pi-Chu; Chiang, Hsiao-Wen; Chiang, Ting-Ting; Chen, Chyang-Shiong

2008-08-01

The purpose of this study was to assess the effectiveness of a pain management education programme in improving the nurses' knowledge about, attitude towards and application of relaxation therapy. Pain of surgical patients has long been an existing problem of health care. Nursing staff need to be educated continuously to develop the professional ability of pain management. A quasi-study design with pre- and posttest and post- and posttest was used. Subjects were chosen from a medical centre in Taipei by convenience sampling. The total sample size of 81 was segregated into a study group of 42 and control group of 39 participants. The study group attended a seven-session pain management programme totalling 15 hours. The control group received no pain management training. Scaled measurements were taken on pain management knowledge and attitude and relaxation therapy practice. (1) Scores for pain management knowledge differed significantly between the two groups (F = 40.636, p = 0.001). (2) Attitudes towards pain management differed between the two groups (F = 8.328, p = 0.005) and remained stable over time (F = 1.603, p = 0.205). (3) Relaxation therapy practice differed significantly between the two groups, with the study group better than the control group (F = 4.006, p = 0.049). (4) Relaxation therapy was applied to nearly all (97.5%) of the patients cared for by study group nurses. All of the instructed patients performed this technique one to three times per day postsurgery. Continuing education can improve nurses' knowledge about, attitude towards and behaviour of pain management. Results of this study could be used to guide the development and implementation of continuing education programmes for nursing staff to enhance patients' care knowledge and skills.

Pain education in pre-registration professional health courses: a protocol for a scoping review.

PubMed

Thompson, Kate; Milligan, James; Johnson, Mark I; Briggs, Michelle

2016-07-18

Pain is a global health concern causing significant health and social problems with evidence that patients experiencing pain are receiving inadequate care. The content of pain education in pre-registration professional health courses is thought to be lacking both in the UK and internationally which is unacceptable considering the prevalence of pain. Evaluating the effect of education is complex in that the outcome (improved healthcare) is some distance from the educational approach. Best evidence medical education has been proposed as a continuum between 'opinion-based teaching' and 'evidence-based teaching'. Searching for evidence to inform best practice in health education is complex. A scoping review provides a practical and comprehensive strategy to locate and synthesise literature of varied methodology including reports from a variety of sources. The aim of this article is to describe a protocol for a scoping review that will locate, map and report research, guidelines and policies for pain education in pre-registration professional health courses. The extent, range and nature of reports will be examined, and where possible titles for potential systematic review will be identified. Reports will be included for review that are directly relevant to the development of the pain curriculum in pre-registration professional health courses, eg nursing, medicine, physiotherapy. The search strategy will identify reports that include [pain] AND [pre-registration education or curriculum] AND [health professionals] in the title or abstract. Two authors will independently screen retrieved studies against eligibility criteria. A numerical analysis regarding the extent, nature and distribution of reports will be given along with a narrative synthesis to describe characteristics of relevant reports. Formal ethical approval was not required to undertake this scoping review. Findings will be published in scientific peer-reviewed journals and via conference presentations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Outcomes and perception of lung surgery with implementation of a patient video education module: a prospective cohort study.

PubMed

Crabtree, Traves D; Puri, Varun; Bell, Jennifer M; Bontumasi, Nicholas; Patterson, G Alexander; Kreisel, Daniel; Krupnick, Alexander Sasha; Meyers, Bryan F

2012-05-01

Although surgeons are constantly making efforts to improve efficiency of care, it is important to also optimize the patients' understanding and satisfaction with their surgical experience. We investigated the effect of a preoperative educational video on patient outcomes and perception of surgery. An educational video was developed outlining preoperative, operative, and postoperative expectations for patients undergoing pulmonary resection. A prospective study was conducted with 150 patients undergoing surgery with routine preoperative discussion (control group, January 2008 to June 2009) and 150 patients who were provided a supplemental video module (video or study group, September 2009 to October 2010) in addition to routine discussion. Demographics and outcomes data were recorded. Patients completed a pain survey (McGill Questionnaire) and a standardized patient satisfaction survey at discharge and within 1 month of operation. The groups were similar in sex, age, comorbidities, and forced expiratory volume, 1 second, % predicted. Length of hospital stay (5.19 ± 7.4 days vs 4.31 ± 4.3 days; p = 0.2) and hospital readmission rates (12 of 134 [9%] vs 5 of 103 [4.9%]; p = 0.3) were similar for the 2 groups. At discharge, patients in the study group reported less pain at rest (0.98 ± 0.09) vs controls (1.39 ± 0.11) (p = 0.01) with no difference in pain with lifting or coughing. Patients in the study group reported better overall satisfaction with their operation (2.14 ± 0.07 vs 1.85 ± 0.07; p = 0.02), believed they were better prepared (2.01 ± 0.07 vs 1.70 ± 0.06; p = 0.006), and reported less anxiety about the surgical experience (2.79 ± 0.10 vs 2.24 ± 0.09; p = 0.0001). Implementation of a pulmonary resection education module improves patient preparedness, relieves anxiety, and improves pain perception. Additional development and dissemination of a comprehensive education program can improve patients' experience with lung surgery and impact outcomes. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Integrating self-management and exercise for people living with arthritis.

PubMed

Mendelson, A D; McCullough, C; Chan, A

2011-02-01

The Program for Arthritis Control through Education and Exercise, PACE-Ex™, is an arthritis self-management program incorporating principles and practice of self-management, goal setting and warm water exercise. The purpose of this program review is to examine the impact of PACE-Ex on participants' self-efficacy for condition management, self-management behaviors, goal achievement levels and self-reported disability, pain and health status. A retrospective review was conducted on participants who completed PACE-Ex from 1998 to 2006. A total of 347 participants completed 24 PACE-Ex programs [mean age 69.9 (±12.2) years, living with arthritis mean of 14.1 (±13.2) years]. Participants showed statistically significant improvements in their self-efficacy to manage their condition (Program for Rheumatic Independent Self-Management Questionnaire) (P < 0.001) and performance of self-management behaviors (Self-Management Behavior Questionnaire) (P < 0.01). Self-reported health status, disability and pain levels improved post-program (P < 0.01) despite reporting statistically significant increase in the total swollen and tender joint counts (Health Assessment Questionnaire) (P < 0.05). Sixty-eight percent of participants achieved or exceeded their long-term goal as measured by Goal Attainment Scaling. These findings remain to be proven with a more rigorous method yet they suggest that PACE-Ex is a promising intervention that supports healthy living for individuals with arthritis.

Short-Term Functional, Emotional, and Pain Outcomes of Patients with Complex Regional Pain Syndrome Treated in a Comprehensive Interdisciplinary Pain Management Program.

PubMed

McCormick, Zachary L; Gagnon, Christine M; Caldwell, Mary; Patel, Jaymin; Kornfeld, Sarah; Atchison, James; Stanos, Steven; Harden, R Norman; Calisoff, Randy

2015-12-01

Complex regional pain syndrome (CRPS) is difficult to effectively treat with unimodal approaches. To investigate whether CRPS can be effectively treated in a comprehensive interdisciplinary pain management program. Observational cohort study of 49 patients aged 18-89 who fulfilled 'Budapest Criteria' for CRPS and completed an interdisciplinary pain management program. Preprogram to postprogram changes in physical functioning, perceived disability, emotional functioning, acceptance, coping, and pain were assessed. The measures used included: Pain Disability Index, Six minute walk test, 2-minute sit-to-stand, Numerical Rating Scale, Center for Epidemiologic Studies Depression Scale, Pain Anxiety Symptoms Scale, Chronic Pain Acceptance Questionnaire, Coping Strategies Questionnaire-Revised, RIC- Multidimensional Patient Global Impression of Change (RIC-MPGIC), and Medication Quantification Scale. For worker's compensation patients, the rate of successful release to work at the end of the program was calculated. Results indicated significant improvements in physical functioning and perceived disability (P's<0.001). Patients reported increased usage of an adaptive coping strategy, distraction (P = 0.010), and decreased usage of maladaptive and passive strategies (P's < 0.001). Patients showed greater chronic pain acceptance (P's ≤ 0.010) and reductions in emotional distress (P's < 0.001). Medication usage at 1-month follow-up was significantly reduced compared to program start (P < 0.001) and discharge (P = 0.004). Patients reported "much improvement" in overall functioning, physical functioning, mood, and their ability to cope with pain and flare-ups (RIC-MPGIC). Patient report of pain was not significantly reduced at discharge (P =0.078). Fourteen (88%) of 16 total worker's compensation patients were successfully released to work at the end of the program. This study demonstrates short-term improvements in physical and emotional functioning, pain coping, and medication usage. These findings are consistent with the rehabilitation philosophy of improving functioning and sense of well-being as of equal value and relevance to pain reduction. © 2015 Wiley Periodicals, Inc.

Emergency nurses' knowledge of perceived barriers in pain management in Taiwan.

PubMed

Tsai, Feng-Ching; Tsai, Yun-Fang; Chien, Chih-Cheng; Lin, Chia-Chin

2007-11-01

To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses' knowledge of and perceived barriers to pain management in Taiwan. Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. The overall average correct response rate for the knowledge scale was 49.2%, with a range of 4.8-89.2% for each survey question. The top barrier to managing pain was identified by these nurses as 'the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses.

The efficacy of a multidisciplinary group program for patients with refractory chronic pain

PubMed Central

Inoue, Masayuki; Inoue, Shinsuke; Ikemoto, Tatsunori; Arai, Young-Chang P; Nakata, Masatoshi; Miyazaki, Atsuko; Nishihara, Makoto; Kawai, Takashi; Hatakeyama, Noboru; Yamaguchi, Setsuko; Shimo, Kazuhiro; Miyagawa, Hirofumi; Hasegawa, Tomomi; Sakurai, Hiroki; Hasegawa, Yoshinobu; Ohmichi, Yusuke; Ushida, Takahiro

2014-01-01

BACKGROUND: Chronic pain is a major problem because it can result in not only a reduction in activities of daily living and quality of life but also requires initiation of social assistance. Seeking only to eliminate pain itself would appear to be too narrow an objective, in addition to often being unachievable; therefore, a multifaceted, comprehensive approach with multiple objectives is needed. OBJECTIVE: To describe the effects of a program (the ‘Chronic Pain Class’) offering cognitive behavioural therapy to small groups of individuals with refractory chronic pain in Japan. Exercise was an important feature of the program. METHODS: A total of 46 patients who were experiencing treatment difficulties and decreased activity participated in the program. The programs were conducted in groups of five to seven patients who met weekly for nine weeks. Weekly sessions, which were approximately 2 h in duration, combined lectures with exercise. Several measures related to pain and physical function were administered at the beginning and the conclusion of the program. RESULTS: Nine patients dropped out during the program. A number of measures (eg, pain intensity, disability, catastrophizing thoughts) showed significant improvements after intervention (P<0.002 after Bonferroni correction). Furthermore, most measures of physical function showed substantial improvement, especially seated forward bends, zig-zag walking, self-care and 6 min walk test (P<0.001). CONCLUSION: The results of the present study provide evidence that a combination of cognitive behavioural therapy and exercise should be recommended to patients with refractory chronic pain. PMID:24992454

Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

PubMed

Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

2017-09-01

Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

A framework for fibromyalgia management for primary care providers.

PubMed

Arnold, Lesley M; Clauw, Daniel J; Dunegan, L Jean; Turk, Dennis C

2012-05-01

Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up.

PubMed

Ris, I; Søgaard, K; Gram, B; Agerbo, K; Boyle, E; Juul-Kristensen, B

2016-12-01

To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. A multicentre randomised controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, EuroQol-5D, Beck Depression Inventory-II, Neck Disability Index, Pain Bothersomeness, Patient-Specific Functioning Scale, Tampa Scale of Kinesiophobia, Global Perceived Effect) and clinical tests (Aastrand Physical Fitness, cervical Range of Motion, Pressure Pain Threshold at infraspinatus, tibialis anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold, cervical extension movement, muscle function, and oculomotion. Per protocol analyses confirmed these results with additional significant improvements in the exercise group compared with controls. This multimodal intervention may be an effective intervention for chronic neck pain patients. The trial was registered on www.ClinicalTrials.govNCT01431261 and at the Regional Scientific Ethics Committee of Southern Denmark S-20100069. Copyright © 2016 Elsevier Ltd. All rights reserved.

International Federation of Nurse Anesthetists' anesthesia program approval process.

PubMed

Horton, B J; Anang, S P; Riesen, M; Yang, H-J; Björkelund, K B

2014-06-01

The International Federation of Nurse Anesthetists is improving anaesthesia patient care through a voluntary Anesthesia Program Approval Process (APAP) for schools and programmes. It is the result of a coordinated effort by anaesthesia leaders from many nations to implement a voluntary quality improvement system for education. These leaders firmly believe that meeting international education standards is an important way to improve anaesthesia, pain management and resuscitative care to patients worldwide. By 2013, 14 anaesthesia programmes from France, Iceland, Indonesia, Philippines, Sweden, Switzerland, Netherlands, Tunisia and the USA had successfully completed the process. Additional programmes were scheduled for review in 2014. Faculty from these programmes, who have successfully completed APAP, show how anaesthesia educators throughout the world seek to continually improve education and patient care by pledging to meet common education standards. As national governments, education ministers and heads of education institutions work to decrease shortages of healthcare workers, they would benefit from considering the value offered by quality improvement systems supported by professional organizations. When education programmes are measured against standards developed by experts in a profession, policy makers can be assured that the programmes have met certain standards of quality. They can also be confident that graduates of approved programmes are appropriately trained healthcare workers for their citizens. © 2014 International Council of Nurses.

The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach.

PubMed

Valenzuela-Pascual, Fran; Molina, Fidel; Corbi, Francisco; Blanco-Blanco, Joan; Gil, Rosa M; Soler-Gonzalez, Jorge

2015-11-23

Low back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients' cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have demonstrated that websites can change and improve chronic patients' knowledge and have a positive impact on patients' attitudes and behaviors. The aim of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18-65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician. The main outcome of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. ClinicalTrials.gov NCT02369120 Date: 02/20/2015.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

Prevalence of Disability in Patients With Musculoskeletal Pain and Rheumatic Diseases in a Population From Cuenca, Ecuador.

PubMed

Guevara-Pacheco, Sergio Vicente; Feican-Alvarado, Astrid; Delgado-Pauta, Jorge; Lliguisaca-Segarra, Angelita; Pelaez-Ballestas, Ingris

2017-09-01

The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)-validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2) years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3) years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P < 0.001). Physical disability was associated with older age, female sex, rural residence, lower education, and lower income. Moderate and severe disability predominated in the dimensions of kneeling, squatting, and picking up objects. Rheumatic diseases associated with disability were hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis.

Reducing the distance: providing challenging and engaging online postgraduate education in pain management.

PubMed

Devonshire, Elizabeth; Henderson, Sarah E

2012-05-01

1. Health professionals need access to flexible, high-quality, advanced education in pain management. 2. There are multiple pedagogical distances to be negotiated in the delivery of effective postgraduate education. 3. A critical consideration in the design and delivery of effective online learning for postgraduate education in pain management is how to: actively engage students in the learning process; and encourage students to become lifelong learners. 4. Conceptual frameworks for encouraging student interaction online provide a useful tool in the design of postgraduate online learning activities.

A novel pain interprofessional education strategy for trainees: Assessing impact on interprofessional competencies and pediatric pain knowledge

PubMed Central

Hunter, Judith P; Stinson, Jennifer; Campbell, Fiona; Stevens, Bonnie; Wagner, Susan J; Simmons, Brian; White, Meghan; van Wyk, Margaret

2015-01-01

BACKGROUND: Health care trainees/students lack knowledge and skills for the comprehensive clinical assessment and management of pain. Moreover, most teaching has been limited to classroom settings within each profession. OBJECTIVES: To develop and evaluate the feasibility and preliminary outcomes of the ‘Pain-Interprofessional Education (IPE) Placement’, a five-week pain IPE implemented in the clinical setting. The utility (content validity, readability, internal consistency and practical considerations) of the outcome measures was also evaluated. METHODS: A convenience sample of 21 trainees from eight professions was recruited over three Pain-IPE Placement cycles. Pre- and postcurriculum assessment included: pain knowledge (Pediatric Pain Knowledge and Attitudes Survey), IPE attitudes (Interdisciplinary Education Perception Scale [IEPS]) and IPE competencies (Interprofessional Care Core Competencies Global Rating Scales [IPC-GRS]), and qualitative feedback on process/acceptability. RESULTS: Recruitment and retention met expectations. Qualitative feedback was excellent. IPE measures (IEPS and IPC-GRS) exhibited satisfactory utility. Postcurriculum scores improved significantly: IEPS, P<0.05; IPC-GRS constructs, P<0.01; and competencies, P<0.001. However, the Pediatric Pain Knowledge and Attitudes Survey exhibited poor utility in professions without formal pharmacology training. Scores improved in the remaining professions (n=14; P<0.01). DISCUSSION: There was significant improvement in educational outcomes. The IEPS and IPC-GRS are useful measures of IPE-related learning. At more advanced training levels, a single pain-knowledge questionnaire may not accurately reflect learning across diverse professions. CONCLUSION: The Pain-IPE Placement is a successful collaborative learning model within a clinical context that successfully changed interprofessional competencies. The present study represents a first step at defining and assessing change in interprofessional competencies gained from Pain-IPE. PMID:25144859

Biopsychosocial influence on shoulder pain: rationale and protocol for a pre-clinical trial

PubMed Central

George, Steven Z.; Staud, Roland; Borsa, Paul A.; Wu, Samuel S.; Wallace, Margaret R.; Greenfield, Warren. H.; Mackie, Lauren N.; Fillingim, Roger B.

2017-01-01

Background Chronic musculoskeletal pain conditions are a prevalent and disabling problem. Preventing chronic musculoskeletal pain requires multifactorial treatment approaches that address its complex etiology. Prior cohort studies identified a high risk subgroup comprised of variation in COMT genotype and pain catastrophizing. This subgroup had increased chance of heightened pain responses (in a pre-clinical model) and higher 12 month post-operatives pain intensity ratings (in a clinical model). This pre-clinical trial will test mechanisms and efficacy of personalized pain interventions matched to the genetic and psychological characteristics of the high-risk subgroup. Methods Potential participants will be screened for high risk subgroup membership, appropriateness for exercise-induced muscle injury protocol, and appropriateness for propranolol administration. Eligible participants that consent to the study will then be randomized into one of four treatment groups; 1) personalized pharmaceutical and psychological education; 2) personalized pharmaceutical and general education; 3) placebo pharmaceutical and psychological education; 4) placebo pharmaceutical and psychological education. Over the 5-day study period participants will complete an exercise-induced muscle injury protocol and receive study interventions. Pain and disability assessments will be completed daily, with primary outcomes being duration of shoulder pain (number of days until recovery), peak shoulder pain intensity, and peak shoulder disability. Secondary outcomes include inflammatory markers, psychological mediators, and measures of pain sensitivity regulation. Conclusion This pre-clinical trial builds on prior cohort studies and its completion will provide foundational data supporting efficacy and mechanisms of personalized interventions for individuals that may be at increased risk for developing chronic shoulder pain. Trial Registration ClinicalTrials.gov registry, NCT02620579 (Registered on November 13, 2015) PMID:28315479

Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial.

PubMed

George, Steven Z; Staud, Roland; Borsa, Paul A; Wu, Samuel S; Wallace, Margaret R; Greenfield, Warren H; Mackie, Lauren N; Fillingim, Roger B

2017-05-01

Chronic musculoskeletal pain conditions are a prevalent and disabling problem. Preventing chronic musculoskeletal pain requires multifactorial treatment approaches that address its complex etiology. Prior cohort studies identified a high risk subgroup comprised of variation in COMT genotype and pain catastrophizing. This subgroup had increased chance of heightened pain responses (in a pre-clinical model) and higher 12month post-operatives pain intensity ratings (in a clinical model). This pre-clinical trial will test mechanisms and efficacy of personalized pain interventions matched to the genetic and psychological characteristics of the high-risk subgroup. Potential participants will be screened for high risk subgroup membership, appropriateness for exercise-induced muscle injury protocol, and appropriateness for propranolol administration. Eligible participants that consent to the study will then be randomized into one of four treatment groups; 1) personalized pharmaceutical and psychological education; 2) personalized pharmaceutical and general education; 3) placebo pharmaceutical and psychological education; 4) placebo pharmaceutical and psychological education. Over the 5-day study period participants will complete an exercise-induced muscle injury protocol and receive study interventions. Pain and disability assessments will be completed daily, with primary outcomes being duration of shoulder pain (number of days until recovery), peak shoulder pain intensity, and peak shoulder disability. Secondary outcomes include inflammatory markers, psychological mediators, and measures of pain sensitivity regulation. This pre-clinical trial builds on prior cohort studies and its completion will provide foundational data supporting efficacy and mechanisms of personalized interventions for individuals that may be at increased risk for developing chronic shoulder pain. ClinicalTrials.gov registry, NCT02620579 (Registered on November 13, 2015). Copyright © 2017 Elsevier Inc. All rights reserved.

Prescription Opioid Abuse: Challenges and Opportunities for Payers

PubMed Central

Katz, Nathaniel P.; Birnbaum, Howard; Brennan, Michael J.; Freedman, John D.; Gilmore, Gary P.; Jay, Dennis; Kenna, George A.; Madras, Bertha K.; McElhaney, Lisa; Weiss, Roger D.; White, Alan G.

2013-01-01

Objective Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Though difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript’s objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. Method A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research, and develop recommendations on solutions that payers might implement to combat this problem. Results While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies, such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. Conclusion Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to6Treatment protocols, have a high potential to reduce insurer risks while addressing a serious public health problem. PMID:23725361

Veterans' Pain Management Goals: Changes During the Course of a Peer-led Pain Self-Management Program

PubMed Central

Bauer, Sarah M.; McGuire, Alan B.; Kukla, Marina; McGuire, Shannon; Bair, Matthew J.; Matthias, Marianne S.

2017-01-01

Objective Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program. Methods Veterans (n = 16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. Results Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. Conclusion The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. Practice implications Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting. PMID:27516437

Veterans' pain management goals: Changes during the course of a peer-led pain self-management program.

PubMed

Bauer, Sarah M; McGuire, Alan B; Kukla, Marina; McGuire, Shannon; Bair, Matthew J; Matthias, Marianne S

2016-12-01

Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program. Veterans (n=16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Problems in implementing a pain management program for rheumatoid patients and studies of its effectiveness].

PubMed

Cziske, R; Jäckel, W; Jacobi, E

1987-01-01

A pain management program is presented which enables patients to reduce pain by means of relaxation and attention-diversion, etc. The problems arising from applying a psychological training to organic diseases, and the most favourable therapist's behaviour in facing these difficulties are elucidated. Finally, controlled studies are cited showing that pain can be reduced and the emotional state improved by pain management techniques.

A Nationally Scaled Telebehavioral Health Program for Chronic Pain: Characteristics, Goals, and Psychological Outcomes.

PubMed

Mochari-Greenberger, Heidi; Peters, Aimee; Vue, Lee; Pande, Reena L

2017-08-01

Millions of U.S. adults suffer from chronic pain with a high prevalence of comorbid mental health issues. Telehealth-delivered behavioral therapy for chronic pain has been evaluated in the research setting. The purpose of this study was 1) to describe a nationally scaled, standardized, telebehavioral therapy program for patients with chronic pain and behavioral comorbidities, and 2) evaluate characteristics, goals, and psychosocial outcomes among program participants. This was mixed-methods retrospective cohort analysis among consecutive program graduates (mean age 53y; 24% male). The 8-week program was delivered by a licensed therapist and a behavior coach through telephone/secure video and tailored to each participant's behavioral health needs and goals. Participant chief complaints, behavioral goals, and mood triggers were abstracted by deidentified clinical record review using structured qualitative research methods. Depression, anxiety, and stress symptom data were collected at baseline and program graduation using the validated Depression Anxiety Stress Scales 21. Back pain (42%) and hip/leg/knee pain (28%) comprised the most common chief complaints. Pain management (44%) and weight loss (43%) were the most frequently cited goals. At baseline, approximately half of participants had elevated depression (59%), anxiety (54%), and/or stress (48%) scores. Triggers for depressed, anxious, or stressed mood included severe pain (47%), health concerns (46%), and interpersonal relationship challenges (45%). At graduation, significant improvement in median depression (-54%), anxiety (-50%), and stress (-33%) symptom scores was observed among those with non-normal baseline values (p < 0.001); degree of improvement did not vary by participant age or sex. Participants in a nationally scaled telebehavioral health program for chronic pain experienced significant improvement in depression, anxiety, and stress symptoms and shared several complaints, goals, and mood triggers.

[Cross-sectional field pain medicine Q14 - the Mainz model : Development of the pain medicine curriculum in the standard study course at the University Medical School of the Johannes Gutenberg University Mainz].

PubMed

Kurz, S; Buggenhagen, H; Schwab, R; Laufenberg-Feldmann, R

2017-10-01

Following the amendment of the Medical Licensure Act (ÄAppO) in 2012, pain medicine was introduced as a mandatory subject for students during undergraduate medical training. Medical schools were required to define and to implement adequate curricular and formal teaching structures based on interdisciplinary and multiprofessional requirements according to the curriculum for pain medicine of the German Pain Society. These aspects were considered in the new interdisciplinary curriculum for pain medicine, the so-called Mainz model. A new curriculum based on the Kern cycle was developed and implemented at the Medical Center of the Johannes Gutenberg University in Mainz. Different teaching methods (lectures, interprofessional tutorials and bedside coaching in small groups) were used to impart professional expertise in pain medicine to medical students in an interdisciplinary clinical context. The new curriculum was put into practice and evaluated starting from the winter semester 2014/2015. Before and after the first implementation, medical students were asked about the relevance of pain medicine and their perception of personal competence. The interdisciplinary course in pain medicine was successfully introduced into the degree program based on the curriculum of the German Pain Society and the Kern cycle. With educational support, interdepartmental and multiprofessional collaboration the process of implementation of new interdisciplinary courses can be facilitated. In the future, the question how to increase the amount of practical lessons without increasing the load on teaching resources has to be resolved. Blended learning modules, such as a combination of E‑learning and practical lessons are currently being studied in smaller cohorts.

Lower back and neck pain among dentistry students: a cross-sectional study in dentistry students in Northern Greece.

PubMed

Samoladas, Efthimios; Barmpagianni, Christina; Papadopoulos, Dimitrios V; Gelalis, Ioannis D

2018-03-28

Dentistry students and dentists comprise a unique group of professionals, whose everyday professional activity requires long hours of standing and working in a position considered unhealthy for the lower back and neck. Our aim was to explore the factors involved in the appearance of low back and neck pain in dentistry students as well as the impact of the pain on the students' professional and everyday activities. A questionnaire was given to all dentistry students of the 4th and 5th year of our university. The questionnaire included 43 questions regarding demographic data, history (spinal injury, other comorbidities), daily activities (exercise, smoking, alcohol and caffeine consumption, use of cell phone), professional activities (length and type of dental work), pattern and intensity of pain, and personal pain evaluation. A statistical analysis of the gathered data was performed. All students having suffered a spinal trauma or indicating any other comorbidity that could cause severe pain of the spine were excluded from the study. Fifty-five students (21 male, 34 female) were included. Our data showed that increased alcohol consumption and prolonged use of cell phone were connected to increased levels of pain. The students reported that the most frequent onset of pain was 1 h after starting to work in a standing position, while the majority believed that their working habits were involved in the appearance and the intensity of neck and low-back pain. Our findings indicate that among dentistry students appears to be a causative relationship between their professional activities and the experienced spinal pain. These findings may be useful in a possible future restructuring of the educational program in dental schools, as well as in improving the ergonomics of dentistry working units.

Associations between education and physical functioning and pain in adult Danish cancer survivors.

PubMed

Winther, Dorte; Nygaard, Tina K; Horsbøl, Trine A; Kjær, Trille; Vedsted, Peter; Johansen, Christoffer; Hovaldt, Hanna B; Sandager, Mette; Dalton, Susanne O

2017-02-01

Late effects after cancer diagnosis and treatment are common, but only few studies have examined the role of social factors in developing these late effects. The aim of this study was to examine the association between educational level and physical function and pain among cancer survivors two years after diagnosis. The study population consisted of adult Danish patients with a first-time cancer diagnosis who were sent a questionnaire in 2010 and followed up in 2012. In total, 4346 returned the first questionnaire shortly after diagnosis and 2568 returned the follow-up questionnaire. After exclusion of 177 due to missing information, we included 2391 cancer survivors in the analyses. Physical function and pain were measured using the EORTC QLQ-C30. Linear regression analyses were conducted separately for men and women, and adjusted for demographic and clinical characteristics. Additionally, analyses were stratified on comorbidity. Differences in mean scores according to educational level were small. Physical function was better in women with medium (2.8; 95% CI 0.1;5.4) and higher education (3.4; 95% CI 0.9;5.9) compared to women with short education. In contrast, men with medium education reported lower physical function (-2.9; 95% CI -5.7;-0.1) than men with short education. Compared to women with short education, we found lower pain scores among women with medium (-5.0; 95% CI -8.7;-1.4) and higher education (-3.4; 95% CI -6.7;0.0). Similarly, men with higher education experienced lower pain score (-3.4; 95% CI -6.9;0.1) than men with short education. The role of educational level differed between those with and without comorbidity. Educational level is slightly associated with physical function and pain among cancer survivors. However, mean differences in this study were small and below what is considered clinically relevant.

[The evaluation of interventions for pain control done by health staff caring the patient].

PubMed

Bacaksiz, Behiye Deniz; Pirbudak Cöçelli, Lütfiye; Ovayolu, Nimet; Ozgür, Servet

2008-07-01

The study was conducted at Sahinbey Research and Intervention Hospital in order to define the interventions of health staff who were in charge of patient pain care. Those who had been an employee already between February- April 2007 were enrolled in the study. As data collecting tools, a questionnaire prepared by the authors and a scale on pain management methods were used. As far as the total scores obtained from the scale are concerned, 34.7% knows the methods to deal with acute pain very well, 57.8% is good, and 7.5% is fair. In addition, the bullet-in questions of the scale revealed that the participants scored highest for knowledge management, followed by pain evaluation, and the least for the maintenance of physical comfort. The results of the study imply that standardization of education is mandatory to decrease individual differences due to educational status, and that more consideration should be given to pain and pain relief topics in schools providing health education.

Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

PubMed

do Carmo, Carolina Mendes; Almeida da Rocha, Bruna; Tanaka, Clarice

2017-11-01

[Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

Comparative Analysis of Registered Nurses' and Nursing Students' Attitudes and Use of Nonpharmacologic Methods of Pain Management.

PubMed

Stewart, Malcolm; Cox-Davenport, Rebecca A

2015-08-01

Despite the benefits that nonpharmacologic methods of pain management have to offer, nurses cite barriers that inhibit their use in practice. The purpose of this research study was to compare the perceptions of prelicensed student nurses (SNs) and registered nurses (RNs) toward nonpharmacologic methods of pain management. A sample size of 64 students and 49 RNs was recruited. Each participant completed a questionnaire about their use and perceptions nonpharmacologic pain control methods. Sixty-nine percent of RNs reported a stronger belief that nonpharmacologic methods gave relief to their patients compared with 59% of SNs (p = .028). Seventy-five percent of student nurses felt they had adequate education about nonpharmacologic pain modalities compared with 51% of RN who felt less than adequately educated (p = .016). These findings highlight the need for education about nonpharmacologic approaches to pain management. Applications of these findings may decrease barriers to the use of nonpharmacologic methods of pain management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Ethics in the Military: A Review of Junior Officer Education and Training Programs

DTIC Science & Technology

2004-12-01

based ethics are founded upon the principles of consequentialism, utilitarianism, and egoism . Consequentialism is the balancing of good and bad results...and pain. It should also consider the good and bad consequences of the action. Egoism lies between utilitarianism and virtue-based ethics . It is...already possesses a moral pre- disposition , but aims to teach virtues that support navy/officer/academy core values. The genesis for the ethics course

Does the Flipped Classroom Improve Learning in Graduate Medical Education?

PubMed

Riddell, Jeff; Jhun, Paul; Fung, Cha-Chi; Comes, James; Sawtelle, Stacy; Tabatabai, Ramin; Joseph, Daniel; Shoenberger, Jan; Chen, Esther; Fee, Christopher; Swadron, Stuart P

2017-08-01

The flipped classroom model for didactic education has recently gained popularity in medical education; however, there is a paucity of performance data showing its effectiveness for knowledge gain in graduate medical education. We assessed whether a flipped classroom module improves knowledge gain compared with a standard lecture. We conducted a randomized crossover study in 3 emergency medicine residency programs. Participants were randomized to receive a 50-minute lecture from an expert educator on one subject and a flipped classroom module on the other. The flipped classroom included a 20-minute at-home video and 30 minutes of in-class case discussion. The 2 subjects addressed were headache and acute low back pain. A pretest, immediate posttest, and 90-day retention test were given for each subject. Of 82 eligible residents, 73 completed both modules. For the low back pain module, mean test scores were not significantly different between the lecture and flipped classroom formats. For the headache module, there were significant differences in performance for a given test date between the flipped classroom and the lecture format. However, differences between groups were less than 1 of 10 examination items, making it difficult to assign educational importance to the differences. In this crossover study comparing a single flipped classroom module with a standard lecture, we found mixed statistical results for performance measured by multiple-choice questions. As the differences were small, the flipped classroom and lecture were essentially equivalent.

How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis.

PubMed

Bennett, Michael I; Bagnall, Anne-Marie; José Closs, S

2009-06-01

This review aimed to quantify the benefit of patient-based educational interventions in the management of cancer pain. We undertook a systematic review and meta-analysis of experimentally randomised and non-randomised controlled clinical trials identified from six databases from inception to November 2007.Two reviewers independently selected trials comparing intervention (formal instruction on cancer pain and analgesia on an individual basis using any medium) to usual care or other control in adults with cancer pain. Methodological quality was assessed, and data extraction undertaken by one reviewer with a second reviewer checking for accuracy. We used random effects model to combine the effect estimates from studies. Main outcome measures were effects on knowledge and attitudes towards cancer pain and analgesia, and pain intensity. Twenty-one trials (19 randomised) totalling 3501 patients met inclusion criteria, and 15 were included in the meta-analysis. Compared to usual care or control, educational interventions improved knowledge and attitudes by half a point on 0-5 rating scale (weighted mean difference 0.52, 95% confidence interval 0.04-1.0), reduced average pain intensity by over one point on 0-10 rating scale (WMD -1.1, -1.8 to -0.41) and reduced worst pain intensity by just under one point (WMD -0.78, -1.21 to -0.35). We found equivocal evidence for the effect of education on self-efficacy, but no significant benefit on medication adherence or on reducing interference with daily activities. Patient-based educational interventions can result in modest but significant benefits in the management of cancer pain, and are probably underused alongside more traditional analgesic approaches.

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain

PubMed Central

Munzing, Timothy

2017-01-01

Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians’ illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient’s well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible. PMID:28488993

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain.

PubMed

Munzing, Timothy

2017-01-01

Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.

Deconstructing One Medical School's Pain Curriculum: II. Partnering with Medical Students on an Evidence-Guided Redesign.

PubMed

Bradshaw, Ylisabyth S; Patel Wacks, Neha; Perez-Tamayo, Alejandra; Myers, Brenden; Obionwu, Chukwueloka; Lee, Rebecca A; Carr, Daniel B

2017-04-01

To reshape medical education about pain to present it as a population-based public health process as well as a neuron-centered phenomenon. Collaborate with students to apply a recent inventory of pain-related preclinical curricular content and clinical training in order to modify the current multiyear presentation and offer a broadened social perspective on pain. Appraise fourth-year medical students' pain-related educational needs by surveying their knowledge, attitudes, experience with the curriculum, and self-reported assessment of pain-related competencies. University-affiliated medical school and its fourth-year medical students. Analysis of a detailed inventory of first- and second-year curricula. Survey of graduating medical students assessing attitudes, skills, and confidence. Construction of a fourth-year pain education elective and collaboration with enrollees to better integrate pain throughout the four-year curriculum. This student-faculty collaboration produced an evidence-guided proposal to reorganize pain-related content across the longitudinal medical curriculum. An attitudes/skills/confidence survey of graduating medical students (104 respondents of 200 polled) found that 70% believed chances for successful outcomes treating chronic pain were low. Self-evaluated competency was high for evaluating (82%) and managing (69%) acute pain; for chronic pain, both were lower (evaluating = 38%; managing = 6%). Self-evaluated knowledge of pain physiology and neurobiology was poor (14%), fair (54%), or good (30%), but rarely excellent (2%). To meet graduating students' desire for increased competency in pain, pain-related curricula can and should be reorganized to include pain as a disease state and a widespread public health burden, not merely a symptom. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education.

PubMed

Louw, Adriaan; Podalak, Jessie; Zimney, Kory; Schmidt, Stephen; Puentedura, Emilio J

2018-07-01

Pain neuroscience education (PNE) is an educational strategy aimed at teaching people more about pain from a neurobiological and neurophysiological perspective. Current best-evidence provides strong support for PNE to positively influence pain ratings, dysfunctions, fear-avoidance and pain catastrophization, limitations in movement, pain knowledge, and healthcare utilization. To date, all PNE studies have been conducted on adult populations. This study set out to explore if an abbreviated PNE lecture to middle school children would result in a positive shift in pain knowledge as well as healthier beliefs regarding pain. One-hundred-and-thirty-three middle school students spanning 5th to 8th grade attended a 30-minute PNE lecture. The primary outcome measures of pain knowledge (neurophysiology of pain questionnaire [NPQ]) and beliefs regarding pain (numeric rating scale) were measured before and immediately after the PNE lecture. Significant improvement in knowledge was found with mean score on NPQ test scores improving from 3.83 (29.5%) pre-PNE to 7.90 (60.8%) post-PNE (p < 0.001), with a large effect size (r = .711). Significant shifts in beliefs were also found in all but one of the pain beliefs questions, with a medium effect size for "you can control how much pain you feel" (p < 0.001; r = 0.354) and large effect size for "your brain decides if you feel pain, not your tissues" (p < 0.001; r = 0.545). This study shows that a 30-minute PNE lecture to middle school children resulted in a significant increase in their knowledge of pain as well various beliefs regarding pain.

The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol.

PubMed

Jensen, Carsten; Roos, Ewa M; Kjærsgaard-Andersen, Per; Overgaard, Søren

2013-01-14

The age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone. A prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient's global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed. To our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients with an indication for surgery on the time to total hip replacement. NCT01697241.

Physical agents used in the management of chronic pain by physical therapists.

PubMed

Allen, Roger J

2006-05-01

Evidence supporting the use of specific physical agents in the management of chronic pain conditions is not definitive; it is largely incomplete and sometimes contradictory. However, the use of agents in chronic pain management programs is common. Within the broad use of physical agents, they are rarely the sole modality of treatment. A 1995 American Physical Therapy Association position statement asserts that "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy". Physical agents may serve as useful adjunctive modalities of pain relief or to enhance the effectiveness of other elements in therapy geared toward resolution of movement impairments and restoration of physical function. Given that a conclusive aggregate of findings is unlikely to exist for all permutations of patient conditions, combined with interacting therapeutic modalities, an evidence-based approach to pain management is not always possible or beneficial to the patient. In the face of inconclusive evidence, a theory-based approach may help determine if the therapeutic effect ofa given physical agent has the possibility of being a useful clinical tool in the context of treating a particular patient's mechanism of pain generation. Until controlled efficacy findings are definitive, careful individual patient response monitoring of thoughtful theoretical application of adjunctive physical agents may be a prudent approach to the management of chronic pain.

Overview of four prescription monitoring/review programs in Canada.

PubMed

Furlan, Andrea D; MacDougall, Peter; Pellerin, Denise; Shaw, Karen; Spitzig, Doug; Wilson, Galt; Wright, Janet

2014-01-01

Prescription monitoring or review programs collect information about prescription and dispensing of controlled substances for the purposes of monitoring, analysis and education. In Canada, it is the responsibility of the provincial institutions to organize, maintain and run such programs. To describe the characteristics of four provincial programs that have been in place for >6 years. The managers of the prescription monitoring⁄review programs of four provinces (British Columbia, Alberta, Saskatchewan and Nova Scotia) were invited to present at a symposium at the Canadian Pain Society in May 2012. In preparation for the symposium, one author collected and summarized the information. Three provinces have a mix of review and monitoring programs; the program in British Columbia is purely for review and education. All programs include controlled substances (narcotics, barbiturates and psychostimulants); however, other substances are differentially included among the programs: anabolic steroids are included in Saskatchewan and Nova Scotia; and cannabinoids are included in British Columbia and Nova Scotia. Access to the database is available to pharmacists in all provinces. Physicians need consent from patients in British Columbia, and only professionals registered with the program can access the database in Alberta. The definition of inappropriate prescribing and dispensing is not uniform. Double doctoring, double pharmacy and high-volume dispensing are considered to be red flags in all programs. There is variability among Canadian provinces in managing prescription monitoring⁄review programs.

The relationship between intolerance of uncertainty in chiropractic students and their treatment intervention choices.

PubMed

Innes, Stanley I; Leboeuf-Yde, Charlotte; Walker, Bruce F

2017-01-01

Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students' intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief. Between October and November of 2016, students from two Australian chiropractic programs ( N  = 444) answered a questionnaire on measures of IU levels, patient case scenarios for neck and low back pain, and questions about self-ratings of their future chiropractic abilities and perceived need for the adoption of a chiropractic technique system. Associations were tested by the IU score and the therapeutic choices relating to a) a neck pain case scenario, b) a low back pain scenario, c) various technique systems, and d) the self-rated competence level treating the IU score both as a continuous and a categorical variable. There was an overall response rate of 53%. Those students who were high in levels of IU were significantly more likely to make incorrect clinical decisions than those with normal or low levels of IU for the neck pain case scenario. No differences were found on the low back pain scenario, on preferences to use a technique system in the future, or on predicted self-rating of competence after graduation. Psychological factors, such as IU, may have an impact on chiropractic students' clinical decisions. However, it does not impact on all aspects of practice. This finding has implications for chiropractic educators, especially when dealing with neck pain. However, it may be relevant to continue the search for specific personality profiles in relation to various favourable and unfavourable practice patterns, as it is unknown whether these dynamics are important for other aspects of chiropractic education.

Minding the Gaps in Cancer Pain Management Education: A Multicenter Study of Clinical Residents and Fellows in a Low- Versus High-Resource Setting.

PubMed

Odonkor, Charles Amoatey; Osei-Bonsu, Ernest; Tetteh, Oswald; Haig, Andy; Mayer, Robert Samuel; Smith, Thomas J

2016-12-01

Inadequate pain management training has been reported as a major cause of undertreatment of cancer pain. Yet, past research has not comprehensively compared the quality of cancer pain management education among physicians in training in high-resource countries (HRCs) with those in low-resource countries (LRCs). The purpose of this study was to examine and compare gaps in cancer pain management education among physician trainees in an HRC (United States) versus an LRC (Ghana). A cross section of physicians at four major academic medical centers completed surveys about the adequacy of cancer pain training. Participation in the study was completely voluntary, and paper or online surveys were completed anonymously. The response rate was 60% (N = 120). Major gaps were identified in cancer pain management education across the spectrum of medical school training. Training was rated as inadequate (by approximately 80% of trainees), although approximately 10% more trainees in HRCs versus LRCs felt this way; 35% said residency training was inadequate in both settings; and 50% in LRCs versus 44% in HRCs said fellowship training was less than good. On the basis of the lowest group means, the three key areas of perceived deficits included interventional pain procedures (2.34 ± 1.12), palliative care interventions (2.39 ± 1.12), and managing procedural and postoperative pain (2.94 ± 0.97), with significant differences in the distribution of deficits in 15 cancer-pain competencies between LRCs and HRCs ( P < .05). This study identifies priority areas that could be targeted synergistically by LRCs and HRCs to advance cancer care globally. The findings underscore differential opportunities to broaden and improve competencies in cancer pain management via exchange training, in which physicians from HRCs spend time in LRCs and vice versa.

Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial.

PubMed

Lluch, Enrique; Dueñas, Lirios; Falla, Deborah; Baert, Isabel; Meeus, Mira; Sánchez-Frutos, José; Nijs, Jo

2018-01-01

This study aimed to first compare the effects of a preoperative treatment combining pain neuroscience education (PNE) with knee joint mobilization versus biomedical education with knee joint mobilization on central sensitization (CS) in patients with knee osteoarthritis, both before and after surgery. Second, we wanted to compare the effects of both interventions on knee pain, disability, and psychosocial variables. Forty-four patients with knee osteoarthritis were allocated to receive 4 sessions of either PNE combined with knee joint mobilization or biomedical education with knee joint mobilization before surgery. All participants completed self-administered questionnaires and quantitative sensory testing was performed at baseline, after treatment and at a 1 month follow-up (all before surgery), and at 3 months after surgery. Significant and clinically relevant differences before and after surgery were found after treatments for both knee pain and disability, and some measures of CS (ie, widespread hyperalgesia, CS inventory), with no significant between-group differences. Other indicators of CS (ie, conditioned pain modulation, temporal summation) did not change over time following either treatment, and in some occasions the observed changes were not in the expected direction. Patients receiving PNE with knee joint mobilization achieved greater improvements in psychosocial variables (pain catastrophizing, kinesiophobia) both before and after surgery. Preoperative PNE combined with knee joint mobilization did not produce any additional benefits over time for knee pain and disability, and CS measures compared with biomedical education with knee joint mobilization. Superior effects in the PNE with knee joint mobilization group were only observed for psychosocial variables related to pain catastrophizing and kinesiophobia.

Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals.

PubMed

Wasser, Joseph G; Vasilopoulos, Terrie; Zdziarski, Laura Ann; Vincent, Heather K

2017-02-01

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies

PubMed Central

Wachholtz, Amy; Gonzalez, Gerardo; Boyer, Edward; Naqvi, Zafar N; Rosenbaum, Christopher; Ziedonis, Douglas

2011-01-01

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain. PMID:24474854

Educational interventions by pharmacists to patients with chronic pain: systematic review and meta-analysis.

PubMed

Bennett, Michael I; Bagnall, Anne-Marie; Raine, Gary; Closs, S José; Blenkinsopp, Alison; Dickman, Andrew; Ellershaw, John

2011-09-01

We hypothesized that educational interventions delivered by pharmacists to patients with chronic pain might improve pain-related outcomes and sought to establish "proof of concept" for this hypothesis. We searched electronic databases and published literature for randomized studies that examined an educational intervention in relation to the management of chronic pain that was delivered by a pharmacist to an adult patient. Four studies were included that randomized 400 patients with chronic pain and which followed up patients between 1 and 16 weeks. Patients receiving these interventions experienced statistically significant benefits in the following outcomes compared with controls: a reduction in average pain intensity of 0.5 on a 0 to 10 rating scale, a reduction in adverse effects by more than 50%, and an improvement in satisfaction with treatment equivalent to approximately 1 point on a 0 to 10 rating scale. The interventions neither had effect on reducing interference from pain on daily life, nor on improving self-efficacy. Pharmacist-delivered educational interventions seem to reduce adverse events and improve satisfaction, but their clinical benefit on pain intensity is debatable. Our analysis suggests that the role of pharmacists may be important but a deeper understanding and evaluation of the active components of these interventions is needed within clinical trials before wider implementation into clinical practice can be recommended.

Spine Conditions: Mechanical and Inflammatory Low Back Pain.

PubMed

Ledford, Christopher

2017-10-01

Mechanical low back pain (LBP) is an injury or derangement of an anatomic structure in the low back. When evaluating patients with LBP, clinicians should maintain clinical suspicion for vertebral fracture, cancer, and cauda equina syndrome. Management includes patient education focused on exercise, massage, and behavioral approaches such as cognitive behavioral therapy. Acupuncture can be an effective alternative and specific herbal supplements may provide short-term pain relief. The prognosis for patients with mechanical LBP is good. Inflammatory LBP is pain resulting from a systemic inflammatory condition, often referred to as axial spondyloarthritis. Ankylosing spondylitis is chronic inflammatory LBP characterized by early onset (mean age 24 years), with a higher prevalence in men. Five clinical parameters can help identify inflammatory LBP: improvement with exercise, pain at night, insidious onset, onset at younger than 40 years, and no improvement with rest. Management of inflammatory LBP typically includes nonsteroidal anti-inflammatory drugs and structured exercise programs, with emphasis on the involvement of a rheumatology subspecialist. Spondyloarthritis is associated with other rheumatic or autoimmune conditions, including rheumatoid arthritis, inflammatory bowel disease, and psoriasis. These should be considered when evaluating patients with inflammatory LBP. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity.

PubMed

Chelminski, Paul R; Ives, Timothy J; Felix, Katherine M; Prakken, Steven D; Miller, Thomas M; Perhac, J Stephen; Malone, Robert M; Bryant, Mary E; DeWalt, Darren A; Pignone, Michael P

2005-01-13

Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

PubMed Central

Chelminski, Paul R; Ives, Timothy J; Felix, Katherine M; Prakken, Steven D; Miller, Thomas M; Perhac, J Stephen; Malone, Robert M; Bryant, Mary E; DeWalt, Darren A; Pignone, Michael P

2005-01-01

Background Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. Results Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). Conclusions A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up. PMID:15649331

Lasers in Periodontics: Review of Literature

DTIC Science & Technology

2015-06-01

Alex Printed Name Orofacial Pain Fellowship Naval Postgraduate Dental School Program and Program Location Uniformed Services University LASERS IN...PERIODONTICS: REVIEW OF THE LITERATURE By Alex Smith MAJ, DC, USA A thesis submitted to the Faculty of the Orofacial Pain Graduate Program Naval...Department Chair Orofaci I Pain Department Glenn Munro, CAPT, DC, USN Dean, Naval Postgraduate Dental School NAVAL POSTGRADUATE DENTAL SCHOOL BETHESDA

Tailoring cancer education and support programs for low-income, primarily African American cancer survivors.

PubMed

Martin, Michelle Y; Pollack, Lori A; Evans, Mary B; Smith, Judith Lee; Kratt, Polly; Prayor-Patterson, Heather; Watson, Christopher D; Dignan, Mark; Cheney, Lydia C; Pisu, Maria; Liwo, Amandiy; Hullett, Sandral

2011-01-01

to identify the information and stress-management topics of most interest to low-income, predominantly African American cancer survivors. descriptive, cross sectional. outpatient oncology clinic in a public hospital in Birmingham, Alabama. 25 patients with cancer; 12 were men, 22 were African Americans, and 16 had a 12th-grade education or less. patients ranked potential topics to be included in an educational curriculum. quantitative rankings of information and stress-management priorities. learning about cancer, understanding cancer treatments, relieving cancer pain, and keeping well in mind and body were the most highly ranked topics among those offered within the American Cancer Society's I Can Cope curriculum, which also included supportive topics such as mobilizing social support. The preferred stress-management topics were humor therapy, music therapy, meditation, and relaxation; lower-ranked topics included pet therapy and art as therapy. cancer survivors appear most interested in topics specific to their illness and treatment versus supportive topics. Stress management also received high rankings. nurses have a key role in providing patient education and support. Tailoring education programs may better target specific needs and improve the quality of cancer care of underserved patients.

Back pain in physically inactive students compared to physical education students with a high and average level of physical activity studying in Poland.

PubMed

Kędra, Agnieszka; Kolwicz-Gańko, Aleksandra; Kędra, Przemysław; Bochenek, Anna; Czaprowski, Dariusz

2017-11-28

The aim of the study was (1) to characterise back pain in physically inactive students as well as in trained (with a high level of physical activity) and untrained (with an average level of physical activity) physical education (PE) students and (2) to find out whether there exist differences regarding the declared incidence of back pain (within the last 12 months) between physically inactive students and PE students as well as between trained (with a high level of physical activity) and untrained (with an average level of physical activity) PE students. The study included 1321 1st-, 2nd- and 3rd-year students (full-time bachelor degree course) of Physical Education, Physiotherapy, Pedagogy as well as Tourism and Recreation from 4 universities in Poland. A questionnaire prepared by the authors was applied as a research tool. The 10-point Visual Analogue Scale (VAS) was used to assess pain intensity. Prior to the study, the reliability of the questionnaire was assessed by conducting it on the group of 20 participants twice with a shorter interval. No significant differences between the results obtained in the two surveys were revealed (p < 0.05). In the group of 1311 study participants, 927 (70.7%) respondents declared having experienced back pain within the last 12 months. Physically inactive students declared back pain frequency similar to the frequency declared by their counterparts studying physical education (p > 0.05). Back pain was more common in the group of trained students than among untrained individuals (p < 0.05). Back pain was mainly located in the lumbar spine. A frequent occurrence of back pain (70.7%) was noted in the examined groups of students. The percentage of students declaring back pain increased in the course of studies (p < 0.05) and, according to the students' declarations, it was located mainly in the lumbar spine. No significant differences regarding the incidence of back pain were found between physically inactive students and physical education students (p > 0.05). The trained students declared back pain more often than their untrained counterparts (p < 0.05).

Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

PubMed Central

2009-01-01

Background Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. Trial Registration [Clinical Trials Identifier: NCT00283166] PMID:19737424

Improving communication in cancer pain management nursing: a randomized controlled study assessing the efficacy of a communication skills training program.

PubMed

Canivet, Delphine; Delvaux, Nicole; Gibon, Anne-Sophie; Brancart, Cyrielle; Slachmuylder, Jean-Louis; Razavi, Darius

2014-12-01

Effective communication is needed for optimal cancer pain management. This study assessed the efficacy of a general communication skills training program for oncology nurses on communication about pain management. A total of 115 nurses were randomly assigned to a training group (TG) or control group (CG). The assessment included the recording of interviews with a simulated cancer patient at baseline for both groups and after training (TG) or 3 months after baseline (CG). Two psychologists rated the content of interview transcripts to assess cancer pain management communication. Group-by-time effects were measured using a generalized estimating equation. Trained nurses asked the simulated patient more questions about emotions associated with pain (relative rate [RR] = 4.28, p = 0.049) and cognitions associated with pain treatment (RR = 3.23, p < 0.001) and used less paternalistic statements about cancer pain management (RR = 0.40, p = 0.006) compared with untrained nurses. The general communication skills training program improved only a few of the communication strategies needed for optimal cancer pain management in nursing. General communication skills training programs should be consolidated using specific modules focusing on communication skills related to cancer pain management.

Effectiveness of Tai-Chi for decreasing acute pain in fibromyalgia patients.

PubMed

Segura-Jiménez, V; Romero-Zurita, A; Carbonell-Baeza, A; Aparicio, V A; Ruiz, J R; Delgado-Fernández, M

2014-05-01

Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i. e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i. e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; P<0.001) and cumulative pain post-session (95% CI=-0.021; -0.015; P<0.001) along the 24-week intervention only. In conclusion, a low-moderate intensity Tai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e. g. 24 weeks) for observing cumulative changes in pain. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial.

PubMed

Malfliet, Anneleen; Kregel, Jeroen; Coppieters, Iris; De Pauw, Robby; Meeus, Mira; Roussel, Nathalie; Cagnie, Barbara; Danneels, Lieven; Nijs, Jo

2018-04-16

Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. clinicaltrials.gov Identifier: NCT02098005.

[Design of an educational tool for Primary Care patients with chronic non-specific low back pain].

PubMed

Díaz-Cerrillo, Juan Luis; Rondón-Ramos, Antonio

2015-02-01

Current scientific evidence on the management of chronic non-specific low back pain highlights the benefits of physical exercise. This goal is frequently undermined due to lack of education of the subjects on the multifactorial, benign, and non-specific nature of low back pain, which can lead to a chronic disease with genuine psychosocial risk factors. Its influence may not only interfere with individual decision to adopt more adaptive coping behaviors, but also with the endogenous mechanisms of pain neuromodulation. Thus, the educational strategies and control of these factors have become important objectives to be incorporated into the management of the disorder and research guidelines. This paper presents the theoretical models and the scientific basis on which it has based the design of an educational tool for patients with chronic non-specific low back pain treated in Primary Care physiotherapy. Structure, content and objectives are also presented. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Influence of schizophrenia diagnosis on providers' practice decisions.

PubMed

Sullivan, Greer; Mittal, Dinesh; Reaves, Christina M; Haynes, Tiffany F; Han, Xiaotong; Mukherjee, Snigdha; Morris, Scott; Marsh, Laura; Corrigan, Patrick W

2015-08-01

Persons with schizophrenia often receive suboptimal physical health care, but the reasons are poorly understood. Vignettes have been used to examine how a patient's race, gender, or physical health influences a provider's practice; in this study, we used vignettes to examine the effect of a mental health diagnosis (schizophrenia) on providers' clinical expectations and decision making regarding physical health care. A cross-sectional survey was administered from August 2011 to April 2012 to 275 primary care and mental health providers in 5 US Department of Veterans Affairs medical centers. Vignettes described identical scenarios for patients with and without schizophrenia. The survey assessed providers' clinical expectations of patients (adherence, competence, ability to read and understand health education materials) and practice behaviors (referrals to weight reduction, pain management, and sleep study). Clinicians expected persons with schizophrenia would be less adherent to treatment (P = .04), less able to read and understand educational materials (P = .03), and less capable of managing their health and personal affairs (P < .01). Providers were less likely to refer a patient with schizophrenia to a weight-reduction program (P = .03). Other types of referral decisions (for pain management and sleep study) were not influenced by a schizophrenia diagnosis. For both mental health and primary care providers, a history of schizophrenia was found to negatively affect provider expectations of patients' adherence to treatment, ability to understand educational materials, and capacity to manage their treatment and financial affairs as well as some treatment decisions, such as referral to a weight-reduction program. © Copyright 2015 Physicians Postgraduate Press, Inc.

Effects of a back-pain-reducing program during pregnancy for Korean women: a non-equivalent control-group pretest-posttest study.

PubMed

Shim, Mi-Jung; Lee, Young-Sook; Oh, Hyun-Ei; Kim, Jin-Sun

2007-01-01

Although many pregnant women experience back pain, it has not considered an important health problem. No study has investigated the effects of a back-pain-reducing program (BPRP) during pregnancy for Korean women. The purpose of this study was to evaluate the effect of a program designed to reduce back pain in pregnant women. A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended an antenatal clinic and experienced back pain during their pregnancy were included in an intervention group (n=29), and their intensity of back pain, functional limitation and anxiety were compared with women in a control group from another antenatal clinic (n=27). The data were collected at three time points: prior to intervention, and 6 and 12 weeks after intervention. At 12 weeks after intervention, the intensity of back pain experienced by the intervention group was significantly lower than that of the control group. However, there were no statistically significant differences between the groups with respect to functional limitations and anxiety. The findings show that the pain-reducing program developed for this study was effective in reducing the intensity of back pain experienced by pregnant women. Promoting good posture and regular exercise can be recommended as a method to relieve back pain in pregnancy women. Further studies are needed to confirm the effect of the BPRP during pregnancy.

Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program.

PubMed

Logan, Deirdre E; Conroy, Caitlin; Sieberg, Christine B; Simons, Laura E

2012-09-01

The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. A total of 157 children ages 10 to 18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pretreatment, posttreatment, and short-term follow-up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children's readiness to self-manage pain from pretreatment to posttreatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents' readiness to adopt a pain self-management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pretreatment willingness to self-manage pain and posttreatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Awareness of the German population of common available guidelines of how to cope with lower back pain.

PubMed

Werber, Andreas; Zimmermann-Stenzel, Monique; Moradi, Babak; Neubauer, Eva; Schiltenwolf, Marcus

2014-01-01

Several countries developed guidelines in order to provide a systematic approach for treatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differs significantly within the general population. A serious lack of research exists concerning the risk factor "dysfunctional behavior of the subjects in terms of acute lower back pain." The purpose of this study was to assess the knowledge of the German population regarding the availability of guidelines about managing lower back pain. Prospective observational cohort study. We interviewed 983 subjects by phone. The study population included 50 - 70-year-old men and women with German residency and sufficient language ability. Of all the subjects, 70.2% claimed that they suffered at least once in their lifetime with lower back pain. Lower back pain with radiating symptoms occurred in 28.7%. Women were affected significantly more frequently compared to the epidemiological data. Of all the subjects with lower education, 82.9% suffered from lower back pain at least once in their lifetime compared to only 62.4% of people with university degrees. Education was also a protective factor for lower back pain with radiating pain. People who completed secondary modern school were 42% less likely to suffer from lower back pain than those who did not graduate. Knowing active rules of conduct occurred significantly more often at higher educational levels (i.e. all kinds of sports and exercises requiring physical strength, flexibility, power, agility, coordination, grace, balance and control, in particular stretching exercises) odds ratio = 7.78, physical activities odds ratio = 3.92, relaxation exercises odds ratio = 3.51). Data acquisition was performed by an external company and therefore provided only limited options for external validity. Furthermore data acquisition was restricted to 50 - 70-year-old patients, since this age group is at higher risk of suffering from lower back pain. A conclusion upon the knowledge of the whole population has to be drawn with caution, especially when considering the size of the study population. The life-time prevalence of lower back pain was assessed by interviewing patients about prior episodes of lower back pain. Slightly biased results may have occurred since the memory of prior episodes might result in too many or too few episodes. The study revealed a lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population. Passive coping strategies like taking pain medication or ointment therapy were favored over active coping strategies like gymnastics, physical activities, and relaxation exercises. Respondents with a higher level of education suffered significantly less often from lower back pain and tended toward active treatment strategies. Respondents with lower levels of education more often demanded passive treatment strategies. The general population, especially those with lower education, is not sufficiently aware of behavioral strategies for managing lower back pain as proposed in available guidelines.

Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients.

PubMed

Platts-Mills, Timothy F; Hollowell, Allison G; Burke, Gary F; Zimmerman, Sheryl; Dayaa, Joseph A; Quigley, Benjamin R; Bush, Montika; Weinberger, Morris; Weaver, Mark A

2018-01-05

Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain. ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48-72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0-10 numerical rating scale. Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function. Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes. ClinicalTrials.gov, NCT02438384 . Registered on 5 May 2015.

Adaptation to illness in relation to pain perceived by patients after surgery.

PubMed

Chabowski, Mariusz; Junke, Michał; Juzwiszyn, Jan; Milan, Magdalena; Malinowski, Maciej; Janczak, Dariusz

2017-01-01

Pain is one of the factors that decrease quality of life. Undergoing surgery is inevitably associated with the sensation of pain, which can affect a patient's level of acceptance of an illness. The aim of the study was to evaluate the level of acceptance of illness in patients undergoing surgical treatment with relation to the pain perceived by them during surgical treatment and to determine other factors that affect adaptation to illness among patients subjected to invasive treatment. The study was conducted on a group of 100 patients with mean age of 51.27 (SD=18.98) hospitalized in surgery departments in the Provincial Specialist Hospital in Wrocław, Poland, in April 2016. The Acceptance of Illness Scale (AIS) and the Visual Analog Scale (VAS) for pain were used. The mean score of VAS was 3.86 (SD =2.02). The mean score of AIS was 24.42 (SD =7.35). The level of acceptance of illness was significantly negatively correlated with the intensity of pain ( p <0.001; r =-0.498), the number of coexisting diseases ( p =0.002; r =-0.31), age ( p <0.001; r =-0.391), and the period of time since the operation ( p =0.007; r =-0.266). Patients taking analgesics showed a significantly lower acceptance of illness than those who did not ( p =0.009). A patient's place of living, education, and sex had no significant impact on their acceptance of illness. A higher level of pain translates into a lower adaptation to illness despite the use of analgesics, which may indicate that inadequate pain control leads to a decrease in the acceptance of illness. Further research on monitoring postoperative pain, as well as the development of postoperative prevention programs, is required.

American Pain Society

MedlinePlus

... 2014 News Releases Press Room - Pain Education in Physical Therapy Schools Press Room - Misuse of Therapeutic Opioids Press ... of Chronic or Severe Pain in U.S. Adults Physical Therapy for Carpal Tunnel Syndrome Pain Often As Effective ...

Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods.

PubMed

Drake, Gareth; de C Williams, Amanda C

2017-02-01

The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain

PubMed Central

Frutiger, Martin; Tuchin, Peter Jeffery

2017-01-01

Objective: The purpose of this study was to provide a best-synthesis summary of the literature for effective workplace health promotion interventions (WHPI) for work-related mechanical neck pain (MNP) and to determine the congruence between knowledge of WHPI for work-related MNP and coverage of MNP in the chiropractic postgraduate program at Macquarie University. Methods: A literature review was undertaken to determine effective WHPI for work-related MNP. We searched Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro (from 1991 to 2016) for systematic reviews and meta-analyses. The PRISMA (2009) 27-item checklist was used to critically appraise included articles. Lectures, tutorials, and assessment tasks within the chiropractic postgraduate program were mapped to the literature review findings and analyzed. Results: There was moderate-quality evidence for multidimensional WHPI, including aspects of mental and physical functioning, activity performance and modifications, and environmental modifications, to reduce MNP and disability in workers, particularly in the long term. Education on coverage of MNP and effective WHPI for MNP was inadequately covered although congruent with synthesis of current literature. Education on body functions and structures and personal factors were the most commonly covered components. Conclusion: Multidimensional WHPI, focusing on physical, mental, and environmental modifications, appear to reduce self-reported MNP primarily in office workers. There is adequate congruence between the chiropractic postgraduate program at Macquarie University and the published literature on some WHPI. However, there is inadequate coverage on aspects of MNP and effective WHPI for MNP, particularly those focusing on activity and participation and environmental factors. PMID:28742974

Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain.

PubMed

Frutiger, Martin; Tuchin, Peter Jeffery

2017-10-01

The purpose of this study was to provide a best-synthesis summary of the literature for effective workplace health promotion interventions (WHPI) for work-related mechanical neck pain (MNP) and to determine the congruence between knowledge of WHPI for work-related MNP and coverage of MNP in the chiropractic postgraduate program at Macquarie University. A literature review was undertaken to determine effective WHPI for work-related MNP. We searched Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro (from 1991 to 2016) for systematic reviews and meta-analyses. The PRISMA (2009) 27-item checklist was used to critically appraise included articles. Lectures, tutorials, and assessment tasks within the chiropractic postgraduate program were mapped to the literature review findings and analyzed. There was moderate-quality evidence for multidimensional WHPI, including aspects of mental and physical functioning, activity performance and modifications, and environmental modifications, to reduce MNP and disability in workers, particularly in the long term. Education on coverage of MNP and effective WHPI for MNP was inadequately covered although congruent with synthesis of current literature. Education on body functions and structures and personal factors were the most commonly covered components. Multidimensional WHPI, focusing on physical, mental, and environmental modifications, appear to reduce self-reported MNP primarily in office workers. There is adequate congruence between the chiropractic postgraduate program at Macquarie University and the published literature on some WHPI. However, there is inadequate coverage on aspects of MNP and effective WHPI for MNP, particularly those focusing on activity and participation and environmental factors.

Palliative care education in Latin America: A systematic review of training programs for healthcare professionals.

PubMed

Vindrola-Padros, Cecilia; Mertnoff, Rosa; Lasmarias, Cristina; Gómez-Batiste, Xavier

2018-02-01

The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation. We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings. We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff. Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.

Changes in willingness to self-manage pain among children and adolescents and their parents enrolled in an intensive interdisciplinary pediatric pain treatment program

PubMed Central

Logan, Deirdre E.; Conroy, Caitlin; Sieberg, Christine B.; Simons, Laura E.

2013-01-01

The importance of willingness to adopt a self-management approach to chronic pain has been demonstrated in the context of cognitive-behaviorally oriented interdisciplinary pain treatment programs for adults, both as a treatment outcome and as a process that facilitates functional improvements. Willingness to self-manage pain has not been studied in pediatric interdisciplinary pain treatment settings. Study aims were (1) to investigate willingness to self-manage pain among children and parents undergoing intensive interdisciplinary pain treatment and (2) to determine whether increased willingness to self-manage pain influenced functional treatment outcomes. 157 children ages 10-18 and their parents enrolled in a pediatric pain rehabilitation program completed the Pain Stages of Change Questionnaire (PSOCQ youth and parent versions) at pre-treatment, post-treatment, and short-term follow up. They also reported on pain, functional disability, depressive symptoms, fear of pain, and use of passive and accommodative coping strategies. Results show that willingness to self-manage pain increased during treatment among both children and parents, with gains maintained at follow-up. Increases in children’s readiness to self-manage pain from pre- to post-treatment were associated with decreases in functional disability, depressive symptoms, fear of pain, and use of adaptive coping strategies. Increases in parents’ readiness to adopt a pain-self management approach were associated with changes in parent-reported fear of pain but not with other child outcomes. Few associations emerged between pre-treatment willingness to self-manage pain and post-treatment outcomes. Findings suggest that interdisciplinary pediatric pain rehabilitation may facilitate increased willingness to self-manage pain, which is associated with improvements in function and psychological well-being. PMID:22749194

An innovative approach to targeting pain in older people in the acute care setting.

PubMed

Phelan, Caroline

2010-06-01

This paper reports the findings of an exploratory pilot study which used mixed methods to determine (a) the feasibility of the study design for a larger multi site project and (b) whether a pain education promotion approach, termed 'Targeting Pain', using a multidisciplinary educational campaign and promotional media such as staff badges and ward signage, improves the detection and management of pain in older people in an acute care setting. Pre and post evaluation surveys and interviews were used to evaluate the approach. Findings showed an increase in pain assessment and documentation of pain by nursing staff, as well as an increase in the prescription of oral analgesics. However, the study indicated that the uptake regarding pain management from the education campaign was different between professional groups. Although there was a positive response by patients and staff to the use of staff badges, the ward signage failed to attract attention. The mixed methods approach used highlighted several areas that need to be improved for the next phase of the study.

Improving physician-patient communication about cancer pain with a tailored education-coaching intervention.

PubMed

Street, Richard L; Slee, Christina; Kalauokalani, Donna K; Dean, Dionne Evans; Tancredi, Daniel J; Kravitz, Richard L

2010-07-01

This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Grounded in social-cognitive and communication theory, a tailored education-coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients' questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians' communication. Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians' information about pain were higher when patients talked more about their pain concerns. The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Telephone Delivered Cognitive Behavioral Therapy for Chronic Pain Following Traumatic Brain Injury

DTIC Science & Technology

2016-10-01

impression of change, and life satisfaction (secondary outcomes) relative to a telephone-delivered pain psycho-educational active control condition...global impression of change, and life satisfaction (secondary outcomes) relative to a telephone-delivered pain psycho-educational active control...interference, sleep problems, and depression, as well as improving global impression of change and life satisfaction . •We will determine whether

Singaporean nurses' provision of guidance to parents on non-pharmacological postoperative pain-relief methods: An educational intervention study.

PubMed

He, Hong-Gu; Jahja, Riawati; Sinnappan, Rajammal; Ang, Emily Neo Kim; Lee, Tat-Leang; Chan, Moon Fai; Vehviläinen-Julkunen, Katri

2011-09-01

This study examined the impact of an educational intervention (booklet distribution and lectures) on Singaporean nurses' provision of guidance to parents on the use of non-pharmacological methods of pain relief for their child's postoperative pain. Using a quasi-experimental one-group pre- and post-test study design, 134 and 112 registered nurses completed the questionnaires pre- and post-test, respectively. More than 75% of the nurses "always" guided parents to use breathing techniques, relaxation, positioning, comforting/reassurance, helping with activities of daily living, and creating a comfortable environment in the pretest and touch, presence, and distraction in addition to the aforementioned methods in the post-test. The nurses' provision of guidance to parents on all non-pharmacological methods increased, but statistically significant increases only were found in relation to massage and positive reinforcement. The results suggested that the educational intervention had some impact on nurses' provision of guidance to parents on the use of non-pharmacological methods of pain relief for children's postoperative pain. Continuing education in pain management should be provided to nurses in order to equip them with the knowledge to improve their practice. © 2011 Blackwell Publishing Asia Pty Ltd.

Exploring the Use of Educational Material About Shoulder Dysfunction: A Quality Improvement Project in People With Amyotrophic Lateral Sclerosis.

PubMed

Burke, Katherine; Ellrodt, Amy Swartz; Levine, Jason; Adams, Taylor; Allis, Rebecca; Macmurdie, Ian; Paganoni, Sabrina

2018-05-01

Shoulder pain is a common secondary complication of amyotrophic lateral sclerosis (ALS) that can contribute to functional decline and decreased participation in daily activities. The purpose of this study was to assess the effectiveness of an educational brochure aimed at improving knowledge regarding shoulder pain and dysfunction in people with ALS. Participants completed a preintervention survey with questions regarding their knowledge of how ALS may affect their shoulders. After completing the presurvey, they were mailed a brochure that described shoulder health and range of motion and stretching exercises. Four weeks after receiving the brochure, participants were then asked to determine the effectiveness of the educational materials in terms of impact on shoulder-related knowledge and self-efficacy with regard to prevention of shoulder pain and dysfunction. More than 50% of participants reported pain, decreased range of motion, or weakness in at least one shoulder since being diagnosed with ALS. All participants were interested in receiving educational materials, and all agreed that the brochure was easy to interpret and understand, with most (87%) reporting that it was helpful. Educational brochures are one strategy to improve awareness about shoulder health and to educate patients with ALS about exercises that may help reduce shoulder pain and dysfunction.

Yoga versus education for Veterans with chronic low back pain: study protocol for a randomized controlled trial.

PubMed

Saper, Robert B; Lemaster, Chelsey M; Elwy, A Rani; Paris, Ruth; Herman, Patricia M; Plumb, Dorothy N; Sherman, Karen J; Groessl, Erik J; Lynch, Susan; Wang, Shihwe; Weinberg, Janice

2016-04-29

Chronic low back pain is the most frequent pain condition in Veterans and causes substantial suffering, decreased functional capacity, and lower quality of life. Symptoms of post-traumatic stress, depression, and mild traumatic brain injury are highly prevalent in Veterans with back pain. Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials. However, it is unknown if results from previously published trials generalize to military populations. This study is a parallel randomized controlled trial comparing yoga to education for 120 Veterans with chronic low back pain. Participants are Veterans ≥18 years old with low back pain present on at least half the days in the past six months and a self-reported average pain intensity in the previous week of ≥4 on a 0-10 scale. The 24-week study has an initial 12-week intervention period, where participants are randomized equally into (1) a standardized weekly group yoga class with home practice or (2) education delivered with a self-care book. Primary outcome measures are change at 12 weeks in low back pain intensity measured by the Defense and Veterans Pain Rating Scale (0-10) and back-related function using the 23-point Roland Morris Disability Questionnaire. In the subsequent 12-week follow-up period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. We also assess cost-effectiveness from three perspectives: the Veteran, the Veterans Health Administration, and society using electronic medical records, self-reported cost data, and study records. This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities. ClinicalTrials.gov: NCT02224183.

Predictors of pain control in patients undergoing flexible bronchoscopy.

PubMed

Lechtzin, N; Rubin, H R; Jenckes, M; White, P; Zhou, L M; Thompson, D A; Diette, G B

2000-08-01

The purpose of this study was to assess the extent to which patients undergoing flexible bronchoscopy (FOB) experience pain and to identify patient factors and process of care factors that are associated with pain. We conducted a prospective cohort study on 481 patients undergoing FOB. Overall control of pain during FOB was the primary outcome. The mean age of the patients was 48 yr, 50% were male, and 32% required supplemental oxygen prior to FOB. Pain control was excellent in 36% of patients, but 10% considered it to be fair or poor. Patient factors associated with excellent pain control were excellent health (versus poor health, OR = 6.25 [95% CI, 2.28-16.67]), more education (college education versus high school education, OR = 1.72 [95% CI, 1.05-2.86]), and not having asthma (OR = 2.86 [95% CI, 1.09-7.14]). Process of care factors associated with excellent pain control were not being bothered by scope insertion (versus bothered, OR = 3.65 [95% CI, 1.99-6.98]), no memory of FOB (versus some memory, OR = 2.33 [95% CI, 1.24-4.44]), and higher ratings of information about the procedure (per 1-point increase on a 12-point scale, OR = 1.57 [95% CI, 1.41-1.78]). This is the first large-scale, prospective study to evaluate patient and process of care factors that influence pain control during FOB. It demonstrated that there are patient characteristics and process of care factors that need to be considered when evaluating pain during bronchoscopy. Improved preparation of patients with lower education, inferior health status, and asthma may lead to decreased pain during FOB. Bronchoscopists may be able to reduce pain during FOB by identifying methods to decrease pain on scope insertion, by improving the information provided to patients, and by achieving greater levels of amnesia during FOB.

Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial.

PubMed

Hurley, M V; Walsh, N E; Mitchell, H; Nicholas, J; Patel, A

2012-02-01

Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs. Copyright © 2012 by the American College of Rheumatology.

The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial.

PubMed

Saral, Ilknur; Sindel, Dilsad; Esmaeilzadeh, Sina; Sertel-Berk, Hanife Ozlem; Oral, Aydan

2016-10-01

We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the 'per-protocol' set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.

Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.

PubMed

Abdel-Aziem, Amr Almaz; Soliman, Elsadat Saad; Mosaad, Dalia Mohammed; Draz, Amira Hussin

2018-02-01

[Purpose] To examine the effect of physiotherapy rehabilitation program on moderate knee osteoarthritis in patients with different pain intensities. [Subjects and Methods] Sixty subjects (37 men and 23 women) with moderate knee osteoarthritis participated in the current study. Randomization software was used to select the participating subjects' numbers from the clinic records. They were classified into three groups according to pain intensity: mild, moderate, and severe pain groups. All groups underwent a standard set of pulsed electromagnetic field, ultrasound, stretching exercises, and strengthening exercises. Pain intensity, knee range of motion, knee function, and isometric quadriceps strength were evaluated using the visual analogue scale, universal goniometer, Western Ontario and McMaster Universities osteoarthritis index, and Jamar hydraulic dynamometer, respectively. The evaluation was performed before and after a 4-week rehabilitation program. [Results] All groups showed significant differences in pain intensity, knee range of motion, isometric quadriceps strength, and knee function. The score change in moderate pain group was significantly greater than those in mild and severe pain groups. [Conclusion] Pain intensity is one of the prominent factors that are responsible for the improvement of knee osteoarthritis. Consequently, pain intensity should be considered during rehabilitation of knee osteoarthritis.

Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors.

PubMed

Larrieux, Gregory; Wachi, Blake I; Miura, John T; Turaga, Kiran K; Christians, Kathleen K; Gamblin, T Clark; Peltier, Wendy L; Weissman, David E; Nattinger, Ann B; Johnston, Fabian M

2015-12-01

Despite previous literature affirming the importance of palliative care training in surgery, there is scarce literature about the readiness of Surgical Oncology and hepatopancreaticobiliary (HPB) fellows to provide such care. We performed the first nationally representative study of surgical fellowship program directors' assessment of palliative care education. The aim was to capture attitudes about the perception of palliative care and disparity between technical/clinical education and palliative care training. A survey originally used to assess surgical oncology and HPB surgery fellows' training in palliative care, was modified and sent to Program Directors of respective fellowships. The final survey consisted of 22 items and was completed online. Surveys were completed by 28 fellowship programs (70 % response rate). Only 60 % offered any formal teaching in pain management, delivering bad news or discussion about prognosis. Fifty-eight percent offered formal training in basic communication skills and 43 % training in conducting family conferences. Resources were available, with 100 % of the programs having a palliative care consultation service, 42 % having a faculty member with recognized clinical interest/expertise in palliative care, and 35 % having a faculty member board-certified in Hospice and Palliative Medicine. Our data shows HPB and surgical oncology fellowship programs are providing insufficient education and assessment in palliative care. This is not due to a shortage of faculty, palliative care resources, or teaching opportunities. Greater focus one valuation and development of strategies for teaching palliative care in surgical fellowships are needed.

Pain chronification: what should a non-pain medicine specialist know?

PubMed

Morlion, Bart; Coluzzi, Flaminia; Aldington, Dominic; Kocot-Kepska, Magdalena; Pergolizzi, Joseph; Mangas, Ana Cristina; Ahlbeck, Karsten; Kalso, Eija

2018-04-12

Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.

What's Your Position? Strategies for Safely Reaching Patient Comfort Goals After Cardiac Catheterization via Femoral Approach.

PubMed

Suggs, Patricia M; Lewis, Rebecca; Hart, Ann C; Troutman-Jordan, Meredith; Hardin, Sonya R

Patients frequently complain of back pain after cardiac catheterization, and there is a lack of evidence to guide practice regarding patient comfort while maintaining hemostasis at femoral access site after cardiac catheterization. The aim of this study was to examine if frequent position changes affect a patient's pain level or increase incidents of bleeding in the recovery period after cardiac catheterization. A quasi-experimental pretest/posttest design was used to evaluate a patient's reported pain levels and positioning changes during bed rest period postprocedure. Twenty charts were reviewed to note documentation of patient position, self-reported pain rating related to pain relief goals, and occurrence of bleeding at the procedure site. A survey was conducted to reveal nurse attitudes, knowledge, and beliefs regarding positioning and pain management for patients in the post-cardiac catheterization period. Results from this survey were used to develop education and data collection tools. Education regarding perceived barriers and importance of maximizing activity orders for patient comfort was provided to nursing staff. After nurse education, an additional 20 charts were reviewed to note if increasing frequency of position change affects pain levels reported by patients or if any increased incidence of bleeding was noted with greater frequency of position change. Data were analyzed using correlation analyses. Greater levels of pain were associated with higher pain ratings (r = 0.796, P < .000). Use of position change only as a comfort measure was negatively associated with pain ratings; in other words, lower patient pain ratings were associated with use of positioning only without addition of medications to address complaint (r = -0.493, P < .023). There was a significant increase in number of pain management goals met from before to after education intervention (P < .046). Nurse concern for increased bleeding was found to be the most common barrier for use of position changes for comfort after cardiac catheterization. This initial analysis suggests position changes in conjunction with pain medication are beneficial in managing pain after cardiac catheterization. There was no increase in bleeding or complications reported; however this study had a small sample size, and caution should be used regarding generalization of findings.

Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

PubMed Central

2013-01-01

Background Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors. Methods A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices. Results Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents’ presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio ≥ median was associated with better pain management at triage. Conclusions Despite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced. PMID:24020369

Fostering change in back pain beliefs and behaviors: when public education is not enough.

PubMed

Gross, Douglas P; Deshpande, Sameer; Werner, Erik L; Reneman, Michiel F; Miciak, Maxi A; Buchbinder, Rachelle

2012-11-01

Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

Epidemiology of chronic pain in the office of a pain specialist neurologist.

PubMed

Ferreira, Karen dos Santos; Speciali, José Geraldo

2015-07-01

The objective of the present report was to describe the working experience of a pain specialist neurologist after concluding a medical residency program on neurology, area of concentration pain. A retrospective study was conducted for one year in the office of a pain specialist neurologist. Patients older than 18 years with chronic pain according to the criteria of the International Association for the Study of Pain, were included. Demographic data, chronic pain data and the treatments instituted were investigated. A total of 241 medical records were reviewed, mean patient age was 52.4 years and 79 (66.9%) were women, and the mean score on a numeric pain scale was 8.69. The diagnoses were headaches (74.6%), neuropathic pain (17%) and ostheomuscular pain (8.2%). We did not detect cancer pain. Patients received medication and procedures of anesthetic blockade. This data can guide new medical residency programs on Neurology, area of concentration pain, to plan activities and studies.

Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis.

PubMed

de Campos, Tarcisio F; Maher, Chris G; Steffens, Daniel; Fuller, Joel T; Hancock, Mark J

2018-06-13

What is the effectiveness of interventions that aim to prevent a new episode of neck pain? Systematic review and meta-analysis of randomised, controlled trials. People without neck pain at study entry. Any intervention aiming to prevent a future episode of neck pain. New episode of neck pain. Five trials including a total of 3852 individuals met the inclusion criteria. The pooled results from two randomised, controlled trials (500 participants) found moderate-quality evidence that exercise reduces the risk of a new episode of neck pain (OR 0.32, 95% CI 0.12 to 0.86). One of the meta-analysed trials included some co-interventions with the exercise. There was low-quality evidence from three randomised, controlled trials (3352 participants) that ergonomic programs do not reduce the risk of a new neck pain episode (OR 1.00, 95% CI 0.74 to 1.35). This review found moderate-quality evidence supporting the effectiveness of an exercise program for reducing the risk of a new episode of neck pain. There is a need for high-quality randomised, controlled trials evaluating interventions to prevent new episodes of neck pain. PROSPERO CRD42017055174. [de Campos TF, Maher CG, Steffens D, Fuller JT, Hancock MJ (2018) Exercise programs may be effective in preventing a new episode of neck pain: a systematic review. Journal of Physiotherapy XX: XX-XX]. Copyright © 2018 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students:a randomized controlled study.

PubMed

Toprak Çelenay, Şeyda; Özer Kaya, Derya

2017-04-18

To investigate the effects of an 8-week thoracic stabilization exercise program on back pain, spinal alignment, postural sway, and core endurance in university students. University students were randomly allocated into exercise (n: 28) and control (n: 25) groups. The exercise program was carried out 3 days a week for 8 weeks. Postural pain, spinal alignment, postural sway, and core endurance were assessed via visual analogue scale, Spinal Mouse, Biodex Balance System, and McGill's trunk muscle endurance tests at the baseline and after 8 weeks of training. Differences were observed for postural pain, thoracic and lumbar curvature, dynamic stability index (eyes closed), and core endurance scores in the exercise group between baseline and week 8 (P < 0.05) and all the parameters were significantly different when compared to those of the control group (P < 0.05). The program decreased postural pain, spinal curvatures, and postural sway, and increased core endurance in university students. The program can be effective in postural pain and misalignment of spine problems related to core weakness and balance disorders.

The business of palliative medicine--Part 3: The development of a palliative medicine program in an academic medical center.

PubMed

Nelson, Kristine A; Walsh, Declan

2003-01-01

Palliative medicine is the total continuing care of patients with cancer. Most resources for cancer care focus on curative attempts while often ignoring the symptoms created by the disease and its treatment. Attempts at curative treatment of the malignancy must be coupled with pain and symptom relief psychosocial and spiritual care, and support for the patient and family extending from the time of diagnosis through the bereavement period. To accomplish this important goal, we must establish comprehensive palliative medicine programs in cancer centers throughout the world. These programs must include education, research, and patient care and must work through an interdisciplinary team. The Cleveland Clinic Foundation palliative medicine program (PMP) is composed of a primary inpatient service, consult service, outpatient clinic, hospice homecare, and cancer homecare services. In this article, we describe the structure and development of the program and suggest future avenues for growth.

The Pain Course: Exploring the Feasibility of an Internet-delivered Pain Management Program When Offered by a Tertiary Pain Management Service.

PubMed

Dear, Blake F; Courtney, Catherine; Khor, Kok Eng; McDonald, Sarah; Ricciardi, Tahlia; Gandy, Milena; Fogliati, Vincent J; Titov, Nick

2018-06-01

This study examined the acceptability and preliminary outcomes of an internet-delivered pain management program, the Pain Course, when offered by a specialist pain management clinic in a large public hospital. A single-group feasibility open-trial design was used and 39 patients participated in the program, which ran for 8 weeks. Participants were supported through the program with weekly contact from a Clinical Psychologist at the clinic. All participants provided data at posttreatment and >90% of participants completed all 5 lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M=71.99 min/participant; SD=32.82 min) was required to support patients through the program. Preliminary evidence of clinical improvements in depression symptoms (avg. improvement=38%; Cohen d=0.74), but not disability levels or anxiety symptoms, was observed in the overall sample. However, evidence of improvements was observed across all the primary outcomes among patients who had clinical levels of difficulties with disability (n=20; avg. improvement=11%; Cohen d=0.64), depression (n=17; avg. improvement=35%; Cohen d=1.24) and anxiety (n=8; avg. improvement=29%; Cohen d=0.57). These findings highlight the potential value of internet-delivered programs when provided by specialist pain management clinics as a part of their services and the value of larger scale studies in this area.

Facts and Figures on Pain

MedlinePlus

... Care, Education, and Research , pain is a significant public health problem that costs society at least $560-$635 billion annually, an ... pain or children. ( 20 ) Pain is a significant public health problem that costs society at least $560-$635 billion annually (an ...

What a Pain! Kids and Growing Pains

MedlinePlus

... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body ... for Educators Search English Español What a Pain! Kids and Growing Pains KidsHealth / For Kids / What a ...

Placebo Use in Pain Management: A Mechanism-Based Educational Intervention Enhances Placebo Treatment Acceptability.

PubMed

Kisaalita, Nkaku R; Hurley, Robert W; Staud, Roland; Robinson, Michael E

2016-02-01

Health care providers use treatments whose effectiveness derives partially or completely from 'nonspecific' factors, frequently referred to as placebo effects. Although the ethics of interventional placebo use continues to be debated, evidence suggests that placebos can produce clinically meaningful analgesic effects. Burgeoning evidence suggest that patients with chronic pain might be open to placebo treatments in certain contexts despite limited knowledge of their well-established psychoneurobiological underpinnings. In this investigation we sought to examine the effects of a brief, mechanism-based placebo analgesia educational intervention on aspects placebo knowledge and acceptability. Participants with chronic musculoskeletal pain completed a web-based survey in which they rated their knowledge of placebo analgesia, assessed placebo acceptability across different medical contexts, and evaluated 6 unique patient-provider treatment scenarios to assess the role of treatment effectiveness and deception on patient-provider attributions. Using a pre-post design, participants were randomized to receive either a placebo educational intervention or an active control education. Results showed that the educational intervention greatly improved perceptions of placebo knowledge, effectiveness, and acceptability, even in deceptive treatment contexts. This was the first study of its kind to show the value of an educational intervention in increasing openness to and knowledge of placebo analgesic interventions among patients with chronic musculoskeletal pain. In this we article highlight how patients with chronic pain might be open to placebo interventions, particularly adjunct and/or complementary treatments, when provided education on the neurobiological and psychological mechanisms that underlie placebo effects. Study findings highlight ethically acceptable ways to potentially use placebo factors to enhance existing pain treatments and improve patient health outcomes. Published by Elsevier Inc.

Depression (Major Depressive Disorder)

MedlinePlus

... through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed Feb. 11, 2016. Stanos S. Focused review of interdisciplinary pain rehabilitation programs for chronic pain management. Current Pain and ...

Toward the development of a motivational model of pain self-management.

PubMed

Jensen, Mark P; Nielson, Warren R; Kerns, Robert D

2003-11-01

Adaptive management of chronic pain depends to a large degree on how patients choose to cope with pain and its impact. Consequently, patient motivation is an important factor in determining how well patients learn to manage pain. However, the role of patient motivation in altering coping behavior and maintaining those changes is seldom discussed, and theoretically based research on motivation for pain treatment is lacking. This article reviews theories that have a direct application to understanding motivational issues in pain coping and presents a preliminary motivational model of pain self-management. The implications of this model for enhancing engagement in and adherence to chronic pain treatment programs are then discussed. The article ends with a call for research to better understand motivation as it applies to chronic pain self-management. In particular, there is a need to determine whether (and which) motivation enhancement interventions increase active participation in self-management treatment programs for chronic pain.

Evaluation of an occupational rehabilitation program.

PubMed

Goodman, Glenn; Browning, Margaret; Campbell, Sims; Hudak, Huison

2005-01-01

The purpose of this study was to report the findings of a program evaluation for an occupational rehabilitation program in the Midwest. An ex-post facto chart review was performed on 50 charts using demographic data, results from tests of performance and pain measures, and data from patient satisfaction questionnaires to find evidence of excellence in the program, and to identify areas for improvement. Over 97% of the participants actually completed the program and 76% returned to work within 3 months after program completion. Ninety-two percent indicated overall satisfaction with the program, and all aspects of the program were rated with a mean score of 4.25 or above on a 1 to 5 Likert scale. Evaluation of perceived pain scales of the participants indicate no discernable relationship between intensity of pain and successful return to work. The program showed a high completion rate, a high return to work rate, and high levels of patient satisfaction. Suggestions for improvement include an increase in use of real and simulated work activities, better documentation of pain measures, better programs to address psychosocial issues, lengthening the program, and increased communication with case managers and professionals outside of the work program.

Knee osteoarthritis related pain: a narrative review of diagnosis and treatment.

PubMed

Alshami, Ali M

2014-01-01

Osteoarthritis is a common progressive joint disease, involving not only the joint lining but also cartilage, ligaments, and bone. For the last ten years, majority of published review articles were not specific to osteoarthritis of the knee, and strength of evidence and clinical guidelines were not appropriately summarized. To appraise the literature by summarizing the findings of current evidence and clinical guidelines on the diagnosis and treatment of knee osteoarthritis pain. English journal articles that focused on knee osteoarthritis related pain were searched via PubMed (1 January 2002 - 26 August 2012) and Physiotherapy Evidence Database (PEDro) databases, using the terms 'knee', 'osteoarthritis' and 'pain'. In addition, reference lists from identified articles and related book chapters were included as comprehensive overviews. For knee osteoarthritis, the highest diagnostic accuracy can be achieved by presence of pain and five or more clinical or laboratory criteria plus osteophytes. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. Generally, paracetamol, oral and topical non-steroidal anti-inflammatory drugs, opioids, corticosteroid injections and physical therapy techniques, such as therapeutic exercises, joint manual therapy and transcutaneous electrical nerve stimulation, can help reduce pain and improve function. Patient education programs and weight reduction for overweight patients are important to be considered. Some inconsistencies in the recommendations and findings were found between the clinical guidelines and systematic reviews. However, it is likely that a combination of pharmacological and non-pharmacological treatments is most effective in treating patients with knee osteoarthritis.

The Use of Mind-body Medicine in Chronic Pain Management: Differential Trends and Session-by-Session Changes in Anxiety

PubMed Central

Cosio, David; Swaroop, Sujata

2016-01-01

The evidence to date suggests that the use of mind-body medicine in chronic pain management can improve physical and psychological symptoms. However, past research evidence has largely relied on global measures of distress at pre- and post-intervention. Even though it is plausible that reported anxiety occurs in the context of pain, there is also evidence to suggest a reciprocal relationship. Thus, the purpose of the current study was to determine the differential impact that mind-body medical interventions have on anxiety among Veterans with chronic, non-cancer pain. The current study utilized multiple, repeated assessments of anxiety to better understand changes made over time between two mind-body interventions (Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT)) used for chronic pain management. Ninety-six Veterans elected to participate in either intervention following the completion of a pain health education program at a Midwestern VA Medical Center between November 3, 2009–November 4, 2010. A 2 × 7 repeated measures multivariate analyses of variance indicated significantly lower levels of global distress by the end of both the ACT and CBT interventions. Trend analysis revealed differential patterns of change in levels of anxiety over time. Helmert contrast analyses found several modules of ACT were statistically different than the overall mean of previous sessions. Implications related to timing and patterns of change for the interventions are discussed. PMID:27158683

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.

PubMed

Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

2014-06-01

Case report. Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.

A randomized, clinical trial of education or motivational-interviewing-based coaching compared to usual care to improve cancer pain management.

PubMed

Thomas, Mary Laudon; Elliott, Janette E; Rao, Stephen M; Fahey, Kathleen F; Paul, Steven M; Miaskowski, Christine

2012-01-01

To test the effectiveness of two interventions compared to usual care in decreasing attitudinal barriers to cancer pain management, decreasing pain intensity, and improving functional status and quality of life (QOL). Randomized clinical trial. Six outpatient oncology clinics (three Veterans Affairs [VA] facilities, one county hospital, and one community-based practice in California, and one VA clinic in New Jersey)Sample: 318 adults with various types of cancer-related pain. Patients were randomly assigned to one of three groups: control, standardized education, or coaching. Patients in the education and coaching groups viewed a video and received a pamphlet on managing cancer pain. In addition, patients in the coaching group participated in four telephone sessions with an advanced practice nurse interventionist using motivational interviewing techniques to decrease attitudinal barriers to cancer pain management. Questionnaires were completed at baseline and six weeks after the final telephone calls. Analysis of covariance was used to evaluate for differences in study outcomes among the three groups. Pain intensity, pain relief, pain interference, attitudinal barriers, functional status, and QOL. Attitudinal barrier scores did not change over time among groups. Patients randomized to the coaching group reported significant improvement in their ratings of pain-related interference with function, as well as general health, vitality, and mental health. Although additional evaluation is needed, coaching may be a useful strategy to help patients decrease attitudinal barriers toward cancer pain management and to better manage their cancer pain. By using motivational interviewing techniques, advanced practice oncology nurses can help patients develop an appropriate plan of care to decrease pain and other symptoms.

The palliative care knowledge questionnaire for PEACE: reliability and validity of an instrument to measure palliative care knowledge among physicians.

PubMed

Yamamoto, Ryo; Kizawa, Yoshiyuki; Nakazawa, Yoko; Morita, Tatsuya

2013-11-01

In Japan, a nationwide palliative care education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. Effective delivery of such programs relies on adequate evaluations of program efficacy; however, such an instrument does not exist. This study aimed to develop and validate a measurement tool to quantify knowledge level of physicians about broader areas of palliative care, by which the effect of an education program could be measured. We conducted a cross-sectional, anonymous, self-administered questionnaire survey with a group of 801 conveniently sampled physicians in October 2010. To examine the test-retest reliability of items and domains, the questionnaire was reissued two weeks after the first survey was completed. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. The response rate was 54% (n=434). We included 33 items across the following 9 domains: (1) philosophy of palliative care, (2) cancer pain, (3) side effects of opioids, (4) dyspnea, (5) nausea and vomiting, (6) psychological distress, (7) delirium, (8) communication regarding palliative care, and (9) community-based palliative care. For these items, the intraclass correlation was 0.84 and the Kuder-Richardson Formula 20 (KR-20) test of internal consistency was 0.87. There was a significant difference in the scores between palliative care specialists and other physicians. We successfully validated a newly developed palliative care knowledge questionnaire to evaluate PEACE effectiveness (PEACE-Q). The PEACE-Q could be useful for evaluating both palliative care knowledge among physicians and education programs in primary palliative care.

Minding the Gaps in Cancer Pain Management Education: A Multicenter Study of Clinical Residents and Fellows in a Low- Versus High-Resource Setting

PubMed Central

Osei-Bonsu, Ernest; Tetteh, Oswald; Haig, Andy; Mayer, Robert Samuel; Smith, Thomas J.

2016-01-01

Purpose Inadequate pain management training has been reported as a major cause of undertreatment of cancer pain. Yet, past research has not comprehensively compared the quality of cancer pain management education among physicians in training in high-resource countries (HRCs) with those in low-resource countries (LRCs). The purpose of this study was to examine and compare gaps in cancer pain management education among physician trainees in an HRC (United States) versus an LRC (Ghana). Methods A cross section of physicians at four major academic medical centers completed surveys about the adequacy of cancer pain training. Participation in the study was completely voluntary, and paper or online surveys were completed anonymously. Results The response rate was 60% (N = 120). Major gaps were identified in cancer pain management education across the spectrum of medical school training. Training was rated as inadequate (by approximately 80% of trainees), although approximately 10% more trainees in HRCs versus LRCs felt this way; 35% said residency training was inadequate in both settings; and 50% in LRCs versus 44% in HRCs said fellowship training was less than good. On the basis of the lowest group means, the three key areas of perceived deficits included interventional pain procedures (2.34 ± 1.12), palliative care interventions (2.39 ± 1.12), and managing procedural and postoperative pain (2.94 ± 0.97), with significant differences in the distribution of deficits in 15 cancer-pain competencies between LRCs and HRCs (P < .05). Conclusion This study identifies priority areas that could be targeted synergistically by LRCs and HRCs to advance cancer care globally. The findings underscore differential opportunities to broaden and improve competencies in cancer pain management via exchange training, in which physicians from HRCs spend time in LRCs and vice versa. PMID:28717725

Home-Based Palliative Care Program Relieves Chronic Pain in Kerala, India: Success Realized Through Patient, Family Narratives.

PubMed

Ajjarapu, Aparna Sai; Broderick, Ann

2018-06-14

An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment. The current project features the pain stories of six patients who received treatment from Pallium India. Basic patient demographic information was collected, and a Pallium India staff member who was fluent in Malayalam and English asked questions about each patient's pain experience. Pain narratives illustrate the substantial impact of Pallium India's home visit program and the role of total pain assessment in delivering high-quality palliative care.

A Stress Inoculation Program for Parents Whose Children Are Undergoing Painful Medical Procedures.

ERIC Educational Resources Information Center

Jay, Susan M.; Elliott, Charles H.

1990-01-01

Compared program efficacy in helping parents cope with children's painful medical procedures. Parents (n=72) of pediatric leukemia patients participated in either stress inoculation program or observed child participating in cognitive behavior therapy. Found parents in stress inoculation program reported lower anxiety scores and higher positive…

Sports and performing arts medicine. 2. Shoulder and elbow overuse injuries in sports.

PubMed

Akuthota, Venu; Chou, Larry H; Drake, David F; Nadler, Scott F; Toledo, Santiago D

2004-03-01

This self-directed learning module discusses classic topics and highlights new advances in this area. This article discusses upper-limb sports injuries as part of a section of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article uses case vignettes as a vehicle to elaborate on shoulder and elbow pain in the athlete. To discuss shoulder and elbow overuse injuries in sports.

Knowledge, compliance with good clinical practices and barriers to effective control of postoperative pain among nurses from hospitals with and without a "Hospital without Pain" certificate.

PubMed

Tomaszek, Lucyna; Dębska, Grażyna

2018-04-01

(i) To compare knowledge and compliance with good clinical practices regarding control of postoperative pain among nurses employed at hospitals with and without a "Hospital without Pain" certificate, (ii) to identify the determinants of nurses' knowledge and (iii) to define barriers to effective control of postoperative pain. Only a slight improvement in postoperative pain control has been observed recently, if any. Implementation of good clinical practices in the control of postoperative pain requires involvement of nurses. A cross-sectional study. The study included 257 nurses from hospitals with a "Hospital without Pain" certificate and 243 nurses from noncertified hospitals, with mean job seniority of 17.6 ± 9.6 years. All respondents answered 26 questions regarding postoperative pain control-related issues. Based on the answers, overall scores were calculated for (i) nurses' knowledge, (ii) compliance with good clinical practices and (iii) barriers to effective control of postoperative pain. Nurses from the certified hospitals presented with significantly higher levels of knowledge and compliance with good clinical practices and identified significantly more barriers to effective control of postoperative pain. Apart from certification of a hospital, better knowledge of postoperative pain control was determined by higher education, participation in postgraduate training programmes and other relevant courses, self-education from medical journals, employment at paediatric ward or intensive care unit. The most commonly reported barriers to effective control of pain included too low doses of painkillers prescribed by physicians and inability to modify the protocol of pain treatment by the nurse. Control of postoperative pain can be improved by enrolling nurses in various forms of continuous training and by providing them with greater autonomy in administering painkillers to surgical patients. Better quality of care offered to patients with postoperative pain can be achieved by continuous education of nurses and physicians, and greater compliance with relevant good clinical practices. © 2017 John Wiley & Sons Ltd.

Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature.

PubMed

Puentedura, Emilio J; Flynn, Timothy

2016-07-01

Teaching people with chronic low back pain (CLBP) about the neurobiology and neurophysiology of their pain is referred to as pain neuroscience education (PNE). There is growing evidence that when PNE is provided to patients with chronic musculoskeletal pain, it can result in decreased pain, pain catastrophization, disability, and improved physical performance. Because the aim of PNE is to shift the patient's focus from the tissues in the low back as the source of their pain to the brain's interpretation of inputs, many clinicians could mistakenly believe that PNE should be a "hands-off," education-only approach. An argument can be made that by providing manual therapy or exercise to address local tissue pathology, the patient's focus could be brought back to the low back tissues as the source of their problem. In this narrative literature review, we present the case for a balanced approach that combines PNE with manual therapy and exercise by considering how manual therapy can also be incorporated for interventions with patients with CLBP. We propose that as well as producing local mechanical effects, providing manual therapy within a PNE context can be seen as meeting or perhaps enhancing patient expectations, and also refreshing or sharpening body schema maps within the brain. Ideally, all of this should lead to better outcomes in patients with CLBP.

The effects of a standardized belly dance program on perceived pain, disability, and function in women with chronic low back pain.

PubMed

Castrillon, Tabitha; Hanney, William J; Rothschild, Carey E; Kolber, Morey J; Liu, Xinliang; Masaracchio, Michael

2017-01-01

An alternative approach to facilitate movement and control through the trunk and pelvis is belly dancing. Investigations of belly dancing mechanics indicate similar muscular activation patterns of those known to influence chronic low back pain (cLBP). However, no documented studies have examined its effectiveness as a treatment for cLBP. The purpose of this study was to investigate the influence of a standardized belly dance program in women with cLBP. A single subject design was used to evaluate weekly outcomes during a three-week baseline period, six-week belly dance program, and again at a two-month follow-up. Outcome measures for pain, disability, function, and fear-avoidance beliefs were utilized. Two subjects completed the program. No significant differences were noted during the baseline assessment period. At two months, subject one demonstrated change scores of -1.12, -1%, and 2.2 for pain, disability, and function respectively while subject two demonstrated change scores of 5.4, 5%, and 1.1 for pain, disability, and function, respectively. Subject one showed a clinically significant change score for both fear avoidance of work and physical activity, with score changes of 4 and 3.3, respectively. The results of this study suggest a standardized belly dance program may positively influence pain and function in women with cLBP.

[Development and application of a computerized nursing process program for orthopedic surgery inpatients-- NANDA, NOC, and NIC linkages].

PubMed

Kim, Hye-Suk

2005-10-01

The purpose of this study was to develop and to apply the NANDA, NOC, and NIC (NNN) linkages into a computerized nursing process program using the classification systems of nursing diagnoses, nursing outcomes and nursing interventions. The program was developed with planning, analysis, design and performance stages. The program was applied to 117 patients who were admitted to orthopedic surgery nursing units from January to February, 2004. Thirty-five of fifty-three nursing diagnoses were identified. Five nursing diagnoses in order of frequency were: Acute pain (28.4%), Impaired physical mobility (15.6%), Impaired walking (8.7%), Chronic pain (5.5%) and Risk for disuse syndrome (5.0%). The nursing outcomes of the 'Acute pain' nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (95.2%), Comfort level (35.5%) and Pain level (17.7%). The nursing interventions of the 'Acute pain' nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (71.0%), Splinting (24.2%) and Analgesic administration (17.7%). In comparison of outcome indicator scores between before and after the intervention according to the 61 nursing outcomes, the mean scores of 52 outcome indicators after the intervention were significantly higher than before the intervention. It is expected that this program will help nurses perform their nursing processes more efficiently.

Knowledge levels of pharmaceutical sales representatives in pain therapy: a descriptive questionnaire-based study.

PubMed

Lassen, Christoph L; Fragemann, Kirstin; Klier, Tobias; Meyer, Nicole; Graf, Bernhard M; Wiese, Christoph H R

2012-02-01

Pain is a common physiological reaction. The development and sale of medication against pain is a main focus of pharmaceutical companies, with total sales of prescription analgesics amounting to US$50 billion in 2009. In this market, advertising is necessary. One way to market both new and old drugs is through direct physician-to-pharmaceutical sales representative (PSR) contact. PSRs see themselves ideally as equal partners to the physicians they advise, thereby setting high standards for themselves. In this setting, PSRs should therefore have an adequate knowledge of pain therapy. The aim of this study was to evaluate whether these standards can be met by PSRs working in the area of pain medicine in terms of their level of education and knowledge of pain topics. We distributed 114 questionnaires that were divided into demographic and knowledge sections. Of these, 90 questionnaires (79%) were returned completed. Since there is no complete list of PSRs working in pain medicine in Germany, we could not draw a representative sample for our study. We collected general demographic data on PSRs as well as on their educational backgrounds. Analysis of the completed questionnaires revealed that there was a high requirement for PSRs to acquire further education in pain therapy. In the knowledge section, PSRs were asked to rate a total of 70 statements on pain therapy as to whether they were true or false. The mean total of correctly rated statements was 48 (69%). Based on the results, we conclude that most PSRs do not meet their ideal high standards of being equal partners to the specialist physicians they visit. More education is needed to achieve this goal.

Four components of pain management in Iranian neonatal Intensive Care Units: The nurses’ and physicians’ viewpoint

PubMed Central

Mohamadamini, Zahra; Namnabati, Mahboobeh; Marofi, Maryam; Barekatein, Behzad

2017-01-01

BACKGROUND: As an important right and a treatment priority, pain management and alleviation can prevent harmful consequences and sever effects to the infant. The aim of this study was to determine the nurses and physicians’ viewpoints about assessment, intervention, and evaluation of pain in the infants in the neonatal Intensive Care Units (NICUs). METHODS: The cross-sectional study was performed in census method in the NICUs of educational hospitals with participation of 157 staff in 2015 in Iran. Data collection tool was a questioner that was designed to assess the four components of pain management namely assessment, pharmacological intervention, nonpharmacological intervention, and evaluation. The collected data were analyzed in a descriptive and inferential statistics by means of the SPSS software, version 16. RESULTS: The findings of study indicated the total average scores of pain management from nurses and physicians’ viewpoint 66.7 and 65.5, respectively that were at the moderate level. The average score of nonpharmacological interventions from nurses’ viewpoint (69.4) was meaningfully higher than that of the physicians’. A significant relationship was noticed between the respondents’ viewpoint on the nonpharmacological interventions and their NICU background (r = 0.18, P = 0.03). A meaningful relation was found between participation in continuing education and scores of pain management. CONCLUSIONS: The results of this study showed that the nurses and physicians’ viewpoint about pain management was at a moderate level. The effect of work experience and continuing education on pain management is proved in the study. Researchers suggest that both experienced staff employment and education continuation must be incorporated in pain management in NICUs. PMID:28852655

[Self-efficacy and self management of healthy habits in fibromyalgia].

PubMed

Pérez-Velasco, María; Peñacoba-Puente, Cecilia

2015-01-01

Fibromyalgia is a disorder characterized by general chronic pain, together with other symptoms such as fatigue, sleep disorders, anxiety and depression. To analyze, in FM patients, the effects of a multi-component intervention program (nursing+cognitive-behavioural therapy, focused on improving resting habits, physical exercise, and family relationships, working simultaneously on empowerment and patient self-efficacy. A quasi-experimental design was used following-up 5 women diagnosed with fibromyalgia. An analysis was performed on their daily habits, self-efficacy for chronic pain, pain perception, functional limitation, and affect. The intervention was composed by 8 group sessions: Six of them aimed at health education and self-management of healthy habits (nursing), and two sessions dedicated to increasing self-efficacy (cognitive-behavioural therapy). Follow-up consisted of five individual sessions (nursing) so as to consolidate the newly acquired habits, maintain self-management and self-efficacy based on observing compliance. Statistically significant improvements were observed (pre-, pos-) in habit modification and in self-efficacy, as well as for positive and negative affect. Also, statistically significant differences were found pre-follow up for functional limitation. The role of nursing has to be considered within multi-component programs, in particular during follow-up, for changing habits and for self-efficacy, in response to some of the current limitations of interventions with these patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Higher education is associated with a better rheumatoid arthritis outcome concerning for pain and function but not disease activity: results from the EIRA cohort and Swedish rheumatology register.

PubMed

Jiang, Xia; Sandberg, Maria E C; Saevarsdottir, Saedis; Klareskog, Lars; Alfredsson, Lars; Bengtsson, Camilla

2015-11-06

Whether low socioeconomic status (SES) is associated with worse rheumatoid arthritis (RA) outcomes in countries with general tax-financed healthcare systems (such as Sweden) remains to be elucidated. Our aim was to investigate the influence of educational background (achieving university/college degree (high) or not (low)) on the outcomes of early RA, in terms of disease activity (DAS28), pain (VAS-pain), and functional impairment (HAQ). We evaluated DMARD-naïve RA patients recruited in the Epidemiological Investigation of RA (EIRA) study with outcomes followed in the Swedish Rheumatology Quality (SRQ) register (N = 3021). Outcomes were categorized in three ways: (1) scores equal to/above median vs. below median; (2) DAS28-based low disease activity, good response, remission; (3) scores decreased over the median vs. less than median. Associations between educational background and outcomes were calculated by modified Poisson regressions, at diagnosis and at each of the three standard (3, 6, 12 months) follow-up visits. Patients with different educational background had similar symptom durations (195 days) and anti-rheumatic therapies at baseline, and comparable treatment patterns during follow-up. Patients with a high education level had significantly less pain and less functional disability at baseline and throughout the whole follow-up period (VAS-pain: baseline: 49 (28-67) vs. 53 (33-71), p <0.0001; 1-year visit: RR = 0.81 (95% CI 0.73-0.90). HAQ: baseline: 0.88 (0.50-1.38) vs. 1.00 (0.63-1.50), p = 0.001; 1-year visit: 0.84 (0.77-0.92)). They also had greater chances to achieve pain remission (VAS-pain ≤20) after one year (1.17 (1.07-1.28)). Adjustments for smoking and BMI altered the results only marginally. Educational background did not influence DAS28-based outcomes. In Sweden, with tax-financed, generally accessible healthcare system, RA patients with a high education level experienced less pain and less functional disability. Further, these patients achieved pain remission more often during the first year receiving standard care. Importantly, education background affected neither time to referral to rheumatologists, disease activity nor anti-rheumatic treatments.

Answering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health.

PubMed

Schoneboom, Bruce A; Perry, Susan M; Barnhill, William Keith; Giordano, Nicholas A; Wiltse Nicely, Kelly L; Polomano, Rosemary C

2016-01-01

Chronic noncancer pain (CNCP) in military and veteran populations mirrors the experience of chronic pain in America; however, these two populations have unique characteristics and comorbid conditions such as traumatic brain injuries, postconcussive syndrome, posttraumatic stress disorder, and behavioral health disorders that complicate the diagnosis and treatment of chronic pain. Military members and veterans may also be stigmatized about their conditions and experience problems with integration back into healthy lifestyles and society as a whole following deployments and after military service. The military and veteran health care systems have made chronic pain a priority and have made substantial strides in addressing this condition through advances in practice, education, research, and health policy. Despite this progress, significant challenges remain in responding to the wide-spread problem of chronic pain. The purpose of this article is to: (a) examine the state of CNCP in military and veteran populations; (b) discuss progress made in pain practice, education, research, and health policy; and (c) examine research, evidence-based practice guidelines, and expert consensus reports that are foundational to advancing pain care and improving health for military service members and veterans with CNCP. In addition, recommendations are proposed to address this widespread health problem through the expanded use of advanced practice registered nurses, the implementation of models of care, and use of national resources to educate health care providers, support practice, and promote effective pain care. Copyright © 2016 Elsevier Inc. All rights reserved.

An educational strategy for treating chronic, noncancer pain with opioids: a pilot test.

PubMed

Elhwairis, Huda; Reznich, Christopher B

2010-12-01

Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain. This article demonstrates that multiple teaching modalities-including didactic lectures, case discussions, write-up of a management plan following a model, and role-play group activities-are effective methods of teaching internal medicine residents how to use opioids to manage chronic noncancer pain. Copyright © 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

Learned Resourcefulness and the Long-Term Benefits of a Chronic Pain Management Program

ERIC Educational Resources Information Center

Kennett, Deborah J.; O'Hagan, Fergal T.; Cezer, Diego

2008-01-01

A concurrent mixed methods approach was used to understand how learned resourcefulness empowers individuals. After completing Rosenbaum's Self-Control Schedule (SCS) measuring resourcefulness, 16 past clients of a multimodal pain clinic were interviewed about the kinds of pain-coping strategies they were practicing from the program. Constant…

Training of medical staff positively influences postoperative pain management at home in children.

PubMed

Sepponen, K; Kokki, H; Ahonen, R

1999-08-01

The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

Parent Perspectives on Pain Management in Preschool-Age Children With Sickle Cell Disease.

PubMed

Smith, Kelsey; Reinman, Laura; Schatz, Jeffrey; Roberts, Carla W

Pain episodes occur for many preschoolers with sickle cell disease (SCD), but little is known about parent perceptions of managing pain episodes in young children. We surveyed parents of young children with SCD who had managed pain episodes in the past year to assess their management and satisfaction with their strategies, challenges of pain management, and interest in additional education. Parents were recruited from health maintenance visits at a SCD specialty clinic. Forty-two of 51 parents (82%) of 2- to-6-year-olds reported managing pain over the past year. Parents who had managed pain primarily reported using medications. These parents reported at least moderate satisfaction with current management strategies and resources. At least one-third of parents found each facet of pain management queried as at least somewhat challenging. Identifying when their child was in pain, encouraging functional activities, and managing irritable behavior were reported as most challenging. Parents of young children with SCD reported interest in additional pain management education, which could promote better parent and child coping skills.

Are low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers? A follow-up study.

PubMed

Faber, Anne; Giver, Hanne; Strøyer, Jesper; Hannerz, Harald

2010-12-01

A high job turnover and dropout among eldercare workers has led to a significant shortage of qualified manpower in the Danish eldercare sector. The predictive effect of some non-work-related causes for leaving the eldercare sector 2 years after qualification, physical capacity, duration, and severity of previous low back pain, was investigated. A 2-year prospective cohort study of all the Danish eldercare workers, who finished their education during 2004 (n = 6347). Questionnaire data from 2004 were followed up by register data on attachment to labour market, educational status, and association to trade from Statistics Denmark in 2006. Data on physical capacity, duration, and severity of low back pain the last 12 months among the female participants were analysed by multinomial logistic regression to estimate odds-ratios for being either in the eldercare sector, in other health- and welfare sectors, in all other sectors, under education, or outside labour market, 2 years after qualification. Disability due to and duration of low back pain were significant predictors for dropout from the eldercare sector 2 years after qualification. Low physical capacity was not. Data on duration of low back pain suggest a trend towards a dose-response relationship: The longer the duration of low back pain, the higher odds for dropout. Low back pain and disability due to low back pain during the last year of education were independent predictors for dropout from the eldercare sector 2 years after qualification. However, low self-rated physical capacity did not predict job dropout or turnover.

Health promotion and patient education benefits for employees.

PubMed

Mullen, P D

1988-01-01

One step that employers can take to assure that employees receive such education services is pursuing coverage of education as a separate service. For some time now, insurers have shown interest in patient education services (15-17, 61), but patient education "integral to care" is typically covered only as a part of the "per diem" in the case of hospitals or as part of the visit fee in the case of outpatient visits. Education for patients with diabetes is being covered experimentally as a separate service in at least 17 states. Physicians whose practice is composed largely of "cognitive services" rather than "procedures" are also interested in education as a reimbursable service. The same arguments as described in relation to coverage of risk reduction services generally apply to this case. Education programs for employees who are under medical care can improve their adherence to the recommended regimen and hence can improve the effectiveness of care. Education and counseling prior to surgical and other stressful procedures decrease stress and the need for pain medications, and they can shorten the length of hospital stays. Education is an important component of programs to substitute home care for hospital care or expensive outpatient care. Currently, however, a patient cannot rely on usual providers of medical care to offer adequate education. Reimbursement for patient education on a selected, experimental basis is probably warranted for chronic conditions requiring complex adjustments and regimens. Cases of asthma where there is a history of hospitalization or emergency room visits is an excellent possibility. The experience of covering diabetes education should be monitored to help resolve the debate.

Content and Evaluation of the Benefits of Effective Exercise for Older Adults With Knee Pain Trial Physiotherapist Training Program.

PubMed

Holden, Melanie A; Whittle, Rebecca; Healey, Emma L; Hill, Susan; Mullis, Ricky; Roddy, Edward; Sowden, Gail; Tooth, Stephanie; Foster, Nadine E

2017-05-01

To explore whether participating in the Benefits of Effective Exercise for knee Pain (BEEP) trial training program increased physiotherapists' self-confidence and changed their intended clinical behavior regarding exercise for knee pain in older adults. Before/after training program evaluation. Physiotherapists were asked to complete a questionnaire before the BEEP trial training program, immediately after, and 12 to 18 months later (postintervention delivery in the BEEP trial). The questionnaire included a case vignette and associated clinical management questions. Questionnaire responses were compared over time and between physiotherapists trained to deliver each intervention within the BEEP trial. Primary care. Physiotherapists (N=53) who completed the BEEP trial training program. Not applicable. Self-confidence in the diagnosis and management of knee pain in older adults; and intended clinical behavior measured by a case vignette and associated clinical management questions. Fifty-two physiotherapists (98%) returned the pretraining questionnaire, and 44 (85%) and 39 (74%) returned the posttraining and postintervention questionnaires, respectively. Posttraining, self-confidence in managing older adults with knee pain increased, and intended clinical behavior regarding exercise for knee pain in older adults appeared more in line with clinical guidelines. However, not all positive changes were maintained in the longer-term. Participating in the BEEP trial training program increased physiotherapists' self-confidence and changed their intended clinical behavior regarding exercise for knee pain, but by 12 to 18 months later, some of these positive changes were lost. This suggests that brief training programs are useful, but additional strategies are likely needed to successfully maintain changes in clinical behavior over time. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial.

PubMed

Valenza, M C; Rodríguez-Torres, J; Cabrera-Martos, I; Díaz-Pelegrina, A; Aguilar-Ferrándiz, M E; Castellote-Caballero, Y

2017-06-01

To investigate the effects of a Pilates exercise program on disability, pain, lumbar mobility, flexibility and balance in patients with chronic non-specific low back pain. Randomized controlled trial. University laboratory. A total of 54 patients with chronic non-specific low back pain. Patients were randomly allocated to an experimental group ( n=27) included in a Pilates exercise program or to a control group ( n=27) receiving information in a form of a leaflet. Disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), current, average and pain at it least and at its worst (Visual Analogue Scales), lumbar mobility (modified Shober test), flexibility (finger-to-floor test) and balance (single limb stance test) were measured at baseline and after the intervention. A between-group analysis showed significant differences in the intervention group compared to the control group for both disability scores, the Rolland-Morris questionnaire (mean change±standard deviation of 5.31±3.37 and 2.40±6.78 respectively and between-groups mean difference of 3.2 ± 4.12, p=0.003) and the Oswestry Disability Index ( p<0.001), current pain ( p=0.002) and pain at it least ( p=0.033), flexibility (0.032) and balance (0.043). An 8-week Pilates exercise program is effective in improving disability, pain, flexibility and balance in patients with chronic non-specific low back pain.

Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review.

PubMed

Gay, C; Chabaud, A; Guilley, E; Coudeyre, E

2016-06-01

Highlight the role of patient education about physical activity and exercise in the treatment of hip and knee osteoarthritis (OA). Systematic literature review from the Cochrane Library, PubMed and Wiley Online Library databases. A total of 125 items were identified, including 11 recommendations from learned societies interested in OA and 45 randomized controlled trials addressing treatment education and activity/exercise for the treatment of hip and knee osteoarthritis. In the end, 13 randomized controlled trials and 8 recommendations were reviewed (1b level of evidence). Based on the analysis, it was clear that education, exercise and weight loss are the pillars of non-pharmacological treatments. These treatments have proven to be effective but require changes in patient behaviour that are difficult to obtain. Exercise and weight loss improve function and reduce pain. Education potentiates compliance to exercise and weight loss programs, thereby improving their long-term benefits. Cost efficiency studies have found a reduction in medical visits and healthcare costs after 12 months because of self-management programs. Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The Influence of Social Structure on Cancer Pain and Quality of Life.

PubMed

Ham, Ok-Kyung; Chee, Wonshik; Im, Eun-Ok

2017-12-01

The aim of this study was to investigate whether social structure is associated with cancer pain and quality of life using the Social Structure and Personality Research Framework. This study was a secondary analysis of data from 480 cancer patients. The measurements included socioeconomic variables, self-reported cancer pain using the McGill Pain Questionnaire-Short Form (MPQ-SF), and quality of life measured using the Functional Assessment of Cancer Therapy Scale (FACT-G). The data were analyzed using moderated multiple regression. Cancer pain and quality of life differed significantly with income. The associations between income and pain and quality of life were significant only for the high education group (≥ partial college), and these associations were greater for Caucasians than for their counterparts ( p < .05). When developing interventions, nurses should consider the influence of socioeconomic variables on pain and quality of life while considering possible moderating factors such as education.

Pain Assessment and Management in Nursing Education Using Computer-based Simulations.

PubMed

Romero-Hall, Enilda

2015-08-01

It is very important for nurses to have a clear understanding of the patient's pain experience and of management strategies. However, a review of the nursing literature shows that one of the main barriers to proper pain management practice is lack of knowledge. Nursing schools are in a unique position to address the gap in pain management knowledge by facilitating the acquisition and use of knowledge by the next generation of nurses. The purpose of this article is to discuss the role of computer-based simulations as a reliable educational technology strategy that can enhance the learning experience of nursing students acquiring pain management knowledge and practice. Computer-based simulations provide a significant number of learning affordances that can help change nursing students' attitudes and behaviors toward and practice of pain assessment and management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.

PubMed

Johnson, Sara S; Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-10-17

Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans' stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program's long-term effects on pain and pain self-management. ©Sara S Johnson, Deborah A Levesque, Lynne E Broderick, Dustin G Bailey, Robert D Kerns. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 17.10.2017.

The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain.

PubMed

Louw, Adriaan; Diener, Ina; Butler, David S; Puentedura, Emilio J

2011-12-01

To evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain. Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All experimental studies including randomized controlled trials (RCTs), nonrandomized clinical trials, and case series evaluating the effect of NE on pain, disability, anxiety, and stress for chronic MSK pain were considered for inclusion. Additional limitations: studies published in English, published within the last 10 years, and patients older than 18 years. No limitations were set on specific outcome measures of pain, disability, anxiety, and stress. Data were extracted using the participants, interventions, comparison, and outcomes (PICO) approach. Methodological quality was assessed by 2 reviewers using the Critical Review Form-Quantitative Studies. This review includes 8 studies comprising 6 high-quality RCTs, 1 pseudo-RCT, and 1 comparative study involving 401 subjects. Most articles were of good quality, with no studies rated as poor or fair. Heterogeneity across the studies with respect to participants, interventions evaluated, and outcome measures used prevented meta-analyses. Narrative synthesis of results, based on effect size, established compelling evidence that NE may be effective in reducing pain ratings, increasing function, addressing catastrophization, and improving movement in chronic MSK pain. For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The First National Pain Medicine Summit--final summary report.

PubMed

Lippe, Philipp M; Brock, Charles; David, Jose; Crossno, Ronald; Gitlow, Stuart

2010-10-01

Pain is ubiquitous. At some point in time it affects everyone. For many millions pain becomes chronic, a scourge that impacts every facet of life-work, hobbies, family relations, social fabric, finances, happiness, mood, and even the very essence of identity. According to the National Institutes of Health (NIH), pain is one of our most important national public health problems, a silent epidemic. In 1998, NIH reported that the annual amount spent on health care, compensation, and litigation related to pain had reached one hundred billion dollars ($100,000,000,000). Considering that health care costs have doubled since then, it is not unreasonable to assume that the costs related to pain care have doubled as well. Millions of patients suffer needlessly with acute pain, with cancer pain, and with chronic pain. The ineffective management of pain results in an escalating cascade of health care issues. Acute pain that is not treated adequately and promptly results in persistent pain that eventually causes irreversible changes in the nervous system. This translates into progressive bio-psycho-social epiphenomena resulting in further pain and disability. It creates a vicious cycle transforming a functional human being into an invalid who becomes a burden to family, to society, and to oneself. In the face of adequate medical science, adequate technical skills, and adequate resources the reality of delayed and inadequate pain care is paradoxical. This dilemma deserves close scrutiny and effective remediation. The American Medical Association (AMA), long dedicated to the need to improve pain care in this country, has been faced with this reality. It was from this vision that the idea of holding a Pain Medicine Summit was conceived. Resolution 321 (A-08) set in motion a process that would bring together a diverse group of stakeholders for the purpose of discussing the present and future status of pain care; a process that culminated in a broad-based coalition of physicians and organizations dedicated to improving pain care, the first National Pain Medicine Summit. The process began with the adoption of Resolution 321 (A-08) at an AMA Annual House of Delegates meeting in June 2008. Resolution 321 (A-08) states, in part, that "...the AMA encourages relevant specialties to collaborate in studying: 1) the scope and practice and body of knowledge encompassed by the field of Pain Medicine; 2) the adequacy of undergraduate, graduate, and post graduate education in the principles and practices of the field of Pain Medicine, considering the current and anticipated medical need for the delivery of quality pain care; and 3) appropriate training and credentialing criteria for this multi-disciplinary field of medical practice." The next step was delegating the responsibility for implementing Resolution 321 (A-08) to the Pain and Palliative Medicine Specialty Section Council (PPMSSC). The PPMSSC, under the direction of its chairman, Philipp M. Lippe, MD, FACS, assumed responsibility in November 2008 for identifying a process that would achieve the goals established by Resolution 321 (A-08). The PPMSSC in turn established an Advisory Committee, charged with strategic planning, and an Implementation Committee, charged with tactical operations. The two groups began work immediately. The process included three distinct phases centered on a Pain Medicine Summit. Phase One involved a modified Delphi process identifying the five most pressing and relevant themes in pain care. Phase Two consisted of the Pain Medicine Summit itself, including a gathering of representatives from across the pain care spectrum to address the previously identified five most pressing themes. Phase Three was the preparation of this report, which describes the conclusions drawn and recommendations developed by the attendees at the Pain Medicine Summit. Based on a recommendation from the Advisory Committee, the PPMSSC decided to retain the services of a consulting firm to help the PPMSSC implement the Pain Medicine Summit process. In August 2009, PPMSSC selected Grey Matters, a New York-based advisory firm. The PPMSSC also appointed a Steering Committee to assist Grey Matters and to coordinate all activities. The Committee consisted of Charles Brock, MD; Ronald Crossno, MD; Jose David, MD; Michel Dubois, MD; Albert Ray, MD; and Philipp M. Lippe, MD, FACS (chair). The consulting firm, Grey Matters, proposed a multi-phasic process in order to facilitate the implementation of the Pain Medicine Summit and to ensure a coordinated, efficient, and productive outcome. This process consisting of three phases-pre-summit, summit, and post-summit-is described in detail in the following section. All aspects of the project were closely coordinated and supervised by the Steering Committee, which included the selection of the team leaders of the five Workgroups, based on specific criteria. The Pain Medicine Summit, adhering to the dictates of Resolution 321 (A-08), explored the body of knowledge and the scope of practice of Pain Medicine; the education and training in medical school, graduate, and postgraduate programs; and the credentialing and certification processes in the field of Pain Medicine. It addressed the barriers hampering delivery of high quality pain care. It recognized the need for clarification and consensus in many areas. Several points of consensus emerged: The continuum of medical education in the field of Pain Medicine is inadequate and fragmented. It needs to be fortified in scope, content, and duration. Credentialing and certification processes in Pain Medicine are variable, diverse, and deficient in many instances. Deficiencies in these areas lead to suboptimal and fragmented pain care having a negative impact on direct patient care and public health. Effective and prompt remediation is desirable and essential to achieving the goal of high quality pain care. Barriers exist inhibiting or retarding progress toward the common good. There are several viable avenues to achieving our stated goal, "excellence in the delivery of high quality, cost-effective pain care to the patients we serve," including the development of Pain Medicine as a distinct specialty with ACGME accredited residency programs and ABMS certification. The Pain Medicine Summit concluded with a number of recommendations, including the following: That the pain community remains engaged in addressing the issues raised and in mitigating the barriers. That the recommendations be referred to the AMA and the PPMSSC for support and implementation. That another national Pain Medicine Summit with enhanced participation be convened. That consideration be given to convening an International Pain Summit in conjunction with the IASP World Congress in Montreal.   That the final report of the Pain Medicine Summit be widely disseminated. Wiley Periodicals, Inc.

Why Do I Have Pain?

MedlinePlus

... and Sprains Are a Pain What Is an Ear Infection? Headaches How Do Pain Relievers ... All information on KidsHealth® is for educational purposes only. For specific medical advice, diagnoses, and treatment, ...

The effectiveness of a back school program in lowerlimb amputees: a randomized controlled study.

PubMed

Anaforoğlu, Bahar; Erbahçeci, Fatih; Aksekili, Mehmet Atıf Erol

2016-06-23

A few studies have been carried out in lower limb amputees (LLAs) and they examined the incidence of and reasons for low back pain. The aim of this study was to assess the effectiveness of a back school program in LLAs with mechanical low back pain (MLBP). Forty male unilateral transfemoral amputees with MLBP were randomly allocated into two groups. A back school program was applied to Group 1 over 2 weeks. A booklet for home use was given to each participant in Group 2. Pain was assessed using a visual analogue scale. Spinal flexibility measurements were obtained. For the assessment of back pain-related disability, the Oswestry Disability Index was used. Patients were assessed at baseline, at month 1, and at month 3. At the month 1 assessment, a reduction in pain intensity and disability, and increase in spinal flexibility measurements were detected in Group 1 only (P < 0.05). At the month 3 assessment, there were improvements in all measured parameters in both groups(P < 0.05). Group 1 had better results in all parameters compared with Group 2. The back school program, combined with an exercise program, decreased pain and disability and improved the spinal flexibility significantly in LLAs with MLBP.

An Exploratory Study of Student Pharmacists' Self-Reported Pain, Management Strategies, Outcomes, and Implications for Pharmacy Education.

PubMed

Axon, David Rhys; Hernandez, Carlos; Lee, Jeannie; Slack, Marion

2018-01-22

The objective of this study was to describe the prevalence, management strategies, and outcomes of pain experienced by student pharmacists, and to discuss implications for pharmacy education. A questionnaire administered to student pharmacists collected data about their experience, management strategies, and outcomes of pain. Data were analyzed using t -tests, chi-square or Fisher's tests, and logistic regression. Of the 218 student pharmacists who completed the survey, 79% experienced pain in the past five years. Chronic pain impacted students' ability to work (15%) and attend school (9%). Respondents most commonly used prescription (38%) and over-the-counter (OTC, 78%) non-steroidal anti-inflammatory drugs (NSAIDs), and rest (69%) to manage pain. Men used more opioids, whereas women used more OTC NSAIDs ( p < 0.05). Emergency department visits were associated with increased prescription drug use to manage pain. This study found that 15% of student pharmacists had chronic pain in the past five years, which was managed with medical and non-medical strategies.

Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

PubMed

Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

2016-07-01

Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients.

Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial.

PubMed

Dias, João Marcos; Cisneros, Lígia; Dias, Rosângela; Fritsch, Carolina; Gomes, Wellington; Pereira, Leani; Santos, Mary Luci; Ferreira, Paulo Henrique

Currently, there is poor evidence of the effect of hydrotherapy alone on patients with hip or knee osteoarthritis. The study aimed to assess the impact of hydrotherapy on pain, function, and muscle function in older women with knee osteoarthritis. A randomized controlled trial was conducted to evaluate the efficacy of hydrotherapy in women with knee osteoarthritis. Seventy-three women aged 65 and older were randomized to hydrotherapy (n=36) or a control group (n=37). The hydrotherapy group received the intervention program in a heated pool (twice per week for six weeks) and an educational protocol while the control group received an educational protocol only. Primary outcomes (before and post-treatment) were pain intensity (0-100) and function (0-100), assessed with the WOMAC questionnaire. Secondary outcomes (before and post-treatment) were knee extensor and knee flexor muscle performance (strength, power, and endurance), assessed by an isokinetic dynamometer. The magnitude of change between the groups for the outcomes was calculated using linear regression models adjusted by baseline outcome values. The hydrotherapy group had better outcomes for pain (adjusted mean difference=11 points, 95% CI: 3-18) and function (adjusted mean difference=12 points, 95% CI: 5-18). Patients receiving hydrotherapy had better performance for knee flexor and extensor strength, knee flexor power, and knee extensor endurance. Older women with knee osteoarthritis are likely to have benefits from a course of hydrotherapy exercises. Registry of clinical trials (Trial number RBR-8F57KR) - http://www.ensaiosclinicos.gov.br/rg/RBR-8f57kr/. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs

PubMed Central

Hahn, Kathryn L.

2011-01-01

Background The use of prescription opioid drugs has the potential to lead to patient abuse of these medications, addiction, and diversion. Such an abuse is associated with increased costs because of excessive healthcare utilization. Finding ways to minimize the risk for abuse and addiction can enhance patient outcomes and reduce costs to patients and to payers. Objective To review current strategies that may reduce the risk for misuse and abuse of opioid medications, which in turn can enhance patient outcomes and lower costs to health insurers and patients. Discussion Implementing approaches that will encourage the use of safe practices (universal precautions) in pain management by providers can reduce the risk for abuse and misuse associated with chronic pain medications, especially opioids. These approaches include, but are not limited to, extensive physician and patient education regarding these medications and their associated risks for abuse; the development of prescription monitoring programs to detect physician or pharmacy shopping; the detection of inappropriate prescribing and medical errors; the use of physician-patient contracts concerning opioid treatment; the requirement of presenting a photo identification to pick up an opioid prescription at the pharmacy; urine drug toxicology screening; provisions for safe disposal of unused opioids; referrals to pain and addiction specialists; and potentially encouraging the use of opioid formulations aimed at reducing abuse. Conclusion Supporting such approaches by health insurers and educating providers and patients on the risks associated with chronic pain medications can help minimize the risk of prescription opioid abuse, addiction, and diversion; reduce health services utilization associated with opioid abuse; improve patient outcomes; and reduce overall costs. PMID:25126342

Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial

PubMed Central

Traeger, Adrian C; Moseley, G Lorimer; Hübscher, Markus; Lee, Hopin; Skinner, Ian W; Nicholas, Michael K; Henschke, Nicholas; Refshauge, Kathryn M; Blyth, Fiona M; Main, Chris J; Hush, Julia M; Pearce, Garry; McAuley, James H

2014-01-01

Introduction Low back pain (LBP) is the leading cause of disability worldwide. Of those patients who present to primary care with acute LBP, 40% continue to report symptoms 3 months later and develop chronic LBP. Although it is possible to identify these patients early, effective interventions to improve their outcomes are not available. This double-blind (participant/outcome assessor) randomised controlled trial will investigate the efficacy of a brief educational approach to prevent chronic LBP in ‘at-risk’ individuals. Methods/analysis Participants will be recruited from primary care practices in the Sydney metropolitan area. To be eligible for inclusion participants will be aged 18–75 years, with acute LBP (<4 weeks’ duration) preceded by at least a 1 month pain-free period and at-risk of developing chronic LBP. Potential participants with chronic spinal pain and those with suspected serious spinal pathology will be excluded. Eligible participants who agree to take part will be randomly allocated to receive 2×1 h sessions of pain biology education or 2×1 h sessions of sham education from a specially trained study physiotherapist. The study requires 101 participants per group to detect a 1-point difference in pain intensity 3 months after pain onset. Secondary outcomes include the incidence of chronic LBP, disability, pain intensity, depression, healthcare utilisation, pain attitudes and beliefs, global recovery and recurrence and are measured at 1 week post-intervention, and at 3, 6 and 12 months post LBP onset. Ethics/dissemination Ethical approval was obtained from the University of New South Wales Human Ethics Committee in June 2013 (ref number HC12664). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings. Trial registration number https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612001180808 PMID:24889854

Pain buddy: A novel use of m-health in the management of children’s cancer pain

PubMed Central

Fortier, Michelle A.; Chung, Winnie W.; Martinez, Ariana; Gago-Masague, Sergio; Sender, Leonard

2017-01-01

Background Over 12,000 children are diagnosed with cancer every year in the United States. In addition to symptoms associated with their disease, children undergoing chemotherapy frequently experience significant pain, which is unfortunately often undertreated. The field of m-Health offers an innovative avenue for pain assessment and intervention in the home setting. The current study describes the development and initial evaluation of a tablet-based program, Pain Buddy, aimed to enhance pain management and foster improved quality of life in children ages 8–18 years undergoing cancer treatment. Methods An animated avatar-based tablet application was developed using state-of-the-art software. Key aspects of Pain Buddy include daily pain and symptom diaries completed by children, remote monitoring of symptoms by uploading patient’s data through internet to a cloud server, cognitive and behavioral skills training, interactive three-dimensional avatars that guide children through the program, and an incentive system to motivate engagement. Twelve children between the ages of 8 and 18 participated in a pilot study of Pain Buddy. Results Children were highly satisfied with the program. Pain and appetite disturbances were most frequently endorsed. Symptom trigger alerts to outside providers were largely related to clinically significant pain. Children infrequently used analgesics, and reported using some non-pharmacological pain management strategies. Conclusion Pain Buddy appears to be a promising tool to improve pain and symptom management in children undergoing cancer treatment. Results from the current study will inform future improvements to Pain Buddy, in preparation for a randomized controlled trial to assess the efficacy of this innovative treatment. PMID:27479493

End of Life Care Policy for the Dying: Consensus Position Statement of Indian Association of Palliative Care

PubMed Central

Macaden, Stanley C; Salins, Naveen; Muckaden, Maryann; Kulkarni, Priyadarshini; Joad, Anjum; Nirabhawane, Vivek; Simha, Srinagesh

2014-01-01

EXECUTIVE SUMMARY Purpose: To develop an End of Life Care (EOLC) Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery. Recommendations: Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI) to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policyProviding a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom controlPalliative care and EOLC to be part of all hospital and community/home based programsStandards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC) met and standards accredited and monitored by national and international accreditation bodiesAll health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education. PMID:25191002

Pain Management: A Practical Approach to Nursing Education.

ERIC Educational Resources Information Center

Wacker, Margaret S.; Pawasauskas, Joyce

2002-01-01

Nine brief onsite educational sessions of 10-20 minutes each trained nurses in pain management techniques. Participants recognized the value of brief presentations, but wanted more time to learn the material. The content was made available on disk for further study. (SK)

[Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

PubMed

Nolli, M; Nicosia, F

2000-09-01

The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of Institution, are the procedures of a growing integrated program for postoperative pain treatment. The organizational processes should interact effectively with a plan of education, updating, revision and information in a definite development timing. It should be emphasized a collaborative, interdisciplinary approach to pain control, assessment and treatment, including all the members of the health care team, with an input from the patient and a protective collaboration from the Institution. The development of a postoperative care team must be considered as part of the largest project for "a Painfree Hospital". It represents a keystone of a Institutional Quality Assurance Plan for health care providers, patients (customs) and Institution.

Opioid management of pain: the impact of the prescription opioid abuse epidemic.

PubMed

Rauenzahn, Sherri; Del Fabbro, Egidio

2014-09-01

The greater emphasis on pain control over the last decade has been accompanied by increased opioid prescriptions and an epidemic of opioid abuse. This review examines the financial, regulatory, and clinical practice impact of the epidemic, the factors contributing to its growth, and strategies that may counter this public health crisis. Despite the call for urgent practice change and the introduction of new initiatives such as electronic prescription monitoring and additional education programs for providers and patients, the evidence for improved outcomes are limited. There are also concerns that some patients may suffer from underprescribing as an unintended consequence of more stringent state and federal regulations. There is consensus that some form of universal precautions should be adopted for all patients, including those being treated for cancer-related pain, in order to better identify and manage those at risk of opioid abuse. The opioid prescription abuse epidemic has precipitated calls for increased regulation. Clinicians can improve patient care and diminish opioid abuse by identifying patient risk factors, increasing vigilance and structure for those at risk, and providing interdisciplinary care for any patients coping in a maladaptive manner.

Early intervention for adolescents with Patellofemoral Pain Syndrome - a pragmatic cluster randomised controlled trial

PubMed Central

2012-01-01

Background Self-reported knee pain is highly prevalent among adolescents. As much as 50% of the non-specific knee pain may be attributed to Patellofemoral Pain Syndrome (PFPS). In the short term, exercise therapy appears to have a better effect than patient education consisting of written information and general advice on exercise or compared with placebo treatment. But the long-term effect of exercise therapy compared with patient education is conflicting. The purpose of this study is to examine the short- and long-term effectiveness of patient education compared with patient education and multimodal physiotherapy applied at a very early stage of the condition among adolescents. Methods/Design This study is a single blind pragmatic cluster randomised controlled trial. Four upper secondary schools have been invited to participate in the study (approximately 2500 students, aged 15-19 years). Students are asked to answer an online questionnaire regarding musculoskeletal pain. The students who report knee pain are contacted by telephone and offered a clinical examination by a rheumatologist. Subjects who fit the inclusion criteria and are diagnosed with PFPS are invited to participate in the study. A minimum of 102 students with PFPS are then cluster-randomised into two intervention groups based on which school they attend. Both intervention groups receive written information and education. In addition to patient education, one group receives multimodal physiotherapy consisting primarily of neuromuscular training of the muscles around the foot, knee and hip and home exercises. The students with PFPS fill out self-reported questionnaires at baseline, 3, 6, 12 and 24 months after inclusion in the study. The primary outcome measure is perception of recovery measured on a 7-point Likert scale ranging from "completely recovered" to "worse than ever" at 12 months. Discussion This study is designed to investigate the effectiveness of patient education compared with patient education combined with multimodal physiotherapy. If patient education and multimodal physiotherapy applied at an early stage of Patellofemoral Pain Syndrome proves effective, it may serve as a basis for optimising the clinical pathway for those suffering from the condition, where specific emphasis can be placed on early diagnosis and early treatment. Trial Registration clinicaltrials.gov reference: NCT01438762 PMID:22280484

Maintaining professionalism in today's business environment: ethical challenges for the pain medicine specialist.

PubMed

Lebovits, Allen

2012-09-01

There are many external influences in today's market force that impair the relationship between the pain medicine specialist and the patient, and ultimately prevent optimal quality of care. This article explores the ethical challenges facing the pain medicine specialist in today's increasingly "business" environment and will offer solutions for maintaining the professionalism of pain medicine. Four commonly encountered bioethical principles in the practice of pain medicine are reviewed: beneficence, nonmaleficence, justice, and autonomy. The following ethical challenges of the pain medicine specialist are reviewed: practicing outside ones specialty area, practice characteristics, the consultant role, the economic lure of aggressive intervention, not evaluating for and treating comorbid psychopathology, reimbursement pressures, workers' compensation, and use of unproven methods. Solutions offered include collegial associations, social responsibility, legislative initiatives, pain education, interdisciplinary evaluation and treatment, improved relationships with third-party payers, reduced racial disparities, and ethics education. Ethics is the "roadmap" that enables the pain medicine specialist to navigate the increasingly murky waters of practicing pain management today by maintaining the professionalism necessary to combat today's "business" pressures. Wiley Periodicals, Inc.

Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change.

PubMed

Huestis, Samantha E; Kao, Grace; Dunn, Ashley; Hilliard, Austin T; Yoon, Isabel A; Golianu, Brenda; Bhandari, Rashmi P

2017-12-07

Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

Evaluation of a cognitive-behavioral pain management program for children with chronic abdominal pain: a randomized controlled study.

PubMed

Groß, Martina; Warschburger, Petra

2013-09-01

Chronic abdominal pain (CAP) in childhood is widely prevalent and has adverse effects on mental health and quality of life. Earlier research emphasized the positive effects of psychological intervention on pain symptoms. This study describes the results of a cognitive-behavioral pain management program for children with CAP. The newly developed cognitive-behavioral group program, "Stop the pain with Happy-Pingu," includes six sessions for the children and one meeting for the parents. We hypothesized that the training would significantly reduce pain symptoms (frequency, duration, intensity, and pain-related impairment) and increase health-related quality of life compared to wait-list controls, with improvement seen both at the end of treatment and at a 3-month follow-up. In all, 29 children were randomized into two groups: 15 in the intervention group (IG) and 14 as the wait-list controls (WLC). An intent-to-treat analysis was performed using two-factorial multivariate analyses of variance with repeated measures. Children in the IG experienced both a reduction in pain (primary outcome) and an improvement in health-related quality of life (secondary outcome) as compared to the WLC. The effect sizes ranged from medium to high. Cognitive-behavioral methods seem to be appropriate for treating children with CAP.

A multimodal physical therapy approach utilizing the Maitland concept in the management of a patient with cervical and lumbar radiculitis and Ehlers-Danlos syndrome-hypermobility type: A case report.

PubMed

Pennetti, Adelina

2018-07-01

The purpose of this case report is to present a multimodal approach for patient management using the Maitland concept framework for cervical and lumbar radiculitis with an underlying diagnosis of Ehlers-Danlos Syndrome-Hypermobility Type (EDS-HT). This case presents care guided by evidence, patient values, and rationale for the selected course of physical therapy treatment provided by therapist experience. A 35-year-old female with a 2-year history of worsening lumbar and cervical pain was referred to physical therapy to address these musculoskeletal issues concurrent with diagnostic testing for EDS. A multimodal approach including manual therapy, therapeutic exercise, postural and body mechanics education, and a home exercise program was used. The patient specific functional scale (PSFS) was used to gauge patient's perceived improvements which were demonstrated by increased scores at reevaluation and at discharge. Following the Maitland concept framework, the physical therapist was able to make sound clinical decisions by tracking the logical flow of constant patient assessment. A 10-month course of treatment designed to maximize recovery of function was successful with a chronic history of pain and the EDS-HT diagnosis. The role of education and empowering the patient is shown to be of utmost importance. Optimizing therapeutic outcomes long-term for this patient population requires maintaining a home exercise program, adaptation and modifications of work and lifestyle activities.

Neck/shoulder and back pain in new graduate nurses: A growth mixture modeling analysis.

PubMed

Lövgren, Malin; Gustavsson, Petter; Melin, Bo; Rudman, Ann

2014-04-01

Although it is well known that musculoskeletal disorders are common among registered nurses, little longitudinal research has been conducted to examine this problem from nursing education to working life. The aim was to investigate the prevalence and incidence of neck/shoulder and back pain in nursing students in their final semester, and one and two years after graduation. Furthermore, to identify common trajectories of neck/shoulder and back pain, and explore sociodemographic and lifestyle-related factors, contextual factors and health outcome that might be characteristic of individuals in the various trajectories. Longitudinal study following nursing students from their final year of studies, with follow-ups one and two years after graduation. Nursing students who graduated from the 26 universities providing undergraduate nursing education in Sweden 2002 were invited to participate (N=1700). Of those asked, 1153 gave their informed consent. The participants answered postal surveys at yearly intervals. Descriptive statistics were used to analyze prevalence and incidence of pain, and growth mixture modeling was applied to identify different homogeneous clusters of individuals following similar trajectories in pain development across time. The prevalence of neck/shoulder and back pain remained constant over time (around 50% for neck/shoulder pain and just over 40% for back pain). Six different development trajectories for each symptom were found, reflecting patterns of stable pain levels or variation in levels over time: one symptom-free group, two decreasing pain groups, two increasing pain groups, and one chronic pain group. With few exceptions, the same factors (sex, children, chronic disease, working overtime, work absence, sickness presence, physical load, depression, self-rated health, sleep quality and muscular tension) were associated with neck/shoulder and back pain trajectories. Different types of physical load characterized new nurses with neck/shoulder pain and back pain respectively. The high prevalence of pain among nursing students and among new graduate nurses, suggests that it would be effective to implement preventive strategies already during nursing education, but they should also preferably continue after graduation. Many factors associated with pain in the neck/shoulder and back seem to be modifiable, and thereby constitute targets for preventive strategies. Copyright © 2013 Elsevier Ltd. All rights reserved.

The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care.

PubMed

Breivik, Harald; Eisenberg, Elon; O'Brien, Tony

2013-12-24

Chronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently published data confirming its clinical and socioeconomic impact, this paper argues that chronic pain should be ranked alongside other conditions of established priority in Europe. We outline strategies to help overcome barriers to effective pain care resulting in particular from deficiencies in education and access to interdisciplinary pain management services. We also address the confusion that exists between proper clinical and scientific uses of opioid medications and their potential for misuse and diversion, as reflected in international variations in the access to, and availability of, these agents. As the economic costs are driven in part by the costs of lost productivity, absenteeism and early retirement, pain management should aim to fully rehabilitate patients, rather than merely to relieve pain. Accredited education of physicians and allied health professionals regarding state-of-the-art pain management is crucial. Some progress has been made in this area, but further provision and incentivization is required. We support a tiered approach to pain management, whereby patients with pain uncontrolled by non-specialists are able to consult a physician with a pain competency or a specialist in pain medicine, who in turn can recruit the services of other professionals on a case-by-case basis. A fully integrated interdisciplinary pain service should ideally be available to patients with refractory pain. Governments and healthcare systems should ensure that their policies on controlled medications are balanced, safeguarding public health without undue restrictions that compromise patient care, and that physician education programmes support these aims. Strategic prioritization and co-ordinated actions are required nationally and internationally to address the unacceptable and unnecessary burden of uncontrolled chronic pain that plagues European communities and economies. An appreciation of the 'return on investment' in pain management services will require policymakers to adopt a long-term, cross-budgetary approach.

Attitude and knowledge of physicians about cancer pain management: young doctors of South Korea in their early career.

PubMed

Kim, Myung-Hyun; Park, Hyeonggeun; Park, Eun Chul; Park, Keeho

2011-06-01

This study is aimed at evaluating the attitude and knowledge about the optimal use of opioids and finding out the barriers to cancer pain management especially for young doctors in South Korea. A survey through questionnaire form was conducted on 1204 physicians. Physicians were grouped by their medical specialties and personal characteristics. Specialties were grouped into internal medicine and family medicine doctors, surgeons, anesthesiologists, pediatricians, other board holders and general physicians. Personal characteristics were grouped by their past experiences and current surroundings. Though many doctors thought that they were fairly well educated for pain management strategy, a large population of physicians showed a negative attitude and inadequate knowledge status about cancer pain management. The degree of attitude and knowledge status was different as their specialties and personal experiences. The factors that affected doctors' attitude and knowledge were: (i) medical specialty, (ii) past history of using practical pain assessment tool, (iii) self-perception of knowledge status about pain management, (iv) experience of prescribing opioids, (v) experience of education for cancer pain management. Although many physicians had a passive attitude in prescribing opioid analgesics, they are willingly open to use opioids for cancer pain management in the future. The most important perceived barriers to optimal cancer pain management were the fear for risk of tolerance, drug addiction, side effects of opioid analgesics and knowledge deficit about opioid analgesics. From this study, we found that further education and practical training will be needed for adequate cancer pain management for young physicians in their early career.

Ergonomics content in the physical education teacher's guide in Rwanda.

PubMed

Nellutla, Manobhiram; Patel, Hetal; Kabanda, Aline; Nuhu, Assuman

2012-01-01

An important aspect that affects the effectiveness of ergonomic programs is that inefficient mechanical functioning start at an early age and that back pain and posture problems are already evident in children. Children, from a very early age, as well as adults spend an ever increasing amount of their time in front of computer and television screens. The cumulative effect of this sedentary lifestyle leads to improper posture, as well as inefficient and harmful movement patterns and loss of basic physical skills. Physical Education course should deal not only with sports and physical activities, but also with broader aspects of life-skills and physical functionality. It should offer a solution to the modern technology-based society. Keeping this in perspective, Ergonomics content was introduced in Physical Education Teacher's Guide in Rwandan schools with an aim in preventing musculoskeletal disorder in children.

Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.

PubMed

Plagge, Jane M; Lu, Mary W; Lovejoy, Travis I; Karl, Andrea I; Dobscha, Steven K

2013-08-01

We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). Descriptive, including pre- and posttreatment assessment results. Portland Veterans Affairs Medical Center. Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms. Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers. Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality. Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better." These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD. Wiley Periodicals, Inc.

Part-time, e-learning interprofessional pain management education for the primary and community care setting.

PubMed

Jenkins, M Sue; Bean, W Geinor; Luke, Karl

2014-02-01

Chronic pain is a long-term condition, which has a major impact on patients, carers and the health service. Despite the Chief Medical Officer setting chronic pain and its management as a national priority in 2008, the utilisation of health services by patients with long-term conditions is increasing, people with pain-related problems are not seen early enough and pain-related attendances to accident and emergency departments is increasing. Early assessment with appropriate evidence-based intervention and early recognition of when to refer to specialist and specialised services is key to addressing the growing numbers suffering with chronic pain. Pain education is recommended in many guidelines, as part of the process to address pain in these issues. Cardiff University validated an e-learning, master's level pain management module for healthcare professionals working in primary and community care. The learning outcomes revolve around robust early assessment and management of chronic pain in primary and community care and the knowledge when to refer on. The module focuses on the biopsychosocial aspects of pain and its management, using a blog as an online case study assessment for learners to demonstrate their knowledge, understanding and application to practice. The module has resulted in learners developing evidence-based recommendations, for pain management in clinical practice.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention

PubMed Central

Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-01-01

Background Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management. PMID:29042341

Psychological Care, Patient Education, Orthotics, Ergonomics and Prevention Strategies for Neck Pain: An Systematic Overview Update as Part of the ICON§ Project

PubMed Central

Gross, Anita R.; Kaplan, Faith; Huang, Stacey; Khan, Mahweesh; Santaguida, P. Lina; Carlesso, Lisa C.; MacDermid, Joy C.; Walton, David M.; Kenardy, Justin; Söderlund, Anne; Verhagen, Arianne; Hartvigsen, Jan

2013-01-01

Objectives: To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain. Search Strategy: Computerized databases and grey literature were searched (2006-2012). Selection Criteria: Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review. Main Results: We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial. Reviewers' Conclusions: Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions PMID:24133554

The effects of compensatory workplace exercises to reduce work-related stress and musculoskeletal pain1

PubMed Central

de Freitas-Swerts, Fabiana Cristina Taubert; Robazzi, Maria Lúcia do Carmo Cruz

2014-01-01

OBJECTIVES: to assess the effect of a compensatory workplace exercise program on workers with the purpose of reducing work-related stress and musculoskeletal pain. METHOD: quasi-experimental research with quantitative analysis of the data, involving 30 administrative workers from a Higher Education Public Institution. For data collection, questionnaires were used to characterize the workers, as well as the Workplace Stress Scale and the Corlett Diagram. The research took place in three stages: first: pre-test with the application of the questionnaires to the subjects; second: Workplace Exercise taking place twice a week, for 15 minutes, during a period of 10 weeks; third: post-test in which the subjects answered the questionnaires again. For data analysis, the descriptive statistics and non-parametric statistics were used through the Wilcoxon Test. RESULTS: work-related stress was present in the assessed workers, but there was no statistically significant reduction in the scores after undergoing Workplace Exercise. However, there was a statistically significant pain reduction in the neck, cervical, upper, middle and lower back, right thigh, left leg, right ankle and feet. CONCLUSION: the Workplace Exercise promoted a significant pain reduction in the spine, but did not result in a significant reduction in the levels of work-related stress. PMID:25296147

The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty.

PubMed

Vukomanović, Aleksandra; Popović, Zoran; Durović, Aleksandar; Krstić, Ljiljana

2008-04-01

Hip arthroplasty is a routine operation which relieves pain in patients with osteoarthritis. The role of physical therapy after hip arthroplasty was recognized, but the importance of preoperative physical therapy and education is still to be judged. The aim of this paper was to investigate the effect of short-term preoperative program of education and physical therapy on patients' early functional recovery immediately after total hip arthroplasty (THA). This prospective study included 45 patients with hip osteoarthritis scheduled to undergo primary THA and admitted to the Department of Orthopedics of Military Medical Academy. They were randomized into 2 groups: study and control one (with and without preoperative education and physical therapy). Preoperative education was conducted through conversation (1 appointment with physiatrist) and brochure. The study group was instructed to perform exercises and basic activities from the postoperative rehabilitation program (2 practical classes with physiotherapist). Effects were measured with questionnaires (Harris, Oxford and Japanese Orthopaedic Association (JOA) hip scores), range of motion and visual analog scale of pain. Marks showing ability to perform basic activities and endurance were from 0 (did not perform activity) to 5 (independent and secure). Analyses examined differences between the groups over the preoperative and immediate postoperative periods and 15 months after the operation. There were no differences between the groups at discharge according to pain, range of motion, Harris hip score and JOA hip score. Oxford hip score did not differ between the groups 15 months after the operation. The groups started to walk at the same time, but the study group walked up and down stairs (3.7+/-1.66 vs 5.37+/-1.46, p< or =0.002), used toilet (2.3+/-0.92 vs 3.2+/-1.24, p< or =0.02) and chair (2.2+/-1.01 vs 3.25+/-1.21, p< or =0.006) significantly earlier than the control group. On the third day after the operation the study group was significantly more independent than the control one while performing any basic activities (changing position in bed from supine to side lying, from supine to sitting on the edge of the bed, from sitting to standing, from standing to lying in the bad, standing, walking, using toilet and chair). At discharge the patients from the control group still needed the therapist help for walking up and down stairs (3+/-1.26), while the patients from the study group performed there activities independently (4.85+/-0.37) (p< or =0.000). Endurance while walking was significantly better in the study group than in the control one. The length of hospital stay after the operation was similar for both groups, but the patients from the study group needed significantly less classes with the therapist (5.2+/-2.35 vs 6.85+/-1.14, p< or =0.02) during hospital stay. The short-term preoperative program of education with the elements of physical therapy accelerated early functional recovery of patients (younger than 70) immediately after THA and we recommend it for routine use.

Home-based aerobic conditioning for management of symptoms of fibromyalgia: a pilot study.

PubMed

Harden, R Norman; Song, Sharon; Fasen, Jo; Saltz, Samuel L; Nampiaparampil, Devi; Vo, Andrew; Revivo, Gadi

2012-06-01

This pilot study was designed to evaluate the impact of a home-based aerobic conditioning program on symptoms of fibromyalgia and determine if changes in symptoms were related to quantitative changes in aerobic conditioning (VO(2) max). Twenty-six sedentary individuals diagnosed with fibromyalgia syndrome participated in an individualized 12-week home-based aerobic exercise program with the goal of daily aerobic exercise of 30 minutes at 80% of estimated maximum heart rate. The aerobic conditioning took place in the participants' homes, outdoors, or at local fitness clubs at the discretion of the individual under the supervision of a physical therapist. Patients were evaluated at baseline and completion for physiological level of aerobic conditioning (VO(2) max), pain ratings, pain disability, depression, and stress. In this pilot study subjects who successfully completed the 12-week exercise program demonstrated an increase in aerobic conditioning, a trend toward decrease in pain measured by the McGill Pain Questionnaire-Short Form and a weak trend toward improvements in visual analog scale, depression, and perceived stress. Patients who were unable or unwilling to complete this aerobic conditioning program reported significantly greater pain and perceived disability (and a trend toward more depression) at baseline than those who completed the program. Patients suffering from fibromyalgia who can participate in an aerobic conditioning program may experience physiological and psychological benefits, perhaps with improvement in symptoms of fibromyalgia, specifically pain ratings. More definitive trials are needed, and this pilot demonstrates the feasibility of the quantitative VO2 max method. Subjects who experience significant perceived disability and negative affective symptoms are not likely to maintain a home-based conditioning program, and may need a more comprehensive interdisciplinary program offering greater psychological and social support. Wiley Periodicals, Inc.

HOME-BASED SELF-DELIVERED MIRROR THERAPY FOR PHANTOM PAIN: A PILOT STUDY*

PubMed Central

Darnall, Beth D.; Li, Hong

2014-01-01

Objective To test the feasibility and preliminary efficacy of self-delivered home-based mirror therapy for phantom pain. Design Uncontrolled prospective treatment outcome pilot study. Participants Forty community-dwelling adults with unilateral amputation and phantom pain >3 on a 0–10 numeric rating scale enrolled either during a one-time study visit (n = 30) or remotely (n = 10). Methods Participants received an explanation of mirror therapy and were asked to self-treat for 25 min daily. Participants completed and posted back sets of outcomes questionnaires at months 1 and 2 post-treatment. Main outcome was mean phantom pain intensity at post-treatment. Results A significant reduction in mean phantom pain intensity was found at month 1 (n = 31, p = 0.0002) and at month 2 (n = 26, p = 0.002). The overall median percentage reduction at month 2 was 15.4%. Subjects with high education (>16 years) compared with low education (<16 years) (37.5% vs 4.1%) had greater reduction in pain intensity (p = 0.01). Conclusion These findings support the feasibility and efficacy of home-based self-delivered mirror therapy; this low-cost treatment may defray medical costs, therapy visits, and the patient travel burden for people with motivation and a high level of education. More research is needed to determine methods of cost-effective support for people with lower levels of education. PMID:22378591

Under Treatment of Pain: A Prescription for Opioid Misuse Among the Elderly?

PubMed Central

Levi-Minzi, Maria A.; Surratt, Hilary L.; Kurtz, Steven P.; Buttram, Mance E.

2013-01-01

Objective To examine the demographic, physical, and mental health characteristics; current drug use patterns; motivations for use; and diversion sources among elderly prescription opioid misusers. Design Mixed methods design. Setting Research field offices, or senior or community center offices in South Florida. Subjects Individuals aged 60 and over reporting past 90-day prescription medication misuse; only prescription opioid misusers (N = 88) were included in the final analysis. Methods The Global Appraisal of Individual Needs was the main survey instrument. A subsample of elderly reporting substantial prescription drug misuse were chosen for the in-depth interview (N = 30). Results The mean age was 63.3. Fifty percent reported ever being admitted to a drug treatment program; several endorsed recent illicit drug use: powder cocaine and/or crack (35.2%), marijuana (30.7%), heroin (14.8%). The majority reported past year severe physical pain and discomfort (86.4%), and misuse of their primary opioid for pain (80.7%); over half (52.3%) obtained their primary opioid from their regular doctor. Qualitative data highlight the misuse of prescription opioids due to untreated or undertreated pain. Participants with primary opioid misuse for pain had over 12 times higher odds of obtaining the medication from their regular doctor (odds ratio [OR] = 12.22, P = 0.002) and had lower odds of using a dealer (OR = 0.20, P = 0.005). Conclusions Findings suggest that this group of elderly participants often misuse their own prescriptions for pain management. This study highlights the need to educate prescribing professionals on appropriate pain management for older adults while still being sensitive to issues of substance abuse and dependence. PMID:23841571

Prevention of chronic pain after whiplash

PubMed Central

Ferrari, R

2002-01-01

The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. This biopsychosocial model takes into account the mechanism by which acute pain becomes chronic pain, and how this can be prevented. Specific education and treatments encourage a behaviour after whiplash injury that is conducive to more rapid recovery, and provides the whiplash patient with insight into the mediators of chronic pain. The article describes in practical terms how to use education, reassurance, a more judicious use of therapy, and exercise to achieve this goal. Practical guidelines are provided on educating the patient about other symptoms that may cause concern. PMID:12421777

Effects of mindfulness meditation on chronic pain: a randomized controlled trial.

PubMed

la Cour, Peter; Petersen, Marian

2015-04-01

This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR]) or to a wait list control. Pain, physical function, mental function, pain acceptance, and health-related quality of life were measured. The SF36 vitality scale was chosen as the primary outcome measure; the primary end point was after completing the MBSR course. Within a 2.5-year period, 43 of the 109 randomized patients completed the mindfulness program, while 47 remained in the control group. Data were compared at three time points: at baseline, after completion of the course/waiting period, and at the 6-month follow-up. Significant effect (Cohen's d = 0.39) was found on the primary outcome measure, the SF36 vitality scale. On the secondary variables, significant medium to large size effects (Cohen's d = 0.37-0.71) were found for lower general anxiety and depression, better mental quality of life (psychological well-being), feeling in control of the pain, and higher pain acceptance. Small (nonsignificant) effect sizes were found for pain measures. There were no significant differences in the measures just after the intervention vs the 6-month follow-up. A standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects on several important dimensions in patients with long-lasting chronic pain. © 2014 American Academy of Pain Medicine.

[Cross-sectional field 14 pain medicine. Implementation of the German Pain Society (DGSS) core curriculum in the model study course MaReCuM].

PubMed

Dusch, M; Benrath, J; Fischer, J; Schmelz, M; Fritz, H; Klüter, H; Thiel, M; Treede, R D

2013-08-01

The recent introduction of amendments to the medical licensure laws led to the introduction of the field of pain medicine into the study program "Human Medicine". The implementation has to be completed by all medical faculties before 2016. Pain medicine was implemented into the model study course"MaReCuM" at the medical faculty in Manheim as a compulsory subject in the year 2010. It is structured into five sections in a longitudinal manner. The core section is the "pain awareness week" in the fifth academic year of the medical studies. The content and structure is based on the German Pain Society (DGSS) curriculum. For the purpose of this study the examination results and the student evaluation forms from the academic years 2010/2011 and 2011/2012 were analyzed. The students regarded pain medicine as being highly relevant concerning its impact on the professional activities. The competence to develop a specific and individual therapy was of special interest. A good coordination of the contents of teaching between preclinical and clinical teaching was considered to be of major importance. The DGSS curriculum is a useful tool for the implementation of pain medicine in a study program. In order to improve access to basic pain medicine in general, a combined teaching program consisting of pain medicine and general medicine could be helpful. Pain medicine could be used as a guide for teaching contents of outpatient medicine.

The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain.

PubMed

Javanshir, Khodabakhsh; Amiri, Mohsen; Mohseni Bandpei, Mohammad Ali; De las Penas, Cesar Fernandez; Rezasoltani, Asghar

2015-01-01

The effect of different exercise programs on cervical flexor muscles dimensions in patients with chronic neck pain is yet to be demonstrated. The purpose of this study was to assess the effect of two exercise programs; craniocervical flexion (CCF) and cervical flexion (CF), on flexor muscles dimensions in patients with chronic neck pain. Following ethical approval, 60 patients were randomly assigned into either a CCF group or a CF group. Patients in the CCF group were given CCF exercises and those in the CF group received CF exercises. All patients received interventions for a period of ten weeks. Pain intensity and functional disability were assessed using numerical pain rate scale and neck disability index, respectively. Dimensions of longus colli (LC) and sternoclidomastoid (SCM) muscles were measured using ultrasonography (US). All measurements were taken before and after interventions. Following intervention, the CCF group demonstrated a significant increase in LC muscle dimensions including cross sectional area, width and thickness compared with the CF group. A statistically significant increase was found on SCM thickness in the CF group. Following intervention, SCM thickness measurement in the CCF group showed no significant changes. Statistically significant decrease on pain intensity and disability were also found in both groups. Present findings demonstrated that craniocervical flexion program which specifically recruiting deep cervical flexor muscles increased LC muscle dimension significantly and CF program as an endurance training program increased SCM thickness.

The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises.

PubMed

Kuru Çolak, Tuğba; Kavlak, Bahar; Aydoğdu, Onur; Şahin, Emir; Acar, Gönül; Demirbüken, İlkşan; Sarı, Zübeyir; Çolak, İlker; Bulut, Güven; Polat, M Gülden

2017-03-01

The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.

Musculoskeletal pain reports among Mashhad dental students, Iran.

PubMed

Movahhed, Taraneh; Ajami, Behjatalmolook; Soltani, Mostafa; Shakeri, Mohammad Taghi; Dehghani, Mahboobe

2013-01-15

Dental practitioners are susceptible to Musculoskeletal Disorders (MSDs). The symptoms may begin from education courses. The aim of this study was to assess prevalence of musculoskeletal pain reports and correlated factors among the Mashhad Dental School students, Iran. A total of 177 undergraduate and postgraduate dental students, who were involved in educational clinical training, completed a questionnaire focusing on pain reports of different body anatomical regions. Variables such as gender, academic grade, academic year, clinical working hour, regular exercise times and also pain characteristics including pain duration intensity and frequency were evaluated. As results 82% of undergraduate students and 90% of postgraduate students reported body pain in at least one region. The most prevalent pain locations were: chest/shoulder (46.9%), head/neck (41.8%), middle back (33.9%) and right hand (25.4%). Severity of reported pain was increased due to performing dental work, increased working stress and working fatigue. Regular exercise was associated with alleviated some pain characteristics. As conclusions musculoskeletal pain reports were highly prevalent among dental students. Attention to prevention of musculoskeletal disorders should be considered as priority in dental schools. For dental students exercise training courses for strengthening muscles of shoulder/chest, neck and back are necessary.

[The German program for disease management guidelines. Results and perspectives].

PubMed

Ollenschläger, Günter; Kopp, Ina

2007-05-15

The Program for National Disease Management Guidelines (German DM-CPG Program) is a joint initiative of the German Medical Association (umbrella organization of the German Chambers of Physicians), the Association of the Scientific Medical Societies (AWMF), and of the National Association of Statutory Health Insurance Physicians (NASHIP). The program aims at developing, implementing and continuously updating best-practice recommendations for countrywide and regional disease management programs in Germany. Since 2003 twelve national guidelines (topics: asthma, chronic obstructive pulmonary disease, HI (Chronic heart failure), CVD (Chronic coronary heart disease) back pain, depression, several aspects of diabetes) have been produced by use of a standardized procedure in accordance with internationally consented methodologies. For countrywide dissemination and implementation the program uses a wide range of specialist journals, continuous medical education and quality management programs. So far, 36 out of 150 national scientific medical associations, four allied health profession organizations, and twelve national consumer organizations have been participating in the DM-CPG Program. Studies to evaluate the program's effects on health-care providers' behavior and patients' outcomes are under way.

The Relaxation Response Resiliency Program (3RP) in Patients with Headache and Musculoskeletal Pain: A Retrospective Analysis of Clinical Data.

PubMed

Gonzalez, Adam; Shim, Minjung; Mahaffey, Brittain; Vranceanu, Ana-Maria; Reffi, Anthony; Park, Elyse R

2018-05-14

Headache and musculoskeletal pain are associated with both physical and mental health symptoms, which together are mutually reinforcing. Addressing mental and physical health symptoms (including pain) concomitantly may provide an effective and efficient way to improve outcomes in this population. We tested an evidence-based, eight-session multimodal group program, the Relaxation Response Resiliency Program (3RP), in patients with headache and musculoskeletal pain. A total of 109 adults (30 with headaches, 79 with musculoskeletal pain). Participant were 109 adults (30 with headaches, 79 with musculoskeletal pain) referred by their medical doctor, who completed a battery of questionnaires before and after completion of the 3RP. On average, patients with headache and musculoskeletal pain had higher pretreatment scores for anxiety, depression, and somatization symptoms than the nonpatient normative sample for the Symptom Checklist 90-Revised. Significant improvements were identified from pre- to post-treatment in all mental health symptoms (moderate to large effects) and frequency of pain and co-occurring physical health symptoms (small to moderate effects). Patients also reported significant decreases in degree of discomfort and life interference, which were relatively more modest in the musculoskeletal pain group compared with the headache group. Overall, results of this study suggest that the 3RP may be an effective treatment for reducing pain and psychological symptoms in patients with headaches and musculoskeletal pain. Future work is needed to evaluate the 3RP via a randomized clinical trial in these patient populations. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Fear of pain in the context of intensive pain rehabilitation among children and adolescents with neuropathic pain: associations with treatment response.

PubMed

Simons, Laura E; Kaczynski, Karen J; Conroy, Caitlin; Logan, Deirdre E

2012-12-01

Recent research has implicated pain-related fear in relation to functional outcomes in children with chronic pain. The current study examined fear of pain, disability, and depression within the context of an intensive pain rehabilitation program. One hundred forty-five children and adolescents who participated in an intensive interdisciplinary pediatric pain rehabilitation day program were assessed in this study. Patients completed measures of pain intensity, pain-related fears, functional disability, and depressive symptoms at admission, discharge, and on average, 2 months postdischarge. After controlling for pain intensity, pain-related fear was significantly related to disability and depressive symptoms at all time points. As predicted, a decline in pain-related fear was significantly associated with a decrease in disability and depressive symptoms. Interestingly, high levels of pain-related fears at admission predicted less reduction in functional disability and depression at discharge, suggesting that high levels of pain-related fear may be a risk factor in relation to treatment outcomes. Overall, results indicate that the relationship between fear of pain and changes in disability and depressive symptoms are closely linked, with fear of pain playing an important role in treatment. This paper presents results underscoring the importance of pain-related fear in relation to treatment response for children and adolescents with chronic pain. These findings support the need to develop and implement interventions that target reductions in pain-related fear. Copyright © 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.

[The painful hemiplegic shoulder: effects of exercises program according to Bobath].

PubMed

Gialanella, B; Benvenuti, P; Santoro, R

2004-01-01

To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, p<0.04 respectively) after three months. The others variables measured did not change. This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

Exploring the Facets of Empathy and Pain in Clinical Practice: A Review.

PubMed

Roche, Jenny; Harmon, Dominic

2017-11-01

Empathy is an essential element in providing quality patient care. The significance of empathy is even more striking in pain medicine, as chronic pain is notorious for the way it can compromise an individual, leaving him or her isolated and feeling misconceived. This review examines the role of empathy in pain medicine practice. Current and past literature focusing on empathy and pain was searched for in PubMed, Science Direct, MEDLINE (Ovid), MEDLINE (Ebsco), Research Gate, and Google Scholar in July 2015. Search dates were not limited and languages included English only. Search terms were "empathy and pain," "empathy and chronic pain," "physician empathy and pain," "neural mechanisms and empathy," "empathy in clinical practice," "empathy and stigma," and "empathy and medical students". To select relevant publications, the title and abstract of every publication were examined, and when in doubt, the rest of the publication was read. Four major themes were identified: (1) the neural basis for empathy and pain; (2) the value and challenges of practicing empathy pain medicine; (3) stigma and empathy for pain; and (4) empathy and physician education and training. The review reveals that empathy deserves an unchallenged place in medical care, especially in pain medicine and medical education. It highlights the need to nurture empathy at all levels of professional expertise from medical student to senior doctors. © 2017 World Institute of Pain.

Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey.

PubMed

Schmidt, Carsten Oliver; Raspe, Heiner; Pfingsten, Michael; Hasenbring, Monika; Basler, Heinz Dieter; Eich, Wolfgang; Kohlmann, Thomas

2007-08-15

A population-based cross-sectional multiregion postal survey. To provide a descriptive epidemiology of the prevalence and severity of back pain in German adults and to analyze sociodemographic correlates for disabling back pain within and across regions. Back pain is a leading health problem in Germany. However, comprehensive population-based evidence on the severity of back pain is still fragmentary for this country. Despite earlier findings concerning large prevalence differences across regions, systematic explanations remain to be ascertained. Questionnaire data were collected for 9263 subjects in 5 German cities and regions (population-based random samples, postal questionnaire). Point, 1-year, and lifetime prevalence were assessed using direct questions, and graded back pain was determined using the Graded Chronic Pain Scale. Poststratification was applied to adjust for cross-regional sociodemographic differences. Point-prevalence was 37.1%, 1-year prevalence 76.0%, and lifetime prevalence 85.5%. A substantial minority had severe (Grade II, 8.0%) or disabling back pain (Grade III-IV, 11.2%). Subjects with a low educational level reported substantially more disabling back pain. This variable was an important predictor for large cross-regional differences in the burden of back pain. Back pain is a highly prevalent condition in Germany. Disabling back pain in this country may be regarded as part of a social disadvantage syndrome. Educational level should receive greater attention in future cross-regional comparisons of back pain.

Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Yu, Hainan; Côté, Pierre; Southerst, Danielle; Wong, Jessica J; Varatharajan, Sharanya; Shearer, Heather M; Gross, Douglas P; van der Velde, Gabrielle M; Carroll, Linda J; Mior, Silvano A; Ameis, Arthur; Jacobs, Craig L; Taylor-Vaisey, Anne L

2016-12-01

In 2008, the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders recommended patient education for the management of neck pain. However, the effectiveness of education interventions has recently been challenged. To update the findings of the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of structured patient education for the management of patients with whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). Systematic review of the literature and best-evidence synthesis. Randomized controlled trials that compared structured patient education with other conservative interventions. Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes such as depression or fear, or adverse effects. We systematically searched eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, DARE, PubMed, and ICL) from 2000 to 2012. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized in evidence tables and synthesized following best-evidence synthesis principles. We retrieved 4,477 articles. Of those, nine were eligible for critical appraisal and six were scientifically admissible. Four admissible articles investigated patients with WAD and two targeted patients with NAD. All structured patient education interventions included advice on activation or exercises delivered orally combined with written information or as written information alone. Overall, as a therapeutic intervention, structured patient education was equal or less effective than other conservative treatments including massage, supervised exercise, and physiotherapy. However, structured patient education may provide small benefits when combined with physiotherapy. Either mode of delivery (ie, oral or written education) provides similar results in patients with recent WAD. This review adds to the Bone and Joint Decade 2000 to 2010 Task Force on Neck Pain and Its Associated Disorders by defining more specifically the role of structured patient education in the management of WAD and NAD. Results suggest that structured patient education alone cannot be expected to yield large benefits in clinical effectiveness compared with other conservative interventions for patients with WAD or NAD. Moreover, structured patient education may be of benefit during the recovery of patients with WAD when used as an adjunct therapy to physiotherapy or emergency room care. These benefits are small and short lived. Copyright © 2014 Elsevier Inc. All rights reserved.

Belly Pain (For Kids)

MedlinePlus

... First Aid & Safety Doctors & Hospitals Videos Recipes for Kids Kids site Sitio para niños How the Body Works ... Educators Search English Español Belly Pain KidsHealth / For Kids / Belly Pain What's in this article? All About ...

Pharmacist's role in dispensing opioids for acute and chronic pain.

PubMed

Marlowe, Karen F; Geiler, Richard

2012-10-01

Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

Unlicensed staff members' experiences with patients' pain on an inpatient oncology unit: implications for redesigning the care delivery system.

PubMed

Schulman-Green, Dena; Harris, Debra; Xue, Ying; Loseth, Diane B; Czaplinski, Cindy; Donovan, Constance; McCorkle, Ruth

2005-01-01

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program

PubMed Central

Patti, Antonino; Bianco, Antonino; Paoli, Antonio; Messina, Giuseppe; Montalto, Maria Alessandra; Bellafiore, Marianna; Battaglia, Giuseppe; Iovane, Angelo; Palma, Antonio

2016-01-01

Abstract Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP. Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T1). Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P < 0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7 ± 5.0 compared with T1, 6.5 ± 4.0 (P < 0.001); and CG, T0, 10.7 ± 7.8 compared with T1, 8.4 ± 7.8 (P < 0.01). A greater extent of reduction in pain was achieved in the EG. The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings. PMID:26765419

For what illnesses is a disease management program most effective?

PubMed

Jutkowitz, Eric; Nyman, John A; Michaud, Tzeyu L; Abraham, Jean M; Dowd, Bryan

2015-02-01

We examined the impact of a disease management (DM) program offered at the University of Minnesota for those with various chronic diseases. Differences-in-differences regression equations were estimated to determine the effect of DM participation by chronic condition on expenditures, absenteeism, hospitalizations, and avoidable hospitalizations. Disease management reduced health care expenditures for individuals with asthma, cardiovascular disease, congestive heart failure, depression, musculoskeletal problems, low back pain, and migraines. Disease management reduced hospitalizations for those same conditions except for congestive heart failure and reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain. Disease management did not have any effect for individuals with diabetes, arthritis, or osteoporosis, nor did DM have any effect on absenteeism. Employers should focus on those conditions that generate savings when purchasing DM programs. This study suggests that the University of Minnesota's DM program reduces hospitalizations for individuals with asthma, cardiovascular disease, depression, musculoskeletal problems, low back pain, and migraines. The program also reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain.

[Organisation of Perioperative Pain Management].

PubMed

Meißner, Winfried; Erlenwein, Joachim; Stamer, Ulrike

2018-04-01

Organisational issues of acute pain management are as important as details of pharmacologic treatments or regional analgesia. Lothar Lachgas is a young intern in the department of anaesthesiology of a German hospital. This overview illuminates organisation of perioperative pain management based on his virtual experiences and questions: pain assessment and documentation, patient information and education, tasks of an Acute Pain Service. Georg Thieme Verlag KG Stuttgart · New York.

Group interventions for co-morbid insomnia and osteoarthritis pain in primary care: the lifestyles cluster randomized trial design.

PubMed

Von Korff, Michael; Vitiello, Michael V; McCurry, Susan M; Balderson, Benjamin H; Moore, Amy L; Baker, Laura D; Yarbro, Patricia; Saunders, Kathleen; Keefe, Francis J; Rybarczyk, Bruce D

2012-07-01

Six weekly sessions of group cognitive-behavioral therapy for insomnia and osteoarthritis pain (CBT-PI), and for osteoarthritis pain alone (CBT-P) were compared to an education only control (EOC). Basic education about pain and sleep was comparable, so EOC controlled for information and group participation. Active interventions differed from EOC in training pain coping skills (CBT-P and CBT-PI) and sleep enhancement techniques (CBT-PI). Persons with osteoarthritis age 60 or older were screened for osteoarthritis pain and insomnia severity via mailed survey. Primary outcomes were pain severity (pain intensity and interference ratings from the Graded Chronic Pain Scale) and insomnia severity (Insomnia Severity Index). Secondary outcomes were arthritis pain (AIMS-2 symptom scale) and sleep efficiency assessed by wrist actigraphy. Ancillary outcomes included: cognitive function, depression, and health care use. A clustered randomized design provided adequate power to identify moderate effects on primary outcomes (effect size>0.35). Modified intent to treat analyses, including all participants who attended the first session, assessed effects across CBT-PI, CBT-P, and EOC groups. Treatment effects were assessed post-intervention (2 months) and at 9 months, with durability of intervention effects evaluated at 18 months. The trial was executed in 6 primary clinics, randomizing 367 participants, with 93.2% of randomized patients attending at least 4 group sessions. Response rates for post-intervention and 9 month assessments were 96.7% and 92.9% respectively. This hybrid efficacy-effectiveness trial design evaluates whether interventions yield specific benefits for clinical and behavioral outcomes relative to an education only control when implemented in a primary care setting. Copyright © 2012 Elsevier Inc. All rights reserved.

Attitudes and concerns of Canadian animal health technologists toward postoperative pain management in dogs and cats.

PubMed

Dohoo, S E; Dohoo, I R

1998-08-01

Three hundred and twenty-two Canadian animal health technologists (AHTs) were surveyed to determine their attitudes toward postoperative pain management in dogs and cats following 6 surgical procedures, their concerns regarding the use of opioid analgesics, and their role within veterinary practices with respect to postoperative pain control. Two hundred and sixty-four (82%) returned the questionnaire. Pain perception was defined as the average of pain rankings for dogs and cats (on a scale of 1 to 10) following abdominal surgery, or the value for dogs or cats if the AHT worked with only 1 of the 2 species. Maximum concern about the risks associated with the postoperative use of morphine or oxymorphone was defined as the highest rating assigned to any of the 6 risks evaluated in either dogs or cats. Animal health technologists reported significantly higher pain perception scores than did veterinarians who completed a similar survey 2 years previously. Higher pain perception scores were associated with decreased satisfaction with the adequacy of analgesic therapy in their practice, higher pain control goals, and attendance at continuing education within the previous 12 months. The majority of AHTs (55%) agreed that one or more risks associated with the use of morphine or oxymorphone outweighed the benefits. The 3 issues that were perceived to pose the greatest risk were respiratory depression, bradycardia, and sedation and excitement, for dogs and cats, respectively. Most AHTs (68%) considered their knowledge related to the recognition and control of pain to be adequate, compared with 24% of veterinarians who responded to a similar previous survey. As for veterinarians, experience gained while in practice was ranked as the most important source of knowledge, while the technical program attended was ranked as least important. Over 88% of the AHTs provided nursing care during the postoperative period, monitored animals for side effects of postoperative analgesic therapy, informed veterinarians when animals were in pain, recommended analgesic therapy when they believed it was warranted, reported that animals received analgesics when they believed it was warranted, administered analgesics under the instruction of a veterinarian, and believed they were part of a team working to provide adequate postoperative pain control.

Prevalence of neuro-musculoskeletal pain and dysfunction in open-heart surgical patients preoperatively and at 6 and 12 weeks postoperatively: a prospective longitudinal observation study.

PubMed

Bellet, R Nicole; Lamb, Rhonda L; Gould, Tonya D; Bartlett, Harold J

2017-01-01

Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation. Of 114 elective patients who provided consent, 98 subjects were surveyed preoperatively, and at week 6 and week 12 post-OHS. Open and closed questions encompassed numerical rating of pain scales for various body areas summed as a total pain score (TPS), the shoulder disability score (SDS), exercise compliance, and sternal clicking. Usual care comprised mobility exercises, walking program, and cardiac rehabilitation referral. Survey return rates were 100%, 88%, and 82%, respectively. Of the 76 (78%) subjects with complete data sets, 68% subjects reported a history of previous neuro-musculoskeletal injuries/conditions preoperatively while prevalence for neuro-musculoskeletal pain was 64%, 88%, and 67% and 38%, 63%, and 42% for shoulder disability, at the three assessments. In all, 11% subjects reported sternal clicking at week 6 and 7% at week 12. Pain commonly occurred in the lower back and neck preoperatively, and in front of the chest, neck, rib cage, upper back, and left shoulder at week 6. Rib cage pain alone remained significantly greater than preoperative levels by week 12 post-OHS. Preoperative SDS was positively correlated with post-OHS length of stay; women had higher SDSs than men at week 6 and week 12 and week 12 SDS was negatively correlated with height. Surgical risk score was negatively correlated with change in SDS and TPS from pre-operation to week 12. In conclusion, neuro-musculoskeletal pain and shoulder disability were common preoperatively and while prevalence increased at week 6 post-OHS, overall preoperative levels were restored by week 12.

Prevalence of neuro-musculoskeletal pain and dysfunction in open-heart surgical patients preoperatively and at 6 and 12 weeks postoperatively: a prospective longitudinal observation study

PubMed Central

Bellet, R Nicole; Lamb, Rhonda L; Gould, Tonya D; Bartlett, Harold J

2017-01-01

Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation. Of 114 elective patients who provided consent, 98 subjects were surveyed preoperatively, and at week 6 and week 12 post-OHS. Open and closed questions encompassed numerical rating of pain scales for various body areas summed as a total pain score (TPS), the shoulder disability score (SDS), exercise compliance, and sternal clicking. Usual care comprised mobility exercises, walking program, and cardiac rehabilitation referral. Survey return rates were 100%, 88%, and 82%, respectively. Of the 76 (78%) subjects with complete data sets, 68% subjects reported a history of previous neuro-musculoskeletal injuries/conditions preoperatively while prevalence for neuro-musculoskeletal pain was 64%, 88%, and 67% and 38%, 63%, and 42% for shoulder disability, at the three assessments. In all, 11% subjects reported sternal clicking at week 6 and 7% at week 12. Pain commonly occurred in the lower back and neck preoperatively, and in front of the chest, neck, rib cage, upper back, and left shoulder at week 6. Rib cage pain alone remained significantly greater than preoperative levels by week 12 post-OHS. Preoperative SDS was positively correlated with post-OHS length of stay; women had higher SDSs than men at week 6 and week 12 and week 12 SDS was negatively correlated with height. Surgical risk score was negatively correlated with change in SDS and TPS from pre-operation to week 12. In conclusion, neuro-musculoskeletal pain and shoulder disability were common preoperatively and while prevalence increased at week 6 post-OHS, overall preoperative levels were restored by week 12. PMID:29066939