Pain management in persons with intellectual disabilities living in institutions

2020 ◽  
Vol 33 (1) ◽  
pp. 35-39
Author(s):  
G. Pickering ◽  
A. Boyer ◽  
N. Danglades ◽  
S. Arondo ◽  
C. Lucchini ◽  
...  
Keyword(s):  
Pain Management ◽  
Intellectual Disabilities ◽  
Pain Assessment ◽  
Healthcare Professionals ◽  
Opioid Analgesic ◽  
Pain Evaluation ◽  
Vulnerable Patients ◽  
Assessment And Treatment ◽  
Effective Assessment ◽  
Pain Care

Background: Persons with severe intellectual disabilities often live in specialised care settings and suffer from comorbidities, some of them generating pain. The literature concerning pain assessment and management in this population is however limited. The main objective of this study was to determine the modalities of pain care in a sample of French institutions. Methods: This observational study focused on the modalities of pain assessment and management in six specialised care settings for persons with intellectual and/or psychomotor disabilities. Information about patients, pain evaluation, prevalence and how do healthcare professionals assess pain in noncommunicating intellectually disabled people was recorded. Results: The study included 218 residents and over the last month, 55% had pain, 87% suffered from acute pain and 16% from neuropathic pain. The use of pain scales for patients with communication impairment was unknown to the majority of healthcare professionals. Patients were prescribed 4 drugs a day, 68% had psychotropic drugs and over the last month, 98% of painful residents had received a non-opioid analgesic combined with a non-pharmacological technique in 78 % of them. Conclusion: Pain management must be carried out through accurate pain assessment and the limited knowledge of caregivers about pain assessment methods might contribute to insufficient pain care. It is necessary to train all caregivers about pain evaluation tools that must be adapted to the disability profile of the residents in order to provide the most effective assessment and treatment in these vulnerable patients.

Tools, Time, Training, and Team—Military Primary Care Providers’ Perspectives on Improving Chronic Pain Assessment and Management

2021 ◽  
Author(s):  
Asha Mathew ◽  
Honor McQuinn ◽  
Diane M Flynn ◽  
Jeffrey C Ransom ◽  
Ardith Z Doorenbos
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Pain Assessment ◽  
Insurance Coverage ◽  
Primary Care Providers ◽  
Stepped Care ◽  
Chronic Pain Management ◽  
Care Providers ◽  
Pain Care

ABSTRACT Introduction Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. Materials and Methods Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. Results Four categories captured providers’ challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. Conclusions Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.

Pain in children

2018 ◽  
Author(s):  
Julia Wager ◽  
Boris Zernikow
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Acute Pain ◽  
Pain Assessment ◽  
Education For All ◽  
Special Focus ◽  
Assessment And Treatment ◽  
Specialized Service ◽  
Pain Patients

Pain management in children is a specialized service. Pain aetiology, assessment, and treatment vary at every age from pre-term foetuses at 23 weeks gestation to adolescence. In this chapter of European Pain Management advances in our understanding of pain assessment are reviewed, particularly in the use of developmentally relevant technology. Advances in acute pain, cancer pain, and in chronic pain are also reviewed, with a special focus on innovations in multidisciplinary treatments for chronic pain. There is a need to raise awareness and understanding of the needs of paediatric pain patients, and their family members. Education for all professionals who interact with pain patients is essential, as is the need to invest in specialized pain management services, and professionals, across Europe.

CRIES: A Neonatal Postoperative Pain Measurement Score

2018 ◽  
pp. 263-267
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Assessment ◽  
Reliable Method ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Neonatal Pain ◽  
Reliable Assessment ◽  
Assessment And Treatment ◽  
Neonatal Population

This case focuses on neonatal pain management by asking the question: Is the CRIES score a valid and reliable method for assessing neonatal postoperative pain? Regular pain assessment and treatment in the neonatal population are important postoperatively. The CRIES scale was designed to measure pain in the neonatal population, and this study demonstrated CRIES to be a valid and reliable assessment tool for identifying postsurgical pain in neonates. Multiple pain assessment tools, including CRIES, are available for use in neonatal patients and in patient populations who are otherwise unable to verbalize discomfort.

scholarly journals Pain assessment and registration in medical oncology clinics: operationalised through the lens of health care professionals and patients

2021 ◽  
Vol 4 ◽  
pp. 86
Author(s):  
Laserina O'Connor ◽  
Aileen Hassett ◽  
Noeleen Sheridan
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Cancer Treatment ◽  
Pain Assessment ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Medical Oncology ◽  
Pain Treatment ◽  
Self Report ◽  
Common Symptom

Background: Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Systematic screening and documentation of pain are necessary to improve the quality of cancer pain treatment, because a key pain-related barrier is that patients are reluctant to discuss pain, due to fear that reporting pain will distract the healthcare professional from their cancer treatment. Methods: This study adopted an explanatory sequential mixed-methods design. Data collection incorporated three strands. The first strand involved a quantitative enquiry in which medical chart reviews of patients (n=100) attending the medical oncology outpatient clinic were examined. The second qualitative strand comprised of semi-structured interviews with patients (n=10) attending that service. The third strand was qualitative and consisted of focus group discussions with healthcare professionals (n=12). Results: All 100 patients had cancer. The quantitative findings confirmed the suboptimum assessment and subsequent recording of patient’s pain, that seemed to afford a reality check for all healthcare professionals. For patients, the outcomes of the anti-cancer treatment were their priority, and pain was perceived as inevitable, being associated with a cancer diagnosis. There were multifaceted complexities voiced amongst healthcare professionals associated with balancing the benefits and harms aligned with treating cancer pain. Conclusions: Pain assessment in medical records was not systematically recorded by healthcare professionals. Patients were reluctant to self-report pain during their medical oncology outpatient review. The expectation that patients will self-report pain can be accommodated by healthcare professionals if a personalized pain goal is part of the cancer pain management plan during each clinical encounter. Healthcare professionals reported a need to take distinct responsibility for supplementing their dearth of knowledge, skills and beliefs regarding assessing and managing patients’ cancer pain. Optimal pain management stems from an interprofessional approach that was applied in this study design.

scholarly journals Acute pain management in children: a survey of Italian pediatricians

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
Gian Luigi Marseglia ◽  
Maria Alessio ◽  
Liviana Da Dalt ◽  
Maria Giuliano ◽  
Angelo Ravelli ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Cross Sectional Study ◽  
Moderate Intensity ◽  
Moderate Pain ◽  
Cross Sectional ◽  
Assessment And Treatment ◽  
Chi Squared ◽  
Data Heterogeneity

Abstract Background Current guidelines recommend assessing and relieving pain in all children and in all instances; yet, in clinical practice, management is frequently suboptimal. We investigated the attitude of Italian family pediatricians towards the evaluation and treatment of different types of acute pain in children aged 7–12 years. Methods This is a cross-sectional study based on a 17-question survey accessible online from October 2017 to October 2018. Responders had to describe cases of children suffering from any type of acute pain among headache, sore throat, musculoskeletal/post-traumatic pain, and earache. Children’s characteristics, pain assessment modalities and therapeutic approaches were queried. The following tests were used: Z-proportion to evaluate the distribution of categorical data; chi-squared and Kruskall-Wallis to explore data heterogeneity across groups; Mann-Whitney for head-to-head comparisons. Results Overall, 929 pediatricians presented 6335 cases uniformly distributed across the types examined. Pain was more frequently of moderate intensity (42.2%, P < 0.001) and short duration (within some days: 98.4%, P < 0.001). Only 50.1% of responders used an algometric scale to measure pain and 60.5% always prescribed a treatment. In children with mild-moderate pain (N = 4438), the most commonly used first-line non-opioids were ibuprofen (53.3%) and acetaminophen (44.4%). Importantly, a non-recommended dosage was prescribed in only 5.3% of acetaminophen-treated cases (overdosing). Among the misconceptions emerged, there were the following: i) ibuprofen and acetaminophen have different efficacy and safety profiles (when choosing the non-opioid, effectiveness weighted more for ibuprofen [79.7% vs 74.3%, P < 0.001] and tolerability for acetaminophen [74.0% vs 55.4%, P < 0.001]); ii) ibuprofen must be taken after meals to prevent gastric toxicities (52.5%); ibuprofen and acetaminophen can be used combined/alternated for persisting mild-moderate pain (16.1%). In case of moderate-severe pain not completely controlled by opioids, ibuprofen and acetaminophen were the most used add-on medications, with ibuprofen being much more prescribed than acetaminophen (65.2% vs 23.7%, respectively) overall and in all pain types. Conclusions Several gaps exist between the current practice of pain assessment and treatment and recommendations. Further efforts are needed to raise awareness and improve education on the possible exposure of the child to short- and long-term consequences in case of suboptimal pain management.

scholarly journals Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Anna Giulia Falchi ◽  
Anna Spadoni ◽  
Chiara Blatti ◽  
Federica Manzoni ◽  
Stefano Perlini
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Prospective Study ◽  
Nursing Staff ◽  
Emergency Care ◽  
Present Status ◽  
Pain Control ◽  
Urban Hospital ◽  
Pain Evaluation ◽  
Assessment And Treatment

Although a correct assessment of pain and an adequate analgesia represent a priority in the setting of emergency care, many studies documented an inadequate pain control. The purpose of our study is to characterize the present status of a second level Emergency Department in Italy in terms of pain assessment and treatment. Our survey investigates the multidimensional aspects of pain, the accomplishment of appropriate pain evaluation by the medical and nursing staff and the effectiveness of the treatment, in terms of pain reduction and also of customer satisfaction.

New directions in pain assessment and treatment

1989 ◽  
Vol 9 (5) ◽  
pp. 549-568 ◽  
Author(s):  
Francis J. Keefe ◽  
David A. Williams
Keyword(s):  
Pain Assessment ◽  
New Directions ◽  
Assessment And Treatment
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