scholarly journals Opioid cessation is associated with reduced pain and improved function in people attending specialist chronic pain services

2021 ◽  
Author(s):  
Hilarie Tardif ◽  
Christopher Hayes ◽  
Samuel F Allingham
Keyword(s):  
Chronic Pain ◽  
Improved Function ◽  
Pain Services

The changing face of acute pain services

2017 ◽  
Vol 16 (1) ◽  
pp. 204-210 ◽  
Author(s):  
Adriana Miclescu ◽  
Stephen Butler ◽  
Rolf Karlsten
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Severe Pain ◽  
Care Hospital ◽  
Opioid Dependency ◽  
Number Of Patients ◽  
History Of ◽  
Number Of Visits ◽  
Pain Services

AbstractBackground and AimsAcute Pain Services have been implemented initially to treat inadequate postoperative pain. This study was undertaken to prospectively review the current challenges of the APS team in an academic hospital assessing the effects of its activity on both surgical and medical pain intensity. It also define the characteristics of the patients and the risk factors influencing the multiple visits from the APS team.MethodThis prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to the APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before, after treatment and the number of follow-ups. The patients were visited by APS at regular intervals and divided by the number of visits by APS team into several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 9 follow-ups); group 4 (10 to 19 follow-ups); group 5 (>20 followups). The difference between groups were analyzed with ordinal logistic regression analyses.ResultsPatients (n = 730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P = 0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 8.7–9.9) to 6.3 (6.1–7.4) for the severe pain (P < 0.0001), from 3.8 (3.2–4.3) to 2.4 (1.8–2.9) for the moderate pain. The odds ratio for frequent follow-ups of the patients between 18 and 85 years (n = 609) was 2.33 (95% CI: 1.35–4.02) if the patient had a history of chronic neuropathic pain, 1.80(1.25–2.60) in case the patient had a history of chronic nociceptive pain, 2.06(1.30–3.26) if he had mental diseases, and 3.35(2.21–5.08) if he had opioid dependency at the time of consultation from APS. Strong predictors of frequent visits included female gender (P = 0.04).ConclusionsBeside the benefits of APS in reducing pain intensity, this study demonstrates that the focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients with a high comorbidity of psychiatric diseases, opioid dependency and chronic pain.ImplicationsThe concept of an APS will ultimately be redefined according to the new clinical variables. In the light of the increasing number of patients with complex pain states and chronic pain, opioid dependency and psychiatric comorbidities it is mandatory that the interdisciplinary APS team should include other specialties besides the “classical interdisciplinary APS team”, as psychiatry, psychology, rehabilitation and physiotherapy with experience in treating chronic pain patients.

Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital

2017 ◽  
Vol 17 (1) ◽  
pp. 345-349 ◽  
Author(s):  
Daniel W. Wheeler ◽  
Sara Kinna ◽  
Andrew Bell ◽  
Peter J. Featherstone ◽  
David J. Sapsford ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Acute Exacerbation ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Healthcare Providers ◽  
University Hospital ◽  
Specialist Nurses ◽  
Recurrent Hospitalization ◽  
Pain Services ◽  
Attending Physician

AbstractBackground and aimsHospitalization as a result of acute exacerbation of complex chronic pain is a largely hidden problem, as patients are often admitted to hospital under a variety of specialities, and there is frequently no overarching inpatient chronic pain service dedicated to their management. Our institution had established an inpatient acute pain service overseen by pain physicians and staffed by specialist nurses that was intended to focus on the management of perioperative pain. We soon observed an increasing number of nurse-to-nurse referrals of non-surgical inpatients admitted with chronic pain. Some of these patients had seemingly intractable and highly complex pain problems, and consequently we initiated twice-weekly attending physician-led inpatient pain rounds to coordinate their management. From these referrals, we identified a cohort of 20 patients who were frequently hospitalized for long periods with exacerbations of chronic pain. We sought to establish whether the introduction of the physician-led inpatient pain ward round reduced the number and duration of hospitalizations, and costs of treatment.MethodsWe undertook a retrospective, observational, intervention cohort study. We recorded acute Emergency Department (ED) attendances, hospital admissions, and duration and costs of hospitalization of the cohort of 20 patients in the year before and year after introduction of the inpatient pain service.ResultsThe patients’ mean age was 38.2 years (±standard deviation 13.8 years, range 18-68 years); 13 were women (65.0%). The mode number of ED attendances was 4 (range 2–15) pre-intervention, and 3 (range 0–9) afterwards (p = 0.116). The mode bed occupancy was 32 days (range 9–170 days) pre-intervention and 19 days (range 0–115 days) afterwards (p = 0.215). The total cost of treating the cohort over the 2-year study period was £733,010 (US$1.12m), comprising £429,479 (US$656,291) of bed costs and £303,531 (US$463,828) of investigation costs. The intervention did not achieve significant improvements in the total costs, bed costs or investigation costs.ConclusionsDespite our attending physician-led intervention, the frequency, duration and very substantial costs of hospitalization of the cohort were not significantly reduced, suggesting that other strategies need to be identified to help these complex and vulnerable patients.ImplicationsFrequent hospitalization with acute exacerbation of chronic pain is a largely hidden problem that has very substantial implications for patients, their carers and healthcare providers. Chronic pain services tend to focus on outpatient management. Breaking the cycle of frequent and recurrent hospitalization using multidisciplinary chronic pain management techniques has the potential to improvepatients’ quality of life and reduce hospital costs. Nonetheless, the complexity of these patients’chronic pain problems should not be underestimated and in some cases are very challenging totreat.

scholarly journals Chronic Pediatric Pain in Low and Middle Income Countries

2018 ◽  
Author(s):  
Camila Walters ◽  
Matthew Kynes ◽  
Jenna Sobey ◽  
Tsitsi Chimhundu-Sithole ◽  
Kelly McQueen
Keyword(s):  
Chronic Pain ◽  
Pediatric Population ◽  
Poor Quality ◽  
Health Concern ◽  
Pediatric Pain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pediatric Patient Population ◽  
Pain Services ◽  
Low And Middle Income

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

Organizational systems in paediatric pain

2013 ◽  
pp. 642-652
Author(s):  
Mark Embrett ◽  
Norman Buckley
Keyword(s):  
Chronic Pain ◽  
Acute Pain ◽  
Patient Flow ◽  
Organizational Systems ◽  
Management Approach ◽  
Flow Process ◽  
Pain Model ◽  
Multidisciplinary Pain Management ◽  
Pain Services ◽  
Similar Elements

This chapter first focuses on an overview of the similar elements to approaches of chronic pain, acute pain, and palliative care, concluding with a description of the ideal multidisciplinary pain management approach (MPMA). The chapter then proceeds to review the specific organization and operations of acute pain and chronic pain services, respectively. Finally, research about the expectation of parents when they enter a clinic and importance of accommodating and promoting positive expectations is presented. The patient flow process in acute pain differs from the chronic pain model and is described. The emphasis remains on consistent clear communication among providers and between providers and patient/family.

scholarly journals Improving Access to Chronic Pain Services Through eConsultation: A Cross-Sectional Study of the Champlain BASE eConsult Service

Pain Medicine ◽  
2016 ◽  
pp. pnw038 ◽  
Author(s):  
Clare Liddy ◽  
Catherine Smyth ◽  
Patricia A. Poulin ◽  
Justin Joschko ◽  
Melanie Rebelo ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Pain Services

Interventional Techniques and Surgical Management of Pain

2019 ◽  
pp. 176-198
Author(s):  
Mark Young ◽  
Andrew Rubens ◽  
Antje M. Barreveld
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Medicine ◽  
Surgical Pain ◽  
Behavioral Therapies ◽  
Management Techniques ◽  
Formally Trained ◽  
Improved Function

Chapter 11 describes many of the most common interventional and surgical procedures performed in the field of chronic pain medicine. They are discussed in a cranial to caudal pattern, and this is done not only for logical arrangement but also to highlight the breadth of procedures that are utilized in practice. Interventional and surgical pain management techniques using image or landmark guidance may provide diagnostic and therapeutic relief for patients suffering from pain. Performed by formally trained and experienced proceduralists, interventions, in conjunction with other multimodal strategies such as medications, physical therapy, and behavioral therapies, can be useful techniques for helping patients achieve improved function and pain relief. Benefits may be short or longer term, depending on the interventional strategy utilized. Indications, evidence, and risks must be considered when choosing the most appropriate interventional options for a patient.

scholarly journals Using patient experiences to develop services for chronic pain

2018 ◽  
Vol 12 (2) ◽  
pp. 122-131 ◽  
Author(s):  
Peter Outlaw ◽  
Shiva Tripathi ◽  
Jacqueline Baldwin
Keyword(s):  
Chronic Pain ◽  
Patient Experience ◽  
Patient Experiences ◽  
Pain Clinic ◽  
Service Improvement ◽  
Patient Interviews ◽  
Lack Of Information ◽  
Large Teaching Hospital ◽  
Wide Range ◽  
Pain Services

Purpose: The aim of this study was to improve the overall experience for patients using chronic pain services at a large teaching hospital in England. Experience-based co-design methodology was used to gain a greater understanding of patients’ experiences and to produce a list of priorities for change when improving the patient experience. Method: A total of seven video-recorded patient interviews were conducted to capture a range of patient experiences of using the chronic pain service. The interviews were analysed to identify ‘touchpoints’ which are areas in which patients experienced a heightened emotional response to their interaction with the service or staff. A short trigger film was compiled to illustrate these touchpoints to staff and gain their commitment to improve patients’ experiences when using the service. A patient experience event was held at which patients discussed the touchpoints and identified the most significant areas for change that would improve their experiences of using the chronic pain service. Results: A wide range of touchpoints were identified. The lack of information provided before arriving for a procedure and the need for a short debrief after clinic were prioritised for improvement. Patients valued the development of good relationships with clinic staff and feeling properly listened to for the first time. The patient experience event allowed the key points patients would like to know before a procedure, to be drawn up in a list, which could be passed onto staff. Conclusion: This study featured collaboration between patients and staff to improve patients’ experiences of using chronic pain services. Through patient participation, a comprehensive list of recommendations for service improvement was produced, and possible solutions were identified. The involvement of patients in driving change and re-designing services is shaping a more patient-centred chronic pain clinic and improving the experience for all the patients who use the service.

Psychosomatic Aspects of Endometriosis

2011 ◽  
Vol 3 (3) ◽  
pp. 166-170
Author(s):  
Johannes Bitzer
Keyword(s):  
Chronic Pain ◽  
Recurrent Disease ◽  
Psychological Needs ◽  
Patient Centered ◽  
Biomedical Diagnosis ◽  
Sexual Counselling ◽  
Psychosomatic Aspects ◽  
Psychosomatic Care ◽  
Pain Services ◽  
Basic Psychosomatic Care

From a patient's perspective and experience endometriosis is characterized by six major challenges and stressors: 1) often the diagnosis is delayed; 2) the cause of the disease is unknown; 3) it is a chronic recurrent disease; 4) it affects young women; 5) it is accompanied by chronic pain and dyspareunia; 6) it may lead to infertility. These features create psychological needs for patients which should be responded to by an integrated basic psychosomatic care. This includes respect and empathy, patient centered communication, adequate response to negative emotions, establishment of a helpful and lasting therapeutic relationship, psychoeducation, empowerment and shared decision making. Apart from this basic psychosomatic care which can be provided by each treating physician or nurse, some conditions need more specialized psychosomatic care in the context of a multidisciplinary team: Chronic pain services, Infertility treatment teams, Sexual counselling and therapy and treatment of psychiatric comorbities or sequelae of the disease like depression, anxiety disorder etc. Psychosomatic care should thus be integrated into the biomedical diagnosis and therapy of endometriosis.

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