The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center,Controlled before-after Study in China

BackgroundEffective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown.AimsThe current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients.DesignA single-center, propensity score-matched, controlled before–after study.MethodsThe patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses’ pain knowledge and attitude between group A and group B.ResultsA total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X² = 38.926, p < .05; vomit: X² = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05).ConclusionOur study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.     

Impact of Different Illness Perceptions and Emotions Associated with Chronic Back Pain on Anxiety and Depression in Patients Qualified for Surgery

BackgroundAnxiety and depression are known comorbidities of chronic back pain. Their psychological predictors are not well established in patients with chronic back pain qualified for neurosurgery.AimsThe purpose of this study was to determine the psychological predictors of depression and anxiety in patients with chronic back pain qualified for surgery.DesignThis was a cross-sectional study.SettingsA neurosurgical ward in Gdańsk, Poland.Participants/SubjectsAll patients who were admitted to the neurosurgical ward and met the inclusion criteria were recruited for the study. Finally, 83 patients with chronic back pain waiting for surgery were recruited.MethodsA battery of questionnaires, including Illness Perceptions Questionnaire–Revised, Multidimensional Health Locus of Control Scale, Hospital Anxiety and Depression Scale, and Brief Pain Inventory, was used in 83 spinal surgery candidates.ResultsHigher anxiety was predicted by stronger beliefs about negative consequences of illness (β = .205, p < .05), worse illness coherence (β = .204, p < .05), negative emotional representations of illness (β = .216, p < .05), and depression (β = .686, p < .001). Higher depression was predicted by anxiety (β = .601, p < .001), pain interference (β = .323, p < .01), lower personal control over pain (β = −.160, p < .05), and lower external control of health (β = −.161, p < .05) but, surprisingly, higher internal control of health (β = .208, p < .01).ConclusionsAnxiety and depression commonly coexist in chronic back pain sufferers qualified for spine surgery but are derived from dissimilar beliefs. The results highlight the usefulness of advising about the disease and treatment in comprehensive care for this group of patients.     

The effect of Therapeutic Touch on Back Pain in Adults on a Neurological Unit: An Experimental Pilot Study

BackgroundChronic back pain affects many aspects of everyday life and is a common reason for medical visits, leading to high direct and indirect health care costs. Innovative and cost-effective nonpharmacologic pain management methods should be promoted to ensure adequate treatment.AimsThe aim of this pilot study was to investigate the pain-relieving effect of Therapeutic Touch in adult neurologic patients with back pain.DesignA pretest–post-test randomized controlled trial.SettingsA university hospital in Austria.Participants/SubjectsPatients with back pain diagnosis (N = 29) on hospital admission.MethodsA pilot study was conducted for 3 months. The control group (n = 14) received the pharmacologic pain management recommended by the World Health Organization; patients in the intervention group (n = 15) received additionally four Therapeutic Touch treatments on 4 consecutive days. The Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale were used as outcome measures to evaluate activity domains affected by back pain and pain intensity.ResultsPain improvement was found in the intervention group according to the mean score of the Quebec Back Pain Disability Scale (day 1: 72.53, standard deviation [SD] ± 14.10; day 4: 39.47, SD ± 8.77; p < .001). The Numerical Pain Rating Scale score averaged 4.33 points (SD ± 2.09) on the first day and 2.47 points (SD ± 1.12) on the fourth day. The long-term effect of Therapeutic Touch was significant and indicated a major effect (Pillai's trace = .641, F_(3.12) = 7.1, p = .005, η_p² = .641).ConclusionsTherapeutic Touch seems to be a noninvasive nursing intervention for back pain management to provide more professional patient care.     

Turkish Translation of the Patterns of Activity Measure-Pain in Patients with Chronic Low Back and Neck Pain: Validity and Reliability

ObjectiveTo translate the Patterns of Activity Measure-Pain (POAM-P) into Turkish and test its validity and reliability.MethodsA total of 252 patients with chronic low back and neck pain were included. The Turkish translation of the POAM-P (POAMP/T), which has subgroups of Avoidance, Overdoing, and Pacing, was performed in accordance with international recommendations. The POAMP/T was administered twice. Physical activity level was assessed with the International Physical Activity Questionnaire-7 (IPAQ-7), and psychologic status was assessed with the Hospital Anxiety (HADS-A) and Depression Scales (HADS-D). The internal and external construct validity, internal consistency, and test-retest reliability were analyzed.ResultsThree related factorial structures were defined in Confirmatory Factor Analysis. Indexes and factor loads were found to be sufficient. A negative relationship was observed between avoidance and IPAQ-7 (rho = –0.328, p < .001), HADS-D (ρ = ?0.163, p = .009), and HADS-A scores (ρ = ?0.164, p = .009); whereas, a positive relationship was observed between overdoing and IPAQ-7 (ρ = 0.362, p < .001), HADS-D (ρ = 0.309, p < .001), and HADS-A scores (ρ = 0.325, p < .001). A negative correlation was found between pacing and IPAQ-7 (ρ = ?0.200, p = .001), HADS-D (ρ = ?0.507, p < .001), and HADS-A scores (ρ = ?0.509, p < .001). The Cronbach alpha values for avoidance, overdoing, and pacing were obtained as 0.941, 0.917, and 0.940, respectively. The intraclass correlation coefficient for avoidance, overdoing, and pacing was found as 0.972, 0.973, and 0.972, respectively. Test and retest scores were similar (p > .05).ConclusionsThe Turkish version of the POAM-P is a valid and reliable scale for the assessment of pain-related activity patterns in patients with chronic low back or neck pain.     

A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case–Control Study

PurposeThis study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct.MethodsThis retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST.ResultsAfter a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ² = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ² = 25.65, p < .001).ConclusionFSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.     

Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain

BackgroundAimsThe aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain.DesignThis work was a prospective randomized controlled study.SettingsStudy was conducted in the orthopedics clinic of a university hospital.Participants/SubjectsMethodsThe sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded.ResultsThe patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ? .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group.ConclusionValsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.     

Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services

BackgroundSomatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services.AimWe focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service.MethodsA cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied.ResultsOf all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ² = 18.4, p < .001), as well as more severe (t = –4.6, p < .001), and prolonged (χ² = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms.ConclusionsIn this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.     

Feasibility of Investigational Procedures and Efficacy of a Personalized Omega-3 Dietary Intervention in Alleviating Pain and Psychoneurological Symptoms in Breast Cancer Survivors

BackgroundBreast cancer survivors (BCS) are at risk for psychoneurological symptoms (PNS) and inflammation for years following cancer treatment. Fish, particularly salmon, provides a rich source of omega-3 long chain fatty acids (omega-3LC), which has an anti-inflammatory effect. However, the benefit of omega-3LC on PNS is not well-known.AimsThis study evaluated the feasibility and the initial efficacy of a personalized meal plan with dietary omega-3LC in reducing PNS.MethodsA prospective, randomized controlled trial design (n = 46) was used to evaluate the feasibility of a personalized meal plan using two omega-3LC dose levels (high and low omega-3LC) in reducing PNS including pain, depression, fatigue, sleep, and stress.ResultsThe recruitment rate was 4.9% with overall retention rate of 74% and 67.1% adherence to personalized meal plan and dietary procedures. Of participants who completed the investigation, 94% completed fish adherence logs and consumed ≥70% of the assigned quantity of fish. Saliva collection was 97.8% at baseline and 100% at follow-up. BCS in the high omega-3LC group had a significant decrease in pain (p < .01), perceived stress (p < .05), sleep (p < .001), depression (p < .001), and fatigue (p < .01) over the course of intervention. There were trends of PNS improvement in the low omega-3LC group but the differences did not reach statistical significance.ConclusionOur results support the feasibility of our investigational design, procedures, and intervention. The outcomes provide preliminary support for an expanded research effort using fish as a source of omega-3LC and personalized dietary planning as a vehicle for symptom self-management in BCS.     

Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study

BackgroundUnresolved postpartum LBP may affect women...s physical and psychological health.AimTo investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.MethodPostpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.ResultsIn all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.ConclusionsFor postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.     

Arteriovenous Graft for Hemodialysis: Effect of Cryotherapy on Postoperative Pain and Edema

BackgroundArteriovenous grafting offers an alternative for patients whose vessels are unsuitable for arteriovenous fistula. However, as a result of subcutaneous tunnel dissection, postoperative pain and edema of the operated limb present early after surgery. As a traditional therapeutic approach, cryotherapy has the ability to suppress postoperative pain and edema.AimsThe purpose of the study was to investigate the feasibility of cryotherapy after arteriovenous graft surgery to decrease perioperative medication usage.DesignThis study was a randomized controlled trial.SettingA large integrated health care facility in South China.Participants/SubjectsA total of 85 hemodialysis patients who received arteriovenous graft surgery from March 2011 to February 2017 were enrolled.MethodsThe participants were divided into an intervention group and a control group according to the postoperative management. Ice packs were applied covering the operative forearm for 120 minutes after wound closure in the intervention group. General information, pain score, analgesic consumption, wound inflammation, forearm edema, and participant satisfaction were compared between the two groups.ResultsCryotherapy-treated patients required less analgesia (26.19% vs. 48.84%, p < .05), reported lower pain score from 30 minutes to 48 hours postoperative (p < .05), less wound inflammation (11.90% vs. 25.58%, p < .05), and higher participant satisfaction (8.92 ± 0.57 vs. 6.52 ± 0.63, p < .05), whereas the incidence of forearm edema was equivalent (p > .05). No adverse events were reported in either group.ConclusionsCryotherapy is a preferable intervention for patients after arteriovenous graft implantation as a result of its favorable cost, convenience, and fewer side effects.     

Do Warmed Blankets Change Pain,Agitation, Mood or Analgesic Use Among Nursing Home Residents?

BackgroundPain, agitation, and thermal discomfort are common symptoms of older adults residing in nursing homes. Nonpharmacologic interventions are recognized as a best practice strategy for people living in nursing homes because of their low adverse effect profile and increased evidence of effectiveness. Warmed blankets have not been empirically tested for use in long-term care.AimsThe purpose of this quality improvement project was to describe the use of warmed blankets in a nursing home setting and determine if use was associated with changes in pain, agitation, mood, or analgesic use.DesignA pretest posttest design was used along with a comparison of intact groups.SettingsThe setting was one 160-bed skilled long-term care facility.Participants/SubjectsThere were 141 residents eligible since they did not have a condition that could be worsened by superficial heat.MethodsWarmed blankets were unfolded and placed over residents with pain, agitation, or thermal discomfort. Short-term pain measures included use of the Revised FACES Pain Scale, the PAINAD (Pain Assessment in Advanced Dementia) scale, and the Brief Agitation Rating Scale. Long-term measures were taken from the electronic medical record.ResultsOf the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the 1- month study period. There were statistically significant decreases in both pain level and agitation among baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and as-needed analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures.ConclusionsWarmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.     

Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis

BackgroundDistraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings.AimTo determine the current evidence on the effects of distraction on procedural pain in children with cancer.DesignThis systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelinesSettingsSix different databases from 1990 to June 2019.MethodA literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects.ResultsTen randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (–0.92, 95% CI –1.48 to –0.36, p = .001) and on needle insertion as well (–1.12, 95% CI –1.52 to –0.72, p = .000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p = .012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p = .28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p = .06).ConclusionsDistraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.     

Development of Knowledge and Attitudes Survey on Pain Management for Korean Long-term Care Professionals

PurposeInappropriate knowledge and attitude toward pain management of professionals has been pointed to be major obstacles to effective pain management in long-term care setting. The purpose of this study was to develop the knowledge and attitudes survey on pain management for Korean long-term care (LTC) professionals (KASP-K).MethodsTo develop the KASP-K, the knowledge and attitudes survey regarding pain developed by Ferrell and McCaffery in 2014 was amended after a review of broad literature and the latest pain management standards. A rigorous validation process of the KASP-K was performed by testing the content validity, item difficulty and discrimination index, construct validity, test–retest reliability, and internal consistency.ResultsThe KASP-K consisted of 22 items and showed a content validity index of >0.7. The average difficulty of the KASP-K was 0.56 and the discrimination index was >0.2. The construct validity of the KASP-K was verified because of the differences in the sum scores depending on pain education (t = 2.30, p = .024). The test–retest reliability was r = .79 (p < .001) and the Cronbach's alpha was 0.73.ConclusionThis preliminary evaluation of the KASP-K demonstrated acceptable validity and reliability. The KASP-K will be able to provide scientific and empirical data regarding the knowledge of and attitude toward pain management by LTC professionals.     

The Impact of Guided Imagery on Pain and Anxiety in Hospitalized Adults

BackgroundThe use and impact of guided imagery in the acute care setting is limited.AimsThe purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting.DesignQuality improvement project using three measurements (baseline, 24 hours, and 48 hours).SettingsAcute care hospital.Participants/SubjectsAdult inpatients referred to an APRN-led pain management service.MethodsThe intervention was the use of a 30-minute guided imagery recording delivered via MP3 player which patients used twice daily.ResultsLimited changes were seen in pain scores, with no statistically significant results (p = .449). Statistically significant reductions were found in both anxiety scores (p < .001) and opioid analgesia usage (p = .043).ConclusionsFindings from this quality improvement project support the impact of guided imagery on anxiety and opioid analgesia use. Changes in pain scores were not demonstrated in this project. Additional research with a rigorous design is needed to determine cause and effect conclusions.Clinical ImplicationsThe use of guided imagery as an adjunctive intervention for pain control may engage and empower the patient in self-care activities, which may have an impact on how care is perceived. Guided imagery is a low-cost, easily implemented approach that can be incorporated into patient care to reduce anxiety and, potentially, opioid analgesia use.