Pain management outcomes for hospitalized Hispanic patients.

The purposes of the study were to describe outcomes of pain management and predictors of patient satisfaction in a minority sample. By using a survey design, 3 instruments were used to collect data: (1) The American Pain Society's Patient Outcome Questionnaire-Modified, a 16-item self-report tool about pain and patient satisfaction; (2) a demographic form; and (3) the Pain Management Index. The sample consisted of 104 hospitalized Hispanic inpatients in a Rio Grande Valley hospital. Mean ratings for current and average pain were moderate, whereas severe mean ratings were reported for worst pain. High interference caused by pain was found for walking and sleep. Patients were satisfied with pain management. However, a negative correlation was found between satisfaction and current pain intensity (r = -.49, p = .001). Pain Management Index scores revealed that 36% of the participants were inadequately treated for pain; also, negative correlations with age indicated less effective management for elders. Reliability estimates for tool subscales were greater than 0.70 except for the Beliefs subscale (0.63). By using logistic regression, satisfaction with pain management was predicted by general pain in the last 24 hours (odds ratio = 4.02), pain-related interference with mood (odds ratio = 7.31), and age (odds ratio = 1.8). Clinical implications include the need to apply standardized guidelines, such as those from the Agency for Health Care Policy and Research, and to educate patients, particularly minority elders, about pain management approaches. The emergence of Hispanics as the fastest growing minority group increases the need for research regarding pain management outcomes to plan more effective intervention.     

Postoperative pain management: study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of pain

The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for 'worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management.     

A survey of perceptions with pain management in Spanish inpatients

The aim of this study was to document the satisfaction with pain management in a Spanish inpatient population and its relationship with pain ratings. Two hundred fifty inpatients of four departments were interviewed: Surgery, Orthopedics, Gynecology, and Internal Medicine. A 32-item questionnaire was used, and the main variables evaluated were pain severity, dissatisfaction with pain management and caregivers, and patient expectations regarding pain relief. Relationships among the variables were analyzed by means of Spearman's correlation between item scores and regression analysis. Median satisfaction scores were consistent with "very satisfied." Mean (SD) worst pain during the past 24 hours was 68.8 (27.5) on a 100 mm visual analogue scale. "Dissatisfaction with Pain Management" correlated positively with "Dissatisfaction with Medical Staff" (0.42), and inversely with "Pain Now" (-0.41) and "Expected Pain Relief" (-0.38). Regression analysis showed that "Dissatisfaction with Pain Management" was dependent on "Pain Now," "Least Pain," and "Dissatisfaction with Medical Staff," with statistically significant beta weight values of 0.277, 0.197, and 0.280, respectively. The study shows that patients were highly satisfied with pain management, even when they were in pain. Moreover, it establishes that patient dissatisfaction with treatment was highly related to the satisfaction with caregivers and pain intensity.     

住院患者疼痛管理现状及满意度调查分析

目的 了解住院患者疼痛控制结局的现状及对疼痛控制的满意度,为疼痛管理提供依据。 方法 2012年5月运用便利抽样法选取206例住院患者为研究对象,采用调查问卷的方式了解患者疼痛管理现状和满意度。调查工具为自行设计的患者基本信息调查表、美国疼痛协会结局问卷修订量表。 结果 调查对象当前、过去24 h内最剧烈的疼痛程度及疼痛平均水平以轻度为主,分别占43.2%、42.2%、40.3%;疼痛对一般活动、情绪和其他康复活动的影响程度以中度为主,分别占52.4%、58.3%、53.4%;对疼痛处理结果的满意度以一般为主,占40.8%;78.6%的患者在入院时未被告知疼痛治疗的重要性;66.5%～84.5%的患者对疼痛和止痛药的认知均较差。 结论 二级医院住院患者的疼痛程度较轻,其对生活影响程度尚不严重,但患者对疼痛控制的满意度欠佳,对疼痛相关知识的认知也较差,急需医护人员采取相应的措施提高疼痛控制的效果和质量,从而提高患者在住院期间的满意度。     

Influence of expectations and actual pain experiences on satisfaction with postoperative pain management.

Experience of moderate or even severe postoperative pain has remained a clinical problem despite major progress in pain assessment and management. The aim of the present study was to assess any association between different pre- as well as postoperative factors, actual pain experiences in the postoperative period, and the overall patient satisfaction with the pain management. A random sample of surgical patients (n =191) responded to pre- and postoperative questionnaires detailing presence of preoperative baseline pain, expected and actually experienced postoperative pain levels and perceived adequacy of the pain relief provided. Patient satisfaction was assessed and factors of importance for satisfaction/dissatisfaction were analysed. It was found that 88% of the patients had previously undergone surgical procedures and that 53% of these patients claimed to have experienced moderate or severe pain at that time. Current pain prior to the present surgical procedure was reported by 61% of the patients. Most patients (91%) expected pain of moderate to severe intensity and 76% reported to have experienced such pain levels. In spite of this 81% of the patients claimed to be satisfied with the pain management while only 8% were dissatisfied. Sex, age, pre-operative expectation and actual experience of pain relief, and the overall pain experience were found to be factors associated with the probability of being satisfied/dissatisfied. Main characteristics of the dissatisfied patient were a younger age and female sex. It is concluded that patients commonly expect moderate to severe pain in the postoperative period and that the actual pain experience is mainly in accordance with the pre-operative expectations. Therefore, the validity of patient satisfaction as an optimal outcome variable in quality assurance processes of postoperative pain management may be questioned.     

Pain prevalence in a French teaching hospital

To measure the prevalence and intensity of pain in hospitalized patients and to assess the quality of pain management, an exhaustive cross-sectional study was conducted in every department in a university hospital. Patients hospitalized for 24 hours or more completed an anonymous self-report questionnaire. Among the 1,475 inpatients, 998 completed the questionnaire. During the 24-hour period prior to our survey, 55% experienced pain. On 100 mm pain intensity measures, the median maximum pain experienced in the 24 preceding hours was 60 mm and the median pain intensity at the time of the survey was 30 mm. Although pain measured at the time of survey disappeared in only 16% of patients, 79% were satisfied with pain management. Despite a high satisfaction level, the prevalence and intensity of pain were very high. This study provided baseline data on pain in a French hospital and led to the implementation of a program for improving pain management.     

The effect of standard care, ibuprofen, and music on pain relief and patient satisfaction in adults with musculoskeletal trauma.

OBJECTIVE: The purposes of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction. METHODS: Patients were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization); (2) standard care and ibuprofen; or (3) standard care and music distraction. Patients were monitored for pain ratings for 60 minutes. Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included. Two patient satisfaction questions were asked upon discharge from the emergency department. RESULTS: Seventy-seven patients met the inclusion criteria. No differences in pain ratings between groups were demonstrated. A statistically significant reduction in pain for all patients occurred at 30 minutes (F = 16.18, P <.01) and was maintained at 60 minutes. However, 70% of patients continued to report pain ratings of 4 or greater (on a scale of 1 to 10) at 60 minutes. The reduction in pain was not found to be clinically significant.Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage. No differences in satisfaction existed between treatment groups, although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores (F = 9.375, P =.003). CONCLUSION: None of the therapies-standard care (ice, elevation, immobilization), standard care with ibuprofen, or standard care with music distraction-provided clinically significant pain relief to patients who had minor musculoskeletal trauma (ie, sprains and fractures) and moderate pain at triage. Interestingly, satisfaction scores were sometimes positive, even when pain was not relieved.     

Pain beliefs and pain management of oncology patients

Cancer pain is estimated to occur in 30% to 70% of patients with early-stage cancer and 60% to 95% with advanced cancer. Current research shows that cancer pain continues to be undertreated despite the availability of analgesics and established guidelines to maximize their effectiveness. The purpose of this study was to describe oncology patients' pain experience during an episode of hospitalization with particular emphasis on exploring the relationship between oncology patients' beliefs about pain and the treatment they received. Consecutive patients (n = 126) were interviewed 48 hours after admission to an urban and a regional hospital in Australia; 47.6% of patients had experienced moderate to severe pain in the previous 24 hours but had only received 40.4% of available analgesic. Patients held varying beliefs about pain and pain treatments in particular, 41% held strong beliefs about the potential for addiction to narcotics. Patients who held this belief reported higher current pain, worst pain intensity, and higher average pain intensity in the previous 24 hours. Effective pain management in the inpatient oncology setting continues to be an important clinical issue, and patients do not receive all available pain treatment. There may be an important association between patients' beliefs about pain and pain management and the pain management they receive.     

Using the American Pain Society's patient outcome questionnaire to evaluate the quality of postoperative pain management in a sample of Norwegian patients.

In the United States, quality improvement (QI) approaches have been used to evaluate pain management. However, the use of QI approaches to evaluate the quality of patient care is just emerging in many European countries. The purposes of this study, using the American Pain Society's QI Standards, were: to describe changes over time, in pain severity, in pain interference with function, and in the doses of analgesics administered; to describe patients' level of satisfaction with postoperative pain management; and to determine the relationships between pain severity and patient outcomes. Results from a sample of patients who underwent orthopedic surgery suggest that undertreatment of pain persists across the first 5 postoperative days and that pain's level of interference with function decreases significantly between the third and fifth postoperative days. As in other studies, despite high pain intensity scores, patients reported high levels of satisfaction with postoperative pain management. PERSPECTIVE: Findings suggest that the undertreatment of pain results in significant decrements in function over the first 5 postoperative days. Future studies designed to improve the quality of postoperative pain management need to use multimodal approaches and evaluate not only pain intensity, but improvements in function as critical outcome measures.     

MIGRAINE TREATMENT

Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 hours (43.4% vs 18.4% placebo; P < .0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 hours postdose (53.7% vs 70.4% placebo; P < .01), or required further medication within 24 hours (46.4% vs 71.1% placebo; P < .0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 minutes following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset.     

Efficacy of Intravenous Ibuprofen and Intravenous Paracetamol in Multimodal Pain Management of Postoperative Pain After Percutaneous Nephrolithotomy

PurposeMany different techniques, including multimodal analgesia, have been used for the management of postoperative pain after Percutaneous nephrolithotomy (PCNL). Ketorolac, intravenous (IV) paracetamol, rofecoxib, and IV ibuprofen have been used as a part of a multimodal analgesic approach in different surgical procedures. However, the efficacy of IV ibuprofen has not been well elucidated in adult patients undergoing elective PCNL. The aim of the study was to examine the efficacy of IV ibuprofen compared to IV paracetamol after elective PCNL.DesignThis was a prospective randomized clinic study.MethodsThe study was conducted with 50 patients scheduled for PNCL between the ages of 18 and 65. IV ibuprofen 800 mg infusion was used for Group I, and 1 g IV paracetamol infusion Group P. IV tramadol infusion was administered with a Patient Controlled Analgesia device for postoperative analgesia. The primary outcome was 24-hour tramadol consumption. Secondary outcomes were pain intensity and side effects of the drugs. All outcomes were recorded in the 30th minute in the PACU and in 2, 4, 6, 12, 24 hours postoperatively.FindingsTotal postoperative tramadol consumption was significantly lower in Group I compared with Group P (P = .031). There was also a significant decrease in the cumulative tramadol consumption between the two groups in the 2nd and 24th hours (P < .012). In all measurement periods, pain intensity, sedation score, nausea and vomiting, itching, additional analgesia, and satisfaction with pain management were similar between the two groups.ConclusionIV ibuprofen, used as a part of multimodal tramadol-based analgesia reduced tramadol consumption compared with IV paracetamol in the first 24 hours postoperatively after elective PCNL. The IV ibuprofen-tramadol combination seems appeared superior to a paracetamol-tramadol combination.     

Effects of performance feedback on patient pain outcomes

The purpose of this study was to examine the effects of an individual feedback intervention provided to nurses on selected patient outcomes related to postoperative pain management Individual performance feedback served as the intervention. Thirty orthopedic staff nurses received feedback information on their past performance of recommended pain management practices. Data were collected preintervention and postintervention on selected patient pain outcomes from the medical records of 240 patients who had undergone total knee arthroplasty. The patient outcome measures were mean 4-hour pain intensity ratings, mean highest pain intensity ratings, mean number of times pain ratings exceeded patients' acceptable level of pain, mean administered morphine equivalents, and mean pain ratings on reassessment following analgesia administration. An improvement was noted in all pain outcomes following the feedback intervention. Results indicate that providing nurses with feedback on their past performance of pain management practices may contribute to decreased postoperative pain.     

Patient-controlled analgesia versus conventional intramuscular injection: a cost effectiveness analysis

BACKGROUND: In previous studies comparing patient-controlled-analgesia and intramuscular pain management have been unable to provide conclusive evidence of the benefits of either method of postoperative pain control. AIM: The purpose of the study was to compare the efficacy and cost-effectiveness of intravenous patient-controlled-analgesia with intermittent intramuscular morphine for Chinese women in the first 24 hours following elective gynaecological surgery. METHODS: A randomized control design was used. The main outcomes were level of pain and cost for the two types of pain management. Participants indicated their level of pain at rest and when deep breathing or coughing on a 100 mm Visual Analogue Scale, on seven occasions within 24 postoperative hours. Costs for the two types of pain management were based on the costs of equipment, drugs and nursing time. RESULTS: A total of 125 women participated in the study. Mean pain level over the 24 hours in the patient-controlled-analgesia group was significantly lower than in the intramuscular group (P < 0.001). Mean pain level over the seven occasions for the patient-controlled-analgesia group was 11.83 points (95% CI 7.14-16.52) lower when at rest and 11.73 points (95% CI 5.96-17.50) lower during motion than the intramuscular group. Cost per patient was $81.10 (Hong Kong) higher for patient-controlled-analgesia than for intramuscular pain management. Women in the patient-controlled-analgesia group had significantly greater satisfaction with pain management than those in the intramuscular group (P < 0.001), but reported significantly more episodes of nausea (P < 0.05). CONCLUSIONS: While patient-controlled-analgesia was more costly, it was also more effective than conventional on-demand intramuscular opioid injections after laparotomy for gynaecological surgery.     

Assessment of pain experiences after elective surgery

Pain in the postoperative period has remained a clinical problem in spite of major progress in pain assessment and management. The aim of the present study was to describe in detail the time course of pain experiences of surgical patients (n=200) following elective surgical procedures. Visual analogue scale (VAS, 0-100 mm) was used for pain intensity ratings at 4, 24, 48, and 72 hours after surgery. Interviews were carried out to assess the occurrence of intermittent worst pain episodes during each 24-hour period and to relate such experiences to clinical events. At 4, 24, 48, and 72 hours postoperatively, 39%, 43%, 27%, and 16% of the patients, respectively, experienced moderate or even severe pain (VAS > or =40 mm) at rest. During the first 24 hours after surgery, 88% of the patients had experienced moderate or severe pain at some time (VAS > or =40 mm). Corresponding figures for the following 24 hour periods were 81% and 72%, respectively. Spontaneous pain breakthrough and movement/mobilization were identified as reasons for the worst pain episodes during the first 72-hour period after surgery. The probability of pain intensity of VAS >40 mm was calculated from individual regression functions. The probability was found to be much higher for patients receiving parenteral analgesics than for patients receiving prolonged epidural analgesia. Despite major improvements in pain assessment and management, postoperative patients often experience moderate to severe pain, and worst pain episodes occur even in the late postoperative phase. The present study emphasizes that in the clinical routine management of pain, further quality assurance efforts are necessary.