Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible.     

Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative

BACKGROUND: Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline. METHODS: A 59-item survey was used to measure physicians' attitudes, knowledge, and psychologic factors that contribute to pain management practices. RESULTS: Overall, a significant number of physicians in this survey revealed opiophobia (prejudice against the use of opioid analgesics), displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. There were significant differences among groups of physicians based on size of geographic practice area and medical discipline. CONCLUSIONS: New educational strategies are needed to overcome these barriers and to improve pain treatment in routine medical practice. The effect of practice milieu must be taken into consideration.     

肛周脓肿患者术后疼痛管理方案内容框架的构建

目的构建肛周脓肿患者术后疼痛管理方案内容框架,为科学的疼痛管理提供依据。方法2018年7月—2019年5月,以曼彻斯特疼痛管理模式、跨文化护理理论为理论指导,通过提取循证证据结合质性访谈凝练肛周脓肿患者术后疼痛管理需求,形成方案初稿。采用目的抽样法选取上海市15名长期从事疼痛管理的医学及护理专家,运用德尔菲(Delphi)法对方案初稿进行修订,建立肛周脓肿患者术后疼痛管理方案内容框架。结果经过2轮专家咨询,形成包含5个一级指标、23个二级指标、67个三级指标的疼痛管理方案内容框架。专家咨询权威系数为0.90,专家协调系数检验P<0.01。结论肛周脓肿患者术后疼痛管理方案内容框架构建的过程科学、可靠,内容结合了患者疼痛管理的循证证据、患者需求,具有实用性,对实施肛周脓肿术后疼痛管理具有指导作用。     

The nursing management of elderly patients with pain in the community: study and recommendations

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given.     

Case report: A patient with dementia presenting with hip fracture in the emergency department – Challenges of acute pain assessment

The purpose of this case report is to stimulate debate on the practicalities of detecting pain in patients with dementia in the emergency department (ED) – in this case, a patient who sustained a hip fracture subsequent to a fall in a nursing home. Although case reports are low in the hierarchy of evidence, they serve as useful glimpses into future possible detection and management of the pain status of the person with dementia in the ED who present with injuries such as hip fractures. Older patients with dementia, who are unable to provide a self-report of pain post hip fracture in the ED are at risk for under-detection and under-treatment of acute pain. The utilisation of a specific pain assessment framework, based on best available evidence, will enable nurses to detect and manage acute pain for this vulnerable group in the emergency department.     

Cancer pain management at home (I): do older patients experience less effective management than younger patients?

Goals of work  We wanted to examine whether older cancer patients living at home experienced poorer pain management than younger patients, and if so, what were the potential explanations for this. Materials and methods  We interviewed 90 new referrals to community palliative care services who were aged 75 years and above or aged 60 years and below. We asked about pain intensity, pain relief and pain quality, access to and type of analgesic medication and, finally, sources of support and self-management strategies. Main results  Older and younger cancer patients who were living at home had very similar experiences of pain, pain relief, access to and use of analgesia, contact with health care professionals and use of additional pain management strategies. As a whole, participants had more frequent contact with family members, community nurses and pharmacists than with general practitioners. Conclusions  In this sample, the experience and management of pain in older cancer patients was no different from that in younger patients. This suggests that delivering improvements in cancer pain management in the community is appropriate for all age groups. In addition, focussing efforts on patients, carers and non-medical health care professionals may prove to be the most successful strategy.     

Effects of continuing education. Pain assessment and documentation

Even though greater than 60% oncology patients experience pain sometime during the course of their illness, management of this pain still remains an enormous clinical problem. Based on this report, it would appear that pain assessment and management would be a key concern in the care of oncology patients. Yet, from previous research, it is clear that a lack of pain assessment documentation exists, which essentially means legally assessment has not been performed. Because a lack of knowledge about pain could be a major reason for inadequate pain documentation, a continuing education class was designed for oncology nurses regarding pain assessment and the need for subsequent documentation of that assessment. This study evaluated the different groups of nurses: (a) a control group who attended the class, (b) an experimental group who attended the class and received a laminated pain assessment tool, and (c) a group who did not participate in the class; effects on pain assessment documentation. Effectiveness was measured by extracting pain assessment documentation from charts. No significant differences in documentation scores were noted across the three groups. Recommendations and nursing implications concerning continuing education strategies and pain assessment documentation are made.     

Assessment of neuropathic pain in the community

The purpose of this paper is to provide the reader with evidence basedclinical guidance regarding assessing neuropathic pain. Persistent pain is a huge burden on health-care provision and the prevalence of persistent neuropathic pain is likely to increase owing to the ageing population. The provision of appropriate relieving interventions depends on accurate assessment. This paper sets out to provide the reader with simple neuropathic assessment tools that can be applied to community care. This will allow the community nurse to identify patients who have neuropathic pain and will therefore enable appropriate management.     

基于5M1E分析法的现场管理模式在自行来院高危胸痛患者中的应用

目的:探讨基于5M1E分析法的现场管理模式在自行来院高危胸痛患者中的应用效果。方法:选取2017年7月—2018年10月自行前往首都医科大学附属北京潞河医院就诊的高危胸痛患者263例为研究对象,其中以2017年7月—2018年2月行常规模式就诊患者为常规模式组（ n=128）,以2018年3—10月行基于5...     

Improving Knowledge,Assessment, and Attitudes Related to Pain Management: Evaluation of an Intervention

Pain control in the acute care setting is repeatedly described in the literature as problematic. The purpose of this clinical research project was to evaluate an educational intervention designed to improve the management of pain in an acute care setting. A quasi-experimental pre- and post-intervention design was used. Three hundred and forty-one medical-surgical and critical care nurses completed the Brockopp-Warden Pain Knowledge/Bias Questionnaire (2004) (203 pre, 138 post). Data were collected before the intervention and 3 months following the educational experience. Sixty patients (30 pre, 30 post) recorded numerical assessments of their pain every 2 hours in a pain diary. Patient charts were reviewed to compare patients' pain assessments with nurses' documentation. A 50% decrease in the mean difference between patients' assessment of pain and nurses' documentation (p < .04) was found post-intervention. Although no significant differences were found on total knowledge or bias scores, 20% of nurses who participated responded incorrectly to six of 21 knowledge items both pre- and post-intervention. In keeping with earlier research on bias regarding pain management, patients with non-physiological conditions were not attended to as well as patients who had clearly defined physical problems. Results of this project have precipitated major changes regarding the management of pain in this institution. A pain steering committee has been formed and additional unit-based projects have been conducted. The challenge of finding the most effective method for changing biases toward specific patient populations and increasing knowledge regarding pain management remains.     

Management of pain in patients with myocardial infarction

A survey of analgesics used for pain relief in patients suffering with myocardial infarction was carried out for a duration of one month. Forty-eight patients were studied regarding pain relief prior to transfer to hospital and on admission to the Coronary Care Unit (CCU), out of 48, only three patients did not require any analgesic. It was found that the management of pain in the community and the CCU was variable. Intravenous diamorphine 5 mgs was found to be most effective practice for pain relief. Out of twenty-six patients who received IV diamorphine 5 mgs initially 16 patients (62%) had adequate pain relief, in contrast to 21% (3) of those who received only 2.5 mgs. In 14 patients who received this lower dose it was found only to be effective in three patients.     

Life after shingles: the management of postherpetic neuralgia

Chronic pain may have devastating effects on the physical and psychological well being of many patients (Harden, 1999). Most community nurses are in contact with a number of patients with chronic pain and will be asked for advice and recommendations with regards to its management. Chronic neuropathic pain is a complex and sometimes intractable condition that patients will seek help for, from either GPs or from the community nursing teams. This article will examine one neuropathic pain syndrome - post-herpetic neuralgia - and review the evidence base in relation to treatment strategies, in an attempt to support community staff in the management of this difficult to treat pain syndrome.     

依托医联体分层管理模式在社区糖尿病护理管理中的探讨

目的：评价依托普陀区西部医联体,在社区内对糖尿病患者进行分层的社区护理,研究其在血糖水平控制、减少并发症、改善预后等方面的作用,探讨适合中国国情的糖尿病社区护理分层管理模式。方法：于2014年1月~2015年1月 入选医联体范围内包括真如、桃浦、曹杨、长征社区卫生服务中心登记在册372例糖尿病患者进行分层管理。比较实施分层管理模式与实施一般糖尿病护理干预的社区患者一年内空腹血糖、糖化血红蛋白、住院率、严重并发症发生率等的差异。结果：分层管理组一年空腹血糖(6.8 ± 2.3 vs. 8.2 ± 2.8),糖化血红蛋白(6.0 ± 0.8 vs. 7.3 ± 2.0)低于对照组(p<0.05);且通过分层管理高危亚组患者服药遵从、饮食控制、合理运动、血糖监测、足部护理的依从性都优于普通亚组患者(p<0.05);一年肾脏病变、眼部病变、足部病变、总并发症发生率及入院率都少于对照组患者(P<0.05)。结论：依托医联体的糖尿病社区护理分层管理模式能够充分利用有限的医疗资源,做好社区管理,从而提高患者的生活质量,也能在控制糖尿病进程中起到积极作用。     

Barriers to Postoperative Pain Management in Hip Fracture Patients with Dementia as Evaluated by Nursing Staff

This paper reports a study of the perceptions of nursing staff regarding barriers to postoperative pain management in hip fracture patients with dementia, their expectations, and facilitators offered by their employers to overcome these barriers. Patients with dementia are at high risk for insufficient postoperative pain treatment, mainly owing to inability to articulate or convey their pain experience. Nursing staff have an essential role in the treatment and care of patients who are vulnerable, and therefore unable to advocate for their own pain treatment. Questionnaires with both structured and open-ended questions were used to collect data from nursing staff members in seven university hospitals and ten city-center hospitals from March to May 2011. The response rate was 52% (n = 331). According to nursing staff, the biggest barrier in pain management was the difficulty in assessing pain owing to a patient's cognitive impairment (86%). Resisting care and restlessness among patients with dementia can lead to use of restraints, although these kinds of behavioral changes can point to the occurrence of pain. There were statistically significant differences between the sufficiency of pain management and barriers. Those who expected pain management to be insufficient identified more barriers than those who expected pain management to be sufficient (p < .001). Further updating education for nursing staff in pain detection and management is needed so that nursing staff are also able to recognize behavioral symptoms as potential signs of pain and provide appropriate pain management.     

Krebsschmerz: Coping und Kommunikation

Anxieties and emotional disturbances associated with cancer often cause pain therapy to be unsuccessful. When psychological support is required it is mostly aimed at supporting cancer patients in attempts to cope with their disease so as to improve the efficiency of pain therapy. In our study we focused on the barriers to cancer pain management that lie in patient’s beliefs about pain and their coping behavior. A pilot study was designed to examine the subjective experience of pain and coping strategies. In a sample of 146 cancer outpatients with pain we found moderate pain intensity levels and good physical conditions (Karnofsky), but an extensive impact on mood and vegetative symptoms associated with “constant or daily pain” and/or attribution of pain to cancer. Coping was characterized by stoicism, “being brave”, comparison with others and self-encouragement, but seldom by communication, requests for help or such strategies as distraction, enjoyment and relaxation. Only one third of the pain patients communicated their pain. Women and the patients who had higher pain intensity levels were more likely to suffer in silence, but those who communicated had better acceptance levels of pain intensity than those who did not. In a second study we focused on two questions. What do patients think about pain therapy? Can patients’ attitudes on pain and pain management be changed by an information brochure? Selected results obtained in a sample of 72 cancer pain patients are reported. From a 30-item list of statements about pain and pain management, which were extracted from the previous interviews, three distinct types of attitudes in pain patients were derived by cluster analysis. One group of 29 patients was characterized by “non-acceptance of analgesic pain management’. With respect to medication intake, they were afraid of subjecting themselves to physical stress, of addiction and side effects and of loss of control over the disease. They hoped their pain would disappear when the tumour therapy took effect (as with acute pain) and thought they could tolerate it stoically. These patients wanted to take medication only if tumour therapy had no effect and when death was imminent. They had a pain intensity level of 5.5 VAS (without therapy). Adequate pain therapy was given to 14.3% of the “nonacceptors”, significantly less (P=0.002) than to the “acceptors” (n=31) who had pain intensity levels of 7.7 VAS (without pain therapy) and had attitudes quite opposed to those of the first group. Adequate pain therapy was given to 58.6% of this group. The third group of patients (n=12) was characterized by “ambivalence toward analgesic pain management”. They were similar to the acceptors insofar as they did not fear addiction and side effects of medication, but they were similar to the non-acceptors insofar as they were afraid of losing control over the disease and of putting their body under stress. They also tended to bear pain stoically. Their pain intensity level without therapy was 6.3 VAS. With respect to coping strategies, communication was found significantly less often (P=0.001) than cognitive and behavioural coping. Those patients who used cognitive coping strategies and did not communicate often received inadequate pain therapy. Those who talked about pain but did not use any other coping strategies were mostly well treated. We have designed a brochure, “What tumour patients should know about pain” directly oriented on the above pain beliefs; this is now being evaluated with reference to its educational effect.     

Views on radiography use for patients with acute low back pain among chiropractors in an Ontario community

BACKGROUND: Recent studies suggest that chiropractors continue to widely use radiography for assessing patients with acute low back pain. This practice is contrary to growing evidence that suggests only a small percentage of patients with acute low back pain require radiographic evaluation. OBJECTIVES: To assess quantitatively and qualitatively the views of chiropractors in a selected community in Ontario on the use of radiography for evaluating patients with acute low back pain. Study Design: Mailed surveys and focus group interview. METHOD: Surveys were mailed to all chiropractors (N = 26) in a selected community in Ontario, followed by a focus group session with local chiropractors (n = 7). Surveys requested information on personal and practice characteristics and the management of low back pain, including the use of radiography. The focus group, led by a facilitator, discussed issues surrounding practice guidelines and radiography use. RESULTS: There was a 76% response rate to the mailed surveys. Of those who responded, 63% stated they would use radiography on patients with uncomplicated acute low back pain lasting 1 week; 68% stated that radiographs were useful in the diagnostic evaluation of patients with acute low back pain lasting less than 1 month. Most reasons given for use of radiography in this patient population are not supported by existing evidence. CONCLUSIONS: There appears to be a high rate of radiographic use by chiropractors in the study community, which is consistent with findings in previous studies. Many of the reasons given for use of radiography are not supported by existing evidence and may contribute to the gap between current chiropractic practice and available evidence with respect to use of radiography for acute low back pain.     

Pain experience following radical treatment for head and neck cancer.

During an investigation into the quality of life of people in the year following radical treatment for head and neck cancer, it became apparent that pain was a significant problem. Therefore, the current study was conducted to gain an understanding of the incidence and nature of pain in people who had received radical treatment for head and neck cancer and to explore their attitudes to pain and pain relief. A single cohort study was undertaken using a structured questionnaire designed for people with head and neck cancer (the EORTC QLQ-C30 and the EORTC QLQ H+N35). Fifty questionnaires were received from people who had received radical treatment between 6 and 12 months previously and who were disease-free. Twenty nine of the respondents also consented to a follow-up semi-structured interview. The interviews generated qualitative data about personal experiences of pain and pain management in head and neck cancer. Patient recollections from interviews identified that only nine out of 29 (31%) interviewees had pain at diagnosis. However, 74% (37) of respondents to the questionnaire reported some degree of pain at follow-up. Patients having both surgery and radiotherapy were significantly more likely to have troublesome pain than patients who received radiotherapy only (Fisher's exact test=0.039). The qualitative data identified a wide variety of pain sites, a number of which were not covered by the EORTC tool. A significant number of patients were rejecting regular pharmacological management and using a variety of other pain-relieving measures. We conclude that through an understanding of pain experience and attitudes to pain management, nurses can facilitate the care and support of patients in pain following treatment for head and neck cancer.     

Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature

BACKGROUND: Recent empirical evidence suggests that childhood abuse may be related to the experience of chronic pain in adulthood. To date, a systematic quantitative review of the literature has not been presented. OBJECTIVES: The purpose of this study was to use meta-analytic procedures to evaluate the strength of existing evidence of the association between self-reports of childhood abuse and the experience of chronic pain in adulthood. METHODS: Analyses were designed to test the relationship across several relevant criteria with 4 separate meta-analyses. RESULTS: Results of the analyses are as follows: 1) individuals who reported being abused or neglected in childhood also reported more pain symptoms and related conditions than those not abused or neglected in childhood; 2) patients with chronic pain were more likely to report having been abused or neglected in childhood than healthy controls; 3) patients with chronic pain were more likely to report having been abused or neglected in childhood than nonpatients with chronic pain identified from the community; and 4) individuals from the community reporting pain were more likely to report having been abused or neglected than individuals from the community not reporting pain. CONCLUSION: Results provide evidence that individuals who report abusive or neglectful childhood experiences are at increased risk of experiencing chronic pain in adulthood relative to individuals not reporting abuse or neglect in childhood.     

胃肠道疾病患者围手术期疼痛现状调查分析

目的调查胃肠道疾病患者围手术期的疼痛状况,为建立无痛病房,优化医疗和护理服务提供依据。方法对2011年12月5日-2012年1月14日胃肠外科所有的新住院患者共227例,采用《四川大学华西医院住院病人疼痛现状调查问卷》进行调查,并同期调查胃肠外科27名主管医师对疼痛药物了解状况。结果有明确行为能力的216例患者完成调查问卷,其中有195例（90.28%）接受手术治疗,全身麻醉患者193例（占手术患者98.97%）,诊断为胃肠道肿瘤163例（占手术人数的83.59%）,手术等级为三级146例（占手术人数的74.87%）。有168例（86.15%）患者术后镇痛,在术后镇痛过程中使用镇痛泵156例（92.86%）,其中75例（48.08%）认为镇痛泵镇痛＂基本有效＂,30例（19.23%）认为＂无效＂。39例术后未使用镇痛泵,其中20例（51.28%）认为＂未使用术后镇痛泵＂最主要原因为＂不了解镇痛泵＂。受调查的主管医师了解的疼痛药物仅占罗列药物52种的（20±5.36）种。结论疼痛现象在胃肠道疾病围手术期患者中属普遍现象,由于不断增强镇痛意识和镇痛需求与相关知识缺乏的矛盾存在,及较少的医疗护理干预,导致镇痛效果不佳,影响了疼痛管理长效机制的建立和无痛病房的建设。     

Development and validation of a questionnaire to assess disabling foot pain

This study outlines the design and validation of a new self-administered instrument for assessing foot pain and disability. The 19-item questionnaire was tested on 45 rheumatology patients, 33 patients who had attended their general practitioner with a foot-related problem and 1000 responders to a population survey of foot disorders. Levels of reported disability were found to be greatest for rheumatology patients and least for community subjects. In addition, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a health care professional and those who did and did not have a history of past and current foot pain. A good level of agreement was found when items on the questionnaire were compared with similar items on the ambulation sub-scale of the Functional Limitation Profile questionnaire. A Cronbach's alpha value of 0.99 and item-total correlation values between 0.25 and 0.62 confirmed the internal consistency of the instrument. Finally the results of a principal components analysis identified three constructs that reflected disabilities that are associated with foot pain: functional limitation, pain intensity and personal appearance. The design of the foot disability questionnaire makes it a suitable instrument for assessing the impact of painful foot conditions in both community and clinical populations.