scholarly journals A Personalized Approach to Assessing and Managing Pain in Patients With Cancer

2014 ◽  
Vol 32 (16) ◽  
pp. 1640-1646 ◽  
Author(s):  
David Hui ◽  
Eduardo Bruera
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Paradigm Shift ◽  
Treatment Plan ◽  
Evidence Based ◽  
Systematic Screening ◽  
Patients With Cancer ◽  
Pain Expression ◽  
Personalized Approach

Pain is one of the most common and distressing symptoms in patients with cancer. In this review, we discuss an evidence-based approach to personalized pain assessment and management. Recent insights into the pain expression pathway have led to a paradigm shift in pain management, allowing clinicians to deliver personalized treatments tailored to the individual's needs. Personalized pain management begins with systematic screening, followed by comprehensive pain assessment. Impeccable characterization of pain informs its etiology and the mechanism to guide treatment choices. Identification of modulators of pain expression such as psychological distress, alcoholism, substance use, and delirium allow clinicians to further tailor treatment recommendations. Documentation of a personalized pain goal provides an individualized response criterion. A multidimensional treatment plan is then formulated targeting the pain mechanism, etiologic factors, and modulators. Finally, longitudinal monitoring customized to the individual's needs allows clinicians to improve adherence and, ultimately, to optimize pain control over time.

scholarly journals The Chinese Association for the Study of Pain (CASP): Expert Consensus on the Cervicogenic Headache

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Hong Xiao ◽  
Baogan Peng ◽  
Ke Ma ◽  
Dong Huang ◽  
Xianguo Liu ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pain Management ◽  
Clinical Features ◽  
Treatment Plan ◽  
Cervicogenic Headache ◽  
Expert Consensus ◽  
Evidence Based ◽  
Unique Form ◽  
Evidence Based Treatment ◽  
Chinese Association

Cervicogenic headache is a relatively common but unique form of headache, and in China, as well as in several other countries, both diagnosis and a clear evidence-based treatment plan remain controversial. Therefore, the Chinese Association for the Study of Pain organized a meeting of pain management experts and created an expert consensus on the diagnosis and treatment of cervicogenic headache in China. This article summarizes the conclusions of the consensus group regarding the epidemiology, etiology, clinical features, diagnosis, differential diagnosis, treatment, and rehabilitation of cervicogenic headache in China.

Evidence-Based Recommendations for Cancer Fatigue, Anorexia, Depression, and Dyspnea

2008 ◽  
Vol 26 (23) ◽  
pp. 3886-3895 ◽  
Author(s):  
Sydney M. Dy ◽  
Karl A. Lorenz ◽  
Arash Naeim ◽  
Homayoon Sanati ◽  
Anne Walling ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Treatment Effectiveness ◽  
Treatment Plan ◽  
Evidence Based ◽  
Initial Visit ◽  
Patients With Cancer ◽  
Associated Symptoms ◽  
Hastened Death ◽  
Underlying Causes

Purpose The experience of patients with cancer often involves symptoms of fatigue, anorexia, depression, and dyspnea. Methods We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results For fatigue, providers should screen patients at the initial visit, for newly identified advanced cancer, and at chemotherapy visits; assess for depression and insomnia in newly identified fatigue; and follow up after treatment for fatigue or a secondary cause. For anorexia, providers should screen at the initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on chemotherapy or radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response after treatment. For general dyspnea, providers should evaluate for causes of new or worsening dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer opioids in advanced cancer when other treatments are unsuccessful. For dyspnea and malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer pleurodesis or a drainage procedure for patients with reaccumulation and dyspnea. Conclusion These standards provide a framework for evidence-based screening, assessment, treatment, and follow-up for cancer-associated symptoms.

QIM19-116: Barriers and Trends in Cancer Patients’ referrals to Pain Management in Qatar: A Randomized Cohort Prospective Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-116
Author(s):  
Rehab Abdelwahab ◽  
Anas Hamad ◽  
Shereen El Azzaz ◽  
Randa Al Okka ◽  
Mohd A. Wahid ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Pain Treatment ◽  
Pain Clinic ◽  
List Type ◽  
Patients With Cancer ◽  
Referral Criteria ◽  
Management Techniques ◽  
Primary Physicians

Background: Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008), beside the challenges to accurately assess pain, which might affect drug selection and pain control (Stewart, Ulster Med J 2014). In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain Management Team (PMT), based on evaluation or as requested by patients. This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred cases whether they need to be refereed or not. Objectives: To determine the efficiency of the referral pathway to the pain clinic by PMT. Methods: PMT is going to assess the referred patient to their clinics according to pain assessment methods. Patients will be evaluated whether they have been appropriately referred or not, any unnecessary referral will be documented based on the following;• If the patient was referred by hematologist or oncologist• If the patient required specialized treatment• If the patient required urgent treatment/prescription or advanced pain management techniques• If the patient required further consultation by pain management• If the patient could be managed by PP Results: 195 patients were newly referred to the pain clinic during the period from March 8, 2018 to August 31, 2018. 12% (23/195) were deemed as unnecessary referrals based on PMT assessment; 43% (10/23) of them were hematology patients, while 57% (13/23) were oncology. The majority was for breast cancer and sickle cell disease patients with 35% for each. According to the PMT assessment, 61% (14/23) patients (95% CI, 40.79%–77.84%) considered unnecessary referrals due to improper basic pain assessment and management by PP, while 30% (7/23) patients (95%CI, 15.60%–50.87%) asked for refill medications. Conclusion: There is 12% unnecessary referrals to PMT, which need further improvement in the referral pathway, via the development of a definite referral criteria to PMT. PP should be encouraged to provide basic pain treatment and to consider multidisciplinary management with appropriate coordination for better improvements in patients’ quality of life.

scholarly journals Looking into mechanisms of change: Evaluation of a multifaceted implementation strategy to change pain management behavior of care workers

2020 ◽  
Author(s):  
Thekla Brunkert ◽  
Michael Simon ◽  
Franziska Zúñiga
Keyword(s):  
Pain Management ◽  
Nursing Homes ◽  
Pain Assessment ◽  
Self Efficacy ◽  
Implementation Strategies ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Mixed Effect ◽  
Care Workers ◽  
The Impact

Abstract BackgroundUnderutilization of evidence-based pain management in nursing homes is common. Evidence towards effective approaches to improve adoption of evidence-based practices in nursing homes is limited. To get a better understanding of the impact of our multi-faceted implementation strategies, care worker training workshops and the introduction of trained pain champions, this study explored the underlying mechanisms of the implementation strategies using behavioral theory.MethodsWe conducted a mixed-methods evaluation alongside an implementation- effectiveness study in four Swiss nursing homes. Based on an a priori contextual analysis in the participating homes implementation strategies were developed. Furthermore, we developed a conceptual framework describing hypotheses concerning determinants of implementation and mechanisms of change underlying our implementation strategies.Care workers’ questionnaire surveys were conducted at baseline (n=136), after three (n= 99) and six months (n=83) to assess self-efficacy in pain management and self-reported guideline adoption. We computed linear mixed-effect models to assess changes over time in self-efficacy and logistic regressions to assess associations between self-efficacy and guideline adoption. Concurrently, we conducted focus groups with care workers (n=8) to explore their response to the implementation strategies and to gain a deeper understanding of the potential mechanisms. After transcription, interview data was analyzed using content analysis.ResultsOverall, there was a significant increase in self-efficacy after three and six months (p<0.001). Self-reported adoption of guideline components ranged between 44% and 73% depending on the component. We found significant associations between self-efficacy and adoption of two guideline components, i.e. performing a comprehensive pain assessment and using an observational pain assessment tool in cognitively impaired residents.Qualitative findings showed that the training workshops and pain champions were received positively by care workers. Focus group participants reported to be more attentive to residents` pain experience and to assess and document pain more frequently and with more detail than before.ConclusionsOur findings highlight the importance of continuous commitment of an implementation facilitator, e.g., a pain champion, within an organization. Regarding persistent implementation challenges, a theory-based conceptual model contributes to the overall understanding.Trial registrationClinicalTrials.gov (NCT03471390)

scholarly journals AB0267 HOW EFFECTIVE IS PAIN MANAGEMENT IN THE PATIENTS’ OPINION? DATA FROM THE COMPAS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1160.1-1160
Author(s):  
E. Pogozheva ◽  
A. Karateev ◽  
V. Amirdzhanova
Keyword(s):  
Pain Management ◽  
Pain Therapy ◽  
Significant Proportion ◽  
Connective Tissue Diseases ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Results Of Treatment ◽  
Analgesic Therapy ◽  
Folk Remedies ◽  
Personalized Approach

Objectives:to evaluate the effectiveness and satisfaction of pain management in patients with rheumatic diseases (RD) according to a survey in the COMPAS (Quality of Pain Management according to Patients with Arthritis and Back pain) study.Methods:the survey involved 1040 patients with RD (rheumatoid arthritis-40.6%, osteoarthritis -32.1%, spondyloarthritis-10.6%, connective tissue diseases-8.6% of patients). 76.8% were women, the mean age was 55.8±14.0 years. 35.7% of patients continued to work in their specialty, 31.6% had various degrees of disability. The effectiveness of pain therapy was evaluated by the patient in the last month preceding the survey on a 5-point scale, where 1 - no effect and 5-excellent effect. Patients ‘ satisfaction with treatment, possible reasons for the lack of effectiveness of pain therapy and the use of additional treatment tools were also evaluated.Results:as therapy for the underlying disease, 40% of patients received conventional disease modifying antirheumatic drugs, 33.1% - glucocorticoids, 7.2% - biological agents and 15.2% - symptomatic slow-acting drugs in osteoarthritis. At the same time, 68% of patients needed additional analgesic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). Slightly less than half of the surveyed patients (46.9%) noted a moderate effect of analgesic therapy, 22.7% - a low effect and 5% - no effect, 23.7% rated the effectiveness of therapy as good and only 1.7% - as excellent. At the same time, only 15.6% of patients were completely satisfied with the result of NSAIDs, 64% were partially satisfied with the treatment and 20.4% were completely dissatisfied. As the reason of insufficient effectiveness of NSAIDs, most often (34.3%) patients named fear of adverse events associated with taking drugs, 19.4% - weak drugs, 15.3% - insufficient attention of doctors to complaints, 6.6% - poor diagnosis of the causes of pain. Others found it difficult to answer or were completely satisfied with the treatment. 40% of patients used additional methods, most often chiropractic (12.3%), acupuncture (4.8%), physiotherapy (12.7%) and folk remedies (7.4%).Conclusion:A significant proportion of patients with RD don’t have adequate pain control. Only 25.4% of patients rate the result of treatment as good and excellent, and even fewer patients (15.6%) are completely satisfied with the results of therapy. Thus, a personalized approach to analgesic therapy is necessary, taking into account the expectations of patients regarding the results of treatment.Disclosure of Interests:None declared

scholarly journals Methods for Pain Assessment in Calves and Their Use for the Evaluation of Pain during Different Procedures—A Review

Animals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 1235
Author(s):  
Theresa Tschoner
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Research Data ◽  
Narrative Review ◽  
Literature Research ◽  
Field Practice ◽  
Definition Of ◽  
Evaluation And Assessment

The evaluation and assessment of the level of pain calves are experiencing is important, as the experience of pain (e.g., due to routine husbandry procedures) severely affects the welfare of calves. Studies about the recognition of pain in calves, and especially pain management during and after common procedures, such as castration, dehorning, and disbudding, have been published. This narrative review discusses and summarizes the existing literature about methods for pain assessment in calves. First, it deals with the definition of pain and the challenges associated with the recognition of pain in calves. Then it proceeds to outline the different options and methods for subjective and objective pain assessment in calves, as described in the literature. Research data show that there are several tools suitable for the assessment of pain in calves, at least for research purposes. Finally, it concludes that for research purposes, various variables for the assessment of pain in calves are used in combination. However, there is no variable which can be used solely for the exclusive assessment of pain in calves. Also, further research is needed to describe biomarkers or variables which are easily accessible in the field practice.

scholarly journals Pain Assessment: Benefits of Using Pain Scales for Surgical Patients in South Bohemian Hospitals

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 171
Author(s):  
Vera Olisarova ◽  
Valerie Tothova ◽  
Martin Cerveny ◽  
Vendula Dvorakova ◽  
Petr Sadilek
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Pain Assessment ◽  
Exploratory Study ◽  
Surgical Patients ◽  
The South ◽  
Pain Scales ◽  
Emotional Component ◽  
Attention To Pain

Pain is a medical and nursing problem that is common in surgical departments. Inadequate pain management can lead to patient distress, as well as extending the period in which the patient’s quality of life is reduced. The standardized SF-MPQ-2 questionnaire provides nurses with the opportunity to assess pain within a broader context. The aim of this descriptive and exploratory study was to describe the state of pain assessment in surgical patients in the South Bohemian Region and to highlight the benefits of using a standardized tool for proper pain assessment. The research was carried out using a quantitative survey within the South Bohemian Region (Czech Republic). The participants in the study were nurses working in surgical departments in hospitals in the region as well as hospitalized patients. The results show that nurses pay slightly more attention to pain assessments than doctors. We know that, generally, pain decreases with time after surgery. Nonetheless, returning pain, as well as continuous pain, can occur, both of which have an emotional component. The results of this study are directed at nurses and include a call for more effective pain management through improved assessment.

Facile syringe filter-enabled bacteria separation, enrichment, and buffer exchange for clinical isolation-free digital detection and characterization of bacterial pathogens in urine

The Analyst ◽  
2021 ◽  
Author(s):  
Pengfei Zhang ◽  
Aniruddha Kaushik ◽  
Kathleen E Mach ◽  
Kuangwen Hsieh ◽  
Joseph C. Liao ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Evidence Based ◽  
Pathogen Identification ◽  
Accelerated Methods ◽  
Syringe Filter

The development of accelerated methods for pathogen identification (ID) and antimicrobial susceptibility testing (AST) for infectious diseases is necessary to facilitate evidence-based antibiotic therapy and reduce clinical overreliance on broad-spectrum...

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