Pain Quality of Life Questionnaire
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How to Complete a Rapid Pain Assessment in a Busy ED
How to Complete a Rapid Pain Assessment in a Busy ED Phyllis Hendry, MD Sophia Sheikh, MD Course Description .Pain is a component of up to 78% of ED presenting complaints yet most ED physicians have had minimal training related to pain recognition, assessment and management. Adequate pain assessment is complex and requires time to determine the patient’s past pain and medication history, current pain history, and pain intensity. ED providers are under pressure to recognize and treat pain while also dealing with overcrowding, a vast array of patient complaints, and concerns over opioid addiction and over prescribing. This course will review critical components of a rapid ED pain assessment, the current status of pain scales in the ED, electronic medical record documentation of pain and current literature. Disclosures .Phyllis Hendry, MD, FACEP, FAAP (Principal Investigator) .Sophia Sheikh, MD, FACEP (Sub-Investigator) .Pain Assessment and Management Initiative (PAMI) .Funded by Florida Medical Malpractice Joint Underwriting Association, Alvin E. Smith Safety of Health Care Services Grant: 2014-2018 Learning Objectives .Describe various pain assessment tools currently in the literature and pros/cons to using these tools in the ED setting; .Discuss barriers to utilizing pain assessment tools and ways to overcome those barriers; .List advantages to implementing a common pain assessment tool in the ED among the entire ED health care team; and .Discuss evidence and controversy behind pain and patient satisfaction scores. Pain as of August 2016 .Total upheaval in the world of pain management –New research regarding the neurobiological complexity of pain and long term consequences of untreated acute pain. -
Pain Management Assessment and Reassessment
North Shore-LIJ Health System is now Northwell Health System Patient Care Services POLICY TITLE: CLINICAL POLICY AND PROCEDURE Pain Management: Assessment and MANUAL Reassessment POLICY #: PCS.1603 CATEGORY SECTION: System Approval Date: 10/20/16 Effective Date: NEW Site Implementation Date: 12/2/16 Last Reviewed/Revised: NEW Prepared by: Notations: System Nursing Policy and Procedure This policy was created by incorporating the Committee Northwell Health’s Geriatric Guidelines for Pain Management into the Northwell Health’s Pain Management : Assessment and Reassessment Policy dated 11/10 that can be found on the Intranet. GENERAL STATEMENT of PURPOSE To establish a standard for routine assessment, reassessment and documentation of pain as appropriate to the patient’s condition and treatment regimen. POLICY 1. Patients are screened and assessed for pain based upon clinical presentation, services sought, and in accordance with the care, treatment, and services provided. Facility personnel use methods to assess pain that are consistent with the patient’s age, condition, and ability to understand. 2. If the patient reports pain to a health care worker other than a licensed health care provider, the health care worker will escalate the report of pain to a licensed health care provider for assessment. 3. Pain assessment performed by health care providers will address individual, cultural, spiritual, and language differences. Pain measurement scales are available in various languages and, if necessary, access to a medical interpreter will be provided to assist in the evaluation of the patient’s pain. 4. The patient’s self-report of pain is considered the “gold standard.” For those patients who are unable to communicate the health care provider will assess pain by using the appropriate pain Measurement Scale. -
Pediatric Pain Management
Pediatric pain management An individualized, multimodal, and interprofessional approach is key for success. By Sharon Wrona, DNP, PMGT-BC, CPNP, PMHS, AP-PMN, FAAN, and Michelle L. Czarnecki, MSN, PMGT-BC, CPNP, AP-PMN ACCORDING to the Healthcare Cost and Uti- lization Project, more than 5,000,000 children in the United States had a hospital stay in 2017. Many of them experienced some type of pain. Pain has an immense impact on the mind and body. In addition to the physical sensation of pain, effects include emotion- al suffering, pulmonary complications, de- creased mobility, poor sleep, immune impair- ment, reduced quality of life, economic costs, and a potential for developing persistent (chronic) pain syndromes. Despite advances in care, many children continue to experience significant pain because of undertreatment and inadequate pain management after surgery. Sparing children the short- and long-term ef- fects of pain requires early recognition and CNE 1.4 contact treatment. hours Nurses are critical to pain prevention, recog- nition, and treatment in children. They’re with LEARNING O BJECTIVES patients more than any other healthcare pro- 1. Identify strategies for assessing pain in children. fessionals and have the opportunity to assess 2. Discuss nonpharmacologic pain interventions for children. pain throughout their shift. When pain is diag- 3. Describe pharmacologic pain interventions for children. nosed, the nurse can start planning which in- The authors and planners of this CNE activity have disclosed no relevant terventions are most appropriate for individual financial relationships with any commercial companies pertaining to this patients. After interventions are implemented, activity. See the last page of the article to learn how to earn CNE credit. -
The Relation Between Tender Points and Fibromyalgia Symptom Variables
268 Annals of the Rheumatic Diseases 1997;56:268–271 CONCISE REPORTS Ann Rheum Dis: first published as 10.1136/ard.56.4.268 on 1 April 1997. Downloaded from The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic Frederick Wolfe Abstract Fibromyalgia represents the intersection of a Objective—To investigate the relation considerably abnormal and reduced pain between measures of pain threshold and threshold with a series of clinical distress vari- symptoms of distress to determine if ables, including pain, fatigue, sleep distur- fibromyalgia is a discrete construct/ bance, anxiety, and depression, among others. disorder in the clinic. In the clinic, it is best diagnosed by counting Methods—627 patients seen at an the number of tender points a patient has. In outpatient rheumatology centre from 1993 the presence of 11 or more tender points and to 1996 underwent tender point and dolor- widespread pain, fibromyalgia is diagnosed (classified) according to American College of imetry examinations. All completed the Rheumatology (ACR) Criteria.1 assessment scales for fatigue, sleep The ability to diagnose fibromyalgia with disturbance, anxiety, depression, global commonly agreed upon criteria has stimulated severity, pain, functional disability, and a research into basic and clinic aspects of the composite measure of distress con- syndrome. In general, research has used structed from scores of sleep disturbance, ‘normals’ or patients with other rheumatic dis- fatigue, anxiety, depression, and global eases as control subjects. This comparison, of severity—the rheumatology distress index fibromyalgia with such control subjects, (RDI). implies that fibromyalgia is a discrete entity. -
Pain” in the Modern Neurosciences: a Historical Account of the Visualization Technologies Used in the Development of an “Algesiogenic Pathology”, 1850 to 2000
Brain Sci. 2015, 5, 521-545; doi:10.3390/brainsci5040521 OPEN ACCESS brain sciences ISSN 2076-3425 www.mdpi.com/journal/brainsci/ Review Objectifying “Pain” in the Modern Neurosciences: A Historical Account of the Visualization Technologies Used in the Development of an “Algesiogenic Pathology”, 1850 to 2000 Frank W. Stahnisch Department of Community Health Sciences & Department of History, The University of Calgary, 3280 Hospital Drive NW, Calgary T2N 4Z6, AB, Canada; E-Mail: [email protected]; Tel.: +1-403-210-6290. Academic Editor: Patrick W. Stroman Received: 31 August 2015 / Accepted: 9 November 2015 / Published: 17 November 2015 Abstract: Particularly with the fundamental works of the Leipzig school of experimental psychophysiology (between the 1850s and 1880s), the modern neurosciences witnessed an increasing interest in attempts to objectify “pain” as a bodily signal and physiological value. This development has led to refined psychological test repertoires and new clinical measurement techniques, which became progressively paired with imaging approaches and sophisticated theories about neuropathological pain etiology. With the advent of electroencephalography since the middle of the 20th century, and through the use of brain stimulation technologies and modern neuroimaging, the chosen scientific route towards an ever more refined “objectification” of pain phenomena took firm root in Western medicine. This article provides a broad overview of landmark events and key imaging technologies, which represent the long developmental path of a field that could be called “algesiogenic pathology.” Keywords: pain; history of medicine; Leipzig; Montreal; New York; nineteenth century; precursors to functional neuroimaging of pain; twentieth century “The past of a present-day science is not the same thing as that science in the past.” (Georges Canguilhem) [1] 1. -
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ORIGINAL CONTRIBUTION Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: Results of a randomized clinical pilot project RUSSELL G. GAMBER, DO; JAY H. SHORES, PHD; DAVID P. RUSSO, BA; CYNTHIA JIMENEZ, RN; BENARD R. RUBIN, DO Osteopathic physicians caring for patients with fibro- treatments for FM incorporate nonpharmacologic ap- myalgia syndrome (FM) often use osteopathic manipu- proaches such as OMT. lative treatment (OMT) in conjunction with other forms of (Key words: osteopathic manipulative treatment, standard medical care. Despite a growing body of evi- orthopedic manipulation, fibromyalgia, clinical trials) dence on the efficacy of manual therapy for the treatment of selected acute musculoskeletal conditions, the role of ibromyalgia (FM) syndrome is a common nonarticular, OMT in treating patients with chronic conditions such Frheumatic musculoskeletal pain disorder for which a as FM remains largely unknown. definite cause has yet to be identified.1 Diffuse muscu- Twenty-four female patients meeting American Col- loskeletal pain and aching, the presence of multiple tender lege of Rheumatology criteria for FM were randomly points (TP), disturbed sleep, fatigue, and morning stiffness assigned to one of four treatment groups: (1) manipulation characterize the syndrome. Central to the American College group, (2) manipulation and teaching group, (3) moist of Rheumatology’s FM diagnostic criteria are the presence of heat group, and (4) control group, which received no addi- -
Pain Management
PAIN MANAGEMENT A Practical Guide for Waitemata District Health Board’s Healthcare Professionals 1st Edition Developed by Waitemata Pain Services, Department of Anaesthesiology and Perioperative Medicine, and Department of Pharmacy Waitemata DHB, Auckland, New Zealand CONTRIBUTORS TO THIS EDITION Dr Michal Kluger Anaesthesiologist & Pain Physician Anaesthesiology & Perioperative Medicine I WDHB Dr Glenn Mulholland Specialist Anaesthetist & Clinical Lead Acute Pain Service Anaesthesiology & Perioperative Medicine I WDHB Ms Christine Sherwood Clinical Pain Nurse Specialist Anaesthesiology & Perioperative Medicine I WDHB Ms Claire McGuinniety Surgical Team Leader Pharmacist Pharmacy I WDHB Staff who contributed to the publication of this resource: Ms Lourensa Bezuidenhout, Ms Mandy McGowan and Dr Jerome Ng I WDHB DISCLAIMERS Although great care has been taken in compiling and checking the information given in this publication to ensure that it is accurate, the authors, editor and publisher shall not be responsible for the continued currency of the information or for any errors, omissions or inaccuracies in this publication. Waitemata DHB gives no warranty or assurance, and makes no representation as to the accuracy or reliability of any information or advice contained, or that it is suitable for your intended use. Subject to any terms implied by law which cannot be excluded, in no event shall Waitemata DHB be liable for any losses or damages, including incidental or consequential damages, resulting from use of the material or reliance on the information. The resource provides links to external internet sites. These external internet sites are outside the Waitemata DHB’s control. It is the responsibility of the user of the resource to make their decision about the accuracy, currency, reliability and correctness of information found. -
Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescents (Review)
Psychological interventions for needle-related procedural pain and distress in children and adolescents (Review) Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 10 http://www.thecochranelibrary.com Psychological interventions for needle-related procedural pain and distress in children and adolescents (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 4 METHODS ...................................... 4 RESULTS....................................... 10 Figure1. ..................................... 13 Figure2. ..................................... 14 DISCUSSION ..................................... 17 AUTHORS’CONCLUSIONS . 20 ACKNOWLEDGEMENTS . 21 REFERENCES ..................................... 22 CHARACTERISTICSOFSTUDIES . 33 DATAANDANALYSES. 103 Analysis 1.1. Comparison 1 Distraction, Outcome 1 Self-reportedpain.. 105 Analysis 1.2. Comparison 1 Distraction, Outcome 2 Observer-reported pain. 106 Analysis 1.3. Comparison 1 Distraction, Outcome 3 Self-reported distress. 107 Analysis 1.4. Comparison 1 Distraction, Outcome 4 Observer-reported distress. 107 Analysis 1.5. Comparison 1 Distraction, Outcome -
Acute Pain Management
Acute pain management {Color index: Important★| Notes | Book | 433 Notes | Extra | Editing File} Objectives: ➢ Not given Done by: Luluh Alzeghayer & Munerah alOmari. Revised by: Dalal Alhuzaimi PAIN: ● It’s an un unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.1 ● Pain is the fifth vital sign ● Pain is subjective and difficult to quantify. ● The management of pain is a multidisciplinary team effort involving physicians, psychologists, nurses, and physical therapists. ● Unrelieved pain is morally and ethically unaccepted. GOAL OF PAIN TREATMENT: ● Improve quality of the pt . ● Facilitate rapid recovery & return to full function . ● Reduce morbidity . ● Allow early discharge from hospital. Cost effective for both hospital and patients. 1. Acute pain (see here) ● Caused by noxious stimulation due to: injury, a disease process or abnormal function of muscle or viscera ● Recent onset, - Limited duration, - Has a causal relationship, ● It is nearly always nociceptive “ he can point the site of pain”. MCQ! ● Nociceptive pain serves to detect, localize and limit the tissue damage. ● Acute pain plays a useful positive physiological role by providing a warning of tissue damage. ● Postoperative pain is a type of “Acute Pain”23 1 International association of study of pain 1979 2 Pain following surgery is usually relatively short lived and significantly reduced in intensity by 48–72 hours. 3 Although much of acute pain is postoperative, there are many other causes: preoperative surgical (renal colic, peritonitis), medical (acute MI) and trauma (rib fractures). Types of acute pain: imp Type 1. Somatic 2. Visceral: Subtypes ● Superficial: ● Deep: ● Visceral: ● Parietal: True localized or Referred Localized or Referred Origin Nociceptive input from Arise from Muscles, Due to disease process, abnormal function of internal skin, subcutaneous Tendons and Bones organ or its covering, e.g. -
Assessment of Pain
Assessment of Pain Assessment of Pain Author: Ayda G. Nambayan, DSN, RN, St. Jude Children’s Research Hospital Content Reviewed by: Nursing Education Department, International Outreach Program, St. Jude Children’s Research Hospital Cure4Kids Release Date: 1 September 2006 Basic pain assessment is a simple task; however, the assessment of pain in children and adolescents with cancer may be more complex. Matters that can complicate pain assessment in this population group may include the inability of the child to verbalize the pain, the use of proxy reports (A – 1) by parents and caregivers, the lack of training of clinicians in the use of pain assessment tools appropriate for the age and developmental level of the patient and the underestimation of the patient’s pain, especially after he or she has been given an analgesic (Romsing et al., 1996; Manne et al., 1992; Miller, 1996). Common Causes of Pain in Pediatric Patients with Cancer Pain may occur as a result of cancer or other factors (A – 2); not all pain that a child or adolescent expresses is due to his or her cancer. Like adults, children and adolescents with cancer may have pain that is due to the following. Procedures such as venipuncture, bone marrow aspiration, biopsy and lumbar puncture Causes related to cancer, e.g., tumor enlargement, ischemia, metastasis, oncologic emergencies Other causes unrelated to cancer, e.g., accidental trauma. Cancer pain in children and adolescents and its intensity depend upon the type of cancer, the extent (or stage of the disease) and the patient’s tolerance to pain. Persistent cancer pain may be due to enlargement of the tumor and the pressure of the tumor on the body organs, nerves or bones. -
Advances in Spinal Cord Stimulation
From DEPT OF CLINICAL NEUROSCIENCE Karolinska Institutet, Stockholm, Sweden ADVANCES IN SPINAL CORD STIMULATION ENHANCEMENT OF EFFICACY, IMPROVED SURGICAL TECHNIQUE AND A NEW INDICATION Göran Lind Stockholm 2012 All previously published papers were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by Larserics Digital Print AB, Bromma © Göran Lind, 2012 ISBN 978-91-7457-938-3 ABSTRACT Introduction and aim: Spinal cord stimulation (SCS) has been used for treatment of otherwise therapy-resistant chronic neuropathic pain for about four decades. However, 30-40 % of the patients do not benefit from SCS, despite careful case selection and technical advances. In search of ways to improve the outcome mechanisms underlying the pain relieving effect of SCS have been extensively explored. Experimental findings suggest a possibility to enhance the effect of SCS by concomitant intrathecal (i.t.) administration of pharmaceuticals, such as baclofen, clonidine and adenosine. Animal research has indicated that hypersensitivity to colonic dilatation can be attenuated by SCS. This finding, as well as related clinical observations, forms a basis for the possibility of treating irritable bowel syndrome (IBS) with SCS. Implantation of an SCS system with a plate electrode requires extensive surgery. This can be painful and cumbersome for the patient, since finding an optimal electrode position demands patient cooperation with reporting of stimulation evoked sensations. Aims of the thesis were to study: 1) if co-administration of baclofen (Study I and III), clonidine (Study III) or adenosine (Study I) can enhance the effect of SCS, 2) if long-term i.t. administration of a drug will continue to support the effect of SCS over time (Study II), 3) if implantation of plate electrodes can be performed in spinal anesthesia, retaining the possibility for the patient to feel and report stimulation evoked paresthesias and 4) if SCS can be used as a treatment option for IBS, otherwise resistant to therapy. -
East Midlands Ambulance Service NHS Trust Is Committed to Providing High Quality, Safe and Effective Care to All Service Users
Pain Management Standard Operating Procedure Links The following documents are closely associated with this policy: Medicines Management Policy Drug Management Procedure Implementation of National Guidance and Information Policy Community First Responder Policy Medical First Responder SOP Untoward Incident Reporting Procedure End of Life Clinical Management Procedure Document Owner : Medical Director Document Lead: Consultant Paramedic Document Type: Standard Operating Procedure For use by: All clinical/operational staff Equality Impact Assessment September 2014 This document has been published on the: Name Date Library (EMAS Public Drive) 17 August 2017 Intranet 17 August 2017 Pain Management Standard Operating Procedure Page: 1 of 10 Document ID: OR/113.2 Version: 2.0 Date of Approval: 19 July 2017 Status: Final Approved by: Clinical Governance Group Date of Review: July 2019 Document Location Version Control If using a printed version of this document ensure it is the latest published version. The latest version can be found on the Trust’s Intranet site. Version Date Approved Publication Date Approved By Summary of Changes Clinical Governance 1.0 22/07/15 02/10/15 New procedure Group Amended title Updated roles Clinical Governance 2.0 19 July 2017 17 August 2017 Updated monitoring group Group Addition of Wong-baker faces assessment tool Removal of diclofenac Pain Management Standard Operating Procedure Page: 2 of 10 Document ID: OR/113.2 Version: 2.0 Date of Approval: 19 July 2017 Status: Final Approved by: Clinical Governance Group Date of Review: July 2019 Contents Page 1. Introduction 4 2. Objectives 4 3. Scope 4 4. Definitions 4 5. Responsibilities 4 6.