Pain management techniques - aasem.org

Using informatics to improve the quality of care through pain management is one way to ensure that your patients receive the care they need. However, there are some limitations to this type of study. For example, nurses’ biases and prejudices often influence how they approach pain management.nStudies show increasing pain awareness results in improved pain management in long-term care.nIncreasing pain awareness is key to improving pain management in long-term care. Research shows that healthcare professionals are more likely to provide adequate pain relief if they are well-trained in pain management techniques. The VA has developed an initiative to increase pain awareness and improve the quality of care.nAccording to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all patients have a right to appropriate pain assessment. The organization recommends that every hospitalized patient be assessed for pain regularly.nThe most important part of a successful pain management program is a comprehensive assessment. This assessment serves as a baseline for the plan of care. The project should be modified as needed and updated periodically. The evaluation should include personal information and objective data. The program should also include nonpharmacologic therapies, such as exercise, physical therapy, or massage. These interventions should be based on the factors identified in the pain assessment.nAn ongoing assessment of pain should also include monitoring of adverse effects of treatment. Other indicators of pain have changes in activity, interpersonal interactions, and body movements. This assessment may also involve family members and caregivers.nPharmacologic therapies aim in older adults to enhance their quality of life and prevent adverse effects. These treatments can include opioids, adjunct drugs, and exercise. However, the majority of older adults experience pain regularly. This can lead to undertreatment.nA systematic pain assessment can reduce stress on staff and improve symptom relief for the care recipient. This assessment should be completed on admission and should be repeated at least quarterly. During the evaluation, the staff should document the patient’s baseline behaviors. In addition to their physical examination, they should be observed for signs of pain, including confusion, social withdrawal, apathy, and agitation.nStudies show decreasing medication errors results in improved pain management in long-term care.nSeveral studies, including one from the CDC, have shown that decreasing medication errors can improve pain management in long-term care settings. These results highlight the importance of adequate training and resources for clinicians and caregivers.nThe CDC conducted an interactive study, which included video conversations and a community-wide phone survey. Participants were from all 50 states and included physicians, nurses, patients, and other healthcare providers. The results are a rich treasure trove of information, which the CDC is currently using to produce a new clinical practice guideline on pain management. The CDC will use the findings to inform future policies on pain management, such as a pain management guide for older adults.nAs with any new guideline, the CDC will conduct a comprehensive review of the resulting document to determine what works, what doesn’t, and what should be improved. The CDC will also consider public input when it revises its clinical practice guideline. The most important thing to remember is that the CDC is just one of many stakeholders in the healthcare arena, which is why it is essential to consult with as many experts as possible. Ultimately, the CDC is attempting to improve the quality of life for all Americans through better patient and caregiver education, enhanced patient and caregiver safety, and improved pain management. This feat will require a concerted effort.nThe CDC’s pain management initiative is just the latest in a long line of initiatives to improve the health of our nation’s most vulnerable citizens. For example, the CDC is currently involved in a multi-site opioid prescribing program designed to prevent opioid misuse in patients who need pain management. The program collaborates with the CDC, the state of California, and local health departments.nNurses’ biases and prejudices influence their approach to managing pain.nWhether you are a health care provider or patient, bias and prejudices can affect your treatment and result in poor outcomes. Many health organizations are taking steps to address discrimination in pain management. However, more research is needed to determine what strategies work best and the feasibility of introducing new techniques into clinical practice.nResearchers have studied a variety of approaches to combat bias in pain management. These include practicing evidence-based medicine, using clinical pathways, and providing adequate organizational support.nSeveral studies found that healthcare providers’ implicit biases can lead to adverse events. For example, a study found that physicians underestimated the pain of black patients. Another study demonstrated that white physicians were more likely to minimize the pain of black patients.nResearch has shown that various factors influence nurses’ judgments. Some are based on a person’s race, gender, religion, culture, and social support. Other factors may be based on an individual’s economic status, weight, and age.nOne study found that medical students and residents who believed that African-Americans had thicker skin were more likely to recommend that black patients’ pain be treated less aggressively. This is based on the assumption that African-Americans are more drug-seeking.nSimilarly, a study showed that physicians were twice as likely to underestimate the pain of nonblack patients. This is based on the assumption that nonblack patients have less sensitive nerve endings.nA study by the University of Virginia found that medical students and residents who endorsed false beliefs about the physiological characteristics of black patients were more likely to rate the pain of black patients as less severe.nResearchers also studied the effects of implicit bias on nursing decision-making. They measured implicit stereotypes in nursing students by having them view short video clips of actual patients expressing pain. They were then asked to imagine the feelings of the patient.nNondrug approaches for pain managementnAmong the many challenges facing veterans in today’s society, disproportionately high rates of chronic pain are a primary concern. In addition, opioid addiction is a significant factor in causing overdose deaths. These factors underscore the need for innovative delivery of interventions to alleviate the impact of pain on veterans.nOne promising approach is mobile technologies. These tools provide access to pain self-management treatments efficiently, conveniently, and individualized manner. The Health eRide program is a prototype of a mobile intervention designed to improve the quality of care through pain management for veterans. The program uses a multidimensional theory of pain to guide patients. This includes guidance to prevent relapse to an earlier stage. It also incorporates input from experts and enhancements to enhance the program. The trial has been completed, and the results suggest that the Health eRide program may significantly impact improving the quality of care through pain management for veterans.nApproximately 79% of adults in the United States own a smartphone. This high percentage reflects the shrinking digital divide for historically less-accessible groups. It also shows that a mobile-delivered intervention can be tailored to individual needs and reduce access barriers. In addition, it allows for a high degree of personal tailoring, which is critical to reducing the burden of chronic pain.nFor the pilot test, 69 veterans were recruited through community outreach, Facebook, and Web-based survey companies. They were eligible for participation if they had a history of chronic musculoskeletal pain lasting more than three months, were not currently undergoing treatment for anxiety, and were veterans or current military personnel.nParticipants were randomly assigned to a mobile-delivered intervention or an in-person cognitive behavioral therapy (CBT) group. The in-person intervention consisted of a series of 10-week sessions of interactive voice response-based CBT. The effect sizes were large, and the participants reported clinically meaningful improvements in their pain levels and the use of pain self-management strategies.nStudy limitationsnUsing data, such as pain measurement and reporting, is a great way to bridge the gap between patients and health professionals. However, the quality of the data can vary widely. Future research is needed to determine the best ICT system for pain management.nEarly engagement with palliative care patients is needed to determine which ICT systems are the best. Studies have shown that cancer patients strongly desire to engage with technology. This can inform the design of an ICT system, especially if this engagement takes place before the actual implementation of the system.nThe most petite possible sample sizes, coupled with limited data, can lead to a lack of scientific validity. This is particularly true in the realm of pain management. For example, a study examining patient responses to nonpharmacologic therapies stumbled upon only a modest number of positive results.nOn the other hand, a study using automated telephone technology made a meaningful connection between patient pain levels and self-management. In addition to demonstrating the benefits of nonpharmacologic therapies, the COMPACT (Comprehensive Online Assessment of a Telehealth Self-Management Training) study also tested the efficacy of the safe and effective use of opioids.nTo determine the best ICT system for pain management, further research is needed to determine whether a simple approach using well-established technologies is the way to go. Alternatively, a more ambitious process might involve developing a system that is both user-friendly and aligned with the needs of the patients.nTo determine the best ICT system, more research is needed to understand the limitations of existing ICT systems. Specifically, we must examine the potential for ICT to improve pain management in patients with cancer. The most important consideration is that ICT must be relevant to the patient’s needs.