THE ROLE OF THE CLINICAL NURSE SPECIALIST IN PAIN MANAGEMENT
Postoperative pain management
Training and Education
What has been reached in the Department an the hospital?
An optimal pain therapy requires time, staff an dedication. Especially in this time of very short financial as well as personal resources, this fact must not be underestimated. On the other hand good postoperative pain management is cost effective, the patients have less complications an leave the hospital earlier.
PAIN AND PATIENTHOOD
People who have learned to live with their pain and, therefore, do not depend on the healthcare
system for an alleviation of their pain (non-consumers) may serve as a reference group for treatment
efficacy. Studying such a group may have consequences for the treatment strategy of multidisciplinary
THE McGILL PAIN QUESTIONNAIRE: A PRACTITIONER PERSPECTIVE AND CURRENT RESEARCH IN THE COMMUNITY
Aim of investigation: To examine life-style disability, resource usage and pain profiles of chronic pain patients and other patients in the community.
Methods: Development and utilisation of the McGill Pain Questionnaire will be reviewed from a practitioner perspective. The current study pre-identified criteria for one chronic pain and two "non pain" groups (n = 120) selected at random from general practices in the U.K. At interview, an additional cohort of unrecognised chronic pain patients were subsequently identified from the two "non-pain" groups (n = 16). The interview schedule included the McGill Pain Questionnaire, the Sickness Impact Profile and a Resources Questionnaire.
Results: With reference to the McGill Pain Questionnaire, Group 1 with previously identified chronic pain have consistently higher scores across all dimensions and the overall profile score when compared to those in Group 4 with previously unidentified chronic pain. Sickness Impact Profile data also reflects such findings, with both pain groups scoring higher disability profile scores than other "non-pain" diagnostic groups in the community.
Conclusions: Whilst this is a small exploratory study, findings indicate the need for further more large-scale studies. In view of legislative changes in the UK, which affect the primary and secondary health/social care interface, priority should be placed on addressing education and training needs of health care professionals in relation to screening and treatment programmes for long-term chronic pain management in the community.
HOW TO FACILITATE TRANSMURAL INTERDISCIPLINARY CHRONIC PAIN TREATMENT IN AN ACADEMIC PAIN - CENTER:
THE NIJMEGEN MODEL
Aim of the project: to create a transmural organization of pain treatment for chronic pain in which first echelon pain care is able to perform pain treatment for patients who have been diagnosed in the academic paid center. Primary goals are to 1/ increase the number of chronic pain treatment possibilities in the first echelon pain care and 2/ establish a sohd treatment collaboration between the second and first echelon pain care.
Strategy: as a first step treatment protocols were developed for psychological and TENS treatment. As a second step courses were developed to educate psychologists and physiotherapists in the first echelon health care how to treat patients with chronic pain in accordance with the treatment protocols developed. As a third step periodical supervision was provided in order to strengthen the collaboration.
Results: In 1998 and 1999 24 psychologists and over 100 physiotherapists were trained and were included in a regional network. In 1999 350 patients with chronic pain were diagnosed in the academic Pain Center. 240 patients were diagnosed to receive a physiotherapeutic and/or psychological treatment. In all patients the treatment proposed was started within 4-6 weeks in the first echelon. The psychologists and physiotherapists judged the training and supervision as very practical and contributing to their abibty to treat chrome pain patients. A pilot study showed that referrers (general practitioners) were very satisfied with the care for their patients (20 referrers gave a mean 7.5 score on a 0-10 satisfaction rate)
Conclusion: The transmural organization of interdisciplinary chrome pain treatment is very promising and creates a new way of collaboration between second and first echelon health care for chronic pain treatment. A major study is under way in order to study the effects of this new way of organizing chronic pain care.
HET NUMEEGS MODEL I Pain Centre Nijmegen
Introduction: The main problem was the long time between the first visit of the patient with chronic pain to the outpatient clinic and the outlining of the treatment strategy. This resulted in unsatisfied patients and reference physicians. Due to the fact that the anaesthesiologist decided about the involvement of other disciplines there were multiple consultations needed. As a consequence patients had to return several times (average in 1993: 3,8).
Aim of the project in 1993: To develop an efficient method and high quality treatment strategy for patients as well as reference physicians. Participating disciplines are anaesthesiology, psychology and physical therapy.
The set up: Since 1995 a questionnaire was sent to patients before their first visit. Each discipline determines the need of a consultation on the basis of the questionnaire and medical data. The patient visits the outpatient clinic only once. Each discipline in question offers its treatment options. The final treatment strategy will be determined on a basis of consensus. This proposal is offered to the patient, who will be asked whether he/she agrees. The reference physicians will be informed and involved in performing the treatment.
Conclusion: This method has been successful.
IS PMOR KNOWLEDGE HELPFUL? A SURVEY OF PATIENTS UNDERGOING TREATMENT FOR CHRONIC PAIN
Aims of Investigation:
Methods: A semi structured interview was conducted with 40 first time patients. They were asked to state the name of their proposed procedure and to describe it in their own words. Their expectations and experiences of the actual procedure and recovery period were elicited. The first 20 patients questioned were asked if preparation by a specialist nurse would have been helpful, and the second 20 were asked if they would have liked to be sent a leaflet prior to attending.
Results: 91% of patients did not know the name of their procedure and 53% were not able to describe it. Perceptions of the experience were generally positive. When asked about provision of information, 67% thought they had enough information, only 20% thought talking to a specialist nurse would be helpful, but 71% were in favour of receiving a leaflet.
Conclusion: Despite feeling that they had enough information, patients in this group demonstrated a very poor knowledge of their proposed treatment. This raises issues of comprehension and retention of information, and potentially with regard to obtaining informed consent. A greater interest in receiving a leaflet, than talking to a specialist nurse was shown. These two findings merit further investigation.
PAIN MANAGEMENT IN A FRENCH COUNTY : PICARDIE
Aim of the study: The authors study the organization of pain management and his history in a county called Picardie, situated at north of France.
Materials ans Methods: Methodology consists in presentation of Picardie county, of french laws and guidelines and of local use and history.
Results: Results are regional realizations : Multidis-ciplinary Pain Committees, Pain Consultations, opinion polls among health care professionals, quality assurance assessments, opiods use, research, professionnal education, regional organization in chronic pain and in cancer pain.
Conclusions: Changing practices on pain management are discussed according to main results. Further evolutions are required in comparison with other french counties and european countries.
THE USE OF STRONG OPIOIDS IN MURES DISTRICT, FOR TREATING PAIN IN CANCER
Aim of investigation: The use of strong opioids in cancer pain is an important indicative of pain management.
Methods: The assessment vas made on all cancer patients treated in Mures district in the last 7 years (1992-1999).
Results: Morphine prescriptions enhanced from 77 in 1997 to 323 in 1999. Daily doses increased from 60-80 mg in 1992 (most cases) to 80-120 mg in 1999 (most cases). There was prescribed 50 treatments with control released oral morphine from October 1999. After a previous increase, the pethidine consumption decreased to the level of 1992.
Conclusions: According to the WHO guidelines, morphine becomes the most used strong opioid for cancer pain, in our district. Immediate release morphine vas administered by the clock, to prevent pain. When the oral morphine becomes available, it was preferred to subcutaneous morphine. The use of higher doses indicates the decrease of fair concerning the adverse effects of morphine. Evaluation of use of strong opioids in cancer pain is an important way to increase the quality of life of cancer patients. Education of medical on the use of strong opioids, and the benefits of the treatment are essential for a better pain control in the future.
OPTIMISATION OF ANTI-PAIN MEDICAL ASSISTANCE IN RUSSIA
Aim of investigation: To investigate the requirements for providing specialized anti pain medical assistance and prospects for its organization in Russia
Methods: Epidemiological study of prevalence of pain and analysis of activity of existing anti-pain medical institutions
Results: Epidemiological study of prevalence of pain syndromes has been performed in a randomized sample of 565 persons over 18 years old from population of Novosibirsk The pain prevalence accounted for 92,4% whereas chronic pains did 44,1% It was found that 57% of respondents considered ineffective the medical assistance and tried to relieve pain on their own The main difficulties in organizing the specialized anti-pain medical assistance lie in the following:
Conclusions: The structure of specialized interdisciplinary anti pain medical assistance should comply with the system of staged medical assistance existing in Russia It is necessary to reorganize the available structural subdivisions and to combine them with new forms of property in public health institutions It is also essential to provide a training for specialists in the field of pain curing
Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 253, 255, 256, 365, 366, 368.
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