Journal Club

Pain Management: Predicting Outcomes

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Glossary

A set of guidelines targeted to the long-term use of sedatives and analgesics in critical care patients was revised in 2002.⁷

These guidelines review and rate evidence for recommendations on the assessment and treatment options for pain. The guidelines also suggest patient education strategies, evidence for guidelines on the use of pharmacologic agents, and adjunctive approaches (such as heat application, massage, imagery, music, or other therapies). Patients have sought these complementary and alternative medicine (CAM) strategies.  In a recently reported survey, between 52 and 80% of patients used CAM therapies for pain.⁸ Most commonly reported CAM use included temperature (heat, cold, ice), exercise and stretching, chiropractic, massage, and prayer or meditation. Herbal products and supplements were less common, but used by between 17-35% of patients, the most common of which was glucosamine. These authors note the importance of including the use of CAM strategies in patient histories.

Persistent and undertreated pain, particularly in elderly patients, has been discussed in nursing home literature.  One study in the nursing home setting cited perceptions and attitudes of care providers and residents as potential barriers to adequate pain assessment and treatment.⁹ Education about assessments and pain treatment options were suggested as a part of the solution.  Some facilities have defined information and pain management “rights” for patients. The LaPorte Hospital and Health Services in Indiana notes that patients should be taken seriously, treated with dignity, have their pain appropriately assessed, reassessed, and promptly treated, remain informed about and participate in decisions on all aspects of their pain care (including causes, risks and benefits of treatment options, and costs), and be referred to a specialist as needed.¹⁰

This Journal Club will explore the following areas of pain management: the development of a prognostic scale to anticipate successful pain management and a longitudinal evaluation of pain management outcomes, and racial and ethnic differences in chronic pain perceptions.