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Undertreatment pain

Elyse R Thakur, Amber B Amspoker, Shubhada Sansgiry, A Lynn Snow, Melinda Stanley, Nancy Wilson, Jessica Freshour, Mark E Kunik
OBJECTIVE:  To identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain. DESIGN:  Secondary analysis of a randomized controlled trial. SETTING:  Michael E. DeBakey Veterans Affairs Medical Center. SUBJECTS : Two hundred and two older adults (mean age = 79.27 years). METHODS:  Guided by the Behavioral Model of Health Service Utilization, participants completed questionnaires regarding predisposing (age, gender, race, educational level, care partner relationship), enabling (income), and need (pain interference, depressive symptoms, cognitive functioning) characteristics...
September 30, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Kevin M Wymer, Shane M Pearce, Kelly T Harris, Phillip M Pierorazio, Siamak Daneshmand, Scott E Eggener
PURPOSE: Testicular cancer is the most common malignancy among young men and well-established treatment guidelines exist to optimize outcomes. We characterized errors in the management of testicular cancer observed among patients seen at three referral centers in the United States. METHODS: We retrospectively reviewed data from 593 patients presenting with testicular cancer to three academic medical centers from 2007-2016. Non-guideline directed care (NGDC) was defined as management differing from National Comprehensive Care Network (NCCN) Guideline recommendations...
September 20, 2016: Journal of Urology
Lucy Ziegler, Matthew Mulvey, Alison Blenkinsopp, Duncan Petty, Michael I Bennett
We linked UK cancer registry data with the corresponding electronic primary care medical records of 6080 patients who died of cancer over a 7-year period in a large United Kingdom city. We extracted all prescriptions for analgesics issued to each patient in the linked cohort during the 12 months before death and analysed the extent and duration of strong opioid treatment with clinical and patient characteristics. Strong opioids were prescribed for 48% of patients in the last year of life. Median interval between first prescription of a strong opioid and death was 9 weeks (interquartile range 3-23)...
November 2016: Pain
Hamed Yazdanshenas, Mohsen Bazargan, James Smith, David Martins, Hooman Motahari, Gail Orum
Older African Americans who experience pain are especially at high risk of underassessment and undertreatment. This study examined patterns and correlates of pain medication use: severity of pain, medical conditions, and access to care. African Americans aged 65 and older were recruited from 16 churches located in south Los Angeles (N = 400). Structured face-to-face interviews and visual inspection of each participant's medications were conducted. More than 39% of participants were aged 75 and older, and 65% were female...
September 2, 2016: Journal of the American Geriatrics Society
Wojciech Leppert, Jaroslaw Woron
Opioid-induced constipation (OIC) and other gastrointestinal (GI) symptoms of opioid-induced bowel dysfunction (OIBD) significantly deteriorate patients' quality of life and may lead to noncompliance with opioid schedule and undertreatment of pain. Although traditional oral laxatives are the first-line treatment of OIC, they do not address OIBD pathophysiology, and display numerous adverse effects. OIC treatment includes prokinetics (lubiprostone), opioid switch, and changing route of opioid administration...
September 2016: Therapeutic Advances in Gastroenterology
Nalini Vadivelu, Sukanya Mitra, Alice M Kai, Gopal Kodumudi, Karina Gritsenko
Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudoaddiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process...
July 2016: Journal of Opioid Management
Robert M Kaiser, Susan L Kaiser
As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous...
August 6, 2016: Gerontologist
Teresa Sobhy
The provision of care for patients with type II diabetes in primary care must involve assessing patients for peripheral neuropathy of the feet. Objectives. This paper will demonstrate that painful diabetic neuropathy (PDN) is poorly assessed for and treated in primary care. Methods. A critical analysis of research will be conducted to identify the prevalence and impact of PDN among individuals with type II diabetes. Results. Research evidence and best practice guidelines are widely available in supporting primary care practitioners to better assess for and treat PDN...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
Charlotte Griffioen, Eva G Willems, Bettina S Husebo, Wilco P Achterberg
AIM: To describe the prevalence of opioid use in persons with a cognitive impairment compared with cognitively intact persons and to explore factors associated with opioid prescription. METHOD: A search was made in PubMed (Medline), Embase, Cochrane, Central, Cinahl, PsychInfo and Web of Science and additional articles were identified by manual search of reference lists. Titles and abstracts were screened and eligible articles reviewed in full-text. A citation check was performed on the included articles for a complete search...
June 28, 2016: Current Alzheimer Research
Judith A Paice
Although controversial in recent years, the use of opioid analgesics is a fundamental component of the management of patients with malignant pain. Decisions about whether to initiate opioid therapy require comprehensive patient assessment and a great deal of compassion, with an eye toward achieving a safety balance among patients, prescribers, and the community. At the NCCN 21st Annual Conference, Judith Paice, PhD, RN, reviewed the basics of pain assessment, the dangers of undertreatment and overtreatment, goals of pain management, and practical strategies for navigating through the continuum of pain and substance abuse...
May 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Tareef Al-Aama
To assess the basic knowledge of medical trainees, in the absence of a structured geriatrics curriculum, around a variety of geriatric medicine components that are considered essential for the care of the rapidly increasing elderly population. Eighty-three trainees at different levels of training in internal medicine were asked about a variety of common geriatric conditions. Those included: delirium, falls, geriatric syndromes, pain, cognitive impairment, and medications. The trainees' knowledge about common geriatric condition was overall poor...
June 2016: Journal of Cross-cultural Gerontology
Sue Lillyman, Mary Bruce
With growing numbers of people dying with, and from, dementia there is a need for professionals and health-care organisations to review the access to and provision of palliative care. This literature review has identified several key themes in relation to the person dying with dementia including: diagnosis of the dying phase, appropriate timing of referral to specialist palliative care services; ethical decisions in relation to medication and nutrition; the environment; undertreatment especially, for pain relief; over and burdensome treatment interventions; carer involvement; collaborative working and advance decision making...
February 2016: International Journal of Palliative Nursing
Mark G Lebwohl, Arthur Kavanaugh, April W Armstrong, Abby S Van Voorhees
BACKGROUND: The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP), a population-based survey of patients, dermatologists, and rheumatologists, was conducted for better understanding of the unmet needs of psoriasis and psoriatic arthritis (PsA) patients. OBJECTIVE: To report results from US physicians and patients. METHODS: Adults were contacted by household telephone, using random digit dialing, and asked to participate if they had ever been diagnosed with psoriasis or PsA...
February 2016: American Journal of Clinical Dermatology
Lindsay M Oberleitner, Mark Beitel, Richard S Schottenfeld, Robert D Kerns, Christopher Doucette, Renee Napoleone, Christopher Liong, Declan T Barry
OBJECTIVES: To examine methadone counselors' attitudes toward individual and group-based nonpharmacologic treatments for chronic pain. METHODS: Thirty methadone drug counselors were interviewed about their attitudes toward pain interventions and completed a survey on the perceived efficacy of and willingness to refer patients to nonpharmacologic pain treatments. RESULTS: Counselors reported favorable attitudes toward interventions commonly found in interdisciplinary pain management, particularly, conventional psychological approaches...
January 2016: Journal of Addiction Medicine
Mar Tintoré
Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices...
2015: Neurodegenerative Disease Management
Aimee R Kroll-Desrosiers, Melissa Skanderson, Lori A Bastian, Cynthia A Brandt, Sally Haskell, Robert D Kerns, Kristin M Mattocks
BACKGROUND: A growing number of reproductive-age women veterans are returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). In 2010, 42% of women veterans receiving Veterans Health Administration (VHA) services were aged 18 to 45. Prescription opioid use has increased among all veterans over the past decade; however, exposure among pregnant veterans has not been examined. METHODS: We identified 2,331 women who delivered babies within the VHA system between 2001 and 2010...
March 2016: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
Mamoona Arif Rahu, Mary Jo Grap, Pam Ferguson, Patty Joseph, Sarah Sherman, R K Elswick
BACKGROUND: Self-report is the best indicator of pain; however, pain is more difficult to assess in noncommunicative patients who may be receiving mechanical ventilation or sedated and unable to report pain. OBJECTIVES: To evaluate the validity and sensitivity of 6 pain scales (Adult Nonverbal Pain Scale; Behavior Pain Scale [BPS]; Comfort Scale; FACES; Face, Legs, Activity, Cry, and Consolability scale; Pain Assessment Behavioral Scale with Numeric Rating Scale [NRP]) to identify the best measure of pain in noncommunicative patients...
November 2015: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Brooke Faria da Cunha
Patients with substance abuse history make up 14% of inpatient admissions to acute care units, where it has been reported a great deal of patient pain is unrelieved (Substance Abuse and Mental Health Service Administration [SAMHSA], 2009. Definitions of substance abuse terms including tolerance, dependence, addiction, and pseudoaddiction are essential to a nurse's understanding of pain medication administration in patients with substance abuse history. Pain management is one of the nurse's main responsibilities, and using the principles of autonomy, beneficence, nonmaleficence, and justice can guide the nurse to making appropriate pain management decisions for and with these patients...
January 2015: Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses
Christopher Lundborg
Despite great progress in our understanding and management of pain, undertreatment of postoperative pain is still a major problem. There are individual patient differences in terms of nociception and perception, as well as varying responses to pain management. Postoperative pain can impact on the length of hospital stay, mobilization after surgery, and patient satisfaction. --This report is adapted from paineurope 2015: Issue 1, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe...
September 2015: Journal of Pain & Palliative Care Pharmacotherapy
Donna S Zhukovsky, Cathy L Rozmus, Rhonda S Robert, Eduardo Bruera, Robert J Wells, Gary B Chisholm, Julio A Allo, Marlene Z Cohen
BACKGROUND: Systematic symptom assessment is not routinely performed in pediatric oncology. The objectives of the current study were to characterize the symptoms of pediatric oncology outpatients and evaluate agreement between patient and proxy reports and the association between children's ratings and oncologists' treatment recommendations. METHODS: Two versions of the pediatric Memorial Symptom Assessment Scale (pMSAS) were translated into Spanish. An age-appropriate and language-appropriate pMSAS was administered independently before visits to the oncologist to patients and family caregivers (caregivers) and after visits to consenting oncologists...
November 15, 2015: Cancer
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