Nursing Continuing Professional Development Pain is one of the most prevalent, misunderstood, and complex issues in health care and a leading reason Americans seek health care. In 2017, pain accounted for more than 22 million visits to U.S. EDs. 1 A 2016 systematic review of studies published between 1990 and 2013, which examined the prevalence of pain in hospitalized adult patients, found that hospitalwide pain prevalence ranged from 37.7% to 84% and severe pain prevalence ranged from 9% to 36%. 2 Pain prevalence was higher among surgical patients than medical patients, though up to 55% of medical patients reported pain. Data collected in the 2010 National Hospital Ambulatory Medical Care Survey indicate that an estimated 48.3 million ambulatory surgery procedures were performed that year in hospitals (25.7 million) and ambulatory surgery centers (22.5 million), 3 suggesting that postsurgical pain is a likely source of the prevalent acute pain reported by hospitalized patients.A National Pain Strategy. Over a decade ago, the Institute of Medicine (now the National Academy of Medicine) proclaimed the need to revolutionize how health care professionals, researchers, and the public understand and treat pain. 4 This spotlight on a major public health problem led the U.S. Department of Health and Human Services to develop a National Pain Strategy to prevent the progression of acute to chronic pain and the development of highimpact chronic pain, which is characterized by painrelated functional decline and physical disability that limits participation in work, social, and self-care activities for six months or longer. 5 The problem with one-dimensional pain-rating scales. A cross-sectional study by van Boekel and colleagues of patients who underwent major surgery between January 2008 and August 2013 found that a one-dimensional numeric rating scale (NRS) reflected little about the tolerability of postoperative pain. 6 In this study, a low NRS score did not indicate that patients found postoperative pain acceptable.
Background: Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country.Methods: PAIN OUT, an international perioperative pain registry, provided standardized methodology for assessing management and multi-dimensional PROs on the first postoperative day, in patients undergoing orthopaedic, general surgery, obstetric & gynaecology or urological procedures.Results: Between 2017 and 2019, data obtained from 10,415 adult patients in 105 wards, qualified for analysis. At the ward level: 50% (median) of patients reported worst pain intensities ≥7/10 NRS, 25% spent ≥50% of the time in severe pain and 20-34% reported severe ratings for pain-related functional and emotional interference. Demographic variables, country and surgical discipline explained a small proportion of the variation in the PROs, leaving about 88% unexplained. Most treatment processes varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Conclusions:This comprehensive evaluation demonstrates that many patients in this international cohort reported poor pain-related PROs on the first postoperative day. PROs and treatments varied greatly. Most of the variance of the PROs could not be explained. The findings served as a basis for devising and implementing QI programmes in participating hospitals.Author names are listed in the acknowledgement section.
Drug treatment for nociceptive musculoskeletal pain (NMP) follows a three-step analgesic ladder proposed by the World Health Organization (WHO), starting from non-steroidal anti-inflammatory drugs (NSAIDs), followed by weak or strong opioids until the pain is under control. However, effective pain treatment is challenged by inter-individual differences, and unsatisfied pain treatment response (PTR) rates ranging from 34 to 79% in those suffering from NMP. To investigate the underlying genetic component of PTR, we performed a genome-wide association study (GWAS) in ~ 23,000 participants with NMP from the UK Biobank. In our primary analysis, we compared NSAID vs. opioid users as a reflection of (non)response to NSAIDs, adjusting for age, sex, BMI, population substructure, and study-specific covariates. One genome-wide significant hit was identified in an intergenic region on chromosome 4, rs549224715 (P = 3.88x10-8), and seven signals pass the suggestively significant threshold (P < 1x10-6). All identified loci were in non-coding regions, but most variants showed potential regulatory functions. SNPs in LD (r2 > 0.6) with the lead SNPs passing the nominal significant threshold (P < 0.05) were mapped to 28 target genes in FUMA. Eight of these 28 genes are involved in processes linked to neuropathic pain and musculoskeletal development. Pathway and network analyses with Ingenuity resulted in the identification of immunity-related processes and a (putative) central role of EGFR. Genetic correlation analysis including 596 traits resulted in the identification of 67 nominally significant (P < 0.05) genetic correlations, and these traits were significantly enriched for chronic pain and socioeconomic status traits (P = 3.35 x 10-12). Additionally, we conducted a subtype GWAS for inflammatory NMP and a secondary GWAS for participants with NMP disease history, but no significant hits or overlap with the primary analysis were observed. Overall, we identified one genome-wide significant association in this first GWAS focusing on pain treatment using the analgesic ladder as phenotype. However, we realize that this study lacked power and should be viewed as a first step to elucidate the genetic background of NMP treatment.
without hip-related groin pain. The presence of these features has been used previously as a reason for interventions, with the aim of preventing the development of pain and OA in later life. As such, it is of critical importance to determine whether hip morphology is associated with pain in young active individuals. This study aimed to determine the prevalence of bony morphology/early osteoarthritis (OA) features in football players with and without hip-related groin pain and the relationship between the presence of pain and hip morphology. Methods: This large prospective cohort study was conducted in Victoria and Queensland, Australia. 187 amateur football players (51% soccer/ 49% Australian rules football (ARF); median age 26yrs; height 179cm; weight 79kg; 20% women) with hip/groin pain (pain for at least 6 months; and positive flexion/adduction/internal rotation (FADIR) test); and 55 age-and activity-matched control football players (54% soccer/ 46% ARF; 26yr; 178cm; 78kg; 25% women) were evaluated for bony morphology and early OA features from radiographs. Bony morphology and hip osteoarthritis were measured using anterior-posterior (AP) and Dunn 45 radiographs. Hip morphology was determined using the alpha angle for cam morphology and the lateral centre edge angle (LCEA) for pincer morphology and hip dysplasia. An alpha angle 60 represented cam morphology; alpha angle 78 represented pathological cam morphology; LCEA 40 represented pincer morphology; and LCEA 20 represented hip dysplasia. Hip OA was determined using OARSI atlas to score the different OA features including the presence of osteophytes and joint space narrowing. Between group differences for patient characteristics, morphology and OA were evaluated with parametric and non-parametric tests. Binomial logistic regression (covariates: sex and body mass index (BMI)) determined the relationship between presence of pain (yes/no), morphology and OA features. Statistical significant was set at <0.05. Results: There were no significant differences in patient characteristics between football players with and without hip/groin pain (p¼0.291 to 0.945). The alpha-angle (AP 50 vs 48 p¼0.72; Dunn 68 vs 66 p¼0.274) and LCEA (31 vs 32 p¼0.508) were not different between groups. The prevalence of morphology and OA features did not differ between groups. For the alpha-angle 60 , the prevalence was 69% in the symptomatic group, and 60% in the asymptomatic group (p¼0.223). For the alpha-angle 78 , the prevalence was 38% in the symptomatic group, and 36% in the asymptomatic group (p¼0.85). For the LCEA 40 the prevalence was 7% in the symptomatic group and 7% in the asymptomatic group (p¼1.00). For the LCEA 20 , the prevalence was 4% in the symptomatic group and 3% in the asymptomatic group. The prevalence of osteophytes was 7% in the symptomatic group compared to 5% in the asymptomatic group (p¼0.736). Joint space narrowing was present in 9% of the symptomatic group compared to 5% of the asymptomatic group (p¼0.527). There was no relationship between hip morphology a...
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