CE: Assessing Movement-Evoked Pain

Abstract

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.

CE: Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery

“…For example, after surgery, a combination of medications, nerve blocks, physical therapy, education, and counseling, along with complementary comfort measures, is likely to produce the best outcomes. (See Figure 1 for a case scenario 1…”

“…Our previous AJN article addressed several methods for assessing MEP and the importance of MEP assessment as a standard practice. 1 This follow-up article delineates ways to manage postoperative MEP using a multifaceted and person-centered approach in TJ, a 40-year-old man, is postcystectomy, with a local anesthetic TAP block plus prn acetaminophen for mild pain and oxycodone for moderate pain. TJ reports his pain at rest as a 6 out of 10.…”

“…Determine baseline MEP intensity by having the patient reposition in bed. 1 To reduce postoperative MEP, encourage the patient to adopt nonpharmacological treatments, such as thermal wraps, cold vibration, distraction (listening to music [which could continue while walking/activity], meditation), and TENS at least 20 minutes before activity.…”

The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: a blinded, placebo-controlled, explanatory, randomized trial

“…There is a quickly emerging field of research on movement-evoked pain, 5,13,18 which is distinct from resting pain and assesses pain within a clinically relevant context. For individuals with AT, movement-evoked pain with tendon-loading exercise is routinely used to individualize assessment of AT severity and determine exercise progression.…”

“…Moreover, the effectiveness of PSE plus exercise on other pain-related factors, such as performance-based function, psychosocial factors, and central nervous system (CNS) nociceptive processing, is still unclear. 19,22,30,32,42,45,48 There is a quickly emerging field of research on movementevoked pain, 5,13,18 which is distinct from resting pain and assesses pain within a clinically relevant context. For individuals with AT, movement-evoked pain with tendon-loading exercise is routinely used to individualize assessment of AT severity and determine exercise progression.…”