I. Managing pain: recent advances and new challenges

Rowbotham, D. J.

doi:10.1093/bja/aet222

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…This was led by the British Pain Society. The programme consisted of feedback of National Pain Audit results to patients, politicians and policy-makers through the Chronic Pain Policy Coalition, regular newsletter updates, development of specific best practice pathways, 19 revised speciality standards, 20,21 population data on chronic pain from the Health Survey for England, 22 a roadshow to all regions in England and Wales, commissioning guidance, 23 a pain summit that brought together many stakeholders 24 and linkage of audit results to NHS Choices, the main public source of information on NHS providers and treatments available in England.…”

Section: Methodsmentioning

confidence: 99%

The National Pain Audit for specialist pain services in England and Wales 2010–2014

Price

Williams

Smith

et al. 2018

British Journal of Pain

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BackgroundNumerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A national audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This paper describes a quality improvement programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. MethodsClinics were audited over a four year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results Ninety-four percent of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35% to 56%, p<0.001) over the four year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. ConclusionsA National Audit found that whilst generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.

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Section: Methodsmentioning

confidence: 99%

The National Pain Audit for specialist pain services in England and Wales 2010–2014

Price

Williams

Smith

et al. 2018

British Journal of Pain

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“…The last two decades have seen great advances in our understanding of pain [1]. In particular, the molecular biology of pain and the way in which the central nervous system perceives and processes pain have been transformed.…”

Section: Pain Pathways and The Importance Of Cognitionmentioning

confidence: 99%

Research Tools for the Measurement of Pain and Nociception

Johnson

2016

Animals

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Simple SummaryPain is an integral aspect of many diseases and it is important to be able to measure it in the clinic so that the progression of disease and the animal’s response to treatment can be monitored. When research into pain is undertaken, it is also important to be able to measure the pain, but this time the aim is to provide meaningful results that will further our understanding of the mechanisms of pain or how it can be better treated. This change in emphasis between clinical and research measurement of pain means that the advantages and disadvantages of the many ways in which pain can be measured influence the choice of the most suitable technique and the way in which it is used. It is important to carefully select the most appropriate methodologies so that the data generated are relevant to the hypotheses being tested.AbstractThere are many ways in which pain in animals can be measured and these are based on a variety of phenomena that are related to either the perception of pain or alterations in physical or behavioural features of the animal that are caused by that pain. The features of pain that are most useful for assessment in clinical environments are not always the best to use in a research environment. This is because the aims and objectives of the two settings are different and so whilst particular techniques will have the same advantages and disadvantages in clinical and research environments, these considerations may become more or less of a drawback when moving from one environment to the other. For example, a simple descriptive pain scale has a number of advantages and disadvantages. In a clinical setting the advantages are very useful and the disadvantages are less relevant, but in a research environment the advantages are less important and the disadvantages can become more problematic. This paper will focus on pain in the research environment and after a brief revision of the pathophysiological systems involved will attempt to outline the major advantages and disadvantages of the more commonly used measurement techniques that have been used for studies in the area of pain perception and analgesia. This paper is expanded from a conference proceedings paper presented at the International Veterinary Emergency and Critical Care Conference in San Diego, USA.

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“…Nociception is the mechanism by which the central and peripheral nervous systems process information about noxious stimuli, whereas pain is the perception generated when this information reaches the cerebral cortex [1]. Under general anaesthesia, patients are unconscious, but their body still shows reflex responses to the surgical procedure, including changes in heart rate and blood pressure, eyes tearing or sweating [2].…”

Section: Introductionmentioning

confidence: 99%

“…During the past two decades, we have seen great advances in our understanding of pain. In particular, the molecular biology of pain and the way in which the central nervous system perceives and processes pain have been transformed [2]. The key to adequate pain management during general anaesthesia, is to assess its presence and severity, to identify those signs which require intervention, and by appreciating treatment efficacy [2,3].…”

Section: Introductionmentioning

confidence: 99%

Monitoring the Nociception Level Intraoperatively - An Initial Experiences

Pether

2018

JAICM

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Background: Estimating pain stimuli in the anesthetized patient can be difficult when based solely upon physiological parameters, especially when vasopressors are used as well. There is an increasing interest during general anesthesia to understand how optimal anesthesia changes by the level of noxious stimulation. Objectively, noxious stimulation measurement monitoring techniques are gaining interest. Although currently, its exact use in routine clinical practice is still not well proven. The aim of this study was to identify relationships between PMD 200 monitoring, Nociception Level (NOL-index) and monitored known physiological signs as well as outcomes during general anesthesia.Method: Eight patients between the ages of 43 and 83 years old and scheduled for major head and neck surgery under general anesthesia were observed in this study. NoL index sensor was placed on one of the patient's fingers before anesthesia was induced, and values were extracted during the intraoperative period. Results:NoL index values increased intraoperatively during nociceptive stimuli such as jaw lift, endotracheal intubation, catheterization of the bladder, and with surgical skin incision. NoL index increased at several occasions faster, and were more prominent than physiological parameters (BP, HR). Conclusion:There are identified relationships between PMD 200 monitoring, NOL-index and nociceptive stimulation. NoL index tends to indicate nociceptive responses earlier and more often than hemodynamic outcomes. NoL index can be a physiological marker for optimal analgesic administration and an interesting complement to monitoring equipment intraoperatively worth further studies.

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I. Managing pain: recent advances and new challenges

Cited by 7 publications

References 34 publications

The National Pain Audit for specialist pain services in England and Wales 2010–2014

The National Pain Audit for specialist pain services in England and Wales 2010–2014

Research Tools for the Measurement of Pain and Nociception

Monitoring the Nociception Level Intraoperatively - An Initial Experiences

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