Evidence Based Practice in Management of Cancer Pain

The aim of this review is to examine what is the most appropriate method of pain assessment and management when working with clients with cognitive impairment.

The ratings for this scale vary from no pain, a zero, to the worst pain one could possibly endure, a ten ('Misha' Backonja & Farrar, 2015).  This type of tool used for measuring pain is considered a self-assessment.  Meaning, the individual rates his/her pain on the provided scale.  All individuals who have received medical treatment, whether for a serious injury or a yearly physical, has been asked, “What would you rate your pain today, on a scale of one to ten?”.  This pain assessment tool is considered a fully ordered variable due to the individual having a wide range to rate his/her

Pain is a condition that is determined and described by the person reporting it. There are several components to pain including the emotional, psychological, and physical aspects. Many health professionals struggle to understand this phenomenon and thereby insert their own perspectives into the pain assessment of patient reporting pain. The Affordable Care Act (ACA) (2010), also titled the Patient Protection and Affordable Care Act H.R. 3590, was passed by Congress and signed into law on March 23, 2010 (U.S. Department of Health and Human Services (DHHS), 2013). Hospital value based purchasing programs (VBP) were developed to align patient quality care and outcomes to the support initiatives from the ACA. A component of the VBP includes patient satisfaction. Patient satisfaction is a self-reported response to questionnaire administered by a third party. Many hospitals utilize Press Ganey to administer the survey for the inpatient and outpatient patients. One component the survey includes patient’s self-reporting how well their pain was managed during their hospitalization. This measure of satisfaction can have an adverse effect on patient outcomes and increase opioid use in this setting. Patient satisfaction and pain management are both subjective however pain management while within scope of healthcare professionals should not be included in the patient satisfaction survey.

Assessing and managing the pain of the patient is critical in delivering quality care services, but what if the presenting individual has cognitive impairment? According to Fry, et. al. (2014), there is also evidence that cognitive impairment is a significant risk factor for analgesic delay. The immediate recognition of pain and the timely intervention is a

Step one, Geraldine pains will be monitored and documented at a regular interval by asking her to score her pain on a scale of (0-10) with 0 meaning zero pains and 10 being highly in pain. This will help in evaluating her cancer-related pain symptoms, which may involve viscera, nerve, or bone tissue. Use of rating scale aids helps in assessing level of pain and provides a tool for evaluating the effectiveness of analgesics, enhancing patient control of pain. Geraldine’s reported and unreported pain will be assessed. The discrepancy between reported and nonverbal cue can give us clues to the degree of pain, the effectiveness of

Because severe pain is more difficult to control, Mrs R may become anxious and fatigued, and may also withdraw again from the regimen if there is no success in achieving pain relief; therefore, the preventive approach needs to be considered. (Wells, 2014). For an effective pain control pain, Mrs R should also keep a daily record of her pain. Writing a diary can help empower the patient in her own care, give her confidence and increase self-efficacy (Bastable, 2014). Also, a strategy of pain management is to combine opiods with non-narcotics, such as Tylenol, in order to enhance pain relief and to slowly decrease the use of narcotics overtime (Lewis, 2014). Mrs R was explained to always follow the right dosage of medication to optimize the narcotic results. A complete assessment of pain should be performed: PQRST. Pain is a subjective concept and the patient must describe the pain in order to provide an effective care plan (Jarvis, 2013). Responses to pain medication should be documented to facilitate communication between health care providers, therefore to maximise effective pain management strategies (Lewis, 2014). The use of non-pharmacological therapy for pain is also recommended to Mrs R because it helps reduce the dose of an analgesic/opiod required to control pain and helps to minimize analgesic side effects, and also promote the release of endorphins which inhibit pain signals (NCBI, 2010). Mrs R is encouraged to use distraction such as watching TV, listening to the radio/music, which redirect the attention on something and away of the pain. Imagery can also be proposed to divert the focus away from the pain by stimulating the client’s imagination to develop sensory images. Relaxation strategies can also be used to help Mrs R to be free of her anxiety and stress, and to reduce muscle tension (Lewis,

Major themes associated with this study included: cancer pain, emotional pain, spiritual pain, pain management, and barriers to pain management.

Treating pain associated with cancer is very complex. Significant factors with the initial intensity of pain are metastasis to the bony area, temporary pain despite administering other pain medications, below the age of 60-year-old and bad result in the (KPS) Karnofsky performance scale (Caraceni & Portenoy, 1999).

Furthermore, this activity has linked to my overarching goal because through a literature search and completing a data extraction table of at least three articles that are recent (within the past 5 years), I have acknowledged various pain assessment tools used in oncology patients. I am able to compare and contrast different pain assessment tools and choose which is more insightful and effective to evaluate my patient’s pain, which will then help me improve my pain assessment

Managing pain – To determine if Mr Dwight’s pain is well managed, 0-10 numerical pain rating scale with measure of patient pain satisfaction is advised (Phillips, Gift, Gelot, Duong, & Tapp, 2013, p.684). If Mr Dwight reported a lower numerical pain score after implementing interventions for his pain and reports being satisfied then that would support that the goal of managing his pain is achieved.

Introduction: Patient Reported Outcome Measures (PROMs) can help improve patient-care provider communication and may be used to inform interdisciplinary care for Low Back Pain (LBP). To garner potential benefits of using PROMs, clinicians need to be able to integrate PROMs into their clinical workflow and interpret scores to support treatment planning. Professional interventions tailored to implementation barriers may enhance clinicians to increase the routine use of PROMs.

Common concerns were found which included; lack of education on pain management, inability to recognize an individualized plan of care, failure to communicate with the physician about pain, and lack of self-awareness of each nurse’s practice.

A Cancer pain level is one of the first things medical doctors intend to regulate.

Introduction: Clinical guidelines recommend interdisciplinary care for individuals with chronic low back pain (LBP). The use of Patient Reported Outcome Measures (PROMs) is a critical component of the interdisciplinary intervention for LBP to improve the quality of care. However, using PROMs is perceived by interdisciplinary clinicians as the most complicated component. Therefore, it is important to identify the most appropriate intervention that will address barriers and support clinicians’ application of PROMs.

The specific aim of this cross-sectional study is to reduce cost and improve pain outcome in patients with chronic idiopathic neck pain (CINP). To do this, the study will examine whether the number of visits of mobilization (hypothesis) affect the MCID on pain reduction for patients to begin exercising. In addition, the study will also identify which patients are likely to respond or not to mobilization based on their conditioned pain modulation (CPM) profile? (research questions). These findings could potentially cut costs