No description available.

Class of 2017 Abstract / Objectives: Specific Aim 1: Pharmacist will use pharmacological pain self-management strategies over non- pharmacological strategies. Specific Aim 2: Pharmacist pain self-management strategies will differ based on whether or not the pharmacist has chronic pain. Specific Aim 3: Pharmacist pain self-management strategies will differ across age. Specific Aim 4: Pharmacist pain self-management strategies will differ across gender. Methods: A survey was sent to all pharmacists with an email address registered with the State Board of Pharmacy in a single Southwestern state. The survey asked about characteristics of pain, strategies for managing pain, outcomes, and demographics. The primary outcome was severity of pain after treatment. Results: Responses were received from 417 pharmacists; 219 reported acute, 206 reported chronic pain, and 55 reported no pain. The chronic pain group was more likely to have a disability with poor/fair health status (P<0.006) and to report higher levels of pain before treatment (6.9 versus 5.8). Both groups reported similar relief from all strategies (76% versus 78% ; P equals 0.397), but the chronic pain group reported higher levels of pain after treatment (3.2 versus 2.0), less confidence in pain management, and less satisfaction (P less than 0.004). Conclusions: Age and gender did not affect the use of specific pain management strategies or the amount of pain relief received from all strategies used by participants with either acute or chronic pain. However, participants with chronic pain had higher levels of pain before and after treatment.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

No description available.

In order to eliminate the unnecessary suffering of children requiring painful procedures to diagnose and treat their illness, management of this pain must be a priority for nurses. The role nurses assume in the current undermanagement of children's pain requires further examination. In the first paper, a comprehensive review of the available literature on pediatric pain management was conducted in order to provide the context in which this issue is situated. The second paper is a qualitative inquiry seeking nurses' accounts of the individual level factors they identify that influence their choices for distraction to manage children's procedural pain. Nurses described the three key determinants of nursing knowledge, experience and relational capacity as influencing their practice. These descriptions provided an extended understanding on nurses' choices for using distraction to manage children's procedure-related pain. Nurses disclosed using distraction for themselves, as well as for the child experiencing a painful procedure.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Introdução: A Associação Internacional para o Estudo da Dor (IASP) tem estimulado a organização de Programas de Tratamento de Dor Aguda (SDAP) para um manejo mais efetivo, bem como avaliar seu impacto em desfechos passiveis de mensuração. Estudos têm sido conduzidos para mostrar a necessidade dos hospitais organizarem serviços de dor aguda pós-operatória, com vistas a melhora do tratamento da dor e para avaliar o processo de recuperação do paciente, redução do tempo de internação consequente ao uso de técnicas analgésicas mais eficazes. Então o objetivo deste estudo foi comparar o tempo de internação de pacientes submetidos a cirurgias eletivas com alta probabilidade de apresentarem dor pós operatória intensa sob os cuidados de uma equipe multidisciplinar especializada do SDAP comparado a uma coorte submetida a procedimentos cirúrgicos equivalentes no mesmo período, que tiveram seu tratamento da dor pós-operatório sob o cuidado da cirurgia equipe. Métodos: trata-se de uma coorte naturalista, retrospectiva, que incluiu 1011 pacientes com idade superior a 18 anos, de ambos os sexos submetidos à cirurgia eletiva de grande porte, tais como cirurgias torácicas com toracotomia, cirurgias proctológicas com abertura da cavidade abdominal e cirurgias ortopédicas para prótese de joelho e quadril. Os dados foram obtidos a partir do pontuaria o eletrônico do Hospital de Clinicas de Porto Alegre (HCPA) no período compreendido entre 2011 e 2015. Resultados: Avaliamos retrospectivamente 1050 pacientes assim distribuídos [cirurgia proctológica 506 (50,4%), cirurgia torácica 216 (21,36%) e cirurgia ortopédica 293 (29,17%)]. A média (SD) da internação hospitalar em pacientes sob o atendimento do SDAP foi de 7,84 (4,41) comparado controles correspondentes sob o cuidado da equipe cirúrgica, que apresentaram uma média (SD) de internação de 9,72 (8,64), respectivamente. Foram fatores associados com prolongada internação pós-operatória a mortalidade pós-operatória, reoperação cirúrgica e pacientes que necessitaram de terapia intensiva pós-operatória. Conclusão: Estes resultados sustentam a hipótese de que uma mudança no cuidado pós-operatório de pacientes submetidos a cirurgias com propensão para dor pós-operatória intensa, sob os cuidados de uma equipe multidisciplinar especializada do SDAP reduziu o tempo de internação pós-operatório comparado aos pacientes submetidos a cirurgias equivalentes com o tratamento da dor pós-operatória aos cuidados da equipe assistente. / Background: The American Pain Society stimulate to organize Programs of the Acute Pain Services (APS) fora most efficient pain management, as well to assesses its impact on the measurable outcomes. Studies around the world remind us of the imminent need for hospitals maintain service acute postoperative pain, since it is known that in this way, through better treatment of pain increases the likelihood of establishing strategies to improve patient recovery, coupled with reductions in average length of stay (hospital), more effective analgesic techniques and potential cost savings. Thus, this study compared the long hospital stay between patients underwent to care for a specialized multidisciplinary team of the APS, with a matched cohort suffered to same surgical procedures, during the same period, which had their postoperative pain management under the care of the surgical team. Methods: This is a retrospective naturalistic cohort that included 1011 patients older than 18 years, male and female underwent to elective major surgery, with an open cavity (proctologic and thoracic surgeries) and orthopedic surgeries (knee and hip replacement). The Electronic Information Database, comprehend the years of 2011 through 2015 at a teaching hospital in the south of Brazil. Results: We assessed retrospectively 1050 patients [proctologic surgery 506 (50.4%), thoracic surgery 216 (21.36%) and orthopedic surgery 293 (29.17%)]. The mean (SD) of hospital stay in patients under of the APS care was 7.84 (4.41) compared to their matched controls, which had a mean (SD) of hospital stay of 9.72 (8.64), respectively. Another risk factor for the long hospital stay were the postoperative mortality, surgical re-operation, and patients that needed postoperative intensive care. Conclusion: These findings support the hypothesis that a change in patients undergone to surgeries with a higher propensity to have severe postoperative pain with the postoperative pain management under a specialized multidisciplinary team of APS reduced the postoperative extended hospital stay.

Opioid misuse and addiction constitute a significant public health challenge in the 21st century, with opioids involved in the majority of drug overdose deaths since 1999. A vigorously researched area that contributes substantially to the opioid misuse and addiction challenge is pain. The impact of pain, however, on important health outcomes for individuals in recovery from opioid use is less well understood. The effects of pain on substance use and mental health outcomes was investigated among individuals in recovery from opioid use disorder. Two studies are reported. First, the relationships between pain status and severity on substance use, treatment utilization, and mental health outcomes (e.g., depressive symptoms) was characterized cross-sectionally. Second, subgroups of OUD recovery defined by depression, opioid withdrawal, and pain were identified. Relationships between recovery subgroups, OUD symptoms, remission, opioid use, and quality of life were assessed. Finally, transitions among subgroups across 4 years of recovery were characterized. The present findings support pain as a key dimension of opioid use disorder recovery, highlighting the distinction between acute and chronic pain, the dynamic nature of opioid use disorder recovery, and emphasizing the necessity of integrating pain into opioid use disorder treatment. / Doctor of Philosophy / Misuse of and addiction to opioids is a significant health challenge. Pain has played a central role in facilitating the opioid epidemic in the United States, but the impact of pain on substance use and mental health outcomes for individuals in recovery from opioid use is less well understood. The following two studies investigated how pain affects substance use and mental health outcomes among individuals in recovery from opioid use disorder. Study 1 examined how different types of pain (chronic pain, acute pain, no pain) affect substance use, treatment use, and mental health measures (e.g., depression, quality of life). Study 2 investigated the role that depression, opioid withdrawal, and pain have in defining different groups in opioid recovery. Together these studies support pain as an important factor in OUD recovery, highlight the distinction between acute and chronic pain, emphasize the importance of integrating treatment for opioid use disorder and pain, and demonstrate that opioid use disorder recovery is a dynamic process with individuals transitioning among different recovery groups over time.

Pain is a leading cause of disability and the most common reason for clinical care. The field of pain research has focused on sex differences in the recent years with an expansive body of literature demonstrating sex-related differences in pain behavior and responsiveness to pharmacological interventions. Prescription opioids are potent analgesics and the mainstay for the clinical management of moderate-to-severe acute and chronic pain conditions. However, the long-term clinical use of prescription opioids for chronic pain remains controversial due to concerns about severe adverse effects, including tolerance, dependence, and addiction associated with opioid use. The non-medical use and abuse of prescription opioids has become a public health crisis, the problem even arising in a subset of chronic pain patients receiving opioid therapy. The vulnerability factors, specifically the role of pain in the propensity to prescription opioid abuse, are poorly understood. The present research project sought to investigate the propensity to opioid reward as a function of pain in male and female mice by incorporating acute (acetic acid-induced) visceral nociceptive and chronic chemotherapy (paclitaxel)-induced peripheral neuropathic pain models. Sexually dimorphic variations in the sensitivities of mice to nociceptive and allodynic behaviors were initially assessed using the two putative pain models. Following that, the two prescription opioids, morphine and oxycodone were examined under both pain contexts and the capacity of the two prescription opioids to produce reward-related behavioral effects were measured using drug discrimination, conditioned place preference, and intravenous drug self-administration procedures. The presence of acute noxious state but not chronic pain selectively attenuated the discriminative stimulus effects of the prescription opioid, morphine in male mice. The magnitude of modulation of the stimulus effects of opioids by the acute noxious state were further observed to be inversely related to the relative intrinsic antinociceptive effectiveness of the two opioids in reversing the acute noxious state and sex-specific sensitivities of mice to opioid-induced antinociception. In contrast, while no change was observed in opioid-reward as a function of the acute noxious state in both sexes, the presence of paclitaxel-induced chronic pain opioid-selectively and dose-selectively enhanced the conditioned rewarding effect of morphine (0.3 mg/kg dose), and the effect was more pronounced in male relative to female mice. These data were further supported by the self-administration results, in that the reinforcing efficacy (breakpoints under progressive ratio (PR) responding) and the incentive-motivational salience of morphine significantly increased in the presence of chronic pain in male mice, while non-selectively increasing regardless of the presence/absence of pain in female mice. Overall, the converging empirical evidence presented here suggest that these models provide preclinical tools to further understand the overlapping neurobiology of pain and opioid abuse, the behavioral effects of prescription opioids, and advance the development of novel sex-specific pain therapeutics with low addiction liability. / Pharmaceutical Sciences

Socioemotional selectivity theory posits that as people age, they become motivated and successful at maximizing positive emotions and minimizing negative ones. Yet, 70% of older adults report physical pain, which is associated with negative affect. The strategies and resources that older adults use to maintain positive affect in the face of pain remain largely unknown. Specific positivity-enhancing strategies include recalling, recognizing, and responding to positive stimuli and prioritizing close over knowledgeable social partners. Executive functions (EF, i.e., task-switching, working memory, and inhibition) and heart rate variability (HRV) may be important resources for coping with pain. The current project used two studies to test whether older adults used positivityenhancing strategies and maintained emotional wellbeing following pain more than younger adults; associations with EF and HRV were also investigated. In Study 1, 50 older and 50 younger adults experienced a control and a pain condition, were given the chance to employ positivity-enhancing strategies, and provided EF and HRV data. Study 2 used longitudinal data from community-dwelling older adults (n =150) to test whether task-switching moderated the within-person relationship between pain and wellbeing. In Study 1, after the pain condition, younger adults demonstrated lesser preference toward knowledgeable social partners than older adults (γ = -0.15, p = .016). No other age group x pain condition x valence interactions were found. Older and younger adults did not differ in changes in positive or negative affect following pain. Task-switching and HRV were both associated with reduced preference for knowledgeable social partners following pain, but no other significant EF or HRV interactions were found. Study 2 failed to support the hypothesis that task-switching protected against pain-related declines in wellbeing. Future research on strategies that older adults use to maintain emotional wellbeing in the face of pain is needed.