No / A significant number of people in the UK experience chronic pain, resulting in high levels of suffering and reduced quality of life. Management of chronic pain is complex, time consuming and not always successful. Good communication between patients and healthcare professionals is essential to ensure realistic treatment plans and outcomes can be negotiated. Accurate assessment is also key, and nurses play a fundamental role in ensuring patients with chronic pain receive the most appropriate care.

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)

There is an identified problem with patients receiving suboptimal pain management at a hospice agency in the northwestern United States. At this agency, undertreatment of pain is prevalent. Evidence indicates that this may be a result of a lack of guidelines, education, and knowledge of appropriate prescribing. Known barriers to the correct prescription and administration of potent opioids in the hospice setting include prevailing beliefs, knowledge, skills, and attitudes, all of which can impact care negatively. Contextually, hospice principles mandate patient comfort and caregiver involvement in continuous quality improvement, which includes adequate and informed pain management. Moreover, hospice metrics demand requisite knowledge, skills, and attitudes for optimal care, including pain management at the end of life. The Academic Center for Evidence-Based Practice (ACE) star model was used to guide the development of an evidence-based, guideline-supported educational program that will improve pain management at the hospice agency when implemented. The purpose of this project was to use transdisciplinary expertise and team collaboration to develop the program and then to conduct a formative and summative evaluation utilizing experts to prepare the guidelines and process for implementation. Ten experts reviewed the guideline, the educational materials, the process, and the evaluation plan and conducted reviews using the AGREE II tool. The panel of experts agreed within the 6 AGREE domains. Future implementation of this guideline, translation process, and evaluation tool will impact social change through the empowerment of the clinical staff, patients, and caregivers to provide the best pain control and comfort at end of life, a vulnerable time for all patients.

Cette étude a été subventionnée par le Fonds de recherche du Québec - Santé (FRQ-S, grant # 21230 – 2) / Les infiltrations foraminales cervicales sont associées à un risque de complications neurologiques majeures. Cette étude compare l’efficacité des infiltrations facettaires, plus sécuritaires, à celle des infiltrations foraminales dans le traitement de la cervico-brachialgie secondaire à une spondylose et/ou à une hernie discale, à 4 semaines post traitement. Cinquante-six sujets ont été randomisés pour recevoir une infiltration foraminale (15 hommes, 13 femmes ; âge moyen 52 ans) ou facettaire (8 hommes, 20 femmes ; âge moyen 44 ans). L’issue principale était l’intensité de la douleur mesurée sur une échelle visuelle analogique (0 – 100). Les issues secondaires étaient le Neck Disability Index et le Medication Quantitative Scale. Suivant les analyses en intention-de-traiter et en intention-du-protocole, pour un score de douleur initial moyen, une réduction significative de l’intensité de la douleur a été observée avec les infiltrations facettaires [45.3% (95%CI: 21.4; 69.2) et 37.0% (95%CI: 9.2; 64.7)] contrairement aux infiltrations foraminales [9.8% (95%CI: +11.5; 31.2) et 17.8% (95%CI: +6.6; 42.2)]. Les infiltrations facettaires ont procuré une amélioration cliniquement (mais non statistiquement) significative du Neck Disability Index [24.3% (95%CI: +2.9; 51.5) et 20.7% (95%CI: +6.2; 47.6),], contrairement aux infiltrations foraminales [9.6% (95%CI: +15.2; 34.4) et 12.8% (95%CI: +11.2; 36.7)]. Les infiltrations facettaires étaient au moins aussi efficaces que les infiltrations foraminales pour un score initial de douleur ≤ 60, alors que l’analyse de non infériorité n’était pas concluante pour un score initial ≥ 80, de même que pour le Neck Disability Index. Les infiltrations n’ont pas été associées à une réduction du score de Medication Quantitative Scale. Les infiltrations facettaires sont efficaces dans le traitement de la névralgie cervico-brachiale et représentent une alternative valable et plus sécuritaire aux infiltrations foraminales. / Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks post treatment. We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age 52 years; range 28 – 72 years) or facet (8 men, 20 women; mean 44 years; range 26 – 60 years) injections. The primary outcome was pain severity rated on a visual analog scale (0-100). Secondary outcome measures were the Neck Disability Index and the Medication Quantitative Scale. In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95%CI: 21.4; 69.2) and 37.0% (95%CI: 9.2; 64.7), while transforaminal injections showed nonsignificant pain score reduction of 9.8% (95%CI: +11.5; 31.2) and 17.8% (95%CI: +6.6; 42.2). While facet injections demonstrated an improvement in Neck Disability Index score of [24.3% (95%CI: +2.9; 51.5); 20.7% (95%CI: +6.2; 47.6),] as opposed to transforaminal injections [9.6% (95%CI: +15.2; 34.4); 12.8% (95%CI: +11.2; 36.7)], the results did not reach statistical significance. Noninferiority of facet to transforaminal injections was demonstrated for baseline pain score ≤ 60, while noninferiority analysis was inconclusive for baseline pain score ≥ 80 and for the Neck Disability Index score. Neither intervention showed a significant medication intake score reduction over time. Facet injections are effective for the treatment of cervical radiculopathy and represent a valid and safer alternative to transforaminal injections.