Pain is a public health issue affecting the lives of nearly 116 million adults in the US, annually. Understanding the physiological and phenotypic changes that occur in response to painful stimuli is of tremendous clinical interest, but, the complexity of pain and the lack of a representative in vitro model hinders the development of new therapeutics. Pain stimuli are first perceived and transmitted by the neurons within the dorsal root ganglia (DRG) which become hyperexcitable under these conditions. It has now been established that satellite glial cells (SGCs) that ensheathe the DRG cell body actively contribute to this neuronal dysregulation. To understand the role of SGCs in this pain circuit, first, we looked at the development of SGCs within the DRG of rats, and we showed that SGCs developed postnatally, and appeared morphologically, transcriptionally and functionally similar to Schwann cells precursors (SCs), supporting the idea that these cells may exhibit multipotent behavior. Secondly, we describe here, a three-dimensional in vitro model of the DRG which is functionally characterized on a microelectrode array (MEA). This model can be used to assess the long-term recording of spontaneous activity from bundles of axons while preserving the neuronal-SGC interactions similar to those observed in vivo. Furthermore, using capsaicin, an agonist of the TRPV1 nociceptive receptor, we show that this model can be used as an in vitro assay to acquire evoked responses from nociceptive neurons. Overall, this study advances our knowledge on the development and differentiation of SGCs and establishes a novel functional three-dimensional model for the study of SGCs. This model can now be used as a tool to study the underlying basis of neuronal dysregulation in pain.

The Southern Arizona Veterans Affairs Health Care System (SAVAHCS) Chronic Pain Rehabilitation Clinic (CPRC) is an interdisciplinary pain management team. The team consists of physicians, a psychologist, a kinesiotherapist, a nurse and a pharmacist, who work together, to manage pain. In order to monitor and improve the effectiveness of treatment at SAVAHCS CPRC, the team created a pain outcomes measure collection program. A pilot study of the pain outcomes data collection process was conducted. The purpose of this project was to evaluate the data collection procedure and identify areas for improvement. The program planned to collect outcomes data at a new patient education/orientation class using an intake questionnaire. After three months, a follow-up questionnaire was to be mailed to the patient. The patient would then return the questionnaire, by mail, to the clinic where responses would be entered into an electronic database. Eight items in the data collection process were recognized as needing improvement. Three of the most important items follow. (1) Mailing out questionnaires had a low response rate, which could be solved by administering the intake questionnaire during the pharmacist medication evaluation, and the follow-up questionnaire, 6 months later, during a provider appointment. (2) The investigational review board approval process took longer than anticipated but could be corrected through enforcement of a submission time line. (3) Data entry required a large amount of time but could be rectified through the use of volunteers. Overall, the data collection program could gather outcome measures, but procedural adjustments need to occur.

Introduction and Background As chronic and acute pain disorders continue to be diagnosed in the clinical setting, the number of patients searching for medical care in hopes of alleviating their symptoms is on the rise. Working in both medical and psychiatric facilities as a certified nursing assistant, I saw opioids frequently prescribed as a pharmacological treatment for individuals looking to lessen the pain associated with a multitude of pain related disorders. Working in long term care facilities, I watched individuals who had never struggled with substance use disorders develop clinical dependencies on narcotic medication due to the fact that they were prescribed opioids as a means of pain reduction. I watched as individuals who had no prior history of substance abuse or addiction begin to scream in anger and frustration every four hours demanding their medication the second it was available to them after undergoing an event that caused them to experience severe pain (e.g, invasive procedures, falls, etc). Being even a few minutes late to administer their narcotic medication could mean completely destroying a therapeutic rapport with a patient. I saw patients who were previously able to carry out pleasant conversation spending all day in an opioid induced stupor, declining in neurological functioning, and so high from their medication, they were unable to complete ADLs without extensive assistance from a member of the healthcare team. While the patient is not to blame for this phenomenon, as they are just doing what is available to them as treatment for their condition, the healthcare system is doing patients a disservice by not offering alternative forms of pain management for individuals suffering with pain related symptoms. Because of this, we became interested in researching the opioid crisis, how it came to be, and ways that healthcare providers can help to reduce the amount of patients who are forced to deal with clinical dependency and opioid induced debilitation by providing alternative forms of pain management, specifically for individuals experiencing post-operative pain, as it was the most common trigger of pain I saw in the patient populations I have worked with in the clinical setting. Purpose Statement The population we will be researching includes individuals experiencing postoperative pain, who would typically undergo pharmacotherapy with opioids to alleviate their symptoms. The interventions we will be researching include ways that the registered nurse and providers can help reduce their patient’s pain using different forms of alternative pain management that do not include opioid medication. We will be comparing the effectiveness and practicality of opioid therapy to that of other forms of pain management to better understand the ways that patients can work to reduce their pain symptoms in ways that do not include narcotic medication. The way we will evaluate outcomes is by evaluating the current literature surrounding the topic and comparing the results from studies comparing the effectiveness of opioid therapy and the results from alternative forms of pain management. Literature Review In order to research this topic in greater depth, we used google scholar, PubMed, and CINAHL to ensure that each source we used was evidence-based and peer reviewed to the information we gathered was accurate, unbiased, and applicable to the clinical setting. Some databases we utilized included The National Library of Medicine, The Journal of Nursing Regulation, & Arthroscopy: The Journal of Arthroscopic & Related Surgery, all evidence-based and peer-reviewed databases. Luckily, there is an objectively large amount of data existing around the concept of pain management, as it is such a prevalent problem for individuals seeking medical care. Findings After researching forms of alternative pain management for post operative patients, we found three concepts to explore as an alternative to narcotic medication for pain management. These three concepts include: acupuncture therapy, low dose steroid use, and medical cannabis. There is strong evidence to support the effectiveness of these three treatments for managing pain symptoms. While the research on medical cannabis for post operative pain tends to be limited due to legality issues and issues regarding how to correctly dose the drug, there is large evidence to support the effectiveness of cannabis for chronic pain disorders and neuropathy that can result from undergoing surgical procedures. Conclusion After reviewing these three concepts as a form of alternative pain management, we found that there is evidence to support these forms of treatment as a viable alternative to opioid medication, or by implementing these treatments, patients may be able to reduce the amount of opioids it takes to alleviate their pain, reducing their chances of developing side effects or overdosing. There are gaps in the literature regarding cannabis as an effective treatment for acute pain due to complications of researching a schedule one substance, but there is evidence to support cannabis as a treatment for chronic pain issues that can develop from invasive surgical procedures. It is important that nurses are informed about these methods of alternative pain management in order to ensure that their clients are undergoing the best course of care possible if opioids are not a reasonable form of treatment for managing postoperative pain.

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Class of 2007 Abstract / Objectives: This study evaluated the didactic pain management curriculum from 2003 to 2006 at the University of Arizona College of Pharmacy in comparison to a compilation of current published standards. Methods: The study design was a utilization-focused evaluation conducted by two doctor of pharmacy candidates. The eleven domains of cognitive and affective abilities used for analysis were compiled from the International Association for the Study of Pain (IASP) guidelines and from published expert-panel competencies in the American Journal of Pain Management (AJPM). These documents were chosen for comparison because they were created with the purpose of developing competent and proficient pharmacy clinicians. Results: The analysis revealed that the University of Arizona College of Pharmacy was unsuccessful in meeting the recommended standards for pain management competencies. Instruction in pain management was poorly integrated, incomplete, and sporadic throughout the coursework. Conclusions: Pain management was insufficiently addressed in coursework at the University of Arizona. Separating pain from other topics, integrating pain entirely into the therapeutics course, creating a course devoted to pain management, and/or fulfilling standards through a required clerkship may improve the current curriculum. The results of the assessment will be used to provide recommendations to improve the curriculum concerning pain management.

MMed, Faculty of Health Sciences, University of the Witwatersrand / Postoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.

Postoperative pain management is a major responsibility of nurses who provide care for patients recovering from surgery. In the postsurgical environment, the nurse has a pivotal role in assessing the patient with pain, implementing both doctor and nurseinitiated pain interventions and evaluating the patient's response to pain control treatments. Apart from its humanitarian utility, effective relief of postoperative pain is a critical element of a patient's postoperative recovery. Failure to manage pain effectively in the immediate postoperative period can produce undesirable immediate and longterm physical and psychological consequences that can severely disrupt an individual's quality of life. Despite the availability of multidimensional assessment measures, sophisticated pharmacological therapies and a greater range of complementary pain therapies, postoperative pain remains treated ineffectively by those professionally responsible for its management. In particular, evidence indicates that nurses are poor managers of their patients' postoperative pain. This thesis reports research that was conducted in two stages to explore, describe and analyse how nurses managed their patients' postoperative pain and their perceptions of factors that influenced this practice. A predominantly descriptive design was utilised in Stage 1 of the study to collect data from patients' hospital records and with a demographic questionnaire administered to nurses. This was complemented with interview data from nurses in Stage 2. / Previous studies offer limited views of the clinical realities of nursing practice in postoperative pain management. From this perspective, there is a need for research that incorporates these realities to permit analysis of clinical practice and greater understanding therefore of the problem of poor postoperative pain management. The purpose of this study was to provide an illuminative and authentic account of nursing practice in postoperative pain management. For the first part of Stage 1, data were collected retrospectively from nurses' documented accounts of pain assessment and intervention over the first three postoperative days for 100 patients in a major adult acute care teaching hospital. Analysis of nurses' documented responses to patients' reports of postoperative pain revealed that less than one-third of all responses could be considered appropriate for pain management. In particular, nurses failed to provide any pharmacological relief for 53% of patients' reports or severe and excruciating pain. Exploration of the influence of nurses' professional characteristics of education and experience on pain management practice was then undertaken in part 2 of Stage 1 with the use of a demographic questionnaire distributed to 106 nurses who were identified as signatories to the documented responses identified in part 1. Results indicated that length of professional experience accounted for most variations in practice, with older, more experienced nurses managing pain more appropriately than their younger and less experienced colleagues. Irrespective of education or experience, however, nurses failed to respond appropriately to patients reporting excruciating pain. / In Stage 2, in-depth interviews were conducted with 8 nurses caring for postoperative patients at the research site. Thematic content analysis revealed four major themes from nurses' perceptions of their practice of postoperative pain management that served to elucidate and enrich the findings of Stage 1 of the research. These were finding out about the patient's pain, making decisions about pain and pain management, individual factors affecting pain management, and interpersonal and organisational factors affecting pain management. This thesis provides an authentic account of nursing practice in postoperative pain management, and contributes understanding and insight into factors that provoke ineffective management of pain after surgery. It has implications for the development of intervention strategies aimed at improving nursing practice, at both individual and organisational levels, and suggests new directions for nursing education and research toward achieving optimum care and eliminating unnecessary pain for patients recovering from surgery.