Pain management nursing : official journal of the American Society of Pain Management Nurses
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Changes over time to self-managed chronic pain treatments are not a routine part of pain management discussions and might provide insight into adjustments that improve pain outcomes. ⋯ The ePMLHC has the potential to enhance communication about past pain management treatments and promote more personalized pain treatment regimens, but further development is required.
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Racial and ethnic disparities in pain management are widely documented in the United States. The 2016 Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing have generated new imperatives for using complementary and alternative medicine approaches (CAM) to manage chronic pain, including cancer pain. This review's purpose was to explore the prevalence of CAM use for cancer-related pain among racial and ethnic minorities and to organize these findings according to the CAM modalities proposed by the National Center for Complementary and Integrative Health (NCCIH). ⋯ Overall, CAM use for any modality ranged from 51% to 83%. Mind-body therapies were reported most, and energy therapies the least. Differences in CAM use were most often attributable to socioeconomic status (SES), with those of higher SES associated with greater use of practitioner-assisted CAM therapies and those of lower SES with greater use of free therapies. This difference has implications for achieving adequate and consistent pain relief among subgroups of patients with cancer. This review also identifies a literature gap regarding racial/ethnic disparities in access to CAM for cancer pain, and a need for validated measures to assess CAM use.
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People with dementia experience a decline in language skills required to self-report pain; researchers thus recommend the use of nonverbal behaviors to assess pain. Although multiple instruments exist for assessing nonverbal pain behaviors, psychometric data are lacking for African American nursing home residents with dementia. ⋯ Initially, 15 nonverbal pain behaviors were evaluated. Based on the alpha scores and additional literature review, the 15 nonverbal pain behaviors were expanded to 28 behaviors. The PATCIE had a Cronbach's alpha of .73 during movement. Construct validity for the pain behaviors was demonstrated because higher scores were noted during movement, and scores before movement were significantly higher than those obtained after movement. For movement over time, there was a significant difference in the PATCIE score, regardless of ethnicity or time (p < .0001). There were no significant differences found between ethnic groups, either overall or in change over time between movements or between the categories of cognitive function. African Americans were more likely to display frowning, and Caucasians to display irritability. The PATCIE demonstrates preliminary reliability and validity in assessing pain in African American and Caucasian nursing home residents with dementia.
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The experience of musculoskeletal pain is widespread among adults and entails high costs to both individuals and society. Few studies look at disparities in pain management. ⋯ Nurses should be aware of the association of education and income with pain-medication use, which suggests that pain medication use is less accessible to those with fewer resources. Pain is a significant public-health problem, and access to medicine deserves attention from nurses, healthcare workers and policymakers.
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The prevalence of pain in nursing home (NH) residents is high. Insufficiently treated pain reduces quality of life and often leads to negative health consequences. Pain experience in older people can be influenced by physical, psychosocial, emotional, and spiritual factors. ⋯ The perceived lack of responsiveness may prompt NH residents to bypass care workers with their pain management concerns. This study's findings will inform the development of an educational intervention for NH care workers.