Pain medicine : the official journal of the American Academy of Pain Medicine
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Prescription drug abuse and undertreatment of pain are public health priorities in the United States. Few options to manage these problems are balanced, in simultaneously supporting pain relief and deterring prescription drug abuse. Prescription monitoring programs (PMPs) potentially offer a balanced approach; however, the medical/scientific communities are not well informed about their current status and potential risks/benefits. The purpose of this study was to provide a benchmark of the current status of PMPs for healthcare providers upon which to engage PMP administrators. ⋯ Initial public safety orientation of PMPs is evolving to include improving public health and patient care. Beginning with efforts to engage healthcare providers through data sharing and education, and progressively including program evaluation on public health and patient care, our results suggest a rapid movement in the direction of utilization of PMPs to improve health care.
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Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. ⋯ When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.
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Older adults with dementia are frequently hospitalized, and a substantial minority present with (or develop) pain during hospitalization. Although general pain management guidelines are available, care can prove challenging in the setting of dementia. The purposes of this study were to review cases of older demented adults with pain admitted to an inpatient geriatric medicine service, and to identify difficulties in their management, which arise as a consequence of patients' dementia. ⋯ The cases presented herein highlight the need to conduct a thorough cognitive assessment of all older hospitalized patients with pain prior to implementing pain medicines. Research is needed to develop effective strategies for managing pain among demented elders in the acute-care setting.
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The best evidence should inform all clinical decisions, but physicians cannot realistically keep up with all of the literature. Two types of preprocessed evidence that can help busy clinicians incorporate evidence into everyday medical decision-making are systematic reviews and clinical practice guidelines. However, conclusions of systematic reviews and recommendations of evidence-based clinical practice guidelines should not be accepted at face value. ⋯ This article discusses what factors distinguish a high-quality systematic review. It also examines the difference between systematic reviews and clinical practice guidelines, and what factors distinguish a high-quality guideline. A separate article discusses how to interpret and apply systematic reviews and clinical practice guidelines, particularly when evidence is weak or inconclusive, or when different systematic reviews or guidelines are discordant.
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Systematic reviews and clinical practice guidelines are useful tools for bringing evidence into pain practice. However, even when their conclusions or recommendations appear valid, interpreting and applying systematic reviews and clinical practice guidelines in everyday practice is not always straightforward. ⋯ Other challenges to using systematic reviews and clinical practice guidelines in pain practice include the need to make decisions about pain interventions when evidence is weak or inconclusive, and the increasing and confusing presence of discordant systematic reviews and clinical practice guidelines. This article discusses how to evaluate applicability and clinical relevance of systematic reviews and clinical practice guidelines, and provides a framework for approaching clinical decisions when evidence is weak or conflicting.