PAIN IN THE COMMUNITY

Pain in the Community



Pain in the Community

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Table of Contents

ABSTRACTV

1. INTRODUCTION1

1.1 Background1

1.2 Purpose of the study3

2. LITERATURE REVIEW4

2.1 Introduction4

2.2 Mechanism Of Pain And Analgesia10

2.3 Pain Measurement11

2.4 Assessment14

2.6 Setting Realistic Pain Management Expectations19

2.7 Documentation Of Pain Management20

2.8 Analagesics In Acute Pain Management21

2.8.1 Nonopioid Analgesics22

2.8.2 Opioid Analgesics24

2.8.3 Dosing Regimens and Delivery System26

2.8.4 Adverse Effects of Opioid Underuse27

2.9 A multicultural evidence-based framework30

2.10 Examining the evidence: factors in pain management31

2.12 Cultural variables in pain management34

2.13 Importance of Language and communication in pain assessment39

2.14 Alternative post-operative pain management40

2.15 Patient satisfaction with pain management42

2.16 Summary43

3. MATERIALS AND METHODS45

3.1 Sample and setting45

3.2 Instruments45

3.3 Procedures for data collection47

3.4 Data analysis procedures48

4. RESULTS49

4.1 Instrument reliability49

4.2 Actual pain experience49

4.3 Outcomes of pain management50

4.4 Ways of managing pain52

5. DISCUSSION54

5.1 Clinical implications and future research57

5.2 Key points58

REFERENCES59

APPENDIX69

Interview Questionnaire69

Observation Sheet71

Ethics summary75

POSTER77

Abstract

A multinational project involving pain research teams from three countries examined pain management outcomes in Hispanics. The limited research on pain management outcomes in Hispanics are primarily from the UK, lacking the distinct multinational cultural influences. There were similarities in expectations related to pain relief, proportion of patients reporting worst pain, usual pain and pain-related interference with function. Significant differences were found on adequacy of pain management. Participants reported high use of non-pharmacologic approaches, particularly prayer and family support. The newly developed instrument indicated acceptable reliability in all settings, Chronbach's Alpha 0.75, with some variability by study site. Further cross-ethnic and multinational research are needed to provide culturally relevant evidence-based practice models to overcome barriers and reduce disparity.

1. Introduction

1.1 Background

Acute pain is associated with a rapid and sudden onset, and it is frequently associated with surgery or trauma. Acute pain serves as a warning to our body to protect us from further injury. In the postsurgical period, acute pain serves no additional purpose except to cause patient distress and suffering. (Medical Research Council 2007:56-69)

Earlier studies have confirmed the significance of understanding the post-operative pain experience from a cultural perspective (McNeill et al., 2001; Sherwood et al., zoo g a, 2003b:12), yet few instruments are available to assess pain outcomes in non-English-speaking population groups, nor have they been tested among populations representing multiple countries.

Global migration patterns among major world populations challenge traditional homogeneous views of the universal problem of pain management. Little research is reported about pain management relative to culture, and particularly for Britishers, one of the world's largest population groups. Increasing scientific evidence confirms the benefits of effective pain management from the perspectives of human comfort and recovery, as well as regarding economic implications. Evidence related to post-operative pain management can significantly improve recovery following surgery with the benefits of early mobility, less nausea and vomiting for improved nutrition, and less interference with mood and interactions. While standards that gUide patient care interventions continue to increase provider awareness and monitor adherence, reports of poorly managed pain, particularly ...