Pain Management Nursing最新文献

{"title":"Maximizing the mental health of patients with chronic pain","authors":"Megan Filoramo MSN, RN-BC, APRN-BC, PGMT-BC, AP-PMN, IHWNC-BC","doi":"10.1016/j.pmn.2025.01.080","DOIUrl":"10.1016/j.pmn.2025.01.080","url":null,"abstract":"<div><h3>Problem</h3><div>The prevalence of depression in patients with chronic pain is 22.9%-60.8%. Despite this, many patients do not have access to or are resistant to the idea of behavioral therapy. While nurses acknowledge the gravity of this situation, they can lack the knowledge of available resources and how to help patients utilize them.</div></div><div><h3>Summary of Evidence</h3><div>Cognitive Behavioral Therapy (CBT) is the gold standard for the treatment of mood disorders with chronic pain. The cognitive distortions addressed in CBT can also be addressed in nursing interactions with patients through motivational interviewing. Internet based CBT is also an effective alternative to in-person therapy. Should a patient want other options, Empowered Relief is a single session pain management skills class that is non-inferior to 16 hours of CBT and is readily available, online or in-person. Mindfulness-Based Stress Reduction (MBSR) is a third option that can improve function and decrease pain catastrophizing. This 8-week group approach, online or in-person, focuses on awareness, acceptance, and mindfulness strategies. For a self-directed approach, there are many apps available. The MARS criteria for app selection scores the strength of the evidence base of the app combined with user experience rating.</div></div><div><h3>Methods</h3><div>Reviewed scientific studies</div></div><div><h3>Results/Relevance</h3><div>The prevalence of depression in patients with chronic pain is 22.9%-60%. Chronic pain has a direct effect on sleep quality with 40.7%-86.7% of patients with chronic pain suffering with sleep disturbance. In turn, poor sleep quality has a positive and direct effect on depression. Therefore, treating only the pain symptoms is an inadequate approach to improving the quality of life for these patients. There are options available for nurses to recommend beyond a referral for CBT including Empowered Relief and MBSR, both of which can decrease pain interference, pain catastrophizing and improve quality of life. Other approaches include mental health apps, and motivational interviewing based on a knowledge of the cognitive distortions addressed with formal CBT. For patients who are willing and able, there are multiple ways to locate a CBT provider.</div></div><div><h3>Future Implications</h3><div>Patients look to nurses for guidance to make informed decisions regarding their health care. As access to online modalities grow, nurses can help more patients find an option that works for them. Staying abreast of these options is the challenge for nurses going forward.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e234-e235"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lunch CE: Therapeutic Touch: The Basics, Learn Therapeutic Touch (TT) in a simple way to immediately address acute needs, for self-care, and for family/community care purposes","authors":"Kathleen Barnett MSN, APRN, QTTT,&nbsp;Susan Gormley MSN, AHCNS-BC, PMGT-BC, QTTP","doi":"10.1016/j.pmn.2025.01.083","DOIUrl":"10.1016/j.pmn.2025.01.083","url":null,"abstract":"<div><div>Complementary therapies are increasingly used as an adjunct to the standard management of pain to achieve overall well-being. Learning complementary therapies is often resource-intensive which creates barriers to learning and utilizing them. Therapeutic Touch (TT) is a holistic, evidence-based practice that incorporates the intentional and compassionate use of universal energy to promote balance and well-being. It does not require physical touch. Research has shown that TT is effective in promoting relaxation, altering the perception of pain, decreasing anxiety, and mobilizing the individual's own healing energies to restore balance to the body. TT can be learned and used effectively by anyone with training and practice.</div><div>Therapeutic Touch has been practiced in our 750-bed hospital since 2014. It has been provided to thousands of patients, and hundreds of colleagues, visitors, and other community members. It is provided by practitioners who complete a competency program, including taking the original introductory 12-hour course for TT. Since 2014, staff, patients, visitors, and community members have shown interest in learning more about TT but have not always been able to commit the time or financial resources to attend a 12-hour course. Therapeutic Touch Community Care (TTCC) courses are shorter classes that are designed to introduce people to TT and to meet the specific needs of individual groups. They were established in 2022 by Therapeutic Touch International Association and are offered by approved facilitators.</div><div>Therapeutic Touch: The Basics is an approved, 4-hour TTCC course designed to give participants a foundation from which to serve themselves and their communities with TT; for those who might wish to deepen their TT knowledge and practice, this course is a wonderful introduction to the next level of learning, The Foundations of Therapeutic Touch. (This course is NOT intended to prepare one to establish an independent healing practice).</div><div>A wide variety of people who have taken Therapeutic Touch: The Basics, are now using TT in many ways, using it on themselves or with family, friends, and coworkers to promote comfort, relaxation, and improved sleep, and to reduce stress and anxiety so prevalent in these times.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e235-e236"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting patients and family's affected by a substance use disorder","authors":"Rochelle Perry DNP, FMHNP-BC","doi":"10.1016/j.pmn.2025.01.067","DOIUrl":"10.1016/j.pmn.2025.01.067","url":null,"abstract":"<div><h3>Background &amp; Purpose</h3><div>Data from the National Survey on Drug Use and Health shows that 40 million in U.S. (14.5% of the population) had a substance use disorder (SUD) in 2020. Treatment guidelines for SUDs concur that family participation in treatment provides strong support for patient recovery, and family members also benefit. Several national directives focus on the future of healthcare and the role of the engaged consumer Patient Center Care (PCC) and Patient Engagement (PE), the National Priorities Partnership (NPP), and the National Strategy for Quality Improvement in Health Care (NSQIHC). However, there is a gap between guidelines, policies, and healthcare practice when it comes to family inclusion. A literature review was conducted to summarize evidence-based interventions to improve outcomes in SUD by incorporating family and patient-identified support systems.</div></div><div><h3>Synthesis of evidence</h3><div>This review revealed a limited body of research exploring the inclusion and experiences of family members of someone with a SUD. Inductive thematic analysis was used to identify key potential areas for family interventions. Relapse, stress, stigma, medication for opioid use disorders, and recovery emerged as avenues to target family-centered interventions. Nurses can use this information to incorporate family members in their assessment, diagnosing, planning, implementation, and evaluation process when working with patients with SUD.</div></div><div><h3>Method of Evaluation</h3><div>The literature search resulted in high-quality, methodologically appropriate research studies: three national guidelines, three systematic reviews of RCTs, four quantitative studies (3 RCT and 1 nonrandom), two qualitative studies, a descriptive study, and an integrated review. The level of evidence is primarily level I or II.</div></div><div><h3>Relevance to Pain Management</h3><div>Often chronic pain is comorbid among patients diagnosed with SUD with estimates ranging from 50–60%. It is prudent to assess for risky use of all substances, use motivational interviewing, brief intervention strategies, and refer to treatment if indicated.</div></div><div><h3>Future Implications for Nursing Profession</h3><div>Family interventions focusing on reducing relapses, providing support for family stress, addressing stigma, providing education and resources for access to both buprenorphine and naloxone when indicated and a focus on recovery, not abstinence, have the greatest potential in improving outcomes for individuals, their families, and the American population.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e230"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Interdisciplinary Simulation: Recognition and Intervention in Patients Receiving PCA/NCA Therapy","authors":"Deb Bruene MA, RN, PMGT-BC","doi":"10.1016/j.pmn.2025.01.027","DOIUrl":"10.1016/j.pmn.2025.01.027","url":null,"abstract":"<div><div>A simulation lab was used to promote interdisciplinary learning and collaboration within a scenario that does not frequently occur, but requires timely assessment and interdisciplinary intervention opioid-induced respiratory depression in children receiving PCA therapy. Over a 6 month timeframe approximately 60 nurses and 27 residents participated in a 60 minute scenario and debriefing. The scenarios were held in a simulation lab similar to an inpatient pediatric room utilizing a high fidelity manikin and a trained staff member who simulated a parent. Supplies, equipment, computer documentation, IV/PCA pumps and emergency equipment were similar to the inpatient setting. Staff were unaware of the scenario prior to their pre-scheduled simulation time.</div><div>Objectives of the sessions were to:<ul><li><span>1)</span><span><div>Recognize signs of opioid overdose in a pediatric patient including respiratory failure</div></span></li><li><span>2)</span><span><div>Demonstrate appropriate escalation of respiratory support for a patient with respiratory failure</div></span></li><li><span>3)</span><span><div>Demonstrate appropriate treatment of opioid overdose, including naloxone administration</div></span></li><li><span>4)</span><span><div>Demonstrate effective teamwork with delineation of clear roles and closed-loop communication</div></span></li></ul></div><div>Data was collected via electronic survey and staff observation through a rubric and will be presented on the poster. Data include staff perceptions of their confidence in assessment and management of decompensating pediatric patients and understanding of their role in the team. Additional staff provided feedback related to the degree to which participation in the simulation improved their overall knowledge related to opioid induced respiratory depression and utilization of naloxone. Other metrics evaluated were impact of the scenario on promoting collegial relationships and increasing their knowledge of other team member's roles. All data demonstrated the effectiveness of simulation in providing education and training related to opioid induced respiratory depression in pediatric patients.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e218"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in the Gut Microbiome between Patients with Chronic Low Back Pain and Healthy Controls","authors":"Anitha Saravanan PhD, RN, APRN-BC","doi":"10.1016/j.pmn.2025.01.074","DOIUrl":"10.1016/j.pmn.2025.01.074","url":null,"abstract":"<div><h3>Purpose</h3><div>Chronic low back pain (CLBP) is a major cause of disability, lost wages, and health care costs. Gut dysbiosis has been identified as one of the factors that could affect pain. While most studies have been conducted in abdominal pain and fibromyalgia, there are very limited studies with a focus on the gut microbiome diversity and composition in patients with CLBP. Hence, the purpose of this study was to examine the differences in diversity and abundance of the gut microbiome between patients with CLBP and psycho-behavioral symptoms compared to controls.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, men and women (N=30) with CLBP and healthy controls (N=30) were enrolled. Participants completed demographics and psycho-behavioral symptoms (depressive mood, sleep quality, sleep disturbances, physical function, pain interference, and pain severity) assessed using PROMIS measures. Rectal swabs were collected for the gut microbiome, which was processed by 16S rRNA sequencing. Descriptive statistics and standardized pipelines were conducted to answer the research question.</div></div><div><h3>Results</h3><div>The Permutational multivariate analysis of variance revealed significant difference in relative abundance of the gut microbiome between CLBP and control groups (p=0.03). Compared to controls, patients in CLBP group belonged to older age, female gender, higher BMI, and reported poor physical function, sleep disturbances, sleep problems and sleep quality. Chi-Square tests yielded significant associations between greater pain interference and depressive mood (p = 0.004), sleep disturbance (p = 0.01), opioid use (p = 0.001), smoking (p = 0.014), and BMI (p = 0.02).</div></div><div><h3>Conclusions</h3><div>The findings suggest that there are differences in relative abundance and diversity among patients with CLBP compared to controls. Assessing the extent of underlying inflammation and effects of lifestyle changes can further help identify the specific gut microbiome characteristics that might be beneficial to decrease pain and associated symptoms. Dietary interventions to promote healthy gut microbiome as part of a comprehensive pain management program may benefit patients with chronic low back pain. Early interventions which identify prevention and promotion strategies such as lifestyle modifications can also help reduce symptom burden and improve quality of life in those with CLBP.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Pages e232-e233"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's in Your Toolbox? Managing Acute Pain in the Adult Hospitalized Patient","authors":"Michelle Lavelle-Henry APRN, ACHPN CNP, PMGT-BC, ACHPN ,&nbsp;Scott Faust Ed.D, MS, APRN, CNP, ACNP-BC, ACNP-C, ACHPN, CEN, CNMAP, PHN","doi":"10.1016/j.pmn.2025.01.088","DOIUrl":"10.1016/j.pmn.2025.01.088","url":null,"abstract":"<div><div>Purpose, problem statement, PICO: The half-day pain management boot camp aims to equip nurses with evidence-based strategies for effective pain management. Targeting acute and chronic pain scenarios, this program addresses the need for enhanced nursing competencies in pain assessment and intervention.</div><div>Method of Evaluation/Validation of Evidence: The boot camp curriculum is developed based on the appraisal of high-quality evidence sources, including randomized controlled trials and meta-analyses. Evaluation methods include pre- and post-assessments, competency checklists, and participant feedback surveys to validate the effectiveness of the training in enhancing nurses' pain management skills.</div><div>Summary/Synthesis of Evidence: Drawing from systematic reviews, clinical guidelines, and expert consensus, the boot camp synthesizes evidence on pharmacological and non-pharmacological interventions for pain management. Emphasis is placed on multimodal approaches, patient-centered care, and tailored interventions for diverse patient populations.</div><div>Results/Relevance to Pain Management: Participants gain proficiency in pain assessment techniques, medication administration, and non-pharmacological interventions. They learn to implement individualized pain management plans, promote patient autonomy, and collaborate effectively within interdisciplinary teams. The boot camp's relevance lies in empowering nurses to deliver high-quality, patient-centered pain care across diverse healthcare settings.</div><div>Future Implications for Nursing Profession: The boot camp serves as a model for ongoing professional development in pain management nursing. It underscores the importance of continuous education to address evolving pain management challenges and advance nursing practice. Future iterations may incorporate advanced topics, simulation-based learning, and interprofessional collaboration to further enhance pain management outcomes.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e237"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Virtual Reality in the Management of Postoperative Pain Undergoing Cystoscopy: Systematic Review","authors":"Gamze Bozkul PhD, RN ,&nbsp;Hande Nur Arslan PhD Candidate, RN ,&nbsp;Mehmet Avcul PhD Student, RN ,&nbsp;Sevilay Şenol Çelik PhD, RN","doi":"10.1016/j.pmn.2025.01.036","DOIUrl":"10.1016/j.pmn.2025.01.036","url":null,"abstract":"<div><h3>Background</h3><div>Cystoscopy is one of the most commonly used diagnostic and therapeutic procedures due to its high efficacy and low risk of complications. This procedure causes pain in patients. Determining the effectiveness of virtual reality one of the methods used in postoperative pain management, in these patients will play a key role in improving the quality of care for them.</div></div><div><h3>Aim</h3><div>This study aimed to determine the effectiveness of virtual reality used in the management of postoperative pain in patients undergoing cystoscopy.</div></div><div><h3>Methods and Design</h3><div>This study used systemic review design. Articles from PUBMED, Web of Science, Science-Direct, DergiPark, Council of Higher Education-Thesis Center, Google Scholar and TRDizin databases were included. Eligibility criteria were that articles had to be in English-Turkish, published by June 2024, and include articles on virtual reality for postoperative pain management in patients undergoing cystoscopy. The RoB2 tool developed by Cochrane was used for the risk of bias.</div></div><div><h3>Results</h3><div>Two thousand four hundred and twenty-four articles were searched from databases, 386 of these articles were excluded due to patients without cystoscopy, 246 were not randomized controlled trials, experimental and semi-experimental study, 1489 were not related to virtual reality, and 299 were duplicates. As a result of the study, four randomized controlled studies met our study criteria. In two of these studies, virtual reality goggles were found to be effective on pain, while in two studies there was no significant difference with the control group.</div></div><div><h3>Conclusion</h3><div>The half of the studies in this systematic review has shown that virtual reality in postoperative pain management for patients undergoing cystoscopy was effective. These results will be a guide for nurses on non-pharmacologic nursing practices in pain management for this patient group.</div></div><div><h3>Implications for future research</h3><div>The results of this study revealed that it is need to more studies on the effectiveness of virtual reality in postoperative pain management for patients undergoing cystoscopy.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e221"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telecollaborative Pain Care For Rural Veterans: The Role Of Nurse Care Managers Within Interdisciplinary Teams","authors":"Adele E. Moore MS, BSN, BS, BA, RN, NC-BC,&nbsp;Benjamin J Morasco PhD,&nbsp;Lillian Nickerson-Houston RN, BSN,&nbsp;Natassja Pal BS,&nbsp;Patricia Maloy RN,&nbsp;Rachel Childs MS, MA, MSSA, RN, APRN, PMHNP,&nbsp;Susan Holmes-Walker PhD, RN,&nbsp;Tara Nichols DNP, ARNP, AGCNS, CCNS, PMGT-BC","doi":"10.1016/j.pmn.2025.01.068","DOIUrl":"10.1016/j.pmn.2025.01.068","url":null,"abstract":"<div><h3>Background</h3><div>Non-pharmacologic interventions are a first-line treatment for chronic pain. Yet, availability of these treatments may be reduced for those living in rural areas. Compounding poor access to services, patients in rural areas may also need to navigate multiple systems of care.</div></div><div><h3>Purpose</h3><div>The Tele-Collaborative Outreach to Rural Patients with Chronic Pain (CORPs) trial is a four-year multi-site pragmatic effectiveness randomized controlled trial being conducted in VA healthcare settings. The purpose of the study is to examine the effectiveness of a remotely delivered collaborative care intervention for improving pain interference among Veterans with high impact chronic pain living in rural areas. The uniqueness of this study is the nurse-led collaborative care intervention.</div></div><div><h3>Design</h3><div>Participants (n=608) will be randomized to either the CORPs intervention or to minimally enhanced usual care (MEUC). Participants randomized to the intervention will complete a biopsychosocial intake appointment, five follow-up visits with a Nurse Care Manager (NCM) receiving personalized care recommendations, and education in both one-on-one and a 6-session group education class. Consistent with collaborative care models, the NCM will be supported by a consulting clinician. Participants randomized to the comparator will receive a brief one-time education session with the NCM to review available pain services. All participants will complete quarterly research assessments for one year. The primary study outcome is pain interference.</div></div><div><h3>Results</h3><div>The design of the CORPs intervention and MEUC comparator was informed by semi-structured interviews with patient engagement groups comprising Veterans enrolled in VA care (n=35), VA clinicians and administrators (n=24), and non-VA clinicians and administrators (n=7). The activities constructed as part of the nurse-led collaborative care team reflect the defining elements of the intervention: patient education and care coordination and navigation. This presentation will provide a detailed explanation of the NCM role and the tele-collaborative care model, including how it can be tailored to systems of care outside of the VA.</div></div><div><h3>Conclusion</h3><div>This pragmatic trial will test the real-world effectiveness of a remotely delivered nurse-led collaborative care intervention for chronic pain. The trial findings can provide guidance on nursing activities that facilitate integrative care and use of non-pharmacologic treatments for chronic pain.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e230"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TENS Use for People with Opioid Use Disorder for Reduction of Craving, Withdrawal, Pain: A Pilot Study","authors":"Barbara St. Marie PhD, AGPCNP, FAANP, FAAN ,&nbsp;Carol Vance PhD, PT ,&nbsp;Jamie Morton PhD, RN ,&nbsp;Jihye Lee PhD, RN ,&nbsp;Maria Hein MSW ,&nbsp;Shaoshuai Chen MS, BSN, RN ,&nbsp;Yelena Perkhounkova PhD","doi":"10.1016/j.pmn.2025.01.018","DOIUrl":"10.1016/j.pmn.2025.01.018","url":null,"abstract":"<div><h3>Problem</h3><div>Of the two million people in the US with opioid use disorder (OUD), one-third are treated with pharmacological intervention. Buprenorphine is a frequently used treatment that saves lives. However, even with optimal buprenorphine administration, half of the patients have unsuccessful outcomes, measured by withdrawal and craving, treatment retention, and taper results. Grounded in neural mechanisms of animal pain/addiction, delta opioid-receptor activity mediates addictive behaviors (drug-seeking, emotional responses, impulsivity, and loss of control over drug intake). TENS reduces pain in humans via descending inhibitory pathways releasing serotonin, endogenous opioids, and Gamma-aminobutyric acid (GABA).</div></div><div><h3>Study aims</h3><div>Establish feasibility and preliminary efficacy of TENS on opioid withdrawal, opioid craving, pain intensity, and pain interference for 6-week duration.</div></div><div><h3>Method/Design</h3><div>Participants receiving buprenorphine for OUD treatment at midwestern facilities were recruited and instructed in TENS (100Hz, 100us) use for 6 weeks. Data collected: pain severity/pain interference, withdrawal, craving, usability, and acceptability on day 0; weeks 1,2,4, and 6. Interviews were completed. Descriptive statistics were calculated, p&lt;.05 established for Wilcoxon signed rank test to detect variable changes between day 0 and week 6.</div></div><div><h3>Results</h3><div>N=19, 12 female; 14 White, 4 Black/African American, 2 Hispanic or Latino. Means (SD): age 49 years (15.4), OUD duration before treatment 9.9 years (9.6), time on buprenorphine 2 years (3.2). Preliminary results show craving reduced from mean (SD):4.4 (2.8) to 2.3 (2.8) (p=.022). Withdrawal reduced from mean (SD): 8.3 (5.3) to 4.0 (4.2) (p&lt;.001). Pain severity and pain interference were reduced. Interviews revealed: 1) symptom changes from TENS use, 2) TENS is useable and acceptable for treating OUD, and 3) strategies were recommended based on the 6-week use.</div></div><div><h3>Conclusions</h3><div>These exciting results show TENS as a promising adjunctive treatment for people receiving buprenorphine for OUD to reduce craving, withdrawal, and pain.</div></div><div><h3>Implications for future research</h3><div>Nurses can be educated on the implementation of TENS for their patients. Future research is required using randomized clinical trials to determine the effect of TENS on craving, withdrawal, and pain in people with OUD treated with buprenorphine.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e215"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On-Demand Use of Ketamine for Adult Inpatients in Critical Care and Medical-Surgical Settings","authors":"Kathy Baule DNP, RN, APN-ACNS-BC, CCRN, CNRN, RNFA","doi":"10.1016/j.pmn.2025.01.019","DOIUrl":"10.1016/j.pmn.2025.01.019","url":null,"abstract":"<div><div>Ketamine, a versatile anesthetic and analgesic agent, is gaining recognition for its efficacy in managing pain and agitation among adult inpatients in critical care and medical-surgical settings. This presentation explores the known effectiveness of ketamine and addresses the critical need for enhanced provider training to optimize its safe and effective use. Ketamine's unique pharmacological profile offers distinct advantages in acute care settings. As a potent N-methyl-D-aspartate (NMDA) receptor antagonist, it provides rapid analgesic effects while preserving cardiovascular stability, making it particularly suitable for patients at risk of hemodynamic instability. Moreover, its dissociative properties offer effective sedation without compromising airway reflexes, which is crucial in managing mechanically ventilated patients or those requiring procedural sedation.</div><div>Recent studies and clinical experiences underscore ketamine's potential role in managing acute pain and procedural sedation highlighting its utility across diverse patient populations. However, despite its promising benefits, the widespread adoption of ketamine in clinical practice is hindered by the perceived complexity in prescribing it among many healthcare providers. Clinicians express a lack of confidence in prescribing ketamine due to insufficient training. This presentation emphasizes the urgent need for structured education and training programs tailored to healthcare providers to enhance their comfort and competence in utilizing ketamine effectively. By addressing knowledge gaps and promoting evidence-based protocols, healthcare systems can facilitate safe and judicious ketamine use, thereby improving patient outcomes and satisfaction. In conclusion, while ketamine offers substantial promise in critical care and medical-surgical environments, its optimal utilization hinges on comprehensive provider training and education. This presentation supports a paradigm shift towards effective training initiatives to empower healthcare providers in harnessing ketamine's therapeutic potential while ensuring patient safety and care quality.</div></div>","PeriodicalId":19959,"journal":{"name":"Pain Management Nursing","volume":"26 2","pages":"Page e215"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}