American Society for Pain Management Nursing position statement: pain management at the end of life.

Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population.

Procedural pain management: a position statement with clinical practice recommendations.

The American Society for Pain Management Nursing (ASPMN) has developed a position statement and clinical practice recommendations related to procedural preparation and comfort management. Procedures potentially produce pain and anxiety, both of which should be assessed and addressed before the procedure begins. This position statement refers to "comfort management" as incorporating the management of pain, anxiety, and any other discomforts that may occur with procedures. It is the position of ASPMN that nurses and other health care professionals advocate and intervene based on the needs of the patient, setting, and situation, to provide optimal comfort management before, during, and after procedures. Furthermore, ASPMN does not condone procedures being performed without the implementation of planned comfort assessment and management. In addition to outlining this position with supporting evidence, this paper reviews the ethical considerations regarding procedural comfort management and provides recommendations for nonpharmacologic and pharmacologic management during all phases of the procedure. An appendix provides a summary of this position statement and clinical practice recommendations.

Putting evidence into practice: what are the pharmacologic interventions for nociceptive and neuropathic cancer pain in adults?.

Cancer pain continues to be undertreated in adults despite the substantial amount of research on pain management. The Oncology Nursing Society coordinated a team for the Putting Evidence Into Practice (PEP) project to develop (and update) a PEP resource summarizing the current evidence for the pharmacologic management of adults with nociceptive and neuropathic cancer pain. The aim of this article is to describe the development process and outcomes of the project. The review established that long-acting opioids in conjunction with immediate-release opioids are recommended for practice; radionuclides and radioisotopes as useful adjuncts for metastatic bone pain are likely to be effective; the effectiveness of tetrodotoxin, a neurotoxin, is not yet established; and spinal opioids, caffeine, or sympatholytic agents have beneficial and harmful effects and should be considered on an individual basis. Pain is a nursing-sensitive patient outcome; that is, pain can be directly affected by nursing interventions. Knowing the current evidence for pharmacologic management of cancer pain is critical to improve patient outcomes.

Unequal quality of cancer pain management: disparity in perceived control and proposed solutions.

PURPOSE/OBJECTIVES: To examine poverty-related and racial and ethnic disparity in cancer pain management. DATA SOURCES: Published articles, conference proceedings, testimony, and clinical case studies. DATA SYNTHESIS: Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care. CONCLUSIONS: Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes. IMPLICATIONS FOR NURSING: Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.