Factors influencing use of analgesics among construction workers in the Ga-Eastmunicipality of the Greater Accra region, Ghana.

BACKGROUND: Analgesics also known as painkillers are widely used for pain relief. There are severe health implications associated with excessive use of analgesics. This paper examines factors influencing the use of analgesics among construction workers in the Ga-East Municipality (GEM) of the Greater Accra region of Ghana. METHODS: This is a cross-sectional study involving 206 construction workers randomly sampled from 7 construction sites in the GEM. A structured questionnaire was used to elicit responses on knowledge of analgesics, types of analgesics used and factors influencing the use of analgesics. Chi-square test analysis was used to examine factors influencing analgesic use. RESULTS: The majority of workers were aged between 15 to 44 years (89.8%) and 51.9 percent of respondents had completed Junior high school. Many respondents (68.0%) used Brand 1 a locally manufactured analgesic with paracetamol, aspirin and caffeine as the active ingredients and 31.6 percent of respondents had no knowledge of possible side effects of continuous use of analgesics. Chi square analysis showed that age was significantly associated with use of analgesics (p<0.01). Knowledge of the types of analgesics, dosage and side effects did not influence use (p>0.05). Television and radio advertisements influenced use of analgesics (p<0.01). CONCLUSION: Knowledge on analgesic use and knowledge of probable serious side effects was inadequate. Pharmacists and chemists involvement in education of clients of the side effects of analgesics is highly recommended to minimise misuse. The Food and Drugs Authority should regulate the proliferation of advertisements for analgesics in the media. FUNDING: None declared.

Time since diagnosis, treatment pathways and current pain status: a retrospective assessment in a back pain population.

OBJECTIVES: The purpose of this study is to report on long-term treatment patterns in a back pain population and to consider whether these may be considered as reflective of under-treatment of pain or poor pain control. METHODS: Data are from a commissioned recontact SELECT survey of persons who had previously reported experiencing pain in the 2010 National Health and Wellness Survey. The analysis covers five countries: the UK, France, Spain, Germany and Italy. It is restricted to patients who reported moderate or severe pain in the last 3 months and who were judged to be experiencing back pain from the pain conditions reported. A total of 1018 subjects met the back pain criteria. Of these, 738 had their back pain initially diagnosed by a physician. It is this latter group that is the focus for the analysis. Subjects were further allocated to categories to assess potential pain chronicity and the intensity and self-limiting aspects of pain experience. RESULTS: Irrespective of the pain classification used, 56.10% of subjects in this back pain population report their first physician diagnosis of pain as occurring at least 6 years ago. At the same time 36.81% report experiencing severe pain in the last 3 months and 63.69% moderate pain. Overall, 53.11% of respondents are assessed as experiencing probable chronic pain and 24.12% as possible chronic pain. Among those experiencing probable chronic pain, 61.48% were diagnosed with back pain more than 6 years ago. In addition, 43.22% of respondents found the impact of pain on daily activities to be severely limiting and 22.63% found it to be moderately limiting. The majority of subjects, whether they were diagnosed and treated initially by primary care or another physician specialty, apparently experience no change in their treatment regimen. The absence of treatment change is 69.03% in the case of those experiencing severe pain and 84.89% in the case of those with moderate pain (p < 0.05). LIMITATIONS: The NHWS is an internet survey, as a self-report there is no separate validation of pain experience reported; as subjects are asked to recall pain and treatment experience there is the possibility of recall error and bias. CONCLUSIONS: Two features of this analysis stand out: (i) time since first diagnosis of pain for those currently experiencing severe or moderate back pain and (ii) the 'inertia' that appears to characterize long-term treatment decisions. Irrespective of current pain status, 70% or more of those experiencing current severe or moderate pain report no change from their initial treating physician or no change in prescription once referred to a pain specialist. This occurs over an extended time frame. Whether this should be interpreted as a failure in pain management is a moot point. The fact remains, however, that despite time since first diagnosis subjects not only currently experience severe or moderate pain but a substantial proportion may be expected to continue.

Headache: insight, understanding, treatment and patient management.

Tension-type headache and migraine are the most frequent primary headaches. Diagnosis is based on the patient's history and a normal neurological examination. Most patients with these two headache entities treat headache episodes with over-the-counter analgesics or non-steroidal anti-inflammatory drugs (NSAIDs). There is good scientific evidence from randomised, placebo-controlled trials indicating that aspirin, ibuprofen, ketoprofen, diclofenac and naproxen are effective in tension-type and migraine headache. Paracetamol seems to be less effective. In patients with migraine who do not respond to analgesics or NSAIDs, triptans should be prescribed. Frequent primary headaches should not be treated with frequent intake of analgesics or triptans. In these cases, preventive therapy needs to be implemented.

Chronic pain: clinical features, assessment and treatment.

A significant number of people in the UK experience chronic pain, resulting in high levels of suffering and reduced quality of life. Management of chronic pain is complex, time consuming and not always successful. Good communication between patients and healthcare professionals is essential to ensure realistic treatment plans and outcomes can be negotiated. Accurate assessment is also key, and nurses play a fundamental role in ensuring patients with chronic pain receive the most appropriate care.

Repackaged pharmaceuticals in the California workers' compensation system: from distribution and pricing options to physician and retail dispensing.

OBJECTIVE: The California Workers' Compensation (WC) pharmaceutical pricing system cannot price 60% of National Drug Codes (NDCs) (mostly repackaged pharmaceuticals). This study will estimate the lost savings due to repackaged pharmaceuticals and potential cost savings associated with alternative pharmacy fee schedules for repackaged pharmaceuticals. In addition, we will determine what characteristics explain repackaged costs to identify reasons for repackaged pharmaceutical use. METHODS: All pain-related repackaged pharmaceuticals were identified by NDC using claims data from the California Workers' Compensation Institute (CWCI) database during 2002. RESULTS: Repackaged pharmaceuticals represented 55% of all NDCs and 92% of all Medi-Cal non-equivalent NDCs, but only 22% ($8,494,297/$38,968,233) of total pharmacy costs. Total repackaged pharmaceutical costs could be reduced by 36% ($3,059,177) using an alternative formula based on Medi-Cal. Compared with Medi-Cal priced manufacturer-packaged pharmaceuticals, repackaged pharmaceuticals are approximately 85% more expensive on a cost-per-pill basis. CONCLUSION: We propose limiting the generous pricing of repackaged pharmaceuticals. However, Medi-Cal payment rates may be extreme, and more moderate repricing might compensate physician-dispensing time more fairly and preserve patient access.

The impact of reference pricing of nonsteroidal anti-inflammatory agents on the use and costs of analgesic drugs.

OBJECTIVE: To estimate the effect of reference pricing (RP) of nonsteroidal anti-inflammatory drugs (NSAIDs) on drug subsidy program and beneficiary expenditures on analgesic drugs. DATA SOURCES/STUDY SETTING: Monthly claims data from Pharmacare, the public drug subsidy program for seniors in British Columbia, Canada, over the period of February 1993 to June 2001. STUDY DESIGN: RP limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest cost interchangeable drug; any cost above that is borne by the patient. Pharmacare introduced two different forms of RP to the NSAIDs, Type 1 in April 1994 and Type 2 in November 1995. Under Type 1 RP, generic and brand versions of the same NSAID are considered interchangeable, whereas under Type 2 RP different NSAIDs are considered interchangeable. We extrapolated average reimbursement per day of NSAID therapy over the months before RP to estimate what expenditures would have been without the policies. These counterfactual predictions were compared with actual values to estimate the impact of the policies; the estimated impacts on reimbursement rates were multiplied by the postpolicy volume of NSAIDS dispensed, which appeared unaffected by the policies, to estimate expenditure changes. PRINCIPAL FINDINGS: After Type 2 RP, program expenditures declined by $22.7 million (CAN), or $4 million (CAN), annually cutting expenditure by about half. Most savings accrued from the substitution of low-cost NSAIDs for more costly alternatives. About 20 percent of savings represented expenditures by seniors who elected to pay for partially reimbursed drugs. Type 1 RP produced one-quarter the savings of type 2 RP. CONCLUSIONS: Type 2 RP of NSAIDs achieved its goal of reducing drug expenditures and was more effective than Type 1 RP. The effects of RP on patient health and associated health care costs remain to be investigated.

Learning pain assessment and management: a goal of the End-of-Life Nursing Education Consortium.

BACKGROUND: Relief of pain for patients requires that palliative care practitioners have knowledge and skill in both pain assessment and the use of pharmacologic and complementary therapies. METHOD: Pain assessment and management and the teaching strategies suggested within the End-of-Life Nursing Education Consortium curriculum are presented. RESULTS: By addressing the pain experienced by patients with life-limiting illnesses and those at the end of life, the quality of care can be greatly improved. As a multidimensional phenomenon that relates to physical, emotional, and spiritual well-being, the relief of pain enhances the quality of life of patients and lessens the stress experienced by family caregivers. CONCLUSION: The relief of pain and suffering is consistent with the philosophy and goals of nursing as a profession and is a nursing responsibility.

The assessment and treatment of patients with chronic pain.

Chronic pain is an illness in its own right, with its own signs, symptoms, and complications. It has biological, psychosocial, physical, and emotional dimensions and due to its complexity it is often poorly understood. In many cases treatment cannot rely purely on the medical model of analgesic drugs but must encompass the management of all the other factors resulting from the pain. This article discusses the assessment of chronic pain, and the range of treatment methods available.

Chronic non-cancer pain in older people: current evidence for prescribing.

Chronic pain is a serious problem for many older people, yet its management in this population is often less than satisfactory. The high incidence of toxicity and side effects with some medications and irrational fears of opioid dependence are significant barriers to effective pain management. In this article, the research evidence relating to these issues is examined, and their impact on nurse prescribing considered. More studies are needed to assess the veracity of opposing arguments, and to support effective assessment and prescribing by nurses.

Assessment and management of chronic pain in elderly people.

The ageing process can bring with it an increased incidence of conditions which give rise to chronic pain. Persistent musculoskeletal and/or neuropathic pain due to conditions such as back pain, arthritis, osteoporosis and diabetes in elderly people can lead to a marked deterioration in their quality of life. Pain assessment can be complicated by concomitant disorientation, confusion and communication deficits, leading to the undertreatment of pain in this client group. Pain management can be difficult due to the existence of multiple medical problems and the increased incidence of side-effects related to the treatment. This article aims to update nurses on the assessment and management of pain in the older adult, and will provide a broad overview of pain management strategies suitable for elderly patients.

[Chronic pain during dialysis. Pharmacologic therapy and its costs]. / Il dolore cronico in dialisi. Terapia farmacologica e i suoi costi.

BACKGROUND: There is very little research into the problem of chronic pain in dialysed patients, despite the fact that pain is a widely diffused phenomena amongst these patients. This work proposes to evaluate the intensity of pain, supply a scale of levels of intervention, with an indication of the consumption and relative costs of pharmacological therapies. METHODS: 37 out of 100 patients undergoing haemodialysis suffer chronic pain. Aetiological research has shown that osteoarticular pain (24 cases), is the most common, peripheral vascular pain (3 cases), is subjectively and indirectly considered to be the most serious form. Nine cases have presented pain of a neuromuscular origin, whilst one case of a neoplastic origin. The degree of personal invalidism shows serious invalidism in 11 cases. RESULTS: The therapeutic file that forsaw four levels of pharmacological intervention (1st levels: FANS, 2nd level: Codeine+paracetamol, 3rd level: Buprenorphine, 4th level: Morphine for os), accompanied by instrumental and pharmacological support intervention, has proved to be indispensable in confronting the problem. Through pharmacy data, we have noticed a progressive increase over the year in the use of analgesic medicines, of which we can confirm the effectiveness, tolerability, low level of side-effects, at low costs. CONCLUSIONS: In our opinion chronic pain in dialysed patients should not be neglected. The perfection of diagnostic techniques, the discovery of pain-killers with reduced side-effects, the multidisciplinary approach, and reduced costs of treatment, are all valid arguments in favour of an intervention that improves the quality of life of these patients, already so compromised by the nature of the illness itself.

[Assessment of chronic pain in elderly patients]. / Assessment chronischer Schmerzen bei älteren Menschen.

Pain is extremely common among older people but often inadequately treated. Chronic pain and its management have major implications for quality of life and quality of care, especially for terminal ill patients and residents of long-term-care facilities. Many physicians lack information about pain assessment and may have an inaccurate knowledge base about pharmacological agents and non-pharmacological approaches used in pain control. Although fundamental data on the pathophysiology and management of chronic pain is still lacking there is some information to provide a framework for rational nosology and therapeutic strategy. Some guidelines may help to improve pain assessment and management in elderly people and may help to enhance physicians' awareness about that problem.

Effect of insurance status on pain medication prescriptions in a hematology/oncology practice.

To determine whether insurance status (payer class) affects the amount and type of pain medication prescribed, and whether patients in those groups without prescription drug coverage received lower-cost medications, a case-control study with retrospective chart review was initiated in a university-based hematology/oncology practice in northwest Louisiana. Charts of 710 active patients among all insurance groups (private insurance, Medicare, Medicaid, State Hospital System) were analyzed to determine insurance status, pain medication (amount and type), and diagnosis. The proportion of Medicaid patients receiving pain medications was significantly increased in relation to their representation in the practice when compared with Medicare patients, patients with private insurance, uninsured patients whose health care costs were provided by the State Hospital System, and the overall patient population. Medicaid patients, especially those with solid tumor malignancies, received the most expensive class of pain medications at a significantly higher rate than other patients. In the studied population of hematology and oncology patients, there is a significant difference in the amount and type of pain medications prescribed between patients with prescription drug coverage (Medicaid) and those without (all other groups including those covered by the statewide system). We propose that consideration be given to alternative methods of financing prescription medications for medically indigent patients.