Assessment of Pain and Associated Comorbidities: A Survey of Real Life Experiences Among Nurses in Italy.

PURPOSE: Pain is a symptom that should be evaluated along with its comorbidities in order to plan an effective holistic treatment strategy involving specific pharmacological interventions, side effect management, psychological support, control of therapeutic effects over time, and dialogue with the patient and their relatives. In this holistic process of caring for patients with pain, nurses play a central role as they deal with suffering patients directly and continuously. The purpose of this study was to evaluate the types of pain identified by nurses in their daily clinical practice and the associated comorbidities (anamnestic history taking) by geographical region and to evaluate the pharmacological strategies used. METHODS: A cross-sectional survey was performed among 696 registered nurses in Italy. Data were collected using an online questionnaire. RESULTS: There was a significant difference between geographical regions in terms of reports of acute and chronic pain: acute pain was more frequently reported in the South (63.5%), while chronic pain was more frequent in the Central region (32.3%; p=0.0008). Additionally, chronic oncological pain was more frequent in the Northeast (29.6%), while chronic non-oncological pain was more frequently reported in the Central region (33.9%; p=0.0001). The underlying pain disorders reported were also different between geographical regions; rheumatic pain (21.8%) and neurological pain (18.6%) were more frequent in the Central region, while musculoskeletal pain was significantly more frequent in the South (43.4%; p=0.004). Anxiety, sleep disorders and somatization were found in acute pain (60.82%, 43.56% and 53.12%), while depression and mood disorders were more frequently detected in chronic pain condition (p<0.001). CONCLUSION: Our study showed differences among Italian regions in pain assessment. Specific education on pain management nursing is essential for nurses. Promotion of optimal nursing care for people affected by pain is the main focus of pain management nursing. Nowadays, nurses should focus on personalized complex care and research in order to improve the patient's quality of life.

Correction to: What to Do and What Not to Do in the Management of Opioid-Induced Constipation: A Choosing Wisely Report.

The original article can be found online.

What to Do and What Not to Do in the Management of Opioid-Induced Constipation: A Choosing Wisely Report.

INTRODUCTION: Despite the essential utility of opioids for the clinical management of pain, opioid-induced constipation (OIC) remains an important obstacle in clinical practice. In patients, OIC hinders treatment compliance and has negative effects on quality of life. From a clinician perspective, the diagnosis and management of OIC are hampered by the absence of a clear, universal diagnostic definition across disciplines and a lack of standardization in OIC treatment and assessment. METHODS: A multidisciplinary panel of physician experts who treat OIC was assembled to identify a list of ten corrective actions-five "things to do" and five "things not to do"-for the diagnosis and management of OIC, utilizing the Choosing Wisely methodology. RESULTS: The final list of corrective actions to improve the diagnosis and clinical management of OIC emphasized a need for: (i) better physician and patient education regarding OIC; (ii) systematic use of diagnostically validated approaches to OIC diagnosis and assessment (i.e., Rome IV criteria and Bristol Stool Scale, respectively) across various medical contexts; and (iii) awareness about appropriate, evidence-based treatments for OIC including available peripheral mu-opioid receptor antagonists (PAMORAs). CONCLUSIONS: Physicians who prescribe long-term opioids should be forthcoming with patients about the possibility of OIC and be adequately versed in the most recent guideline recommendations for its management.

Dexmedetomidine Sedation in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: A Case Series of 3 Patients.

Magnetic resonance-guided focused ultrasound thalamotomy is an innovative minimally invasive treatment for medication-resistant tremor in patients with essential tremor and Parkinson disease. Sedation with common hypnotic agents is discouraged because the patient's cooperation is required during the procedure, and these drugs interact with the patient's tremor, interfering with the results of intraprocedural neurological evaluations. Dexmedetomidine may be the best choice for sedation during magnetic resonance-guided focused ultrasound thalamotomy, which can be prolonged and poorly tolerated by the awake patient. We report the first use of dexmedetomidine for sedation in magnetic resonance-guided focused ultrasound thalamotomy in 3 patients: none of them experienced relevant hemodynamic changes or apnea.

Ultrasound-guided Dry Needling Treatment of Myofascial Trigger Points for Piriformis Syndrome Management: A Case Series.

OBJECTIVE: The purpose of this case series was to describe the outcomes of diagnostic ultrasound-assisted dry needling in the management of piriformis syndrome. CLINICAL FEATURES: Case 1: a 45-year-old woman reported gluteal pain occasionally radiating in the sciatic region. Her magnetic resonance imaging showing sciatic nerve edema in the underlying portion of the piriformis muscle. Case 2: a 55-year-old man had gluteal pain after deep palpation or being in a prolonged sitting position. A previous magnetic resonance imaging showed a disk herniation at L2-L3. Case 3: a 65-year-old woman reported pain in the sciatic area when she was walking and at nighttime rest. All patients had been treated with oral drugs, with poor results. INTERVENTIONS AND OUTCOME: Patients had the same quality and duration of symptoms. The treatments of piriformis muscle and gluteus minimus, medius, and maximus muscles were performed using a convex probe and a 0.30 × 60 mm needle, which was inserted out of plane, maintaining a constant view of its tip. All patients were treated over 10 days and followed up for 6 months. Their symptoms resolved during this time and no adverse reactions were reported. CONCLUSION: For these 3 patients with piriformis syndrome who were treated with ultrasound-guided dry-needling treatment, their symptoms resolved and their quality of life improved.