The Application of Radiofrequency Ablation in Acute and Chronic Pain Management.

Radiofrequency ablation (RFA), also known as rhizotomy, is one of the frequently used modalities in interventional pain management. This nonsurgical procedure delivers radiofrequency waves to the targeted nerves to interrupt transmission of nociceptive signals from the peripheral tissues to the central nervous system, thereby reducing pain perception. Recent studies have demonstrated the efficacy of RFA treatment as an effective interventional pain management technique to treat a variety of acute and chronic pain conditions including facial pain, headaches, postmastectomy, musculoskeletal, and major joint pain (knee, hip, shoulder, sacroiliac), and cancer pain. As more certified registered nurse anesthetists are involved in pain management, it is important to be familiar with current nonsurgical pain interventions. This journal course describes the unique mechanism of action of radiofrequency for pain modulation and provides emerging evidence to support its applications in both acute and chronic pain management.

The Effect of a Nurse Initiated Therapeutic Conversation Compared to Standard Care for Patients With Acute Pain in the ED: A Randomized Controlled Trial.

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.

Paciente con úlceras vasculares infectadas. Un abordaje desde la teoría de Dorothea Orem / A patient with infected vascular ulcers: An approach based on Dorothea Orem's Theory

La úlcera vascular es muy dolorosa por lo que suele ir acompañada por dificultad en la movilidad y disminución de la calidad de vida. Por ello es fundamental una correcta curación de las úlceras junto con un adecuado manejo del dolor y llevar a cabo prevención de caídas. Se expone el caso de un varón de 71 años que presenta cuatro úlceras vasculares infectadas en miembros inferiores. Para el abordaje del caso clínico se ha realizado la valoración enfermera según la teoría del déficit de autocuidado de Dorothea Orem, se han utilizado las taxonomías de lenguaje enfermero NANDA, NIC y NOC, y se ha aplicado el modelo AREA de Pesut. Se identificaron los diagnósticos enfermeros de Intolerancia a la actividad y Riesgo de caídas; y como problemas de colaboración las úlceras vasculares, la infección de las úlceras vasculares y el dolor agudo. Los resultados (NOC) planteados fueron: "Curación de la herida: por segunda intención", "Tolerancia a la actividad" y "Movilidad". Las intervenciones (NIC) desarrolladas fueron: "Cuidados de las heridas", "Terapia de ejercicios (ambulación), "Manejo ambiental (seguridad)", "Administración de medicación (antibióticos): intravenosa" y "Manejo del dolor: agudo". Tras una semana de aplicación del plan de cuidados se consiguió la regresión completa de la infección de las úlceras y una buena evolución de las lesiones cutáneas

Vascular ulcers are very painful, and they usually entail mobility difficulties and a reduction in quality of life. Therefore, the correct cure of ulcers, together with an adequate pain management, and conducting the prevention of falls are essential. The case of a 71-year-old male is presented, with four infected vascular ulcers in lower limbs. For this clinical case approach, a nursing assessment has been conducted according to Dorothea Orem's Self-Care Deficit Nursing Theory, using the NANDA, NIC and NOC taxonomy, and applying the Pesut's AREA model. The Activity Intolerance and Risk of Falls nursing diagnoses were identified; and as collaboration problems: vascular ulcers, vascular ulcer infection, and acute pain. The (NOC) outcomes raised were: "Wound Healing: Secondary Intention", "Activity Tolerance" and "Mobility". The (NIC) interventions conducted were: "Wound Care", "Exercise Therapy (Ambulation)", "Environmental Management (safety); "Medication Administration (antibiotics): Intravenous", and "Acute Pain Management". After one week of implementing the care plan, complete regression of ulcer infections was achieved, as well as good evolution of skin lesions

Riscos potenciais no processo de preparo e administração de medicamentos por via intravenosa: revisão literária de ações integradas para alívio da dor e educação em saúde / Potential risks in the preparation and administration of intravenous drugs: a literary review of integrated actions for pain relief and health education / Riesgos potenciales en el proceso de preparación y administración de medicamentos por vía intravenosa: revisión literaria de acciones integradas para alivio del dolor y educación en salud

Objective: The study's main purpose has been to analyze scientific articles on the world scenario about nursing interventions in the process of preparation and administration of intravenous drugs, risks inherent in professional practice and actions integrated with medical prescription. Methods: It is a research of literary nature that was carried out through the main databases of online indexed studies. For the development of this research, books related to the practice of intravenous therapy and current legislation were consulted. Results: This investigation describes the main urgent and emerging pathologies in the hospital service, nursing actions aimed at intravenous therapy and pain relief. Conclusion: Finally, it is needed to improve the instruments used to measure acute pain, because they have limitations in its implementation, either for evaluating the size of a single aspect or to be extensive in its application in the level of hospital care

Objetivo: Objetivo do estudo consiste em analisar artigos científicos no cenário mundial acerca das intervenções de enfermagem no processo de preparo e administração de medicamentos por via venosa, riscos inerentes a pratica profissional e ações integradas à prescrição médica. Método: pesquisa de natureza literária, realizada através dos principais bancos de dados online de pesquisas indexadas. Para desenvolvimento do estudo foram consultados livros relacionados à prática da terapia intravenosa e legislações vigentes. Resultados: descrição das principais patologias urgentes e emergentes no serviço hospitalar, ações de enfermagem voltadas para terapia intravenosa e alivio da dor. Conclusão: necessidade de aprimoramento dos instrumentos utilizados para mensurar a dor aguda, pois possuem limitações em sua implementação, seja por avaliar a dimensão de um único aspecto ou serem extenso em sua aplicação em nível de atendimento hospitalar

Objetivo: El objetivo del estudio consiste en analizar artículos científicos en el escenario mundial acerca de las intervenciones de enfermería en el proceso de preparación y administración de medicamentos por vía venosa, riesgos inherentes a la práctica profesional y acciones integradas a la prescripción médica. Método: investigación de naturaleza literaria, realizada a través de las principales bases de datos en línea de investigaciones indexadas. Para el desarrollo del estudio se consultó libros relacionados con la práctica de la terapia intravenosa y las legislaciones vigentes. Resultados: descripción de las principales patologías urgentes y emergentes en el servicio hospitalario, acciones de enfermería dirigidas a terapia intravenosa y alivio del dolor. Conclusión: necesidad de perfeccionamiento de los instrumentos utilizados para medir el dolor agudo, pues poseen limitaciones en su implementación, sea por evaluar la dimensión de un solo aspecto o ser extenso en su aplicación a nivel de atención hospitalaria

The Use of Ketamine for the Management of Acute Pain in the Emergency Department.

Ketamine has been used as an anesthetic agent for over 50 years. At the upper end of the dosing range, it displays dissociative anesthetic and amnestic effects, while at lower doses, it acts as an analgesic and demonstrates opioid-sparing capabilities. Ketamine is unique in its preservation of hemodynamic stability and respiratory function, and is used extensively in the emergency department (ED) for procedural sedation and the facilitation of brief painful procedures. Despite evidence supporting its safety and efficacy as an analgesic agent at sub-dissociative doses, its use in the ED for the management of acute pain remains uncommon. New guidelines were published in July 2018 by the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists that provide a framework for identifying patients who are likely to benefit from the use of Ketamine in an acute pain setting.

Pharmacologic Management of Acute Migraines in the Emergency Department.

Migraine headaches account for approximately 1.2 million emergency department (ED) visits annually. Despite the prevalence of this condition, there is little consensus on the best pharmacotherapeutic interventions to use in the ED setting. Guidelines published by the American Headache Society and the Canadian Headache Society offer some direction to ED providers but are not widely utilized. This article reviews the best evidence behind some of the medications frequently used to treat acute migraines in the ED setting, including dopamine receptor antagonists, serotonin receptor agonists, anti-inflammatory medications, opioids, magnesium, valproate, and propofol. The evaluation of patients presenting to the ED with an acute headache, the diagnostic criteria for migraines, and implications for advanced practice are also discussed.

Effectiveness of an Educational Program on Nurses' Knowledge and Practice in the Management of Acute Painful Crises in Sickle Cell Disease.

BACKGROUND: Sickle cell disease (SCD) affects millions of people worldwide and is associated with significant morbidity and mortality. Nurses can have a significant role in improving the outcomes of individuals with SCD. This study examined the effectiveness of an educational program on the knowledge and practice of nurses who provide care for individuals with acute sickle cell crisis. METHOD: A pretest-posttest control group design was used. The study was conducted at two hospitals in the northern region of Egypt. The sample included 77 RNs working in hematologic and genetic units. Data were collected using a self-administered knowledge questionnaire and a clinical performance checklist. RESULTS: Findings indicated a significant difference in nurses' knowledge and care practices after implementing the educational program. CONCLUSION: This educational program enhanced nurses' knowledge and practice for managing SCD. Training and continuing education programs need to be provided for nurses in hospital settings who provide care for individuals with SCD. Moreover, nursing curricula should reflect the standardized care for individuals with sickle cell crisis. [J Contin Educ Nurs. 2019;50(2):87-95.].

Measuring Acute Pain Over Time in the Critically Ill Using the Multidimensional Objective Pain Assessment Tool (MOPAT).

BACKGROUND: A valid and reliable instrument is needed to assess acute pain in critically ill patients unable to self-report and who may be transitioning between critical care and other settings. AIM: To examine the reliability, validity, and clinical utility of the Multidimensional Objective Pain Assessment Tool (MOPAT) when used over time by critical care nurses to assess acute pain in non-communicative critically ill patients. METHODS: Twenty-seven patients had pain assessed at two time points (T1 and T2) surrounding a painful event for up to 3 days. Twenty-one ICU nurses participated in pain assessments and completed the Clinical Utility Questionnaire. RESULTS: Internal consistency reliability coefficient alphas for the MOPAT were .68 at T1 and .72 at T2. Inter-rater agreement during painful procedures or turning was 68% for the behavioral dimension and 80% for the physiologic dimension. Validity was evidenced by decreases (p < .001) in the MOPAT total and behavioral and physiologic dimension scores when comparing T1 and T2. Nurses found the tool clinically useful. CONCLUSION: The MOPAT can be used in the critical care setting as a helpful tool to assess pain in non-communicative patients. The MOPAT is unique in that the instrument can be used over time and across settings.

Approaches to acute pain management in older people.

Pain is a diverse, individual experience and is associated with distress and suffering. Uncontrolled acute pain has been linked to delayed recovery and prolonged hospital stay. Nurses have a duty of care to their patients and acute pain management is integral to this. However, acute pain in older people can be difficult to manage, often because of under-reporting or difficulties in assessment. Older people have altered physiology often compounded by multiple co-morbidities and polypharmacy, all of which affect the appropriateness of, and available, pharmacological pain management strategies. In addition, older people are at greater risk of adverse drug reactions, drug interactions and side effects from analgesia. Consequently, non-pharmacological strategies should also be integral to pain management.

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study.

BACKGROUND: Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department. METHODS: In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described. DISCUSSION: Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.

Interventions of the nursing diagnosis "Acute Pain" ­ Evaluation of patients' experiences after total hip arthroplasty compared with the nursing record by using Q-DIO-Pain: a mixed methods study / Interventionen zur Pflegediagnose "Akute Schmerzen" ­ Evaluation der schmerzlindernden Pflege bei hospitalisierten Patientinnen und Patienten nach Hüftendoprothesenversorgung im Vergleich zur Pflegedokumentation mittels Q-DIO-Pain: eine Mixed Methods Studie.

Background: Pain affects patients' rehabilitation after hip replacement surgery. Aim: The study aim was to compare patients' responses, on their received pain relieving nursing interventions after hip replacement surgery, with the documented interventions in their nursing records. Method: A mixed methods design was applied. In order to evaluate quantitative data the instrument "Quality of Diagnoses, Interventions and Outcomes" (Q-DIO) was further developed to measure pain interventions in nursing records (Q-DIO-Pain). Patients (n = 37) answered a survey on the third postoperative day. The patients' survey findings were then compared with the Q-DIO-Pain results and cross-validated by qualitative interviews. Results: The most reported pain level was "no pain" (NRS 0 ­ 10 Points). However, 17 ­ 50 % of patients reported pain levels of three or higher and 11 ­ 22 % of five or higher in situations of motion / ambulation. A significant match between patients' findings and Q-DIO-Pain results was found for the intervention "helping to adapt medications" (n = 32, ICC = 0.111, p = 0.042, CI 95 % 2-sided). Otherwise no significant matches were found. Interviews with patients and nurses confirmed that far more pain-relieving interventions affecting "Acute Pain" were carried out, than were documented. Conclusions: Based on the results, pain assessments and effective pain-relieving interventions, especially before or after motion / ambulation should be improved and documented. It is recommended to implement a nursing standard for pain control.

Foreword.

This special supplement examines and summarizes the current state of the science on acute pain management and its practice.

Valoración del dolor en pacientes intervenidos quirúrgicamente de hernioplastia con cirugía ambulatoria en el Hospital Universitario Santa María del Rosell / Evaluation of pain in surgically operated patients with hernioplasty with outpatient surgery at the University Hospital Santa Maria del Rosell

Introducción/Objetivos: Se realiza un estudio para valorar la calidad del manejo del dolor hospitalario y extrahospitalario durante las primera 24 horas con la Escala Analógica Visual y Verbal del dolor (EVA) en cirugía mayor ambulatoria (CMA) de los pacientes intervenidos de hernioplastia, conocer los analgésicos más utilizados y confirmar que tienen un adecuado control del dolor (EVA ≤ 3). Material y Métodos: Estudio observacional, longitudinal y descriptivo para valorar el Dolor Agudo Postquirúrgico (DAP) y los analgésicos precisos para controlar el dolor; desarrollado en el Servicio de Anestesia y Reanimación del Hospital Universitario Santa Mª del Rosell del Área II de Cartagena durante los meses de octubre a diciembre de 2014. Los participantes fueron individuos mayores de edad intervenidos quirúrgicamente de hernioplastia con riesgo anestésico según el sistema de clasificación American Society of Anesthesiologists (ASA) I-II, y III muy seleccionados. El análisis estadístico se realizó con el paquete estadístico SPSS para Windows versión 19.0. Resultados: Participaron 70 individuos. Refirieron EVA≤1 un 80% al ingreso en reanimación, un 98,6% al alta en reanimación, un 82,6% al alta del CMA y un 87% en su domicilio. Todos fueron infiltrados con anestésico local y los analgésicos más utilizados fueron los 'no opiáceos'. Conclusiones: La mayoría de los individuos durante las primeras 24 horas postquirúrgicas refirieron un EVA ≤ 1 presentando un adecuado control del dolor, siendo los analgésicos "no opiáceos" los más utilizados junto con las infiltraciones locales (AU)

Introduction / Objectives: A study was carried out to evaluate the quality of hospital and out-of-hospital pain management during the first 24 hours with the Visual and Verbal Analog Pain Scale (VAS) in major outpatient surgery of patients undergoing hernia repair, Know the most commonly used analgesics and confirm that they have adequate pain control (EVA ≤ 3). Material and Methods: Observational, longitudinal and descriptive study to assess Acute Post-Operative Pain and analgesics to control pain; Developed in the Anesthesia and Resuscitation Service of the Santa Mª del Rosell University Hospital of Area II of Cartagena during the months of October to December of 2014. The participants were elderly individuals surgically operated on hernioplasty with anesthetic risk according to the American classification system Society of Anesthesiologists (ASA) I-II, and III highly selected. Statistical analysis was performed with the SPSS statistical package for Windows version 19.0 Results: 70 individuals participated. They reported EVA≤1 80% at resuscitation admission, 98.6% at resuscitation discharge, 82.6% at CMA discharge and 87% at home. All were infiltrated with local anesthetic and the most commonly used analgesics were 'non-opiates'. Conclusions: Most individuals during the first 24 postoperative hours reported an EVA ≤ 1 with adequate pain control, with non-opioid analgesics being the most used together with local infiltrations (AU)

Emergency nurses' evaluation of observational pain assessment tools for older people with cognitive impairment.

AIMS AND OBJECTIVES: To explore emergency nurses' perceptions of the feasibility and utility of Pain Assessment in Advanced Dementia tool in people over 65 with cognitive impairment. The Pain Assessment in Advanced Dementia tool was then compared with The Abbey Pain Scale, Doloplus-2 and PACSLAC. The objective was to determine which observational pain assessment tool was the most appropriate for the emergency department context and the cognitively impaired older person. BACKGROUND: The number of older people with cognitive impairment conditions, such as dementia, presenting to the emergency department is increasing. Approximately 28% of people over 65 years who present will have cognitive impairment. Older people with cognitive impairment often receive suboptimal pain management in the ED. There is limited evidence of the use and/or appropriateness of dementia-specific pain observation assessment tools in the ED. DESIGN: This was a multicentre exploratory qualitative study, which was conducted within a constructivist paradigm. METHODS: Focus group interviews were conducted with nurses across three hospital emergency departments. Data were subject to thematic analysis. RESULTS: Six focus groups were conducted with 36 nurses over a 12-week period. Four themes emerged from the analysis: 1) cognitive impairment is a barrier to pain management; 2) PAINAD gives structure to pain assessment; 3) PAINAD assists to convey pain intensity; and 4) selection of an appropriate observational pain assessment tool. CONCLUSIONS: This study identified that emergency nurses find it challenging to detect, assess and manage pain in cognitively impaired people. While the use of the PAINAD helped to address these challenges compared to other tools, nurses also identified the important role that family and carers can play in pain assessment and management for older people with cognitive impairment. RELEVANCE TO CLINICAL PRACTICE: This study has generated new knowledge that has broad application across clinical settings, which can assist to transform pain management practice and reduce human suffering. The use of an observational pain assessment tool can provide for greater practice consistency for patients with communication difficulties. Pain management for older people with cognitive impairment is best achieved by the use an appropriate observational pain assessment tool and with a multidisciplinary approach that includes the person and their family/carer.

Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory / Avaliação e manejo da dor em pacientes submetidos a procedimentos endovasculares em laboratório de hemodinâmica / Evaluación y tratamiento del dolor en pacientes sometidos a procedimientos endovasculares en el laboratorio de cateterismo

Abstract OBJECTIVE To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. METHOD Cross-sectional study with retrospective data collection. RESULTS Overall, 345 patients were included; 116 (34%) experienced post-procedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. CONCLUSION The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions.

Resumo OBJETIVO Descrever como se dá na prática clínica a avaliação (característica, localização e intensidade) e o tratamento da dor em pacientes submetidos a procedimentos endovasculares em Laboratório de Hemodinâmica. MÉTODO Estudo transversal com coleta de dados retrospectiva. RESULTADOS Foram incluídos 345 pacientes; 116 (34%) apresentaram dor após o procedimento; em 107 (92%), as características da dor não foram registradas; a localização foi registrada em 100% dos pacientes, e a intensidade da dor em 111 (96%); o principal manejo foi o farmacológico; dos pacientes que receberam algum manejo (n=71), 42 (59%) tiveram sua dor reavaliada. CONCLUSÃO A localização e a intensidade da dor estão bem documentadas na prática clínica. O tratamento farmacológico foi prevalente. Mais esforços são necessários para que as características da dor sejam registradas, assim como sua reavaliação após intervenção.

Resumen OBJETIVO Describir cómo se evalúa el dolor (características, localización e intensidad) y su manejo en la práctica clínica en pacientes sometidos a procedimientos endovasculares en el laboratorio de cateterización. MÉTODO Estudio transversal con recolección retrospectiva de datos. RESULTADOS En total, se incluyeron 345 pacientes; 116 (34%) experimentaron dolor post-procedimiento; en 107 (92%), no se registraron las características del dolor; la localización del dolor se informó en el 100% de los pacientes, y su intensidad en 111 (96%); el manejo fue en gran medida farmacológico; de los pacientes que recibieron algún tipo de tratamiento (n=71), 42 (59%) fueron sometidos a reevaluación del dolor. CONCLUSIÓN La ubicación y la intensidad del dolor se informan bien en la práctica clínica. El manejo farmacológico del dolor sigue siendo frecuente. Se necesitan esfuerzos adicionales para asegurar el registro de las características del dolor y su reevaluación después de las intervenciones.

Dificultades para abordar el dolor mamario en madres lactantes desde atención primaria / Primary care problems addressing breast pain in nursing mothers

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Nurses' Beliefs Regarding Pain in Critically Ill Children: A Mixed-Methods Study.

The purpose of this study was to provide a current and comprehensive evaluation of nurses' beliefs regarding pain in critically ill children. DESIGN AND METHODS: A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared. RESULTS: Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to "start low" with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child's word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child's pain report. CONCLUSIONS: Findings from this study regarding the accuracy of nurses' pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses' pain beliefs are not static and may vary with patient characteristics. PRACTICE IMPLICATIONS: While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.

Pain Intensity in Hospitalized Adults: A Multilevel Analysis of Barriers and Facilitators of Pain Management.

BACKGROUND: Despite an enhanced interest and evolution in pain management, prevalence remains high. Interventions to optimize pain-related care can only be effective if barriers are identified and accounted for. AIM: To assess pain intensity and examine its association with patient- (including health literacy defined in this study as "requiring help to read health information"), nurse-, and system-related (including social capital defined as "the importance of network and norms at work") barriers/facilitators to pain management. METHODS: A two-center, cross-sectional study was performed between October 2012 and April 2013. The study included patients and nurses of 39 noncritical wards of two hospitals in Belgium. Patients who were 18 years of age or older and without impaired cognition or consciousness were eligible to take part. All nurses working in the included ward were invited to participate. Pain intensity and patient-related barriers were collected by a structured and standardized questionnaire, completed in dialogue with the patient. Nurses completed the questionnaire on the nurse- and system-related barriers and the social capital scale. Multilevel analysis was used to analyze the data because of the hierarchical structure of the data. RESULTS: The average pain of all patients across all wards on a 0-10 scale was 2.2 (SD = 3.6). The multilevel analysis indicates that pain intensity can be explained by variables at patient and ward levels. A significant independent association was found between higher pain intensity and younger age, receiving pain medication, the conviction of patients that pain medication does not improve pain, inadequate health literacy in patients, nurses without advanced education, and nurse's concerns about side effects. Social capital did not emerge as predictor of pain intensity. DISCUSSION: Patient and nurse level factors should be taken into account in hospitals when setting up strategies to improve pain management.