Effect of regional cooperative rescue systems based on chest pain centers for patients with acute myocardial infarction in a first-tier city in China.

Given the increasing burden of acute myocardial infarction (AMI) in China, regional cooperative rescue systems have been constructed based on chest pain centers (CPCs). This study evaluated the effects of these regional cooperative rescue systems on reperfusion time and prognosis of AMI patients. This study included 1937 AMI patients, divided into two groups according to the date of admission, group A (July 2017-June 2018) and group B (July 2018-June 2019). Reperfusion time, the fatality rate for any cause during hospitalization, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the 6 months following discharge were compared between the two groups. The proportion of patients treated within the guideline goals for first medical contact to balloon (FMC-to-B) time showed improvement from 40.7% in group A to 50.4% in group B (P = 0.005). The fatality rate for any cause (5.5% vs. 8.0%, P = 0.026) during hospitalization was lower in the B group compared to the A group. Multivariate logistic regression analysis revealed that the fatality rate for any cause (OR 0.614, 95% CI 0.411-0.918, P = 0.017) was significantly lower in group B compared with group A. No significant differences were detected between the two groups for the incidence of MACCE and death for any cause at 6 months using the log-rank test and multivariate Cox regression analysis. The improvement of regional cooperative rescue systems shortened system delays and reduced in-hospital deaths. Although the system has resulted in some substantial improvements, additional improvement is needed.

Inequity in outcomes from New Zealand chronic pain services.

AIM: To evaluate outcomes from chronic pain services in New Zealand based on patient ethnicity. METHOD: Clinical and demographic data were obtained from 4,876 patients from the Electronic Persistent Pain Outcomes Collaboration (ePPOC) database, a database of standardised assessments from chronic pain services across New Zealand. Clinical questionnaires included the Brief Pain Inventory (BPI); Depression, Anxiety and Stress Scale - 21 items (DASS-21); Pain Catastrophising Scale (PCS); and the Pain Self-Efficacy Questionnaire (PSEQ). Regression analysis (adjusting for age, body mass index, and baseline values) was used to determine whether patient ethnicity was associated with clinical questionnaire data at treatment end and at 3-6-month follow-up. RESULTS: At treatment end, there were significantly poorer scores for Pacific people compared to Europeans for several of the DASS-21 and PCS subscales, while there were no differences between European and Maori and Asian ethnicities. At follow-up, almost all outcome measures were poorer for Maori compared to European, and several of the DASS-21 and PCS subscales were poorer for Asian and Pacific people compared to Europeans. CONCLUSION: There are ethnic inequalities in the efficacy of treatment for chronic pain services in New Zealand. The cultural safety of the chronic pain clinics should be reviewed regarding both assessment and management procedures.

A vueltas con el dolor discogénico / Facings with discogenic pain

No disponible

Escuela de pacientes con dolor crónico no oncológico y tratamiento opioide / School of non-oncologic chronic pain patients and opioid treatment

El dolor es uno de los trastornos que más afecta y preocupa a las personas y es el síntoma acompañante que con mayor frecuencia motiva una consulta médica. La frecuencia de dolor crónico en la población adulta española es muy elevada y constituye un problema generalizado de salud pública. La Escuela de Pacientes ha demostrado su eficacia en el abordaje terapéutico de determinados procesos (hipertensión arterial, diabetes mellitus y otros). Presentamos la primera Escuela de Paciente con Dolor Crónico No Oncológico y Tratamiento Opioide implementada en el Sistema Sanitario Público de Andalucía, que ha permitido formar a pacientes en el tratamiento opioide para su proceso de dolor crónico no oncológico con muy elevado grado de satisfacción

Pain is one of the disorders that most affects and worries people and is the accompanying symptom that most often motivates medical consultation. The frequency of chronic pain in the spanish adult population is very high and constitutes a general publich health problem. The school of patients has demonstrated its effectiveness in the therapeutic approach of certain processes (arterial hypertension, mellitus diabetes and others). We present the first school of patients with non-onologic chronic pain and opioid treatment implemented in the Public Health System of Andalusia, which has allowed training patients with opioids treatment for their pain processes with a very high satisfaction degree

Las Unidades del Dolor en la era COVID-19 / The Pain Units in the COVID-19 era

No disponible

La pandemia que nos sorprendió y que ha alterado la atención de los pacientes con dolor / The pandemic that surprised us and has altered the care of patients with pain

No disponible

Sociedad Española del Dolor (SED). Recomendaciones asistenciales para unidades de dolor ante la normalización progresiva de la actividad durante la pandemia por COVID-19 / Spanish Pain Society (SPS). Healthcare recommendations for pain units in the face of progressive normalization of activity during the COVID-19 pandemic

INTRODUCCIÓN: La infección por SARS-CoV-2 es una nueva infección viral que ha emergido en forma de pandemia, con un espectro clínico respiratorio y multisistémico, que ocasiona una elevada morbimortalidad. Su rápida expansión es dependiente de la ausencia de exposición e inmunidad previas, la ausencia de vacuna y de tratamientos específicos, y de un mecanismo de transmisión por vía respiratoria y contacto con mucosas y proximidad entre los individuos, incluso asintomáticos. La necesidad de protección sobre la población y sus profesionales sanitarios obliga a establecer protocolos de control y prevención de exposiciones. Una de las nuevas situaciones generadas es el restablecimiento de la actividad asistencial en condiciones de seguridad, que en muchos casos son específicas de cada especialidad. OBJETIVO: Elaborar un documento de recomendaciones clínicas y de gestión que oriente a los gestores y personal asistencial de las unidades de dolor sobre cómo afrontar el retorno escalonado a la labor asistencial con la mejor evidencia disponible. El documento tiene en cuenta la seguridad de los pacientes y profesionales en el contexto de la pandemia por SARS-CoV-2, aunque reconocemos que el entorno cambiante puede modificar en un futuro cercano las recomendaciones. METODOLOGÍA: Tras una revisión narrativa de la literatura en PubMed, Google Scholar, y recomendaciones de autoridades competentes y sociedades científicas, la Sociedad Española del Dolor publicó un primer documento (V1.0) el 21 de abril del 2020 en su web (www.sedolor.es) que fue compartido con los socios y presidentes de las sociedades autonómicas de dolor, dejando abierta la posibilidad para su mejora a través de un correo (posicionamiento.covid.sed@sedolor.es), donde se han recibido sugerencias hasta la Versión 2.1, publicada el 13 de mayo de 2020. Algunos socios también se han dirigido directamente a la junta directiva y sus aportaciones han sido asimismo evaluadas e incorporadas cuando ha sido posible. El presente documento está basado en esta última versión. RESULTADOS: El documento ofrece una serie de recomendaciones generales y otras adaptadas a los diferentes entornos asistenciales, desde la asistencia telemática a la organización de los espacios físicos de consulta, como la atención hospitalaria, las salas de técnicas o el quirófano. Las recomendaciones contemplan desde las medidas higiénicas y protección al diagnóstico de la enfermedad, la categorización del riesgo, las modificaciones en las opciones farmacológicas y técnicas analgésicas disponibles, así como un documento de acompañamiento al consentimiento informado. CONCLUSIONES: Una nueva realidad asistencial se está imponiendo. Esta realidad no solo pasa por unos estándares de seguridad adaptados a la contagiosidad y otros efectos del virus, si no también a un nuevo modelo asistencial que incorpore las herramientas telemáticas con seguridad tecnológica y un adecuado marco legal. Las secuelas biológicas y psicológicas deletéreas del virus sobre los pacientes con dolor aún no han sido esclarecidas plenamente por lo que debemos estar atentos, previniendo y tratando dicha posibilidad

INTRODUCTION: SARS-CoV-2 infection is a new viral infection that has emerged in the form of a pandemic, with a respiratory and multisystemic clinical spectrum, which causes high morbidity and mortality. Its rapid expansion is dependent on the absence of previous exposure and immunity, the absence of a vaccine and specific treatments, as well as its mechanism of air transmission and contact with mucous membranes, including asymptomatic individuals. The need for protection on the population and its health professionals requires the establishment of exposure and prevention protocols. One of the new situations generated is the need for a safe return to normal healthcare activities, which in many cases are specific to each specialty. OBJECTIVE: To elaborate a document of clinical and management recommendations to guide managers and staff of pain units on how to face the staggered return to normal care with the best available evidence. The document takes into account the safety of patients and professionals in the context of the SARS-CoV-2 pandemic, although we recognize that the changing environment may change the recommendations in the near future. METHODOLOGY: After a narrative review of the literature on PubMed , Google Scholar, and recommendations of competent authorities and scientific societies, The Spanish Pain Society published a first document (V1.0) on April 21st 2020 into its WEB (www.sedolor.es), which was shared with the members of the society as well as the presidents of the Spanish autonomous pain societies, leaving open the possibility for improvement through an email posicionamiento.covid.sed@sedolor.es, where suggestions have been received up to Version 2.1 published on May 13th, 2020. Some partners have also addressed the board of directors directly and their contributions have also been evaluated and incorporated when possible. This document is based on this latest version. RESULTS: The document offers a series of general recommendations and others adapted to the different healthcare settings, from telematic assistance to the organization of physical consultation spaces, hospital care, interventional rooms and operating theaters. The recommendations cover from the hygienic measures and protection, to the diagnosis of the disease, risk categorization, the potential modifications in the pharmacological options and available analgesic techniques, as well as an accompanying document to the informed consent. CONCLUSIONS: A new healthcare reality is prevailing. This reality not only goes through security standards adapted to the contagiousness and other consequences of the virus, but also a new healthcare model that incorporates telematic tools with technological security and an adequate legal framework. The deleterious biological and psychological consequences of the virus on pain patients have not yet been fully clarified, so we must be vigilant, preventing and treating this possibility

Novedades en el tratamiento del dolor de espalda: ¿son el futuro las terapias celulares? / News in the treatment of back pain: are the future cell therapies?

No disponible

Applicability of scales/indicators for pain monitoring in critically ill patients incapable of verbalizing: a systematic review of the literature / Aplicabilidad de escalas/indicadores para el control del dolor en pacientes críticamente incapaces de verbalizar: una revisión sistemática de la literatura

Objective: To conduct a systematic review of the existing literature about the applicability of scales/indicators for pain monitoring in critically ill patients who are unable to verbalize. Methods: We performed a systematic review of the literature, according to the Joanna Briggs Institute's guidelines, in the following databases: MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials. The search was executed using, as main descriptors, "Critically Ill Patient", "Pain", "Scale" and "Instrument", in Portuguese, English, Italian, and Spanish. We considered the period between January 2012 and December 2017, and obtained a total of 149 results. From these, we selected 11 final full-text articles for extraction and analysis, which met the required inclusion criteria. Two researchers made the search and two independent reviewers carried out the critical evaluation, extraction and synthesis of the data. Results: The key to adequate pain management lies in detecting and assessing several indicators, such as: facial expression, vocalization, body movements, muscle tone, adaptation to mechanical ventilation. Subsequently, it is fundamental to intervene accordingly and to reassess the patient's status. The BPS (Behavioral Pain Scale) and the CPOT (Critical-care Pain Observation Tool) are considered the most appropriate scales for pain assessment in critically ill patients who are incapable of verbalizing. While the BPS should only be used in ventilated patients, the CPOT can be used in both ventilated and non-ventilated patients. Conclusion: The BPS and the CPOT are two scales recognized as reliable, valid, and easy to apply, for pain monitoring in critically ill patients who are unable to verbalize their pain

Objetivo: Llevar a cabo una revisión sistemática de la literatura existente sobre la aplicabilidad de escalas/indicadores para el control del dolor en pacientes críticamente enfermos que no pueden verbalizar. Métodos: Se realizó una revisión sistemática de la literatura en las siguientes bases de datos: MEDLINE, CINAHL y el Registro Cochrane Central de Ensayos Controlados, como descriptores principales "Paciente en estado crítico", "Dolor", "Escala" e "Instrumento". Consideramos el periodo entre enero de 2012 y diciembre de 2017, y obtuvimos un total de 149 resultados. De estos, seleccionamos 12 artículos finales de texto completo para extracción y análisis, que cumplieron con los criterios de inclusión requeridos. Dos revisores independientes llevaron a cabo la evaluación crítica, extracción y síntesis de los datos. Resultados: La clave para el manejo adecuado del dolor radica en detectar y evaluar varios indicadores, tales como: expresión facial, tamaño de la pupila, vocalización, movimientos corporales, tono muscular, adaptación a la ventilación mecánica, presión arterial y frecuencia cardiaca. Posteriormente, es fundamental intervenir en consecuencia y reevaluar el estado del paciente. La BPS (Escala de dolor conductual) y la CPOT (herramienta de observación del dolor en cuidados críticos) se consideran las escalas más adecuadas para la evaluación del dolor en pacientes críticos que son incapaces de verbalizar. Si bien el BPS solo se debe utilizar en pacientes ventilados, el CPOT se puede usar tanto en pacientes ventilados como no ventilados. Conclusión: el BPS y el CPOT son dos escalas reconocidas como confiables, válidas y fáciles de aplicar para el control del dolor en pacientes críticamente enfermos que no pueden verbalizar su dolor

Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review.

BACKGROUND: Pediatric functional gastrointestinal disorders (FGIDs) are common and well-accepted to be etiologically complex in terms of the contribution of biological, psychological, and social factors to symptom presentations. Nonetheless, despite its documented benefits, interdisciplinary treatment, designed to address all of these factors, for pediatric FGIDs remains rare. The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic (APC) would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement. AIM: To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes. METHODS: Participants were 392 children, ages 8-18 [M = 13.8; standard deviation (SD) = 2.7], seen between August 1, 2013 and June 15, 2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital. To be eligible, patients had to be 8 years of age or older and have had abdominal pain for ≥ 8 wk at the time of initial evaluation. Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study. Logistic regression was used to model odds of reporting vs never reporting improvement, as well as to differentiate rapid from slower improvers. RESULTS: Nearly 70% of patients followed during the study period achieved resolution on at least one of the employed outcome indices. Among those who achieved resolution during follow up, 43% to 49% did so by the first follow up (i.e., within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment). Patient age, sleep, ease of relaxation, and depression all significantly predicted the likelihood of resolution. More specifically, the odds of clinical resolution were 14% to 16% lower per additional year of patient age (P < 0.001 to P = 0.016). The odds of resolution were 28% to 42% lower per 1-standard deviation (SD) increase on a pediatric sleep measure (P = 0.006 to P < 0.040). Additionally, odds of clinical resolution were 58% lower per 1-SD increase on parent-reported measure of depression (P = 0.006), and doubled in cases where parents agreed that their children found it easy to relax (P = 0.045). Furthermore, sleep predicted the rapidity of clinical resolution; that is, the odds of achieving resolution by the first follow up visit were 47% to 60% lower per 1-SD increase on the pediatric sleep measure (P = 0.002). CONCLUSION: Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep, ensuring adequate skills for relaxation, and screening of and referral for treatment of comorbid depression.

Situación actual del dolor agudo postoperatorio en el Sistema Nacional de Salud. Las tecnologías de la información y comunicación ayudan a conseguir un hospital (y atención primaria) sin dolor / Situation of acute postoperative pain in the Spanish National Health System. Icts help to reach a "pain-free" hospital an primary care

No disponible

Optimización de la gestión del dolor postoperatorio basado en una nueva herramienta tecnológica. Mapa del dolor / Optimization of postoperative pain management based on a new technological tool. Pain map

Introducción: En el año 2005 el Ministerio de Sanidad, Servicios Sociales e Igualdad (MSSSI) impulsó y promovió la Estrategia de Seguridad del Paciente del Sistema Nacional de Salud (SNS), en colaboración con las comunidades autónomas, que integraba las aportaciones de los profesionales sanitarios y de los pacientes a través de sus organizaciones. Uno de los objetivos de las prácticas seguras era la necesidad de prevención y control del dolor en el adulto y en el niño, incluyéndose la gestión de este en los estándares de calidad. En el Hospital Universitario Germans Trias i Pujol (HUGTIP), en el año 2016 se inició la elaboración de los indicadores que se querían evaluar para una mejor detección y eficiencia terapéutica del dolor agudo intrahospitalario de cualquier área y que finalizó con el diseño y creación de lo que denominamos "Mapa del dolor". El objetivo fue diseñar una herramienta que, a través de la variable clínica dolor, permitiera mejorar la visualización de esta y extraer los datos estadísticos de los indicadores defi nidos para una óptima gestión del dolor dentro de un hospital universitario de tercer nivel. Material y método: Análisis descriptivo de la herramienta que denominamos "Mapa del dolor" en el Hospital Universitario Germans Trias i Pujol (HUGTiP) durante el año 2016. Se incluyeron todos los pacientes ingresados en los que el registro de dolor se realizó a través de la historia clínica informatizada GacelaCare(R). Considerando el dolor como 5.ª constante, la variable principal fue el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) en cada turno de enfermería. El procedimiento de creación de la herramienta para la elaboración del denominado "Mapa del dolor" se realizó con la colaboración del Departamento de Sistemas de Información del HUGTiP, junto con miembros de la Unidad del Dolor. Resultados: El "Mapa del dolor" se fundamenta en el registro de la intensidad del dolor mediante la escala visual analógica (EVA) o escala verbal numérica (EVN) por turno de enfermería, acción previa imprescindible por parte de enfermería. Permite visualizar en la pantalla los registros de la intensidad del dolor de todos los pacientes hospitalizados de manera simultánea y en tiempo real. El "Mapa del dolor" identifi ca los registros con distintos colores a modo de semáforo del dolor, en color verde marca los valores de EVN entre 1-3 (dolor leve), en color naranja EVN entre 4-6 (dolor moderado) y en color rojo EVN entre 7-10 (dolor intenso); asimismo señala con una franja de color morado aquellos pacientes operados el día anterior, facilitando el control del dolor durante las primeras 24 horas postoperatorias. La explotación estadística de los registros informatizados de dolor permite obtener resultados de los indicadores relacionados con su gestión, previamente defi nidos por nuestro hospital. Discusión: El "Mapa del dolor" es una herramienta innovadora que permite desarrollar con garantías la efi ciencia de las unidades de dolor agudo de bajo coste

Introduction: In 2005, the Ministry of Health, Social Services and Equality (MSSSI) promoted the Patient Safety Strategy of the National Health System (SNS), in collaboration with the Autonomous Communities, which integrated the contributions of health professionals and patients through their organizations. One of the objectives of safe practices was the need for prevention and control of pain in adults and children, including management of the same in quality standards. At the Germans Trias and Pujol University Hospital (HUGTIP) in 2016, the development of the indicators that were intended to be evaluated for better detection and therapeutic effi ciency of acute in-hospital pain in any area ended with the design and creation of what we call as "pain map". The objective was to design a tool that, through the clinical pain variable, could improve the visualization of pain and extract statistical data from the defi ned indicators for optimal pain management in a university hospital of the third level. Material and method: Descriptive analysis of the tool we call pain map at the Germans Trias and Pujol University Hospital during 2016. The population was all patients admitted to hospital units where the pain registry was made through the GacelaCare(R) computerized medical record. The main variable was the recording of pain intensity using the Visual Analogue Scale (VAS) or Numeric Verbal Scale (NVA) by nursing shift considering pain as the 5th constant. The tool creation procedure was carried out with the collaboration of the hospital information systems department together with members of the Pain Unit for the elaboration of the so-called pain map. Results: The pain map is based on the previous action required by nursing which is the recording of the intensity of pain using the Visual Analogue Scale (VAS) or Numerical Verbal Scale (NVA) in turn considering pain as the 5th constant. The map allows to visualize on the screen the registers of the pain intensity of all hospitalized patients simultaneously and in real time. The pain map identifi es with different colors as a traffi c light of pain. In green color, the EVN values are between 0-3 (mild pain), orange EVN between 4 and 6 (moderate pain) and red color between 7 and 10 (intense pain). Likewise, it indicates with a purple band those patients operated on the previous day, facilitating pain control during the fi rst 24 postoperative hours. The statistical exploitation of computerized pain registers allows obtaining results of the quality indicators related to pain management defi ned by our hospital. Discussion: The pain map is an innovative tool that allows the development of low-cost Acute Pain Units to be guaranteed with effi ciency

Interdisciplinary spinal pain clinics in primary care: Outcomes from one service

BACKGROUND AND OBJECTIVES: Management of spinal pain in Australia is a common problem that often requires input from a range of health providers. Interdisciplinary care can be difficult to access, and care can easily become fragmented. A novel approach of setting up an interdisciplinary clinic in a primary care setting was analysed in this study. METHODS: Follow-up of patients 2­3 years after attending the clinic was undertaken. Specialist general practitioners (GPs) referring to the clinic were invited to give feedback. RESULTS: Forty-three patients participated in the study. Approximately half of patients reported clinically significant reductions in their overall pain and disability levels. GPs and participants broadly supported the clinic approach. DISCUSSION: Complex spinal pain interdisciplinary assessment in a primary care setting shows reasonable long-term outcomes comparable to more intensive interventions. Further exploration and fine-tuning of this model would seem a sensible option as current models of care are under strain.

Epidemiology of Chronic Pain in the Latium Region, Italy: A Cross-Sectional Study on the Clinical Characteristics of Patients Attending Pain Clinics.

In Italy, chronic pain affects more than a quarter of the population, whereas the average European prevalence is 21%. This high prevalence might be due to the high percentage of Italian people who do not receive treatment, even after the passing of law 38/2010 (the right to access pain management in Italy), which created a regional network for the diagnosis and treatment of noncancer chronic pain. Italian epidemiologic studies on chronic pain are scanty, and this observational, multicenter, cross-sectional study is the first to investigate the clinical characteristics of patients who attended the pain management clinics in the Latium Region, Italy, for the management of their noncancer chronic pain. A total of 1,606 patients (mean age 56.8 years, standard deviation ± 11.4), 67% women, were analyzed. Severe pain was present in 54% of the sample. Women experienced pain and had it in two or more sites more often than men (57% vs. 50%, p = .02; and 55.2% vs. 45.9%, p < .001, respectively). Chronic pain was musculoskeletal (45%), mixed (34%), and neuropathic (21%). In more than 60% of the cases, chronic pain was continuous, and in 20% it had lasted for more than 48 months; long-lasting pain was often neuropathic. Low back (33.4%) and lower limbs (28.2%) were the main locations. Severe intensity of pain was statistically significantly associated with female gender (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.06-1.84); with International Classification of Diseases, Ninth Revision, codes for chronic pain syndrome (OR 2.14; 95% CI 1.55-2.95); and with continuous pain (OR 2.02; 95% CI 1.54-2.66). Neuropathic pain and mixed pain were significantly associated with number of sites, and a trend seemed to be present (OR 2.11 and 3.02 for 2 and 3 + sites; 95% CI 1.59-2.79 and 2.00-4.55, respectively).

The effect of an interprofessional pain service on nonmalignant pain control.

PURPOSE: The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. METHODS: Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3-14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. RESULTS: Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. CONCLUSION: An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population.

The development and first six years of a nurse-led chest pain clinic.

AIM: Chest pain is a common symptom that creates significant anxiety for patients until a diagnosis can be offered. However, hospital cardiology services can struggle to cope with referral demands from primary care. The aim of this paper is to describe the development and implementation of a nurse-led chest pain service, its care processes and clinical outcomes to show feasibility, safety and sustainability. METHOD: We retrospectively analysed referral, demographic, cardiovascular risk, management and clinical outcome data relating to patients assessed in the nurse-led chest pain clinic in a large metropolitan district health board. RESULTS: Between January 2010 to December 2016, 3,587 patients attended the clinic, median 2.6 weeks (IQR 2-3) from referral to attendance. 1,921 (54%) were male and 2,059 (57%) were less than 60 years old. Most patients, 3,059 (85%), had an exercise tolerance test (ETT) and of those, 294 (10%) were positive, 572 (18%) non-diagnostic and 2,193 (72%) negative. Cardiovascular disease (CVD) prevention medication was added or modified for 1,150 (32%) patients, all patients who smoked were offered cessation support and all patients were provided with tailored lifestyle advice depending on their absolute CVD risk. Of the 319 (9%) referred for a diagnostic coronary angiogram, 205 (64%) had important coronary disease. The majority of patients, 2,088 (58%) were able to be discharged without any further investigation planned. Over a median follow-up period of 3.6 years, we identified 14 (0.4%) cardiac-related deaths, median (IQR) 2 (1-4) years from review to death. CONCLUSION: The nurse-led clinic offers an enhanced prevention focus that is sustainably managing large numbers of patients with outcomes similar to international studies and within recommended local timeframes.

Cartera de servicios y cuadro básico de indicadores de calidad para las unidades de cefalea: estudio de consenso / Portfolio of services and basic table of quality indicators for Headache Units: a consensus study

Objetivo. Elaborar una propuesta de cartera de servicios para una unidad de cefalea y un conjunto básico de indicadores de calidad asistencial en cefalea. Desarrollo. Estudio que aplicó técnicas de búsqueda de consenso con participación de un total de 15 profesionales expertos en tratamiento de cefaleas (experiencia de más de 15 años) y en gestión de calidad. La descripción de los indicadores incluyó: enunciado, definición, estándar, tipo de indicador, dimensión, fuente, nivel de evidencia y aclaraciones de términos. La propuesta de cartera de servicios incluyó los siguientes ámbitos: gestión clínica, atención centrada en el paciente, implicación comunitaria, gestión del conocimiento, investigación traslacional y difusión social. La propuesta se concretó en 13 indicadores que abarcaban cinco dimensiones. Conclusiones. Esta propuesta contribuye a asegurar y evaluar el nivel de calidad de una unidad de cefaleas o de las consultas monográficas de cefaleas

Aim. To develop a proposal for a portfolio of services and a set of indicators for Headache Units. Development. Qualitative study that applied techniques of consensus with the participation of 15 professionals who are experts in the treatment of headaches (experience of 15 years) and in quality assurance. The description of the indicators included: statement, definition, standard, type of indicator, dimension, source, level of evidence, and clarification of terms. The proposal for a portfolio of services included the following areas: clinical management, patient-centered care, community involvement, knowledge management, translational research, and social dissemination. The proposal converged in 13 indicators exploring five dimensions. Conclusions. This proposal contributes to ensure and assess the level of quality of a Headache Unit or outpatient clinic

Clinical Pharmacy Services in a Multidisciplinary Specialty Pain Clinic.

PURPOSE: To describe a model of clinical pharmacy services as part of a multidisciplinary specialty pain clinic by discussing (1) the role of a clinical pharmacist in a specialty setting, including clinical interventions implemented, and (2) how integration of a clinical pharmacist may translate into an improved patient care model for the management of chronic pain. METHODS: A retrospective chart review was conducted of pharmacist visits from October 1, 2013, to September 30, 2015, in a specialty pain clinic at an academic medical center in Los Angeles, California. Data were collected regarding medication-related problems (MRPs) identified by the pharmacist, interventions implemented to resolve the MRPs, and types of medication care coordination activities (MCCAs) performed by the pharmacist, such as responding to medication refill requests and insurance issues. Descriptive statistics were used. Institutional review board approval was obtained prior to initiating the study. RESULTS: At least 1 MRP was identified in 98.7% of the 380 visits. Problems identified by the clinical pharmacist were divided into 5 categories: medication refills needed (43%), medication appropriateness/effectiveness (18%), miscellaneous (17%), safety (16%), and nonadherence/patient variables (6%). Interventions focused on referral to appropriate providers, medication counseling, medication initiation, dose adjustment, and medication discontinuation. The most common MCCA was responding to refill requests. CONCLUSION: A clinical pharmacist can identify many MRPs and implement interventions in chronic pain management. Integration of clinical pharmacy services may improve practice management by facilitating the completion of MCCAs and increase access to patients' needs outside the clinic.

Exploring the Role of Chronic Pain Clinics: Potential for Opioid Reduction.

BACKGROUND: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. OBJECTIVE: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. STUDY DESIGN: This study used a retrospective design. SETTING: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. METHODS: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients' latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. RESULTS: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. LIMITATION: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. CONCLUSION: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients. KEY WORDS: Pain clinic, pain management, multimodal pain management, chronic pain, opioid reduction, improved pain, improved functional capacity.