PubMed Health⌕ Search

Biomedical subjects

Debra B Gordon

Publications and source records attributed to Debra B Gordon.

16 recordsLinked to original sources
PubMed2006

Oral transmucosal fentanyl citrate for cancer breakthrough pain: a review.

PURPOSE/OBJECTIVES: To review the dose titration, efficacy, and safety of oral transmucosal fentanyl citrate (OTFC). DATA SOURCES: Phase I and II clinical trial abstracts and evidence-based review articles. DATA SYNTHESIS: OTFC has an onset, peak, and duration of action similar to that of an IV dose of an opioid and has been demonstrated to be effective and well tolerated for the management of breakthrough pain in patients with cancer. CONCLUSIONS: Studies of OTFC demonstrate that it is easy to use,noninvasive, effective, safe, and acceptable to patients, caregivers, and healthcare providers. However, OTFC is expensive and approved for use only in opioid-tolerant patients with cancer. IMPLICATIONS FOR NURSING: Breakthrough pain in patients with cancer is a common problem with characteristics that make it difficult to treat. Oncology nurses should familiarize themselves with OTFC's unique characteristics to be able to best help patients manage their therapy.

Administration, Buccal↗
PubMed2006

Prospective analysis of a novel long-acting oral opioid analgesic regimen for pain control after total hip and knee arthroplasty.

Parenteral opioid use after total knee (TKA) and hip (THA) arthroplasty often results in substantial functional interference and side effects. This prospective study compared use of traditional intravenous patient-controlled analgesia (IV PCA) with a novel oral regimen after TKA and THA. Sixty-two patients received IV PCA and 62 received scheduled long-acting and, as needed, short-acting oral opioids postoperatively. Surveys and chart audits documented functional interference, pain scores, opioid-related side effects, and opioid consumption. Patients who received the oral regimen had significantly less opioid consumption (P < .05) and experienced less functional interference (P < .05) than the IV PCA group. Both groups had similar pain scores and incidence of opioid side effects. This study demonstrates some significant advantages of an oral analgesic regimen compared with IV PCA after TKA and THA.

Administration, Oral↗
PubMed2006

The WPI's review of Wisconsin's managed care climate for pain management: opportunities for improvement.

BACKGROUND: Reimbursement obstacles, such as inadequate insurance coverage, have been identified as barriers to adequate pain management. The purpose of this study was to determine Wisconsin insurers' and managed care organizations' (MCOs) policies and practices regarding pain treatment and MCO medical directors' perceptions of barriers to providing effective pain management for their enrollees. METHODS: A descriptive qualitative design was used with semi-structured interviews of 6 administrative executives of commercial health management organizations' products from the major insurers in Wisconsin. RESULTS: None of the companies interviewed had systematically tracked data or had processes in place to allow them to track, analyze or trend data specific to pain management. Chronic noncancer pain is recognized more frequently as an insurance coverage issue because of high drug costs. Pharmacologic and interventional therapies are routinely covered compared with nonpharmacologic therapies with some prior authorizations, especially for newer medications. A uniformly identified barrier was lack of a comprehensive, interdisciplinary, integrated approach to pain management and inadequate data on the cost effectiveness of various approaches. CONCLUSIONS: Opportunities exist to educate and improve communication between health care professionals, purchasers of health care (employers), primary care providers and pain specialists. The economics of pain management needs to be made more "visible" through the development of coding and tracking mechanisms.

Data Collection↗
PubMed2005

American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.

BACKGROUND: The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. METHODS: Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. RESULTS: The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. CONCLUSION: Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.

Acute Disease↗
PubMed2005

Incidence and characteristics of naloxone use in postoperative pain management: a critical examination of naloxone use as a potential quality measure.

The administration of naloxone may be an important monitor of the quality and safety of postoperative pain management. However, studies that support the use of naloxone as a quality measure are absent. The purposes of this study are to determine the incidence and factors associated with naloxone administration in the postoperative setting and to critically examine naloxone as a potential quality measure. Participants included all postoperative adult inpatients at an academic hospital who received naloxone and an equal number of matched control patients who did not receive naloxone during the calendar year 2003. Medical record audits were performed to examine patient demographics, relevant medical history, postoperatively administered analgesics and central nervous system depressants, documented sedation and respiratory assessments, reason provided for naloxone administration, and patient outcome. Naloxone was administered to .53% (56/10,511) of all adult inpatient postoperative patients. Patients who received naloxone were significantly older and received more central nervous system depressants than cohorts. No significant differences were found in comorbidities, route of opioid administration, or amount of opioids taken by the two groups. Reversal of excessive opioid-induced sedation was the primary reason provided for naloxone administration. However, 25% of the patients were later determined to have a new diagnosis that contributed to sedation. Examination of naloxone administration proved useful in uncovering deficits in structures and processes of care. However, caution is warranted when using naloxone as a quality measure to avoid the implication that higher use indicates opioid analgesic over-treatment or error.

Adult↗
PubMed2005

The use of 'as-needed' range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society.

The use of "as-needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. This paper presents the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain.

Acute Disease↗
PubMed2004

The use of "as-needed" range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society.

The use of "as needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. The purpose of this paper is to present the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain. The implementation of this statement should promote quality pain management through safe medication practices and the appropriate use of range orders for opioid analgesics in acute pain management.

Acute Disease↗
PubMed2004

Pharmacologic management of neuropathic pain.

The mechanisms underlying the pathogenesis of neuropathic pain are complex but are gradually coming to light. Agents that have been found effective in a variety of neuropathic pain conditions include drugs that act to modulate (a) sodium or calcium channels, (b) N-methyl-D-aspartate receptors, (c) norepinephrine or serotonin reuptake, (d) opioid receptors, and (e) other cellular processes. Clinical trials have primarily evaluated these treatments for postherpetic neuralgia and painful diabetic neuropathy, the two most common types of neuropathic pain. Nonetheless, the identification of effective treatment regimens remains challenging, often because multiple mechanisms may be operating in a given patient giving rise to the same symptom. Alternatively, a single mechanism may be responsible for multiple symptoms. Currently available diagnostic tools are inadequate to determine the best treatment using a mechanism-based model. Clinically, drug treatment of neuropathic pain is often a matter of treatment trials. This article presents a summary of available clinical information on first-line and lesser-known treatments for neuropathic pain.

Analgesics↗
PubMed2004

Continuous local anesthetic infusion for pain management after outpatient inguinal herniorrhaphy.

BACKGROUND: The purpose of the present study is to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a continuous wound infusion of bupivacaine to those who receive an infusion of saline. METHODS: A prospective, randomized, blinded, placebo-controlled trial was conducted in adults undergoing outpatient inguinal herniorrhaphy. Patients received saline or bupivacaine through a disposable infusion pump for 60 hours postoperatively. Pain outcomes were assessed, as were functional outcomes (activity, return of bowel function) and side effects. RESULTS: On postoperative day 1, patients who received bupivacaine had lower ratings for worst pain than patients who received saline, (5.0 +/- 2.3 vs 6.7 +/- 2.2, P=.002). On day 1, least pain ratings were also lower, and patients ambulated more frequently than those who received placebo. There were no differences between groups from postoperative days 2 to 5. There were no differences between groups in the amount of hydrocodone consumption. CONCLUSIONS: Continuous infusion of local anesthetic after inguinal herniorrhaphy provides modest improvements in pain scores and functional outcomes when compared with placebo. However, these effects are limited to the first postoperative day only. The additional costs associated with this intervention may limit its widespread use in clinical practice.

Adult↗
PubMed2003

Nonopioid and adjuvant analgesics in chronic pain management: strategies for effective use.

Nonopioid and adjuvant analgesics encompass a huge range of heterogenous drugs that differ chemically and mechanistically. These drugs generally are prescribed for mild-to-moderate pain, as coanalgesics for severe pain, or to target specific pain-generating mechanisms. This article provides an overview of some of the more commonly used nonopioid and adjuvant analgesics used to treat chronic pain, including salicylates, acetaminophen, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, anticonvulsants, N-Methyl-D-Aspartate receptor antagonists, lidocaine, skeletal muscle relaxants, and topical analgesics.

Acetaminophen↗
PubMed2002

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.

Activities of Daily Living↗
PubMed2002

Treatment of pain crisis at end of life from severe lower extremity venous outflow obstruction with hyperalgesia and allodynia.

Pain crisis in metastatic disease can be a therapeutic dilemma when differing mechanisms contribute to severe hyperalgesia and neuropathic pain. We discuss clinical presentation and management of excruciating pain from severe lower limb venous outflow obstruction in an opioid tolerant, terminally ill patient with locally invasive and metastatic adenocarcinoma of the cervix. This case illustrates how pain crises at end of life can be successfully managed by using a rational, complementary, multimodal approach. Key points include possible mechanisms of pain from venous outflow obstruction, benefit of hyperbaric subarachnoid bupivacaine, opioid rotation to methadone, and use of ketamine by mouth.

Journal Article↗
PubMedDate not supplied

Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005.

The Acute Pain Summit 2005 was convened to critically examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence. Clinicians with expertise in treatment of postsurgical pain were asked to evaluate 10 practice-based statements. The statements were written to reflect areas within the field of acute-pain management, where significant questions remain regarding everyday practice. Each statement made a specific claim about the usefulness of a specific therapy (eg, PCA or epidural analgesia) or the use of pain-control modalities in specific patient populations (eg, epidural analgesia after colon resection). Members of the American Society of Regional Anesthesia and Pain Medicine (ASRA) were asked, via a Web-based survey, to rate their degree of agreement with each of the 10 statements; 22.8% (n = 632) of members responded. In preparation for the pain summit, a panel member independently conducted a literature search and summarized the available evidence relevant to each statement. Summit participants convened in December 2005. The assigned panel member presented the available evidence, and workshop participants then assigned a category for the level of evidence and recommendation for each statement. All participants then voted about each statement by use of the same accept/reject scale used earlier by ASRA members. This manuscript details those opinions and presents a critical analysis of the existing evidence supporting new and emerging techniques used to control postsurgical pain.

Acute Disease↗
PubMedDate not supplied

Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty.

PURPOSE: The purpose of this study was to compare pain and anxiety in orthopaedic patients scheduled for elective total hip or knee arthroplasty who have received a kit of nonpharmacologic strategies for pain and anxiety in addition to their regularly prescribed analgesics to those who receive the usual pharmacologic management alone. DESIGN: Descriptive comparative and correlational design using surveys and chart audits. SAMPLE: Sixty-five patients randomized to receive usual care or usual care plus a kit of nonpharmacologic strategies. FINDINGS: Patients who received the kit used nonpharmacologic measures for pain and anxiety more often than patients who did not receive the kit. The kit group tended to use less opioid and have less anxiety on postoperative day 1 (not statistically significant) and use significantly less opioid on postoperative day 2 than the patients who did not receive the kit. There were no between-group differences in pain intensity. There were significant correlations among postoperative pain intensity, opioid use, and anxiety. The coping method of diverting attention was related to lower present (now) pain scores, and ignoring the pain was associated with higher worst pain. DISCUSSION: Providing a kit of nonpharmacologic strategies can increase the use of these methods for postoperative pain and anxiety and decrease the amount of opioid taken. The influence of coping strategies in acute postoperative pain needs to be examined further.

Adaptation, Psychological↗