Improving Outcomes of Analgesic Treatment: Is Education Enough?
Annals of Internal MedicinePublished 1 December 1990
Mitchell B. Max
Citations240
SJR quartileQ1
SJR score3.38
SNIP3.27
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Interventions may include monitoring and displaying patient pain ratings routinely, making available educational tools to assist optimal drug ordering, encouraging patients to communicate about unrelieved pain, reviewing quality assurance of pain treatment regimens, increasing behavioral research into analgesic prescribing, and selectively modifying narcotics regulatory practices.
Abstract
Frequent undertreatment of analgesic-responsive acute pain and chronic cancer pain persists, despite intensive efforts to provide clinicians with information about analgesics. A set of background factors must be addressed in interventions to improve pain treatment: Traditional patterns of clinician and patient interaction on the ward, quality assurance, and drug regulatory practices do not support prompt recognition and treatment of pain. Possible interventions to modify these patterns of daily practice include monitoring and displaying patient pain ratings routinely, making available educational tools to assist optimal drug ordering, encouraging patients to communicate about unrelieved pain, reviewing quality assurance of pain treatment regimens, increasing behavioral research into analgesic prescribing, and selectively modifying narcotics regulatory practices.
Keywords
Medicine
New England Journal of MedicineContinuous Improvement as an Ideal in Health Care
1,725 Citations1989Donald M. Berwick
Imagine two assembly lines, monitored by two foremen, one of whom has the means to measure the work, and the other who watches, and finds those among you who are unprepared or unwilling to do their jobs.
Annals of Internal MedicineUndertreatment of Medical Inpatients with Narcotic Analgesics
1,090 Citations1973Richard M. Marks, EDWARD J. SACHAR
Structured interviews of medical inpatients being treated with narcotic analgesics for pain showed that 32% of the patients were continuing to experience severe distress, despite the treatment, according to the authors.
New England Journal of MedicineImproving Drug-Therapy Decisions through Educational Outreach
862 Citations1983Jerry Avorn, Stephen B. Soumerai
Physicians who were offered personal educational visits by clinical pharmacists along with a series of mailed "unadvertisements" reduced their prescribing of the target drugs by 14 per cent as compared with controls, resulting in substantial cost savings.
New England Journal of MedicineProtocol-Based Computer Reminders, the Quality of Care and the Non-Perfectability of Man
811 Citations1976Clement J. McDonald
It appears that the prospective reminders do reduce errors, and that many of these errors are probably due to man's limitations as a data processor rather than to correctable human deficiencies.
PainPostsurgical pain relief: Patientsʼ status and nursesʼ medication choices
511 Citations1980Felissa L. Cohen
The adequacy of pain relief in hospitalized post‐surgical patients was assessed and described and ways in which nurses on the same units chose analgesic medications were examined and analyzed.
New England Journal of MedicineThe Physician's Responsibility toward Hopelessly Ill Patients
438 Citations1989Sidney H. Wanzer, Daniel D. Federman +10 more
The value of a sensitive approach to care is emphasized--one that is adjusted continually to suit the changing needs of the patient as death approaches, and the appropriate and, if necessary, aggressive use of pain-relieving substances is recommended.
PainIncidence and characteristics of pain in a sample of medical-surgical inpatients
434 Citations1987Marilee I. Donovan, Paula Dillon +1 more
Pain in hospitalized patients is more prevalent than has previously been reported, patients with pain continue to receive inadequate dosages of analgesics and the identification and treatment of patients withPain remains a significant health care problem.
Annals of NeurologyCentral nervous system excitatory effects of meperidine in cancer patients
411 Citations1983Robert F. Kaiko, Kathleen M. Foley +5 more
In 48 patients, excitatory effects ranging from mild nervousness to tremors, twitches, multifocal myoclonus, and seizures were directly correlated with accumulation of normeperidine in plasma, suggesting that renal dysfunction may contribute to but is not the sole factor in the accumulation ofnormeperidine or its relation to adverse neurological signs.
PainThe incidence of postoperative pain in children
408 Citations1983Laurence E. Mather, Josephine Mackie
There is considerable scope to improve pain management in children after surgery and this improvement must be based on improved education of medical and nursing staff in contemporary clinical pharmacology and on improved communication between staff, parents and patients.
Journal of Chronic DiseasesDoes patient education in chronic disease have therapeutic value?
350 Citations1982Steven A. Mazzuca
Behaviorally-oriented program, often with special attention to changing the environment in which patients care for themselves, were consistently more successful at improving the clinical course of chronic disease.
New England Journal of MedicineThe Quality of Mercy
304 Citations1982Marcia Angell
The treatment of severe pain in hospitalized patients is regularly and systematically inadequate, and it is generally agreed that most pain, no matter how severe, can be effectively relieved by narcotic analgesics.
JAMAAnalysis of Narcotic Analgesic Usage in the Treatment of Postoperative Pain
250 Citations1983Kampon Sriwatanakul
The optimal doses and duration of action of meperidine, as judged by the house staff and nurses, did not agree with the accepted pharmacologic profile of this drug.
Survey of AnesthesiologyAttitudes of Patients, Housestaff, and Nurses Toward Postoperative Analgesic Care
202 Citations1983Otto F. Weis, K. Sriwatanakul +3 more
The need for better and more comprehensive training of housestaff and nurses in analgesic care is emphasized, as there was no correlation between the amount of analgesic required postoperatively and either the degree to which patients believed pain builds character or the level to which they rated themselves sensitive to pain.
Medical CareQuality Assurance through Automated Monitoring and Concurrent Feedback Using a Computer-Based Medical Information System
193 Citations1978G. Octo Barnett, Richard N. Winickoff +3 more
A computer-based medical information system (COSTAR) has been used to support a quality assurance program where the data collection is an integral part of the patient care recording activity and, therefore, does not require a separate abstracting or encoding process.
Advances in Alcohol & Substance AbuseAmerican Opiophobia:
162 Citations1985John P. Morgan
Re-education might better be directed to the changing of mistaken attitudes about drug use and abuse that are part of the American culture and which are not amenable to alteration by medical education.
Anesthesia & AnalgesiaAttitudes of Patients, Housestaff, and Nurses Toward Postoperative Analgesic Care
132 Citations1983Otto F. Weis, Kampon Sriwatanakul +3 more
Archives of Internal MedicineReduction of Incorrect Antibiotic Dosing Through a Structured Educational Order Form
118 Citations1988Jerry Avorn
In a period of increasing constraints on hospital budgets and proliferating restrictions on physicians' clinical choices, educational intervention at the time orders are written can provide a cost-effective and noncoercive means of improving some forms of acute-care clinical decision making.
Arthritis & RheumatismEvaluation of a continuing education program in rheumatoid arthritis
116 Citations1980Jeoffrey K. Stross, Giles G. Bole
Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians.
Patient Education and CounselingEnhancing cancer pain control regimens through patient education
111 Citations1987Barbara K. Rimer, Michael Levy +4 more
A randomized clinical trial with a Solomon Four-Group design was used to assess the effectiveness of a patient education intervention consisting of nurse counseling and printed materials that aimed at improving cancer patients' pain control through a planned patient education program.
The Milbank Memorial Fund Quarterly Health and SocietyEfficacy and Cost-Containment in Hospital Pharmacotherapy: State of the Art and Future Directions
104 Citations1984Stephen B. Soumerai, Jerry Avorn
The pharmaceutical industry has taken a central role in continuing drug education for the practicing physician, but there is concern that the commercial origins of such efforts may have a biasing effect on the information thus provided.
JAMAThe Care of Patients With Severe Chronic Pain in Terminal Illness
102 Citations1984William T. McGivney
It is incumbent on the physician and on all others who care for the dying patient with severe chronic pain to understand clearly the dynamics of the pain experience, the clinical pharmacology of analgesics, and the needs of the patient, family, and friends.
Cambridge University Press eBooksMorbid Appearances
72 Citations1987Russell C. Maulitz
The context of English pathology, 1800-1830, and the London Academy of Minute Anatomy, after Waterloo: medical journalism and the surgeon-apothecaries are examined.
Academic MedicineEffect of physician tutorials on prescribing patterns of graduate physicians
53 Citations1981Lawrence E. Klein, Patricia Charache +1 more
A prospective controlled trial of a specific form of educational intervention, the physician tutorial, suggests that educational programs can be effective in modifying graduate physician prescribing practices.
Academic MedicineSkills of medical students and house officers in prescribing narcotic medications
47 Citations1985Stuart A. Grossman, Vivian R. Sheidler
Correct answers to the patient management questions markedly increased after instruction on the use of a narcotic equivalency table, and more emphasis on the importance of adequate pain control and better teaching of the pharmacology of narcotic analgesic drugs are needed in medical school and house staff training programs.
PubMedFederal and state regulation of opioids.
40 Citations1990Joranson De
Federal and state policy governing opioids is discussed in relation to achieving balance between efforts to control drug abuse and maintain drug availability for legitimate medical purposes and to improve communication between health care professionals and regulators.
Cancer NursingNurse$sA perceptions of cancer patient$sA pain
38 Citations1984MARGARET A. RANKIN, Bill Snider
A descriptive study of 52 nurses' perceptions of the pain suffered by patients with documented pain from terminal or metastatic cancer was conducted in a midwestern university hospital over a 33-week period and seemed to indicate that nurses often perceived moderate relief of pain as an appropriate goal.
Clinical Pharmacology & TherapeuticsDrug use in the hospital: Evaluation of determinants
32 Citations1974Franklin E. May, Ronald B. Stewart +1 more
The average patient drug exposure to index therapeutic drug groups was found to be significantly higher during the February‐March and April‐May periods than during the August‐September and December‐January periods of the study.
Journal of Clinical OncologyCancer pain education: a call for role models.
24 Citations1988David E. Weissman