Pain management nursing : official journal of the American Society of Pain Management Nurses
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Misuse of prescription opioids is a public health crisis in the United States. In 2016, it was estimated that 3.3 million Americans were misusing prescription opioids (SAMHSA, 2017) and nearly 63,632 deaths were due to prescription opioid misuse. From 1999 to 2010, the number of prescription opioid drugs sold to health care facilities from pharmaceutical companies, nearly quadrupled. Cesarean delivery is the most common surgical procedure performed in the United States and opioids are most often chosen to manage post-operative pain. Research has shown that women, who deliver via cesarean section, are prescribed an excess of opioid tablets upon discharge and often store them in unsecure locations. Furthermore, the vast majority, are not disposed of properly. ⋯ Engaging post-operative patients in decisions regarding pain management, educating women on multi-modal methods to manage pain, and providing women with a means to properly dispose of excess tablets, can reduce opioid tablets available for misuse and diversion in the community.
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Assessing and managing pain while evaluating risks associated with substance use and substance use disorders continues to be a challenge faced by health care clinicians. The American Society for Pain Management Nursing and the International Nurses Society on Addictions uphold the principle that all persons with co-occurring pain and substance use or substance use disorders have the right to be treated with dignity and respect, and receive evidence-based, high quality assessment, and management for both conditions. The American Society for Pain Management Nursing and International Nurses Society on Addictions have updated their 2012 position statement on this topic supporting an integrated, holistic, multidimensional approach, which includes nonopioid and nonpharmacological modalities. ⋯ Opioids should not be excluded for anyone when indicated for pain management. A team-based approach is critical, promotes the active involvement of the person with pain and their support systems, and includes pain and addiction specialists whenever possible. Health care systems should establish policies and procedures that facilitate and support the principles and recommendations put forth in this article.
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Heart rate variability biofeedback (HRVB) is a self-management strategy that guides individuals to breathe at a designated resonance frequency of the cardiovascular system. Resonant breathing may reduce FM-related symptoms as well as improve physical functioning and quality of life. Although prior research recommends HRVB for chronic pain, we found no studies testing the feasibility for individuals with FM regarding protocol adherence or acceptability of the treatment. ⋯ Results of this study suggest difficulties operating the emWave2 and scheduling challenges interfered with HRVB implementation. However, veterans reported self-awareness of the benefits of HRVB, positive physiological effects, and improved psychological effects. Future studies require a larger sample size to provide a deeper insight.
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Presurgical and Postsurgical Opioid Rates in Patients Undergoing Total Shoulder Replacement Surgery.
The purpose of this study was to describe the pre- and postsurgical opioid prescription rates and average morphine milligram equivalents (MME) per day in patients undergoing total shoulder replacement (TSR) procedures. ⋯ Although presurgical non-opioid patients were more likely to receive a postsurgical opioid prescription, based on dosage, most patients were at low risk for an opioid-related overdose or death according to CDC guidelines.