Pain practice : the official journal of World Institute of Pain
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National survey data indicate that more than 25% of American adults suffer from pain that lasts for more than 24 hours in duration. Chronic pain can have a devastating impact on an individual's relationships, daily functioning, and employment. ⋯ Many clinicians feel that managing side effects, identifying and managing potential drug abusers, and navigating regulatory and legal issues can make pain management a complicated undertaking. This review discusses key patient assessment and treatment strategy tools, together with common medico-legal concerns to assist clinicians in more effectively managing their patients' pain.
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Delirium is an acute fluctuating disturbance in cognitive status, linked to increased morbidity and mortality. The purpose of this pilot study was to assess the feasibility in terms of required time and yield of delirium monitoring by the Acute Pain Service (APS) using the Confusion Assessment Method for Intensive Care Unit instrument. ⋯ The use of this tool required little training, and only 2 minutes per patient. It detected more patients with delirium than did the standard nursing assessments or other patient-clinician interactions. The use of this instrument by the pain service was feasible in terms of time consumption and most likely would be valuable in its yield. Early detection may help in initiating prompt treatment, eliminating known risk factors and thus reducing morbidity.
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Informed consent is important: in research, it allows subjects to make an informed and voluntary choice to participate--or refuse to participate--in a project where they will be asked to take risks for the benefit of others. In both research and clinical care, informed consent represents a permission to intervene on a person's private sphere. The elements of informed consent are usually described as disclosure, understanding, decision-making capacity, and voluntariness. ⋯ Moreover, trust is a motivating factor for research participation, and thus we run risks if we allow false expectations and prove ourselves unworthy of this trust. Although improving consent forms does not have a clear effect on understanding, improving the consent process may help. Finally, better information may decrease anxiety and seems to have at most a small negative effect on research recruitment.