Articles: pain-clinics.
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Comparative Study
Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons.
The treatment of acute pain remains unsatisfactory despite advances in pain research and the publication of numerous guidelines. The aim of this study was to survey postoperative and emergency room acute pain treatment in Switzerland, particularly regarding compliance with practice guidelines on therapeutic responsibility, treatment algorithms, pain documentation, quality control and education. A representative sample of anaesthesiologists and surgeons (general and orthopaedic) was selected from all Swiss hospitals with regular surgical activity and sent a 256 point questionnaire on acute pain management. ⋯ Respondents accept the contribution of postoperative and emergency room analgesia to reduced costs and improved medical outcomes. Asked to highlight their major concerns in acute pain management, lack of education and inadequate organisation are listed in first and second positions. This survey suggests that compliance with published practice guidelines for acute pain management can be improved, and highlights the need for continuing organisational and educational development in acute analgesia, particularly for the emergency room.
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Treatment satisfaction is an increasingly popular outcome measure in pain management. While it is a subjective variable, it may nonetheless reflect the quality of care and it may predict other important patient behaviors. The purpose of this study was to prospectively evaluate predictors of satisfaction with treatment for chronic pain. ⋯ Changes in pain, depression, and pain-related anxiety were associated with treatment satisfaction but change in pain was a relatively weak predictor. Nine of the 16 characteristics of the patient's clinic experience correlated with treatment satisfaction. Regression analyses showed that the strongest unique predictors of treatment satisfaction were the patients feeling their evaluation was complete, believing they received an explanation for clinic procedures, and finding that treatment helped them improve their daily activity.
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A prospective cohort study on chronic non-malignant pain patients was performed to describe health consequences and changes in use of health care resources and social transfers following multidisciplinary pain treatment. Patients, referred to a Danish Multidisciplinary Pain Center (MPC), were evaluated during four periods: six months prior to referral, waiting list period, intervention, nine months follow-up. ⋯ pain intensity (VAS), The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), The Psychological General Well-Being Index (PGWB), The Hospital Anxiety and Depression Scale (HAD). Use of health care resources and social transfers were retrieved from public registers. Statistically significant improvements were obtained in pain intensity, SF-36 bodily pain, PGWB index and subscores vitality, and general health at discharge and follow-up. Intervention costs amounted to EUR 1102 (SD 721). Health care costs were not significantly reduced, but significant reductions in social transfers were seen.
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The goals of this study were to define the endpoints of pain research that are important to patients with chronic pain and to identify clinical and demographic variables that are associated with patients' choices of endpoints. ⋯ These data suggest that empirical research can provide data to guide the choice of endpoints in clinical studies of pain interventions.