Management of chronic nonmalignant pain with nonsteroidal antiinflammatory drugs. Joint opinion statement of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy.

Chronic nonmalignant pain is a major burden on the health care system in the United States. Frequently, nonsteroidal antiinflammatory drugs (NSAIDs) are used to assist in the management of various chronic pain syndromes. Although evidence is accumulating on the potential toxicities associated with NSAIDs, clear recommendations are lacking to guide the appropriate use of these drugs. Equivocal data, especially with respect to cardiovascular risk, further confuse a clear treatment pathway when assessing pharmacotherapy. Originally, cyclooxygenase selectivity appeared to be a determining factor in choosing an agent because of the presumed lack of effect on the cardiovascular and gastrointestinal renal systems. This theory, however, was recently dispelled. To provide guidance on the selection of an NSAID for various chronic pain syndromes, members of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy evaluated evidence-based use of NSAIDs for frequently encountered pain syndromes, with special focus on the adverse effects of this class of agents.

Challenges in acute post-operative pain management.

PURPOSE: The epidemiology of acute post-operative pain is reviewed. Data from retrospective studies of the effectiveness of post-operative pain treatment are summarized. The impact of undertreatment of post-operative pain is discussed. Efficacy, safety, and the potential for error associated with intramuscular, intravenous, and epidural modes of analgesia are reviewed. SUMMARY: Seventy-three million patients undergo surgical procedures each year in the United States. Of these, 80% experience acute post-operative pain, and approximately 20% experience severe pain. Clinical, psychologic, and institutional consequences may arise from inadequate pain management. There is strong evidence that the intermittent intramuscular administration of opioids results in higher rates of both moderate-to-severe and severe pain. CONCLUSION: There exists a need for interventions that are patient focused and characterized by ease of use, improved adverse-effect and safety profiles, and manageable overall costs.

Evaluation of a behavioral assessment tool for the individual unable to self-report pain.

Assessment of pain intensity using a standard self-reported pain score is standard practice in most institutions. These instruments require the cognitive ability to process the pain intensity into a numeric or descriptive value. Many institutions are considering adopting an assessment tool for cognitive impairment. The purpose of this study is to evaluate a clinician-administered assessment tool, PAINAD, in patients with cognitive impairment. Opioid consumption and frequency of documented unknown pain were collected in 2 cognitive impaired groups. In the control group, a self-reporting pain intensity tool was used, and in a second group, the PAINAD was used. Opioid use was significantly higher (P = .003) and the rates of reported unknown pain were significantly lower (P < .01) in the group using the PAINAD instrument compared to the control group of patients with cognitive impairment. There were no noted differences in opioid-induced adverse reactions in either group.