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1.
Arch Intern Med ; 165(14): 1574-80, 2005 Jul 25.
Article in English | MEDLINE | ID: mdl-16043674

ABSTRACT

BACKGROUND: The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. METHODS: Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. RESULTS: The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. CONCLUSION: Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.


Subject(s)
Neoplasms/complications , Pain Management , Pain/etiology , Total Quality Management , Acute Disease , Humans , Outcome Assessment, Health Care , Pain Measurement , Patient Participation , Practice Guidelines as Topic , Societies, Medical , Treatment Outcome , United States
2.
Pain ; 22(3): 271-277, 1985 Jul.
Article in English | MEDLINE | ID: mdl-3162134

ABSTRACT

The current study investigated the utility of the Back Pain Classification Scale with chronic, intractable low back pain and headache patients. Subjects consisted of 50 chronic low back pain and 50 chronic headache patients referred to a university based Pain Center for evaluation. Data indicated that subjects were a representative sample of severely intractable chronic pain patients typically referred for Pain Center evaluation and treatment. Each was administered the Back Pain Classification Scale as part of a thorough physical and psychological/behavioral evaluation. All subjects were classified by blind review of medical records into one of two categories: (1) presence of psychopathologically based pain complaint with little or no pathophysiological findings and (2) presence of pathophysiologically based pain complaints with little or no psychopathological findings. Subjects were also independently classified from blind review of their scores on the Back Pain Classification Scale into one of these two categories. Findings revealed that the Back Pain Classification Scale accurately predicted the actual classification of 80% of the low back pain patients (i.e., 30% above baseline prediction rate) and only 60% of the chronic headache patients (i.e., only equal to the baseline prediction rate). Furthermore, the scale was found to be most accurate in predicting low back pain patients with primary psychopathologically based pain. It was concluded that the Back Pain Classification Scale was an empirically valid instrument to use with chronic low back pain patients, but not with chronic headache patients. This lack of utility with chronic headache patients was also viewed as support for the construct validity of the scale. Wider use of the scale with chronic low back pain patients was suggested.


Subject(s)
Back Pain/classification , Pain, Intractable/classification , Psychological Tests , Adult , Back Pain/psychology , Female , Headache/classification , Headache/psychology , Humans , Male , Pain, Intractable/psychology
3.
Pain ; 9(1): 103-109, 1980 Aug.
Article in English | MEDLINE | ID: mdl-7422335

ABSTRACT

A portable low-cost instrument system for reliable and automatic measurement of "up-time" in chronic pain patients was described. The system used a miniature electronic stopwatch/calculator to accumulate up-time. A mercury tilt switch mounted on the outer thigh was used to control time accumulation. Performance assessment showed excellent reliaility, as well as high concurrent validity (r = 0.999) for the system. Initial field testing with normal subjects and chronic pain patients indicated reliable and easy operation.


Subject(s)
Behavior Therapy/instrumentation , Pain, Intractable/therapy , Humans , Pain, Intractable/physiopathology , Self-Assessment
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