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Module 2: Pain Management. Section I: Introduction to Pain Management. Definition of pain Status of pain Barriers to pain assessment and management VHA’s commitment to pain management. What is Pain?.

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Module 2: Pain Management


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    1. Module 2:Pain Management

    2. Section I:Introduction to Pain Management • Definition of pain • Status of pain • Barriers to pain assessment and management • VHA’s commitment to pain management

    3. What is Pain? • “An unpleasant sensory and emotional experience associated with actual or potential tissue damage”IASP, 2007 • “What the person says it is…” Pasero & McCaffery, 2011 • “Subjective” APS, 2008

    4. Current Status of Pain • >50% of cancer patients at EOL report pain • AIDS with prognosis < 6 months report intense pain • Less research conducted in chronic illness • Inadequate pain relief hastens death • Cost: $100 billion in lost productivity/annually APF, 2006; Paice 2010; Selwyn, 2007

    5. Barriers to Pain Relief • Lack of education • Importance of recognizing and addressing barriers • Specific barriers • Inadequate assessment • Fear of side effects • Fear of addiction/tolerance • Fear of respiratory depression • Fear of hastening death • Healthcare systems • Cost and reimbursement National Consensus Project (NCP), 2009

    6. Status of Pain Specific to Veterans Serving in Recent Conflicts • Pain is one of the most frequently reported symptoms since the Persian Gulf War • Headaches (54%) • Joint pain (45%) • Back pain (44%) • Muscle pain (33%) • Abdominal pain (23%) Gironda et al., 2006

    7. VHA and IHI Collaborative • History of VHA and IHI Collaborative • Goal: Improve pain management throughout 21 VISNs • 70 teams identified • Identified attributes of ideal pain management system

    8. Pain assessment Routine and timely Access Multidisciplinary team Specialty consults Treatment protocols Specific Understood by staff Healthcare providers Knowledgeable Veterans and families Education Pain management standards Facility-wide pain policy Education Outcomes Monitored/reviewed Improvements identified and implemented Cleeland et al., 2003 VHA and IHI Collaborative: Attributes of an Ideal Pain Management System

    9. VHA and IHI Collaborative: Results • Moderate or severe pain ↓ from 24% to 17% • Pain assessments ↑ from 75% to 85% • Pain care plans with at least mild pain ↑ from 58% to 78% • # of Veterans given pain educational materials ↑ from 35% to 62% Cleeland et al., 2003

    10. Future Objectives by VHA to Promote Effective Pain Management • Build on existing infrastructure • Develop partnerships with VHA and non-VHA organizations • Focus on pain across all clinical settings and pain conditions • Improve pain assessment and documentation • Promote cost-effective pain care • Promote staff education • Develop Veteran/family educational programs • Use performance improvement methods much more effectively Kerns et al., 2006

    11. Web-based information on pain from the VA: http://www.va.gov/painmanagement/

    12. STOP AND CONSIDER • Which barriers listed on slide 5 do you think are the biggest problems at your facility? • What efforts can be made to break-down these barriers in your institution? • On slide 10, which objectives are adhered to in your facility? Which one(s) need more attention? What can YOU do to improve pain management?