Dialing Back on Pain
Pain Research Drives Many of MCW's Patient Care Efforts
MCW physicians are conducting and translating research to improve pain care for both adults and pediatric patients.
On the pediatric side, Amy Drendel, DO, (pictured below), has developed a simplified pain assessment tool based around a construct widely understood by parents and pediatric patients alike – the stoplight. The pain assessment tool has three options for pain reporting:
- "green" (the child feels OK)
- "yellow" (the child is not sure and should be reassessed)
- "red" (the child is hurting and something is needed to make the child feel better)
The goal of the project is to get this assessment tool in the hands of parents and improve the treatment of pain for children after they have been discharged from the emergency department.
"The child's self-report has come to the forefront because as medical providers, we often don't do a good job assessing children's pain severity by observing them," says Dr. Drendel.
"The gold standard for pain assessment is the traditional 10-point pain scale. For children, a pain scale with faces has been used to simplify pain assessment. Even though there are pain assessment tools made specifically for children, kids have historically been undertreated for pain."
The project to validate the Stoplight Pain Tool is a collaboration with Keri Hainsworth, MS, PhD, MCW associate professor of anesthesiology, (pictured right), and has been tested on pediatric patients with arm fractures because they are common (more than 700 children per year are treated for arm fractures at Children's), and because they all experience similar acute pain – but the goal is to use the tool for any child experiencing pain.
Another tool Dr. Drendel created to more effectively manage pediatric pain is a two-page comic designed to provide discharge instructions to kids and conveys three main points about pain care.
Amy Drendel, DO
Keri Hainsworth, MS, PhD
The comic has proven to be likeable, easy to read and effective in educating both patients and parents about how to manage pain at home; 86 percent of parents had accurate recall of the three main points 72 hours after their child was provided the comic. Dr. Drendel and Aaron Hanson, MD, are now evaluating the best distribution model for the comic.
Dr. Drendel also has developed an automated texting tool with Sheikh Iqbal Ahamed, PhD, and members of the Marquette University department of mathematics, statistics and computer science to collect patient-reported outcomes after discharge from emergency departments. The texts serve as daily check-ins to evaluate pain levels and medication use.
"Texting has totally changed how I do research," notes Dr. Drendel. "No research staff is needed to call parents, and these research queries don't interrupt the patient's daily activities; they can respond to the texts on their time, so participants like it – and it opens up my research to multi-site studies because we can follow outcomes for patients anywhere in the country centrally. Texting has the potential to supercharge our efforts to better understand the at-home pain for children and more effectively improve their functional outcomes – especially in the outpatient setting, which historically has been tougher because we can't keep an eye on the patient."
On the adult side, Robert Hurley, MD, PhD; Meredith Adams, MD; Sarah Endrizzi, MD; Stacy Peterson, MD, GME '11, FEL '12 and '13; and Gwynne Kirchen, MD, are conducting a variety of research projects to improve the treatment of adult patients with acute and chronic pain.
Dr. Adams (pictured left) recently was awarded a grant to identify opioid response phenotypes in low back pain electronic health data. Lower back pain is the leading cause of disability worldwide, but not much data exists to develop predictive models for clinical care.
As part of the project, Dr. Adams will examine opioid response patterns for patients with lower back pain and translate their clinical experiences into discrete and analyzable data. The database created from this effort will provide a foundation for advancing clinical care as well as future approaches to genomic and personalized medicine.
Dr. Hurley (pictured right) introduced a clinical research warehouse bank to collect and store electronically obtained patient-reported outcomes using the Collaborative Health Outcomes Information Registry platform from Froedtert and the Medical College of Wisconsin health network (F&MCW) and Children's patients.
The primary benefit of this registry is to bring together patient-reported clinical data from disparate clinical sources into a single repository and store it in a manner easily accessible by researchers. Data from this will enhance future pain research efforts, and as a result, improve pain care.
Currently the Pain Psychology Service also has two ongoing research projects to assess outcomes of heart rate variability biofeedback training and functional improvement during Spinal Cord Stimulator trials to determine if this combined therapy increases the efficacy of pain management.
Additionally, a pilot program being developed with MCW's department of orthopedic surgery will include a "prehabilitation" model. This is based on the observation that when the care team takes better and more consistent care of patients, patients are happier, their satisfaction scores increase and fewer opioids are used. It is common for patients to be taking opioids before surgery, so this model will optimize patient physical function and medication regimen from a pain standpoint in order to reduce opioid use prior to surgery – which, in turn, should reduce opioid use post-surgery.
New Acute-Pain Classification System
A professor in MCW's department of anesthesiology's division of pain medicine has contributed to a significant publication outlining a new acute-pain classification system.
Steven Weisman, MD, (pictured left), was part of an expert panel that recently published "The ACTTION–APS–AAPM Pain Taxonomy (AAAPT) Multidimensional Approach to Classifying Acute Pain Conditions," which appeared in both Pain Medicine and the Journal of Pain. "With the increasing societal awareness of the prevalence and impact of acute pain," states the article's objective, "there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain."
The expert panel involved the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM). The AAAPT pain classification system is designed to classify acute pain according to the following dimensions: 1) core criteria; 2) common features; 3) modulating factors; 4) impact/functional consequences; and 5) putative pathophysiologic pain mechanisms.
– Anthony Braza • Greg Calhoun • Sara L. Wilkins
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