2. For adults with SCD who have chronic pain related to SCD, the ASH guideline panel suggests other provider- delivered integrative approaches (e.g., massage therapy and acupuncture) as available and as tolerated and conditional upon individual patient preference and response. These approaches should be delivered in the context of a comprehensive disease and pain management plan (conditional recommendation based on very low certainty in the evidence about effects). Nonopioid pharmacological therapies for chronic SCD Pain with another identifiable cause Care Question : Should nonopioid pharmacological therapy, either in addition to or instead of opioids or other usual care interventions, be used for children and adults with SCD and chronic pain with another identifiable cause (e.g., avascular necrosis, leg ulcers)? 1. For adults with SCD who have chronic (as opposed to episodic) pain from the SCD-related identifiable cause of avascular necrosis of bone, the ASH guideline panel suggests the use of duloxetine (and other serotonin and norepinephrine reuptake inhibitor [SNRI] medications, because there is evidence of a class effect) as an option for management, in the context of a comprehensive disease and pain management plan (conditional recommendation based on very low certainty in the evidence about effects). 2. For adults with SCD who have chronic (as opposed to episodic) pain from the SCD-related identifiable cause of avascular necrosis of bone, the ASH guideline panel suggests the use of NSAIDs as an option for management, in the context of a comprehensive disease and pain management plan (conditional recommendation based on very low certainty in the evidence about effects). Nonopioid pharmacological therapies for chronic SCD pain with no identifiable cause Care Question : Should nonopioid pharmacological therapy, either in addition to or instead of opioids or other usual care interventions, be used for children and adults with SCD and chronic pain with no identifiable cause beyond SCD? Guidelines on the management of postoperative pain This guideline is considered the most referenced in the clinical care of postoperative pain in adults and children. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and the development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. The following guidelines are the recommendations as they relate to the theme of this course. Preoperative education and perioperative pain management planning 1. The panel recommends that clinicians provide patient and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for the management of postoperative pain, and document the plan and goals for postoperative pain management. 2. The panel recommends that the parents (or other adult caregivers) of children who undergo surgery receive instruction in developmentally appropriate methods for
1. For adults who have SCD-related chronic pain with no identifiable cause beyond SCD, the ASH guideline panel suggests SNRIs (e.g., duloxetine and milnacipran) as options for pain management (conditional recommendation based on very low certainty in the evidence about effects). 2. For adults who have SCD-related chronic pain with no identifiable cause beyond SCD, the ASH guideline panel suggests tricyclic antidepressants (TCAs; e.g., amitriptyline) as an option for pain management (conditional recommendation based on very low certainty in the evidence about effects). 3. For adults who have SCD-related chronic pain with no identifiable cause beyond SCD, the ASH guideline panel suggests gabapentinoids (e.g., pregabalin) as options for pain management (conditional recommendation based on very low certainty in the evidence about effects). Chronic opioid therapy for chronic pain in SCD Care Question : Should COT vs no COT or periodic opioid therapy be used in patients with SCD who have chronic pain? 1. For adults and children with SCD and emerging and/ or recently developed chronic pain, the ASH guideline panel suggests against the initiation of COT unless pain is refractory to multiple other treatment modalities (conditional recommendation based on very low certainty in the evidence about effects). 2. For adults and children with chronic pain from SCD who are receiving COT, are functioning well, and have perceived benefits, the ASH guideline panel suggests shared decision-making for the continuation of COT (conditional recommendation based on very low certainty in the evidence about effects). 3. For adults and children with chronic pain from SCD who are receiving COT, are functioning poorly, or are at high risk for aberrant opioid use or toxicity, the ASH guideline panel suggests against the continuation of COT (conditional recommendation based on very low certainty in the evidence about effects). assessing pain as well as counseling on the appropriate administration of analgesics and modalities. 3. The panel recommends that clinicians conduct a preoperative evaluation including an assessment of medical and psychiatric comorbidities, concomitant medications, history of chronic pain, substance abuse, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan. 4. The panel recommends that clinicians adjust the pain management plan based on the adequacy of pain relief and the presence of adverse events. 5. The panel recommends that clinicians use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly. Use of multimodal therapies in postoperative pain care 1. The panel recommends that clinicians offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacological interventions, for the treatment of postoperative pain in children and adults. Use of physical modalities 1. The panel recommends that clinicians consider transcutaneous electrical nerve stimulation (TENS) as an adjunct to other postoperative pain treatments. 2. The panel can neither recommend nor discourage acupuncture, massage, or cold therapy as adjuncts to other postoperative pain treatments.
Book Code: PYFL4024
EliteLearning.com/Psychology
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