Department of Orthopedic Surgery, Wayne State University, Detroit, MI 48202, USA.
Department of Orthopedics and Sports Medicine, Wayne State University, Detroit, MI 48202, USA.
Medicina (Kaunas). 2023 Nov 9;59(11):1976. doi: 10.3390/medicina59111976.
: Orthopedic surgeons commonly prescribe opioids, surpassing all medical specialties. Our objective was to develop a pain management scale that captures medication use, patient-reported pain scores, and helps orthopedic surgeons evaluate their post-operative prescribing practice. : An IRB-approved prospective study followed 502 post-operative orthopedic surgery patients over a six-month period. All patients were surveyed in an orthopedic clinic at a Level 1 US Trauma Center, during a routine follow-up. Patient pain satisfaction was assessed using the validated Interventional Pain Assessment (IPA) scale, which uses three categories: 0 (no pain), 1 (tolerable pain), and 2 (intolerable pain). Daily narcotic use was translated to morphine milligram equivalents (MMEs) using the Michigan Automated Prescription System (MAPS) narcotics registry. When patient pain satisfaction and narcotic usage were combined, this scale was called the Detroit Interventional Pain Assessment (DIPA) scale. : The five classes based on common prescription and usage of narcotics in this cohort include the following: A (no pain medication), B (over-the-counter medication), C (occasional use of short-acting narcotics 1-30 MMEs), D (consistent/regular use of short-acting narcotics 31-79 MMEs), and E (long-duration or stronger short-acting narcotics 80+ MMEs). Patients were most satisfied with their pain management at six weeks (80.5%) and three months (75.65%), and least satisfied at two weeks (62.5%) and six months (60.9%). Additional information displayed on the DIPA graph revealed there was a significant decrease in the percentage of patients on narcotics at two weeks (65.2%) to six months (32.6%) at < 0.001. : The DIPA pain scale shows the relationship between patient pain perception and opioid prescription/usage, while also tracking prescriber tendencies. Providers were able to visualize their post-operative pain management progression at each designated clinic visit with corresponding alphabetical daily MME categories. In this study, results suggest that surgeons were not effective at managing the pain of patients at two weeks post-operative, which is attributed to an inadequate number of pain pills prescribed upon discharge. Overall, the DIPA graph signaled that better pain management interventions are necessitated in periods with lower efficiency scores.
骨科医生通常会开出阿片类药物,超过所有其他医学专业。我们的目标是开发一种疼痛管理量表,该量表可以捕捉药物使用情况、患者报告的疼痛评分,并帮助骨科医生评估他们的术后处方实践。
一项经过机构审查委员会批准的前瞻性研究,在六个月的时间里跟踪了 502 名接受过术后骨科手术的患者。所有患者均在一家美国一级创伤中心的骨科诊所接受调查,在常规随访期间进行调查。患者疼痛满意度使用经过验证的介入性疼痛评估(IPA)量表进行评估,该量表使用三个类别:0(无痛)、1(可忍受的疼痛)和 2(无法忍受的疼痛)。使用密歇根州自动化处方系统(MAPS)麻醉品登记册将每日麻醉品使用量转换为吗啡毫克当量(MME)。当患者疼痛满意度和麻醉品使用量结合在一起时,该量表称为底特律介入性疼痛评估(DIPA)量表。
根据该队列中常见的处方和麻醉品使用情况,将其分为五类:A(无疼痛药物)、B(非处方药物)、C(偶尔使用 1-30 MME 的短效麻醉品)、D(持续/定期使用 31-79 MME 的短效麻醉品)和 E(使用时间长或更强效的短效麻醉品 80+MME)。患者对六周(80.5%)和三个月(75.65%)的疼痛管理最满意,对两周(62.5%)和六个月(60.9%)的疼痛管理最不满意。DIPA 图表上显示的其他信息表明,在两周时(65.2%)使用麻醉品的患者百分比在六个月时(32.6%)显著下降,<0.001。
DIPA 疼痛量表显示了患者疼痛感知与阿片类药物处方/使用之间的关系,同时还跟踪了处方者的倾向。提供者可以通过字母每日 MME 类别,在每个指定的诊所就诊时查看他们的术后疼痛管理进展。在这项研究中,结果表明,外科医生在术后两周时无法有效控制患者的疼痛,这归因于出院时开具的止痛片数量不足。总的来说,DIPA 图表表明,在效率得分较低的时期需要进行更好的疼痛管理干预。
J Shoulder Elbow Surg. 2017-12-14
J Am Acad Orthop Surg Glob Res Rev. 2021-9-2
JAMA Netw Open. 2020-10-1
J Am Acad Orthop Surg. 2021-3-1
J Bone Joint Surg Am. 2020-5-20
J Public Health Manag Pract. 2020
N Engl J Med. 2019-6-20
J Pain Res. 2017-12-18