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Evaluation of Pain Relief Outcomes With Topical Applications of 0.1% Morhpine in Intrasite Gel® to Open, Painful Wounds
Meeting Abstracts
function in osteoparthritis pain patients. A prospective, multicenter, open-label effectiveness trial. Osteoarthritis Cartilage 12(3), 253-255. Dworkin, R.H., Backonja, M., Rowbotham, M.C., Allen, R.R., Argoff, C.R., Bennett, G.J., Bushnell, M.C., Farrar, J.T., Galer, B.S., Haythornthwaite, J.A., Hewitt, D.J., Loeser, J.D., Max, M.B., Saltarelli, M., Schmader, K.E., Stein, C., Thompson, D., Turk, D.C., Wallace, M.S., Watkins, L.R., & Weinstein, S.M. (2003). Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Archives of Neurology, 60(11), 1524-1534. Meier, T., Wasner, G., Faust, M., Kuntzer, T., Ochsner, F., Hueppe, M., Bogousslavsky, J., & Baron, R. (2003). Pain 106(1-2), 151-158. White, W.T., Patel, N., Drass, M., & Nalamachu, S. (2003). Lidocaine patch 5% with systemic analgesics such as gabapentin: A rational polypharmacy approach for the treatment of chronic pain. Pain Medicine, 4(4), 321-330. Evaluation of Pain Relief Outcomes With Topical Applications of 0.1% Morhpine in Intrasite Gel® to Open, Painful Wounds Debra Drew, APRN, BC; Christine Peltier, BSN, RN Fairview University Medical Center, Minneapolis, Minnesota RELEVANCE TO AMERICAN SOCIETY FOR PAIN MANAGEMENT NURSING Nurses are challenged with providing optimal analgesia that will support comfort and function with minimal drug side effects. Topical analgesics typically are indicated only for application to intact skin. An effective topical analgesic that can be applied to inflamed or open skin lesions would add greatly to the array of pain therapies. Local analgesia could decrease the need for systemic analgesics and decrease the associated systemic side effects. RESEARCH QUESTION What effect does using 0.1% morphine sulfate in Intrasite Gel® (Smith & Nephew, London, England) in open, painful wounds have on pain ratings and use of systemic opioids? BACKGROUND Interest in topical morphine for use in painful wounds was spurred by discovery of mu receptor activity in the peripheral nervous system. Peripheral opioid receptors are dormant in normal tissue but activate within minutes in response to inflammation. The exact mechanism of exogenous morphine binding to peripheral opioid receptors continues to be investigated. DESIGN This study is a noncontrolled, descriptive, retrospective review of medical records. A convenience sample of approximately 40 inpatients will be derived from two sources. • The pharmacy’s list of prescriptions filled for 0.1% morphine in Intrasite Gel® for inpatients in the last 24 months. • The inpatient Pain Management Consult Service database identifying inpatients who have received 0.1% morphine in Intrasite Gel®.
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DATA ANALYSIS Specific data to be gathered will include patient age, gender, type/size/location of wound, subjective pain rating, and opioid morphine equivalents before and after application of 0.1% morphine in Intrasite Gel®. Statistical analysis will be conducted using a paired t test or repeated-measures analysis of variance if data are normally distributed. If data result in a non-normal distribution, then the Wilcoxon, Kruskall Wallis, or Friedman test will be used. Care Management of Chronic Pain in the Primary Care Clinics Judith Engen, RN; Isaac Bernal, RN; Cynthia McCorvey, MSN, RN New Mexico VA Health Care System, Albuquerque, New Mexico The purpose of this poster abstract is to demonstrate how care managers in the primary care setting facilitate improved access to care for patients with chronic pain and how this improved access to care leads to enhanced and more sustained outcomes for patients. This project will show that patients assigned to care managers have decreased pain levels, decreased aberrant behaviors, and increased compliance and function. Outcome measurement will be presented through data collected from medical record reviews and patient satisfaction surveys. A Web-Based Survey of Pain Management Nurses: Practice Characteristics and Experiences with Intrathecal Therapy Diane Wheeler, PhD, RN; Sidney Spector, MD, PHD; Rosemary Polomano, PhD, RN, FAAN Elan Pharmaceuticals, Dublin, Ireland PURPOSE The study evaluates clinical practice experiences unique to pain management nurses and assesses nurses’ attitudes toward intrathecal (IT) therapy and PRIALT® (ziconotide intrathecal infusion, Elan Pharmaceuticals, Inc., San Diego, CA), a new nonopioid IT analgesic. METHODS A Web-based survey targeted nurses with more than 2 years and less than 40 years of experience practicing in anesthesiology-based chronic pain management settings, pain management and rehabilitation, or neurosurgical or orthopedic nursing. Nurses personally managed three or more patients receiving IT therapy and worked in practices in which at least 35% of patients are treated for chronic pain. Results from this survey were not confirmed by other health care professionals. RESULTS Sixty-nine targeted nurses completed the survey. Clinics averaged 646 patients; 81% of patients in these practices experienced nonmalignant pain, 10% experienced cancer-related pain; 1% had human immunodeficiency virus/acquired immune deficiency syndrome-related pain; and 8% experienced other types of pain. The per-clinic mean percentage of
function in osteoparthritis pain patients. A prospective, multicenter, open-label effectiveness trial. Osteoarthritis Cartilage 12(3), 253-255. Dworkin, R.H., Backonja, M., Rowbotham, M.C., Allen, R.R., Argoff, C.R., Bennett, G.J., Bushnell, M.C., Farrar, J.T., Galer, B.S., Haythornthwaite, J.A., Hewitt, D.J., Loeser, J.D., Max, M.B., Saltarelli, M., Schmader, K.E., Stein, C., Thompson, D., Turk, D.C., Wallace, M.S., Watkins, L.R., & Weinstein, S.M. (2003). Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Archives of Neurology, 60(11), 1524-1534. Meier, T., Wasner, G., Faust, M., Kuntzer, T., Ochsner, F., Hueppe, M., Bogousslavsky, J., & Baron, R. (2003). Pain 106(1-2), 151-158. White, W.T., Patel, N., Drass, M., & Nalamachu, S. (2003). Lidocaine patch 5% with systemic analgesics such as gabapentin: A rational polypharmacy approach for the treatment of chronic pain. Pain Medicine, 4(4), 321-330. Evaluation of Pain Relief Outcomes With Topical Applications of 0.1% Morhpine in Intrasite Gel® to Open, Painful Wounds Debra Drew, APRN, BC; Christine Peltier, BSN, RN Fairview University Medical Center, Minneapolis, Minnesota RELEVANCE TO AMERICAN SOCIETY FOR PAIN MANAGEMENT NURSING Nurses are challenged with providing optimal analgesia that will support comfort and function with minimal drug side effects. Topical analgesics typically are indicated only for application to intact skin. An effective topical analgesic that can be applied to inflamed or open skin lesions would add greatly to the array of pain therapies. Local analgesia could decrease the need for systemic analgesics and decrease the associated systemic side effects. RESEARCH QUESTION What effect does using 0.1% morphine sulfate in Intrasite Gel® (Smith & Nephew, London, England) in open, painful wounds have on pain ratings and use of systemic opioids? BACKGROUND Interest in topical morphine for use in painful wounds was spurred by discovery of mu receptor activity in the peripheral nervous system. Peripheral opioid receptors are dormant in normal tissue but activate within minutes in response to inflammation. The exact mechanism of exogenous morphine binding to peripheral opioid receptors continues to be investigated. DESIGN This study is a noncontrolled, descriptive, retrospective review of medical records. A convenience sample of approximately 40 inpatients will be derived from two sources. • The pharmacy’s list of prescriptions filled for 0.1% morphine in Intrasite Gel® for inpatients in the last 24 months. • The inpatient Pain Management Consult Service database identifying inpatients who have received 0.1% morphine in Intrasite Gel®.
119
DATA ANALYSIS Specific data to be gathered will include patient age, gender, type/size/location of wound, subjective pain rating, and opioid morphine equivalents before and after application of 0.1% morphine in Intrasite Gel®. Statistical analysis will be conducted using a paired t test or repeated-measures analysis of variance if data are normally distributed. If data result in a non-normal distribution, then the Wilcoxon, Kruskall Wallis, or Friedman test will be used. Care Management of Chronic Pain in the Primary Care Clinics Judith Engen, RN; Isaac Bernal, RN; Cynthia McCorvey, MSN, RN New Mexico VA Health Care System, Albuquerque, New Mexico The purpose of this poster abstract is to demonstrate how care managers in the primary care setting facilitate improved access to care for patients with chronic pain and how this improved access to care leads to enhanced and more sustained outcomes for patients. This project will show that patients assigned to care managers have decreased pain levels, decreased aberrant behaviors, and increased compliance and function. Outcome measurement will be presented through data collected from medical record reviews and patient satisfaction surveys. A Web-Based Survey of Pain Management Nurses: Practice Characteristics and Experiences with Intrathecal Therapy Diane Wheeler, PhD, RN; Sidney Spector, MD, PHD; Rosemary Polomano, PhD, RN, FAAN Elan Pharmaceuticals, Dublin, Ireland PURPOSE The study evaluates clinical practice experiences unique to pain management nurses and assesses nurses’ attitudes toward intrathecal (IT) therapy and PRIALT® (ziconotide intrathecal infusion, Elan Pharmaceuticals, Inc., San Diego, CA), a new nonopioid IT analgesic. METHODS A Web-based survey targeted nurses with more than 2 years and less than 40 years of experience practicing in anesthesiology-based chronic pain management settings, pain management and rehabilitation, or neurosurgical or orthopedic nursing. Nurses personally managed three or more patients receiving IT therapy and worked in practices in which at least 35% of patients are treated for chronic pain. Results from this survey were not confirmed by other health care professionals. RESULTS Sixty-nine targeted nurses completed the survey. Clinics averaged 646 patients; 81% of patients in these practices experienced nonmalignant pain, 10% experienced cancer-related pain; 1% had human immunodeficiency virus/acquired immune deficiency syndrome-related pain; and 8% experienced other types of pain. The per-clinic mean percentage of