Effect of Complementary and Alternative Medicine on Pain Among Inpatients

补充和替代医学对住院患者疼痛的影响

• 批准号: 8269882
• 负责人: Jeffery A Dusek
• 金额: $ 61.26万
• 依托单位: ALLINA HEALTH SYSTEM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8269882
• 关键词: Accounting; Acupuncture procedure; Acute; Address; Admission activity; Adoption; Adverse event; Affect; American; Area; Caring; Characteristics; Clinical; Clinical Trials; Complement; Complementary and alternative medicine; Data Collection; Decision Making; Documentation; Dose; Drug Utilization; Effectiveness; Growth; Guidelines; Healed; Health; Health Priorities; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hour; Income; Inpatients; Institutes; Intervention; Joints; Knowledge; Length of Stay; Logit Models; Massage; Measures; Modeling; NIH Program Announcements; Narcotics; Observational Study; Operative Surgical Procedures; Outcome; Pain; Pain management; Patient Selection; Patient Self-Report; Patients; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Postoperative Period; Process; Productivity; Provider; Recovery; Regimen; Relaxation Techniques; Reporting; Research; Risk; Series; Services; Shapes; Subgroup; Surveys; Symptoms; Techniques; Therapeutic; Therapy Evaluation; Time; Triage; Visit; Work; addiction; base; body-mind; cost effectiveness; demographics; design; economic cost; healing; programs; prospective; rapid growth; systematic review; treatment as usual

DESCRIPTION (provided by applicant): Effective and safe pain management is a major health priority for the US healthcare system. Pharmaceutical interventions remain the primary approach to pain management, despite their well documented risk of adverse events, potential for addiction, and adverse impact on recovery if used excessively. Nowhere is this more evident than in the post-operative period where roughly 80% of patients report moderate to severe pain after surgery even after receiving pharmaceutical interventions. In inpatient settings, finding an effective non-pharmacologic intervention to augment narcotic medications would be a significant benefit. National surveys indicate that complementary and alternative medicine (CAM) interventions are currently used by 15% of American hospitals. Most often, these therapies are employed to address specific unmet clinical needs, the most frequent of which is pain. Eleven clinical trials have demonstrated the efficacy of CAM therapies to reduce pain (short- and long-term) in hospitalized patients along with traditional pharmaceutical interventions. Generating additional evidence of the effectiveness of these therapies for pain relief would advance knowledge and potentially affect practice patterns. In a preliminary study, we retrospectively studied 1,837 patients who received CAM therapies at Abbott Northwestern Hospital. We found an average reduction in immediate pain of 56% and roughly 33% reported complete pain relief after the initial CAM visit. We recognize inadequacies of this study that limit both our knowledge of how adjunctive CAM therapies are implemented in hospitals and the effect of various CAM therapies on pain management, which can only be answered with prospective data collection. Using a prospective, observational design, we propose a large scale study to build on this exploratory work. It will document predictors of CAM referral, service delivery, and therapy selection for pain management. It will also examine the impact of CAM therapies as adjuncts to traditional interventions on short and long-term changes in pain across clinical groups in a hospital setting. The setting for this study of CAM is the Penny George Institute for Health and Healing at Abbott Northwestern Hospital. The George Institute is uniquely suited for this work as it is the nation's largest inpatient CAM program serving over 19,000 patients since 2004. The proposed study has 3 aims: 1) quantitatively describe a model for delivering CAM therapies to understand selection of patients and CAM therapies for pain management, 2) examine the effects of selected CAM therapies on immediate change in pain, and 3) examine the effects of selected CAM therapies on duration of pain change. Positive results from this study will assist hospitals in the integration of usual care and CAM therapy for pain reduction. Findings may also drive future research on the cost effectiveness of these therapies for pain management, as well as impact on patient outcomes such as length of stay and use of narcotics.

描述（由申请人提供）：有效且安全的疼痛管理是美国医疗保健系统的主要健康优先事项。尽管过度使用，但药物干预仍然是疼痛管理的主要方法，尽管有充分的不良事件，成瘾的潜力以及对恢复的不利影响。在术后时期，这一点没有什么比这更明显的了，即使接受药物干预后，大约80％的患者即使在手术后举行中度至严重疼痛。在住院环境中，寻找有效的非药物干预以增加麻醉药物将是一个重大好处。 国家调查表明，目前有15％的美国医院使用互补和替代医学（CAM）干预措施。最常见的是，这些疗法被用来满足特定的未满足的临床需求，其中最常见的是疼痛。 11项临床试验表明，CAM疗法在医院患者中减轻疼痛（短期和长期）的功效以及传统的药物干预措施。为这些疗法缓解疼痛的有效性产生其他证据将提高知识并可能影响实践模式。 在一项初步研究中，我们回顾性地研究了1,837名在雅培西北医院接受CAM疗法的患者。我们发现直接疼痛的平均减少为56％，大约33％的疼痛报告在初次访问后完全缓解了疼痛。我们认识到这项研究的不足，这既限制了我们对医院辅助CAM疗法的实施以及各种CAM疗法对疼痛管理的影响的了解，这只能通过预期的数据收集来解决。 使用前瞻性，观察性设计，我们提出了一项大规模研究，以基于这项探索性工作。它将记录CAM推荐，服务提供和疼痛管理治疗选择的预测因子。它还将检查CAM疗法作为传统干预措施对医院环境中临床组疼痛的短期和长期变化的辅助作用的影响。 CAM研究的设置是雅培西北医院的Penny George Health and Healing研究所。乔治研究所（George Institute）非常适合这项工作，因为它是自2004年以来为19,000多名患者提供服务的全国最大的住院CAM计划。拟议的研究具有3个目的：1）定量描述了一种用于提供CAM疗法的模型，以了解患者的选择和CAM疗法的选择，并了解疼痛管理的疼痛管理，2）检查对疼痛的疼痛效果的影响，并检查了对疼痛的影响效果的影响，并检查了对疼痛的影响以及3次疼痛的影响。 这项研究的积极结果将帮助医院整合通常的护理和CAM治疗，以减轻疼痛。调查结果还可能推动对这些疗法对疼痛管理的成本效益的未来研究，以及对患者预后的影响，例如停留时间和使用麻醉品。