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: 8075342
• 负责人: Jeffery A Dusek
• 金额: $ 61.74万
• 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/8075342
• 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. PUBLIC HEALTH RELEVANCE: The economic cost of the healthcare expense, lost income, and lost productivity due to pain suffering is estimated to be $100 billion per year. While current pain management guidelines emphasize narcotic use, drug utilization does not always adequately reduce pain and can frequently increase adverse events. Complementary and alternative medicine (CAM) therapies for pain management have demonstrated potential value in reducing pain, but evidence for the practical use of these therapies is lacking; to address this, we propose a prospective, observational study evaluating the effectiveness of CAM for pain management in an acute care inpatient hospital.

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。药物干预措施仍然是疼痛管理的主要方法，尽管药物干预措施存在不良事件的风险、成瘾的可能性以及过度使用对康复产生不利影响的风险。这种情况在术后时期最为明显，大约 80% 的患者在术后报告中度至重度疼痛，甚至在接受药物干预后也是如此。在住院环境中，找到有效的非药物干预措施来增强麻醉药物治疗将是一个显着的好处。 全国调查表明，目前 15% 的美国医院采用补充和替代医学 (CAM) 干预措施。大多数情况下，这些疗法用于解决特定的未满足的临床需求，其中最常见的是疼痛。十一项临床试验已证明 CAM 疗法与传统药物干预措施结合使用可有效减轻住院患者的疼痛（短期和长期）。产生这些缓解疼痛疗法有效性的额外证据将增进知识并可能影响实践模式。 在一项初步研究中，我们回顾性研究了 1,837 名在雅培西北医院接受 CAM 治疗的患者。我们发现，在初次 CAM 就诊后，立即疼痛平均减轻了 56%，大约 33% 的患者报告疼痛完全缓解。我们认识到这项研究的不足之处，限制了我们对医院如何实施辅助 CAM 疗法以及各种 CAM 疗法对疼痛管理的影响的了解，这只能通过前瞻性数据收集来回答。 使用前瞻性、观察性设计，我们提出了一项大规模研究以建立在这项探索性工作的基础上。它将记录 CAM 转诊、服务提供和疼痛管理治疗选择的预测因素。它还将研究 CAM 疗法作为传统干预措施的辅助手段对医院环境中临床群体短期和长期疼痛变化的影响。 CAM 这项研究的地点是雅培西北医院的彭尼乔治健康与治疗研究所。乔治研究所非常适合这项工作，因为它是全国最大的住院 CAM 项目，自 2004 年以来为超过 19,000 名患者提供服务。拟议的研究有 3 个目标：1) 定量描述提供 CAM 疗法的模型，以了解患者和 CAM 疗法的选择对于疼痛管理，2) 检查所选 CAM 疗法对疼痛即时变化的影响，以及 3) 检查所选 CAM 疗法对疼痛变化持续时间的影响。 这项研究的积极结果将有助于医院整合常规护理和 CAM 疗法以减轻疼痛。研究结果还可能推动未来对这些疼痛管理疗法的成本效益以及对患者结果（例如住院时间和麻醉剂使用）的影响的研究。 公共卫生相关性：由于疼痛造成的医疗费用、收入损失和生产力损失的经济成本估计每年达 1000 亿美元。虽然当前的疼痛管理指南强调麻醉剂的使用，但药物的使用并不总是能充分减轻疼痛，而且经常会增加不良事件。用于疼痛管理的补充和替代医学 (CAM) 疗法已证明在减轻疼痛方面具有潜在价值，但缺乏这些疗法实际使用的证据；为了解决这个问题，我们提出了一项前瞻性观察性研究，评估 CAM 在急症护理住院医院疼痛管理中的有效性。