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）：有效和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。药物干预仍然是疼痛管理的主要方法，尽管有充分的证据表明它们有不良事件的风险，潜在的成瘾性，以及过度使用对康复的不利影响。这一点在手术后最为明显，大约80%的患者在接受药物干预后报告术后中度至重度疼痛。在住院环境中，找到一种有效的非药物干预来增加麻醉药物将是显著的好处。全国调查显示，目前15%的美国医院使用补充和替代医学（CAM）干预措施。大多数情况下，这些疗法被用来解决特定的未满足的临床需求，其中最常见的是疼痛。11项临床试验已经证明，与传统的药物干预措施一起，CAM疗法可以有效地减轻住院患者的疼痛（短期和长期）。产生更多的证据来证明这些疗法在缓解疼痛方面的有效性，将促进知识的发展，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1837名在雅培西北医院接受CAM治疗的患者。我们发现，在首次CAM就诊后，平均即刻疼痛减少56%，大约33%的患者报告完全疼痛缓解。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疗法以及各种辅助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。采用前瞻性观察设计，我们提出了一项大规模的研究，以建立在这一探索性工作。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。它还将检查辅助辅助疗法作为传统干预措施对医院环境中临床群体疼痛的短期和长期变化的影响。这项CAM研究的背景是Abbott西北医院的Penny George健康与治疗研究所。乔治研究所特别适合这项工作，因为它是全国最大的住院CAM项目，自2004年以来为19,000多名患者提供服务。该研究有3个目的：1)定量描述一个提供CAM疗法的模型，以了解患者和CAM疗法对疼痛管理的选择；2)检查所选CAM疗法对疼痛立即改变的影响；3)检查所选CAM疗法对疼痛改变持续时间的影响。本研究的积极结果将有助于医院整合常规护理和辅助医学治疗以减轻疼痛。这些发现也可能推动未来对这些治疗疼痛的成本效益的研究，以及对患者结果的影响，如住院时间和麻醉剂的使用。