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，尽管它们有不良事件的风险，成瘾的可能性以及过度使用对恢复的不利影响。这一点在术后最为明显，大约80%的患者报告术后中度至重度疼痛，即使在接受药物干预后。在住院患者中，找到一种有效的非药物干预来增加麻醉药物将是一个显著的好处。 全国调查表明，目前有15%的美国医院使用补充和替代医学（CAM）干预措施。最常见的是，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。11项临床试验证明了CAM疗法与传统药物干预沿着减轻住院患者疼痛（短期和长期）的疗效。生成这些疗法缓解疼痛的有效性的额外证据将推进知识并可能影响实践模式。 在一项初步研究中，我们回顾性研究了在Abbott Northwestern Hospital接受CAM治疗的1，837例患者。我们发现，在首次CAM访视后，即刻疼痛平均减少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，这限制了我们对医院如何实施连续性CAM治疗以及各种CAM治疗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，我们提出了一个大规模的研究，建立在这个探索性的工作。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。它还将研究CAM疗法作为传统干预措施的替代品对医院环境中临床组疼痛的短期和长期变化的影响。本CAM研究的背景是雅培西北医院的彭尼乔治健康与治疗研究所。乔治研究所是唯一适合这项工作，因为它是全国最大的住院CAM计划，自2004年以来，为19,000多名患者提供服务。 拟议研究有3个目的：1）定量描述提供CAM治疗的模型，以了解疼痛管理的患者和CAM治疗的选择，2）检查选定CAM治疗对疼痛即时变化的影响，3）检查选定CAM治疗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治疗以减轻疼痛。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的研究，以及对患者结局的影响，如住院时间和麻醉剂的使用。 公共卫生相关性：由于疼痛而造成的医疗费用、收入损失和生产力损失的经济成本估计为每年1000亿美元。虽然目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够充分减轻疼痛，而且经常会增加不良事件。疼痛管理的补充和替代医学（CAM）疗法已被证明在减轻疼痛方面具有潜在价值，但缺乏这些疗法实际应用的证据;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在急性护理住院医院疼痛管理中的有效性。