What outcome measures have been used to assess quality of inpatient pain management?
What strategies are effective in managing chronic non-surgical, non-cancer pain in the inpatient setting?
What harms are associated with pain management among inpatients with chronic non-cancer pain?
Searches
EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), PubMED, Health Economic Evaluations Database (HEED), “Gray Literature” (meeting abstracts from key meetings).
Types of study to be included
Inclusion criteria:
Randomized controlled trials, quasi-randomized controlled trials, observational studies, and intervention studies that address pain management among hospitalized medical or surgical patients. Studies did not need to include a control group. Studies published in all languages considered. Because of the anticipated heterogeneity of studies, narrower inclusion criteria were not made.
Exclusion criteria:
Studies focused exclusively on patients under 18 years of age; studies focused exclusively on patients with cancer pain or with pain related to sickle cell disease; studies with a high risk of bias (based on a predefined threshold).
Condition or domain being studied
Treatment of pain among medical inpatients, and among medical or surgical inpatients with underlying chronic non-cancer pain and/or chronic opioid use.
Pain is common among hospitalized adults, many of whom may have underlying chronic pain diagnoses. Pain management is an important quality measure and affects patient satisfaction as well as patient function. There is little evidence on how best to measure effectiveness of pain management, or to support strategies and benefits of managing pain among medical inpatients. Clinical experience suggests that patients with chronic non-cancer pain or a history of chronic opioid use present a distinct challenge to management of pain symptoms during the inpatient stay. This systematic review aims to identify studies on pain management among hospitalized medical patients and evaluate 1. Methods of assessing quality of pain management 2. Strategies for effective pain management in this setting and 3. Harms associated with inpatient management of pain.
Participants/ population
Inclusion criteria:
Age: 18 years or older; studies including both adults and children were included.
Gender: Any
Admitted to hospital for medical or surgical diagnosis
Exclusion criteria:
Age: under 18 years old
Palliative care patients and hospice patients
Pain associated with cancer
Exclusively sickle-cell population
Intervention(s), exposure(s)
Strategies to assess and manage pain, including patient or provider education, pharmacological intervention, and non-pharmacologic intervention
Comparator(s)/ control
Usual care (no documented intervention to improve assessment or pain management).
Outcome(s)
Primary outcomes
Reported pain
Reported improvement in pain
Adverse effects associated with pain management strategies
Functional outcomes (where reported)
Secondary outcomes
Cost of care, including direct costs, hospital length of stay, and readmission where these are available.
Risk of bias (quality) assessment
The Cochrane Collaboration's tool for assessment of risk of bias will be used for randomized studies. A risk of bias table will be generated with the following entries: adequate sequence generation, allocation concealment, blinding, incomplete outcome data addressed, free of selective reporting, free of other bias. Only studies meeting specific criteria will be included in the primary analysis. The threshold for study selection will be specified in the protocol. Data from unpublished studies will be included to reduce bias. For non-randomized studies, focus on specific aspects of the studies (for example, outcome assessment) and the extent to which they are susceptible to bias will be used to assess risk of bias. The Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS) will be used to assess risks of bias in non-randomized studies.
Strategy for data synthesis
Included studies will be diverse; a tabular and narrative approach will be used for synthesis. Meta-analysis will be performed on homogeneous studies.
Analysis of subgroups or subsets
No subgroup or subset analysis is planned.
Dissemination plans
The systematic review will be published in a peer reviewed journal and presented at national meeting. It will be disseminated electronically and in print. Brief reports of review findings will be disseminated directly to appropriate. Updates of the review will be conducted to inform and guide healthcare practice and policy.
Contact details for further information
Hilary Mosher
Division of General Internal Medicine
Department of Internal Medicine
University of Iowa Hospitals and Clinics
200 Hawkins Drive
Iowa City, IA 52242
hilary-mosher@uiowa.edu
Organisational affiliation of the review
Department of Internal Medicine, Carver College of Medicine
http://www.int-med.uiowa.edu/About.html
Review team
Dr Hilary Mosher, Department of Internal Medicine, Carver College of Medicine Dr Michele Fang, Ms Amy Blevins,
Anticipated or actual start date
01 October 2012
Anticipated completion date
31 May 2013
Funding sources/sponsors
None
Conflicts of interest
None known
Language
English
Country
United States of America
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Hospitalization; Humans; Pain; Pain Management
Date of registration in PROSPERO
21 September 2012
Date of publication of this revision
21 September 2012
Stage of review at time of this submission
Started
Completed
Preliminary searches
Yes
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis
Prospective meta-analysis
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.
