Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists.


Journal

Pain practice : the official journal of World Institute of Pain
ISSN: 1533-2500
Titre abrégé: Pain Pract
Pays: United States
ID NLM: 101130835

Informations de publication

Date de publication:
06 2023
Historique:
revised: 08 01 2023
received: 06 10 2022
accepted: 17 01 2023
medline: 6 6 2023
pubmed: 24 1 2023
entrez: 23 1 2023
Statut: ppublish

Résumé

Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale. Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.

Identifiants

pubmed: 36690597
doi: 10.1111/papr.13207
doi:

Substances chimiques

Analgesics, Opioid 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

501-510

Informations de copyright

© 2023 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.

Références

Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021;397(10289):2082-97. https://doi.org/10.1016/S0140-6736(21)00393-7
Robert J. Gatchel: award for distinguished professional contributions to applied research. Am Psychol. 2004;59(8):792-805. https://doi.org/10.1037/0003-066X.59.8.792
Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol. 2004;59(8):795-805. https://doi.org/10.1037/0003-066X.59.8.795
Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):168-82. https://doi.org/10.1016/j.pnpbp.2018.01.017
Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624. https://doi.org/10.1037/0033-2909.133.4.581
Cascella M, Miceli L, Cutugno F, di Lorenzo G, Morabito A, Oriente A, et al. A Delphi consensus approach for the management of chronic pain during and after the COVID-19 era. Int J Environ Res Public Health. 2021;18(24):13372. https://doi.org/10.3390/ijerph182413372
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82. https://doi.org/10.1097/j.pain.0000000000001939
Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain. 2009;10(11):1113-20. https://doi.org/10.1016/j.jpain.2009.09.001
Nugraha B, Gutenbrunner C, Barke A, Karst M, Schiller J, Schäfer P, et al. The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain. Pain. 2019;160(1):88-94. https://doi.org/10.1097/j.pain.0000000000001433
Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37. https://doi.org/10.1097/j.pain.0000000000001390
Soyannwo OA. Enhancing effective pain control: the role of education. Pain Manag. 2011;1(6):487-9. https://doi.org/10.2217/pmt.11.57
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2011 [cited 2022 Dec 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92522/
Kress HG, Aldington D, Alon E, Coaccioli S, Collett B, Coluzzi F, et al. A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr med Res Opin. 2015;31(9):1743-54. https://doi.org/10.1185/03007995.2015.1072088
Loeser JD, Schatman ME. Chronic pain management in medical education: a disastrous omission. Postgrad med. 2017;129(3):332-5. https://doi.org/10.1080/00325481.2017.1297668
Briggs EV, Carr ECJ, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15(8):789-95. https://doi.org/10.1016/j.ejpain.2011.01.006
O'Donnell FT, Rosen KR. Pediatric pain management: a review. Mo med. 2014;111(3):231-7.
Watt-Watson J, McGillion M, Hunter J, Choiniere M, Clark AJ, Dewar A, et al. A survey of prelicensure pain curricula in health science faculties in Canadian universities. Pain Res Manag. 2009;14(6):439-44. https://doi.org/10.1155/2009/307932
Watt-Watson J, Peter E, Clark AJ, Dewar A, Hadjistavropoulos T, Morley-Forster P, et al. The ethics of Canadian entry-to-practice pain competencies: how are we doing? Pain Res Manag. 2013;18(1):25-32. https://doi.org/10.1155/2013/179320
Petrucci E, Vittori A, Cascella M, Vergallo A, Fiore G, Luciani A, et al. Litigation in anesthesia and intensive care units: an Italian retrospective study. Healthcare (Basel). 2021;9(8):1012. https://doi.org/10.3390/healthcare9081012
Natoli S, Vittori A, Cascella M, Innamorato M, Finco G, Giarratano A, et al. Raising awareness on the clinical and social relevance of adequate chronic pain care. Int J Environ Res Public Health. 2023;20(1):551. https://doi.org/10.3390/ijerph20010551
Dowd LA, Cross AJ, Veal F, Ooi CE, Bell JS. A systematic review of interventions to improve analgesic use and appropriateness in long-term care facilities. J Am med Dir Assoc. 2022;23(1):33-43.e3. https://doi.org/10.1016/j.jamda.2021.09.024
Singh R, Pushkin GW. How should medical education better prepare physicians for opioid prescribing? AMA J Ethics. 2019;21(8):E636-41. https://doi.org/10.1001/amajethics.2019.636
Adalbert JR, Ilyas AM. A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students. BMC med Educ. 2022;22(1):18. https://doi.org/10.1186/s12909-021-03058-z
Solca M, Savoia G, Mattia C, Ambrosio F, Bettelli G, Berti M, et al. Pain control in day surgery: SIAARTI guidelines. Minerva Anestesiol. 2004;70(1-2):5-24.
Savoia G, Ambrosio F, Paoletti F, Bertini L, Mattia C, Amantea B, et al. SIAARTI recommendations for the treatment of postoperative pain. Minerva Anestesiol. 2002;68(10):735-50.
Savoia G, Coluzzi F, Di Maria C, et al. Italian intersociety recommendations on pain management in the emergency setting (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC). Minerva Anestesiol. 2015;81(2):205-25.
Ambrosio F, Finco G, Mattia C, Mediati R, Paoletti F, Coluzzi F, et al. SIAARTI recommendations for chronic noncancer pain. Minerva Anestesiol. 2006;72(11):859-80.
Cascella M, Vittori A, Petrucci E, Marinangeli F, Giarratano A, Cacciagrano C, et al. Strengths and weaknesses of cancer pain Management in Italy: findings from a Nationwide SIAARTI survey. Healthcare (Basel). 2022;10(3):441. https://doi.org/10.3390/healthcare10030441
Vittori A, Petrucci E, Cascella M, Innamorato M, Cuomo A, Giarratano A, et al. Pursuing the recovery of severe chronic musculoskeletal pain in Italy: clinical and organizational perspectives from a SIAARTI survey. J Pain Res. 2021;14:3401-10. https://doi.org/10.2147/JPR.S328434
Current Status of Pain Education and Implementation Challenges. International Association for the Study of Pain (IASP). [cited 2022 Dec 22]. Available from: https://www.iasp-pain.org/resources/fact-sheets/current-status-of-pain-education-and-implementation-challenges/
Devonshire E, Nicholas MK. Continuing education in pain management: using a competency framework to guide professional development. Pain Rep. 2018;3(5):e688. https://doi.org/10.1097/PR9.0000000000000688
Casey KL. Problems in the differential diagnosis of chronic pain. Anesth Prog. 1990;37(2-3):60-5.
Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55. https://doi.org/10.1001/jama.2014.3266
Castellini G, Iannicelli V, Briguglio M, Corbetta D, Sconfienza LM, Banfi G, et al. Are clinical practice guidelines for low back pain interventions of high quality and updated? A systematic review using the AGREE II instrument. BMC Health Serv Res. 2020;20(1):970. https://doi.org/10.1186/s12913-020-05827-w
Baumbauer KM, Young EE, Starkweather AR, Guite JW, Russell BS, Manworren RCB. Managing chronic pain in special populations with emphasis on pediatric, geriatric, and drug abuser populations. Med Clin North Am. 2016;100(1):183-97. https://doi.org/10.1016/j.mcna.2015.08.013
Twycross AM, Maclaren Chorney J, McGrath PJ, Finley GA, Boliver DM, Mifflin KA. A Delphi study to identify indicators of poorly managed pain for pediatric postoperative and procedural pain. Pain Res Manag. 2013;18(5):e68-74. https://doi.org/10.1155/2013/570478
Humphreys K. Reconciling the present and the future in opioid prescription policy: an ethical dilemma. Pain med. 2018;19(8):1514-5. https://doi.org/10.1093/pm/pny120
O'Brien T, Christrup LL, Drewes AM, Fallon MT, Kress HG, McQuay HJ, et al. European pain federation position paper on appropriate opioid use in chronic pain management. Eur J Pain. 2017;21(1):3-19. https://doi.org/10.1002/ejp.970
Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008;16(5):405-16. https://doi.org/10.1037/a0013628
Fullen B, Morlion B, Linton SJ, Roomes D, Griensven J, Abraham L, et al. Management of chronic low back pain and the impact on patients' personal and professional lives: results from an international patient survey. Pain Pract. 2022;22(4):463-77. https://doi.org/10.1111/papr.13103
Miceli L, Bednarova R, Rizzardo A, Cuomo A, Riccardi I, Vetrugno L, et al. Opioids prescriptions in pain therapy and risk of addiction: a one-year survey in Italy. Analysis of national opioids database. Ann Ist Super Sanita. 2018;54(4):370-4. https://doi.org/10.4415/ANN_18_04_15
Langford AV, Gnjidic D, Lin CWC, Bero L, Penm J, Blyth FM, et al. Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis. BMJ Qual Saf. 2021;30(2):133-40. https://doi.org/10.1136/bmjqs-2020-010881
Miceli L, Bednarova R, Cuomo A, Cascella M, Guardamagna V, Romualdi P, et al. Prescribing opioids to patients with chronic pain: translation of the opioid risk tool into Italian. Minerva Anestesiol. 2020;86(7):693-5. https://doi.org/10.23736/S0375-9393.20.14312-8
Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13-20. https://doi.org/10.1151/spp021113
Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol. 2017;27(12):1185-215. https://doi.org/10.1016/j.euroneuro.2017.08.430
Olsen Y. What is addiction? History, terminology, and Core concepts. Med Clin North Am. 2022;106(1):1-12. https://doi.org/10.1016/j.mcna.2021.08.001
O'Brien CP. Benzodiazepine use, abuse, and dependence. J Clin Psychiatry. 2005;66(Suppl 2):28-33.
Leuter C, Piroli A, Paladini A, Tudini M, Varrassi G. Care strategies and therapeutic pathways for chronic pain patients in Abruzzo region. Italy Ann Ig. 2017;29(1):63-72. https://doi.org/10.7416/ai.2017.2133
Legge 38/2010: un decennio di vita sotto la lente. Carenze attuative di una legge lungimirante: perchè abbiamo dimenticato di prendere in carico il dolore cronico? ALTIS. Published December 21, 2020. [cited 2022 Dec 22]. Available from: https://altis-ops.it/legge-38-2010-un-decennio-di-vita-sotto-la-lente-carenze-attuative-di-una-legge-lungimirante-perche-abbiamo-dimenticato-di-prendere-in-carico-il-dolore-cronico/
Cascella M, Marinangeli F, Vittori A, Scala C, Piccinini M, Braga A, et al. Open issues and practical suggestions for telemedicine in chronic pain. Int J Environ Res Public Health. 2021;18(23):12416. https://doi.org/10.3390/ijerph182312416
2022 Global year for translating pain knowledge to practice - IASP. [cited 2022 Dec 22]. Available from: https://www.iasp-pain.org/advocacy/global-year/translating-pain-knowledge-to-practice/

Auteurs

Alessandro Vittori (A)

Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.

Marco Cascella (M)

Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy.

Emiliano Petrucci (E)

Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy.

Andrea Cortegiani (A)

Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.
Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy.

Elena Giovanna Bignami (EG)

Department of Medicine and Surgery, University of Parma, Parma, Italy.

Massimo Antonio Innamorato (MA)

Pain Unit, Department of Neuroscience, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy.

Arturo Cuomo (A)

Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy.

Vito Torrano (V)

Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Flavia Petrini (F)

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), President 2019-2021, Rome, Italy.

Antonino Giarratano (A)

Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.
Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy.

Silvia Natoli (S)

Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.
IRCCS Maugeri, Pavia, Italy.

Franco Marinangeli (F)

Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy.

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