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Background: At the end of life, patients living in their own homes experience significantly more pain than those who die in either hospital or hospice care (Office for National Statistics, 2015). With an increasing prevalence of this, person-centred medicines optimisation is essential. Aim: To investigate the feasibility of community pharmacist medicines optimisation services for patients living with advanced cancer pain in community settings. Methods: Mixed methods were used, adopting a pragmatic stance and approach. Qualitative interviews, a systematic review and meta-analysis and a proof-of-concept study were undertaken. Results: Patients with advanced cancer pain need support with their medicines which could be provided by a pharmacist. Patients experienced a significant number of medicines related problems, even those already receiving specialist palliative care. Most problems were addressed by pharmacist advice with the remainder being referred for additional prescribing. Care for patients with cancer pain is currently not person-centred and the current medicines optimisation model is unsuitable for this patient group. An enhanced model of medicines optimisation is therefore presented for patients with advanced cancer and this model can be amended and adopted for other patient groups. Conclusions: An enhanced medicines optimisation model (MOCAP) has been created to inform person-centred medicines optimisation for patients with advanced cancer pain. Feasibility and acceptability were also confirmed and it can be adapted for further clinical use. This model contributes to the goals of the NHS agenda of choice and control of care as proposed in the NHS Long Term Plan (NHS, 2019b).

This dissertation comprises two sections. Section one details the production and assessment of a scale designed to measure peoples’ beliefs about the control of pain. Section two details an investigation into individual differences in response to Patient Controlled Analgesia, a method of pain management which requires a high level of participation on the part of surgical patients.

Studies from medical literature have demonstrated prolonged pain relief and reduction in opioid utilization for up to 72 hours postoperatively in patients that received post-surgical infiltration injections with liposomal bupivacaine. At the present time, there are no studies in dental literature that have investigated liposomal bupivacaine for pain control in endodontics. The purpose of this double-blind, randomized controlled trial was to compare bupivacaine HCl to liposomal bupivacaine for endodontic pain control in untreated symptomatic vital posterior teeth in patients experiencing moderate to severe pain. One hundred adult patients were randomly divided into two groups and received either 4 mL of liposomal bupivacaine (13.3 mg/mL) or 4 mL of 0.5% bupivacaine HCl with 1:200,000 epinephrine by infiltration following injection with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine via infiltration or inferior alveolar nerve block. Patients received a diary for the day of the appointment (day 0) and three days post-injection to record tooth numbness, lip numbness, pain levels and analgesics (non-narcotic and narcotic) utilization. No significant differences were found between treatment groups for tooth numbness, pain, use of non-narcotic and narcotic pain medications. A statistically significant difference in lip numbness was found on day 1 to day 3 for the liposomal bupivacaine group. In conclusion, liposomal bupivacaine did not provide prolonged pain control, nor did it reduce analgesic consumption when used for untreated posterior symptomatic vital teeth.

Pain is a multidimensional phenomenon that affects each patient in a unique way. It is essential for nurses in the post anesthesia care unit to be knowledgeable about this multidimensional phenomenon, including the various aspects of pain management, in order to safely care for those patients who are in pain. If nurses lack the necessary knowledge and skills to provide exceptional pain management, then nursing care will be suboptimal. Although there is much literature on this topic, a lack of adequate knowledge on the part of nursing professionals persists. In fact, pain is typically undertreated. The primary purpose of this paper was to explore pain management in the post anesthesia phase of nursing care. This has been accomplished through a comprehensive and systematic review of the available literature. A large amount of information was synthesized from sixty-five peer reviewed, scholarly sources. This paper includes discussion regarding patient preferences and consequences of uncontrolled pain, as well as factors related to assessment, documentation, and pain control methods. Various pain management methods were reviewed, including pharmacologic and non-pharmacologic techniques. This systematic review yielded findings that demonstrated the need for various changes that should be implemented related to pain management in the post operative phase of nursing care. Furthermore, it is important that nursing care evolves as an evidence-based practice profession and that nurses incorporate these recommendations into their day-to-day nursing care of patients.