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Background: Outpatient palliative care clinics may be required to manage patients not typically seen by palliative care. These include patients treated for cancer who no longer have evidence of disease (NED) and patients with chronic pain but no life-limiting illness (NLLI). Treatment response may differ among these groups. Objectives: Our aim was to determine treatment response by change in pain scores and morphine equivalent daily dose (MEDD) between initial visit and first follow-up in patients with active cancer (AC), NED, and those with NLLI. Methods: A retrospective review of 143 consecutive outpatients referred to a clinic staffed by the palliative care program was conducted. Pain treatment response was defined by a ≥2 point difference on the Numerical Rating Scale (NRS) or ≥30% reduction from baseline score. Results: Ninety-four patients had pain scores at both initial and follow-up visits after a median of 29.0 days. Fifty percent had AC, 27% NED, and 23% NLLI. Mean (standard deviation [SD]) pain scores at baseline were not significantly different among AC 6.0 (2.5), NED 5.6 (2.5), and NLLI 6.8 (2.2) patients ( p=0.22), but were significant at follow-up between AC 4.2 (2.7) and NLLI 6.0 (2.6) ( p=0.03) groups. The percent of responders differed significantly between AC 57.4% and NED 20% groups ( p=0.002). MEDD increased by 17.2 mg in AC, 40.9 mg in NED, and 18.1mg in NLLI patients ( p=0.88).Benzodiazepine use was significantly more frequent in the NLLI group than the AC ( p=0.025) and NED ( p=0.002) groups. Conclusions: Although median pain scores improved at follow-up, less than half of patients were responders. Patients with AC had a significantly better response rate than NED patients and a lower pain score than NLLI patients at follow-up. [ABSTRACT FROM AUTHOR]

Objective: Reports from the Institute of Medicine and American Medical Association's Pain and Palliative Medicine Specialty Section Council emphasize the need for pain management education in medical schools, yet training in pediatric pain management (PPM) is limited. In this pilot program, we evaluated the effectiveness of a web-based PPM module on knowledge, confidence, attitudes, and self-reported skills in medical students. Methods: Third- and fourth-year medical students ( n=291) completed the module and a knowledge test. Of these students, 53 completed a pre- and postsurvey of confidence, attitudes, and self-reported skills and module evaluation. Results: For the 291 students, knowledge scores increased significantly by 21.8 points (95% confidence interval [CI]=19.7-23.8; p<0.001). The majority of scores on the survey items significantly increased postmodule, including: increase in confidence in assessing pain in pediatric patients (6% to 25%; p=0.004), increase in responses of 'strongly disagree' or 'disagree' to the belief that opioids will delay diagnosis (62% to 85%; p=0.005), and increase in responses of 'frequently' or 'very frequently' to 'how often do you use behavioral instruments to assess pain severity?' (35% to 57%; p=0.008). The majority reported they intend to make changes in behavior or practice (71%), and would recommend the module to fellow students (88%). Conclusion: This pilot program supports the effectiveness of a web-based module in improving knowledge, confidence, attitudes, and self-reported skills in PPM. Evaluation responses indicate high-quality content. Further evaluation for sustained impact is warranted. [ABSTRACT FROM AUTHOR]

Fibromyalgia is a disorder of chronic generalized musculoskeletal pain affecting 2% of the general population, with an increased frequency in women. Clinical diagnosis relies on history and research-supported tender point criteria. As in other chronic pain syndromes, a multidimensional approach optimizes treatment response. Empirical data and consensus support the use of nonpharmacological modalities, such as education, aerobic exercise, and cognitive behavioral therapy, in the management of fibromyalgia. Evidence-supported pharmacological interventions include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, alpha-2-delta ligands, and other serotonergic-noradrenergic analgesic agents, such as tramadol. This paper offers the primary healthcare provider a systematic approach to the diagnosis of fibromyalgia and management strategies based on available evidence, consensus, and empirical data. [ABSTRACT FROM AUTHOR]