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Aims: To determine key factors that stimulate and drive the ongoing interests of leaders in the field of pain to continue to work for change and to explore how they use their own experiences in their teaching., Background: The assessment and management of acute and chronic pain remains a challenge and the pain education of pre-licensure/undergraduate health professionals (e.g. nurses, physicians, etc.) continues to be suboptimal. Understanding the motivations of pain leaders may provide insights to facilitate the future development of pain clinicians., Design: A Narrative enquiry., Methods: A purposeful sample of 17 Canadian and USA leaders in pain education participated. Data were collected between September 2012-January 2013 using recorded semi-structured telephone interviews. Transcripts were coded to provide storied experiences (themes)., Findings: Six themes were identified as a stimulus for pain leaders: An early pain experience, mentorship and circumstances, a personal shift in understanding, catalysts (institutional or political), recognition of barriers and a determination to improve. Their work towards change appeared to be motivated by their pain 'quest' where leaders embraced their personal experiences of pain, a need for social action and individual change., Conclusions: Educational approaches for health professionals usually focus on the importance of knowledge, skills and attitudes to be competent in pain care. To inspire and educate young health professionals about pain management we suggest the development of future pain leaders may require a different approach that recognizes personal stories of pain, includes a local pain champion and incorporates a model of mentorship., (© 2016 John Wiley & Sons Ltd.)

Aim: To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge., Background: The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals., Design: A descriptive cross-sectional exploratory design., Method: A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge., Findings: A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs., Conclusion: Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience., (© 2013 John Wiley & Sons Ltd.)

Background: Joint Hypermobility Syndrome (JHS) is a multisystemic connective tissue disorder characterised by pain, tissue fragility and laxity. This study aims to investigate the prevalence of chronic widespread pain (CWP) and the extended neurophysiological features reported by a group of patients with JHS. Methods: Ninety patients with JHS (mean age 34.7 ± 9.9 years), which was diagnosed in accordance with the Brighton criteria, and 113 healthy volunteers (mean age 35.7 ± 12.9) with no musculoskeletal pain participated in the study. A self-report questionnaire and pain chart were employed to collect data. Results: CWP was reported by 86% of patients with JHS. The mean number of pain sites in this group was 9.8/17 ± 4.2. Fibromyalgia was reported by 19% of this group. Patients with JHS were significantly more likely to report the following than healthy volunteers: autonomic symptoms (70%, 12%); gastrointestinal symptoms (71%, 9%); and chronic fatigue syndrome (31%, 1%). Patients with JHS reported significantly higher mean functional difficulties scores (22.28 ± 4.90) than healthy volunteers (17.96 ± 3.73) (P<0.001), indicative of functional difficulties associated with developmental coordination disorder/dyspraxia. Conclusion: Patients with JHS reported a wide range of neurophysiological symptoms of which CWP was a salient feature. There is a need to acknowledge and understand the extended symptoms associated with CWP in order to address the holistic needs of patients with JHS. Further studies and discussion are required to identify the complex inter-related multifactorial neurophysiological mechanisms in those with JHS. INSET: COMMENTARIES. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on studies of medical professionals and hospital management in managing severe pain in patients. Estimates on patients suffering from pain problems; Factors responsible for pain of poor; Role of organizational and hospital management policies in delivering effective pain management; Steps suggested to optimize the delivery of pain management.