Exploring assessment of medical students\u27 competencies in pain medicine - A review

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education. Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students. Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016. Results: A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans. Conclusion: This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies

Comparing etoricoxib and celecoxib for preemptive analgesia for acute postoperative pain in patients undergoing arthroscopic anterior cruciate ligament reconstruction: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>The efficacy of selective cox-2 inhibitors in postoperative pain reduction were usually compared with conventional non-selective conventional NSAIDs or other types of medicine. Previous studies also used selective cox-2 inhibitors as single postoperative dose, in continued mode, or in combination with other modalities. The purpose of this study was to compare analgesic efficacy of single preoperative administration of etoricoxib versus celecoxib for post-operative pain relief after arthroscopic anterior cruciate ligament reconstruction.</p> <p>Methods</p> <p>One hundred and two patients diagnosed as anterior cruciate ligament injury were randomized into 3 groups using opaque envelope. Both patients and surgeon were blinded to the allocation. All of the patients were operated by one orthopaedic surgeon under regional anesthesia. Each group was given either etoricoxib 120 mg., celecoxib 400 mg., or placebo 1 hour prior to operative incision. Post-operative pain intensity, time to first dose of analgesic requirement and numbers of analgesic used for pain control and adverse events were recorded periodically to 48 hours after surgery. We analyzed the data according to intention to treat principle.</p> <p>Results</p> <p>Among 102 patients, 35 were in etoricoxib, 35 in celecoxib and 32 in placebo group. The mean age of the patients was 30 years and most of the injury came from sports injury. There were no significant differences in all demographic characteristics among groups. The etoricoxib group had significantly less pain intensity than the other two groups at recovery room and up to 8 hours period but no significance difference in all other evaluation point, while celecoxib showed no significantly difference from placebo at any time points. The time to first dose of analgesic medication, amount of analgesic used, patient's satisfaction with pain control and incidence of adverse events were also no significantly difference among three groups.</p> <p>Conclusions</p> <p>Etoricoxib is more effective than celecoxib and placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent arthroscopic anterior cruciate ligament reconstruction.</p> <p>Trial registration number</p> <p>NCT01017380</p

Multimodal Pain Management for Laparoscopic Adnexal Surgery: A comparative cohort study

Objectives:To determine the morphine-sparing effect of multimodal pain management for laparoscopic surgery.Materials and Methods: A retrospective cohort study was carried out in 210 patients who underwent laparoscopic adnexal surgery from August 2008 to November 2013 at the Songklanagarind Hospital. The patients were divided into three groups (n = 70 each) according to analgesic management. Group I received parecoxib 40 mg intravenously 2 hours preoperatively with postoperative paracetamol/NSAIDs around the clock, Group II received parecoxib 40 mg intravenously 15-30 minutes preoperatively with postoperative paracetamol/NSAIDs as needed, and Group III received only postoperative paracetamol/NSAIDs as needed. Morphine or fentanyl was used during operation and morphine was used as needed for severe postoperative pain in all cases. Patients in each group were matched by the operation in the same time period. The consumption of analgesic agents during surgery and 24 hours postoperation, pain scores, and adverse events were evaluated.results:Intraoperative morphine consumption was not different among the 3 groups. However, in the 24 hours postoperation, 40% of patients in Group I received morphine (mean 1.1 mg) compared to 68.6% in Group II (mean 6.1 mg) and 80% in Group III (mean 9.6 mg) (p < 0.01). Group I received more postoperative paracetamol/NSAIDs than both Group II and Group III (p < 0.01). Group I had 88.5% morphine-sparing effect compared to Group III and 82% compared to Group II. The pain scores were similar between the groups.Conclusions: Preemptive parecoxib and postoperative paracetamol/NSAIDs provide a significant morphine-sparing effect in laparoscopic adnexal surgery

Cancer Pain and its Management: A Survey on Interns’ Knowledge, Attitudes and Barriers

Objective We conducted this study to evaluate the knowledge and attitudes of interns regarding cancer pain and its management. Materials and methods This study included 116 interns recently graduated from the Faculty of Medicine, Prince of Songkla University. They provided their demographic characteristics and completed a questionnaire in regards to their knowledge and attitudes about cancer pain and its management. Results Data were obtained from 116 interns. The majority of interns did not hesitate to provide maximal doses of analgesics for patients in severe pain when the prognosis was poor. A significant number favored to prescribe pethidine more than morphine and thought that pethidine caused less harmful effects in long-term use. Most respondents agreed or strongly agreed that they would prescribe opioids carefully to avoid tolerance and addiction. They considered that barriers to effective pain management were inadequate knowledge, inadequate pain assessment and lack of time to attend patients’ requirements. Conclusion The interns demonstrated positive attitudes toward cancer pain and its management, principally on opioid usage. However, a significant number of them had misconceptions in terms of knowledge for prescribing opioids. To provide better cancer pain management, attention must be given to improving the curriculum and integrating it into clinical practice

Nimmaanrat, S., Geater, A., Plunsangkate, P., Saewong, L., Karnjanawanichkul, O., Chanchayanon, T., Pattaravit, N.

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