CIAP Newsletter

In June 2016, the NSW Agency for Clinical Innovation (ACI) published the 'NSW Pain Management Model of Care: Where are we up to,' by Prof Philip Siddall, Co-chair of the ACI Pain Network. In this presentation, Prof Siddall notes that 1 in 5 people suffer from chronic pain, which not only carries personal and social burdens, but a significant economic one as well. He outlines the historic and current problems associated with pain management and provides an overview of the solutions described in the NSW Pain Management Plan (2012-2016) and their evaluation, and future directions. Clinicians involved with the provision of care to patients experiencing chronic pain will find this presentation of value.

The ACI's website may be accessed on CIAP via the Guidelines panel (left menu). Use the search function or browse the site to find items of interest, including information about the Pain Management Network, as well as many useful pain management resources and the ACI Pain Management Website.

The updated version of Therapeutic Guidelines (eTG complete) is now available on CIAP and may be accessed in several places, most readily at CIAP's new Quick Links panel on the top of the left navigation menu. If you would like further information about using the updated eTG and its new features, you can view the video tutorial in CIAP's Knowledge Centre or on the eTG Home Page.

eTG provides a wealth of evidence-based information to support clinician knowledge and decision making in relation to the management of pain.

Analgesic is the first topic listed in the Therapeutic Guidelines list (left side of the eTG Home Page). Selecting this will open up a list of sub-topics covering acute and chronic pain, pain in children, opioid management, non-pharmacological management, analgesic use in pregnancy, and many more. A collection of useful tables, boxes and figures is also provided, which includes pain assessment tools, PCA settings, opioid tables and selected dosing recommendations.

Searching other guidelines topics will enable you to view pain and pain management information within those topics. For example, the Palliative Care guidelines’ sub-topics include Drug availability, Pain in palliative care, and Drug administration in palliative care (Appendix 10.1), while the Neurology guidelines address facial pain, acute and chronic headache, and neuropathic pain. Browse other guidelines topics for relevant information. For information about specific symptoms, conditions, treatments, drugs or topics, use the search box and/or the new Drug Index feature.

The Australian Medicines Handbook (AMH) contains useful evidence-based information in easy to read format. Select the Chapters tab from the top menu to access detailed Analgesics information. Here you will also find three helpful tables: Pain types and analgesia, Opioid comparative information, and Opioid formulations. AMH provides two complementary resources: the AMH Children’s Dosing Companion (dosing guidelines for children), and the AMH Aged Care Companion, which addresses specific issues relevant to the use of drugs in the elderly population.

CIAP's Evidence-Based Practice panel in the left hand menu provides access to systematic reviews, randomised controlled trials, EBP databases and evidence summaries.

OT seeker is a database for occupational therapists and OT interventions, and is easy to search. For example, enter the word 'music' in the basic search text box to see a wide range of EBP articles on music therapy, including those on the use of music in pain management, such as The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial, in the Journal of Burn Care & Research. Note OT references are not full text, however CIAP or LHD libraries may hold or provide access to the full text documents.

PEDro is the Physiotherapy database and is also easy to search in Basic and Advanced modes. PEDro provides practice guidelines and appraised evidence for physiotherapists. Some full text documents are made available by publishers, or alternatively CIAP or your LHD library may hold or provide access.

The Joanna Briggs Institute Evidence-Based Practice Database allows simultaneous searching across a wide range of summarised and appraised evidence, to inform clinical practice and improve outcomes for patents. Best Practice Information Sheets are one of seven document types available on JBI, and are short summaries based on the results and recommendations of systematic reviews.

Best Practice Information Sheets highlights include:

Effectiveness of non-pharmacological pain management in relieving chronic pain for children and adolescents.
Parental involvement in their children's postoperative pain management in hospital.
Nursing intervention for adult patients experiencing chronic pain.
Post-anesthetic discharge scoring criteria.

You can copy and paste any of these titles in to JBI and try searching for these information sheets.

All JBI documents are provided in full text. A Video tutorial on JBI is available in CIAP's Knowledge Centre.

CIAP's Specialty Guides and Links which can be found at the bottom of the Quick Links panel, provide a selection of recommended journals, books and useful links by topic area. In the Anaesthesia / Pain Specialty Link you will find a link to the Australian Pain Management Association (APMA). The APMA supports people debilitated or disabled by severe pain. It provides a telephone helpline service, pain support groups, develops resources, delivers training and champions improvements in pain health and community care. It also provides news and other information, such as about research clinical trials in progress.

Browse or search CIAP's collection of Journals and Books for further useful resources.

Journals of particular interest may be:

Clinical Journal of Pain, which contains broad and relevant content on non-pharmacological and psychological aspects of pain as well as pharmacological, anaesthetic and surgical content.
Journal of Headache and Pain. This journal's scope has a multidisciplinary perspective and covers headache and related pain syndromes in the following fields: genetics, neurology, internal medicine, clinical pharmacology, child neuropediatrics, anesthesiology, rheumatology, otology, dentistry, neurotraumatology, neurosurgery, psychiatry, pain management, and addiction.

eBooks of interest may include:

To learn more about using CIAP's resources visit the Learning Centre where you can find User Guides, Video Tutorials and other learning options. You will also find the CIAP Workshop and In-service schedules for face to face educational events and the Live Online Training program for WebEx sessions.

National Pain Week will be held on 25 – 31 July 2016. See www.chronicpainaustralia.org.au for further information.

CIAP Update

We are excited to announce that UpToDate is now included in the CIAP collection, following the successful procurement of a statewide licence for NSW.

UpToDate is a highly authoritative, evidence-based and peer reviewed decision support resource, which contains in-depth clinical content and referenced analysis across a range of specialties, delivered in easy to search and easy-to-read formats.

Updates to the CIAP Collection

After extensive collaboration with clinician working groups, specialty experts, and established CIAP networks/committees, a full review of the current CIAP collection has now been completed. This process identified duplications, gaps and redundancies, resulting in a streamlined and optimised collection of resources for NSW Health staff.

New additions

The CIAP review encompassed the identification of highly regarded titles that would provide value to the current collection. Following consultation with clinicians in specialty areas, the following titles are now available on CIAP:

Pediatrics
Archives of Physical Medicine and Rehabilitation
Injury
Journal of Voice
Manual Therapy
International Journal of Stroke
Aphasiology
Australian Social Work

Updates and new additions, along with the inclusion of UpToDate, will provide the best possible collection of evidence-based decision support resources for NSW Health staff via CIAP.

For a full list of discontinued resources with alternate recommendations, download the CIAP Collection Changes document.

You will see some changes to the CIAP website and the CIAP collection over coming months. The CIAP team will work to support CIAP users in this period of transition by providing information via the CIAP website, newsletters, and CIAP Clinical Partners, as well as by providing user guides and other training opportunities.

Journal of Pediatric Hematology/Oncology

Article in Focus

The Relationship Between Parent Trait Anxiety and Parent-reported Pain, Solicitous Behaviors, and Quality of Life Impairment in Children With Cancer

Journal of Pediatric Hematology/Oncology 38(1): Published online January 2016

Abstract

This study sought to investigate how parental anxiety may impact children’s functioning with respect to pain and health-related quality of life in a sample of children with cancer.

There is a growing body of research on parental response to children's pain and the influence of parental behaviors on functioning in children with pain. However, to date, very few studies have focused on pain in children during cancer treatment. Given the fact that children with cancer are largely treated on an outpatient basis, leaving parents primarily responsible for pain management, it is important to investigate parental factors that may contribute to effective pain management.

In this study, 353 parents of children treated for cancer completed measures of anxiety, behavioral responses to children's pain, and of their child's quality of life and pain. Children ages 8 to 18 completed measures of their own quality of life and pain. The findings suggest that parent anxiety plays a significant role in parent perception of children's pain and quality of life in pediatric cancer patients. Future research is needed to further clarify the nature of these relationships, which will help identify how parent anxiety may be an important target for pain management in children with cancer.

Gems on CIAP

Cold and Heat related illnesses on eTG

eTG's Toxicology and Wilderness section contains detailed information and treatment guidelines for the management of cold and heat related illnesses such as hypothermia, exposure, frost bite, heat exhaustion and heat stroke. The information includes clinical presentations, pathophysiology, monitoring, differential diagnoses, pharmacological and non-pharmacological treatments, management flow charts and references.

Select eTG's Toxicology and Wilderness link to view the full range of toxicology topics including comprehensive drug and drug class overdose management, chemicals toxicity, herbicides, toxicology of essential oils, spider and snake bites, marine poisoning, near drowning, and many more. Tables, boxes and figures provide summarised information such as calculations, algorithms and dosing guidelines.

View the eTG Video tutorial via CIAP’s Knowledge Centre or the eTG homepage.