Article: Management of Pain in People Living with Chronic Limb Threatening Ischemia
Year Published: September/October 2024
Please click the link below:
If not automatically directed on the PDF file just click Download PDF file on the Headings tab.
For documents located in SharePoint Site (CA SJ Wound and Ostomy) look for the article and click it to open. March 20205 Journal - Management on Pain in People Living with Chronic Limb Threatening Ischemia
Don't forget to write your name with each posting.
Discuss the research question or main problem discussed in the study.
ReplyDelete-Chronic ischemic leg pain can be weakening and discomforting, leading to poor health - related quality of life. Disruption of sleep at night, restriction of activities due to fear of pain related movement that may lead to disability , negative emotions such as anxiety. Overall management plan for pain associated chronic limb threatening ischemia requires a multi interdisciplinary approach. Though there were published recommendations that focus on potential management strategies for ischemic pain , no direct recommendation that takes into consideration health- related quality of life, age related changes and physical weakness. Evidence based strategies that are appropriate and safe for the elderly with chronic limb threatening ischemia - associated pain.
Describe the method use by the author of the study
- A group of researchers and clinical knowledge users from Queens University and Nurses specialized in Wounds, Ostomy and Continence performed an umbrella review. A technique that includes an overview of multiple existing reviews, to combine and compare numerous management options to inform best practices and quality indicators for management of ischemic pain in older patients with PAD. Included in the review team was a librarian scientist who specialized in systemic reviews to construct search strategies for several electronic databases such as Cochrane Database of Systemic Reviews, Database of Abstracts of Reviews of Effect and the Joanna Briggs Institute EBP database. Only English language publications were considered for the review.
Discuss the research question or main problem discussed in the study:
ReplyDeleteThis article discusses peripheral artery disease. The primary focus is the management of debilitating pain in those living with PAD, but the article also discusses other key factors that are important for managing these patients which include nutrition and diet therapy, smoking cessation, exercise, pharmacology, and of course wound care. For our purposes, the wound care portion of this article examines the tissue injury caused by the diminished perfusion which can lead to deep, nonhealing wounds and necrosis affecting physical functioning and can threaten the viability of the limb if not properly cared for. Pain from these chronic ulcers effect two-thirds of PAD patients and can be moderate or severe in severity.
How does this research article compare to our practice, police and/or procedure?:
There is a complex need for wound care in those whose PAD results in ulcers with black eschar which require topical antiseptics to control bacterial load which reduces the chance of a deep spreading infection which would necessitate amputation. The review of previous studies found that there was no evidence suggesting that any one topical agent or dressing promotes wound healing or improves ischemic pain over other options, but it is very important to select one that is atraumatic so that dressing changes do not increase tissue damage or exacerbate pain. In most cases, it is counterproductive to practice aggressive debridement of dry eschar as it may protect the bone and tissue underneath from further damage. It is crucial to consider pain management with pharmacological agents when scheduling dressing changes to prevent unnecessary pain and suffering. Here at PSJMC, our practice is to use the nonstick dressings with arterial ulcers, which is in alignment with the suggestions within this article to prevent trauma to the wound bed. We also ensure that patients are adequately medicated prior to any dressing changes, and carefully evaluate any irregular increases in pain which may indicate an infection or change in the wound.
Methods: Researchers from Queen's University and Nurses Specialized in Wounds, Ostomy and Continence Canada performed an umbrella review, funded by the Canadian Institute of Health Research, which involves an overview of multiple existing reviews that employ a rigorous and transparent method to comprehensively identify and synthesize relevant literature including systematic, scoping and narrative reviews. The purpose of this was to aggregate and compare various management options to inform best practices and quality indicators for the management of ischemic pain in older patients with PAD. Only English language publications were considered for review. Through these search results the researchers touched on several categories of best practice and quality indicators including standardized instruments to evaluate pain, modifications to diet and nutritional therapies, smoking cessation, exercise, wound care, early referral to vascular specialists and various modes of pharmacotherapy to improve and prevent instances of PAD.
ReplyDeleteComparison to practice: While I have had many patients with a history of PAD, it is seldom that diagnosis is the main reason for admission, in my experience. While the patients may be here for another diagnosis it is likely that their PAD symptoms are not being adequately addressed, either because it is not their chief complaint and perhaps they don't mention their symptoms on admission, or because there is a gap in knowledge about how to effectively treat PAD symptoms. It is noted in the article that a previous study in which 436 clinicians were asked about their experience caring for patient with PAD, over 90% of them identified a need to improve their knowledge in the management of CLTI- associated (chronic limb threatening ischemia) pain. This article outlines several areas in which St Joes already meets their recommendations for PAD patients while they are in our care including using a standardized pain scale, adequate wound care and smoking cessation, however it could be possible to introduce new education on other factors such as diet and exercise that could decease the pain associated with PAD at home and improve overall quality of life.
Describe the method used by the author of the study
ReplyDeleteResearchers and clinical knowledge users, from Queen's University and Nurses specialized in Wounds, Ostomy and Continence Canada reviewed prior published articles in this subject matter. They did an umbrella review of the data in the existing reviews, to get a comprehensive look at the data. They aimed to find the best practices for management of patients with PAD, in order to improve their quality of life. They only analyzed English language publication reviews.
Discuss the research question or main problem discussed in the study?
The purpose of the study was to figure out the best methods for management of patients with chronic limb threatening ischemia. Many of these patients suffer from pain and leg ulcers. Pharmacological pain management and blood thinners, good nutrition, exercise, good wound care, and smoking cessation can benefit the patients with PAD. In the article, recommendations were made in each of these areas, for the improved quality of life of these patients with CLTI.
Bethany Sobesto
Describe the method used by the author of the study
ReplyDeleteThe method used is base from the clinical knowledge users, from Queens University and nurses specialized in Wounds ,Ostomy and Continence Canada reviewed prior published articles in the subject matter.They did an umbrella review the data in the existing reviews to get a comprehensive look at the data.They aimed to find the best practices for management of patients with PAD, in order to improve their quality of life.They only analyze English Language publication reviews.And Several diagnostic studies are used to evaluate leg ischemic pain, which is often a symptom of Peripheral Artery disease (PAD) or Critical limb Ischemia (CLI). The choice of study depends on the severity of symptoms and the specific questions being asked.
Discuss the research question or main problem discussed in the study?
Leg Ischemic disease, also known as lower extremity ischemia or critical limb ischemia, occurs when blood flow to the legs is severely restricted ,leading to insufficient oxygen delivery to the tissues.This can cause pain, numbness,and potentially tissue damage or loss if left untreated.Leg ischemia is a serious condition where there is insufficient blood flow to the legs and feet .Its often a result of peripheral artery disease (PAD),where narrowed arteries restrict blood flow .PAD itself is caused by atherosclerosis ,the buildup of plaque in the arteries .In serve cases ,CLI can lead to pain non healing sores and even amputation.
Describe the method used by the author of the study.
ReplyDeleteThe study used an umbrella review method, based on the number of published articles and research that has already been conducted. The purpose of this style of study is to analyze the already developed data and identify and synthesize indicators and management of ischemic pain in the specific population identified with peripheral artery disease. To find all quality and relevant data several data bases were used to electronic search material.
Discuss the research question or main problem discussed in the study?
The study developed for this research article depicts the occurrence of pain and treatment experienced by patients with peripheral artery disease. It is seen that many who have PAD, experience long standing pain that can contribute to worsening quality of life and increase occurrence of poor quality of health. It is wanted to explore the options available for those living with PAD and chronic limb ischemia to increase overall health and treat pain in a variety of manners rather than only by pharmacological involvement.