Background: Pain is assessed by nurses through either reported or observed intensity. Self-reported assessments, specifically a numeric score, are the gold standard and preferred to behavioral assessments. Disparities in the assessment and management of pain across race, ethnicity, and language status are prevalent, but we do not know how actual numeric pain scores vary and [...]

Background: Assessing and treating pain in older adults is challenging. Although having patients self-report pain on a numeric scale is the recommended approach, age-associated conditions such as dementia, delirium, and impaired vision or hearing can prevent patients from effectively communicating their symptoms. Older patients are also at risk of adverse effects from commonly used analgesics [...]

Background: Sickle cell disease (SCD) causes frequent painful episodes from vaso-occlusion. As hospitalists, we identified that SCD patients occupied a large number of hospital days. Undertreatment and lack of standardization of pain management was a likely reason for this. Many of these patients are opiate dependent at baseline. Varying levels of comfort amongst hospitalists in [...]

Background: Administering opiates safely in hospitalized patients with acute on chronic pain is challenging. There is limited data to guide pain management in this population due to high prevalence of opiate tolerance and variance in daily opiate exposure. There is a need to establish a safe and effective pain medicine regimen in the hospital that stratifies opiates based on [...]

Background: Project Caring for Patients with Opioid Misuse through Evidence-Based Treatment (COMET) launched in 2019 to provide patients with opioid use disorders (OUD) individualized and evidence-based care at Duke University Hospital (DUH). Patients with OUD have higher rates of self-directed discharge (SDD) which is associated with higher healthcare utilization costs, hospital readmissions, and adverse health [...]

Background: Hospitals are compelled by a variety of factors to optimize patient satisfaction. Pain management has been identified as an important determinant of overall inpatient satisfaction. However, effective pain management may be more challenging in the current climate of more cautious opioid use. Purpose: The 32-item Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) [...]

Background: Opiates, frequently used to provide analgesia, are associated with post-analgesia related tolerance effects such as hyperalgesia and hyperkatifeia, which lead to worsening of the pain experience. Patients can subsequently experience dissatisfaction with their care and seek further opiate use as a solution, worsening their experience further. Due to pharmacologic and healthcare-associated operational factors, the [...]

Case Presentation: 46 yo man with chronic pain due to T8-T10 compression fractures from renal osteodystrophy related to tertiary hyperparathyroidism in the setting of end-stage renal disease from sickle cell nephropathy had recurrent prolonged admissions due to uncontrolled pain to the point where the patient was unable to perform his activities of daily living. Traditional [...]

Background: Patients with sickle cell disease (SCD) often face frequent emergency department (ED) visits and hospital readmissions, primarily driven by challenges in pain management, stigma, and system-level barriers. Existing interventions at the CU Division of Hospital Medicine, such as cohorting patients with specific teams, multidisciplinary care conferences, and implementing care plans for high-utilizer patients, have [...]

Case Presentation: A 21-year-old woman presented to the emergency department with 1 month of worsening bilateral foot pain, swelling, and erythema. Her symptoms began shortly after a trip to Arizona, where she spent several days hiking and reported use of a strong massage gun on her feet for hours at a time. She was evaluated [...]