PURPOSE:To evaluate the effects of AA on pain intensity, functional capacity, and depressive symptoms in older women with knee osteoarthritis. DESIGN:In this parallel, open-label randomized clinical trial. METHODS:100 women aged ≥60 years with chronic knee pain were randomized to receive AA (n = 50) or sham auricular stimulation at a neutral point (n = 50), once weekly for 10 weeks. The primary outcome was pain intensity (Numeric Pain Rating Scale). Secondary outcomes were functional capacity (Katz Index and Lawton-Brody Scale) and depressive symptoms (15-item Geriatric Depression Scale). Data were analyzed using Generalized Estimating Equations. RESULTS:Sixty-five participants completed follow-up. Compared with the control group, the AA group showed greater reductions in pain intensity (p < .0001), improved independence in basic activities of daily living (p = .0050), and decreased depressive symptoms (p = .0417). No differences were observed in instrumental activities of daily living (p = .8728). No adverse events were reported. CONCLUSION:Auricular acupuncture significantly reduced pain and depressive symptoms and improved independence in older women with knee osteoarthritis. CLINICAL IMPLICATIONS:These findings support the safe integration of AA into comprehensive geriatric pain management.
Purpose To describe maternity staff’s perceptions of neonatal pain assessment and management focused on the use of nonpharmacological pain-relieving methods during blood sampling, and the background factors associated with these perceptions. Design A descriptive cross-sectional study. Methods The study was conducted in maternity units at five Finnish university hospitals between August 2023 and February 2024. The data were collected using a 45-item electronic questionnaire distributed to maternity staff (N = 576), yielding 119 responses. Results Maternity staff considered the assessment of neonatal pain to be important, and most believed they could reliably assess neonatal pain. Most participants did not use a validated pain assessment scale. Crying and moaning were the most commonly observed indicators of pain, while facial expressions were noted less frequently. During blood sampling, neonates were most commonly offered their own fist, a finger, or a pacifier, and facilitated tucking emerged as a widely used nonpharmacological method for pain relief. Approximately half of the staff reported using kangaroo care and breastfeeding as methods to relieve neonatal pain. Staff participation in education and the availability of written guidelines were significantly associated with both neonatal pain assessment practices and the use of nonpharmacological pain-relieving methods. Conclusions This article highlights the importance of educating maternity staff and ensuring the availability of written guidelines to improve pain assessment and the use of nonpharmacological pain-relieving methods for healthy neonates during painful procedures in maternity units. Clinical Implications Systematic pain assessment and the consistent use of nonpharmacological pain relief should be integrated into standard practice to ensure equitable care for all neonates.
PURPOSE:This study was conducted to examine the effects of a virtual reality (VR) intervention on labor pain and the fear of childbirth in pregnant women during the active phase. DESIGN:The parallel-group randomized controlled trial with repeated measures was performed according to CONSORT guidelines. METHODS:A total of 34 pregnant women (16 intervention, 18 control group) were enrolled in the study. Women in the intervention groups watched a 360° immersive video using a VR goggles while their cervical dilation was 6 cm and 8 cm, and their pain levels were assessed before and after the intervention using the Visual Analog Scale (VAS). The control group received only routine care. Fear of childbirth was assessed 24 hours after delivery using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Data were analyzed using parametric tests, and effect sizes (Cohen's d and Hedges' g) were calculated. RESULTS:In the intervention group, VR significantly reduced pain scores at both 6 cm (mean difference = 2.19, p < 0.001, Hedges' g = 0.96) and 8 cm dilation (mean difference = 1.31, p = 0.003, Hedges' g = 0.80). At 8 cm dilation, the intervention group reported significantly lower pain scores compared to the control group (p = 0.009). The mean W-DEQ scores difference was not statistically significant (p = 0.059). A moderate positive correlation was observed between post-intervention pain scores and fear of childbirth at 8 cm (r = 0.439, p = 0.025). CONCLUSIONS:VR is an effective, safe, and non-invasive method for reducing labor pain, especially in the final stages of the active phase of labor. CLINICAL IMPLICATION:The use of VR technology in intrapartum care has the potential to foster the development of innovative, patient-centered, and evidence-based care approaches in nursing and midwifery practice.
BACKGROUND:Fibromyalgia (FM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and heightened central sensitivity. Women with FM frequently experience sleep disturbances and premenstrual syndrome (PMS), yet the interrelationship among central sensitization (CS), sleep quality, and PMS remains insufficiently understood. AIM:To examine the associations among premenstrual syndrome (PMS) severity, central sensitization (CS), and sleep quality in women with fibromyalgia, and to test whether central sensitization mediates the association between PMS severity and sleep quality. METHODS:A cross-sectional study was conducted among 359 women with FM attending rheumatology outpatient clinics at Cairo University Hospitals, Egypt. Data were collected using Arabic versions of the Central Sensitization Inventory (CSI), Pittsburgh Sleep Quality Index (PSQI), and Premenstrual Syndrome Scale (PMSS). Analyses included descriptive statistics, Pearson correlations, and path analysis with mediation testing using SPSS v29 and AMOS. RESULTS:Participants reported poor sleep quality (PSQI mean = 8.16 ± 4.06), high PMS severity (PMSS mean = 122.54 ± 15.74), and moderate CS symptoms (CSI mean = 51.75 ± 10.43). PMS severity was positively associated with CS (r = 0.487, p < .001) and negatively associated with sleep quality (r = -0.543, p < .001). CS was also negatively associated with sleep quality (r = -0.467, p < .001). Path analysis indicated that CS partially mediated the association between PMS severity and sleep quality. CONCLUSION:Central sensitization partially mediates the association between PMS severity and sleep quality in women with fibromyalgia, highlighting the interconnected role of menstrual symptoms, central pain processing, and sleep disturbances. IMPLICATIONS FOR NURSING PRACTICE:Nurses should incorporate assessment of central sensitization, sleep quality and menstrual symptom patterns when caring for women with fibromyalgia. Nursing interventions such as pain neuroscience education, cognitive-behavioral strategies, relaxation techniques and sleep hygiene counseling may help attenuate central sensitization and improve sleep-related outcomes.
Objectives This study aimed to determine whether the relationship between pain intensity and frailty in patients with knee osteoarthritis (KOA) was mediated by pain catastrophizing and fear of movement (FOM). Methods Patients with KOA aged 45 years or above were recruited from June to August 2024. Cross-sectional data on the patients’ pain intensity, frailty, pain catastrophizing, and FOM were collected using questionnaires. Correlation analysis was performed to analyze the relationship between variables, and multiple mediation effects were analyzed using AMOS 28.0 software. Results Frailty was positively correlated with pain intensity (r = 0.390, p < 0.001), pain catastrophizing (r = 0.426, p < .001) and FOM (r = 0.472, p < .001). Pain catastrophizing and FOM played multiple mediating roles in the correlation between pain intensity and frailty. Conclusions These findings contribute to the understanding of the modifiable factors that can prevent frailty in patients with KOA. Future therapeutic interventions targeting pain catastrophizing and FOM could help prevent frailty.
OBJECTIVE:To examine the scientific production, publication trends, conceptual structure, and thematic evolution of nursing-related literature on spinal surgery. DESIGN:Descriptive bibliometric study. METHODS:Bibliographic data were retrieved from the Web of Science Core Collection, Scopus, and PubMed on May 22, 2026. No language or publication-year restrictions were applied. The search strategy was based on two concept clusters: spinal surgery and nursing. After duplicate removal, eligibility screening, data cleaning, and bibliographic standardization, analyses were performed using Bibliometrix/Biblioshiny and VOSviewer. Publication trends, citation indicators, productive sources, authors, institutions, countries, keyword co-occurrence, thematic mapping, and trend topics were analyzed. RESULTS:A total of 266 publications published between 1951 and 2026 were included. These publications appeared in 96 sources and involved 786 authors. The annual growth rate was 2.63%, with the highest output recorded in 2023 (n = 19). The United States led in publication output and citation impact. The literature was primarily structured around spinal fusion, nursing, lumbar vertebrae, spinal surgery, scoliosis, patient outcomes, pain, and postoperative care. Nursing assessment, patient education, and the perioperative period emerged as motor themes, while postoperative care, enhanced recovery after surgery, and nursing care represented recent trends. CONCLUSIONS:The spinal surgery nursing literature has evolved toward a patient-centered, outcome-focused, perioperative, and multidisciplinary orientation. NURSING PRACTICE IMPLICATIONS:Strengthening evidence-based perioperative assessment, patient education, pain management, postoperative monitoring, complication prevention, discharge planning, and continuity of care may improve recovery, patient safety, functional outcomes, and care coordination.
BACKGROUND:Fibromyalgia (FM) remains difficult to manage due to a highly variable symptom profile. The "FINAL" randomized, placebo-controlled trial examined the efficacy of low-dose naltrexone (LDN) on pain in women with FM, showing no significant difference in pain reduction at the group level but potentially higher 30% pain response rates. Analysis of secondary outcomes showed potential improvements in memory problems. OBJECTIVES:This exploratory analysis aimed to further investigate individual responses to LDN treatment by analyzing 30% responder rates for six secondary FM outcomes. METHODS:The FINAL trial included 99 women with FM who were randomized 1:1 to treatment with LDN or placebo for 12 weeks. Based on original data from this trial, 30% response rates were assessed for the six selected secondary outcomes: tenderness, fatigue, sleep disturbances, depression, memory problems, and stiffness. Risk ratios (RR) with 95% confidence intervals (CI) were calculated to assess differences between groups. RESULTS:No significant differences were found between treatment groups for any of the symptom response categories. The highest RR was observed for memory (RR = 1.67, 95% CI: 0.82-2.95), followed by sleep (RR = 1.28, 95% CI: 0.92-2.64), stiffness (RR = 1.26, 95% CI: 0.84-2.89, p = .47), tenderness (RR = 1.16, 95% CI: 0.88-2.67), fatigue (RR = 1.10, 95% CI: (0.78-3.13) and depression (RR = 0.96, 95% CI: 0.92-2.66). CONCLUSIONS:Response rates for 30% improvement in six selected nonpain outcomes were similar after 12 weeks treatment with LDN or placebo in women with FM. Larger studies investigating 30% response rates are warranted.
PURPOSE:The most common complication after laparoscopic cholecystectomy is pain. One of the nondrug methods used to reduce pain and pain-related complications in the patient is transcutaneous electrical nerve stimulation (TENS). This research was conducted as a randomized controlled trial to evaluate the effect of TENS on patient outcomes following laparoscopic cholecystectomy. DESIGN AND METHODS:The study sample consisted of 140 patients (intervention: 70 and control: 70) who were treated in the general surgery clinic of a training and research hospital between May 2023 and May 2024 and underwent laparoscopic cholecystectomy. TENS was applied to the intervention group three times in 30-minute sessions within 24 hours. The control group received only the routine treatment of the clinic. Data collection tools included a "data collection form" and the "Turkish Revised-American Pain Society Patient Outcome Questionnaire" (APS-POQ-R-TR). The mean age of the patients participating in the study was 47.14 ± 11.42, 51.4% were male, and the groups were homogeneous in terms of their descriptive characteristics (p > .05). It was determined that the 1st-, 11th-, and 19th-hour rest and cough pain levels of the intervention group following the TENS intervention were significantly lower than those of the control group (p < .05). The intervention group had lower postoperative pain intensity in the first 24 hours, lower pain intensity in the 24 hours after surgery, and lower sleep time compared to the control group. Scores for pain reduction, turning in bed, walking and sitting, sleep maintenance, treatment participation (6.65 ± 1.10), and satisfaction (7.70 ± 1.30) in the first 24 hours were higher than those in the control group (p < .05). RESULT:The study demonstrated that TENS is an effective analgesic option for pain management after laparoscopic cholecystectomy, positively impacting comfort and treatment participation. CONCLUSIONS AND CLINICAL IMPLICATIONS:This method should be integrated into pain management protocols and treatment plans to improve patient outcomes.
PURPOSE:To explore the impact of health insurance on the rural-urban disparities in opioid misuse in the United States. METHODS:A secondary analysis of the National Survey on Drug Use and Health (NSDUH) was conducted using datasets from 2021 to 2023. Outcomes examined were past-month and past-year opioid misuse. Residence was categorized using the Core Based Statistical Area (CBSA) classifications: large CBSA (>1 million persons); small CBSA (<1 million persons); rural: residing in a non-CBSA. Statistical analysis included univariate analysis, multivariable logistic regression, and a model for each outcome that accounted for moderation between residence and insurance. RESULTS:The weighted sample comprised 281,769,638 individuals, of whom 3.2% and 1.0% reported past-year and past-month opioid misuse, respectively. The multivariable analysis without moderation showed that, compared with non-Hispanic Whites, non-Hispanic Asians had lower odds of past-year opioid misuse (p < .001). Significant moderation was observed only for past-month opioid misuse. The main effect of residence showed that past-month misuse was lower among individuals living in non-CBSAs than among those in large CBSAs (aOR = 0.58; 95% CI, 0.39,0.85). After adjusting for moderation, individuals in non-CBSAs without health insurance had higher odds of past-month misuse than those in large CBSAs without insurance (aOR = 3.41, 95% CI, 1.37, 8.51). Higher income was protective against opioid misuse, but being male was associated with increased odds of misuse. CONCLUSIONS:People from rural areas without health insurance had higher odds of past-month opioid misuse than those without health insurance in large CBSAs. These findings can guide focused interventions to address opioid misuse.
PURPOSE:The purpose of this research is to examine the effects of organic pain beliefs (OPB) and psychological pain beliefs (PPB) on pain intensity, disability, kinesiophobia, catastrophizing, and pain knowledge in chronic shoulder pain. DESIGN:Cross-sectional observational study. METHODS:In this cross-sectional study, 109 patients (66 females, 43 males; mean age 49.8 ± 10.4 years) with chronic rotator cuff-related shoulder pain were recruited using a convenience sampling method and completed the Pain Beliefs Questionnaire (PBQ), the Numeric Pain Rating Scale (NPRS), the Shoulder Pain and Disability Index (SPADI), the Tampa Scale for Kinesiophobia (TSK), the Pain Catastrophizing Scale (PCS), and the Revised Pain Neurophysiology Questionnaire (Revised-NPQ). Pearson correlation and multiple linear regression analyses were used to assess the relationships of OPB and PPB with the outcome measures. RESULTS:OPB were significantly positively correlated with activity-related pain (r = 0.30, p = .001), disability (SPADI total; r = 0.21, p = .025), kinesiophobia (TSK; r = 0.42, p < .001), and catastrophizing (PCS; r = 0.40, p < .001), and were negatively correlated with Revised-NPQ (r=-0.34, p = .001). In multiple regression models, OPB significantly predicted greater disability (β=0.25, p = .013), kinesiophobia (β=0.45, p < .001), and catastrophizing (β=0.44, p < .001), explaining 4.8%-17.4% of variance in these outcomes (adjusted R²=0.048-0.174). CONCLUSIONS:In chronic shoulder pain, OPB show weak to moderate associations with adverse clinical outcomes and a negative association with pain knowledge, whereas PPB are not significantly related to outcomes. These findings support the potential value of targeting maladaptive beliefs and improving pain knowledge within rehabilitation. CLINICAL IMPLICATIONS:Evaluating OPB and PPB in relation to pain-related parameters, kinesiophobia, and catastrophizing may help identify at-risk patients and support individualized rehabilitation and targeted education in chronic shoulder pain.
PURPOSE:The purpose of this study was to gain a better understanding of patients' experiences with discomfort in the intensive care unit following open-heart surgery. DESIGN:A qualitative descriptive design was used to give participants an opportunity to express their experiences of discomfort in their own words. METHODS:Following institutional review board approval, participants were consented. Semi-structured interviews were conducted in cardiovascular step-down units. Participants were asked to reflect on their intensive care unit experiences. Thematic analysis occurred simultaneously with data collection. RESULTS:Five themes emerged from participant interviews: Pain, Feeling Safe and Cared for, Physical Discomfort, Psychological Discomfort, and Expectations. Various factors both mitigated and exacerbated participants' pain, which was generally described as severe. Participants' experiences of discomfort were impacted by expectations from previous surgical encounters. Nursing care impacted participants' experiences of pain, physical discomfort, and psychological discomfort. Participants expressed that nurses' caring behaviors created feelings of safety and comfort. CONCLUSIONS:This study highlights that intensive care unit discomfort following open-heart surgery extends beyond pain to include sleep disturbance, device-related discomfort, confusion, and loss of dignity. Participant expectations and nursing care both influenced experiences of discomfort. Understanding discomfort from the patient's perspective can guide improvements in care and minimize the psychological effects of critical illness. CLINICAL IMPLICATIONS:Findings support targeted nursing interventions including assessment of nonpain discomfort, preservation of dignity, and education on what to expect to reduce distress and improve patient experiences.
OBJECTIVES:To develop a multidimensional KAP assessment scale evaluating patients' knowledge, attitude and practice toward analgesics, test its reliability and validity, and offer a standardized evaluation tool to carry out targeted health education and boost medication adherence among pain patients. DESIGN:Methodological research of scale development and psychometric verification. METHODS:The initial item pool was established based on KAP theoretical framework, relevant literature review and Delphi expert consultation, followed by item screening to form the preliminary scale. A convenience sampling strategy was adopted. A total of 200 inpatients and outpatients from the pain department, oncology department, bone and joint surgery department, and spinal surgery department of a local tertiary hospital were enrolled to complete the questionnaire. Item analysis, internal consistency reliability test, content validity evaluation, and exploratory factor analysis were conducted to comprehensively verify the psychometric properties of the scale, with the statistical significance level set as α = 0.05. RESULTS:The finalized scale contained 17 items covering three dimensions: 9 knowledge items, 5 attitude (belief) items and 3 practice (behavior) items. The overall Cronbach's α of the scale was 0.85. Deleting any single item could not raise the overall Cronbach's α, and the Cronbach's α of each dimension remained above 0.82. The item-level content validity index (I-CVI) of all items was ≥ 0.98, and the scale-level content validity index (S-CVI) reached 0.91. Exploratory factor analysis extracted five common latent factors, which jointly explained 71.16% of the total variance of all items. CONCLUSIONS:The self-developed multidimensional KAP scale for patients' cognition, belief and behavior related to analgesics possesses satisfactory reliability, good construct validity and favorable clinical applicability. It can serve as a reliable quantitative evaluation instrument for pain-related patient assessment. CLINICAL SIGNIFICANCE:This standardized KAP scale can help clinical medical staff objectively identify patients' misunderstandings, negative attitudes and non-compliant behaviors regarding analgesic use. It supports personalized pain health education, standardizes refined pain management, optimizes patients' analgesic medication compliance, and ultimately improves the overall quality of clinical pain control.
PURPOSE:Appropriate pain assessment of adults is critical for effective pain management. Technology-driven tools can contribute to improved pain assessments. Training is vital when integrating new clinical digital tools. Minimal studies have evaluated post-training outcomes. The aim of this study was to evaluate the training provided to clinical staff on the use of a pain assessment application for hospitalized adult patients. DESIGN:A cross-sectional study utilizing The Kirkpatrick Model of Training Evaluation. METHODS:Clinical staff (nurses and physiotherapists) on an acute metropolitan hospital orthopedic ward in Western Australia were invited to face-to-face training of PainChek Universal, a pain assessment application using artificial intelligence. One-hour training used didactic delivery and hands-on practice. Training effectiveness was evaluated against Kirkpatrick's Levels 1 and 2 via a 43-item survey, including two open-ended questions. Data were analyzed using SPSS 25 and content analysis of open-ended responses. RESULTS:A total of 44 staff attended training 19 (43.2%) completed the post-training survey. Most respondents were satisfied with the training and confident to use the application (94.7%). Ten participants (52.6%) desired additional post-training support post-training and 14 (73.7%) agreed the application appears easy to use. Eighteen (94.7%) felt it would be a positive addition to pain assessment. Staff's correct knowledge scores varied (36.8% to 84.2%), indicating a need for further education. CONCLUSIONS AND CLINICAL IMPLICATIONS:Training of a technology-driven application for pain assessment is essential for effective implementation to improve care. Training enabled staff to acquire knowledge and skills, develop user confidence, and understand usability and utility of the application.
BACKGROUND:Postoperative pain management in children is a critical aspect of pediatric care. This aspect of pediatric care is important because it can lead to psychological stress and distress, impacting both immediate and future emotional well-being in children if not managed well. PURPOSE:To explore the experiences of nurses during the management of postoperative pain in the pediatric population at the Tamale Teaching Hospital. METHODS:A hermeneutic-phenomenological approach was used, with a sample size estimated at three (3) to ten(10) participants. Data collection involved interviews until the four criteria for data saturation (that is, deepness, richness, relevance, and abstractness) were achieved at the seventh interview, conducted over 2 months in a hospital setting. RESULTS:Four themes developed from the data analysis depicting nurses' experiences: physiological, bodily expressions, and pain scale used for pain diagnosis; nonpharmacological and pharmacological methods used for pain management; institutional, personnel, parents', and patients' constraints; and compassion fatigue, physical bodily depletion, and burnout, highlighting the emotional challenges nurses face. CLINICAL IMPLICATIONS:Hospitals with a similar context to that of the study site should implement these findings to enhance the improvement and quality of pain management in their pediatric units.
PURPOSE:Opioid-related transitions (OrTs) are critical periods requiring focused support and tailored pain management, yet remain poorly understood. This study aimed to examine clinician perspectives on and approaches to managing recurring opioid prescriptions during OrTs for patients with chronic pain. DESIGN:This study used a qualitative descriptive design. METHODS:Semi-structured individual interviews were conducted with 21 interdisciplinary clinicians, including prescribers and nonprescribers, within a large health system in the southeastern United States. Data were analyzed using rapid qualitative analysis. RESULTS:We identified three themes related to our objective. The first theme, "multiple and varied transitions in opioid management," included the following subthemes: (1) care setting transitions, (2) clinician transitions, and (3) medication prescribing transitions. The second theme, "clinician approaches to opioid management," included the following three clinician approaches: (1) accept the patient, (2) accept the patient with guardrails, and (3) defer responsibility to other clinicians. The last theme, "influencing factors to OrT," included: (1) opioid prescribing policies, (2) power dynamics, and (3) system-level barriers and facilitators. CONCLUSION:OrTs often occur amid clinician-reported barriers, limited support, and discomfort with opioid prescribing and management, particularly during changes in care settings, clinicians, and opioid regimens. CLINICAL IMPLICATIONS:These findings underscore the need for improved care coordination and enhanced systems-level support for clinicians who provide care to patients during OrTs. Best practices that support optimal patient pain management are urgently needed to guide clinician decision-making regarding opioid prescribing and management during transitions of care.
PURPOSE:Effective pain management is crucial for the early mobilization and functional recovery of elderly patients with fragility fractures. This study aimed to evaluate the efficacy of transdermal diclofenac patches (DPs) for pain control and their impact on functional recovery, with the primary hypothesis that DPs are superior in shortening the time to mobilization in elderly patients with fragility fractures. DESIGN:Retrospective historical control. METHODS:This retrospective cohort study with historical controls included patients aged ≥70 years hospitalized with proximal femoral fractures or vertebral fractures. Thirty patients treated with DPs (group D) were compared with 30 patients not treated with DPs (group N). Primary outcomes included time to mobilization, recovery of activities of daily living, and ambulatory ability at discharge. RESULTS:The time to initiating walking practice (mean difference 2.76 days, 95% confidence interval [0.28, 5.23], p = .03) and using the toilet (mean difference 2.37 days, 95% confidence interval [0.00, 4.73], p = .049) was significantly shorter in group D. In the vertebral fracture subgroup, significantly fewer patients in group D showed a decline in walking ability at discharge (p < .05). No drug-related adverse events were observed. CONCLUSIONS:DP use was associated with earlier mobilization and better preservation of walking ability. It appears to be a well-tolerated and potentially useful analgesic option for improving the functional outcomes in this high-risk population. However, these findings should be interpreted with caution because of the limitations of unadjusted, nonrandomized historical comparisons. CLINICAL IMPLICATIONS:© 20XX by the American Society for Pain Management Nursing.
PURPOSE:To evaluate whether significant changes in postoperative outcomes and opioid consumption could be detected following the implementation of a comprehensive hospital-wide pain management model centered on multimodal analgesia (MMA) among adults undergoing appendectomy or cholecystectomy. DESIGN:Retrospective cohort study comparing two distinct periods at a single tertiary hospital: an Initial Phase (2016-2018), representing baseline and assimilation of the model; and a Subsequent Phase (2019-2022), reflecting the full operation of the MMA protocols. METHODS:The study included 3,658 adult patients (≥18 years) who underwent appendectomy or cholecystectomy. Data extracted from hospital records included demographics, VAS pain scores, inflammatory markers (CRP, WBC), medication use, surgical details, complications, and hospital length of stay (HLoS). Statistical analysis compared outcomes between the two phases. RESULTS:Following full implementation, nonopioid analgesic use increased significantly from 40.1% to 73.6% (p < .001), while opioid use decreased from 80.2% to 74.5% (p < .001). Mean VAS scores increased modestly from 5.69 ± 1.4 to 5.98 ± 1.6 (p < .001), likely due to improved pain reporting. Mean C-Reactive Protein (CRP) levels dropped substantially from 70.3 ± 81.6 to 14.1 ± 7.4 (p < .001). Average hospital stays shortened modestly from 2.19 ± 3.4 to 1.9 ± 2.9 days (p = .5). Complication rates remained unchanged. CONCLUSIONS:Following the implementation of a systematic, hospital-wide MMA pain management model, a significant increase in nonopioid consumption and a reduction in opioid use were observed. Furthermore, decreased CRP levels and a trend toward shortened HLoS postsurgery were detected during this subsequent period. CLINICAL IMPLICATIONS:These findings document the expected changes that occurred after implementing a system-wide MMA initiative. Future replication studies using more rigorous designs are needed to confirm these effects before supporting broader adoption across diverse surgical procedures.
