Journal of Research in Pharmacy Practice

Abstract This study aims to evaluate current pain assessment and management in critically ill patients and to describe (1) pain management episode, according to the behavioral pain scale (BPS), and (2) the effectiveness of analgesics, according to the recommendation of guidelines. Methods: In this cross-sectional study, a sample of 60 intubated critically ill patients was selected from the intensive care units (ICUs). A researcher evaluated the patient' pain severity using the BPS tool in patients receiving analgesics according to nurses' note. At each time of analgesic administration, the BPS score was recorded, and this process was repeated 72 h later. The appropriateness of pharmacological interventions was assessed according to the American College of Critical Care Medicine guideline. Findings: The most prescribed analgesic was morphine sulfate (48.3%) followed by fentanyl (23.3%). 55% of analgesics on day 1 and 25% on day 3 were prescribed appropriately according to the guideline recommendation and BPS score. Morphine was the most effective drug (17 patients out of 29). Even though a BPS score was <5, 26 patients received analgesics. Conclusion: Quality of pain assessment and management in our setting is inappropriate and inadequate, which leads to over- or under-use of analgesics. The lack of an established pain protocol may contribute to this situation.

Abstract Objective: To monitor pain intensity, pain symptoms, and medication use in elderly 
with dementia.
Methods: Nursing home residents above 65 years of age, diagnosed with dementia, 
and showing pain symptoms were included in the study. The patients’ mental status 
was monitored through a mini‑mental state examination score and observations of pain 
symptoms using Part 1 of the Mobilization‑Observation‑Behaviour‑Intensity‑Dementia‑2 
(MOBID‑2) pain scale. Community pharmacists reviewed the patients’ medication use, 
and the prescriptions were compared with guidelines for treatment of geriatric patients. 
Alterations to the patients’ medicine use were forwarded to the general practitioners.
Findings: Sixty‑one nursing home residents diagnosed with dementia were identified, 
15 of these fulfilled the inclusion criteria, and 12 agreed to participate in the study. 
The mean age was 87 years of age (range: 77–96), and 42% of the residents were 
males. The patients’ overall pain intensity was 83% for observations on the numeric 
pain rating scale (NRS) >0 and 67% for NRS ≥3. Most painful were the situations in 
which the residents were to mobilize their legs, turn around to both sides of the bed, 
and when sitting on the bed. The medication reviews identified a total of 95 individual 
prescriptions, and 33% of these were for nervous system medications, followed by 
medicines for the treatment of alimentary tract and metabolism disorders (31% of 
total). Eleven prescriptions for pain medicine were identified; the majority of these 
were for paracetamol and opioids. Seventeen proposals to patients’ medication use 
were suggested, but the general practitioners accepted only 6% of these.
Conclusion: This study indicates that the MOBID‑2 pain scale in combination with 
medication reviews can be used as a tool for optimization of patients’ medication use. 
However, we recommend the conduction of a larger‑scale study in multiple settings, to 
validate our results and the generalizability of the findings.