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BACKGROUND AND AIMS: Current laboratory methods for opioid detection involve an initial screening with immunoassays which offers efficient but non-specific results and a subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation which offers accurate results but requires extensive sample preparation and turnaround time. Direct Analysis in Real Time (DART) tandem mass spectrometry is evaluated as an alternative approach for accurate opioid detection with efficient sample preparation and turnaround time. MATERIALS AND METHODS: DART-MS/MS was optimized by testing the method with varying temperatures, operation modes, extraction methods, hydrolysis times, and vortex times. The method was evaluated for 12 opioids by testing the analytical measurement range, percent carryover, precision studies, stability, and method-to-method comparison with LC-MS/MS. RESULTS: DART-MS/MS shows high sensitivity and specificity for the detection of 6-acetylmorphine, codeine, hydromorphone, oxymorphone, hydrocodone, naloxone, buprenorphine, norfentanyl, and fentanyl in urine samples. However, its performance was suboptimal for norbuprenorphine, morphine and oxycodone. CONCLUSION: In this proof-of-concept study, DART-MS/MS is evaluated for its rapid quantitative definitive testing of opioids drugs in urine. Further research is needed to expand its application to other areas of drug testing.

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Pain is one of the most common manifestations in the postoperative stage and it has a detrimental effect on both sleep and patient satisfaction. Consequently, this integrative review seeks to identify the outcomes of pain management specifically concerning sleep quality and patient satisfaction among the patients receiving orthopedic surgeries. In a stepwise manner, peer-reviewed articles manually searched in four databases including Scopus, Science Direct, PubMed, and CINAML (Cumulated Index to Nursing and Allied Health Literature) published between 2019 and 2023 were selected. The current review finally encompassed 22 studies. The review elaborates and reaffirms the notion that pain after surgery is still a critical issue that impacts the quality of patients' sleep as well as their overall satisfaction. Chronic sleep disturbance is generally linked with pain while other factors such as light exposure and hospital environment were found to influence sleep quality. It is thus crucial to develop clear multifaceted pain management guidelines that include patient-tailored pharmacological and non-pharmacological interventions aimed at helping patients recover better, sleep better, and be satisfied with the procedures and results.

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Spine surgery may lead to moderate to severe pain.Poorly controlled postoperative pain seriously affects the prognosis and recovery of patients.The erector spinae plane block (ESPB),firstly proposed in 2016 as a novel interfascial plane block,has been widely used in the management of intraoperative and postoperative pain in spine surgery.It has been confirmed as a safe,simple,and effective block.This review describes the anatomic basis,mechanism,and methods of ESPB,summarizes the clinical application of ESPB in spine surgery,and makes an outlook on the potential role of ESPB as a part in the multimodal management of postoperative pain in spine surgery.

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PURPOSE: We aimed to identify the factors influencing the success of Pain Neuroscience Education (PNE) in chronic musculoskeletal (MSK) pain from the perspective of those experiencing PNE first-hand. MATERIALS AND METHODS: We conducted a meta-synthesis of qualitative studies. Articles were found on MEDLINE via Pubmed, EMBASE, Cochrane Library, CINHAL, and PsycINFO up to April 2023. Eligible qualitative studies focussed on adults (>16 years old) with a diagnosis of chronic primary or secondary MSK pain who performed PNE. Thematic synthesis by Thomas and Harden was followed. The Critical Appraisal Skills Programme (CASP) tool ensured the quality of the studies, while the Confidence in Evidence from the Reviews of Qualitative Research (CERQual) approach facilitated data confidence assessment. RESULTS: Nine studies were included (188 participants). Three analytical themes were developed: (i) "Efficient Communication of Information", emphasising the importance of accurate content transmission; (ii) "Emotional Support and Well-being", recognising emotional aspects as integral to treatment; and (iii) "Empowerment Promotion", focusing on information retention and personal transformation. The studies showed good quality, with moderate confidence in the evidence. CONCLUSIONS: The perceived factors influencing the success of PNE are intricately related to the domain of communication, the emotional dimension of personal experience, and the capacity to be empowered.

Tailoring interventions to pain experiences, preferences, and emotions is key for the success of pain neuroscience education;A personalised approach is crucial for effective pain neuroscience education, emphasising the need to understand and address the specific aspects of each patient's pain journey.

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INTRODUCTION: Musculoskeletal pain typically occurs in multiple sites; however, no study has examined whether excessive visceral and subcutaneous adipose tissue are associated with musculoskeletal pain. This study therefore aimed to describe the associations between MRI-derived abdominal adipose tissue and multisite and widespread chronic musculoskeletal pain. METHODS: Data from the UK Biobank, a large prospective, population-based cohort study, were used. Abdominal MRI scans were performed at two imaging visits to quantify visceral adipose tissue and subcutaneous adipose tissue. Pain in the neck/shoulder, back, hip, knee or 'all over the body' was assessed at the corresponding visits. Mixed-effects ordinal/multinomial/logistic regression models were used for the analyses. RESULTS: A total of 32 409 participants were included (50.8% women, mean age 55.0±7.4 years). In multivariable analyses, there was a dose-response association of visceral adipose tissue, subcutaneous adipose tissue and their ratio with the number of chronic pain sites in both women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain in both sexes. The effect estimates of these adipose measures were relatively larger in women than in men. CONCLUSION: Abdominal adipose tissue was associated with chronic musculoskeletal pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain. The identified stronger effects in women than men may reflect sex differences in fat distribution and hormones.

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AIM: To identify and compare factors associated with pain perception and management among paediatric nurses and nursing students using virtual human technology. DESIGN: This study employed a comparative, cross-sectional design. METHODS: Fifty-one paediatric nurses from a tertiary hospital and 50 senior nursing students from a nursing college, both located in South Korea, participated in the study. Virtual vignettes, including scenarios with virtual children and their clinical information, were used to assess participants' pain perception and management. The virtual children, created from real face photos, varied in age (young/old), sex (boy/girl) and facial expressions (smile/grimace). Participants rated perceived pain scores and selected management choices for eight virtual vignettes, which were randomly presented. The Korean version of the Paediatric Nurses' Knowledge and Attitude Survey was completed along with demographic information. RESULTS: Both paediatric nurses and nursing students rated pain scores lower than the actual pain scores reported by virtual children. Nurses rated higher pain scores and accordingly selected more medication doses compared to students. Beyond pain-related knowledge, the facial expression of the virtual child influenced pain rating and medication choices, while age and sex had no effect. CONCLUSION: Nursing students were more sensitive to the facial expressions of virtual children when rating their pain compared to nurses. Future studies should explore how paediatric nurses' clinical experiences impact their assessment and management of child patient pain. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Paediatric nurses' knowledge of pain is inadequate, necessitating ongoing education in pain management. Both nurses and nursing students should self-reflect on their pain assessment practices to ensure unbiased care regardless of child patients' characteristics. IMPACT: Virtual human technology can be utilised to train nurses and students to identify and address any biases in their assessment of patients' pain perception. REPORTING METHOD: STROBE checklist, cross-sectional. PATIENT OR PUBLIC CONTRIBUTION: Digital face photos of four healthy children were used as the fundamental material for creating virtual children, with their parents' consent.

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Introduction: Myofascial pain syndrome is a chronic pain condition prevalent in the general population. Muscular symptoms at the level of the trapezius and rhomboid muscles are frequent and the response to therapeutic interventions established so far is variable. Methods: We present a case series of six patients who underwent a new technique of interfacial trapezius-rhomboid block (TRB) performed under ultrasonographic guidance by applying 10 cubic centimeters (cc) of analgesic solution (bupivacaine 0.25 % and methylprednisolone 40 mg) in the interfacial plane between the trapezius and rhomboid muscles at the level of the fifth and sixth ribs. Results: At a follow-up of one and eight weeks, measurements of numerical rating scale (NRS) pain intensity were carried out, finding an average decrease of NRS pain intensity by 70 %. Conclusion: This new technique may be considered for the treatment of myofascial pain syndrome of the trapezius and rhomboid muscles. Larger future studies are needed to better establish its safety and efficacy.

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This study aims to provide a holistic approach to burn rehabilitation that prioritizes patient care, pain management, mental health, and functional improvement. A 71-year-old woman visited the Physiotherapy Outpatient Department with the main concerns of burns on her right hand, limited movement in the fourth and fifth fingers for two months, swelling on her right hand, and wound contracture. She underwent split skin grafting at the hospital. The case study findings demonstrated the effects of physiotherapy interventions on the burn subject, specifically regarding scar formation improvement, functional ability enhancement, and pain reduction. This case study revealed that administering the mentioned workout to the individual proved advantageous, with pain decreasing on the visual analog scale (VAS) from 10/10 before to 8/10 after implementing cryotherapy, splinting technique, and active range of motion (AROM) exercise. Healthcare professionals can enhance the well-being of senior burn victims by incorporating evidence-based techniques and creative approaches in the rehabilitation process.

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Objective: To compare pragmatic real-world 10-kHz high-frequency spinal cord stimulation (HF-SCS) outcomes at a single academic center to the industry-sponsored SENZA-RCT and Stauss et al. study. Methods: This single-center retrospective study included patients with refractory back or limb pain trialed and/or permanently implanted with the Nevro HF-SCS system from 2016 to 2021. Demographic and outcome data were obtained from the electronic medical record (EMR) and real-world global database maintained by Nevro Corp. Data obtained from the global database were confirmed using the EMR. Main outcome measures included positive responder status (≥50% patient-reported percentage pain reduction (PRPPR)), improvement in function, improvement in sleep, and reduction in pain medication usage. Comparison groups included patient outcomes from the SENZA-RCT and Stauss et al. study. Results: Patients (N = 147) trialed with HF-SCS were reviewed, with data available for 137. Positive trialed patient responder rate (≥50% PRPPR) was 77% (106/137, 95CI 70-84%) vs. 87% (1393/1607, 95CI 85-89%) Stauss et al. vs. 93% (90/97, 95CI 88-98%) SENZA-RCT HF-SCS. At the last available follow-up, positive implanted patient responder rate was 73% (58/80, 95CI 63-82%) vs. 78% (254/326, 95CI 73-82%) Stauss et al. vs. 79% (71/90, 95CI 70-87%) SENZA-RCT HF-SCS. Sixty-seven percent (59/88, 95CI 57-77%) reported improved function vs. 72% (787/1088, 95CI 70-75%) Stauss et al.; 45% (31/69, 95CI 33-57%) reported improved sleep vs. 68% (693/1020, 95CI 65-71%) Stauss et al. and 16% (9/56, 95CI 6-26%) reported decrease in medication use vs. 32% (342/1070, 95CI 29-35%) Stauss et al. Conclusion: Patient responder rates in this retrospective pragmatic real-world study of HF-SCS are consistent with previous industry-sponsored studies. However, improvements in quality-of-life measures and reduction in medication usage were not as robust as reported in industry-sponsored studies. The findings of this non-industry-sponsored, independent study of HF-SCS complement those of previously published studies by reporting patient outcomes collected in the absence of industry sponsorship.

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Prolonged opioid use carries risks, including addiction and dependence. A significant consequence of chronic opioid use is opioid-induced hyperalgesia (OIH), where patients experience heightened pain sensitivity. Managing OIH typically involves reducing opioid intake while mitigating withdrawal symptoms. This case report presents a patient with OIH treated with intravenous lidocaine and morphine. OIH presents complex pain management challenges, and lidocaine infusion has shown promise in mitigating its effects. Further research is needed to comprehensively assess the efficacy and safety of this treatment approach for patients with OIH.

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Background The Pain Understanding and Confidence Questionnaire (PUnCQ) comprises two parts: the first assesses clinical judgments based on contemporary pain knowledge, and the second consists of items querying confidence in pain management for the presented vignette. In contrast to existing measures, PUnCQ can evaluate a therapist's capacity to make appropriate clinical decisions within a specific vignette. Thus, PUnCQ may be a promising measure to assess the clinical competence of physical therapists in pain management. This study evaluated the structural and construct validity of PUnCQ. Methodology Eligible participants were two cohorts of physical therapists managing patients with pain. PUnCQ and Knowledge and Attitudes of Pain (KNAP) data were collected using an anonymous survey. Confirmatory factor analysis was conducted for both parts of the PUnCQ, and an exploratory factor analysis was conducted when multidimensionality was suspected. Construct validity was assessed with the hypothesis that Pearson's r values to KNAP scores, indicating knowledge about modern pain science and biopsychosocial attitudes toward pain, were expected to be 0.3-0.5 in part one and >0.5 in part two. Results Data from 112 participants were analyzed. PUnCQ part one fully satisfied the predetermined criteria for unidimensionality, but part two did not. Exploratory factor analysis for part two revealed a two-factor structure: a 14-item Factor 1 labeled "pain management" and a seven-item Factor 2 labeled "medication guidance and pain mechanism," while Cronbach's alpha was 0.98 across all items. Statistically significant correlations were detected with the KNAP in each part of the PUnCQ (r = 0.26 in part one and r = 0.41 in part two). Conclusion PUnCQ has structural validity and an aspect of construct validity.

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OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) in reducing barriers to the implementation of exercise therapy and promoting exercise therapy, focusing on physical activity. DESIGN: A single, participant-blinded, randomized controlled trial (RCT) with a pre-post design SETTING: Single-institution, orthopedic clinic PARTICIPANTS: Participants had knee pain for at least 3 months (N=63, ≥50 years of age) and were randomly assigned to the TENS (N=21), exercise (N=23), or combined (N=19) group. INTERVENTIONS: Participants were provided with 4 weeks of intervention: the TENS group using a wearable TENS device, exercise group performing designated exercises, and combined group performing activities from the TENS and exercise groups. MAIN OUTCOME MEASURES: The primary outcome measure was physical activity (PA). The secondary outcome measures were 6-minute walk test (6MWT); timed up-and-go test (TUG); stair climbing; knee pain using the visual analog scale at 6MWT, TUG, and stair climbing; and patient-reported changes in knee pain over time. RESULTS: At pre- and post-intervention, light-intensity PA time (LPA) in the TENS, exercise, and combined groups was 735.62±68.82 vs. 714.21±73.06 (p=0.061), 733.05±103.90 vs. 700.31±90.33 (p=0.057), and 710.09±62.98 vs. 685.22±58.35 (p=0.049), respectively, with a significant decrease in the combined group. Significant improvement in knee pain and stair climbing was observed in all groups pre- and post-intervention. CONCLUSIONS: The group using TENS showed improved effects of early reduction in knee pain and when combined with exercise therapy, a reduction in time spent in light-intensity activities such as sedentary behavior. Thus, the use of TENS in combination with conventional exercise therapy has the potential to reduce psychological barriers to the introduction of exercise therapy. It also promotes and ensures the safe implementation and continuation of exercise therapy.

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Hidradenitis suppurativa (HS) is a complex, chronic skin disease characterised by painful inflammatory nodules, abscesses, dermal tunnels, sinus tracts and fistulae with a predilection for intertriginous skin. HS carries a substantial disease burden due to its prevalence, associated comorbidities and quality of life impacts and is associated with high healthcare resource utilisation. Clarity regarding the prevalence and pathogenesis of HS has led to improved therapies and more patients seeking care in both outpatient and acute care settings, including the emergency department. Emergency medicine providers play a critical role in HS diagnosis, management of acute flares and connection of HS patients with long-term dermatologic care, which can in turn help manage utilisation of acute care resources.

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AIM: To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. BACKGROUND: Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non-pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real-life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. DESIGN: A descriptive qualitative design. METHOD: Data were collected through semi-structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. RESULTS: Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost-effectiveness. CONCLUSIONS: While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation.

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Chronic diseases and pain exacerbate depressive symptom in Syria. Limited research on hospital-induced depressive symptom among Syrian patients with chronic diseases warrants further study. A cross-sectional study in four Damascus hospitals revealed high rates of pain and depressive symptom. This study aims to investigate the prevalence and severity of chronic pain and hospital-induced depressive symptom in Syrian patients, as well as the relationship between pain, depressive symptom, and medication behavior. This study analyzes the impact of pain, hospitalization, and medication on patients with chronic diseases. The four Damascus hospitals included 453 patients from various departments. Data were collected through structured interviews and internationally recognized scales such as the PSEQ, HADS, and MMAS. These findings offer insights into pain management and psychological well-being, with implications for patient care and support strategies. The study involved 453 patients with chronic diseases, with gender distribution showing 46.6% females and 53.4% males. The age range was from 7 to 87 years, with an average of 46.87 years. Chi-square tests revealed a significant connection between gender and HADS-A scores, where 48.3% of females had abnormalities (χ2 (1, N = 453) = 7.125, p = 0.028). Marital status was significantly associated with anxiety and depressive symptom levels, particularly among widowed and divorced patients. Employment status, education, and comorbidity were linked to abnormal HADS-A scores, while education level showed a positive correlation with HADS-D scores. ANOVA tests showed significant differences in MMAS scores across income groups (F (3, 449) = 3.167, p = 0.024), with a notable difference between low-income and lower-middle-income groups (mean difference = 0.389, p = 0.031. Chronic pain and HID are prevalent among Syrian patients with chronic diseases and influenced by socio-demographic factors. Personalized interventions are needed to address psychological symptoms and medication behavior.

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PURPOSE: Explore factors influencing pain management among female breast cancer survivors aged 65+ years with moderate to severe pain based on a score of 4 or greater on the 0-10 numeric rating scale. DESIGN: Qualitative descriptive study. METHODS: We interviewed 21 purposefully sampled women aged 65+ years who experienced moderate to severe pain. Researchers coded interview transcripts for factors affecting study participants' pain management experiences. RESULTS: Pain management facilitators included patient-centered interactions with care teams and reliance on psychosocial assets. Challenges included ineffective care team interactions and participants' negative perceptions of opioid analgesia. Other factors included pain attributed to cancer treatment, pain management plan adherence, and psychosocial influencers. CONCLUSIONS: With regard to this sample, patient-centered communication and pain management education help female breast cancer survivors aged 65+ years manage their pain. Mitigation of opioid stigma and undermanaged painful comorbid conditions could further optimize pain management. Further research on the effects of breast cancer treatment, level of adherence to pain management recommendations, and psychosocial influences on pain management is needed. CLINICAL IMPLICATIONS: Providing contact information for care team members during and after clinic hours facilitates open communication, including timely reporting of new and undertreated pain. Collaborating with the patient and care team on a clear pain management plan and establishing parameters for when to notify the care team empower patients to optimize management of their pain. Verifying patients' understanding of prescribed analgesia and management of side effects and providing education as needed may reduce negative perceptions of opioid analgesia.

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INTRODUCTION: Local anesthetic infiltration at the surgical site has been studied in various surgical disciplines; however, its impact on deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously assessed. This study aimed to evaluate the effects of multiple intramuscular ropivacaine injections on donor site pain during DIEP flap breast reconstruction. METHODS: The study included 65 patients who received local ropivacaine injections during DIEP reconstructions between March 2022 and February 2023, compared to 55 patients who underwent surgeries without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was evenly administered at 20 sites along the abdominal wall muscles. The effect of intramuscular ropivacaine injection on postoperative visual analog scale (VAS) was evaluated using linear mixed-effect model. Opioid consumption and hospital days were also compared. RESULTS: The daily median VAS score was lower in the ropivacaine group (all p-values < 0.001). When analyzed using a linear mixed-effects model, those who received ropivacaine had significantly lower VAS scores over the first 5 days postoperatively (p-value < 0.001). The rate of VAS score decline was also faster in the ropivacaine group over the first 24 h postoperative (p-value = 0.045). Although opioid consumption was comparable between the groups, those receiving ropivacaine had significantly shorter hospital stay (p-value = 0.001) and no complications related to the injections were observed. CONCLUSION: Multiple intramuscular injections of ropivacaine to the donor site may reduce postoperative pain and shorten hospital stays, without increasing opioid consumption.

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Many adults with sickle cell disease experience chronic, non-vaso-occlusive pain that can benefit from non-pharmacological interventions available for use in the home setting. Virtual reality has been shown to be effective in decreasing pain in chronic pain conditions and may be useful for home-based self-management of chronic pain in sickle cell. However, the literature lacks studies examining this potential. Additionally, the knowledge and experiences of adults with sickle cell who have tried virtual reality for home-based chronic pain management have not yet been reported. This qualitative, descriptive pilot study explored the knowledge and perceptions of virtual reality among adults with sickle cell and their experience with using in-home virtual reality for chronic pain. Nine participants completed demographic questionnaires and an individual interview that was recorded, transcribed verbatim, and analyzed using thematic analysis. Participants were 21 to 38 years of age, and most were female (88.9%) with a medium or high sickle cell disease severity (88.9%) and a chronic pain grade classification of Grade III (high disability-moderately limiting) or Grade IV (high disability-severely limiting) (55.5%). Interview themes, which aligned with the Technology Acceptance Model, were: (1) pain beliefs and self-management; (2) virtual reality as another world; and (3) experience of using in-home virtual reality. Based on preliminary data, virtual reality shows promise as a strategy for non-pharmacological management of chronic pain in adults with sickle cell. However, further investigations are warranted to mitigate the challenges and limitations associated with using virtual reality in this capacity. PERSPECTIVE: Few evidence-based, non-pharmacological interventions exist for chronic pain in adults with sickle cell disease (SCD). This first qualitative, pilot study of in-home VR for chronic pain in adults with SCD suggests that VR interventions need further exploration as a non-pharmacological strategy for mitigating their pain in the home setting.

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PURPOSE: Patients in the intensive care unit suffer from pain caused by life-threatening illness or injury but also treatments such as surgery and nursing procedures such as venipuncture. Unconsciousness following head trauma or sedation stage complicates self-report, and both under- and over-management of pain can occur. Inadequate assessment and treatment might follow from unsuitable pain assessment practices. The aim of this study was to evaluate the effect of the implementation of a pain assessment tool on nurses` documentation of pain and the administration of analgesia and sedation. DESIGN: Quantitative pre-post design. METHODS: The study was conducted at one intensive care unit at a university hospital and involved 60 patient records and 30 pre-implementations and 30 post-implementations of the Critical-Care Pain Observation Tool (CPOT). RESULTS: After implementation, a 38% adherence rate was found. The frequency of nurses' pain evaluations increased significantly from 1.3 to 2.3 per nursing shift. The implementation of CPOT also improved how often nurses identified pain by use of facial expressions, muscle tension, and cooperation with the mechanical ventilator, whereas focus on vital signs dropped (p = .014). A larger proportion of patients (17%) received paracetamol after the CPOT implementation compared with before (8%). Findings were statistically significant at p < .01. CONCLUSIONS: Implementation of CPOT increased the frequency of pain evaluations, and the observable patient behavior was more often interpreted as pain-related. Nurses' adherence rate to sustained patient behavior focus being modest highlights the essential need for ongoing improvements in practice. Implementation of a new tool must be followed by non-pharmacological and pharmacological pain management steps. CLINICAL IMPLICATIONS: Implementing the CPOT as a pain assessment tool has the potential to enhance assessment practices. However, it is important to note that simply increasing assessment frequency does not guarantee nursing interventions to alleviate pain. This indicates the need for additional steps to be taken in order for nurses to complete the pain assessment cycle and effectively address interventions and reassessments.