Rebecca Kaminsky

December 14, 2015

Intern/Mentor G/T
Annotated Source List
Alford, D. P. (2006). Weighing in on opioids for chronic pain: The barriers to change. In
Emergency medical services (7th ed., Vol. 35).
The subjective and lack of empirical understanding for chronic pain medication
prevents medical departments from understanding how long a pain medication duration
should stop and the physiological and psychological fears of withdrawal, death from
overdose, and changes in dose. The very controversial topic of opioid abuse has caused
federal and state laws and regulations to limit opioid prescription. Patients and society
perceive these medications as the most powerful and desirable painkillers for chronic
pain. This discussion is explained with examples of the decreased need of painkillers
from weight loss from bariatric surgery.
The statement of how many multifaceted and complex and patient and clinician
factors blends seamlessly with the theme of what factors are most important to look at to
determine the subjective clinical outcomes such as pain, function, and quality of life.
There relationship to federal and state laws help tie different fields and how they effect
the management and power of doctors who might know or wish to use a drug that is
difficult to access or takes a much longer process to get a hold of.
American medical association. (n.d.). Retrieved from AMA website:
http://www.ama-assn.org/ama
The American Medical Association website has a wide range of tools and
resources that can be used to find articles for future research. There is a home page,
membership, resources, education, advocacy, publications, news, AMA store, and about
column. This site offers a vision for a healthier nation from advocating on behalf of
physicians and patients to addressing their day-to-day needs. The AMA works to shape a
healthier future. Other categories such as improving patient health, creating the medical
school of the future, and helping physician practices thrive are included. Student news
and articles are displayed at the front page. AMA publications are linked with the Journal
of American Medical Association that is published in categories ranging from
dermatology, neurology, ophthalmology, surgery, and pediatrics.
Many of my articles and resources are based off of the credible sources of JAMA.
Knowing what this site offers and how to find more resources and news about how to
improve upon the medical system are crucial for future research I wish to partake in.

Balighian, E., M.D. (2011, June 14). Pediatric emergency care [Video file].
Retrieved from https://www.youtube.com/watch?v=a8xyZBvnkm8
"Pediatric Emergency Care" gives a comprehensive description of the unique
advantages the Pediatric Emergency Room at St. Agnes Hospital offers to the community
and wide variety of children in need of effective treatment. Eric Balighian M.D. explains
how compassionate and enthusiastic doctors, such as Jenkins, Dada, Hofert, Garcia,
Berke, and Chinsky, are within the closed unit and how genuine their relations are with
the nurses and staff. Procedures such as blood draws, lumbar punctures, spinal taps,
bladder catheterizations, splinting and abscess incisions, and drainage are performed
frequently throughout each week. The medical doctors spend a vast amount of time
discussing and communicating with other doctors and specialists to make the best and
most accurate and effective courses of treatment. In order to insure this, St. Agnes is
affiliated with Johns Hopkins and has specialized pediatricians communicating to each
other to collaborate and help unique cases and illnesses that come within the ER.
This interview gives a very realistic interpretation of the environment within the
Pediatric ER. The mention of experienced and acknowledged doctors present in this field
is very beneficial as resources within this field of study. The affiliations and procedures
that are most common at St. Agnes aid in understanding what makes this environment
unique and functional in the Baltimore, Maryland community. Although this video gave
some insight on the environment and advantages of the ER dedicated to only children and
adolescents, this source would only be beneficial in background knowledge for the future
synthesis.
Balighian, E. D. (2015, October 9). [Personal interview].
Dr. Eric Balighian is an assistant professor of pediatrics at the Johns Hopkins
University School of Medicine. Dr. Balighian earned his medical degree at the University
of Maryland School of Medicine. He completed his residency in pediatrics at the Johns
Hopkins University School of Medicine. He has received the Frederick J. Heldrich
Medical Student Teaching Award at Johns Hopkins Childrens Center and the Alexander
"Buck" Schaffer Award for Outstanding Contribution to the Teaching of House Officers
given by the Institute for Excellence in Education at Johns Hopkins. He also has been
recognized as a Top Doctor by Baltimore magazine. He also received Frederick J.
Heldrich Medical Student Teaching Award, Johns Hopkins Childrens Center, 2011. I am
honored to see him working right in the pediatric ER at St. Agnes on Fridays and
Sundays, and he has mentored other doctors that work in the hospital currently.

Breaux, S. (2010, September 1). Comprehensive care for our youngest patients.
Retrieved September 12, 2015, from Saint Agnes Hospital website:
http://www.stagnes.org/comprehensive-care-for-our-youngest-patients/
"Comprehensive Care for our Youngest Patients" by Susie Breaux exemplifies a
very positive description of the importance and significance of the Pediatric ER and
Neonatal Intensive Care Unit (NICU) within Saint Agnes Hospital. Several statistics
show that at least 90% of children admitted into the hospital arrive through the Pediatrics
department and at least on pediatrician is present at all times. The hospital insures family
privacy and uses cartoon character designs and toy stethoscopes to give a more
welcoming and comfortable experience for incoming patients. St. Agnes' affiliation with
Johns Hopkins is further described and many expert medical professionals devoted to the
pediatric program were names and acknowledged.
This overviews and statistics of the hospital pediatric and NICU program are
crucial for future research and understanding of pediatric ER's and how the one at St.
Agnes is unique. This will be helpful in background knowledge and give helpful
resources for doctors and departments that can aid in this research.
Bruns, D., & Kerns, R. D. (n.d.). Managing chronic pain: How psychologists help
With pain management. American Psychological Association.
This is an overview of how to explain and give hopes to patients who have
chronic pain. Treatment techniques such as meditation or breathing, psychotherapy, and
the process of biofeedback can help alleviate stress and pain. The relationship between
the mind and body are explained in simply terms.
This article was very basic with the rudimentary explanations of how to treat and
understand pain. This is mostly for those who suffer and need to support, however will
not be helpful for a synthesis paper of many different experiments looking at the
connections of law, empirical, psychological data to understand pain management in a
more comprehensive way.
Catalano, J. (n.d.). Pain management and substance abuse: A national dilemma.
Social Work in Public Health, 477489.
http://dx.doi.org/10.1080/19371910802679010
Nonmedical use and abuse of prescription pain medication has risen at an
alarming rate in the United States within the past 5 years, especially among adolescents.
The number of those abusing prescription drugs exceeds even combined numbers of
those abusing cocaine, heroin, inhalants, and hallucinogens. This article examines the
intersection of policies addressing nonmedical use and abuse of prescription pain
medications and effects of enforcement strategies and policy direction on pain patients.
The discussion of policy enforcement and acknowledgement of drug abuse
elaborates on more information for those who are addicted or use recreational drugs like
opioids in the discussion. Understanding where addiction and abuse of drugs comes from
can help edit the procedures of defining when a patient needs medication for only health
reasons.

Cogan, J., Ouimette, M.-F., Vargas-Schaffer, G., Yegin, Z., Deschamps, A., &
Denault, A. (2014). Patient attitudes and beliefs regarding pain medication
after cardiac surgery: Barriers to adequate pain management. Pain
Management Nursing, 15(3), 574-579. http://dx.doi.org/10.1016/j.pmn.2013.01.003
The aim of this survey was to evaluate the beliefs of the patients to help create a
specifically adapted pain education program. All completed questionnaires were collected
from the charts every evening or the morning before surgery. Little or no gains have been
made in decreasing misconceptions related to the treatment of pain. This study underlines
the considerable need for and absolute necessity to provide pain education to patients
undergoing cardiac surgery.
The results show that patients are overwhelmingly misinformed regarding many
aspects of pain man- agreement, the meaning of pain, and the risks involved in taking
medications to control pain. his study found the very high proportion of patients who
hold the incorrect belief held by many that people get addicted to pain medication very
easily. Understanding the point of view of patients will prove and give more wholesome
details about the misconceptions of medication in the public. This topic most likely needs
to be informed more clearly and effectively in society.
Faria da Cunha, B. (n.d.). Ethics and under treatment of pain in patients with a
history of drug abuse. Continuing Nursing Education, 24(1), 2-7.
http://dx.doi.org/AJJ-0215-12M6C
Definitions of substance abuse terms including tolerance, dependence, addiction,
and pseudoaddiction are essential to a nurses understanding of pain medication
administration in patients with substance abuse history. This article speaks about the
ethical considerations, guidelines, nursing implications. By gaining a deeper
understanding of substance abuse, terminology and behaviors such as tolerance,
dependence, addiction, and pseudoaddiction nurses can treat pain effectively at site.
This is a very helpful and detailed article about the way for nurses to avoid the
contradicting evidence about pain management. It summarizes and strays away from the
biases or unknown controversies of the psychological and clinical limits to understanding
pain.

Greenspan, J. D., Craft, R. M., LeResche, L., Arendt-Nielsen, L., Berkley, K. J.,
Fillingim, R. B., the Consensus Working Group of the Sex, Gender, and Pain
SIG of the IASP. (2007). Studying sex and gender differences in pain and analgesia:
A consensus report. Pain, 132(Suppl 1), S26S45.
http://doi.org/10.1016/j.pain.2007.10.014
This wholesome document was created by a collaboration of thirteen professional
doctors and researchers ranging from the department of Biomedical Sciences to the
Department of Psychology. Members of the Sex, Gender and Pain Special Interest Group
of the International Association for the Study of pain discuss what is known about sex
and gender differences in pain and analgesia, what are the best practice guidelines for
pain research with respect to sex and gender, and what are crucial questions to address in
the near future. This 32 page article by the National Institutes of Health recommend that
all pain researchers consider testing their hypotheses in both sexes, or if restricted by
practical considerations, only in females. The physiological systems , influence of
analgesic drug potency, efficacy, and duration for action in highly lipophilic drugs,
metabolism and membrane transport, immune responses, and estrous cycles were greatly
different between different sexes. Hormone manipulations in both animal and human
studies are discussed with detailed examples of studies. In fact, in contrast to the robust
sex difference found in the prevalence and severity of many chronic pain conditions,
reported sex difference in experimental pain responsiveness are often subtle in magnitude
and sometimes absent. This may show why scientists have assumed the animal
experiment were parallel to gender difference in human life. Sex and gender difference in
pain are generally more pronounce in the clinic than in the laboratory. This manuscript
also discusses how important it is to investigate how psychosocial variables differ in men
and women, and how these variables interact with gender role and biological sex to
influence the experience of pain in the two sexes. Then later future directions and impact
is discussed thoroughly, including recommendations of governments and professional and
research bodies.
This article is perfect to use in collaboration with my inspirational TedTalk speech
resource. I can use the well-written and explained scientific experiments as background
and proof of empirical differences in females and males. The citations are going to be
great reference points for any studies on differences in sex that are prevalent and
influential in our society today. This combines the ideas I have read and was interested in
within all of my research tools by looking at social, medical, empirical, psychological,
and governmental aspects of this gender division in medicine. I appreciate the further
actions and will use these considerations to understand the opportunities physicians can
take to make this shift in education and administration of female patient treatment. The
article does have some very advanced and difficult to follow language of several
biological studies of neurotransmitters, however I wish to research and further my
understanding to make a stronger concept and thesis within my paper followed by
credible facts.

Gupta, A., Daigle, S., Mojica, J., & Hurley, R. W. (n.d.). Patient perception of
pain care in hospitals in the united states. Journal of Pain Research, 157-164.
The Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) is summarized and tested to provide valuable information on how hospital
size, geographic location and practice setting may play a role in pain care in US hospitals.
A topic such as inadequate pain control and its leading to delayed wound healing and a
risk factor for the development of chronic pain syndromes was discussed. Despite
statistically significant advancement in documentation of pain scale and use of
nonpharmacologic interventions in addition to analgesics, there was no change in pain
outcomes. The study explained possible divisions between type of pain and confounding
biases such as age and sex.
Most articles discuss that residency training for doctors should continuously
educate more and more, however this approach seems to avoid the problem and will get
lost within the fact of studying for all of the other important procedures in school. There
is a clear trend of psychological biases according to race, sex, class, and even the
institution the hospital itself is in. This article reiterates the topic of how pain is a fifth
factor in determining treatment, however helps relate the relationship between medical
care of hospitals and how statistically significant pain relief and satisfaction is globally.
Habich, M., & Letizia, M. (2015). Pediatric pain assessment in emergency department:
A nursing evidence-based practice protocol. Pediatric Nursing, 41(4), 198-202.
Many children present to the emergency department (ED) in pain and/or
experience pain as a result of interventions necessary to manage their illness. statistically
significant difference in the mean pre- and post-test scores indicated significant learning
gains among participants; strong reliability of this test was demonstrated. Significant
improvements in nurses pain knowledge are demonstrated via an education program.
Implementation of a pain assessment protocol is one mechanism to standardize nursing
practice with pediatric patients in the ED setting.
The importance of improving pediatric pain assessment has been well
documented in the literature. Nurses are primarily responsible for assessing pain and
response to interventions in the ED patient. The protocol chart is very helpful to
potentially create a revised version with more effectiveness.

Hargett, I. (2003, November 20). Inadequate analgesia in emergency medicine

(C. Chen, Ed.). Retrieved October 7, 2015, from National Association of EMS
Physicians website: http://www.naemsp.org/documents/topic004-ruppinadequateanalgesiainemergmed-annemergmed-2004.pdf
This article analyzes and reviews the literature that describes the prevalence and
roots of oligoanalgesia, which is the phenomenon of under treatment of pain. This
treatment may be the result of psychological blocks, attitude, and lack of education in the
medical field. The editorial makes evident the paucity of rigorous studies of populations
with special needs that improve pain management in the emergency department,
inappropriate diagnosis of drug-seeking behavior and inappropriate concern about
addiction, underuse, unappreciated cultural and sex differences, and racial and ethnic
stereotyping. This topic has been a heated discussion since a landmark 1973 article by
Marks and Sachar was published. This shows blend of both psychological and medical
evaluation to become more accurate and successful with treatment of pain. The
seemingly intractable resistance of this problem to solution suggests that its roots lie
deeply entrenched in our health care culture and likely reflect fundamental attitudes of
society in general, as well as those of health care workers. This article discusses, the
evidence of oligoanalgesia, adequacy of training in the assessment and management of
pain, and attitudes of chronic pain. Other factors in medical culture that influence
analgesia are also described in collaboration with the myths regarding the management of
pain on competence and informed consent. Mandates changes in institutional priorities,
pain research in the ED setting, and genetic polymorphisms govern experience of
different types of pain. Parental and patient lack of knowledge about the risks and
benefits of pain medication also contribute to oligoanalgesia. Opioids can have a
psychological affect on children. Lastly, cultural and sex difference in the assessment tin
pain is discussed including emotive, vague, stoic, diffident, or demanding personalities.
With my extensive knowledge and interest in psychology and medicine, this
heated topic is perfect for me to further research. It captivates my attention and is still a
very prevalent problem in hospitalization and treatment currently. Overuse or underuse of
opioids and the understanding of the background and culture of the patients all create an
amalgamation of symptoms and cases to create the proper dosage. I can evaluate this
when the doctors and nurses prescribe pain relief to patients at the Pediatric ER and
become involved with the discussion and analyzation real doctors use today. The section
on cultural and sex differences will be helpful to connect opioids with the gender gap in
medicine. It connects ideas about bias for pain, how it should be treated, and showing the
stark examples of how the treatment of acute and severe pain and tremendously different
in varying demographics. Other factors in medical culture that influence analgesia are
also described in collaboration with the myths regarding the management of pain on
competence and informed consent. I would like to use this for my synthesis paper to
greater understand how opioid distribution and use affects patients world wide and how
these differences help greater the need for individualized medicine.

Jasmin, L., Rabkin, S. D., Granato, A., Boudah, A., & Ohara, P. T. (2003).
Analgesia and hyperalgesia from gaba-mediated modulation of the cerebral
cortex. Nature, 424, 316-319. Retrieved from Science Reference Center database.
The basis of this experiment represents how to examine the relationship between
cortical activity and the nociceptive threshold. The researchers manipulated GABA
neurotransmission in the rostral agranular insular cortex and found that RAIC neurons
produce more pain through projections to the amygdala, the area involved in pain and
fear. This source puts into perspective the neural mechanism underlying the cortical
modulation of pain, not the psychological and medical procedure flaws in prescribing
proper doses and understanding the level of pain a person is feeling. The Nature group
shows the graphs and infections rats felt and overall discussion and hypotheses from
certain anatomical areas and neurotransmitters that are activated.
This is very helpful to look at the more scientific, empirical understanding of pain
without considering any psychological or procedural input. Much of the controversy is
surrounded by biased perceptions and racism towards patients, however this experiment
clearly shows the rational way to examine what parts of the cerebral cortex are stimulated
to create certain levels of measured pain.
Jenkins, D. N., M.D. (2015, September 25). [Personal interview].
Donald Niel Jenkins is a pediatric medical doctor who has worked at St. Agnes
Hospital for 18 years. Before his residency at the ER, Dr. Jenkins attended Ross
University School of Medicine. He is very familiar with working and teaching interns and
medical students. On September 25, 2015, he was kind enough to let me shadow him as a
"medical student" and intern. He demonstrated his ability to communicate kindly and
effectively to a young, 8 year old boy, who had a potential fracture on his left tendon. In
order to properly diagnose the child, Dr. Jenkins carefully analyzed the x-ray and
speculated on whether there was excess fluid or space around the growth plate. He then
invited me to go to the Radiology department to speak with the radiologist in charge of
the x-ray analysis. They discussed the differences in adult and child fractures and how
evident they are with the current x-ray. They looked into the "bible", medical x-ray book,
to discuss the technicalities of the injury. The boy is now getting crutches and treatment
for a possible fracture, just to make sure he is treated if he has one. Then, Dr. Jenkins
went in to the Trauma, also known as the Resus, room to discuss with his 16-year-old
patient about sexual activity and consequences of aggressive behavior. In response to the
patients injury of laceration on the left side of the lip, swollen left cheek, and request for
STD testing, Dr. Jenkins expressed great maturity, experience, and desire to teach the
patient about life and its consequences. Jenkins told the patient about the importance to
realize humanity is the intelligence to prevent and stop physical fighting. In addition to
his strong beliefs in peace and courtesy, Dr. Jenkins explained the importance of
protection during sexual intercourse.

Kanowitz, A., & Taigman, M. (2006). Pain management: Taking EMS into tomorrow. In
Emergency medical services (7th ed., Vol. 35, pp. 93-98).
This article beautifully describes the vital purpose of pain, the history of pain
management, the different types of pain there are, the consequences, pain scale on a face,
why pain is under treated, and strategies to fix this therapy treatment! In a very
pedagogical and humorous way, the author explains how pain is an essential tool to
protect the body, however it's suppressing medications may cause patients may not be
mentally competent enough to consent to surgery should they need it after taking strong
doses of pain relievers. There is a great parallel here of the under-treatment of pain
medication under practical and attitudinal barriers that include psychology, non-verbal
patients, drug-seeking behavior, cultures of patients who rate their pain, and inappropriate
concerns about the safety of opioids compared with non-steroidal anti-inflammatory
drugs that result in their underuse (opiophobia).
This paper can be a basis and staple for my research. It helps give a wholesome
overview of the importance of proper dosage of pain medication, the factors and biases
that have many experiments parallel to other scholarly articles I have read, and explains
the consequences and perspectives of a wide view of problem that prevent emergency
nurses and doctors from acting in a proper and effective way. Everything is very
thoughtful, clear, and concise. The explanation of this ongoing controversy of how to
treat patients for pain and become biased towards false pretenses is still present in the
pediatric ER I intern at currently. I will use this source from the JAMA to find
appropriate sources that correspond with the topic of how to understand the psychological
and physical signs that determine proper treatment with empirical data and validity.
Keefe, F. J., Abernethy, A. P., & Campbell, L. C. (n.d.). Psychological
approaches to understanding and treating disease-related pain. Annual Reviews of
Psychology, 602-615.
This assessed the disease-related pain such as pain secondary to arthritis or
cancer. The review is divided into four sections. A conception background of the
limitations of the biomedical model, special issues and challenges involved in working
with medical staff, overview of psychosocial research, and important future directions.
This is a very wholesome and detailed overview of the effects and biases of the
concepts pain medication should be treated with.

Kerns, T., & Kerns, R. (n.d.). West haven-yale multidimensional pain inventory.
Retrieved from worksafe website: https://www.worksafe.vic.gov.au/__data/
assets/pdf_file/0017/10952/west_haven_yale_multidimensional_pain_inventory.pdf
This pain inventory puts into perspective how a significant other can effect the
perception of pain an individual feels. In fact, pain is also measured in relation to how it
affects overall life, activities, social enjoyment, and strength of relationships. The test is
split up in scales of 0 to 6 from no pain to very intense pain and the participant must rate
how much a level of pain or occurrence in life is present.
In contrast with many philosophical, clinical, and legal essays about the
controversy of pain and the medication for illnesses, the pain inventory survey shows a
very helpful way to analyze and find out the true pain of an individual by taking certain
biased outliers out of the mix. This is a very helpful took to evaluate the tool many have
taken to approach and understand a patients pain. It is not educational; its use is for
implementation and structure.
La, J. (n.d.). Psychological and physical interventions for the management of cancerrelated pain in pediatric and young adult patients: An integrative review. Retrieved
from US National Library of Medicine National Institutes of Health website:
http://www.ncbi.nlm.nih.gov/pubmed/26488841
Interventions such as aromatherapy, art therapy, distraction, hypnosis, physical
activity, physical positioning, touch therapy, and multimodal cognitive-behavior therapy
seem to have some part as nonpharmacologic pain intervention and can decrease pain
intensity significantly.
This objective of looking at nonpharmacologic pain intervention can be an
interesting and helpful field to continue and research. The relationship between the data
synthesis of a total of 32 unique studies can be use to give more validity to the
conclusions and data needed about how psychological intervention can be effective. This
is many involved with cancer-related pain and does not go hand and hand with the
chronic pain syndromes most of the articles discuss.
McGill, C. (2015, October 7). Why do placebos treat pain in U.S. clinical trials?
Retrieved from futurity website: http://www.futurity.org/placebos-pain-clinical-trials1020522/
Compared to other countries, America has had an increase in placebo responses.
The relationship of the Is direct-to-consumer drug advertising in the US and the greatest
exposure tot eh placebo concept in popular media give Americans the advantage in
manipulating clinical trials of antidepressants and antipsychotic drugs.
Although it is interesting to understand the medical relationships between
American and other countries, the placebo effect and international perspective is a bit too
broad and generalized. There is not enough information, data, or validity here. Therefore,
this source would not exactly impact this research thoroughly.

McGill, C. C. (2015, June 29). His pain and her pain may not be the same.
Retrieved from futurity website: http://www.futurity.org/ pain-sexes-personalizedmedicine-950662/
Males and females process pain using different cells. Using rats as test subjects,
women seem to suffer from chronic pain more than men and the immune system cell,
microglia, seems to only effect the pain centers of male mice. T cells, on the other hand
can turn out the be a crucial and difficult cell responsible for the pain, inflammation, and
response to the sites of injury in female medical treatment.
To broaden and look at more scopes and ideas of pain management and the
confusion the medical field is going through to understand how to alleviate pain, looking
at cell differences can impact the psychosocial studies for opioid treatments and overall
administration.

McGregor, A. (2015, October). Why medicine often has dangerous side effects for women
[Video file]. Retrieved from
https://www.ted.com/talks/alyson_mcgregor_why_medicine_often_has_dangerous_s
ide_effects_for_women/transcript?language=en
This inspirational and controversial topic describes the division of medicine
between men and women brought up by a well-practiced emergency room physician, Dr.
McGregor. Government Accountability studies revealed that 80 percent of the drugs
withdrawn from the market are due to side effects on women. This stems from how
World War II changed much-needed guidelines on medical experiments, with a desire to
protect women of childbearing age. In fact, the changing levels of hormones, fluctuating
data, and difficulty of studying women prevented medical research from studying
exclusively women. The sample population of cells used in laboratories of male cells in
both animal and clinical trials were extrapolated and assumed for the female population.
This division causes our medical system to currently disserve female patients with unique
needs. In addition, evidence of sex-determining chromosomes have given strong evidence
to what differences there must be in dosing of drugs and why men and women are in
susceptibility of difference severity of diseases. Dr. McGregor greatly urges to take action
and take away our gender lens in an empirical, medical society. She argues that once
children were analyzed and scientists understood they were not tiny adults, a new
practice of pediatrics and child psychology greatly improved upon the focus and
improvement of medicine for children. This can be an approach for men and women as
well. These steps will help create more personalized, individualized health care for
everyone. She is the co-founder of a national organization called Sex and Gender
Womens Health Collaborative and wishes to create specialized medicine for women.
This TedTalk very much inspired me by addressing a social and medical issue
many doctors are uncomfortable discussing or changing. It can be a revolution of a
plethora of knowledge and improvement in medicine. Understanding an ancestral concept
is wrong or flawed can be the first step in taking a more efficient and moral approach in
the medicine physicians practice. The social events, gender bias and social structures, and
lack of desire or work for change impact the efficiency of how opioids and medicine are
administered to half of Americas population. I may use these base ideas and arguments
to find credible information that supports the different hormones and stories of women
who are not only treated as second class citizens in society, but also the treatment of their
health. I would like to look into the organization Dr. McGregor is a founder of to see how
universities and research facilities can become more open to changes in rudimentary facts
and processes in medicine. I have listened to the personal thoughts of doctors and nurses I
intern with in addition to my mother who is a registered nurse. I wish to use their
understanding of dosages, prescriptions, and patients histories to understand how
prevalent and serious this gender divide in medicine is. This may also start a more heated
argument about what to do with gender-fluid and transgender communities, however I
wish to focus solely on the anatomical, empirical, and unbiased data of how a human
body must be treated in correlation with hormones and metabolism dynamics. I wish to
use this article as the inspiration of my research paper.

Moffit, M., & Brown, G. (2015, October 25). How much pain can you handle?
[Video file]. Retrieved from https://www.youtube.com/watch?v=s4XQo4txlk0
Mitch and Greg learned about the pain retention and receptors that are present
when it comes to spicy nutritious foods, how long one can withstand cold water, and
scientific facts about electronic shock experiments. Humans are the only mammals that
desire eating spicy food that can trigger pain receptors and cause great swelling,
sweating, and palpations. The chemical explanation of milk relieving stress from the
peppers went into detail on how any form of pain relief gives a sense of euphoria.
Therefore, even though spicy nutrients will give painful perceptions, the relief of
euphoria afterwards makes many repeat eating these types foods.
This was a very entertaining and interesting way to look at the basics of pain
relief. Although having milk when eating spicy food is a very simple way of looking at
relieving pain, it puts into perspective that most pain relieve agents will always cause
some sort of high that many doctors, agencies, and management corporations try to
prevent, especially if these symptoms of euphoria may lead to addiction.
Northwestern, N. D. (2015, September 24). Many ER patients don't know
Painkillers are addictive. Retrieved from futurity website:
http://www.futurity.org/painkillers-addiction-1011812/
A quarter of emergency department patients do not know prescription opioids can
be addictive. Hydrocodone-acetaminophen is an opioid for treating acute pain that is
commonly marketed under brand names such as Vicodin and Norco. Many groups of
people only know about drugs due to personal experience or people then knew. Those
who have psychiatric conditions, have a higher risk of becoming addicted to opioids.
An overall understanding of the knowledge the patient population has of pain
medication can help determine why certain attitudes of pain effect data and overall
feeling of pain. Hydrocodone-acetaminophen was a frequently prescribed medication the
pediatric ER at St. Agnes prescribed to injured infants and adolescents.
Pain, pain, go away. (2006, July 7). Retrieved from American Psychological
Association website: http://www.apa.org/research/action/pain.aspx
This analyzation of the research of pain and the controversies behind it gives great
insight and examples of important sources and experiments. Patients with chronic pain
are now viewed from a broad, biopsychosocial perspective and not simply fixing a
broken body part.
The Accreditation of Healthcare Organizations and the 1985 publication of the
West Haven- Yale Multidimensional Pain Inventory are mentioned as pinnacle and
important concepts and tools within this on going search for pain management. This
article puts together all of the psychological, social, and biological backgrounds and fives
good references to also take a look at for further research.

Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (n.d.). Opioids and
The treatment of chronic pain: Controversies, current status, and future directions.
Retrieved from US National Library of Medicine National Institutes of Health
website: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2711509/
The clear overview of how effective the pain reliever opioid has been throughout
the history coming from around 3400 B.C. This narrative reviews briefly the
neurobiology of opioids and then focuses on the complex issues at the interface between
analgesia and abuses, including terminology, clinical challenges, and potential for new
medications, such as buprenorphine, to influence practice.
The terminologies of different legal and clinical terms help differentiate the
different fields that restrict access to the dependent drug. This narrative brilliantly
describes important experiments to help understand the psychopathic dependence of
opioids and whether they are underused in nursing homes and chronic pain patients.
Russel, T. (2012, February 2). Pain management in nursing homes. Retrieved from
PMC database.
Pain management for older adults residing in nursing homes continues to present
multifaceted challenges to health care practitioner. This study, which focuses on
improvement in pain assessment and management, is a secondary analysis of data from a
larger study.
This was very repetitive in comparison to many of the pain medication articles
talking about multifaceted challenges and the factors that cause nurses and doctors to
give low doses of pain medication. The QM/QI scores actually worsened and most of
experiment did not have meaningful or significant statistical results.
[Saint agnes hospital]. (n.d.). Retrieved from Saint Agnes Hospital website:
http://www.stagnes.org
The Saint Agnes Hospital website has opportunities to learn more about the
history of the hospital, patients and visitors, a blog, services, residency, newsroom, and
ways to contact the staff. One can find a physician, get maps and directions, careers, and
login into a physician and staff login. Several popular treatment and categories such as
weight loss, back pain, cancer, and joint pain can be learned more thoroughly. This
website offers ways to learn about the treatment and service Saint Agnes Hospital
provides. There is also a news and events, twitter feed, and newsletter to help support and
sponsor this hospital. This hospital for over 150 years was dedicated to the art of healing
by providing exceptional care to the greater Baltimore area.
This website resource is wonderful for me to use to further understand the
hospital I intern at and how to find more information about the doctors and nurses I
intern. I have a wide range of ways to learn about the procedure, policies, and contact
information I can utilize for further research and understanding of the business, morals,
history, and research.

Shackelford, C. (n.d.). Prehospital pain medication use by US forces in

Afghanistan. Military Medicine.
Pain control for battle injuries has been recognized as essential since the U.S.
Civil War when morphine was first introduced on the battlefield. report the results of a
process improvement initiative to examine the current use and safety of pre-hospital pain
medications by U.S. Forces in Afghanistan. There was no difference in vital signs on
arrival to the hospital between casualties who received no pain medication, morphine,
fentanyl, or ketamine during TACEVAC. In this convenience sample, fentanyl and
ketamine were as safe as morphine for pre-hospital use within the dose ranges
administered. Future efforts to improve battlefield pain control should focus on improved
delivery of pain control at POI and the role of combination therapies.
This article puts an interesting addition to using a different country and how the
effects of the pain management in the United States affect them. This may help lead into
a more applicable and valuable problem of management in other countries and improving
the military medicine.
Takada, C. (2015, September 25). Comparisons of two pediatric flail chest cases.
Retrieved October 6, 2015, from US national library of medicine national institutes of
health search database: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583167/
This article summarizes, explains, and describes two incidents of pediatric ER
patients who experienced the rare complication of "flail chest" resulting from blunt chest
trauma. There is a comparison between adult and small child anatomy and the evidence
underlying surgical fixation. In small children, functional residual capacity is smaller and
the thorax is pliable due to high thoracic compliance. The first and second case of the
children gave an overview of their medical condition and treatment. Lastly, the discussion
summarized how treatment for flail chest can cause patients to need a ventilator, intense
care unit in hospital stays, and incidence of pneumonia. In fact, surgical costal fixation
can force patients to refuse treatment due to not enough money to pay for the procedure.
This article gives me insight to a rare and interesting disease that I can become
familiar about at the Pediatric ER. The medical terminology and research of effective
treatment helps narrow down and evaluate an interesting and unique topic I might like to
research for the synthesis paper.

Thomas, D., Kircher, J., Plint, A., Fitzpatrick, E., & Newton, A. S. (2015). Pediatric pain
management in the emergency department: The triage nurses' perspective. Journal of
Emergency Nursing, 41, 407-413.

This article gives a very interesting overview and analyzation of the

understanding triage nurses have about pain management and whether they provide pain
medication in a timely manner with proper prescriptions. The topic discussed that triage
nurses are willing to implement pain protocols for children in the emergency department,
but difference in comfort and experience exist between PTED and GTED nurses. Many
nurses prefer and feel comfortable to give acetaminophen and ibuprofen rather than oral
morphine or oxycodone. The tope three reported barriers to triage-initiated pain protocols
were monitoring capability, time, and access to medications.
This article gives a good discussion topic that reiterates the basic points of fault in
pain management, however there is not enough information and many statistical
percentages and graphs to explain and reiterate the same viewpoint. There seems to be an
evident skew in dislike towards stronger, addictive pain medications, however this seems
to be self-explanatory. It makes sense that emergency pediatricians and nurses would
prefer to take less of a risk with the addictive nature of drugs sucks as morphine and
oxycodone, but there needs to be a balance and process to determining the level of need
for higher prescriptions. There is such thing as death caused by pain and the
psychological blocks and biases of staff can manipulate patients sometimes.
Todd, K. H., Samaroo, N., & Hoffman, J. R. (1993). Ethnicity as a factor for
inadequate emergency department analgesia. The Journal of the American
Medical Association, 269, 1537-1539.
This brief report covers the division of Hispanic and non-Hispanic oligoanalgesia
for isolated long-bone fractures. Factors of significant statistics, native language,
insurance, occupational injuries, and sex were considered as categorical values. The
conclusion inclined towards assuming most pain medications were based on the factor of
ethnicity itself, however, perception of ethnicity, division of registration clerks and
doctors, and ability to communicate were influential variables.
I appreciated that the authors stated not all patients with similar injuries
experiences the same degrees of pain and found the faults within their own research to try
and gain credibility with empirical data. I can use this source as to show how statistical
data and cultural influences on expression of pain can make vast skews in data and
physiological reactions.

Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain:

Evolution and revolution. Journal of Consulting and Clinical Psychology,
70(3), 678-690. http://dx.doi.org/10.1037//0022-006X.70.3.678

The progression in neuroanatomical pathways and the neurophysiological

mechanism have progressed greatly throughout the past decades. A wide range of
psychosocial factors, including emotions, social and environmental context, sociocultural
background, the meaning of pain to the person, and beliefs, attitudes, and expectations, as
well as biological factors is explained. The article is split up into categories of
biopsychosocial model, patient beliefs, patients attribution of pain onset, fear and harm
avoidance, and self-efficacy.
To review the opinions of the two very highly esteemed medical university
doctors, the resources and opinions of all data can be viewed here.
Vael, A., & Whitted, K. (2014). An educational intervention to improve pain assessment
in preverbal children. Pediatric Nursing, 40, 302-306.
Pediatric nurses often use an inappropriate tool to assess pain in children younger
than 36 months of age. This study helps to improve upon the nursing practice of assessing
pain by using a score of 0 to 2 to assess the fads, legs, activity, cry, and consolability of a
non-verbal child. There are more appropriate pain-scales such as FLACC that increase
the documentation and assessment of the level of pain a child is feeling without any
communication.
Overall this article clearly identifies the different physical stages and flaws that
can be made in assessing the pain of a non-verbal child. This falls into the category of a
tool that can be effective and possibly implement a change in understanding another
person's pain without trusting the psychology of response explaining pain. This can be
used to explain further with more credibility whether pediatric nurses are taking the steps
necessary to assess all aspects of the way a patient feels. I can keep in mind how the
nurses at St. Agnes approach the infants and babies from the NICU to prescribe pain
medication. Doctors seem to make a decision on the dosage and type of medicine quite
quickly without checking alternative tests and procedures. This FLACC test can be used
within the ER online sheet that each staff person must fill out after treating a patient.