Healthcare Worker s (HCWs) Knowledge and Attitudes Related to Pain Management: A Cross-Sectional Study in a Tertiary Hospital in Lebanon

Healthcare Worker s (HCWs) Knowledge and Attitudes Related to Pain Management: A Cross-Sectional Study in a Tertiary Hospital in Lebanon | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Healthcare Worker s (HCWs) Knowledge and Attitudes Related to Pain Management: A Cross-Sectional Study in a Tertiary Hospital in Lebanon Maha Kassem, Celine Bakri, Nadine Zeinab, Nadine Hindi, Serena Abu Samra, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8051757/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Although pain has been designated as the 5th vital sign to ensure pain assessment and management, many patients continue to experience uncontrolled or inadequate management of pain. A major barrier to effective pain management remains the insufficient knowledge of Healthcare Workers (HCWs), including misconceptions about pain evaluation; beliefs that patients overstate their pain; fears about drug tolerance and addiction; limited understanding of analgesic pharmacology; and difficulty assessing pain in children. This study aims to evaluate the knowledge and attitudes of HCWs regarding pain assessment and management at a tertiary medical centre in Beirut, Lebanon and to identify areas for improvement. Methods A cross-sectional study was conducted over one month at a private tertiary hospital in Lebanon using the validated “Knowledge and Attitudes Survey Regarding Pain” (KASRP) questionnaire. The survey assessed HCWs’ knowledge and attitudes toward pain management. Results A total of 161 HCWs participated in the study (41 physicians, 100 nurses, 20 pharmacists), from different departments within the hospital: Internal Medicine, Pharmacy, Nursing, and Quality Management. The overall mean KASRP score was 13.65 (SD = 9.93) for correct responses, indicating a moderate level of knowledge. Only nine participants (5.6%) scored ≥ 80%, considered a satisfactory level of knowledge and attitude. Items of the KASPR score were categorized into five domains: assessment, medication, addiction, spiritual considerations and interventions. Variables potentially affecting knowledge and attitude were analyzed: gender, age, profession, prior training on pain management, and years of experience. No statistically significant differences were observed based on gender, prior training, or years of experience (p > 0.05). However, age and profession showed significant associations with mean scores of correct answers (p < 0.05), suggesting these factors influence HCWs’ understanding of pain management. Conclusion The study reveals notable gaps in HCWs’ knowledge and attitudes toward pain management. These findings underscore the need for structured education and training programs to improve understanding and practices related to pain management, ultimately leading to better patient outcomes. Analgesia Attitudes Education Healthcare Workers Knowledge Pain Management Palliative Care Patients Pharmacology Training Background Pain remains a global health concern that affects individuals of all ages, from different backgrounds, and with different health issues. Despite international guidelines and many interventions to reduce myths and increase awareness among the healthcare professionals and public sector, pain continues to be inadequately controlled or ineffectively managed (1). It is a multidimensional physiological and psychological phenomenon, acute or chronic, that is inherently subjective and can be defined as an unpleasant sensory and emotional experience related to actual or potential tissue damage (2)(3). Pain has been designated as the 5th vital sign to emphasize the importance of its assessment and management (4). Untreated or inadequately treated pain can reduce a person’s quality of life (QoL) compared to the general population and those with other limiting conditions, highlighting the need for accurate assessment, and efficient and effective pain management (5)(6). It can also lead to adverse physiological and psychological outcomes for both patients and their families, while also increasing the burden on healthcare systems through extended hospital stays, higher readmission rates, and increased healthcare costs (7). Effective pain management requires an interdisciplinary approach by various healthcare workers (HCWs), including nurses, physicians, and pharmacists with a strong foundation of knowledge and the right attitude. Such knowledge is believed to affect the attitude of the HCWs in managing pain (8)(9). However, a lack of adequate knowledge among HCWs remains a significant barrier to effective pain management (10), with misconceptions about pain evaluation; incorrect beliefs that patients overstate their pain; fears about drug tolerance and addiction; a lack of understanding of analgesic pharmacology; and difficulties in assessing pain in children (11). Similar key clinical barriers to effective pain management include insufficient knowledge (12), opioid phobia related to addiction and respiratory depression (13), poor interdisciplinary communication (14), reluctance among medical teams to prescribe opioids (15), delays in opioid storage protocols (16), and inadequate pain assessment, lack of protocols, and nursing workload (17). Several studies in the middle east region have shown an array of deficit in knowledge and attitudes of HCWs toward pain management (18)(19)(20). In Lebanon, 2 studies addressed the knowledge and attitudes of physicians and nurses, separately. Nasser et al. evaluated physicians' self-assessed pain management skills and identified barriers to effective pain control and identified fear of adverse events, particularly opioid side effects as barriers and a lack of adequate knowledge about pain management (21). Abdul Rahman, Abu-Saad Huijer, and Noureddine identified a lack of knowledge with only 3.4% of the nurses achieving a score of equal to or greater than 80%, the required score for effective pain management (22). To date, there are no published studies that assessed the knowledge and attitudes of physicians, nurses, and pharmacists toward pain management in Lebanon. Conducting such research is essential to identify discipline-specific gaps and inform strategies to improve pain management knowledge and clinical practice among physicians, nurses, and pharmacists alike. Accordingly, our study aims to (1) evaluate the knowledge and attitudes of HCWs regarding pain assessment and management at a tertiary medical center in Beirut, Lebanon; and (2) identify areas of deficiency for targeted improvement initiatives. Methods Study Design and Setting A cross-sectional study was conducted over a one-month period, from 23 February to 23 March 2025, at a private tertiary hospital in Beirut, Lebanon, to assess the knowledge and attitudes of HCWs towards pain management. The “Knowledge and Attitudes Survey Regarding Pain” (KASRP), a validated practice-based questionnaire, originally developed by Ferrell and McCaffery in 1987 and revised in 2014 was used to assess the participants’ knowledge and attitudes related to pain management in its English form, since the official language used in the hospital was English and all participants were deemed able to read, comprehend and react to the questionnaire in English language (23). The KASPR questionnaire content is based on the standards of pain management such as the American Pain Society, World Health Organization, and the National Comprehensive Cancer Network pain guidelines. The content validity of the tool was established by the original authors, along with the test-retest reliability which was very good (r > 0.8) when tested on a class of staff nurses (N = 60), and the internal consistency reliability was also found to be good (r > 0.70) and its authenticity, both in terms of its appearance and contents, was validated by an impartial panel of experts (24). As per the creators of the tool, questions may be omitted, so we removed some that were mainly related to pediatric pain, culture, and one of the case study. A score of “1” was provided for each correct response and a “0” for the incorrect response. The total score was the sum of all correctly answered questions. The percentage score was calculated by dividing the number of correct responses by the total number of items in the survey. The questionnaire was self-administered electronically via an online survey link distributed to eligible participants. The KASRP questionnaire was divided into two parts and included a total of 32 items from the KASRP based on our study objectives: (1) The sociodemographic data: this section collected information on participants’ gender, age group, profession (doctor, nurse, and pharmacist), clinical specialty, years of working experience, and any prior education or training on pain management; and (2) Knowledge and Attitudes Assessment: the second part included the amended KASRP questionnaire with 19 True/False questions, 12 Multiple Choice Questions, and One clinical case study designed to evaluate participants’ knowledge and attitudes regarding various aspects of pain assessment and management. Data collection took place over 1 month in 2025. HCWs were considered to have adequate knowledge and attitude if the score was 80% and above, a level identified by McCaffery and Robinson (2002). According to Ferrel et al, items should be differentiated with the least correct responses and those with the best scores for better response analysis (23). Study Process The study included HCWs (physicians, nurses, and pharmacists) who were actively employed at the hospital during the study period and consented to participate. The sample size for the study was 161. Inclusion criteria required participants to be licensed HCWs involved in clinical care or pharmaceutical services. Exclusion criteria included HCWs not involved in direct patient care, such as administrative staff and midwives, pediatric nurses and pediatricians. The questionnaire was distributed using an online survey platform to ensure ease of access and confidentiality. Participants received the survey link via their mobile phones and were asked to complete the questionnaire independently without any external assistance to avoid bias. Participation was voluntary, the enrolled staff filled the survey anonymously, and informed consent was obtained electronically before starting the survey questions. Statistical analysis Collected data were exported from the survey platform and analyzed using IBM SPSS Statistics version 25. Descriptive statistics summarized participants’ demographic characteristics and questionnaire responses, presented as frequencies, percentages, means, and standard deviations where applicable. Inferential statistics were applied to evaluate the association between knowledge scores and demographic variables. Independent samples t-tests or ANOVA tests were used to compare mean knowledge scores across different groups (e.g., profession, specialty, previous education on pain management). One-way ANOVA was used for multi-category variables (e.g., age, profession), and independent samples t-tests were used for binary variables (e.g., gender, training). A p-value of less than 0.05 was considered statistically significant. The clinical case study responses were analyzed separately to assess applied knowledge. Results Participants’ Characteristics A total of 161 healthcare professionals participated in the study. The sample included 83 (51.6%) females and 78 (48.4%) males. Most respondents were between 25 and 45 years old (72.1%), with the largest subgroup aged 36 and 45 years (37.3%). Professionally, nurses made up the majority of the sample (62.1%), followed by doctors (25.5%) and pharmacists (12.4%). In terms of experience, 41% had more than 15 years, while 23.6% had less than 5 years. The demographic characteristics are tabulated in Table 1 . Table 1 Demographic Characteristics of Participants (n = 161) Characteristic Category Frequency Percentage (%) P-Value Gender Female 83 51.6 0.513 Male 78 48.4 Age Group 20–24 years 14 8.7 *0.021 25–35 years 56 34.8 36–45 years 60 37.3 46–55 years 24 14.9 > 55 years 7 4.3 Profession Nurse 100 62.1 *0.001 Doctor 41 25.5 Pharmacist 20 12.4 Subspecialty Anesthesiology 10 6.2 0.171 General Practice 14 8.7 Medicine 18 11.2 ONCOLOGY 12 7.5 Surgery 39 24.1 Other 65 40.4 Years of Experience 15 years 66 41.0 Knowledge and attitude amongst HCWs regarding pain The overall mean correct KASPR score obtained across all participants was 13.65 (SD = 9.93) for correct responses out of 33 possible points (Table 3 ), indicating generally poor knowledge. Only 9 out of 161 participants (5.6%) scored ≥ 80%: 4 doctors (9.8%), 5 nurses (5%), and 0 pharmacists (Table 2 ). Table 2 Percent and count of responders by specialty who have 80% or more as an average correct score Specialty Frequency Percent from total by Specialty Physicians 4 9.8% Nurses 5 5% Pharmacists 0 0% Table 3 Percentage of Correct Answers by KASRP Item among HCWs based on Question Category Categories Doctors Nurse Pharmacist Overall Assessment Category n (%) n (%) n (%) n (%) Q6 – Vital signs are always reliable indicators of the intensity of a patient’s pain. 26 (74.3%) 21 (33.87%) 11 (64.71%) 58 (50.9%) Q7 – Patients who can be distracted from pain usually do not have severe pain. 17 (48.57%) 32 (51.61% 10 (58.82%) 59 (51.8%) Q8 – Patients may sleep in spite of severe pain. 19 (54.29%) 23 (37.10%) 9 (52.94%) 49 (43.4%) Q18 – Giving patients sterile water by injection (placebo) is a useful test to determine if the pain is real. 19 (54.29%) 32 (52.50%) 9 (52.94%) 60 (53.1%) Q19 – If the source of the patient’s pain is unknown, opioids should not be used during the pain evaluation period, as this could mask the ability to correctly diagnose the cause of pain. 23 (65.71%) 14 (22.95%) 5 (29.41%) 42 (37.2%) Q27 – Which of the following analgesic medications is considered the drug of choice for the treatment of prolonged moderate to severe pain for cancer patients? 20 (62.5%) 44 (83.02%) 11 (78.57%) 75 (75.8%) Q28 – A 30 mg dose of oral morphine is approximately equivalent to: 22 (68.75%) 33 (63.46%) 13 (92.86%) 68 (69.4%) Q29 – Analgesics for post-operative pain should initially be given around the clock on a fixed schedule. 23 (71.88%) 34 (65.38%) 4 (28.57%) 61 (62.2%) Q30 – The most likely reason a patient with pain would request increased doses of pain medication is experiencing increased pain. 28 (87.50%) 44 (84.62%) 12 (85.71%) 84 (85.7%) Q31 – Which of the following is useful for treatment of cancer pain? 27 (84.38%) 41 (78.85%) 11 (78.57%) 79 (80.6%) Q32 – The most accurate judge of the intensity of the patient’s pain is the patient 26 (81.25%) 39 (75.00%) 11 (84.62%) 76 (78.4%) Q33 – The time to reach peak effect for morphine given IV is: 28 (87.50%) 42 (80.77%) 14 (100.00%) 84 (85.7%) Q34 – The time to reach peak effect for morphine given orally is: 21 (65.63%) 29 (55.77%) 10 (71.43%) 60 (61.2%) Q35 – Following abrupt discontinuation of an opioid, physical dependence is manifested by the following: 5 (15.63%) 10 (19.23%) 2 (15.38%) 17 (17.5%) Q36 – Which statement is true regarding opioid induced respiratory depression? 17 (53.13%) 32 (61.54%) 5 (38.46%) 54 (55.7%) Q37 – On the patient’s record you must mark his pain on the scale below. Choose the number that represents your assessment of Andrew’s pain. 12 (37.50%) 27 (58.70%) 7 (53.85%) 46 (50.5%) Medication Category Q9 – Aspirin and other nonsteroidal anti-inflammatory agents are NOT effective analgesics for painful bone metastases. 20 (57.14%) 25 (40.32%) 7 (41.18%) 52 (55.6%) Q10 – Respiratory depression rarely occurs in patients who have been receiving stable doses of opioids over a period of months. 25 (71.43%) 38 (62.30%) 7 (41.18%) 70 (61.9%) Q11 – Combining analgesics that work by different mechanisms (e.g., combining an NSAID with an opioid) may result in better pain control with fewer side effects than using a single analgesic agent. 34 (97.14%) 52 (85.25%) 11 (64.71%) 97 (85.4%) Q12 – The usual duration of analgesia of 1–2 mg morphine IV is 4–5 hours. 11 (31.43%) 22 (35.48%) 6 (35.29%) 39 (34.2%) Q13 – Opioids should not be used in patients with a history of substance abuse. 16 (45.71%) 24 (38.71%) 8 (47.10%) 48 (42.1%) Q14 – Elderly patients cannot tolerate opioids for pain relief. 29 (82.86%) 41 (66.13%) 13 (76.47%) 83 (72.8%) Q15 – Patients should be encouraged to endure as much pain as possible before using an opioid. 33 (94.29%) 41 (66.13%) 13 (76.47%) 87 (76.3%) Q17 – After an initial dose of opioid analgesic is given, subsequent doses should be adjusted in accordance with the individual patient’s response. 34 (97.14%) 54 (90.00%) 17 (100.00%) 106 (93.8%) Q20 – Anticonvulsant drugs such as gabapentin (Neurontin) produce optimal pain relief after a single dose. 33 (94.29%) 33 (54.10%) 15 (88.24%) 81 (71.7%) Q21 – Benzodiazepines are not effective pain relievers and are rarely recommended as part of an analgesic regiment. 20 (57.14%) 40 (66.67%) 10 (58.82%) 70 (62.5%) Q23 – The term ‘equianalgesia’ means approximately equal analgesia and is used when referring to the doses of various analgesics that provide approximately the same amount of pain relief. 33 (94.29%) 53 (88.33%) 16 (94.12%) 102 (91.1%) Q25 – The recommended route of administration of opioid analgesics for patients with persistent cancer-related pain is: 13 (40.63) 17 (32.10%) 5 (35.7%) 35 (35.4%) Q26 – The recommended route administration of opioid analgesics for patients with brief, severe pain of sudden onset such as trauma or postoperative pain is: 13 (40.63) 30 (56.60%) 3 (21.43%) 46 (46.5%) Addiction Category Q22 – Narcotic/opioid addiction is defined as a chronic neurobiologic disease, characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. 33 (94.29%) 56 (93.33%) 17 (100.00%) 106 (94.6%) Q24 – Sedation assessment is recommended during opioid pain management because excessive sedation precedes opioid-induced respiratory depression. 28 (80.00%) 57 (95.00%) 16 (94.12%) 101 (90.2%) Spiritual Category Q16 – Patients’ spiritual beliefs may lead them to think pain and suffering are necessary. 29 (82.86%) 52 (83.87%) 13 (76.47%) 94 (82.5%) Intervention Category Q38 – Your assessment, above, is made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2/10 as an acceptable level of pain relief. His physician’s order for analgesia is “morphine IV 1–3 mg q1h PRN pain relief.” Check the action you will take at this time. 3 (9.38%) 5 (10.42%) 2 (15.38%) 10 (10.8%) Factors affecting the knowledge and attitude towards pain management were analyzed: gender, age, profession, training status, and years of experience (Table 4 ). Gender: Although male participants had a slightly higher mean score (M = 14.74) than females (M = 12.63), this difference was not statistically significant (p = 0.177) based on an independent samples t-test. Age: A one-way ANOVA revealed a statistically significant difference in mean scores among age groups (p = 0.021). Participants aged 46–55 years achieved the highest mean score (M = 18.04), while those aged 25–35 and 36–45 scored the lowest. Profession: There was a highly significant difference in knowledge scores by profession (p = 0.001, one-way ANOVA). Doctors scored the highest (M = 18.05), followed by pharmacists (M = 16.05), with nurses scoring the lowest (M = 11.37). Training in Pain Management: Those who had received formal training in pain management scored higher (M = 15.11) than those who had not (M = 12.88), but this difference was not statistically significant (p = 0.175). Years of Experience: The effect of years of experience on knowledge scores was analyzed using ANOVA and was found to be not statistically significant (p = 0.482). Table 4 Factors Affecting knowledge on pain management Variable Category Mean Score p-value Gender Male 14.74 0.177 Female 12.63 Age 25–35 11.68 0.021 36–45 11.80 46–55 18.04 Profession Doctors 18.05 0.001 Pharmacists 16.05 Nurses 11.37 Training Status Trained 15.11 0.175 Not Trained 12.88 Years of Experience < 5 years 13.29 0.482 5–9 years 14.08 10–14 years 14.23 15 + years 12.89 Discussion The findings from this study demonstrated moderate overall knowledge of pain management among healthcare professionals, with only 5.6% of participants achieving the benchmark score of ≥ 80% (24). Despite some well-answered items, particularly those related to basic opioid pharmacology and assessment, other areas reveal significant knowledge gaps that reflect a comparable pattern in several Middle Eastern and developing countries. Only 5.6% of the total sample achieved the benchmark score of 80% or higher. Compared to international studies, this rate is substantially lower. In the United States, AlShaer et al. reported that 54% of nurses scored above 80%, while Turkish nurses in Yildirim et al. averaged a 73.3% correct response rate (25)(26). This difference is attributed to better integration of pain education into the nursing curricula and professional training on pain management. In Hong Kong, Lui et al. reported that nurses’ knowledge and attitudes on pain management were significantly influenced by clinical working experience and applied knowledge of pain to daily practice (27). This is comparable to our study where HCW who received formal training in pain management scored higher mean score of correct answers compared to non-trained although statistically non-significant 15.11 vs. 12.88 respectively (P < 0.05). When considering comparison of our study results with other Middle Eastern countries, our results become more mirrored. In Jordan, Nuseir et al. study results reported that physicians and pharmacist scored 36% and 24% respectively, aligning with our study’s results that nurses had the lowest scores, followed by pharmacists (18). In Saudi Arabia, similarly, Al-Quliti and Alamri reported that only 5.7% of participants scored > 60%, mirroring our study results were only 5.6% of the HCWs achieved 80%, this reflects a regional existing gap at the level of pain management education and practice (19). This consistency in regional findings across the Middle East region reflects an existing systemic education regional gap despite the differences in institution systems, professions, and languages. The core deficits, as reflected from the percentage of correct answers by the HCWs are diversified and fall into lack of understanding of the opioid pharmacology, fear of addiction, and appropriate assessment. In our study, with respect to profession-specific observation, physicians scored the highest (mean = 18.05), followed by pharmacists (mean = 16.05) and nurses (mean = 11.37). This profession-specific observation aligns with findings in Jordan, Saudi Arabia, and Iran, where physicians showed highest scores in comparison to nurses and pharmacist. This can be likely attributed to more medical training. However, only 9.8% of the physicians met the adequacy benchmark ≥ 80%, reflecting that profession does not necessarily ensure competency in pain management unless adequate education and professional training exists in place. In our study, none of the pharmacists scored ≥ 80% although pharmacists are positioned to evaluate prescribed pain medications and treatment plan. This can be attributed to limited clinical experience in pain management, lack of adequate training, and underestimation of the role of the pharmacist in appropriate pain management. This contrasts with the Western world where pharmacists are involved in pain stewardship programs and pain management. HCWs who received pain management training scored slightly higher than those who did not, mean of 15.11 vs. 12.88, although not statistically significant (p = 0.175). Similarly, this aligns with the findings of Al-Quliti & Alamri and Nuseir et al. emphasizing the importance of education, training, and curricula integration of pain management (18)(19). There was no statistically significant difference in mean correct scores observed based on gender or years of experience, indicating that experience alone does not replace training and education. The age revealed a statistical significance (P < 0.05) in the mean scores among age groups, with age groups 46–55 scoring the highest mean score of (18.04) among the other age group of 25–35 (11.68) and 36–45 (11.08) respectively. Limitations This research should be interpreted in light of a number of limitations. Being conducted in a single tertiary hospital in Beirut, the findings may not fully reflect the situation in other Lebanese hospitals or in different healthcare systems across the region. The cross-sectional design also provides only a snapshot in time and does not allow assessment of how knowledge and attitudes may change following education or clinical experience. Because the questionnaire was self-administered, some responses could have been affected by over- or under-reporting, or by misinterpretation of items, even though a validated tool was used. The study sample was dominated by nurses, with fewer physicians and pharmacists, which may have influenced subgroup comparisons. In addition, certain groups, such as pediatric healthcare providers, were not included, and the tool measured knowledge and attitudes rather than actual clinical practice, which may not always align. Finally, the modest sample size for some subgroups may have limited the statistical power to detect meaningful differences. Conclusion The study results reflect the need for structured educational programs integrated into the teaching curricula on pain management based on the mean score of correct answers and the adequacy benchmark of ≥ 80% achieved only by 5.6% of the total sample. The low mean scores of nurses and pharmacists reflect the need for educational and practical workshops to increase the interdisciplinary collaboration between HCWs in pain management. Overall, pain management in Middle East region, as our study mirrors national and regional study results, requires change and improvement in pain management education for better patient pain control. Declarations Ethical approval The Ethics Committee at the Clemenceau Medical Center in Beirut, Lebanon approved the study before data collection started. The study purpose, harm, voluntary participation, confidentiality, anonymity and the need for any further clarifications on the study were stated in the survey front sheet where eligible participants will consent for approval to participate. The study was conducted in accordance with the principles of the Declaration of Helsinki. The participants were coded, and the data collection and analysis were accessed and done by the study research team only. Consent for publication Not applicable. Competing interests The authors declare no financial relationships with any organizations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work. Author Details 1 Department of Internal Medicine, Clemenceau Medical Center, Beirut, Lebanon 2 Department of Nursing, Clemenceau Medical Center , Beirut, Lebanon 3 Department of Pharmacy, Clemenceau Medical Center , Beirut, Lebanon 4 Department of Quality, Clemenceau Medical Center , Beirut, Lebanon. 5 Department of Internal Medicine, University of Balamand , Tripoli, Lebanon. Funding: This study did not receive any funding from any source. Author Contribution Conceptualization: MK. Methodology: All authors. Formal analysis and interpretation: CB and NZ; Writing – original draft preparation: CB, with a contribution from MK. Writing –review and editing: all authors. All authors read and approved of the final manuscript. Acknowledgement The authors are thankful to all who contributed to this study, including the participants who generously shared their time and experiences, and the hospital where the survey was conducted. Your support and cooperation were invaluable to the completion of this work. Data Availability All data generated or analyzed for this study are included in this published article. References Thomas T, Robinson C, Champion D, McKell M, Pell M. Pain management: An essential part of palliative care. BMJ Support Palliat Care. 2010;5(2):81‑85. International Association for the Study of Pain (IASP). IASP definition of pain [Internet]. 2019 [cited 2024 Sep 16]. Available from: https://www.iasp‑pain.org/resources/terminology/#pain Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161(9):1976‑82. Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005;165(14):1574‑80 Abdul Hadi A, Alldred DP, Briggs M, Marczewski K, Closs SJ. A qualitative study of chronic pain services in the UK: what can current commissioners and providers do to improve outcomes? BMC Health Serv Res. 2018;18(1):742. Cox T. Pain: Understanding its impact and treatment. J Pain Manag. 2010;3(2):101‑109. Wells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and management. 3rd ed. St. Louis: Elsevier; 2008. Makhlouf SM, Pini S, Ahmed S, Bennett MI. Managing pain in people with cancer: a systematic review of attitudes and knowledge of professionals, patients, caregivers, and public. J Cancer Educ. 2020;35(2):214‑240. doi: 10.1007/s13187‑019‑01548‑9 Urne I, Småstuen MC, Nyblin U. Pain knowledge and attitudes among nurses in cancer care in Norway. J Cancer Educ. 2019;34(4):677‑684. doi: 10.1007/s13187‑018‑1355‑3 Pretorius A, Searle J, Marshall B. Barriers to effective pain management in prehospital care: a review of current literature. Emerg Med J. 2015;32(6):496‑501 Kheshti R, Namazi S, Mehrabi M, Firouzabadi D. Healthcare providers' knowledge, attitude, and practice regarding pain management. J Educ Health Promot. 2016;5:12. Treede RD. The International Association for the Study of Pain definition of pain. Pain Rep. 2018;3(2):12‑18 Uslu Sahan F, Terzioglu F. Nurses' knowledge and attitudes regarding opioid use in cancer pain management. Cancer Nurs. 2017;40(1):1‑9. Glowacki D. Effective pain management and improvements in patients’ outcomes and satisfaction. Crit Care Nurse. 2015;35(3):33‑43. Arthur D, Wong W, Chan C, Pang C, Leung M, Cheng F, Lau Y. Addressing challenges in pain management with opioid analgesics in Hong Kong. J Pain Palliat Care Pharmacother. 2019;33(1):42‑50. Guest P, Berkowitz H, Levin A. Delays in opioid storage protocols: Impact on patient outcomes. J Pain Symptom Manage. 2017;54(2):204‑209. Kahsay WG, Pitkäjärvi M. Knowledge and practice of pain assessment and management and associated factors among nurses working in public hospitals in Mekelle city, Northern Ethiopia. Nurs Open. 2019;6(4):1342‑50. Nuseir K, Kassab M, Almomani B. Healthcare providers’ knowledge and attitudes toward pain management in Jordan. Pain Manag Nurs. 2016;17(1):15‑22. Al‑Quliti KW, Alamri MS. Assessment of pain. Knowledge, attitudes and practices of healthcare providers in Almadinah Almunawwarah, Saudi Arabia. Saudi J Anaesth. 2015;9(1):78‑82. Kahsay DT, Pitkäjärvi M. Emergency nurses' knowledge, attitude and perceived barriers regarding pain management in resource-limited settings: cross-sectional study. BMC Nurs. 2019 Nov 21;18:56. doi: 10.1186/s12912-019-0380-9 . Nasser SC, Nassif JG, Saad AH. Physicians' knowledge and attitudes toward pain management: a cross‑sectional study. Pain Res Manag. 2016; 2016:9634943. Abdul Rahman R, Abu‑Saad Huijer H, Noureddine S. Knowledge and attitudes of Lebanese nurses toward pain management. Pain Manag Nurs. 2013;14(1):42‑48. Ferrell BM. “Knowledge and attitudes survey regarding pain” developed by Betty Ferrell, RN, PhD, FAAN and Margo McCaffery, RN, MS, FAAN; 2012 [Internet]. Available from: http://prc.coh.org . Accessed May 18, 2022. McCaffery M, Robinson ES. Your patient is in pain—here’s how you respond. Nursing. 2002;32(10):36‑45. AlShaer D, AlBekairy A, Alshehri A, et al. Knowledge and attitudes regarding pain management among nurses in a tertiary hospital. J Pain Res. 2020;13:2551‑2558. Yildirim YK, Cicek F, Uyar M. Knowledge and attitudes of Turkish oncology nurses about cancer pain management. Pain Manag Nurs. 2008;9(1):17‑25. Lui LYY, So WKW, Fong DYT. Knowledge and attitudes regarding pain management among nurses in Hong Kong medical units. J Clin Nurs. 2008;17(15):2014‑2021. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 16 Dec, 2025 Reviews received at journal 14 Dec, 2025 Reviewers agreed at journal 11 Dec, 2025 Reviewers invited by journal 09 Dec, 2025 Editor invited by journal 09 Dec, 2025 Editor assigned by journal 18 Nov, 2025 Submission checks completed at journal 14 Nov, 2025 First submitted to journal 14 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8051757","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560028981,"identity":"5abaed03-72bc-4d8d-810c-27f0e16cedf6","order_by":0,"name":"Maha Kassem","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACgwM8DAyMbWA24wO48MMG3FoswVp6wGxmA7hwIh4t9mAtM8BsNgmitJgdP3vwA+MGO3v59u60ip85dgz87d0JDIk78Gg5k5cswfggOXHDmbPbbvZuS2aQOHN2A0PiGTxaDuQYALUwJxhI5G67zbjtAAOQAdTShluLwfk3xj8YN9Tby89/u62YOC03cswkGGccZmy4wbuNmUgtb8wsEnuOA/2Su1kS6BcekF8O4POLwfkc4xsf26qBIXZ244ef2+zk+Nt7Nz74iCfEwCABic0DIg4Q0DAKRsEoGAWjgAAAAFitWi5kitbeAAAAAElFTkSuQmCC","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Maha","middleName":"","lastName":"Kassem","suffix":""},{"id":560028982,"identity":"50ecb7b4-ce70-4915-957b-858d9bde7cfe","order_by":1,"name":"Celine Bakri","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Celine","middleName":"","lastName":"Bakri","suffix":""},{"id":560028983,"identity":"f54f9f77-481b-494b-80ce-54304281fe8b","order_by":2,"name":"Nadine Zeinab","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Nadine","middleName":"","lastName":"Zeinab","suffix":""},{"id":560028987,"identity":"92289cf9-336d-4871-b6d7-294f50938278","order_by":3,"name":"Nadine Hindi","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Nadine","middleName":"","lastName":"Hindi","suffix":""},{"id":560028988,"identity":"81fc5dad-b57c-40cd-8946-9abdafea5aea","order_by":4,"name":"Serena Abu Samra","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Serena","middleName":"Abu","lastName":"Samra","suffix":""},{"id":560028989,"identity":"03d34a9d-5e85-48ee-95ba-bfdc11719d21","order_by":5,"name":"Zeina Jalabi","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Zeina","middleName":"","lastName":"Jalabi","suffix":""},{"id":560028990,"identity":"d4514f39-e768-48f2-bb9d-4ba161eb4511","order_by":6,"name":"Abedelkader Hammoud","email":"","orcid":"","institution":"Clemenceau Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Abedelkader","middleName":"","lastName":"Hammoud","suffix":""}],"badges":[],"createdAt":"2025-11-07 00:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8051757/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8051757/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98249688,"identity":"cb9139a8-9441-4989-a0ae-32a98bf31d1e","added_by":"auto","created_at":"2025-12-15 16:41:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":56033,"visible":true,"origin":"","legend":"","description":"","filename":"PainManagementResearchArticle.docx","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/8ebac99782c1944faf3519a3.docx"},{"id":98249689,"identity":"d01240c5-c65a-4204-ad4d-14457d683677","added_by":"auto","created_at":"2025-12-15 16:41:53","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9147,"visible":true,"origin":"","legend":"","description":"","filename":"16ac6b6a87eb44519c669a665d001858.json","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/c6d8426237e5789ea8247b5b.json"},{"id":98249692,"identity":"f693361d-5ba9-4aa5-b744-de17b4d11375","added_by":"auto","created_at":"2025-12-15 16:41:54","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77769,"visible":true,"origin":"","legend":"","description":"","filename":"16ac6b6a87eb44519c669a665d0018581enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/dee65634fe8e84ee85e1d7b4.xml"},{"id":98249693,"identity":"8b6eded4-4def-421a-8ae6-3cdd1209509d","added_by":"auto","created_at":"2025-12-15 16:41:54","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75618,"visible":true,"origin":"","legend":"","description":"","filename":"16ac6b6a87eb44519c669a665d0018581structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/5b078ccbcea09a88c5ec5001.xml"},{"id":98249690,"identity":"578d5c48-9010-42e7-bf0d-322f76918333","added_by":"auto","created_at":"2025-12-15 16:41:53","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":84371,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/0552e96ce060c7e8dc3be2cb.html"},{"id":98434791,"identity":"ea45876b-4435-4809-92af-c603899253d2","added_by":"auto","created_at":"2025-12-17 16:52:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":943364,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8051757/v1/4d75b6de-22d5-408c-b2d2-00c99a2ac7af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Healthcare Worker s (HCWs) Knowledge and Attitudes Related to Pain Management: A Cross-Sectional Study in a Tertiary Hospital in Lebanon","fulltext":[{"header":"Background","content":"\u003cp\u003ePain remains a global health concern that affects individuals of all ages, from different backgrounds, and with different health issues. Despite international guidelines and many interventions to reduce myths and increase awareness among the healthcare professionals and public sector, pain continues to be inadequately controlled or ineffectively managed (1). It is a multidimensional physiological and psychological phenomenon, acute or chronic, that is inherently subjective and can be defined as an unpleasant sensory and emotional experience related to actual or potential tissue damage (2)(3). Pain has been designated as the 5th vital sign to emphasize the importance of its assessment and management (4). Untreated or inadequately treated pain can reduce a person\u0026rsquo;s quality of life (QoL) compared to the general population and those with other limiting conditions, highlighting the need for accurate assessment, and efficient and effective pain management (5)(6). It can also lead to adverse physiological and psychological outcomes for both patients and their families, while also increasing the burden on healthcare systems through extended hospital stays, higher readmission rates, and increased healthcare costs (7).\u003c/p\u003e\u003cp\u003eEffective pain management requires an interdisciplinary approach by various healthcare workers (HCWs), including nurses, physicians, and pharmacists with a strong foundation of knowledge and the right attitude. Such knowledge is believed to affect the attitude of the HCWs in managing pain (8)(9). However, a lack of adequate knowledge among HCWs remains a significant barrier to effective pain management (10), with misconceptions about pain evaluation; incorrect beliefs that patients overstate their pain; fears about drug tolerance and addiction; a lack of understanding of analgesic pharmacology; and difficulties in assessing pain in children (11).\u003c/p\u003e\u003cp\u003eSimilar key clinical barriers to effective pain management include insufficient knowledge (12), opioid phobia related to addiction and respiratory depression (13), poor interdisciplinary communication (14), reluctance among medical teams to prescribe opioids (15), delays in opioid storage protocols (16), and inadequate pain assessment, lack of protocols, and nursing workload (17).\u003c/p\u003e\u003cp\u003eSeveral studies in the middle east region have shown an array of deficit in knowledge and attitudes of HCWs toward pain management (18)(19)(20).\u003c/p\u003e\u003cp\u003eIn Lebanon, 2 studies addressed the knowledge and attitudes of physicians and nurses, separately. Nasser et al. evaluated physicians' self-assessed pain management skills and identified barriers to effective pain control and identified fear of adverse events, particularly opioid side effects as barriers and a lack of adequate knowledge about pain management (21). Abdul Rahman, Abu-Saad Huijer, and Noureddine identified a lack of knowledge with only 3.4% of the nurses achieving a score of equal to or greater than 80%, the required score for effective pain management (22).\u003c/p\u003e\u003cp\u003eTo date, there are no published studies that assessed the knowledge and attitudes of physicians, nurses, and pharmacists toward pain management in Lebanon. Conducting such research is essential to identify discipline-specific gaps and inform strategies to improve pain management knowledge and clinical practice among physicians, nurses, and pharmacists alike.\u003c/p\u003e\u003cp\u003eAccordingly, our study aims to (1) evaluate the knowledge and attitudes of HCWs regarding pain assessment and management at a tertiary medical center in Beirut, Lebanon; and (2) identify areas of deficiency for targeted improvement initiatives.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted over a one-month period, from 23 February to 23 March 2025, at a private tertiary hospital in Beirut, Lebanon, to assess the knowledge and attitudes of HCWs towards pain management. The \u0026ldquo;Knowledge and Attitudes Survey Regarding Pain\u0026rdquo; (KASRP), a validated practice-based questionnaire, originally developed by Ferrell and McCaffery in 1987 and revised in 2014 was used to assess the participants\u0026rsquo; knowledge and attitudes related to pain management in its English form, since the official language used in the hospital was English and all participants were deemed able to read, comprehend and react to the questionnaire in English language (23). The KASPR questionnaire content is based on the standards of pain management such as the American Pain Society, World Health Organization, and the National Comprehensive Cancer Network pain guidelines. The content validity of the tool was established by the original authors, along with the test-retest reliability which was very good (r\u0026thinsp;\u0026gt;\u0026thinsp;0.8) when tested on a class of staff nurses (N\u0026thinsp;=\u0026thinsp;60), and the internal consistency reliability was also found to be good (r\u0026thinsp;\u0026gt;\u0026thinsp;0.70) and its authenticity, both in terms of its appearance and contents, was validated by an impartial panel of experts (24).\u003c/p\u003e\u003cp\u003eAs per the creators of the tool, questions may be omitted, so we removed some that were mainly related to pediatric pain, culture, and one of the case study. A score of \u0026ldquo;1\u0026rdquo; was provided for each correct response and a \u0026ldquo;0\u0026rdquo; for the incorrect response. The total score was the sum of all correctly answered questions. The percentage score was calculated by dividing the number of correct responses by the total number of items in the survey.\u003c/p\u003e\u003cp\u003eThe questionnaire was self-administered electronically via an online survey link distributed to eligible participants. The KASRP questionnaire was divided into two parts and included a total of 32 items from the KASRP based on our study objectives: (1) The sociodemographic data: this section collected information on participants\u0026rsquo; gender, age group, profession (doctor, nurse, and pharmacist), clinical specialty, years of working experience, and any prior education or training on pain management; and (2) Knowledge and Attitudes Assessment: the second part included the amended KASRP questionnaire with 19 True/False questions, 12 Multiple Choice Questions, and One clinical case study designed to evaluate participants\u0026rsquo; knowledge and attitudes regarding various aspects of pain assessment and management. Data collection took place over 1 month in 2025.\u003c/p\u003e\u003cp\u003eHCWs were considered to have adequate knowledge and attitude if the score was 80% and above, a level identified by McCaffery and Robinson (2002). According to Ferrel et al, items should be differentiated with the least correct responses and those with the best scores for better response analysis (23).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Process\u003c/h3\u003e\n\u003cp\u003eThe study included HCWs (physicians, nurses, and pharmacists) who were actively employed at the hospital during the study period and consented to participate. The sample size for the study was 161. Inclusion criteria required participants to be licensed HCWs involved in clinical care or pharmaceutical services. Exclusion criteria included HCWs not involved in direct patient care, such as administrative staff and midwives, pediatric nurses and pediatricians. The questionnaire was distributed using an online survey platform to ensure ease of access and confidentiality. Participants received the survey link via their mobile phones and were asked to complete the questionnaire independently without any external assistance to avoid bias. Participation was voluntary, the enrolled staff filled the survey anonymously, and informed consent was obtained electronically before starting the survey questions.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eCollected data were exported from the survey platform and analyzed using IBM SPSS Statistics version 25. Descriptive statistics summarized participants\u0026rsquo; demographic characteristics and questionnaire responses, presented as frequencies, percentages, means, and standard deviations where applicable. Inferential statistics were applied to evaluate the association between knowledge scores and demographic variables. Independent samples t-tests or ANOVA tests were used to compare mean knowledge scores across different groups (e.g., profession, specialty, previous education on pain management). One-way ANOVA was used for multi-category variables (e.g., age, profession), and independent samples t-tests were used for binary variables (e.g., gender, training). A p-value of less than 0.05 was considered statistically significant. The clinical case study responses were analyzed separately to assess applied knowledge.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u0026rsquo; Characteristics\u003c/h2\u003e\u003cp\u003eA total of 161 healthcare professionals participated in the study. The sample included 83 (51.6%) females and 78 (48.4%) males. Most respondents were between 25 and 45 years old (72.1%), with the largest subgroup aged 36 and 45 years (37.3%). Professionally, nurses made up the majority of the sample (62.1%), followed by doctors (25.5%) and pharmacists (12.4%). In terms of experience, 41% had more than 15 years, while 23.6% had less than 5 years. The demographic characteristics are tabulated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of Participants (n\u0026thinsp;=\u0026thinsp;161)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.513\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;35 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;55 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;55 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e*0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubspecialty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnesthesiology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eONCOLOGY\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of Experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;15 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge and attitude amongst HCWs regarding pain\u003c/h2\u003e\u003cp\u003eThe overall mean correct KASPR score obtained across all participants was 13.65 (SD\u0026thinsp;=\u0026thinsp;9.93) for correct responses out of 33 possible points (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicating generally poor knowledge. Only 9 out of 161 participants (5.6%) scored\u0026thinsp;\u0026ge;\u0026thinsp;80%: 4 doctors (9.8%), 5 nurses (5%), and 0 pharmacists (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePercent and count of responders by specialty who have 80% or more as an average correct score\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpecialty\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent from total by Specialty\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePercentage of Correct Answers by KASRP Item among HCWs based on Question Category\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePharmacist\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessment Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ6 \u0026ndash; Vital signs are always reliable indicators of the intensity of a patient\u0026rsquo;s pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e (74.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e21\u003c/b\u003e (33.87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e (64.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e58\u003c/b\u003e (50.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ7 \u0026ndash; Patients who can be distracted from pain usually do not have severe pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (48.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e32\u003c/b\u003e (51.61%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e (58.82%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e59\u003c/b\u003e (51.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ8 \u0026ndash; Patients may sleep in spite of severe pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e19\u003c/b\u003e (54.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e23\u003c/b\u003e (37.10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(52.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e49\u003c/b\u003e (43.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ18 \u0026ndash; Giving patients sterile water by injection (placebo) is a useful test to determine if the pain is real.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (54.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (52.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(52.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60 (53.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ19 \u0026ndash; If the source of the patient\u0026rsquo;s pain is unknown, opioids should not be used during the pain evaluation period, as this could mask the ability to correctly diagnose the cause of pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e23\u003c/b\u003e (65.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e (22.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(29.41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e (37.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ27 \u0026ndash; Which of the following analgesic medications is considered the drug of choice for the treatment of prolonged moderate to severe pain for cancer patients?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e (62.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e44\u003c/b\u003e (83.02%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(78.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e75\u003c/b\u003e (75.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ28 \u0026ndash; A 30 mg dose of oral morphine is approximately equivalent to:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e22\u003c/b\u003e (68.75%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (63.46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (92.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e68\u003c/b\u003e (69.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ29 \u0026ndash; Analgesics for post-operative pain should initially be given around the clock on a fixed schedule.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e23\u003c/b\u003e (71.88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e (65.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(28.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e61\u003c/b\u003e (62.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ30 \u0026ndash; The most likely reason a patient with pain would request increased doses of pain medication is experiencing increased pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e28\u003c/b\u003e (87.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e44\u003c/b\u003e (84.62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e (85.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e84\u003c/b\u003e (85.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ31 \u0026ndash; Which of the following is useful for treatment of cancer pain?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e27\u003c/b\u003e (84.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e41\u003c/b\u003e (78.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e (78.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e79\u003c/b\u003e (80.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ32 \u0026ndash; The most accurate judge of the intensity of the patient\u0026rsquo;s pain is the patient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e26\u003c/b\u003e (81.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e39\u003c/b\u003e (75.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e (84.62%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e76\u003c/b\u003e (78.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ33 \u0026ndash; The time to reach peak effect for morphine given IV is:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e28\u003c/b\u003e (87.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e42\u003c/b\u003e (80.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e14\u003c/b\u003e (100.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e84\u003c/b\u003e (85.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ34 \u0026ndash; The time to reach peak effect for morphine given orally is:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e21\u003c/b\u003e (65.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e (55.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e (71.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e60\u003c/b\u003e (61.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ35 \u0026ndash; Following abrupt discontinuation of an opioid, physical dependence is manifested by the following:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e (15.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e (19.23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(15.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (17.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ36 \u0026ndash; Which statement is true regarding opioid induced respiratory depression?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (53.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e32\u003c/b\u003e (61.54%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(38.46%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e54\u003c/b\u003e (55.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ37 \u0026ndash; On the patient\u0026rsquo;s record you must mark his pain on the scale below. Choose the number that represents your assessment of Andrew\u0026rsquo;s pain.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e12\u003c/b\u003e (37.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e27\u003c/b\u003e (58.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(53.85%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e46\u003c/b\u003e (50.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedication Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ9 \u0026ndash; Aspirin and other nonsteroidal anti-inflammatory agents are NOT effective analgesics for painful bone metastases.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e (57.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e25\u003c/b\u003e (40.32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(41.18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e52\u003c/b\u003e (55.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ10 \u0026ndash; Respiratory depression rarely occurs in patients who have been receiving stable doses of opioids over a period of months.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e25\u003c/b\u003e (71.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e (62.30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(41.18%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e70\u003c/b\u003e (61.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ11 \u0026ndash; Combining analgesics that work by different mechanisms (e.g., combining an NSAID with an opioid) may result in better pain control with fewer side effects than using a single analgesic agent.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e (97.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e52\u003c/b\u003e (85.25%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e (64.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e97\u003c/b\u003e (85.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ12 \u0026ndash; The usual duration of analgesia of 1\u0026ndash;2 mg morphine IV is 4\u0026ndash;5 hours.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e11\u003c/b\u003e (31.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e22\u003c/b\u003e (35.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(35.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e39\u003c/b\u003e (34.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ13 \u0026ndash; Opioids should not be used in patients with a history of substance abuse.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (45.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (38.71%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(47.10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48 (42.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ14 \u0026ndash; Elderly patients cannot tolerate opioids for pain relief.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e (82.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e41\u003c/b\u003e (66.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (76.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e83\u003c/b\u003e (72.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ15 \u0026ndash; Patients should be encouraged to endure as much pain as possible before using an opioid.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (94.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e41\u003c/b\u003e (66.13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (76.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e87\u003c/b\u003e (76.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ17 \u0026ndash; After an initial dose of opioid analgesic is given, subsequent doses should be adjusted in accordance with the individual patient\u0026rsquo;s response.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e34\u003c/b\u003e (97.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e54\u003c/b\u003e (90.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (100.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e106\u003c/b\u003e (93.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ20 \u0026ndash; Anticonvulsant drugs such as gabapentin (Neurontin) produce optimal pain relief after a single dose.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (94.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (54.10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e15\u003c/b\u003e (88.24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e81\u003c/b\u003e (71.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ21 \u0026ndash; Benzodiazepines are not effective pain relievers and are rarely recommended as part of an analgesic regiment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e20\u003c/b\u003e (57.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e (66.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e (58.82%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e70\u003c/b\u003e (62.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ23 \u0026ndash; The term \u0026lsquo;equianalgesia\u0026rsquo; means approximately equal analgesia and is used when referring to the doses of various analgesics that provide approximately the same amount of pain relief.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (94.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e53\u003c/b\u003e (88.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e (94.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e102\u003c/b\u003e (91.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ25 \u0026ndash; The recommended route of administration of opioid analgesics for patients with persistent cancer-related pain is:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (40.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (32.10%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(35.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e35\u003c/b\u003e (35.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ26 \u0026ndash; The recommended route administration of opioid analgesics for patients with brief, severe pain of sudden onset such as trauma or postoperative pain is:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (40.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e (56.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(21.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e46\u003c/b\u003e (46.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddiction Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ22 \u0026ndash; Narcotic/opioid addiction is defined as a chronic neurobiologic disease, characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e (94.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e56\u003c/b\u003e (93.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e17\u003c/b\u003e (100.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e106\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(94.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ24 \u0026ndash; Sedation assessment is recommended during opioid pain management because excessive sedation precedes opioid-induced respiratory depression.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e28\u003c/b\u003e (80.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e57\u003c/b\u003e (95.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e16\u003c/b\u003e (94.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e101\u003c/b\u003e (90.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiritual Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ16 \u0026ndash; Patients\u0026rsquo; spiritual beliefs may lead them to think pain and suffering are necessary.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e29\u003c/b\u003e (82.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e52\u003c/b\u003e (83.87%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e13\u003c/b\u003e (76.47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e94\u003c/b\u003e (82.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention Category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ38 \u0026ndash; Your assessment, above, is made two hours after he received morphine 2 mg IV. Half hourly pain ratings following the injection ranged from 6 to 8 and he had no clinically significant respiratory depression, sedation, or other untoward side effects. He has identified 2/10 as an acceptable level of pain relief. His physician\u0026rsquo;s order for analgesia is \u0026ldquo;morphine IV 1\u0026ndash;3 mg q1h PRN pain relief.\u0026rdquo; Check the action you will take at this time.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e3\u003c/b\u003e (9.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e5\u003c/b\u003e (10.42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e\u003cp\u003e(15.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e10\u003c/b\u003e (10.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFactors affecting the knowledge and attitude towards pain management were analyzed: gender, age, profession, training status, and years of experience (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Gender: Although male participants had a slightly higher mean score (M\u0026thinsp;=\u0026thinsp;14.74) than females (M\u0026thinsp;=\u0026thinsp;12.63), this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.177) based on an independent samples t-test. Age: A one-way ANOVA revealed a statistically significant difference in mean scores among age groups (p\u0026thinsp;=\u0026thinsp;0.021). Participants aged 46\u0026ndash;55 years achieved the highest mean score (M\u0026thinsp;=\u0026thinsp;18.04), while those aged 25\u0026ndash;35 and 36\u0026ndash;45 scored the lowest. Profession: There was a highly significant difference in knowledge scores by profession (p\u0026thinsp;=\u0026thinsp;0.001, one-way ANOVA). Doctors scored the highest (M\u0026thinsp;=\u0026thinsp;18.05), followed by pharmacists (M\u0026thinsp;=\u0026thinsp;16.05), with nurses scoring the lowest (M\u0026thinsp;=\u0026thinsp;11.37). Training in Pain Management: Those who had received formal training in pain management scored higher (M\u0026thinsp;=\u0026thinsp;15.11) than those who had not (M\u0026thinsp;=\u0026thinsp;12.88), but this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.175). Years of Experience: The effect of years of experience on knowledge scores was analyzed using ANOVA and was found to be not statistically significant (p\u0026thinsp;=\u0026thinsp;0.482).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors Affecting knowledge on pain management\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean Score\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDoctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmacists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTraining Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.175\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Trained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eYears of Experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.482\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings from this study demonstrated moderate overall knowledge of pain management among healthcare professionals, with only 5.6% of participants achieving the benchmark score of \u0026ge;\u0026thinsp;80% (24). Despite some well-answered items, particularly those related to basic opioid pharmacology and assessment, other areas reveal significant knowledge gaps that reflect a comparable pattern in several Middle Eastern and developing countries.\u003c/p\u003e\u003cp\u003eOnly 5.6% of the total sample achieved the benchmark score of 80% or higher. Compared to international studies, this rate is substantially lower. In the United States, AlShaer et al. reported that 54% of nurses scored above 80%, while Turkish nurses in Yildirim et al. averaged a 73.3% correct response rate (25)(26). This difference is attributed to better integration of pain education into the nursing curricula and professional training on pain management. In Hong Kong, Lui et al. reported that nurses\u0026rsquo; knowledge and attitudes on pain management were significantly influenced by clinical working experience and applied knowledge of pain to daily practice (27). This is comparable to our study where HCW who received formal training in pain management scored higher mean score of correct answers compared to non-trained although statistically non-significant 15.11 vs. 12.88 respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eWhen considering comparison of our study results with other Middle Eastern countries, our results become more mirrored. In Jordan, Nuseir et al. study results reported that physicians and pharmacist scored 36% and 24% respectively, aligning with our study\u0026rsquo;s results that nurses had the lowest scores, followed by pharmacists (18). In Saudi Arabia, similarly, Al-Quliti and Alamri reported that only 5.7% of participants scored\u0026thinsp;\u0026gt;\u0026thinsp;60%, mirroring our study results were only 5.6% of the HCWs achieved 80%, this reflects a regional existing gap at the level of pain management education and practice (19).\u003c/p\u003e\u003cp\u003eThis consistency in regional findings across the Middle East region reflects an existing systemic education regional gap despite the differences in institution systems, professions, and languages. The core deficits, as reflected from the percentage of correct answers by the HCWs are diversified and fall into lack of understanding of the opioid pharmacology, fear of addiction, and appropriate assessment.\u003c/p\u003e\u003cp\u003eIn our study, with respect to profession-specific observation, physicians scored the highest (mean\u0026thinsp;=\u0026thinsp;18.05), followed by pharmacists (mean\u0026thinsp;=\u0026thinsp;16.05) and nurses (mean\u0026thinsp;=\u0026thinsp;11.37). This profession-specific observation aligns with findings in Jordan, Saudi Arabia, and Iran, where physicians showed highest scores in comparison to nurses and pharmacist. This can be likely attributed to more medical training. However, only 9.8% of the physicians met the adequacy benchmark\u0026thinsp;\u0026ge;\u0026thinsp;80%, reflecting that profession does not necessarily ensure competency in pain management unless adequate education and professional training exists in place. In our study, none of the pharmacists scored\u0026thinsp;\u0026ge;\u0026thinsp;80% although pharmacists are positioned to evaluate prescribed pain medications and treatment plan. This can be attributed to limited clinical experience in pain management, lack of adequate training, and underestimation of the role of the pharmacist in appropriate pain management. This contrasts with the Western world where pharmacists are involved in pain stewardship programs and pain management.\u003c/p\u003e\u003cp\u003eHCWs who received pain management training scored slightly higher than those who did not, mean of 15.11 vs. 12.88, although not statistically significant (p\u0026thinsp;=\u0026thinsp;0.175). Similarly, this aligns with the findings of Al-Quliti \u0026amp; Alamri and Nuseir et al. emphasizing the importance of education, training, and curricula integration of pain management (18)(19). There was no statistically significant difference in mean correct scores observed based on gender or years of experience, indicating that experience alone does not replace training and education. The age revealed a statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the mean scores among age groups, with age groups 46\u0026ndash;55 scoring the highest mean score of (18.04) among the other age group of 25\u0026ndash;35 (11.68) and 36\u0026ndash;45 (11.08) respectively.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis research should be interpreted in light of a number of limitations. Being conducted in a single tertiary hospital in Beirut, the findings may not fully reflect the situation in other Lebanese hospitals or in different healthcare systems across the region. The cross-sectional design also provides only a snapshot in time and does not allow assessment of how knowledge and attitudes may change following education or clinical experience. Because the questionnaire was self-administered, some responses could have been affected by over- or under-reporting, or by misinterpretation of items, even though a validated tool was used. The study sample was dominated by nurses, with fewer physicians and pharmacists, which may have influenced subgroup comparisons. In addition, certain groups, such as pediatric healthcare providers, were not included, and the tool measured knowledge and attitudes rather than actual clinical practice, which may not always align. Finally, the modest sample size for some subgroups may have limited the statistical power to detect meaningful differences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study results reflect the need for structured educational programs integrated into the teaching curricula on pain management based on the mean score of correct answers and the adequacy benchmark of \u0026ge;\u0026thinsp;80% achieved only by 5.6% of the total sample. The low mean scores of nurses and pharmacists reflect the need for educational and practical workshops to increase the interdisciplinary collaboration between HCWs in pain management. Overall, pain management in Middle East region, as our study mirrors national and regional study results, requires change and improvement in pain management education for better patient pain control.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e The Ethics Committee at the Clemenceau Medical Center in Beirut, Lebanon approved the study before data collection started. The study purpose, harm, voluntary participation, confidentiality, anonymity and the need for any further clarifications on the study were stated in the survey front sheet where eligible participants will consent for approval to participate. The study was conducted in accordance with the principles of the Declaration of Helsinki. The participants were coded, and the data collection and analysis were accessed and done by the study research team only.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no financial relationships with any organizations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eAuthor Details\u003c/h2\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Internal Medicine, Clemenceau Medical Center, Beirut, Lebanon\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Nursing, \u003cem\u003eClemenceau Medical Center\u003c/em\u003e, Beirut, Lebanon\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Pharmacy, \u003cem\u003eClemenceau Medical Center\u003c/em\u003e, Beirut, Lebanon\u003c/p\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eDepartment of Quality, \u003cem\u003eClemenceau Medical Center\u003c/em\u003e, Beirut, Lebanon.\u003c/p\u003e\u003cp\u003e\u003csup\u003e5\u003c/sup\u003eDepartment of Internal Medicine, \u003cem\u003eUniversity of Balamand\u003c/em\u003e, Tripoli, Lebanon.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis study did not receive any funding from any source.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: MK. Methodology: All authors. Formal analysis and interpretation: CB and NZ; Writing \u0026ndash; original draft preparation: CB, with a contribution from MK. Writing \u0026ndash;review and editing: all authors. All authors read and approved of the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors are thankful to all who contributed to this study, including the participants who generously shared their time and experiences, and the hospital where the survey was conducted. Your support and cooperation were invaluable to the completion of this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analyzed for this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThomas T, Robinson C, Champion D, McKell M, Pell M. Pain management: An essential part of palliative care. BMJ Support Palliat Care. 2010;5(2):81‑85.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eInternational Association for the Study of Pain (IASP). IASP definition of pain [Internet]. 2019 [cited 2024 Sep 16]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.iasp‑pain.org/resources/terminology/#pain\u003c/span\u003e\u003cspan address=\"https://www.iasp‑pain.org/resources/terminology/#pain\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eRaja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161(9):1976‑82.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eGordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005;165(14):1574‑80\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAbdul Hadi A, Alldred DP, Briggs M, Marczewski K, Closs SJ. A qualitative study of chronic pain services in the UK: what can current commissioners and providers do to improve outcomes? \u003cem\u003eBMC Health Serv Res.\u003c/em\u003e 2018;18(1):742.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCox T. Pain: Understanding its impact and treatment. J Pain Manag. 2010;3(2):101‑109.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and management. 3rd ed. St. Louis: Elsevier; 2008.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMakhlouf SM, Pini S, Ahmed S, Bennett MI. Managing pain in people with cancer: a systematic review of attitudes and knowledge of professionals, patients, caregivers, and public. J Cancer Educ. 2020;35(2):214‑240. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13187‑019‑01548‑9\u003c/span\u003e\u003cspan address=\"10.1007/s13187‑019‑01548‑9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eUrne I, Sm\u0026aring;stuen MC, Nyblin U. Pain knowledge and attitudes among nurses in cancer care in Norway. J Cancer Educ. 2019;34(4):677‑684. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13187‑018‑1355‑3\u003c/span\u003e\u003cspan address=\"10.1007/s13187‑018‑1355‑3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePretorius A, Searle J, Marshall B. Barriers to effective pain management in prehospital care: a review of current literature. Emerg Med J. 2015;32(6):496‑501\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKheshti R, Namazi S, Mehrabi M, Firouzabadi D. Healthcare providers' knowledge, attitude, and practice regarding pain management. J Educ Health Promot. 2016;5:12.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTreede RD. The International Association for the Study of Pain definition of pain. Pain Rep. 2018;3(2):12‑18\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eUslu Sahan F, Terzioglu F. Nurses' knowledge and attitudes regarding opioid use in cancer pain management. Cancer Nurs. 2017;40(1):1‑9.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eGlowacki D. Effective pain management and improvements in patients\u0026rsquo; outcomes and satisfaction. Crit Care Nurse. 2015;35(3):33‑43.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eArthur D, Wong W, Chan C, Pang C, Leung M, Cheng F, Lau Y. Addressing challenges in pain management with opioid analgesics in Hong Kong. J Pain Palliat Care Pharmacother. 2019;33(1):42‑50.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eGuest P, Berkowitz H, Levin A. Delays in opioid storage protocols: Impact on patient outcomes. J Pain Symptom Manage. 2017;54(2):204‑209.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKahsay WG, Pitk\u0026auml;j\u0026auml;rvi M. Knowledge and practice of pain assessment and management and associated factors among nurses working in public hospitals in Mekelle city, Northern Ethiopia. Nurs Open. 2019;6(4):1342‑50.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNuseir K, Kassab M, Almomani B. Healthcare providers\u0026rsquo; knowledge and attitudes toward pain management in Jordan. Pain Manag Nurs. 2016;17(1):15‑22.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAl‑Quliti KW, Alamri MS. Assessment of pain. Knowledge, attitudes and practices of healthcare providers in Almadinah Almunawwarah, Saudi Arabia. Saudi J Anaesth. 2015;9(1):78‑82.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKahsay DT, Pitk\u0026auml;j\u0026auml;rvi M. Emergency nurses' knowledge, attitude and perceived barriers regarding pain management in resource-limited settings: cross-sectional study. \u003cem\u003eBMC Nurs.\u003c/em\u003e 2019 Nov 21;18:56. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12912-019-0380-9\u003c/span\u003e\u003cspan address=\"10.1186/s12912-019-0380-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNasser SC, Nassif JG, Saad AH. Physicians' knowledge and attitudes toward pain management: a cross‑sectional study. Pain Res Manag. 2016; 2016:9634943.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAbdul Rahman R, Abu‑Saad Huijer H, Noureddine S. Knowledge and attitudes of Lebanese nurses toward pain management. Pain Manag Nurs. 2013;14(1):42‑48.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFerrell BM. \u0026ldquo;Knowledge and attitudes survey regarding pain\u0026rdquo; developed by Betty Ferrell, RN, PhD, FAAN and Margo McCaffery, RN, MS, FAAN; 2012 [Internet]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://prc.coh.org\u003c/span\u003e\u003cspan address=\"http://prc.coh.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed May 18, 2022.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMcCaffery M, Robinson ES. Your patient is in pain\u0026mdash;here\u0026rsquo;s how you respond. Nursing. 2002;32(10):36‑45.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAlShaer D, AlBekairy A, Alshehri A, et al. Knowledge and attitudes regarding pain management among nurses in a tertiary hospital. J Pain Res. 2020;13:2551‑2558.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eYildirim YK, Cicek F, Uyar M. Knowledge and attitudes of Turkish oncology nurses about cancer pain management. Pain Manag Nurs. 2008;9(1):17‑25.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLui LYY, So WKW, Fong DYT. Knowledge and attitudes regarding pain management among nurses in Hong Kong medical units. J Clin Nurs. 2008;17(15):2014‑2021.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Analgesia, Attitudes, Education, Healthcare Workers, Knowledge, Pain Management, Palliative Care, Patients, Pharmacology, Training","lastPublishedDoi":"10.21203/rs.3.rs-8051757/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8051757/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough pain has been designated as the 5th vital sign to ensure pain assessment and management, many patients continue to experience uncontrolled or inadequate management of pain. A major barrier to effective pain management remains the insufficient knowledge of Healthcare Workers (HCWs), including misconceptions about pain evaluation; beliefs that patients overstate their pain; fears about drug tolerance and addiction; limited understanding of analgesic pharmacology; and difficulty assessing pain in children. This study aims to evaluate the knowledge and attitudes of HCWs regarding pain assessment and management at a tertiary medical centre in Beirut, Lebanon and to identify areas for improvement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional study was conducted over one month at a private tertiary hospital in Lebanon using the validated \u0026ldquo;Knowledge and Attitudes Survey Regarding Pain\u0026rdquo; (KASRP) questionnaire. The survey assessed HCWs\u0026rsquo; knowledge and attitudes toward pain management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 161 HCWs participated in the study (41 physicians, 100 nurses, 20 pharmacists), from different departments within the hospital: Internal Medicine, Pharmacy, Nursing, and Quality Management. The overall mean KASRP score was 13.65 (SD\u0026thinsp;=\u0026thinsp;9.93) for correct responses, indicating a moderate level of knowledge. Only nine participants (5.6%) scored\u0026thinsp;\u0026ge;\u0026thinsp;80%, considered a satisfactory level of knowledge and attitude. Items of the KASPR score were categorized into five domains: assessment, medication, addiction, spiritual considerations and interventions. Variables potentially affecting knowledge and attitude were analyzed: gender, age, profession, prior training on pain management, and years of experience. No statistically significant differences were observed based on gender, prior training, or years of experience (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, age and profession showed significant associations with mean scores of correct answers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting these factors influence HCWs\u0026rsquo; understanding of pain management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study reveals notable gaps in HCWs\u0026rsquo; knowledge and attitudes toward pain management. These findings underscore the need for structured education and training programs to improve understanding and practices related to pain management, ultimately leading to better patient outcomes.\u003c/p\u003e","manuscriptTitle":"Healthcare Worker s (HCWs) Knowledge and Attitudes Related to Pain Management: A Cross-Sectional Study in a Tertiary Hospital in Lebanon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-15 16:41:48","doi":"10.21203/rs.3.rs-8051757/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-11T21:23:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100484237687374263918899762705911998570","date":"2026-03-03T15:18:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30447639819583956720183552562912557809","date":"2026-03-03T08:23:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58726316351577755299537547584073661402","date":"2025-12-17T04:33:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-14T11:11:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149546710179996091599230296195108974259","date":"2025-12-11T16:13:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-10T01:53:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-09T13:34:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T07:06:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-14T18:00:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-11-14T17:57:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"50df996d-222c-4155-a201-875cc237c4c2","owner":[],"postedDate":"December 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:41:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-15 16:41:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8051757","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8051757","identity":"rs-8051757","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}