| | Use, Perceived Effectiveness, and Gender Differences of Pain Relief Strategies Among the Community-Dwelling Elderly in TaiwanReceived 3 July 2009; received in revised form 28 September 2009; accepted 15 October 2009. published online 02 June 2010.
Corrected Proof Chronic pain is a common and significant health problem among the elderly (Allcock, Elkan & Willliams, 2007; Dunn & Horgas, 2004). Epidemiologic research has shown that the prevalence of chronic pain in the elderly population ranges from 25% to 84% (Blyth et al., 2001, Ferrell, 1995, Gloth, 2000, Tsai et al., 2004, Tsai et al., 2005, Yu et al., 2006). Chronic pain influences people not only in the physiologic domains, but also in the emotional and behavioral domains (Weissman, Gordon, & Bidar-Sielaff, 2004). Falling, sleep disorders, depression, anxiety, memory loss, decreased day-to-day activity and social contact, degeneration of physical functions, and increased health utilization and costs may occur during episodes of chronic pain (Gloth, 2000, Tse et al., 2005, Weiner et al., 2001). Furthermore, an economic analysis of medical conditions that considered both direct and indirect costs suggested that chronic pain imposes a greater economic burden compared with other diseases (Maniadakis & Gray, 2000). Therefore, chronic pain is a significant issue not only for the elderly, but also for society as a whole. Clinical evidence has suggested treatments for chronic pain in the elderly, such as pharmacologic management, rehabilitation therapy (e.g., heat, ice, and hydrotherapy), transcutaneous electrical nerve stimulation, and behavior-cognitive therapy (Auret and Schug, 2005, Horwitz et al., 1998, Gordon, 1999). Good clinical evidence for the effectiveness of opioids and published guidelines directing their usage also are widely acknowledged (Auret & Schug, 2005). However, many of the elderly do not receive adequate pain management, because of the barriers of physical inactivity, economic pressure, high medical costs, and fear of side effects associated with the use of medicine (Francesco et al., 1997, Lansbury, 2000). Relatively few studies have examined the pain-related strategies used by older persons (Barry et al., 2004). Lansbury (2000) interviewed 72 Australian community elderly and found that they preferred self-administered pain relief strategies, such as home remedies, massage, topical agents, and other physical agents and informal cognitive pain relief strategies; the least preferred strategies were conventional treatments with medication, physiotherapy, and exercise. In a quantitative study, Tse et al. (2005) reported that most of the elderly residents in a nursing home in Hong Kong usually adopted over-the-counter medication and massage. In Spain, the most common strategy adopted by the elderly subjects was physician consultation, followed by self-medication (Bassols, Bosch, & Banos, 2002). Barry et al. (2004) interviewed 245 elderly people with chronic pain in New England and indicated that prevalent coping strategies included analgesic medications, cognitive methods, religious activities, and activity restriction. Because limited numbers of pain relief strategies have been investigated in previous studies, the entire spectrum of chronic pain relief strategies used by community elderly remains unclear. From the findings of the above studies, we found and assumed that differences exist in pain relief strategies adopted by the elderly in different countries. Pain relief strategies are influenced by culture. Dowden (2003) indicated that a variety of complementary and alternative medicines (CAMs) are found in culturally diverse populations. This is particularly significant in Chinese populations and different from that in other countries. Shen, Sherwood, McNeill, and Li (2008) indicated that pain relief strategies of the elderly Chinese are influenced by their history of alternative methods, particularly through traditional Chinese medicine. In Taiwan, people have a similar cultural background with the Chinese people. For health professionals, it is important to understand the use and effectiveness of pain relief strategies and then to provide appropriate treatments (Sofaer-Bennett et al., 2007). To our knowledge, little is known about the use, effectiveness, and gender differences of pain relief strategies in the Chinese as well as Taiwanese community. Therefore, in the present study, we investigated the use and perceived effectiveness of pain relief strategies adopted by the elderly; gender differences between frequently used relief strategies were also explored. For getting an entire scope, we classified pain relief strategies used by the elderly into three domains: conventional medicine, CAM, and psychologic approaches. Conventional medicine means “medicine as practiced by holders of an medical doctor (MD) or doctor of osteopathy (DO) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses” (National Center of Complementary and Alternative Medicine [NCCAM], 2009). The domain of conventional medicine includes pharmacologic and nonpharmacologic approaches (Gatlian & Schulmeister, 2007; Menefee & Monti, 2005; NCCAM, 2009). Pharmacologic approaches incorporated prescription drug use, over-the-counter drug use, and topical agents. Nonpharmacologic approaches include cold treatment, heat treatment, transcutaneous electrical stimulation, change of position, and surgery. CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered to be part of conventional medicine (NCCAM, 2009). It includes massage, meditation, acupuncture, herbal medicine, chiropractic, manipulation, point massage, acupressure, cupping therapy, and prayer. Psychologic approaches include distraction, ignoring, acceptance, and keeping busy. Methods  Design This study used a cross-sectional research design. Face-to-face interviews were conducted by trained interviewers. Measures A questionnaire was used to collect data in this study. It consisted of three parts: basic data, pain assessment, and the pain relief strategies questionnaire (PRSQ). Basic Data This category included age, gender, and educational level to evaluate the backgrounds of the subjects. Pain Assessment Firstly, a single item was used to discriminate whether the elderly were suffering from chronic pain. In this study, chronic pain was defined as “the frequency of suffering from pain is at least once a week in the past 3 months, it made the elderly feel unpleasant, and it might accompany existing or potential tissue injury (except cancer pain)” (Blyth et al., 2001, Ferrell, 1995). The nature of the pain, including pain duration (<5 minutes, 5-60minutes, and >60minutes), the average pain intensity, and the worst pain intensity were also assessed. In measuring pain intensity, an 11-point pain intensity numeric rating scale (NRS), where the end points were the extremes of no pain and maximal pain, was used. Pain intensity was divided into three degrees: mild (NRS ≤4), moderate (NRS 5-6), and severe (NRS ≥7) (Rosenblum et al., 2003, Serlin et al., 1995). Pain Relief Strategies Questionnaire A self-report questionnaire was used to collect data in this study. The questionnaire was developed by reviewing literature, conducting personal interviews, and consulting experts. Besides one open-ended question, a 22-item self-report questionnaire was designed to evaluate the strategies adopted by the elderly to relieve their pain. The 22 items were classified into three separate domains: conventional medicine (8 items), CAM (10 items), and psychologic approaches (4 items). Moreover, pharmacologic approaches (3 items), and nonpharmacologic approaches (5 items) were classified within the conventional medicine domain (Auret and Schug, 2005, Horwitz et al., 1998, Gordon, 1999). For each item, participants were required to answer three questions: 1.The number of pain relief strategies used: A yes/no question, “Has this strategy ever been used to relieve your pain?,” was used to collect data. For each item, 1 point was given to each “yes” answer, and 0 points were given for a “no” answer. The total scores indicating the number of pain relief strategies used was within the range of 0 and 22, with high scores indicating the use of more strategies. 2.The frequency of using pain relief strategies: This part required a response ranging from 1 to 3, representing “never,” “ sometimes”(up to twice a week),” and “frequently”(more than twice a week).” 3.Perceived effectiveness of pain relief strategies: At first, a 5-point scale from Barry et al. (2004) was used, where 1=worse, 2=no change, 3=minimally improved, 4=much improved, and 5=very much improved. Because few participants chose “very much improved,” this category was combined with “much improved.” Similarly, very few participants answered “worse,” so we combined this category with “no change.” Thus, a 3-point scale was used to present the findings of the present study: 1=no change; 2=minimally improved; and 3=much improved. To evaluate questionnaire validity and reliability of the PRSQ, five experts in the areas of geriatrics, anesthesia, pain, orthopedics, and community health nursing established the questionnaire's content validity. The content validity index (CVI) was 0.95. Ten older persons completed the face validity test. Regarding reliability, the Cronbach alpha coefficient was 0.81. The coefficient of 2-week-interval test-retest reliability was 0.89. The coefficients indicated good reliability in internal consistency and stability of this scale. Ethical Consideration The study protocol and informed consent form were reviewed and approved by the Research Ethics Committee of Taipei Veterans General Hospital, Taiwan. All subjects included in this study were volunteers and received assurances of confidentiality. Informed consent was obtained from each participant in this study. Data Analysis The statistical analysis was carried out in Statistical Package for the Social Science (SPSS) for Windows 15.0 version (SPSS Institute, Chicago, IL). The statistical methods used included frequency, percentage, mean, and standard deviation (SD) for univariate analysis. Descriptive statistics were used to describe the background of subjects, chronic pain assessment, the frequency of use, perceived effectiveness, and gender differences in pain relief strategies. Results Backgrounds of Subjects Among the 219 elderly subjects, 92 subjects (56 women and 36 men) reported chronic pain. The prevalence of chronic pain in the community-dwelling elderly in Taiwan was 42.0%. The average age of these 92 elderly people was 74.16 years (SD 6.10, range 65-91). Fifty-two subjects (56.5%) had an educational level of elementary school or less. Among the 92 subjects, the average pain intensity ranged from mild (68.5%) to moderate (27.2%), and only 4.3% of the subjects rated their pain as severe. However, 40.2% of the subjects described the worst pain they had experienced as severe pain (NRS ≥7). Of all the subjects, 55 (59.8%) complained of pain that persisted for between 5 and 60minutes, and 16 (17.4%) had pain duration of >60minutes (Table 1). | ∗ On a 0-10 numerical rating scale. |
Use of Pain Relief Strategies As shown in Table 2, among the three domains, the elderly used conventional medicine more frequently than CAM and psychologic approaches. Regarding the frequency of pain relief strategies used in the conventional medicine domain, the three most frequently used strategies were change of position (72.8%), prescription drug use (47.8%), and topical agents (46.7%). In the CAM domain, massage (57.6%) was the most frequently used, followed by prayer (15.2%) and herbal medicine (14.1%). However, other strategies appeared to be used less frequently. In the psychologic approaches domain, the two most frequently used strategies were acceptance (46.7%) and ignoring (41.3%). On average, the number of strategies that 92 community-dwelling elderly with chronic pain had ever used was 9.08 (SD 3.56, range 2-18). The findings revealed that the subjects tended to use various and multiple pain relief strategies (including conventional medicine, CAM, and psychologic approaches) to relieve their pain. | | |  | Pain Relief Strategy | | |
|---|
| n | % | |
|---|
| Conventional medicine | | | Pharmacologic approaches | | | Prescription drug use | 44 | 47.8 | | | Over-the-counter drug use | 12 | 13.0 | | | Topical agents | 43 | 46.7 | | | Nonpharmacologic approaches | | | Cold treatment | 1 | 1.1 | | | Heat treatment | 29 | 31.5 | | | Transcutaneous electrical stimulation | 2 | 2.2 | | | Change of position | 67 | 72.8 | | | Surgery | 1 | 1.1 | | | Complementary and alternative medicine | | | Massage | 53 | 57.6 | | | Meditation | 3 | 3.3 | | | Acupuncture | 3 | 3.3 | | | Herbal medicine | 13 | 14.1 | | | Chiropractic | 8 | 8.7 | | | Manipulation | 4 | 4.3 | | | Point massage | 4 | 4.3 | | | Acupressure | 1 | 1.1 | | | Cupping therapy | 5 | 5.4 | | | Prayer | 14 | 15.2 | | | Psychologic approaches | | | Distraction | 13 | 14.1 | | | Ignoring | 38 | 41.3 | | | Acceptance | 43 | 46.7 | | | Keeping busy | 16 | 17.4 | | | | |
Perceived Effectiveness of Pain Relief Strategies As shown in Table 3, overall there are no obvious improvements in all pain relief strategies. No strategy was reported as “much improved” by the majority of users; however, over one-third of the ever user reported five strategies (including topical agents, heat treatment, change of position, massage, and acupressure) as “much improved.” Eight pain relief strategies (including over-the-counter drug use, transcutaneous electrical stimulation, surgery, chiropractic, point massage, prayer, distraction, and keeping busy) were presented as “minimally improved” by the majority of users. Over one-half of the ever users said that three strategies (cold treatment, acupuncture, and acceptance) resulted in no change in the perceived effectiveness measure. | ∗ “No change” includes the few answers of “worse.” †“Much improved” includes the few answers of “very much improved.” |
Gender differences in pain relief strategies According to the data in Table 4 and Figure 1, the top five pain relief strategies used by male and female subjects were the same. They were change of position, massage, prescription drug use, ignoring, and acceptance. Among the top five strategies, change of position was the most frequently used strategy of men (66.7%) and women (76.8%). More than half of male and female elderly subjects had used massage to relieve their chronic pain (58.3% and 55.4%, respectively). Women adopted more psychologic approaches compared with men to relieve pain. For example, 57.1% of women used acceptance as a pain relief strategy, and 44.6% of women ignored chronic pain, whereas only 30.6% and 36.1% of men, respectively, had ever used the strategies of acceptance and ignoring (Fig. 1). Discussion The Use and Perceived Effectiveness of Pain Relief Strategies In the present study, the elderly, on average, undertook multiple pain relief strategies (mean±SD=9.08±3.56, range 2-18) to relieve their pain. Unfortunately, most of the strategies brought no obvious improvement; no strategy was reported as “much improved” by a majority of users. The findings imply that the elderly continue to experience unrelieved pain. This viewpoint is supported by Adama et al., 2006, Allcock et al., 2007, and Williams (2004). Pain is indeed poorly managed by the elderly (Decker et al., 2009, Williams and Manias, 2008). However, the sensitivity of the measurement tools used in the present study may be a limitation. In this community-based study, a 5-point scale was used to measure the improvement of pain relief strategies. This scale had been previously used by Barry et al. (2004). Recently, a work published in the field of analgesia suggested that a successful intervention should involve more reliable clinically based data for measuring the improvement of pain. For example, Farrar, Young, LaMoreaux, Werth, and Poole (2001) examined data from ten clinical trials that involved 2,727 patients with chronic pain, and defined a clinically important change in pain as “much improved” or “very much improved” using an NRS. Farrar et al. (2001) suggested that 2 points or a reduction of approximately 30% in the pain intensity NRS represented a clinically important difference. Salaffi, Stancati, Slivestri, Ciapetti, and Grassi (2004) suggested that decreases of >2.0 points or >33% on an NRS best differentiated patients who described their pain as “much better” from those who described the change as only “slight better” or “worse.” Therefore, we suggest that all of these proposed benchmarks must be confirmed in future studies that directly assess personal evaluations of what is a noticeable, important, and major improvement. In the present study, we found that the elderly used conventional medicine more frequently than CAM and psychologic approaches. The possible reasons included: 1) The empiric evidence of conventional medicine has been supported scientifically (Clark, 2000), whereas most CAMs and psychologic approaches are yet to be evaluated by well designed scientific studies (Adama et al., 2006, Gatlin and Schulmeister, 2007, NCCAM, 2009); and 2) in Taiwan, conventional medicine is less costly than CAM because National Health Insurance pays most of the expenses of conventional medicine. National Health Insurance is compulsory and covers 99.0% of all inhabitants in Taiwan (Bureau of National Health Insurance, 2008). In the domain of conventional medicine, the most frequently used strategies were change of position (72.8%), prescription drug use (47.8%), and topical agents (46.7%). This finding is similar to those of Shen et al. (2008) and Barry et al. (2004), but different from those of Lansbury (2000) in Australia. Shen et al. (2008) indicated that the most common way for Chinese people to manage their pain is by changing positions; Barry et al. (2004) indicated that analgesic medications were the prevalent coping strategies in New England. In contrast, in Australia, the least preferred strategies used by community elderly were conventional treatments with medication, physiotherapy, and exercise (Lansbury, 2000). Thus, the assumption that pain relief strategies vary among countries and cultures is supported in the present study. The reason change of position had the most frequent use by the elderly in the present study is likely explained by a physiologic mechanism. Repositioning can help maintain body alignment and can prevent and alleviate pain (Gatlin & Schulmeister, 2007). Other possible reasons may be related to convenience, noninvasiveness, low risk, free cost, and ease of use at home. It is not surprising that prescription drug use and topical agents were used frequently by most of the subjects in this study, because pharmacologic use has clear physiologic mechanisms. Pharmacologic use of prescription drugs and topical agents has been approved on the basis of efficacy in different pain syndromes (Clark, 2000). However, the present study found low effectiveness of prescription drug use and topical agents. Reasonable explanations for low efficacy include: 1) changes in geriatric pharmacodynamics: for example, the elderly have decreased drug absorbability and metabolism (Nikolaus & Zeyfang, 2004); 2) underprescription: owing to fear of older people's comorbidity, multiple medication use, and inadequate drug excretion, physicians may be compelled to prescribe inadequate medication to treat a particular condition (Williams & Manias, 2008); if the elderly take insufficient medication, improvement in pain would not be expected; and 3) low compliance with medication: poor knowledge and passive attitudes may decrease compliance with medication thus reducing drug efficacy. Therefore, we recommend that future studies should need to investigate older people's perceived barriers to various pain relief strategies. How to maximize the effect of drug use but minimize adverse drug reactions between drug safety and effectiveness are important issues, especially for the elderly (Francesco et al., 1997, Nikolaus and Zeyfang, 2004). In the CAM domain, we found that some of the elderly adopted CAMs to manage their pain. The possible reason is that Chinese people believe that CAMs, such as massage, herbal medicine, and meditation, are natural, healthy, more controlled, and have few side effects (Chao, Christine, Fredi, Debra, & Kalmuss, 2006). Matteliano (2003) believed that CAM allows people to actively participate in their pain control. For low-use CAMs, cost may play a critical role. For example, chiropractic manipulation, point massage, and acupressure are not covered by the National Health Insurance and therefore present lower use rates; conversely, Chinese herbal medicine is covered by the NHI and presents a higher rate of use compared with other CAMs. In the domain of psychologic approaches, over one-half of the elders frequently used ignoring and acceptance to relieve their pain, albeit with very poor improvement. This finding may imply that misconception of pain and passive attitude may be problems for some elderly. For instance, the elderly who view pain as the natural consequence of aging may therefore tolerate it (Briggs, 2006, Francesco et al., 1997, Gibson et al., 1994). Moreover, some elderly may hold the acceptance of pain to be a traditional virtue; such passive attitudes and the misconception of pain prevent them from complaining when they are in pain and result in poor outcomes (Sherwood, McNeill, Hernandez, & Penarrieta, 2005). Based on our findings, we remind nurses to help the elderly to alleviate their pain by providing sufficient knowledge, establishing correct and more active attitude, and developing more effective and culture-sensitive strategies. Gender Differences in Pain Relief Strategies In this study, the top five pain relief strategies used by both genders were the same. However, we found that older women tended to adopt more psychologic approaches to pain relief compared with older men. This finding is consistent with those of Barry et al. (2004) and Grossi, Soares, & Lundberg (2000). Limited resources and low socioeconomic status of the older women may explain this difference (Salway, 2007, World Health Organization, 2009). In applying the findings to clinical practice, it is important for nurses to realize that there may be some gender differences among the elderly in preferred strategies for pain relief. Based on this finding, future studies can examine the actual reasons for gender differences. Limitations Our study has some limitations. 1) Although we used a random sampling method to recruit subjects, the sample size is limited. Further studies should be conducted with a larger sample size. 2) Of the participants in this study, 60.9% were female, although the findings about gender differences in pain relief strategy were consistent with studies by Barry et al. (2004) and Grossi et al. (2000). However, women may have a lower pain threshold (Keogh & Birkby, 1999); women also tend to more easily address their pain compared with men (Kaur, Stechuchak, Coffman, Allen, & Bastian, 2007). Future studies should select more equal gendergroups. 3) Many of the community elderly have more than two types of chronic pain. In this study, we were unable to categorize the various types of pain, such as neuropathic, musculoskeletal, etc. 4) In this study, a 5-point scale was used to measure the improvement of pain following relief strategies. Future studies may use a more reliable measurement tool such as the pain intensity NRS and appropriate proposed benchmarks. Conclusions Based on the findings of this study, we confirm that chronic pain is a common problem among the community elderly (prevalence 42.0%). The elderly tend to adopt multiple strategies (mean±SD=9.08±3.56, range 2-18) to relieve their chronic pain. In three domains of pain relief strategies, conventional medicine was used more frequently compared with CAM and psychologic approaches. The findings indicated that most pain relief strategies used by the elderly have limited effectiveness and that no strategy was reported as “much improved” by a majority of users. The study of pain relief strategy requires further attention. Although the top five pain relief strategies used by men and women were the same, gender comparison indicated that women tended to adopt more psychologic approaches compared with men. Nursing professionals should provide comprehensive (including knowledge, attitude, and behavior scopes) and broad health education program for the elderly, enabling them to effectively relieve their pain. More diverse, effective, gender-specific, and culturally sensitive pain relief strategies also need to be developed in future. References Adama et al., 2006. 1.Adama N, Poole H, Richardson C. Psychological approaches to chronic pain management: Part 1. Journal of clinical nursing. 2006;15:290–300. MEDLINE |
CrossRef
Allcock et al., 2007. 2.Allcock N, Elkan R, Williams J. Patients referred to a pain management clinic: Beliefs, expectations and priorities. Journal of Advanced Nursing. 2007;60(3):248–256.
CrossRef
Auret and Schug, 2005. 3.Auret K, Schug S. Underutilization of opioids in elderly patients with chronic pain: Approaches to correcting the problem. Drugs & Aging. 2005;22:641–654.
CrossRef
Barry et al., 2004. 4.Barry L, Kerns R, Guo Z, Duong B, Iannone L, Carrington M. Identification of strategies used to cope with chronic pain in older persons receiving primary care from a Veterans Affairs Medical Center. Journal of American Geriatric Society. 2004;52:950–956. Bassols et al., 2002. 5.Bassols A, Bosch F, Banos J. How does the general population treat their pain? A survey in Catalonia, Spain. Journal of Pain and Symptom Management. 2002;23:318–328. Abstract | Full Text |
Full-Text PDF (168 KB)
|
CrossRef
Blyth et al., 2001. 6.Blyth F, March L, Brnabic A, Jorm L, Williamson M, Cousins M. Chronic pain in Australia: A prevalence study. Pain. 2001;89:127–134. Abstract | Full Text |
Full-Text PDF (352 KB)
|
CrossRef
Briggs, 2006. 7.Briggs, E. (2006). Commentary on Tse MMY, Pun SPY & Benzie IFF (2005). Pain relief strategies used by older people with chronic pain: An exploratory survey for planning patient-centred intervention. Journal of Clinical Nursing 14, 315–320. Journal of Clinical Nursing, 15, 119–120. Bureau of National Health Insurance (2008),. 8.Bureau of National Health Insurance (2008). National Health Insurance in Taiwan—Profile 2008. Retrieved May 12, 2009, from: http://www.nhi.gov.tw/english/webdata.asp?menu=11&menu_id=290&webdata_id=1884. Chao et al., 2006. 9.Chao M, Christine W, Fredi K, Debra K, Kalmuss F. Women's reasons for complementary and alternative medicine use: Racial/ethnic differences. Journal of Alternative & Complementary Medicine. 2006;12:719–720. Clark, 2000. 10.Clark M. Pharmacological treatments for chronic nonmalignant pain. International Review of Psychiatry. 2000;12(2):148–156.
CrossRef
Decker et al., 2009. 11.Decker SA, Culp KR, Caccbione PZ. Evaluation of musculoskeletal pain management practice in rural nursing homes compared with evidence-based criteria. Pain Management Nursing. 2009;10(2):58–64. Abstract | Full Text |
Full-Text PDF (233 KB)
|
CrossRef
Dowden, 2003. 12.Dowden C. Complementary medicine: Where is the evidence?. The Journal of Family Practice. 2003;52:630–634. MEDLINE Dunn and Horgas, 2004. 13.Dunn K, Horgas A. Religious and nonreligious coping in older adults experiencing chronic pain. Pain Management Nursing. 2004;5:9–28. Abstract | Full Text |
Full-Text PDF (214 KB)
|
CrossRef
Farrar et al., 2001. 14.Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in clinical pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158. Abstract | Full Text |
Full-Text PDF (264 KB)
|
CrossRef
Ferrell, 1995. 15.Ferrell B. Pain evaluation and management in the nursing home. Annual International Medicine. 1995;123:681–687. Francesco et al., 1997. 16.Francesco L, Graziano O, Matteo C, Giovanni G, Knight S, Andrea R, et al. Chronic pain in elderly people. Pain. 1997;70:3–14. Abstract | Full Text |
Full-Text PDF (354 KB)
|
CrossRef
Gatlin and Schulmeister, 2007. 17.Gatlin CG, Schulmeister L. When medication is not enough: Nonpharmacologic management of pain. Clinical Journal of Oncology Nursing. 2007;11(5):699–704. Gibson et al., 1994. 18.Gibson S, Katz B, Corran T, Farrell M, Helme R. Pain in older people. Disability Rehabilitate. 1994;16:127–139. Gloth, 2000. 19.Gloth F. Geriatric pain: Factors that limit pain relief and increase complication. Geriatrics. 2000;55:46–52. Gordon, 1999. 20.Gordon D. Pain management in the elderly. Journal of Perianesthesia Nursing. 1999;14:367–372. Abstract |
CrossRef
Grossi et al., 2000. 21.Grossi G, Soares J, Lundberg U. Gender differences in coping with musculoskeletal pain. International Journal of Behavioral Medicine. 2000;7(4):305–321.
CrossRef
Horwitz et al., 1998. 22.Horwitz A, Hosek R, Boyle J, Cianciulli A, Glass J, Codario R. A new gatekeeper for back pain. The American Journal of Managed Care. 1998;4:576–579. MEDLINE Kaur et al., 2007. 23.Kaur S, Stechuchak KM, Coffman CJ, Allen KD, Bastian LA. Gender differences in health care utilization among veterans with chronic pain. Journal of General Internal Medicine. 2007;22(2):228–233.
CrossRef
Keogh and Birkby, 1999. 24.Keogh E, Birkby J. The effect of anxiety sensitivity and gender on the experience of pain. Cognition & Emotion. 1999;13(6):813–829. Lansbury, 2000. 25.Lansbury G. Chronic pain management: A qualitative study of elderly person's preferred coping strategies and barriers to management. Journal of Disability and Rehabilitation. 2000;22:2–14. Maniadakis and Gray, 2000. 26.Maniadakis N, Gray A. Health economics and orthopaedics. Journal of Bone & Joint Surgery. 2000;82:2–8. Matteliano, 2003. 27.Matteliano D. Holistic nursing management of pain and suffering: A historical view with contemporary application. Holistic Nursing Management of Pain and Suffering. 2003;34:4–8. Menefee and Monti, 2005. 28.Menefee L, Monti D. Nonpharmacologic and complementary approaches to cancer pain management. Journal of the American Osteopathic Association. 2005;105(11):S15–S20. MEDLINE National Center of Complementary and Alternative Medicine (2009, June 25),. 29.National Center of Complementary and Alternative Medicine (2009, June 25). What is complementary and alternative medicine? Retrieved August 5, 2009, from http://nccam.nih.gov/health/whatiscam/overview.htm. Nikolaus and Zeyfang, 2004. 30.Nikolaus T, Zeyfang A. Pharmacological treatments for persistent nonmalignant pain in older persons. Drugs & Aging. 2004;21:19–41.
CrossRef
Polit and Hungler, 2004. 31.Polit DF, Hungler BP. Self-report. In: Polit DF, Hungler BP editor. Nursing research—principles and methods. 7th ed. Philadephia: Lippincott Williams & Wilkins; 2004;p. 331–362. Rosenblum et al., 2003. 32.Rosenblum A, Joseph H, Fong C, Kipnis S, Cleeland C, Portenoy RK. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. Journal of American Medicine Association. 2003;289(18):2370–2378. Salaffi et al., 2004. 33.Salaffi F, Stancati A, Slivestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain. 2004;8(4):283–291. Abstract | Full Text |
Full-Text PDF (228 KB)
|
CrossRef
Salway, 2007. 34.Salway SM. Economic activity among UK Bangladeshi and Pakistani women in the 1990s: Evidence for continuity or change in the family resources survey. Journal of Ethnic & Migration Studies. 2007;33(5):825–847. Serlin et al., 1995. 35.Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61:277–284. Abstract |
Full-Text PDF (735 KB)
|
CrossRef
Shen et al., 2008. 36.Shen Q, Sherwood GD, McNeill JA, Li Z. Postoperative pain management outcome in Chinese inpatients. Western Journal of Nursing Research. 2008;30:975–990.
CrossRef
Sherwood et al., 2005. 37.Sherwood GD, McNeill JA, Hernandez L, Penarrieta I. A multinational study of pain management among Hispanics: An evidence-based approach. Journal of Research in Nursing. 2005;10:403–423. Sofaer-Bennett et al., 2007. 38.Sofaer-Bennett B, Holloway I, Moore A, Lamberty J, Thorp T, O'Dwyer J. Perseverance by older people in their management of chronic pain: A qualitative study. Pain Medicine. 2007;8(3):271–280. MEDLINE |
CrossRef
Tsai et al., 2004. 39.Tsai Y, Tsai H, Lai Y, Chu T. Pain prevalence, experiences and management strategies among the elderly in Taiwanese nursing homes. Journal of Pain and Symptom Management. 2004;28:579–584. Abstract | Full Text |
Full-Text PDF (87 KB)
|
CrossRef
Tsai et al., 2005. 40.Tsai Y, Wei S, Lin Y, Chien C. Depression symptoms, pain experiences, and pain management strategies among residents of Taiwan public elderly care homes. Journal of Pain and Symptom Management. 2005;30:63–69. Abstract | Full Text |
Full-Text PDF (95 KB)
|
CrossRef
Tse et al., 2005. 41.Tse M, Pun S, Benzie I. Pain relief strategies used by older people with chronic pain: An exploratory survey for planning patient-centered intervention. Journal of Clinical Nursing. 2005;14:315–320. MEDLINE |
CrossRef
Weiner et al., 2001. 42.Weiner D, Rudy T, Gaur S. Are all older adults with persistent pain created equal? Preliminary evidence for a multiaxial taxonomy. Pain Research & Management. 2001;6:133–141. MEDLINE Weissman et al., 2004. 43.Weissman D, Gordon D, Bidar-Sielaff S. Cultural aspects of pain management. Journal of Palliative Medicine. 2004;7:715–716. MEDLINE World Health Organization, 2009. 44.World Health Organization (2009). Gender or women's health: Why should WHO work on this? Retrieved August 31, 2009, from http://www.who.int/gender/about/gender_or_womens_health/en/index.html. Williams, 2004. 45.Williams A. Patients with comorbidities: Perceptions of acute care services. Journal of Advanced Nursing. 2004;46:13–22. MEDLINE |
CrossRef
Williams and Manias, 2008. 46.Williams A, Manias E. A structured literature review of pain assessment and management of patients with chronic kidney disease. Journal of Clinical Nursing. 2008;17:69–81. Yu et al., 2006. 47.Yu HY, Tan FI, Kuo BIT, Yu S. Prevalence, interference and risk factors for chronic pain among Taiwanese community older people. Pain Management Nursing. 2006;26(2):2–11. ∗ School of Nursing, National Yang-Ming University, Taipei, Taiwan † Department of Nursing, Jen-Teh Junior College of Medicine, Nursing, and Management, Miaoli County, Taiwan ‡ Department of Nursing, Hungkuang University, Taichung, Taiwan § Taipei Veterans General Hospital, Taipei, Taiwan  Address correspondence to Professor Shu Yu, School of Nursing, National Yang-Ming University, 155, Li-Nong St., Sec. 2, Taipei 112, Taiwan.
PII: S1524-9042(09)00122-2 doi:10.1016/j.pmn.2009.10.002 © 2009 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. | |
|
FULL TEXT
