Pain Management Nursing

Make Mentoring One of Your Professional Career Goals

Joyce S. Willens — 2012-01-12

The process of mentoring can be a mutually satisfying experience. Through mentoring, nurses acquire knowledge and practical skills as well as the assimilation of values, norms, and accepted modes of behavior. Mentor and mentee relationships help to reduce anxiety for beginning nurses during their transition into professional practice.

Experiences of a Web-Based Nursing Intervention—Interviews with Women with Chronic Musculoskeletal Pain

Elma Jelin, Vigdis Granum, Hilde Eide — 2012-03-01

Abstract: Patients with fibromyalgia must simultaneously cope with chronic pain, emotional distress, activity avoidance and disability. The majority of fibromyalgia patients are women. New interventions using information and communications technologies such as Internet applications and smart phones can be used for text-based communications between providers and patients with chronic pain. The aim of this qualitative study was to explore female patients' experiences of participating in a 4-week web-based home intervention after in-house multidimensional rehabilitation. The framework of the intervention was inspired by mindfulness-based cognitive behavioral therapy using daily diaries and situational feedback as tools. Interviews were made with seven women about their general experiences of participation, specific relationship with the therapist, communication, activity, emotions, and coping. The interviews were transcribed and analyzed using systematic text condensation. A main result was that informants experienced this follow-up program as consciousness expanding as well as both motivating and supportive. Another main result was their reported ambivalence in relation to: 1) using web-based technology; 2) experiencing feedback as challenging but positive; and 3) experiencing relationships of trust and detachment with the therapist. Web-based nursing stimulates a “zone for reflection” that may assist in the counseling and support of patients with chronic pain. However, this is a new area of research that needs to be further explored.

Effect of Relaxation Exercises on Controlling Postoperative Pain

Sacide Yildizeli Topcu, Ummu Yildiz Findik — 2010-09-22

Abstract: This study examines the effect of relaxation exercises on controlling postoperative pain in patients who have undergone upper abdominal surgery. This is a cross-sectional and crossover study conducted on 60 patients who underwent upper abdominal surgery between October 2006 and June 2007, in the General Surgery Department, Health and Research Practice Center, Trakya University, Edirne, Turkey. We assessed the patients’ pain levels before and after the relaxation exercises. Patients’ personal information forms were used to collect data, and pain levels were determined using the verbal pain scale. We used the Wilcoxon T test, nonparametric Spearman correlation analysis, and nominal by interval eta analysis to assess the data, percentage, and frequency analyses. Pain levels were found to be reduced after the relaxation exercises compared with the levels before the relaxation exercises (z = −5.497; p < .001). Relaxation exercises, a nonpharmacologic method, are effective in reducing postoperative pain and should therefore be included in a regimen to control postoperative pain in patients who have undergone upper abdominal surgery.

Validation of the COMFORT Behavior Scale and the FLACC Scale for Pain Assessment in Chinese Children after Cardiac Surgery

Jinbing Bai, Lily Hsu, Yan Tang, Monique van Dijk — 2011-02-25

Abstract: Appropriate pain assessment plays a key role in understanding the pain status of critically ill children. However, the utility of the face, legs, activity, cry, consolability (FLACC) scale and the COMFORT Behavior (COMFORT-B) scale have not been extensively explored for children after cardiac surgery in China. A repeated-observation study was conducted to evaluate the concurrent validity and the sensitivity and specificity of the COMFORT-B and FLACC scales for pain assessment after cardiac surgery in 0–7-year-old patients. Patients were assessed with the observational visual analog scale (VASobs), FLACC scale, and COMFORT-B scale simultaneously at 18 fixed time periods for 3 days. Correlations among pain assessments were computed to calculate concurrent validity. Receiver operating characteristic curve analyses identified the FLACC and COMFORT-B scores that could best discriminate pain and no pain based on the VASobs. Multiple regression analyses were performed with FLACC and COMFORT-B pain scores as dependent variables and disease-related treatment characteristics as predictor variables for conducting the analysis. A total of 170 children (98 boys and 72 girls) were included. Significantly positive correlations, ranging from 0.31 to 0.86, were found among the COMFORT-B, FLACC, and VASobs pain assessment instruments. The COMFORT-B and the FLACC scores for children assessed to be in pain (i.e., VASobs ≥4), were significantly higher than scores for children not in pain (VASobs <4). COMFORT-B showed good sensitivity (86%) and specificity (83%) with a cutoff point of 13. FLACC showed excellent sensitivity (98%) and good specificity (88%) for a cutoff point of 2. The COMFORT-B and FLACC scales seem to be useful tools in pain assessment for Chinese children at postcardiac surgery stages, but the study identified that this group of children demonstrated a lower cutoff point for pain than originally set for these two instruments.

The McGill Pain Questionnaire as a Multidimensional Measure in People with Cancer: An Integrative Review

2011-05-23

Abstract: First published in 1975, the McGill Pain Questionnaire (MPQ) is an often-cited pain measure, but there have been no systematic reviews of the MPQ in cancer populations. Our objective was to evaluate the MPQ as a multidimensional measure of pain in people with cancer. A systematic search of research that used the MPQ in adults with cancer and published in English from 1975 to 2009 was conducted. Twenty-one articles retrieved through computerized searches and nine studies from manual searches met the criteria. Review of the 30 studies demonstrated that pain intensity (n = 29 studies) and pain quality (n = 27 studies) were measured more frequently than pain location, pattern, and behavior parameters. Measuring cancer pain using the MPQ provided insights about disease sites, magnitude of pain, and effectiveness of treatment and intervention. Additionally, the MPQ data informed speculations about pain mechanisms, emotional status, overall sensory pain experience, changes in pain over time, and alleviating and aggravating behaviors/factors. Findings supported the MPQ as an effective multidimensional measure with good stability, content, construct, and criterion validity and showed sensitivity to treatment or known-group effects. The MPQ is a valid, reliable, and sensitive multidimensional measure of cancer pain. Cancer pain is a subjective complex experience consisting of multiple dimensions, and measuring cancer pain with the MPQ may help clinicians to more fully understand whether those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.

Spinal Cord Stimulation to Treat Postthoracotomy Neuralgia: Non–Small-Cell Lung Cancer: A Case Report

Kevin L. Wininger, Michelle L. Bester, Kedar K. Deshpande — 2012-03-01

Abstract: Surgery is the mainstay of therapy for resectable-type tumors associated with non–small-cell lung cancer. Today, thoracotomy and video-assisted thoracotomy are surgical options. The prevalence of chronic pain with neuropathic symptoms is relatively high after thoracotomy. Spinal cord stimulation to treat such pain has received limited attention in the literature. The aim of this article is to report on the use of spinal cord stimulation in a single case of neuralgia after thoracotomy with lobectomy to treat non–small-cell lung cancer. At 24 months after implantation of the spinal cord stimulation system, the patient reported >75% pain relief, an overall improvement in quality of life—described as less pain with breathing, and improved functional ability pertaining to arm movements—and improved sleep patterns. This detailed case presentation provides a qualitatively weighted investigation into spinal cord stimulation for postthoracotomy neuralgia against the backdrop of oncologic care. Further investigations relying on quantitative assessment tools are necessary to further explore this form of therapy in this patient population. In the single case reported here, the use of spinal cord stimulation suppressed intractable pain targeted at the T6 and T7 dermatomes of the chest wall in the manifestation of postthoracotomy neuralgia.

The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage

C. Paul van Wilgen, Doeke Keizer — 2010-07-23

Abstract: The interaction of nurses with chronic pain patients is often difficult. One of the reasons is that chronic pain is difficult to explain, because no obvious anatomic defect or tissue damage is present. There is now enough evidence available indicating that chronic pain syndromes such as low back pain, whiplash, and fibromyalgia share the same pathogenesis, namely, sensitization of pain modulating systems in the central nervous system. Sensitization is a neuropathic pain mechanism in which neurophysiologic changes may be as important as behavioral, psychologic, and environmental mechanisms. The sensitization model provides nurses with an opportunity to explain pain as a physical cause related to changes in the nervous system. This explanation may improve the patient's motivation to discuss the importance of psychosocial factors that contribute to the maintenance of chronic pain. In this article, sensitization is described as a model that can be used for the explanation of the existence of chronic pain. The sensitization model is described using a metaphor. The sensitization model is a useful tool for nurses in their communication and education toward patients.

Compact Clinical Guide to Pain Management for Infants and Children: Evidence-Based Guide for Primary Care Practitioners

Renee C.B. Manworren — 2011-01-24

This text fulfills its purpose as described by its distinguished author/editor, Linda Oakes, MSN, RN-BC, CCNS. It is a practical guide to pediatric pain assessment and management for the advanced practice nurse and primary caregivers who are interested in caring for patients with pain, but whose care specialty is not pain management. For the nurses whose specialty is pain management, this text provides a quick pediatric reference of our knowledge and tools of our trade.

CPOT: Is There Any Missing Link?

Stefano Bambi, Massimo Solaro — 2012-03-01

We read with interest the study published in the December 2012 issue of Pain Mnagement Nursing by Paulson-Conger et al. about the comparison between Pain Assessment in Advanced Dementia and the Critical Care Pain Observation Tool (CPOT) in nonverbal critical care patients.

Authors’ Reply:

Melissa Paulson-Conger, Jane S. Leske, Carolyn Maidl — 2012-03-01

We thank Dr. Bambi and M. Solaro for the question about our study. They are concerned about the assessment of pain in a group of patients who are unconscious (GCS ≤8) with endotracheal or tracheostomy tube, but currently breathing spontaneously without a ventilator. All of the subjects in the reported study resided in critical care and were unable to verbalize pain using a traditional method or scale. No patients who were breathing with only adjunct oxygen therapy with an inflated endotracheal cuff were included in this study. We did not advocate the primary use of Critical Care Pain Observation Tool (CPOT). Based on our research findings and stronger reliability, the Pain Assessment in Advanced Dementia (PAINAD) tool should be considered as another option with this critical care patient population. Thank you again for the insightful question.

Editorial Board

2012-03-01

Information for Readers

2012-03-01

Information for Authors

2012-03-01

Pain Management Nursing

Make Mentoring One of Your Professional Career Goals

Experiences of a Web-Based Nursing Intervention—Interviews with Women with Chronic Musculoskeletal Pain

Effect of Relaxation Exercises on Controlling Postoperative Pain

Validation of the COMFORT Behavior Scale and the FLACC Scale for Pain Assessment in Chinese Children after Cardiac Surgery

The McGill Pain Questionnaire as a Multidimensional Measure in People with Cancer: An Integrative Review

Spinal Cord Stimulation to Treat Postthoracotomy Neuralgia: Non–Small-Cell Lung Cancer: A Case Report

The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage

Compact Clinical Guide to Pain Management for Infants and Children: Evidence-Based Guide for Primary Care Practitioners

CPOT: Is There Any Missing Link?

Authors’ Reply:

Editorial Board

Table of Contents

Information for Readers

Information for Authors