Pain Management Nursing - Articles in Press

An Ethnography of Chronic Pain in Veteran Enlisted Women - Corrected Proof

Linda Denke, Donelle M. Barnes — 2012-01-18

Abstract: Enlisted women are an essential subpopulation within the United States (U.S.) Armed Services, yet little is known about their chronic pain experiences. The purpose of this study was to describe veteran enlisted women's chronic pain experiences, both while on active duty and since active duty ended. A total of 15 enlisted women were interviewed. This ethnographic approach produced stories of their beliefs, attitudes, and behaviors regarding their chronic pain and the care they have received both while serving and after discharge or retirement. The findings show that U.S. military culture and training have a major impact on enlisted women's chronic pain experiences. Enlisted women learn to ignore or deny acute pain because it would hamper their ability to complete their military mission. Even when they admit to themselves that they are in pain, they may mask the pain from others for fear of being called weak or fear of discrimination and ostracism. When the pain can no longer be ignored and they seek health care, they are frustrated when their pain reports are not believed by supervisors and health care providers. Chronic pain eventually leads to discharge or retirement when they can no longer do their job. Health care providers must understand both U.S. military culture and enlisted women's strategies concerning pain if they are to accurately diagnose and sufficiently treat enlisted women in pain.

Bridging the Gap Between Mind and Body: A Biobehavioral Model of the Effects of Guided Imagery on Pain, Pain Disability, and Depression - Corrected Proof

Wendy Lewandowski, Ann Jacobson — 2012-01-16

Abstract: Chronic noncancer pain (CNCP) is a common and complex disorder associated with declines in physical health and functional status, emotional well-being, and quality of life. To best address the complexity of this condition, research and clinical practice for CNCP should be guided by a framework incorporating both biologic and psychologic factors. This article presents a biobehavioral model of chronic pain that hypothesizes mechanisms related to the effectiveness of a complementary therapy, guided imagery (GI), for this population. Using the research-to-model/theory strategy, we mapped findings from published reports of interdisciplinary research into physiologic and psychologic aspects of the nature and mechanisms of pain, as well as the use of GI for pain, to build the model of GI's effects on pain, pain disability, and depression. In the model, these outcomes of GI for persons experiencing CNCP are mediated by psychologic (pain self-efficacy and pain beliefs) and physiologic (immune-mediated analgesia and sickness response) variables. A biobehavioral approach to nursing phenomena will advance understanding of health and health-related issues and has the potential to improve outcomes through delineation of mechanisms underlying relationships between psychologic and biologic factors. Increased consumer use of complementary therapies to treat pain, the current cost-driven health care system, and the mandate for evidence-based practice support the need to validate the efficacy of such therapies. This empirically derived model provides a framework for practice and research for nurses and other health care providers to promote health, function, and well-being in persons with CNCP.

Make Mentoring One of Your Professional Career Goals - Corrected Proof

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.

The Use of Oral Sucrose for Procedural Pain Relief in Infants Up to Six Months of Age: A Randomized Controlled Trial - Corrected Proof

Sally Wilson, Alexandra P. Bremner, Judy Mathews, Diane Pearson — 2012-01-09

Abstract: The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into >4-12 weeks and >12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the >4–12-week age group, and 21 and 22, respectively, in the >12–26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged >4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged >4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures.

A Comparison Between Behavioral and Verbal Report Pain Assessment Tools for Use with Residents in Long Term Care - Corrected Proof

2012-01-09

Abstract: The purpose of this study was twofold: 1) to evaluate four pain assessment tools for use with long-term care (LTC) residents who were both able and not able to verbally report their pain; and 2) to assess whether pain behaviors displayed by LTC residents vary as a function of ability to self-report pain. We examined the differences between these two groups of residents in terms of specific pain behaviors assessed through the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in the Communicatively Impaired (PACI). We also examined the interrater reliability, and concurrent and construct validity of these two behavioral observation tools and the concurrent and construct validity of the two verbal report tools. Data were collected from a convenience sample of 338 residents from six LTC homes. The interrater reliabilities for the two behavioral observation tools were good, and concurrent validity was supported for all four pain assessment tools. Pain behaviors, as assessed by the PACSLAC and PACI, varied as a function of resident ability to verbally report pain. Residents with inability to self-report pain are more nonverbally responsive, although certain behaviors (such as guarding and touching the affected area) are seen more frequently in those capable of self-report. Our data also provide psychometric support for the assessment methods used in this study.

Concerns About Pain and Prescribed Opioids in Taiwanese Oncology Outpatients - Corrected Proof

2012-01-03

Abstract: Pharmacologic agents are considered to be a cornerstone of cancer pain management. Patients' concerns about use of analgesics are likely to lead to poor pain management. The purpose of this study was to describe participants' responses to their beliefs regarding pain and prescribed opioids. Ninety-two outpatients age ≥18 years who had taken prescribed opioid analgesics for cancer-related pain in two teaching hospitals in the Taipei area completed the Pain Opioid Analgesics Beliefs Scale–Cancer. An important finding of this study is that large numbers of patients had misconceptions about using opioids for pain. Between 33.7% and 68.5% of the patients in this study held negative beliefs about opioids and beliefs about pain. Specifically, 68.5% of the patients agreed that “opioid medication is not good for a person's body.” Many patients (62%) agreed that “the more opioid medicine a patient used, the greater the possibility that he/she might rely on the medicine forever,” and 61.0% agreed that “if a patient starts to use opioid medicine at too early a stage, the medicine will have less of an effect later.” Two-thirds (66.3%) of the sample agreed that adult patients should not use opioid medicine frequently. The findings provide empirical support for the need for better programmatic efforts to improve beliefs of pain and analgesics in Taiwanese oncology outpatients.

Qualitative Evaluation of a Pain Intensity Screen for Children with Severe Neurodevelopmental Disabilities - Corrected Proof

Joan Parker, John L. Belew — 2012-01-03

Abstract: The population of individuals with severe and profound intellectual disabilities (ID) is extremely heterogeneous, and the unique pain-related behaviors of each individual might not be satisfactorily captured using a standardized checklist such as the Noncommunicating Children's Pain Checklist or the Revised Faces, Legs, Arms, Cry, and Consolability tools. There has been increasing appreciation of the importance of recognizing the idiosyncratic pain behaviors of these individuals. The investigators developed a tool, the Tailored Observational Pain Screen (TOPS), to facilitate recognition of pain in the individual who lacks verbal communication, based on caregivers' descriptions of the individual's unique pain-related behaviors. The aim of this study was to elicit caregivers' evaluations of this personalized pain screen, using qualitative analysis of semi-structured interviews. The participants were the primary caregivers of 13 children with severe or profound ID and ongoing pain issues who were interviewed after they had used the TOPS for 6 weeks. The investigators identified themes from the interviews, including: using the TOPS to recognize and evaluate pain; using the TOPS to facilitate communication; limitations of the TOPS; and recommendations for its improvement. For clinical purposes, the TOPS shows promise as a tool for helping caregivers to share with others the ways that pain of these children can be detected.

Fibromyalgia Syndrome: Is It Related to Vitamin D Deficiency in Premenopausal Female Patients? - Corrected Proof

2011-12-22

Abstract: There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = −0.653; p = .001) and FIQ-ADL scores in the FM group (r = −0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

A Biopsychosocial-Spiritual Model of Chronic Pain in Adults with Sickle Cell Disease - Corrected Proof

2011-12-15

Abstract: Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, that dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A biopsychosocial-spiritual model is proposed for adults with chronic pain from SCD, because it embraces the whole person. This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel’s model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research.

Nurses' Views About the Barriers and Facilitators to Effective Management of Pediatric Pain - Corrected Proof

Alison Twycross — 2011-12-15

Abstract: Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. Participants identified a number of barriers which related to the staff, children and parents and the organization. Nurses indicated that they and the medical staff lacked knowledge about pain management. They also felt that staff shortages and a heavy workload detracted from the quality of the care they could provide. Several participants indicated that insufficient analgesic drugs were sometimes prescribed. Many of the barriers identified related to parents and children. It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and child’s responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their child’s pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.

Managing Pain with Algorithms: An Opportunity for Improvement? Or: The Development and Utilization of Algorithms to Manage Acute Pain - Corrected Proof

2011-12-06

Abstract: Pain management in a hospital setting remains a challenge today. Many health care providers remain anxious and uninformed regarding analgesic titration within a hospital setting. Overcoming the potential risks to obtain the benefits of opiate titration is a challenge within any health care setting. Virginia Commonwealth University, a tertiary medical center which houses schools of medicine, nursing, and pharmacy, evaluated the use of algorithms for managing acute pain. This article describes the Pain Committee's efforts and offers one potential intervention for safe analgesic opioid titration, an algorithm for acute pain management.

Administering Ziconotide and Monitoring Patients Treated with Ziconotide: Expert Opinions - Corrected Proof

2011-11-30

Abstract: Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide.

Self-Treatment of Pain Among Adolescents in an Urban Community - Corrected Proof

Judith M. Fouladbakhsh, April H. Vallerand, Elisabeth S. Jenuwine — 2011-11-24

Abstract: Pain occurrence among adolescents, whether acute or chronic, persistent or intermittent, remains high, with potentially serious effects on quality of life, physical and emotional functioning, and psychosocial adjustment. The prevalence of pain in adolescents varies widely, and although discussed in the literature for more than two decades, data on adolescent knowledge and pain self-treatment is scarce. This descriptive-correlational study identified pain prevalence and intensity and pain self-treatment choices among adolescents in a diverse urban community. Almost 90% (n = 253) of high school students reported pain in the preceding 2 weeks and completed a series of study questionnaires (demographic data form, Brief Pain Inventory–Short Form, Adolescent Self-Treatment Survey). Respondents ranged in age from 14 to 19 years (mean 16) and were predominantly female (70%) and caucasian (75%). The sample was representative of all high school grades, and the majority (86%) reported participation in sports, dance, and physical activities. Mean pain scores ranged from 3.0 (current pain) to 6.5 (worst pain), with significantly higher scores among girls. A gender-related effect was also noted for pain interference in activities, mood, and sleep among the adolescent girls compared with the boys. Gender also predicted use of self-treatment methods, with girls more likely to use over-the-counter medications and nonpharmacologic therapies. Number of pain sites was also a strong predictor of use of self-treatment methods among adolescents. Knowledge of the pain experience during adolescence will help guide community-based nursing initiatives aimed at increasing awareness, promoting knowledge about pain and its treatment, and ensuring safety and positive outcomes related to self-treatment.

Music Provided Through a Portable Media Player (iPod) Blunts Pain During Physical Therapy - Corrected Proof

2011-11-17

Abstract: This research studied, 25 adult patients who underwent physical therapy to assess the analgesic effect of distraction with the use of music during physical therapy. Patients randomly underwent physical therapy once with music provided by an iPod and once without music. In both sessions patients underwent identical physical procedures. At end of both sessions patients filled in 5-item questionnaire where they scored pain and other parameters, such as stress, enjoyment, interaction, and satisfaction, on 10-cm visual analog scale. The mean scores (range, 0-10) of the two sessions were statistically compared. Mean pain scores were significantly lower (p = .031) during the session in which patients received music (4.8 ± 2.5) than during the session without music (5.8 ± 2.3). The other items of the questionnaire did not disclose any statistically significant difference when the sessions with versus without music were compared. Enjoyment (8.5 ± 1.6), interaction (8.3 ± 1.9), and satisfaction (8.6 ± 1.7) scores with music did not significantly differ in the sessions without music (8.5 ± 2.1, 8.5 ± 1.9, and, 8.5 ± 1.5, respectively); mean stress score was, 3.9 in both sessions. The conclusion of the study is that music provided through a portable media player has an analgesic effect. This can be an effective analgesic strategy during painful physical therapy.

Training the Trainer: An Educational Course for Training Pain Nursing Specialists Supported by the International Association for the Study of Pain (IASP) - Corrected Proof

Jing Cui, Lingjun Zhou, Lingjuan Zhang, Li Li, Jijun Zhao — 2011-11-17

Abstract: To train pain nursing specialists through a pain education program, 20 nurses from six hospitals in Shanghai Province and seven in six provinces of China received the training of 2-month pain education and 4-month clinical practice. This nonrandomized pilot study examined the results of tests before and after the program, case report evaluations, future plan evaluations, clinical practice, and satisfaction questionnaire. After the program, the score of the test increased significantly compared with that before the program (44.1 ± 3.19; paired-sample t = 10.363; p < .0001). All of the participants thought that the program had broadened their vision, 19 (95%) thought that the program had raised the level of their theoretical knowledge in pain management, 17 (85%) thought that the program had improved their skills in clinical practice, and 15 (75%) thought that the program had played a role in enhancing their research abilities. Considering the whole program, most students (n = 17; 85%) were quite satisfied, and 3 (15%) were simply satisfied. By content analysis of the opening questions, we found that the participants had deeper and broader ideas about nurses' role and pain nursing specialists' responsibilities in pain management. The program improved nurses' attitudes, knowledge, and skills in pain management. The participants recognized pain nursing specialists' responsibilities in pain management more clearly.

Management of the Hospitalized Patient Experiencing Acute on Chronic Pain: A Case Study - Corrected Proof

Margaret Costello, Hallie Greenberg, Caprie Bell, Jennefer Trowers-Smith — 2011-11-17

Abstract: The ability to balance the patient's level of comfort while minimizing adverse outcomes related to overdosing remains the key to providing excellent post operative care for the patient with chronic pain. This article presents the case of a hospitalized patient with severe pain and the challenges her care presented to the nursing staff.

Integrating the Concept of Pain Interference into Pain Management - Corrected Proof

Marian Wilson — 2011-11-10

Abstract: Undertreatment of pain is a significant problem. Nursing pain assessments have been identified as an area for improvement. This concept analysis sought to examine the use of pain interference as a measurement to assist pain management practices. Existing literature including the term pain interference was reviewed for the years 2000-2010. Pain interference is a common outcome measurement in clinical research. It is not well differentiated from other pain concepts in routine nursing pain assessments, nor consistently defined in research articles. Pain interference has been linked to quality of pain management and recommended as a standard of pain measurement. It aligns with current and emerging theories in pain and symptom control. Further exploration is needed to determine whether integrating this concept into nursing practice will result in improved patient pain experiences.

Information-Seeking Coping Behaviors During Painful Procedures in African-American Children with Sickle Cell Disease - Corrected Proof

2011-11-07

Abstract: This study examined the frequency of information-seeking coping behaviors in 37 African-American children (ages 5-17 years) with sickle cell disease during venipuncture. The relationships between coping behaviors and child- and parent-reported pain and observational distress were also assessed. The majority of children attended to the procedure, but did not seek information via questions. This pattern of coping was only partially effective at reducing distress and had no relation to pain. This pattern of coping is discussed within the context of cultural factors that may be important in understanding responses to procedural pain in pediatric sickle cell disease.

Turkish Pediatric Surgical Nurses' Knowledge and Attitudes Regarding Pain Assessment and Nonpharmacological and Environmental Methods in Newborns' Pain Relief - Corrected Proof

Emine Efe, Şevkiye Dikmen, Nuray Altaş, Cem Boneval — 2011-11-07

Abstract: Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.

A Qualitative Analysis of Adolescent, Caregiver, and Clinician Perceptions of the Impact of Migraines on Adolescents' Social Functioning - Corrected Proof

Elizabeth Donovan, Stacey Mehringer, Lonnie K. Zeltzer — 2011-11-07

Abstract: Migraines dramatically affect adolescents' quality of life. One area of particular importance is the impact of migraines on adolescents' social functioning. To understand the impact of migraines on adolescents' social functioning from multiple informants, we performed semistructured interviews with adolescents who have migraines, their caregivers, and clinicians who treat adolescents who have migraines. Three major themes related to social functioning were identified from the adolescent interviews: The need to be alone; lack of support from siblings; and the feeling of not being understood by others. The caregiver interviews yielded three main themes related to family functioning: that plans can change quickly; that family life revolves around helping the child with the migraine; and parents' feelings of inadequacy in helping their child. There were two main themes derived from the clinician interviews related to perception of family functioning: the importance of parental involvement; and the role of adolescents' school and social lives in migraine prevention. There are a number of unmet needs among adolescents with recurrent migraine and their families. Interviews with adolescents, caregivers, and clinicians suggest a number of areas for intervention.

Complementary and Alternative Medicine: Nurses’ Attitudes and Knowledge - Corrected Proof

Tracy Trail-Mahan, Chia-Ling Mao, Karen Bawel-Brinkley — 2011-10-31

Abstract: Despite significant evidence for the integration of complementary and alternative medicine (CAM) into professional nursing practice, gaps exist regarding nurses’ baseline knowledge, beliefs of efficacy, and learning needs for further education to facilitate the integration of CAM into nursing practice. The top three conditions which adults identified for using CAM were back pain, neck pain, and joint pain. CAM can offer nurses additional treatment options for managing their patients’ pain and discomfort. The California Board of Registered Nursing (BRN) identifies that nurses can help provide the missing link between conventional Western medicine and CAM therapies. Nurses cannot successfully advocate for CAM therapies, nor understand their patients’ prior use of such treatments, unless they themselves are familiar with both the risks and the benefits of these practices. It is necessary to first establish nurses’ baseline knowledge and beliefs related to CAM so that adequate educational programs can be initiated to help mitigate the barriers to incorporating CAM into the acute care setting. This descriptive study explores registered nurses’ attitudes and knowledge related to CAM by using the Nurse Complementary and Alternative Medicine Nursing Knowledge and Attitudes Survey developed by Rojas-Cooley and Grant. Nurses in this study demonstrated limited self-reported knowledge of basic CAM terminology and CAM practices.

Fibromyalgia’s Key Symptoms in Normal-Weight, Overweight, and Obese Female Patients - Corrected Proof

2011-10-31

Abstract: Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.

Adherence to Guidelines of Pain Assessment and Intervention in Internal Medicine Wards - Corrected Proof

Yehudit Kerner, Ygal Plakht, Artur Shiyovich, Pnina Schlaeffer — 2011-10-19

Abstract: Proper management of pain reduces morbidity, assists in recovery, and increases patient satisfaction. The role of a nurse in an accurate pain evaluation is pivotal. It seems that pain evaluation guidelines are not fully adhered to by nurses. The aim of this study was to assess the performance of pain evaluation and management by nurses in patients admitted in internal medicine wards and to identify groups of patients in which pain evaluation was insufficient. In this cross-sectional study medical records of 59 randomly chosen patients were reviewed: age 64.5 ± 18.5 years, 55% women, and hopitalization length 3.9 ± 1.6 days. Data relating to pain evaluation and management were obtained for every patient–hospitalization day (total 213 patient-days) and compared with the guidelines. Pain was evaluated in 176 out of 213 encounters (66.2%): 84.3% upon admission and 72.7% daily routine evaluation in accordance with guidelines. In 23.7% of evaluations, pain level warranted alleviating treatment (visual analog scale ≥3). However, such treatment was administered in only 29.3% of these cases. Reevaluation after treatment and additional evaluations thereafter were performed in 33.3% and 22% of encounters, respectively. The independent factors associated with the reduced performance of pain evaluation were: widower (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.78-0.98; p = .024), reduced level of consicousnness (OR 0.77, 95% CI 0.63-0.95; p = .013), mental disorders as a cause of hospitalization (OR 0.81, 95% CI 0.71-0.94; p = .004), and isolation (OR 0.87, 95% CI 0.76-0.99; p = .03). Pain assessment and management in internal medicine wards is insufficient, especially in the above subgroups. Specific education programs targeted to the latter subgroups and to the unique pain assessment tools are warranted.

Pain and Anxiety During Bone Marrow Biopsy - Corrected Proof

2011-10-17

Abstract: A bone marrow biopsy is considered to be painful, often causing anxiety. We observed large differences between patients and wondered which factors cause pain and anxiety. In a prospective study, 202 patients were analyzed. Experienced hematologists and fellows in training (17% of biopsies) performed bone marrow aspirates and biopsies from the posterior iliac crest. Demographics, disease category, performance score, source of information, number of previous biopsies, experience of the hematologist, and length and quality of the biopsy were recorded. Pain and anxiety were measured using a visual analog scale and verbal rating score. Data were subjected to univariate and multivariate regression. The median pain score was 1.9 (range 0-10); 21% did not experience any pain. Anxiety scored 1.8 (range 0-10), and correlated positively with pain (p = .000). By univariate analysis, young age, poor performance, the physician as source of information, and prolonged procedures were associated with more pain. In multivariate analysis, anxiety, information from the physician, and a prolonged procedure persisted. Length or artifacts of the core biopsy did not correlate with pain. In conclusion, bone marrow biopsies performed in an optimal setting by experienced hematologists cause only mild pain, with, however, some patients experienced serious problems. To reduce pain, not only careful local anesthesia, but also the addition of systemic analgesics and especially anxiety reduction seems to be useful.

Development and Validation of a Brazilian Version of the Short-Form McGill Pain Questionnaire (SF-MPQ) - Corrected Proof

2011-10-10

Abstract: The aim of this study was to develop and validate a short form of the Brazilian version of McGill Pain Questionnaire (SF-MPQ). Three hundred two patients with chronic pain filled out the validated Brazilian long form of the McGill Pain Questionnaire (LF-MPQ). Words chosen by ≥25% of the patients were selected to comprise the SF-MPQ. The Brazilian SF-MPQ consisted of 15 descriptors (8 sensory, 5 affective, and 2 evaluative) rated on a binary mode (present or absent). Four pain scores were derived by counting the words chosen by the patients for sensory, affective, evaluative, and total descriptors. The SF-MPQ showed poor internal consistency (KR-20 = 0.52) but possibly acceptable because it showed discriminant validity to discriminate patients presenting different levels and mechanisms of pain, and it was strongly correlated with the LF-MPQ. The low KR-20 coefficient could result from the small number of items. The Brazilian version of the SF-MPQ proved to be a useful instrument to evaluate the different qualities of pain. It is a reliable option to the long-form MPQ.

An Integrative Review of Literature Examining Psychometric Properties of Instruments Measuring Anxiety or Fear in Hospitalized Children - Corrected Proof

Roxie L. Foster, Jeong-hwan Park — 2011-10-10

Abstract: Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children’s fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.

Cranial Electrical Stimulation Improves Symptoms and Functional Status in Individuals with Fibromyalgia - Corrected Proof

2011-10-10

Abstract: To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

Nursing Knowledge and Beliefs Regarding Patient-Controlled Oral Analgesia (PCOA) - Corrected Proof

Monakshi Sawhney, Eri Maeda — 2011-10-10

Abstract: Patient-controlled oral analgesia (PCOA) allows patients to self-administer oral opioids for pain management. Advantages of PCOA include improved pain control with lower doses of opioids, decreased length of stay, increased patient satisfaction, and better functional outcomes than conventional nurse-administered oral analgesia. Sucessful PCOA programs are well described in the literature. However, nurses have concerns about allowing patients to self-administer opioids. The purpose of this study was to identify nurses’ knowledge and beliefs regarding PCOA. Nurses who work at the Holland Orthopaedic and Arthritic Centre were asked to complete a survey exploring their beliefs regarding PCOA. The nurses were asked to complete the same survey twice: before an education program in February 2010, and 3 months after implementation of PCOA in June 2010. In February 2010, 74 nurses and in June 2010, 32 nurses participated in the survey. Some nurses (18%) had previous experience with PCOA. At both the pre-education and the postimplementation times, nurses thought that the PCOA program reduced wait times for analgesics and improved patient satisfaction with pain management. Before program implementation, negative beliefs included that patients on the PCOA program would lose their analgesics, would give their analgesics to visitors or other patients, and were at risk for having their analgesics stolen and that the nurse was liable if the patient’s analgesics were lost or stolen. After program implementation, no nurse believed that patients would lose their analgesics or give their analgesics to visitors or other patients or that they were liable for lost or stolen analgesics. However, nurses continued to think that patients were at risk for having their analgesics stolen. We found that nurses were concerned that analgesics could be lost, misused, or stolen and that they would be liable for lost analgesics. These findings were consistent with literature discussing patients’ outcomes regarding PCOA. However, after education and experience these concerns decreased or resolved. It is important to address these concerns before PCOA program implementation.

Decoding the Role of Epigenetics and Genomics in Pain Management - Corrected Proof

Angela R. Starkweather, Vincent E. Pair — 2011-08-04

Abstract: Persistent pain is a costly epidemic, affecting >50 million Americans with estimated expenditures of >$200 billion annually for direct care and lost productivity. Recent advances in epigenetic/genomic understanding of pain and analgesic response may lead to improvements in pain management and help curtail costs by providing more precise detection of the pain mechanisms involved and thereby more personalized and effective treatments. However, the translation of epigenetic and genomic strategies for pain management into clinical practice will depend on understanding their potential applications. The purpose of this article is to examine current knowledge about epigenetic and genomic mechanisms of persistent pain and potential opportunities for improving pain management. The initial discussion focuses on present understanding of nociceptive pathways and alterations that lead to pathologic pain. The discussion then moves to a review of epigenetic mechanisms that have been identified in the transition to and maintenance of persistent pain as well as in the individual’s response to analgesics. Potential applications of epigenetics/genomics to identify people at risk and possibly prevent persistent pain and guide diagnosis and the selection of therapeutic modalities are presented.

Patterns and Clinical Correlates of Pain Among Brain Injury Patients in Critical Care Assessed with the Critical Care Pain Observation Tool - Corrected Proof

KangIm Lee, HyunSoo Oh, YeonOk Suh, WhaSook Seo — 2011-07-21

Abstract: This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain.

Pain Management Education in Long-Term Care: It Can Make a Difference - Corrected Proof

Carol O. Long — 2011-07-18

Abstract: Acute and chronic pain management for persons residing in long-term care settings is a serious problem. In an effort to change practice in pain management and improve resident outcomes, the Campaign Against Pain education program was instituted at Beatitudes Health Care Center in Phoenix, Arizona. In this pilot study, professional and certified nursing assistant (CNA) staff were surveyed before and after the training program to ascertain change in knowledge, attitudes, and barriers about pain. After the intensive training program and onsite consultation with the concomitant changes in policies, procedures, and documentation, professional and CNA staff knowledge improved after 6 months (F = 6.273; p = .02), attitudes changed (F = 12.26; p = .002), and barriers were mitigated. With a comprehensive quality improvement pain plan in place, the findings suggest that education in pain management in long-term care and program changes that adopt best practices in pain can make a difference.

Review of Pain Content in Three-Year Preregistration Pediatric Nursing Courses in the United Kingdom - Corrected Proof

Alison Twycross, Lynda Roderique — 2011-07-11

Abstract: The results of several studies suggest that gaps remain in nurses' knowledge about pain in children, and particularly regarding pain assessment, analgesic drugs, and nondrug methods, suggesting a need to explore the pain content of preregistration nursing curricula. Over the past decade, the way nurse education is delivered has changed with the advent of the internet and the use of virtual learning environments. This study, therefore, explored the depth and breadth of pain content in 3-year preregistration pediatric nursing courses across the U.K. as well as ascertaining how this content is delivered. The leads for pediatric nursing at all 56 U.K. higher education institutions running the 3-year preregistration pediatric nursing course were e-mailed a questionnaire. Participants were asked to indicate whether topics are covered in the program, and if so how it was delivered. Results suggest that preregistration pediatric nursing courses in the U.K. do not always equip students to manage pain effectively in clinical practice. There appears to be limited content on pain in nursing curricula, with several institutions not covering key topics. Most teaching is delivered face to face with limited workbooks and virtual learning activities. Further research is needed in this area to ascertain the impact of this on the quality of care provided.

Methods Used by Female Nurses and Lay Women for Everyday Pain Management - Corrected Proof

2011-07-11

Abstract: There are numerous types of pain, with different clinical meanings. Everyday pain might be experienced by everyone under different stressors, such as lack of sleep, alcohol overuse, stay in a stuffy room, and physical overstressors. It also might be related to a job character or attitudes. The aim of the present study was to investigate the methods for the management of everyday pain used by female nurses and lay women. Headaches and back pain were the most common pains reported among the female population included in this study. Analgesic use was the most common method for management of everyday pain. Nurses used prescription medicine and other methods. Lay women used over-the-counter analgesics more often. There is a significant tendency to exceed the maximum analgesic dose when treating migraines, total body pain, and toothaches. The majority of all of the women included in this study used analgesics according to recommendations. Nurses were found to underuse analgesics and lay women to overuse the recommended dose. Speed and safety were identified as key factors driving studied respondents’ decisions when treating pain.

Early Experience with a Brief, Multimodal, Multidisciplinary Treatment Program for Fibromyalgia - Corrected Proof

2011-07-04

Abstract: Fibromyalgia is a complex heterogeneous disorder for which a multidisciplinary individualized approach is currently advocated. We executed a 1-week multidisciplinary fibromyalgia clinical program with seven patients, based on our experience with our existing 1.5-day multidisciplinary fibromyalgia program that has demonstrated both short- and long-term benefits. The current expanded program was not designed as a clinical study, but rather as a clinical feasibility assessment, and it was multidisciplinary in nature, with cognitive behavioral therapy, activity pacing, and graded exercise therapy as major components. We assessed changes in individual patients at 1 week and 3 months after the program with the use of validated self-report measures of pain, fatigue, and self-efficacy. All patients indicated at least small improvements in pain and physical symptoms at both 1 week and 3 months, and all but one patient showed improvement in self-efficacy at 1 week and 3 months. Similar trends were observed for fatigue. Based on our early clinical experience, we conclude that the 1-week multidisciplinary fibromyalgia program is logistically feasible and has potential for clinical efficacy. Further research is needed and is planned to test the clinical efficacy of this program and compare it with other interventions.

Opioid-Induced Hyperalgesia: Is It Clinically Relevant for the Treatment of Pain Patients? - Corrected Proof

Robert B. Raffa, Joseph V. Pergolizzi — 2011-06-27

Abstract: There is a curious and paradoxic phenomenon, reliably demonstrated in animal models, that consists of an increased sensitivity to pain that is apparently induced by the very opioid drugs used to ameliorate the pain. This phenomenon is termed “opioid-induced hyperalgesia.” Whether opioid-induced hyperalgesia occurs in humans, and, if so, to what extent and consequence, is far less established. This is a critical question for attempting to treat pain. If opioid-induced hyperalgesia develops in a patient, it would masquerade as tolerance (because the clinical effectiveness of the opioid would be diminished), yet the appropriate clinical adjustment would be precisely the opposite to that of tolerance. It would be to decrease, rather than increase, the dose of opioid. We review the evidence, particularly the clinical evidence, about opioid-induced hyperalgesia and the postulated mechanisms. We conclude that given the clinical ramifications, opioid-induced hyperalgesia is one of the most understudied important aspects of opioid research.

Nursing Ward Managers’ Perceptions of Pain Prevalence at the Aged-Care Facilities in Japan: A Nationwide Survey - Corrected Proof

2011-06-20

Abstract: This study aimed to examine nursing ward managers’ perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers’ age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups’ pain prevalence estimation and the nursing managers’ beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents’ pain was insufficient (p = .001). The ward managers’ perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required.

Kangaroo Care and Behavioral and Physiologic Pain Responses in Very-Low-Birth-Weight Twins: A Case Study - Corrected Proof

Xiaomei Cong, Regina M. Cusson, Naveed Hussain, Di Zhang, Sharon P. Kelly — 2011-05-30

Abstract: The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition. Infant B had an incident of apnea and tachycardia by the end of the heel stick and a bradycardia episode during recovery in the IC condition. The twins had lower LF/HF ratios (better autonomic nervous system balance) during recovery in both longer and shorter KC conditions compared with the IC condition. Infant B had difficulty returning to LF/HF ratio baseline level after the painful procedure in the IC condition. These data suggest that both longer and shorter KC before and throughout painful procedures can be helpful in reducing behavioral and physiologic pain responses in preterm infants.

The Journey of the Pain Resource Nurse in Improving Pain Management Practices: Understanding Role Implementation - Corrected Proof

2011-05-30

Abstract: Pain assessment and management continues to be challenging for many nurses. Single educational interventions have proven to be unsuccessful in knowledge retention. This study will assist leaders in nursing in understanding how a 4-day educational program delivered to self-selected pain resource nurses (PRNs) could improve pain assessment and management practices. A focus group study was undertaken at a trisite academic health science center to understand the role implementation of the PRNs and required resources to sustain the role at a unit level. To evaluate the PRN role, a qualitative descriptive study design using focus group interviews was used to answer the following questions: What was the experience of the PRN during role implementation? What barriers and enablers affected the implementation of this role? Organizational support, integration within the interdisciplinary team, and organizational role awareness were key themes highlighted in the focus group results. This article will describe how the three-site academic health science center used the PRN role to foster practice-related change and enhance current knowledge of evidence-based pain management

Effect of a Virtual Pain Coach on Pain Management Discussions: A Pilot Study - Corrected Proof

Deborah Dillon McDonald, Stephen Walsh, Cunegundo Vergara, Timothy Gifford — 2011-05-30

Abstract: There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners’ pain management changes, and on older adults’ reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication–only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults’ communicated pain information and practitioners’ pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication–only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.

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

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 if those dimensions of cancer pain influence each other. As a result, clinicians can provide better and effective cancer pain management.

A Pilot Study to Identify Correlates of Intentional Versus Unintentional Nonadherence to Analgesic Treatment for Cancer Pain - Corrected Proof

Salimah H. Meghani, Deborah Watkins Bruner — 2011-04-29

Abstract: Existing studies of medication adherence treat “nonadherence” as a monolithic concept. The goal of this study was to isolate correlates of intentional versus unintentional nonadherence for analgesic treatment for cancer pain. Patients were recruited from outpatient oncology clinics in the middle Atlantic region, ≥18 years old, and diagnosed with solid tumors, and had an active prescription of at least one around-the-clock analgesic. The Morisky Medication Adherence Scale (MMAS) was used to assesses “unintentional” (forgetfulness/carelessness) and “intentional” (stopping use of medication if feeling better or worse) dimensions of analgesic nonadherence. A visual analog scale was used to assess the percentage of analgesic doses taken in the preceding month. A majority of participants (85.5%) took prescribed analgesics in the index period. However, 51% reported taking only up to 60% of the analgesic doses prescribed to them. Stopping taking analgesics when feeling better was the most commonly reported nonadherence behavior (74%); those reporting “intentional” nonadherence when feeling better were more likely to report not using analgesics in the index week (100% vs. 67.7%; p = .029) and agree that pain medication can keep you from knowing what is going on in your body (p = .029) and were less likely to need stronger pain medication (33.3% vs. 81.5%; p = .003). “Unintentional” nonadherence, i.e., forgetfulness/carelessness, though associated with many analgesic beliefs, was not associated with measures of analgesic use in the index period. These preliminary data indicate that different heuristics underlie intentional versus unintentional nonadherence to analgesia and that intentional and unintentional nonadherence behaviors may have different implications for pain treatment outcomes.

Prescribed Opioids Adherence Among Taiwanese Oncology Outpatients - Corrected Proof

Shu-Yuan Liang, Shu-Fang Wu, Shiow-Luan Tsay, Tsae-Jyy Wang, Heng-Hsin Tung — 2011-04-19

Abstract: The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients’ opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence.

Establishing the Validity and Reliability of a Pediatric Pain Knowledge and Attitudes Questionnaire - Corrected Proof

Alison Twycross, Anna Williams — 2011-04-19

Abstract: Children continue to experience unrelieved pain during hospitalization, despite the evidence to guide nurses’ pain management practices being readily available. Nurses’ knowledge and attitudes have been identified as a possible reason for suboptimal pain management. This study examines the validity and reliability of an existing questionnaire to validate it for use in the population of interest. Initial testing demonstrated low reliability and validity. Modifications to the questionnaire were made on the basis of these results and the feedback provided by experts in pediatric pain management. Subsequent testing demonstrated good validity and reliability, suggesting that the questionnaire is appropriate for measuring nurses’ knowledge and attitudes in relation to pediatric pain management.

Prevalence of Pain Among Residents in Japanese Nursing Homes: A Descriptive Study - Corrected Proof

2011-03-28

Abstract: It is often observed that pain causes substantial problems for nursing home residents. However, there has been little research about the prevalence of pain for nursing home residents in Japan. This study aimed to examine the prevalence of pain in older adults living in nursing homes in Japan by using self-reporting and the Abbey Pain Scale–Japanese version (APS-J) and to explore factors related to pain. This is a descriptive study. Residents in two Special Nursing Homes for the Elderly in Tokyo, Japan, were asked to participate in this study, with the exclusion of short-term temporary residents. Data collected from participating residents included their demographics and the results from the Barthel Index, the Folstein Mini-Mental State Examination, the APS-J, and the Verbal Descriptor Scale for pain. The residents were divided into two groups: residents able to report their pain (self-report group) and residents not able to report their pain. The second group was assessed by using the APS-J (APS-J group). The Mann-Whitney U test, the χ2 test, and logistic analyses were performed to derive factors related to pain prevalence. Data were obtained from 171 residents. The prevalence of pain in the self-report group (n = 96) was 41.7%. For the 75 residents unable to report their pain, 52.0% were assessed by the APS-J to have pain. The overall pain prevalence of all residents was 46.2%. Age, Barthel Index score, and length of time of institutionalization were significantly associated with residents’ pain in the APS-J group. Logistic regression analysis showed that contracture (odds ratio 3.8) and previous injury (odds ratio 3.4) were associated with residents’ pain in the self-report group, whereas only the length of nursing home stay (odds ratio 1.03) was a predictor for pain in the APS-J group. Nearly one-half of residents had pain when they moved or were moved. Pain assessment and management is needed for residents.

Factors That Influence Pain Intensity and Fentanyl Requirements After a Gynecologic Laparotomy - Corrected Proof

Peter Chee Seong Tan, Nik Abdullah Nik Mohamad, Siew Hua Gan — 2011-02-28

Abstract: The association between pain intensity and its control by intravenous patient-controlled analgesia (IV-PCA) with fentanyl after a laparotomy for cystectomy/salphingoophorectomy, myomectomy, or hysterectomy was investigated. IV fentanyl infusion was administered to patients (n = 94) at 3 μg/kg/h to provide intraoperative analgesia after induction of general anesthesia. Postoperative fentanyl requirements were quantified via IV-PCA, and the amounts of rescue fentanyl required both during and after surgery were recorded. Mean values for PCA use as well as the visual analog scores (VAS) for pain were documented for up to 24 hours. The association between postoperative fentanyl requirements and VAS were then analyzed by using Mann-Whitney or Kruskal-Wallis tests. Patients with lower midline incisions had greater degrees of pain (p < .05) during the first 16 hours after surgery but did not consume more fentanyl compared with patients with Pfannenstiel incisions. Subjects who underwent operations lasting >4 hours required more rescue fentanyl during surgery (p < .05). However, this group consumed less fentanyl during the first 4 hours after surgery (p < .05). The demand at the fourth 4-hour period was lower among subjects undergoing myomectomy compared with cystectomy/salphingoophorectomy or hysterectomy (p = .045). Only a poor correlation was observed between pain intensity and analgesic usage. Postoperative pain intensity is influenced by the type of surgical incision but not the type of gynecologic surgery nor the duration of surgery. The relationship between subjective pain ratings with analgesic consumption is weak. Prolonged intraoperative administration of continuous IV fentanyl infusion may reduce fentanyl requirements in the immediate postoperative period.

The 6-Minute Walk Test in Female Fibromyalgia Patients: Relationship With Tenderness, Symptomatology, Quality of Life, and Coping Strategies - Corrected Proof

2011-02-28

Abstract: The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (ρ −0.365 and 0.347, respectively, both p < .001). The 6-MWT showed a weak relationship with tenderness (ρ 0.201 and −0.191 for algometer score and tender points count, respectively, both p < .05). The relationship between the 6-MWT and global score of FIQ, and FIQ subscales of pain and fatigue were weak (ρ −0.201, −0.211, and −0.226, respectively, all p < .05). The 6-MWT showed a weak relationship with bodily pain and vitality scales of SF-36 (ρ 0.256 and 0.258, respectively, both p = .005) and with passive and active coping strategies (ρ −0.255 and 0.223, both p < .05). This study in women with fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia.

Pain Management for Older Persons Living in Nursing Homes: A Pilot Study - Corrected Proof

Mimi M.Y. Tse, Suki S.K. Ho — 2011-02-28

Abstract: Because the prevalence of chronic pain among the elderly in nursing homes is high and decreases their quality of life, effective nonpharmacologic pain management should be promoted. The purpose of this quasiexperimental pretest and posttest control design was to enhance pain management in nursing homes via an integrated pain management program (IPMP) for staff and residents. Nursing staff and residents from the experimental nursing home were invited to join the 8-week IPMP, whereas staff and residents from the control nursing home did not receive the IPMP. Baseline data were collected from nursing staff and residents in both groups before and after the IPMP. The IPMP consisted of eight lectures on pain assessment, drug knowledge,and nondrug strategies for the nursing staff, and 8 weeks of activities, including gardening therapy and physiotherapy exercise, for the residents. There were 48 and 42 older people in the experimental and control groups, respectively. No significant differences were found in their educational level, sleep quality, bowel habits, past and present health conditions, pain conditions and psychologic well-being parameters (p > .05) at baseline. After the IPMP, the experimental nursing staff showed a significant improvement in their knowledge of and attitudes to pain management (p < .05), and the experimental residents reported significantly lower pain scores and used more nondrug strategies for pain relief compared with the control group (p < .05). Moreover, the psychologic well-being parameters, including happiness, loneliness, life satisfaction, and geriatric depression, had significantly improved among the experimental residents (p < .05). The IPMP was effective in enhancing the knowledge and attitudes of nursing staff, as well as reducing pain conditions and enhancing psychologic well-being for older persons in nursing homes.

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

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.

Current Knowledge of Pain after Breast Cancer Treatment: A Systematic Review - Corrected Proof

Marese A. Cooney, Elizabeth Culleton-Quinn, Emma Stokes — 2011-02-11

Abstract: Pain and functional compromise are reported as effects that can be expected after breast cancer treatment. The reported prevalence of pain after breast cancer treatment varies widely, ranging from 13% (n = 74) to 93% (n = 590). To date, pain after breast cancer treatment has not been the focus of a systematic review. The aim of this study was to present what is known about the prevalence, location, intensity, nature, and temporal factors of the pain experienced by patients after breast cancer treatment. Searches of the Pubmed, Embase, Scopus, Amed, and Cinhal databases identified 69 articles on the topic. Studies were methodologically assessed by two independent reviewers using a checklist of 18 criteria. Twenty-six of the articles were identified as meeting inclusion criteria. Findings related to research conducted on 15 patient cohorts. Pain is confirmed as a prevalent treatment-related symptom experienced by 13%-51% of women in several different anatomic locations. The onset is variable, ranging from immediate to 24 months, highlighting the need to assess for pain at every evaluation interval. Little is known about the nature of the pain, but descriptors used (tenderness, soreness) suggest that the type of pain may not be confined to neuropathic pain. Reported average numeric intensity is low, but no study measured the impact of pain on function. Incidence of posttreatment pain has yet to be established. Further exploration of the nature, temporal factors, and impact that the pain experienced after treatment has on function, activity, and participation is needed to guide intervention and test its efficacy.

The Effects of Self–Pain Management on the Intensity of Pain and Pain Management Methods in Arthritic Patients - Corrected Proof

Serap Parlar, Cicek Fadiloglu, Gulumser Argon, Yasemin Tokem, Gokhan Keser — 2011-02-09

Abstract: The aims of this study were to investigate the effects of pain management education on the intensity of pain and frequency of utilization of pain management methods in two groups of patients with arthritis of different pathogenesis and clinical features, and to compare whether a significant difference existed between the two groups. The study was carried out between September 2007 and June 2008 on 30 female patients with gonarthrosis and 30 female patients with rheumatoid arthritis (RA) followed at the rheumatology outpatient clinic of a university hospital. Data on sociodemographic characteristics and those related with the illness were collected using a special survey. Each patient was given information about the features, causes, and treatment of the arthritis and how to cope with pain, emphasizing the importance of pain management methods. The intensity of pain and efficacy of pain management methods were assessed using the McGill Pain Questionnaire and the Pain Management Inventory at baseline and the second and sixth weeks after the education. The SPSS (v15.0) statistical package was used for statistical analysis. After education, significant improvements in pain intensity scores compared with baseline scores were observed in both groups (p < .05), and there was no significant difference between the RA and gonarthrosis groups. Among the various pain management methods, the education program led to significantly more utilization of massaging the painful area, exercising, and using complementary methods to control stress in both groups of patients, and there was no significant difference between the groups. In conclusion, the pain management education given in this study alleviated the intensity of pain and significantly increased the use of some pain management methods in both gonarthrosis and RA cases.