The short-form McGill Pain Questionnaire in chronic cancer pain

Update on classic Kaposi sarcoma therapy: new look at an old disease

Classic Kaposi sarcoma (CKS) represents an angioproliferative disease that is originated from endothelial cells, myofibroblasts, and monocyte-macrophage cells. It occurs predominantly in elderly people, particularly men from the Mediterranean area. CKS is described as a disease with a long indolent course but frequently shows a rapid progressive evolution that necessitates systemic chemotherapy. Considering that afflicted patients are often >75 years old, the need to use a convenient treatment schedule with few side effects is evident. No standard therapy is used for CKS and treatment must be tailored to the individual patient. This report summarizes all treatment options in CKS, including classical systemic chemoterapy, immunotherapy, and radiotherapy. Among chemotherapeutic agents, recent data are offered from current trials that have focused on the role of pegylated liposomal doxorubicin as first- and second-line therapy.

Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: a pilot study

Fibromyalgia (FM) is a chronic pain disorder affecting 2% of the population in the United States. Another 16 million Hispanics suffer from generically identified rheumatic diseases that likely include FM. Because there are few reported studies of Hispanics with FM, a pilot study using a repeated-measures pretest-posttest design investigated the effects of a 10-week mind-body intervention (visual imagery with relaxation) on symptom management. The change in means from baseline to week 10 demonstrated improvement in self-efficacy for managing pain and other symptoms and functional status. Visual imagery with relaxation is a mind-body intervention that may be used for symptom management in this population.

Pegylated liposomal doxorubicin as second-line therapy in the treatment of patients with advanced classic Kaposi sarcoma: a retrospective study

BACKGROUND

Classic Kaposi sarcoma (CKS) is a rare neoplasm that predominantly occurs in elderly subjects and has a variable clinical evolution. The clinical course is usually indolent, but occasionally the neoplasm progresses rapidly and spreads to internal organs, necessitating systemic chemotherapy. Because of the rarity of CKS, the best treatment has not been determined to date. To the authors' knowledge, few data exist regarding the use of pegylated liposomal doxorubicin (PLD) as first-line and second-line treatment in advanced CKS. The current retrospective study investigated the activity and toxicity of PLD in pretreated patients with aggressive, nonvisceral CKS.

METHODS

Patients were treated with PLD at a dose of 20 mg/m(2) intravenously every 3 weeks until disease progression or the occurrence of intolerable side effects. Objective responses were determined after 3 and 6 cycles; toxicity was assessed every cycle. Secondary endpoints were pain intensity, progression-free survival, and overall survival.

RESULTS

Twenty men with pretreated CKS (median age, 67 years) were treated with PLD. All patients received at least 6 cycles of therapy. Complete and partial responses were observed in 2 patients (10%) and 14 patients (70%), respectively. Neutropenia was the most significant grade 3 hematologic toxicity observed (evaluated according to the National Cancer Institute Common Toxicity Criteria for Adverse Events [version 3.0]), occurring in 20% of patients. Only 1 patient (5%) demonstrated grade 4 neutropenia. Fourteen patients (70%) achieved remission of pain and/or edema after 6 cycles. The median progression-free survival was 9 months (95% confidence interval, 5-13 months). At a median follow-up of 36 months, 15 patients (75%) remained alive.

CONCLUSIONS

PLD is associated with an improvement in objective response and pain intensity and is well tolerated as a second-line treatment for CKS.

Long-term sequelae after 1,311 primary inguinal hernia repairs

BACKGROUND

Aim of this study was to analyze long-term sequelae, risk factors, and satisfaction after inguinal hernia primary repair.

METHODS

A postal questionnaire was mailed to all patients operated between January 1997 and December 2004 for inguinal hernia repair. Patients who had a lump in the groin and patients who experienced chronic problems were invited for a physical examination. Patients who reported having chronic pain were asked to fill out the short-form McGill Pain Questionnaire (SF-MPQ).

RESULTS

Chronic pain was present in 18.1% of cases. The strongest risk factors were presence of recurrence, use of heavyweight mesh, and age younger than 66 years. By means of the SF-MPQ, we found that the pain reported by most patients was sensory-discriminative in quality, with "tender" and "aching" being the most common descriptors used. About 71.3% of replies used descriptors typical of nociceptive pain, 8.9% of neuropathic pain, and 19.8% of nociceptive plus neuropathic. Chronic pain was severe in 2.1% of patients and interfered with normal activities, work, and exercise. The cumulative recurrence rate was 2.1%. There was a strong correlation between lump and recurrence. Patients declared themselves satisfied with the result of the operation in 93.1% of cases. Due to chronic pain, 6.5% of patients were unsatisfied.

CONCLUSIONS

This study demonstrates that the main problem after inguinal hernia repair remains chronic pain, which was the primary reason of dissatisfaction. The SF-MPQ is feasible and easy to administer to all patients and provides important information about qualitative features of the pain.

Analysis of post-surgical pain after inguinal hernia repair: a prospective study of 1,440 operations

BACKGROUND

Pain remains a significant clinical problem after inguinal hernia repair. We prospectively assessed post-surgical pain following herniorrhaphy in 1,440 operations with the aim of describing the characteristics and identifying predisposing factors for pain.

METHODS

Pain quality was assessed with the short-form McGill Pain Questionnaire (SF-MPQ); pain character was estimated as either nociceptive or neuropathic in nature.

RESULTS

A total of 38.3% of replies reported pain (acute or chronic), and 18.7% reported chronic pain. Independent risk factors for pain were young age, BMI >25, day surgery, and use of Radomesh. In patients with chronic pain, independent risk factors were young age, BMI >25 and use of Radomesh. Analysis of the SF-MPQ revealed that the pain reported by most patients was sensory-discriminative in quality. The most common descriptors were tender and aching. Patients with chronic pain reported more intense pain and used sensory descriptors of greater mean intensity than patients with acute pain. A total of 73.9% of replies used descriptors typical of nociceptive pain, 6.5% used descriptors typical of neuropathic pain and 19.6% used nociceptive plus neuropathic descriptors. Patients considered to have nociceptive pain used significantly more sensory descriptors than those considered to have neuropathic pain. By contrast patients with neuropathic pain used more affective descriptors than those with nociceptive pain. Neuropathic pain was reported as more difficult to treat with analgesics than nociceptive pain and neuropathic plus nociceptive pain.

CONCLUSIONS

Our study confirms that herniorrhaphy frequently produces chronic pain, which can reduce quality of life. The SF-MPQ is a useful instrument to administer to all patients and provides important information about qualitative properties of the pain.

Partner-delivered reflexology: effects on cancer pain and anxiety

PURPOSE/OBJECTIVES

To compare the effects of partner-delivered foot reflexology and usual care plus attention on patients' perceived pain and anxiety.

DESIGN

The experimental pretest/post-test design included patient-partner dyads randomly assigned to an experimental or control group.

SETTING

Four hospitals in the southeastern United States.

SAMPLE

42 experimental and 44 control subjects comprised 86 dyads of patients with metastatic cancer and their partners, representing 16 different types of cancer; 23% of patients had lung cancer, followed by breast, colorectal, and head and neck cancer and lymphoma. The subjects had a mean age of 58.3 years, 51% were female, 66% had a high school education or less, and 58% were Caucasian, 40% were African American, and 1% were Filipino.

METHODS

The intervention included a 15- to 30-minute teaching session on foot reflexology to the partner by a certified reflexologist, an optional 15- to 30-minute foot reflexology session for the partner, and a 30-minute, partner-delivered foot reflexology intervention for the patient. The control group received a 30-minute reading session from their partners.

MAIN RESEARCH VARIABLES

Pain and anxiety.

FINDINGS

Following the initial partner-delivered foot reflexology, patients experienced a significant decrease in pain intensity and anxiety.

CONCLUSIONS

A nurse reflexologist taught partners how to perform reflexology on patients with metastatic cancer pain in the hospital, resulting in an immediate decrease in pain intensity and anxiety; minimal changes were seen in the control group, who received usual care plus attention.

IMPLICATIONS FOR NURSING

Hospitals could have qualified professionals offer reflexology as a complementary therapy and teach interested partners the modality.

Anxiety sensitivity and pain: generalisability across noxious stimuli

Anxiety sensitivity, a fear of anxiety-related symptoms, has been associated with a heightened experience of pain, especially within women. The majority of experimental studies investigating this association have relied heavily on the cold pressor technique as a means of pain induction, limiting the generalisability of results. The aim of the current study was to extend previous research by using two types of pain stimuli (cold and heat) to determine whether the link between anxiety sensitivity and pain generalises beyond cold pressor pain. The pain experience of 125 participants in response to these stimuli was assessed using threshold and tolerance readings, as well as subjective pain ratings. Results indicated a positive association between anxiety sensitivity and subjective pain, with this association observed primarily in females. Although analysis also indicated a basic generalisability of results across pain stimuli, anxiety sensitivity effects appeared to be especially pronounced during heat stimulation. These findings suggest that those high in anxiety sensitivity may respond more negatively to specific types of pain. Possible implications along with suggestions for future research are discussed.

Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures meeting

BACKGROUND/OBJECTIVES

To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials.

DATA SOURCES

Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006.

STUDY SELECTION

The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations.

DATA EXTRACTION

After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator.

DATA SYNTHESIS

Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use.

CONCLUSIONS

A 0-10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination.

Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis

The translation of existing pain measurement scales is considered important in producing internationally comparable measures for evidence based practice. In measuring the pain experience, the short-form of McGill's pain questionnaire (SF-MPQ) is one of the most widely used and translated instruments. The purpose of this study was to examine whether the Turkish version of the SF-MPQ is a valid and reliable tool to assess pain and to be used as a clinical and research instrument. Translation retranslation of the English version of the SF-MPQ was done blindly and independently by four individuals and adapted by a team. Eighty-nine rheumatological patients awaiting control by a rheumatologist were assessed by the Turkish version of the SF-MPQ in the morning and in the afternoon of the same day. Internal consistency was found adequate at both assessments with Cronbach's alpha 0.705 for test and 0.713 for retest. For reliability of the total, sensory, affective, and evaluative total pain intensity, high intraclass correlations were demonstrated (0.891, 0.868, 0.716, and 0.796, respectively). Correlation of total, sensory and affective score with the numeric rating scale was tested for construct validity demonstrating r = 0.637 (p < 0.001) for test and r = 0.700 (p < 0.001) for retest. Correlation with erythrocycte sedimentation rates for concurrent validity was found to be r = 0.518 (p < 0.001) for test and r = 0.497 (p < 0.001) for retest. The results of this study indicate that the Turkish version of the SF-MPQ is a reliable and valid instrument for the measurement of pain in Turkish speaking patients with rheumatoid arthritis.

Predictors of self-rated health in patients with chronic nonmalignant pain

Self-rated health (SRH) is an important outcome measure that has been found to accurately predict mortality, morbidity, function, and psychologic well-being. Chronic nonmalignant pain presents with a pattern that includes low levels of power and high levels of pain, depression, and disability. Differences in SRH may be related to variations within this pattern. The purpose of this analysis was to identify determinants of SRH and test their ability to predict SRH in patients with chronic nonmalignant pain. SRH was measured by response to a single three-option age-comparative question. The Power as Knowing Participation in Change Tool, McGill Pain Questionnaire Short Form, Center for Epidemiological Studies Depression Scale, and Pain Disability Index were used to measure independent variables. Multivariate analysis of variance revealed significant differences (p = .001) between SRH categories on the combined dependent variable. Analysis of variance conducted as a follow-up identified significant differences for power (p < .001) and depression (p = .003), but not for pain or pain-related disability; and discriminant analysis found that power and depression correctly classified patients with 75% accuracy. Findings suggest pain interventions designed to improve mood and provide opportunities for knowing participation may have a greater impact on overall health than those that target only pain and disability.

Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia

OBJECTIVES

(1) To investigate the effects of a 6-week intervention of guided imagery on pain level, functional status, and self-efficacy in persons with fibromyalgia (FM); and (2) to explore the dose-response effect of imagery use on outcomes.

DESIGN

Longitudinal, prospective, two-group, randomized, controlled clinical trial.

SETTING AND SUBJECTS

The sample included 48 persons with FM recruited from physicians' offices and clinics in the mid-Atlantic region.

INTERVENTION

Participants randomized to Guided Imagery (GI) plus Usual Care intervention group received a set of three audiotaped guided imagery scripts and were instructed to use at least one tape daily for 6 weeks and report weekly frequency of use (dosage). Participants assigned to the Usual Care alone group submitted weekly report forms on usual care.

MEASURES

All participants completed the Short-Form McGill Pain Questionnaire (SF-MPQ), Arthritis Self- Efficacy Scale (ASES), and Fibromyalgia Impact Questionnaire (FIQ), at baseline, 6, and 10 weeks, and submitted frequency of use report forms.

RESULTS

FIQ scores decreased over time in the GI group compared to the Usual Care group (p = 0.03). Ratings of self-efficacy for managing pain (p = 0.03) and other symptoms of FM also increased significantly over time (p = < 0.01) in the GI group compared to the Usual Care group. Pain as measured by the SF-MPQ did not change over time or by group. Imagery dosage was not significant.

CONCLUSIONS

This study demonstrated the effectiveness of guided imagery in improving functional status and sense of self-efficacy for managing pain and other symptoms of FM. However, participants' reports of pain did not change. Further studies investigating the effects of mind-body interventions as adjunctive self-care modalities are warranted in the fibromyalgia patient population.

Neuropsychologic functioning and health status in systemic lupus erythematosus: does ethnicity matter?

BACKGROUND

Despite increased severity of lupus in blacks, including more frequent neuropsychiatric manifestations, there is sparse data on neuropsychologic function in black patients with lupus.

METHODS

Neuropsychologic functioning and health-related variables were examined among blacks (n = 34) and whites (n = 14) fulfilling American College of Rheumatology criteria for systemic lupus erythematosus.

RESULTS

Blacks and whites performed comparably on measures of verbal and visual memory, working memory, and motor speed after controlling for estimates of premorbid cognitive ability. Blacks trended towards poorer performance on specific attention/processing speed measures. Pain, fatigue, depression, anxiety, physical and emotional well-being were unrelated to ethnicity. Blacks exhibited a trend towards greater impairment of physical functioning. Ethnicity-related differences in overall damage, noncognitive neuropsychiatric manifestations, and prevalence of nephritis revealed greater severity among blacks.

CONCLUSIONS

Initial differences in premorbid cognitive function possibly contribute to disparate clinical outcomes, including a greater proportion of blacks exhibiting subnormal neurocognitive performance. Blacks evidencing lower premorbid ability may be at greater vulnerability for poorer functional outcomes (eg, coping skills, medical compliance and employment) if they experience disease-related cognitive dysfunction.

The Intersection Between Geriatrics and Palliative Care: A Call for a New Research Agenda

Palliative care is interdisciplinary treatment focused on the relief of suffering and achieving the best possible quality of life for patients and their caregivers. It differs for geriatric patients from what is usually appropriate in a younger population because of the nature and duration of chronic illness during old age. In spite of the fact that death occurs far more commonly in older people than in any age group, the evidence base for palliative care in older adults is sparse. Over the coming years, the research foci in the field of geriatrics and palliative care that must be addressed include establishing the prevalence of symptoms in patients with chronic disease; evaluating the association between treatment of symptoms and outcomes; increasing the evidence base for treatment of symptoms; understanding psychological well-being, spiritual well-being, and quality of life of patients and elucidating and alleviating sources of caregiver burden; reevaluating service delivery; adapting research methodologies specifically for geriatric palliative care; and increasing the number of geriatricians trained as investigators in palliative care research. This article discusses specific methods to improve the current situation within each of these seven areas.

The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population

This study sought to better understand the relationship between religion/spirituality and physical health and mental health in 122 patients with chronic musculoskeletal pain. The current study conceptualized religion/spirituality as a multidimensional factor, and measured it with a new measure of religion/spirituality for research on health outcomes (Brief Multidimensional Measure of Religion/Spirituality). Pain patients' religious and spiritual beliefs appear different than the general population (e.g. pain patients feel less desire to reduce pain in the world and feel more abandoned by God). Hierarchical multiple regression analyses revealed significant associations between components of religion/spirituality and physical and mental health. Private religious practice (e.g. prayer, meditation, consumption of religious media) was inversely related to physical health outcomes, indicating that those who were experiencing worse physical health were more likely to engage in private religious activities, perhaps as a way to cope with their poor health. Forgiveness, negative religious coping, daily spiritual experiences, religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status. Religion/spirituality was unrelated to pain intensity and life interference due to pain. This study establishes relationships between religion/spirituality and health in a chronic pain population, and emphasizes that religion/spirituality may have both costs and benefits for the health of those with chronic pain.

Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia

Object

There are various surgical treatment alternatives for trigeminal neuralgia (TN), but there is no single scale that can be used uniformly to assess and compare one type of intervention with the others. In this study the objectives were to determine factors associated with pain control, pain-free survival, residual pain, and recurrence after gamma knife surgery (GKS) treatment for TN, and to correlate the patients' self-reported quality of life (QOL) and satisfaction with the aforementioned factors.

Methods

Between the years 2000 and 2004, the authors treated 81 patients with medically refractory TN by using GKS. Fifty-two patients responded to a questionnaire regarding pain control, activities of daily living, QOL, and patient satisfaction.

The median follow-up duration was 16.5 months. Twenty-two patients (42.3%) had complete pain relief, 14 (26.9%) had partial but satisfactory pain relief, and in 16 patients (30.8%) the treatment failed. Seven patients (13.5%) reported a recurrence during the follow-up period, and 25 (48.1%) reported a significant (> 50%) decrease in their pain within the 1st month posttreatment. The mean decrease in the total dose of pain medication was 75%. Patients' self-reported QOL scores improved 90% and the overall patient satisfaction score was 80%.

Conclusions

The authors found that GKS is a minimally invasive and effective procedure that yields a favorable outcome for patients with recurrent or refractory TN. It may also be offered as a first-line surgical modality for any patients with TN who are unsuited or unwilling to undergo microvascular decompression.

Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery

Background

Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain.

Methods

A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered.

Results

There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance.

Conclusion

This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain.

Item analysis of cancer patient responses to the Multidimensional Affect and Pain Survey demonstrates high inter-item consistency and discriminability and determines the content of a short form

To construct a short form (SMAPS-CP), item analysis was used to select 30 items, 1 from each of the 30 subclusters in the 101-item Multidimensional Affect and Pain Survey (101-MAPS). Representation of each of the subclusters ensured that the structure of the MAPS dendrogram obtained by cluster analysis was maintained in SMAPS-CP. Responses of outpatients with cancer to the 101-MAPS were treated by item analysis to obtain measures of interitem consistency (criterion between .40 and .80) and discriminability (criterion above .35) for each of the 101-MAPS questions. Both of these criteria for acceptance were met by 53 of the 57 questions in Supercluster I, Somatosensory Pain, by 25 of the 26 questions in Supercluster II, Emotional Pain, and by all 18 of the questions in Supercluster III, Well-being. The item within each cluster that best met the item analysis criteria was selected for the 30-item SMAPS-CP questionnaire.

PERSPECTIVE

Item analysis of responses by cancer patients to a 101-item questionnaire was used to develop a short questionnaire that can be used to identify and treat both physical and emotional levels of pain without the burden of a long questionnaire.

Test-Retest Reliability of the Short-Form McGill Pain Questionnaire

OBJECTIVES

No previous study has adequately demonstrated the test-retest reliability of the Short-Form McGill Pain Questionnaire, yet it is increasingly being used as a measure of pain. This study evaluates the test-retest reliability in patients with osteoarthritis.

METHODS

A prospective, observational cohort study was undertaken using serial evaluation of 57 patients at 2 time points. A sample of patients awaiting primary hip or knee joint replacement surgery were recruited in clinic or via mail (mean age 64.8 years). Short-Form McGill Pain Questionnaires were delivered by mail 5 days apart, and a supplementary questionnaire was completed on the second occasion to explore if the patients' pain report had remained stable.

RESULTS

The intraclass correlation coefficient was used as an estimate of reliability. For the total, sensory, affective, and average pain scores, high intra-class correlations were demonstrated (0.96, 0.95, 0.88, and 0.89, respectively). The current pain component demonstrated a lower intraclass correlation of 0.75. The coefficient of repeatability was calculated as an estimation of the minimum metrically detectable change. The coefficients of repeatability for the total, sensory, affective, average, and current pain components were 5.2, 4.5, 2.8, 1.4 cm, and 1.4, respectively.

DISCUSSION

Problems of adequate completion of the Short-Form McGill Pain Questionnaire were highlighted in this sample, and supervision via telephone contact was required. Patients recruited in clinic who had practiced completing the Short-Form McGill Pain Questionnaire demonstrated fewer errors than those recruited by mail. The Short-Form McGill Pain Questionnaire was demonstrated to be a highly reliable measure of pain. These results should not be generalized to a more elderly population, as increasing age was correlated with greater variability of the sensory component scores.

Self-administered nitrous oxide for the management of incident pain in terminally ill patients: a blinded case series

The treatment of incident pain in terminally ill cancer patients receiving long-term opioid therapy remains a challenge. Self-administered inhaled nitrous oxide has been used for short-term analgesia in this setting, with mixed results. It is unclear whether nitrous oxide exhibits cross-tolerance with opioids, and there is the possibility of a strong placebo effect in previous unblinded reports. We report on a double-blind crossover case series, in which seven patients received either nitrous oxide/oxygen or a placebo air/oxygen mixture on each day of a two-day trial. Outcome indices were obtained before, during and after each use of the gas for anticipated incident pain. The patient population was very heterogeneous with respect to disease, pain scores and concurrent treatments. Nitrous oxide was beneficial during incidents in five of seven patients; the remaining two patients reported an overall preference for the nitrous oxide day. We conclude that a trial of self-administered inhaled nitrous oxide should be considered in patients with difficult incident pain.

Electronic pain questionnaires: a randomized, crossover comparison with paper questionnaires for chronic pain assessment

Electronic questionnaires for pain assessment are becoming increasingly popular. There have been no published reports to establish the equivalence or psychometric properties of common pain questionnaires administered via desktop computers. This study compared responses to paper (P) and touch screen electronic (E) versions of the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain Disability Index (PDI), while examining the role of computer anxiety and experience, and evaluating patient acceptance. In a randomized, crossover design 189 chronic pain patients completed P and E versions of the SF-MPQ and PDI, and self-ratings of anxiety, experience, relative ease and preference. Psychometric properties were highly similar for P and E questionnaires. For the SF-MPQ, 60% or more of subjects gave equivalent responses on individual descriptors and PPI scale, with 80% rating within +/-1 point for an 11-point VAS. Correlations for the SF-MPQ scales ranged from 0.68 to 0.84. For the PDI, 60% or more of subjects responded within +/-1 point on individual questions, and the total score correlation was 0.67. Comparison of mean difference scores revealed no significant differences between modes for any of the questionnaire items or scores. Anxiety and experience scores showed no significant associations through correlations and high/low comparisons. Although nearly half of subjects reported no computer training, anxiety ratings were low, and considerably more subjects rated the E questionnaires as easier and preferred. Findings are consistent with test-retest reliability data, and support the validity and acceptance of electronic versions of the SF-MPQ and PDI.

Differentiating sensory and affective-sensory pain descriptions in patients undergoing magnetic resonance imaging for persistent low back pain

The study design is a cross-sectional survey with psychometric analysis. The objective is to determine the validity of a modified version of the Short-Form McGill Pain Questionnaire (SF-MPQ). The SF-MPQ has been widely used to differentiate between reports of sensory and affective pain. The validity of this instrument to reflect independence between these constructs remains unclear. The SF-MPQ, the Roland-Morris Questionnaire (RM) and a measure of current pain intensity were completed by 373 patients undergoing lumbar magnetic resonance imaging (MRI). Four hypothesized factor structures for the SF-MPQ (three 2-factor and one 1-factor solution) were tested using confirmatory factor analysis. A modified 2-factor solution (MSF-MPQ) containing 3 items labeled sensory and 5 items labeled affective-sensory had the best degree of fit. Correlations between factors were substantially lower for the modified 2-factor solution (0.48) than for previously described 2-factor solutions (0.88 and 0.92) indicating a higher degree of independence between these factors. Correlations with measures of pain intensity and the RM were significant, but slightly lower, for the subscales of the modified 2-factor solution (0.26-0.40) than for the subscales of the previously described 2-factor solutions (0.34-0.45). The MSF-MPQ can be used as a brief tool to differentiate the language used to describe pain in patients who are undergoing lumbar MRI. The evidence indicates that this clinical tool can be used to categorize how these patients describe their pain and potentially may be very valuable in determining the optimal course of treatment.

Defining dignity in terminally ill cancer patients: A factor-analytic approach

The construct of 'dignity' is frequently raised in discussions about quality end of life care for terminal cancer patients, and is invoked by parties on both sides of the euthanasia debate. Lacking in this general debate has been an empirical explication of 'dignity' from the viewpoint of cancer patients themselves. The purpose of the present study was to use factor-analytic and regression methods to analyze dignity data gathered from 213 cancer patients having less than 6 months to live. Patients rated their sense of dignity, and completed measures of symptom distress and psychological well-being. The results showed that although the majority of patients had an intact sense of dignity, there were 99 (46%) patients who reported at least some, or occasional loss of dignity, and 16 (7.5%) patients who indicated that loss of dignity was a significant problem. The exploratory factor analysis yielded six primary factors: (1) Pain; (2) Intimate Dependency; (3) Hopelessness/Depression; (4) Informal Support Network; (5) Formal Support Network; and (6) Quality of Life. Subsequent regression analyses of modifiable factors produced a final two-factor (Hopelessness/Depression and Intimate Dependency) model of statistical significance. These results provide empirical support for the dignity model, and suggest that the provision of end of life care should include methods for treating depression, fostering hope, and facilitating functional independence.

Menstrual Pain Intensity, Coping, and Disability: The Role of Pain Catastrophizing

OBJECTIVE

Menstrual pain or primary dysmenorrhea has not received much attention in the field of pain research. Little is understood about the effects menstrual pain has on the women who experience it. No studies to date have examined the cognitive factors related to the perceived intensity and coping of menstrual pain. To investigate these areas further, this study examined the associations between pain catastrophizing and how women perceive and cope with menstrual pain.

DESIGN

A prospective and retrospective between-subjects study.

PARTICIPANTS

Ninety-three undergraduate women, with a regular menstrual period and no preexisting pain disorder (e.g., endometriosis) that affects menstrual pain, were classified into high or low pain catastrophizing groups.

OUTCOME MEASURES

Participants completed several self-reported questionnaires assessing pain catastrophizing, menstrual pain intensity, coping, and disability.

RESULTS

High pain catastrophizers, in comparison with low pain catastrophizers, reported greater menstrual pain intensities, greater affective menstrual pain intensity, greater variability in the use of pain coping strategies, lower perceived effectiveness of over-the-counter medications and nonmedical pain coping strategies, and greater disability.

CONCLUSIONS

The results extend our knowledge about the associations between pain catastrophizing and menstrual pain, reemphasize that pain experience is best viewed as a multidimensional construct, and have implications for the management of menstrual pain.

The measurement of leg ulcer pain: identification and appraisal of pain assessment tools

OBJECTIVE

To identify and compare the psychometric, clinical sensibility, and pain-specific properties of leg ulcer pain assessment tools for use as a guide for clinicians and researchers.

DESIGN

Pain assessment tools were selected for appraisal based on 4 inclusion criteria: (1) designed specifically to measure either quality and/or intensity of pain, (2) used in at least 2 different diseases and/or pain-inducing interventions in adults, (3) generic, and (4) patient self-reporting. The tools were appraised against psychometric properties, clinical sensibility attributes, and pain-specific issues. Two reviewers independently reviewed each abstract, with a third reviewer resolving any disagreements. Then the first 2 reviewers independently assessed the selected tools using the predetermined appraisal criteria.

RESULTS

Of 54 identified pain assessment tools, 5 (the pain ruler, the numerical rating scale, the visual analogue scale, the verbal descriptor scale, and the short-form McGill Pain Questionnaire) met the inclusion criteria. Each tool met the appraisal criteria to varying degrees.

CONCLUSIONS

The use of a pain assessment tool to measure leg ulcer pain is recommended. Clinicians must decide independently which factors are most important when selecting a tool. Although a specific pain assessment approach cannot yet be recommended, a 2-step pain assessment process is most practical. To optimize pain management, further study is needed to ensure that leg ulcer pain is accurately and reliably assessed.

Pain and quality of life after surgery for breast cancer

BACKGROUND

In breast cancer (BC) patients, conservative surgery (CS) followed by irradiation or immediate breast reconstruction (IBR) after modified radical mastectomy (MRM) has been proposed in the attempt to avoid the negative impact of MRM on feminine body image. Regardless of the type of operation, BC patients may feel pain even without recurrent disease with poor adjustment in terms of quality of life (QL).

METHODS

We adopted a questionnaire comprising the short form of the McGill Pain questionnaire, and a previously validated questionnaire able to identify four subscales exploring physical well-being, physical autonomy, relational life and psychological well-being. The questionnaire was mailed in 1999 to a consecutive series of 757 (CS: 481 cases; MRM + IBR with skin expander: 93 cases; MRM: 183 cases) disease-free patients treated for BC between March 1995 and March 1998.

RESULTS

The final analysis assessed the data relating to 529 patients who underwent axillary dissection. Pain was reported by 39.7% of women with higher incidence in patients who underwent CS than in those who underwent MRM +/- IBR, but this difference did not reach statistical significance (p = 0.07). The only statistically significant difference (p < 0.05) between the surgical groups was the pain appearance that occurred earlier in the CS patients and later in the MRM + IBR patients. No other differences were observed. The women with pain had significantly worse QL scores on all of the subscales than those without.

CONCLUSION

Pain after surgery for BC distress almost one-third of patients, regardless of the type of treatment, and had a negative effect on patients' QL. The different surgical procedures may marginally influence the quantitative characteristics of pain.

Venous leg ulcer pain and its characteristics

This study investigated the prevalence, severity and characteristics of pain associated with venous leg ulceration. Sixty-five patients suffering with venous leg ulceration were randomised to one of three treatment groups over a 12-week treatment period. All patients received short-stretch compression bandaging. Data were collected by use of a visual analogue scale and the McGill Pain Questionnaire. Seventy per cent of patients reported pain on entry to the study and within 2 weeks of effective treatment initial pain was dramatically reduced. Patients typically described their pain as throbbing, sharp, itchy, sore and tender. The affective nature of pain was often described as tiring and patients evaluated their pain as being annoying and nagging. This study highlights the importance of pain associated with venous leg ulceration.

Reliability characteristics of the Donovan spinal cord injury pain classification system

OBJECTIVE

To determine the interrater reliability of the Donovan system for classification of pain in spinal cord injury (SCI) as well as the clinician-based usefulness of each of the classification criteria used in the Donovan system.

DESIGN

Information pertinent to the Donovan system was provided incrementally by videotape for each pain site. After each additional piece of information, the 3 raters classified the pain site into 1 of 5 types and gave a confidence rating (5-point Likert scale) regarding the accuracy of their classifications. Thus, each pain site was classified 6 separate times, each with an associated confidence rating.

SETTING

Academic rehabilitation hospital.

PARTICIPANTS

Twenty-eight persons with traumatic onset SCI reported 60 pain sites.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The short-form McGill Pain Questionnaire.

RESULTS

Interrater agreement ranged from 50% to 70%. Interrater agreement did not change as additional information was provided. In contrast, confidence ratings significantly increased as additional information was provided.

CONCLUSIONS

There was considerable variability between raters using the Donovan system for classifying SCI pain. Additional clinical information increased the rater's confidence in the accuracy of their ratings but did not improve interrater agreement.

Pain classification following spinal cord injury: the utility of verbal descriptors

OBJECTIVES

To determine the predictive utility of verbal descriptors to distinguish between pain types following spinal cord injury (SCI).

DESIGN

Cross-sectional.

SETTING

USA.

METHODS

Participants (n=29) completed the Short Form - McGill Pain Questionnaire (SF-MPQ) for each pain site reported. A total of 64 pain sites were reported with 80% of the sample reporting multiple pain sites. Each pain site was categorized using three different SCI pain classification schemes. The predictive utility of verbal descriptors to distinguish between pain types was examined statistically using (1) each word separately, (2) a combination of words (ie, the SF-MPQ total subscales, the number of words chosen on each scale), and (3) discriminant function analysis.

RESULTS

There was a substantial overlap in the use of verbal descriptors across pain types. Few differences across pain types were found for endorsement of individual words, and differences across pain types were not found for any of the word combination scores. The majority of the verbal descriptors did not enter the step-wise discriminant functions for each SCI pain classification scheme, however, 'tingling' and 'aching' showed modest predictive utility for neuropathic and musculoskeletal pain, respectively. Correct classification was in the low range (ie, 39% to 82%, average=60%, with a 33% chance level). All three pain classification schemes showed the same general pattern of results.

CONCLUSION

In general, verbal descriptors alone offered marginal utility with regard to identifying specific pain types following SCI. Future directions alone and implications are discussed.

Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care

An Expert Working Group was convened under the auspices of the Steering Committee of the Research Network of the European Association of Palliative Care to review the status of the use of pain measurement tools (PMTs) in palliative care research conducted in a multilingual-multicenter setting. Based on a literature review and on the experts' opinion, the present work recommends that standardized methods should be applied for the use of PMTs in research in palliative care. Visual analogue scales, numerical rating scales, and verbal rating scales are considered valid to assess pain intensity in clinical trials and in other types of studies. Among the multidimensional questionnaires designed to assess pain, the McGill Pain Questionnaire and Brief Pain Inventory are valid in many multilingual versions. Specific recommendations for PMT use and administration, depending on the study type and aim, are reviewed. Special population requirements specific of clinical situations encountered in palliative care (elderly, terminal, cognitively impaired patients, pediatric patients) are also considered.

Quality-of-life assessment in palliative care

Success in oncology has traditionally been measured in terms of cure, survival, and tumour response. However, more recently, health-related quality of life has emerged as an important outcome, particularly in the palliation setting. We review published randomised studies from two areas in palliation: those assessing the effectiveness of palliative care programmes and those looking at the effects of palliative chemotherapy compared with best supportive care. In the latter studies, there was an improvement in research methods between the late 1980s and 2000, owing to the use of standardised instruments, specification of endpoints, and improvements in data presentation and interpretation. A range of health-related quality-of-life instruments were used in the studies, which makes comparisons difficult. This was particularly true of the palliative-care programmes. Attrition due to the death of patients in the study groups was also a problem and needs to be taken into account in study planning and design, as well as in data collection. A common standard for scoring health-related quality of life measurements both within and between instruments would improve the interpretation of findings and their clinical application, thereby giving them greater effect on clinical decision-making.

Factorial validity of the short-form McGill pain questionnaire (SF-MPQ)

Although widely used, there have been few investigations of the factorial validity of the short-form McGill Pain Questionnaire (SF-MPQ; Melzack, 1987). Confirmatory factor analysis was performed on item responses to the SF-MPQ obtained from 188 patients with chronic back pain. Consistent with the original structure proposed by Melzack (1987), results indicated that the SF-MPQ is best represented by a two-factor solution. However, these findings are contrary to results obtained by Burckhardt and Bjelle (1994) who, using their Swedish version of the SF-MPQ, obtained a three-factor solution. Potential explanations for the disparity between the results of the two studies are explored and recommendations for continuing clinical and research applications are offered.

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.

The percentage improvement in Pain Scale as a measure of physiotherapy treatment effects

Change in pain is a useful outcome to determine the effectiveness of physiotherapy with many musculoskeletal conditions but is difficult to measure due to the subjective, multidimensional nature of pain and the time taken for measurement. The purpose of this study was to look at the validity and reliability of a quick, easy to administer verbal percentage change in pain rating scale. Thirty-eight subjects had a Short Form McGill Pain Questionnaire (SFMPQ) administered both prior to initial assessment and at their last treatment session. They were also asked to rate their change expressed as a percentage. Good correlations were shown between the percentage change in pain score and all components of the SFMPQ except the affective component. Inter-rater reliability was also very high. In conclusion, the Percentage Improvement in Pain Scale (PIPS) has been shown to be a reliable and valid outcome measure compared to the SFMPQ. The PIPS provides a quick and reliable alternative to the SFMPQ.

Testing a preoperative pain management intervention for elders

The investigators examined whether elders who have been taught pain management communication skills and pain management information obtain greater postoperative pain relief than elders not taught this information. Thirty-one elders were randomly assigned preoperatively to a control or communication group in this posttest-only experiment with repeated measures. Communication group participants were taught pain management, pain communication skills, and the use of two pain-intensity scales. Control group participants were taught to use the two pain-intensity scales. Pain was measured with the McGill Pain Questionnaire Short Form. The communication group elders reported less postoperative pain over the course of their hospital stay. Pain management knowledge alone may have enabled the elders to obtain greater pain relief. Nurses may want to incorporate similar pain management information and pain communication skills when teaching elders how to obtain greater postoperative pain relief.

Reliability and sensitivity measures of the Greek version of the short form of the McGill Pain Questionnaire

The translation of existing healthcare measurement scales is considered a feasible, efficient and popular approach to produce internationally comparable measures. The short form of the McGill Pain Questionnaire is one of the most widely used and translated instruments to measure the pain experience. The Greek version of the short form of the McGill Pain Questionnaire (GR-SFMPQ) has recently been developed and demonstrated satisfactory levels of internal consistency. The objective of the present study was to assess the instrument's reliability and sensitivity.Eighty patients with spinal or knee pain were included. The test-retest reliability of the instrument was estimated for measurements within the same day and after 15 days. The sensitivity of the measure was examined before and after the application of a physiotherapy therapeutic regime. The correlation coefficients (Intraclass Correlation Coefficient and Spearman's) ranged from 0.87-0.98 for within-day measurements and from 0.70-0.92 for administrations between days. All indexes of the GR-SFMPQ (total score, sensory and affective scores, total count of used words, visual analogue score, present pain index) managed consistently to detect the changes in pain experienced (p<0.05), after a therapeutic intervention, when assessing for the sensitivity of the questionnaire. An explorative discriminant analysis of the GR-SFMPQ indexes managed to correctly classify up to 85% of the patients; a classification rate comparable to the full version MPQ rating capacity. It can be argued from the results of this study that the Greek version of the SFMPQ fulfils the criteria of reliability and sensitivity to fluctuations of pain and can be utilized with confidence in cross-cultural comparative research trials.

Minimally invasive technique for sural nerve harvesting: technical description and follow-up

OBJECTIVES

To provide instruction and the results of a minimally invasive technique for sural nerve harvesting in preparation for interposition nerve grafting during radical retropubic prostatectomy.

METHODS

Twelve men underwent nerve harvesting performed using a tendon stripper. The short-form McGill Pain Questionnaire was completed preoperatively and at 6 months postoperatively.

RESULTS

No significant morbidity from the leg resulted as a result of the sural nerve harvest. The results of the short-form McGill Pain Questionnaire demonstrated no significant sensory or affective changes in the leg. The average operative time for the entire harvesting procedure, including skin closure, was 15 minutes. The estimated blood loss was less than 5 mL (range 2 to 10). No wound infection or skin erythema was observed. The discharge to home was not delayed compared with the usual length of stay after radical retropubic prostatectomy.

CONCLUSIONS

This minimally invasive sural nerve harvesting technique is easy to perform and has minimal morbidity.

The development and validation of a Greek version of the short-form McGill Pain Questionnaire

BACKGROUND

The short form of the McGill Pain Questionnaire (SFMPQ) is a widely used instrument for assessing the quality of pain where use of the full form is not possible. To date however, this instrument has not been translated into the Greek language.

AIMS

It is the aim of this study to validate an adopted Greek version of the short form of the McGill Pain Questionnaire.

METHODS

A systematic translation procedure was followed before development of the final version. Sixty spinal and osteoarthritis chronic musculoskeletal pain patients completed the questionnaire. A large percentage of the subjects (43%) was of elementary educational level.

RESULTS

The analysis of the results indicated that an internally consistent (Cronbach's alpha = 0.71) and content valid (all 15 descriptors were used at least by the 33% of the subjects) instrument has been developed. It has been shown to be suitable, easy to understand and administer for this sample of chronic musculoskeletal patients.

CONCLUSIONS

A Greek version of the SFMPQ (the GR-SFMPQ) has been constructed which has the properties of internal validity and consistency. It is easy to administer, easy to understand even for an elementary educational level and it is capable of describing multidimensionally the pain experience of chronic musculoskeletal pain patients.

The impact of nurses' empathic responses on patients' pain management in acute care

BACKGROUND

Although nurses have the major responsibility for pain management, little is known about nurses' responses to patients in the process of managing acute pain.

OBJECTIVE

To examine the relationship between nurses' empathic responses and their patients' pain intensity and analgesic administration after surgery.

METHODS

Two hundred twenty-five patients from four cardiovascular units in three university-affiliated hospitals were interviewed on the third day after their initial, uncomplicated coronary artery bypass graft (CABG) surgery about their pain and current pain management. Concurrently, their nurses' (n = 94) empathy and pain knowledge and beliefs were assessed. Patient data were aggregated and linked with the assigned nurse to form 80 nurse-patient pairs.

RESULTS

Nurses were moderately empathic, and their responses did not significantly influence their patients' pain intensity or analgesia administered. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurse's attention to their pain were not positive, and empathy explained only 3% of variance in patients' pain intensity. Deficits in knowledge and misbeliefs about pain management were evident for nurses independent of empathy, and knowledge explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain inservice education for nurses.

CONCLUSIONS

Empathy was not associated with patients' pain intensity or analgesic administration.

Communicating pain and pain management needs after surgery

This descriptive study explored how patients communicate their pain and pain management needs after surgery. Thirty postoperative patients were interviewed. The majority described avoiding or delaying communicating their pain at some point during their hospitalization. Reasons for decreased pain communication included not wanting to complain; not wanting to take the provider away from other patients; avoiding unpleasant analgesic side effects; and not wanting to take "drugs." Postoperative patients may be unclear about their role in pain management. Pain management communication problems identified in this study could be used to design intervention studies to improve pain communication and consequent pain relief.

A comparison of patient and proxy symptom assessments in advanced cancer patients

The purpose of this study was to compare patient and proxy (physician and nurse) assessments of symptoms in advanced cancer patients. The sample consisted of 49 patients with advanced cancer admitted to an acute palliative care unit. Three independent assessments were completed for each patient on two occasions within 11 days of admission. On each occasion, symptoms were rated independently by the patient and two proxies (treating physician and nurse), using the Edmonton Symptom Assessment System (ESAS). The ESAS is a nine-item visual analogue scale (VAS) for assessing pain, activity, nausea, depression, anxiety, drowsiness, appetite, well-being and shortness of breath. Symptom ratings were compared using a repeated-measures ANOVA procedure and correlations. Average physician ratings were generally lower than average patient ratings for both occasions. Average nurse ratings agreed more closely with patient ratings, with a trend towards lower ratings on occasion 1 and higher ratings on occasion 2. There was a significant rater (person rating the effects) effect (P < 0.01) for three of the nine symptoms: physicians rated drowsiness, shortness of breath and pain significantly lower than patients. For drowsiness and shortness of breath, these differences were clinically relevant, representing a difference of more than 12 mm on a 100-mm VAS. The accuracy of assessments amongst those rating the symptoms did not improve over time. Proxy assessments of symptom intensity, particularly by physicians, were significantly lower than patient assessments for three of the nine symptoms. Further research regarding the reliability of patient and proxy assessments is needed to assess and manage symptoms in advanced cancer effectively.

Measurement of pain

Pain is a personal, subjective experience influenced by cultural learning, the meaning of the situation, attention, and other psychologic variables. Approaches to the measurement of pain include verbal and numeric self-rating scales, behavioral observation scales, and physiologic responses. The complex nature of the experience of pain suggests that measurements from these domains may not always show high concordance. Because pain is subjective, patients' self-reports provide the most valid measure of the experience. The VAS and the MPQ are probably the most frequently used self-rating instruments for the measurement of pain in clinical and research settings. The MPQ is designed to assess the multidimensional nature of pain experience and has been demonstrated to be a reliable, valid, and consistent measurement tool. A short-form MPQ is available for use in specific research settings when the time to obtain information from patients is limited and when more information than simply the intensity of pain is desired. The DDS was developed using sophisticated psychophysical techniques and was designed to measure separately the sensory and unpleasantness dimensions of pain. It has been shown to be a valid and reliable measurement of pain with ratio-scaling properties and has recently been used in a clinical setting. Behavioral approaches to the measurement of pain also provide valuable data. Further development and refinement of pain measurement techniques will lead to increasingly accurate tools with greater predictive powers.

Physical and psychological morbidity after axillary lymph node dissection for breast cancer

PURPOSE

Alternatives to axillary lymph node dissection (ALND) are being developed amid controversy surrounding the therapeutic benefit and overall utility of this routine surgical procedure. Although potential negative side effects associated with ALND are known, we set out to examine whether these side effects contribute significantly to patient reports of quality of life and mental health.

PATIENTS AND METHODS

We surveyed 222 women who had received an ALND as part of breast cancer surgery. All women underwent a physical therapy assessment of range of arm/shoulder motion and completed the Modified Post-operative Pain Questionnaire, the Pain Disability Index, the McGill Pain Questionnaire (short form), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Mental Health Inventory.

RESULTS

Seventy-two percent of the women experienced arm/shoulder pain, weakness, or numbness in the week before the interview, and range of motion of the affected arm/shoulder was impaired in 73% of the women. Severity of pain was reported to be low to moderate, and younger patients experienced greater pain than older patients. Pain severity correlated positively with the number of lymph nodes removed and receipt of chemotherapy and was not significantly related to length of time since surgery or receipt of radiation therapy. Generally high levels of cancer-specific quality of life and mental health were reported. Quality of life was significantly predicted by the McGill Pain Questionnaire, and mental health was significantly predicted by the Pain Disability Index and the physical therapy assessment.

CONCLUSION

Surgery-related symptoms after ALND persist for a majority of women with breast cancer and are not significantly related to time since surgery or receipt of radiation therapy. These symptoms and associated disability are significantly predictive of cancer-specific quality of life and mental health.

Is lidocaine infiltration during femoral sheath removal really necessary?

OBJECTIVES

To compare the effectiveness of intravenous morphine sulfate to intravenous morphine sulfate plus 1% lidocaine infiltration in pain management associated with femoral sheath removal, and to evaluate pain intensity and associated complications during femoral sheath removal in patients with heart disease receiving interventional treatment.

DESIGN

Descriptive, correlational, case-control study.

SETTING

Mid-metropolitan, university-affiliated, tertiary care medical center.

SAMPLE

Fifty patients with heart disease, who had no known allergies to morphine or lidocaine and who had not had an acute myocardial infarction, admitted to the cardiovascular intervention unit.

MEASURES

Vertical visual analogue scale, short-form McGill Pain Questionnaire, and demographic tool for complications.

RESULTS

No significant differences in pain intensity, sensation, affect, and total scores were found between the analgesic regimens. Six (12%) patients had vasovagal reactions develop, but no statistical differences were found between pain intensity scores and associated complications.

CONCLUSION

Morphine sulfate does appear effective in controlling pain associated with femoral sheath removal. The benefit of lidocaine infiltration during this procedure is questionable.

Measurement issues in the comprehensive assessment of cancer pain

OBJECTIVES

To examine issues related to the assessment of pain, symptoms and functional status in patients with cancer and the timing of assessment and appropriate tools to collect this information.

DATA SOURCES

Review articles, research studies book chapters, and government guidelines pertaining to measurement issues in the assessment of cancer pain.

CONCLUSIONS

Each component of the measurement process (ie, choice of an instrument to measure pain, timing and frequency of measurement measurement of symptoms accompanying pain or its treatment, and measurement of functional status) is important in developing an accurate and comprehensive assessment of cancer pain. This comprehensive assessment is a prerequisite to effective pain management.

IMPLICATIONS FOR NURSING PRACTICE

For pain to be evaluated and treated effectively, regular consistent assessment of pain by the clinician is imperative. This comprehensive assessment allows the clinician to choose modalities most likely to work for the individual patient.