Cancer-related pain--II. Assessment with visual analogue scales

Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial

BACKGROUND

Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results.

OBJECTIVES

To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively.

METHODS

Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group.

RESULTS

There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals.

CONCLUSION

RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov identification number NCT02760212.

The Effect of Thunder-Fire Moxibustion on Lumbar Disc Herniation: Study Protocol for a Randomized Controlled Trial

Background

Lumbar disc herniation (LDH) is a common disease seen in orthopedics; it is caused by nucleus pulposus herniation. Its clinical manifestations are low back pain, radiating pain of the lower limbs, and cauda equina symptoms that seriously affect patients' quality of life. At present, oral analgesics are commonly used in the treatment of LDH; but they can produce gastrointestinal reactions and other side effects. Thunder-fire moxibustion is a method that is widely used in China to treat pain syndromes. This study aimed to design a randomized controlled trial to explore the effectiveness and safety of thunder-fire moxibustion in the treatment of lumbar disc herniation.

Methods

Ninety patients will be enrolled and randomly divided into one of two groups: the thunder-fire moxibustion group and the acetaminophen group. The thunder-fire moxibustion group will be treated with moxa sticks at BL25, GV3, BL23, and GV4; and after 15 min of local whirling moxibustion, the contralateral acupoints will be treated with moxibustion for 15 min. The study period will include two 10-day courses of treatment, for a total study duration of 20 days. The acetaminophen group participants will take one acetaminophen sustained-release tablet twice a day for the duration of the study period. In contrast, the thunder-fire moxibustion group participants will be treated with thunder-fire moxibustion every other day for 30 min. The primary outcome will be the Japanese Orthopedic Association (JOA) score. Visual analog scale (VAS) and Oswestry Disability Index (ODI) will be used as the secondary outcome measures. Adverse events (AEs) will also be recorded. Assessments will be conducted at baseline, the end of the first and second courses of treatment.

Discussion

This study will determine whether thunder-fire moxibustion is more effective and safer than acetaminophen in the treatment of patients with LDH.

Trial Registration

Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2000036079.

Adherence to Analgesics Among Outpatients Seriously Ill With Cancer

BACKGROUND

Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort.

OBJECTIVE

The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics.

METHODS

This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAIN Report It, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index.

RESULTS

The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence ( P < .001).

CONCLUSION

Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed.

IMPLICATION FOR PRACTICE

Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.

Decision regret 3 and 6 months after treatment for head and neck cancer: An observational study of associations with clinicodemographics, anxiety, and quality of life

BACKGROUND

While quality of life (QOL), psychosocial health, and adverse treatment outcomes have been studied in head and neck cancer (HNC) patients, decision regret is an important and understudied complication that can negatively impact future health care decision making.

METHODS

Data collected using a HNC patient registry with questionnaires administered at initial consultation visits plus 3 and 6 months after treatment completion was retrospectively analyzed. A visual analog anxiety scale and the University of Washington Quality of Life were given at clinic visits. Decision regret was determined using a validated scale. Demographic and clinical variables were collected retrospectively and at baseline.

RESULTS

Patients with higher anxiety and lower self-reported QOL had higher concurrent regret at 3-month (n = 140) and at 6-month (n = 82) post-treatment. Later disease stage at presentation, nonprimary surgical treatment, and lower health literacy were associated with greater regret.

CONCLUSIONS

Decision regret was highest in HNC patients with high anxiety, low QOL, and more advanced disease.

The effects of exercise and active assisted cycle ergometry in post-operative total knee arthroplasty patients - a randomized controlled trial

Purpose

The purpose of this study was to examine the effect of the use of an active assisted cycle ergometer as an adjunct to post-operative treatment following total knee arthroplasty.

Method

A total of 55 participants aged 50–80 years who had undergone unilateral total knee arthroplasty were randomly assigned to either the control group (standard of care) or the active assisted cycle ergometer (AACE) group. The effect on patient motivation, blood biomarkers, and knee pain, function, range of motion (ROM), strength, and swelling was examined. Qualitative feedback was also obtained post-operatively.

Results

Although there was no statistically significant difference in the standard of care compared to the AACE group, there was a trend for a greater reduction in knee pain on the visual analog scale, improved Lower Extremity Functional Scale scores, and knee extension ROM and strength. A greater percentage of the experimental group demonstrated higher motivation. There was no significant difference in swelling or blood biomarker measures. Qualitative feedback from the AACE group post-operatively was also positive.

Conclusions

The use of an AACE protocol as an adjunct to total knee arthroplasty rehabilitation may improve post-operative clinical outcomes. This study has been registered at clinicaltrials.gov (identifier NCT02265523, Oct 16 2014). Level of evidence: Level 1 – randomized controlled trial. Further research with a larger sample size is needed to confirm the benefits of the ergometer use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40634-021-00363-w.

The prevalence of depressive disorder and its association in Thai cervical cancer patients

PURPOSE

The purpose of this study is to examine the prevalence, associated factors and quality of life associated with depressive disorder in cervical cancer patients.

PATIENTS AND METHODS

This cross-sectional study was carried out in a gynecologic oncology clinic of a university hospital in Northern Thailand from October 2018 to August 2019. Two-hundred cervical cancer patients were screened for depressive disorder using the nine-item Patient Health Questionnaire (PHQ-9), and psychiatrists interviewed eligible patients to confirm diagnoses. We measured the quality of life using questionnaires from the European Organisation for the Research and Treatment of Cancer: Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Cervical Cancer Module 24 (EORTC QLQ-Cx24). Associated factors, including comorbidity, fatigue, and pain, were collected using the Charlson Comorbidity Index (CCI), the eleven-item Chalder Fatigue Scale (CFQ 11), and the visual analog scale (VAS) for pain, respectively.

RESULTS

Twenty-seven (13.5%) cervical cancer patients were diagnosed with depressive disorder by psychiatrists according to the DSM-5. Depressive disorder was related to a worse quality of life in these patients. A binary logistic regression analysis revealed that depressive disorder among these patients was linked with these factors: high fatigue score (aOR: 1.35; CI: 1.18-1.53), high pain score (aOR: 1.25; CI: 1.02-1.54), no perception of social support, (aOR: 3.12; CI: 1.11-8.81), and no previous surgical treatment for cervical cancer (aOR: 2.99; CI: 1.08-8.29).

CONCLUSION

The depressive disorder prevalence was 13.5% in Northern Thai cervical cancer patients. In this demographic, cervical cancer patients-who reported high fatigue or pain scores, did not perceive social support, or had no previous cervical cancer surgery- were more likely to have depressive disorder.

Quantitative-qualitative analyses of patient-reported pain response after palliative radiation therapy

PURPOSE

While the 0-10 pain scale is often used to assess treatment response, it may not accurately reflect change in pain over time. The purpose of this study is to correlate pain improvement using the 0-10 pain scale to patients' perceived improvement in pain following palliative radiation therapy (RT), and to qualitatively characterize themes of pain assessment.

METHODS

Patients age ≥ 20 receiving RT for spinal metastases were enrolled. Patients rated their pain (0-10) at the treatment site at RT start, and 1 and 4 weeks post-RT completion. At 1 and 4 weeks post-RT, patients reported their perceived percent improvement in pain (pPIP) (0-100%), which was compared to calculated percent improvement in pain (cPIP) based on the 0-10 pain scores. At 4 weeks post-RT, 20 randomly selected patients participated in a qualitative pain assessment.

RESULTS

Sixty-four patients treated at 1-2 sites were analyzed. At 1 week post-RT completion, 53.7% (36/67) reported pPIP within 10 percentage points of cPIP, 32.8% (22/67) reported pPIP > 10 percentage points higher than cPIP, and 13.4% (9/67) reported pPIP > 10 percentage points lower than cPIP. Similar degrees of discordance were seen at 4 weeks post-RT. Qualitative analysis revealed five themes: pain quality (n = 19), activities (n = 9), function (n = 7), medication use (n = 2), and radiation side effects (n = 1).

CONCLUSIONS

About half of patients reported a pPIP substantially disparate from their cPIP, and the change in pain measured by the 0-10 scale tended to underestimate the degree of perceived pain improvement. Multiple themes were identified in qualitative analysis of pain response.

A Single-Item Visual Analogue Scale (VAS) Measure for Assessing Depression Among College Students

There is an increased need for efficient, low-cost methods to collect information on a range of widely prevalent mental health outcomes in the general population that can be administered outside of clinical settings. We evaluate the validity of a single-item Visual Analogue Scale (VAS) for assessing the presence and severity of depression and compare its performance with the Patient Health Questionnaire (PHQ-9) depression scale using a large non-clinical sample (N = 1816) of college students from Switzerland. The VAS scale is strongly correlated with the PHQ-9 total score (0.61) and its 9 individual items (ranging from 0.19 to 0.67). ROC analysis shows that the VAS scale has high accuracy for detecting the presence and different levels (mild to severe) of depression corresponding to PHQ-9 cutoffs. The VAS depression scale represents a simple, easily implementable instrument that is suitable for mental health research in common settings and larger population-based studies.

Hospitalized patients quantify verbal pain intensity descriptors: methodological issues and values for 26 descriptors

Patients often tell others about their pain using their own verbal descriptors of pain intensity, but the meaning of this pain language is not universally evident, which could contribute to misinterpretation about pain severity. The study purpose was to discover the intensity values of verbal pain intensity descriptors. The 248 randomly selected inpatients used a visual analogue scale to assign a value to each of 26 pain intensity descriptors. Each participant completed 36 randomly ordered visual analogue scales, 10 of which were replications. Except for descriptors with medians close to 0 or 100 mm, there was large, across-person variability for the descriptors. For example, medians ± SD for some exemplar descriptors were no pain 0.7 ± 2.4; mild 16.2 ± 12.2; discomforting 31.3 ± 22.2; distressing 55.3 ± 24; horrible 87.8 ± 13.6; and excruciating 94.6 ± 9.3. Test-retest reliability indicated small within-person variability on scores assigned to each descriptor. Thirteen descriptors showed some statistically significant but rather small effects of presentation order. Findings contribute estimates for the magnitude of pain represented by each of the 26 descriptors. Clinicians, text data miners, and researchers should consider these values as they interpret the meaning of the descriptors that they hear in daily practice or research settings or that they find in electronic health records, email messages, or social media posts. Despite the wide variability in the magnitude of each descriptor, findings provide insights about the intensity of pain when individuals use verbal pain intensity descriptors in conversations, social media, or clinical encounters.

Research Issues in Palliative Care

Despite the recent proliferation of hospice programs and related research, a number of basic issues remain. Firstly the populations “at risk” for hospice care have not been precisely delineated. Secondly, the impact of the structure of a given hospice program on outcome has been given insufficient attention. Thirdly, assessing the impact of hospice care on quality of life has presented challenges in both definition and measurement. Finally, data relating to the costs of hospice care are difficult to evaluate. It is recommended that palliative care research focus on these areas. In addition, hospice programs and research need to be sensitive to changes over time and to dissemination of principles of hospice care.

Ropinirole Augmentation for Depression: A Randomized Controlled Trial Pilot Study

OBJECTIVE

Evidence both from animal and human studies suggests a role for dopaminergic pathways in the treatment of depression. Ropinirole, a selective agonist of dopamine D2/D3, is in use for the treatment of parkinsonism. Preliminary evidence suggests that such agonists might be useful as antidepressants. We tested whether an add-on ropinirole is an effective in depressed patients.

METHODS

We conducted a double-blind, randomized, placebo-controlled trial of add-on ropinirole in depressed patients unresponsive to at least one antidepressant. We recruited 32 unipolar and bipolar patients who remained depressed (modified 21-item Hamilton Depression Rating Scale) despite at least 4 weeks of treatment with an adequate dose of antidepressant medication. Patients received either 2 mg of oral ropinirole or placebo twice daily added on to their current medication and were evaluated weekly for 7 weeks using the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale.

RESULTS

No difference in primary or secondary outcome measures was detected between the treatment and control groups.

DISCUSSION

These results differ from previous studies and are unexpected in light of theoretical considerations. This may indicate that there are differences in pharmacological activity between ropinirole and other dopaminergic agents such as pramipexole.

Explaining Sad People's Memory Advantage for Faces

Sad people recognize faces more accurately than happy people (Hills et al., 2011). We devised four hypotheses for this finding that are tested between in the current study. The four hypotheses are: (1) sad people engage in more expert processing associated with face processing; (2) sad people are motivated to be more accurate than happy people in an attempt to repair their mood; (3) sad people have a defocused attentional strategy that allows more information about a face to be encoded; and (4) sad people scan more of the face than happy people leading to more facial features to be encoded. In Experiment 1, we found that dysphoria (sad mood often associated with depression) was not correlated with the face-inversion effect (a measure of expert processing) nor with response times but was correlated with defocused attention and recognition accuracy. Experiment 2 established that dysphoric participants detected changes made to more facial features than happy participants. In Experiment 3, using eye-tracking we found that sad-induced participants sampled more of the face whilst avoiding the eyes. Experiment 4 showed that sad-induced people demonstrated a smaller own-ethnicity bias. These results indicate that sad people show different attentional allocation to faces than happy and neutral people.

Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations

BACKGROUND

We aimed at critically appraising the clinimetric properties of existing pain scales or questionnaires and to give recommendations for their use in Parkinson's disease (PD).

METHODS

Clinimetric properties of pain scales used in PD were systematically evaluated. A scale was classified as 'recommended' if was used in PD, showed adequate clinimetric properties, and had been used by investigators other than the original developers; as 'suggested' if it was used in PD and fulfilled only one other criterion; and as 'listed' if it was used in PD but did not meet the other criteria. Only scales rating pain intensity or for syndromic classification were assessed.

RESULTS

Eleven of the 34 scales initially considered fulfilled inclusion criteria. Among the scales rating pain intensity, the "Brief Pain Inventory short form," "McGill Pain Questionnaire short and long forms," "Neuropathic Pain Symptoms Inventory," "11-point Numeric Rating Scale," "10-cm Visual Analog Scale," and "Pain-O-Meter" were "recommended with caution" because of lack of clinimetric data in PD, whereas the "King's PD Pain Scale" was "recommended." Among scales for pain syndromic classification, the "DN4" was "recommended with caution" because of lack of clinimetric data in PD; the "Leeds Assessment of Neuropathic Symptoms and Signs," "Pain-DETECT," and the "King's PD Pain Scale" were "suggested."

CONCLUSIONS

King's PD pain scale can be recommended for the assessment of pain intensity in PD. Syndromic classification of pain in PD may be achieved by the DN4, but clinimetric data in PD are needed for this scale.

Effects of Reflexology on Pain in Patients With Fibromyalgia

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

Pain Coping Profiles in Workers’ Compensation Clients with Chronic Musculoskeletal Pain: A Cluster Analysis

This study investigated pain coping profiles using theCoping Strategies Questionnaire-24(CSQ-24) in a sample of 171 workers’ compensation clients with chronic musculoskeletal pain from Canada. Cluster analysis identified three distinct coping profiles: mixed coping, catastrophising, and positive coping. Multivariate analysis of variance (MANOVA) results revealed that the positive coping group had lower levels of activity interference and depression as well as higher levels of quality of life than the mixed coping and catastrophising groups. Study findings indicate clients with chronic musculoskeletal pain can be categorised according to pain coping strategies, and pain coping strategies used are related to rehabilitation outcomes. The implications of these pain coping profiles for rehabilitation counselling practice are discussed.

Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia

AIM

The aim of this study was to evaluate the effects of guided imagery as a nursing intervention for pain management and depression in patients diagnosed with fibromyalgia.

BACKGROUND

Many studies support the use of guided imagery to improve patient outcomes. Guided imagery has been used for different purposes and it is thought to be an effective intervention for people suffering from nonmalignant pain.

DESIGN

A 2-group quasi-experimental study was conducted during 8 weeks by the University of Nursing in Almeria (Spain).

METHODS

Patients diagnosed with fibromyalgia aged 18 to 70 years (n = 60) were randomly assigned to a guided imagery group (n = 30) or a control group (n = 30). The outcomes measures were scores for pain with the McGill Pain Questionnaire long form (MPQ-LF) and the Visual Analogue Scale (VAS) and depression with the Beck Depression Inventory and the VAS for depression. The effects were examined at baseline, postintervention (4th week), and at the end of the study (8th week).

RESULTS

Treatment efficacy was analyzed by using a t test for paired samples. Temporal changes in the scores were examined by using a 2-way repeated-measures analysis of variance. The treatment group reported statistically significantly lower levels of pain (P < .046) and depression (P < .010) than the control group at the week 4 evaluation. A statistically significant effect on pain as measured by the daily VAS diary was also found in the experimental group. At week 8, no significant differences were found for pain.

CONCLUSION

Patients diagnosed with fibromyalgia may benefit from this nursing intervention in terms of relieving pain and depression. Guided imagery relaxation therapy could be incorporated as part of fibromyalgia treatment to promote health among people with fibromyalgia.

RELEVANCE TO CLINICAL PRACTICE

Guided imagery as a nursing intervention can alleviate pain and depression in patients diagnosed with fibromyalgia.

Toward patient-centered care: a systematic review of how to ask questions that matter to patients

Clinicians rarely systematically document how their patients are feeling. Single item questions have been created to help obtain and monitor patient relevant outcomes, a requirement of patient-centered care.The objective of this review was to identify the psychometric properties for single items related to health aspects that only the patient can report (health perception, stress, pain, fatigue, depression, anxiety, and sleep quality). A secondary objective was to create a bank of valid single items in a format suitable for use in clinical practice.Data sources used were Ovid MEDLINE (1948 to May 2013), EMBASE (1960 to May 2013), and the Cumulative Index to Nursing and Allied Health Literature (1960 to May 2013).For the study appraisal, 24 articles were systematically reviewed. A critical appraisal tool was used to determine the quality of articles.Items were included if they were tested as single items, related to the construct, measured symptom severity, and referred to recent experiences.The psychometric properties of each item were extracted. Validity and reliability was observed for the items when compared with clinical interviews or well-validated measures. The items for general health perception and anxiety showed weak to moderate strength correlations (r = 0.28-0.70). The depression and stress items showed good area under the receiver operating characteristic curve of 0.85 and 0.73-0.88, respectively, with high sensitivity and specificity. The fatigue item demonstrated a strong effect size and correlations up to r = 0.80. The 2 pain items and the sleep item showed high reliability (intraclass correlation coefficient [ICC] = 0.85, κ = 0.76, ICC = 0.9, respectively).The search targeted articles about psychometric properties of single items. Articles that did not have this as the primary objective may have been missed. Furthermore, not all the articles included had the complete set of psychometric properties for each item.There is sufficient evidence to warrant the use of single items in clinical practice. They are simple, easily implemented, and efficient and thus provide an alternative to multi-item questionnaires. To facilitate their use, the top performing items were combined into the visual analog health states, which provides a quick profile of how the patient is feeling. This information would be useful for regular long-term monitoring.

The efficacy of exercise therapy in reducing shoulder pain related to breast cancer: a systematic review

PURPOSE

Recent research indicates that physiotherapy interventions, such as exercise and manual therapy, may be effective in decreasing the frequency of side effects linked with breast cancer treatment, including fatigue, pain, nausea, and decreased quality of life. This systematic review aims to determine the efficacy of exercise therapy in reducing shoulder pain related to breast cancer treatment and to identify outcome measures that can be used to assess shoulder pain in this population.

METHODS

A systematic review of the current literature was conducted using portals such as the Physiotherapy Evidence Database (PEDro), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Ovid MEDLINE (1996 to April 2011), and Allied and Complementary Medicine (AMED) (1985 to April 2011). Databases were searched for relevant studies published up to April 2011. Participants in relevant studies were adults (≥18 years of age) with a primary diagnosis of breast cancer at any point during the treatment of their disease.

RESULTS

Six articles were independently appraised by two blinded reviewers. Six studies met the inclusion criteria, each analyzing different types of exercise-shoulder/arm/scapular strengthening/stabilization, postural exercises, general exercises and conditioning, shoulder range-of-motion exercises, and lymphedema exercises-with respect to their efficacy in reducing shoulder pain related to breast cancer treatment.

CONCLUSIONS

RESULTS suggest that exercise targeting shoulder pain related to breast cancer treatment may be effective. However, definitive conclusions cannot be drawn due to the lack of methodological quality and homogeneity of the studies included. Clinicians should use valid outcome measures, such as the visual analogue scale and brief pain inventory, to evaluate the effectiveness of this treatment.

Gentle Massage Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous Leukemia

OBJECTIVE

Cancer treatment is reported to be stressful, and patients diagnosed with hematologic cancers often exhibit higher levels of anxiety and emotional distress than individuals with other malignancies. Management of these symptoms in patients with hematologic cancer presents significant challenges, as many of them are in and out of the hospital while undergoing high dose chemotherapy. Oncology patients use complementary modalities such as therapeutic massage in an attempt to alleviate disease and treatment-related symptoms, including anxiety and emotional distress. In the current study, the feasibility of a novel massage intervention delivered over the continuum of care, as well as assessment of the immediate and cumulative effects of massage, was examined in patients with acute myelogenous leukemia.

METHODS

A mixed-methods, unmasked, prospective, randomized study was conducted with two groups: a usual care alone control group and a massage therapy intervention plus usual care group.

RESULTS

Significant improvements in levels of stress and health-related quality of life were observed in the massage therapy group versus the usual care alone group, after adjusting for anxiety level, including both immediate and cumulative effects of massage.

CONCLUSIONS

While the findings of the current study regarding acceptability, feasibility, and potential efficacy of therapeutic massage as a complementary health-enhancing intervention in patients diagnosed with acute myelogenous leukemia are very promising, the relatively small size of the study sample limits generalizability.

The use of transcutaneous electrical nerve stimulation (TENS) in a major cancer center for the treatment of severe cancer-related pain and associated disability

BACKGROUND

Cancer pain is difficult to treat, often requiring a multimodal approach. While medication management remains the mainstay for the treatment of cancer pain, medications are often associated with undesired side effects. Transcutaneous electrical nerve stimulation (TENS) provides a potential adjunctive method for treating cancer pain with minimal side effects.

OBJECTIVE

Few studies have been performed evaluating the efficacy of TENS on cancer pain. We sought to examine the usefulness of TENS on all cancer patients and to specifically look at the use of TENS as a goal-directed therapy to improve functionality.

DESIGN

Retrospective cohort study.

METHODS

Since 2008, patients with chronic cancer pain and on multimodal pain regimens were trialed with TENS. Those patients who showed an improvement in pain symptoms or severity were educated about and provided with a TENS unit for use at home. Pain symptoms and scores were monitored with the visual analog scale (VAS), the numerical rating pain (NRP) scale, and Short-Form McGill Questionnaire at the start of TENS treatment and at 2 months follow-up.

RESULTS

TENS proved beneficial in 69.7% of patients over the course of 2 months. In TENS responsive patients, VAS scores decreased by 9.8 on a 0-100 mm scale (P < 0.001), and NRP scores decreased by 0.8 on a 1-10 scale (P < 0.001).

LIMITATIONS

Lack of placebo and lack of blinding of physician and patient.

CONCLUSIONS

TENS provides a beneficial adjunct for the treatment of cancer pain, especially when utilized as a goal-directed therapy.

The effects of music therapy on pain in patients with neuropathic pain

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity.

Validity, reliability, and responsiveness of a digital version of the visual analog scale

The design used in this study was a prospective cohort. Pain intensity levels recorded by the digital version of the visual analog scale (VAS-D) are easy to both score and share with other health care professionals. The purpose of the study was to examine the test-retest reliability, concurrent validity, and responsiveness of the VAS-D. Thirty-three people with upper extremity injuries reported pain intensity levels before and after performing four maximal grip contractions (pre- and postgripping). Our version of the VAS-D had high test-retest reliability (r=0.96) and good concurrent validity (r=0.84-0.97) with both the paper version of the VAS (VAS-P) and the verbal numerical rating scale (NRS-V). Responsiveness of the VAS-D was indicated by a significant increase in pain levels from pre- to postgripping. Similar responsiveness to that of the VAS-P and NRS-V was indicated by similar effect size coefficients and analysis of variance of pain change scores. In conclusion, the VAS-D is a reliable, valid, and responsive measure of pain intensity for people with upper extremity injuries. However, differences in accuracy (resolution) among the VAS-D, VAS-P, or NRS-V may render the three pain scales not fully compatible.

LEVEL OF EVIDENCE

Not applicable.

Sad people are more accurate at face recognition than happy people

Mood has varied effects on cognitive performance including the accuracy of face recognition (Lundh & Ost, 1996). Three experiments are presented here that explored face recognition abilities in mood-induced participants. Experiment 1 demonstrated that happy-induced participants are less accurate and have a more conservative response bias than sad-induced participants in a face recognition task. Using a remember/know/guess procedure, Experiment 2 showed that sad-induced participants had more conscious recollections of faces than happy-induced participants. Additionally, sad-induced participants could recognise all faces accurately, whereas, happy- and neutral-induced participants recognised happy faces more accurately than sad faces. In Experiment 3, these effects were not observed when participants intentionally learnt the faces, rather than incidentally learnt the faces. It is suggested that happy-induced participants do not process faces as elaborately as sad-induced participants.

Sad people avoid the eyes or happy people focus on the eyes? Mood induction affects facial feature discrimination

Depressed people tend to avoid eye-contact in social situations and in experimental settings, whereas happy people actively seek eye-contact. We report an experiment in which participants made discriminations between faces that had either configural or featural changes made to the eyes, nose, or head shape. The results showed participants induced to be happy detected changes in eyes more often than participants induced to be sad, but failed to detect changes in other facial features. Sad-induced participants detected changes to the head shape but not the eyes. The results are interpreted in terms of differential use of features attended to by happy and sad participants, whereby happy people are more likely to attend to eyes during face perception than sad people.

A Multidimensional Model for Understanding Cancer Pain

The experience of pain pervades the physical and psychosocial domains of a patient's existence. It has a concrete underpinning in the form of an injury or disease process, yet subjective responses to pain sensations are psychosocial processes that influence the experience of pain and the capacity to cope with it. Anticipation of pain is one of the key fears associated with cancer, and uncontrolled pain strips away morale and quality of life. The interacting biopsychosocial dimensions are important areas for consideration in the comprehensive, skillful approach to assessment and treatment of cancer pain. This article addresses the interactive relationships between pain and mood using the biopsychosocial model as a heuristic for assessment.

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.

The Effects of Psychosocial Factors on Quality of Life Among Individuals With Chronic Pain

This study investigated the psychosocial factors affecting the quality of life (QOL) of 171 individuals with chronic pain. Participants completed a battery of self-rated inventories measuring three sets of predictor variables—demographic (age, gender, income, marital status), pain-specific (chronicity, severity, duration, frequency, pain impairment), and psychosocial (interference, social support, depression, coping)—and one criterion variable with five models (physical, psychological, social, environmental, total). Hierarchical multiple regression indicates that income predicts the psychological and environmental domains of QOL. Across all five models, 56% to 76% of the variance was accounted for with the three sets of variables. Demographics remained minimally predictive of all models. Pain impairment was predictive of all five models. Depression was predictive of all but physical QOL, and coping was predictive of all but physical and environmental QOL. The pain impairment variable and the two psychosocial variables (depression and coping) remained imperative in predicting QOL of individuals with chronic pain.

Depression, hopelessness, and sleep in cancer patients' desire for death

OBJECTIVE

The aim of this study was to evaluate the prevalence of clinical characteristics and risk factors for hastened death in advanced cancer patients.

METHODS

Patients completed the Greek version of Schedule of Attitudes toward Hastened Death (G-SAHD), a sleep quality measure, the Pittsburgh Sleep Quality Index (PSQI), a Greek version of a depression inventory, the Beck Depression Inventory (BDI), a hopelessness scale, the Beck Hopelessness Scale (BHS), and a Visual Analogue Scale (VAS) for the assessment of pain.

PATIENTS

The final sample consisted of 102 terminally ill cancer patients attending a Palliative Care Unit.

RESULTS

Statistically significant associations were found between G-SAHD and patients performance status (ECOG) (chi2 = 8.62, p = 0.003). Strongest associations were observed between desire for death, depression, and hopelessness (r = 0.468, p < 0.0005, r = 0.678, p < 0.0005, respectively). In the prediction of G-SHAD the contribution of "hopelessness" (p < 0.0005), "depression" (p < 0.0005), "use of sleeping medication" (p < 0.0005), and "sleep quality" (p = 0.001) was high (59% of variance).

CONCLUSION

Depression, hopelessness, and sleep quality appeared to have a statistically significant relationship with desire for hastened death. Health care professionals finding desire for death in advanced cancer patients should not only consider depression and hopelessness, but also other factors such as poor sleep quality in their diagnostic formulations in order to provide the appropriate treatment.

Effects of early weight bearing on the functional recovery of ambulatory children with cerebral palsy after bilateral proximal femoral osteotomy

This study evaluates the effects of early versus delayed weight bearing on the functional recovery of ambulatory children with cerebral palsy (CP) after they have undergone proximal femoral osteotomies (PFOs). We retrospectively reviewed the cases of 25 ambulatory children with CP who underwent PFO to correct excessive hip internal rotation and intoeing. Thirteen children were permitted to weight-bear as tolerated (WBAT) immediately after surgery, and 12 were placed on non-weight bearing restrictions for 3 to 7 weeks (mean +/- SD, 30 +/- 6.7 days). There were no major complications. The children in the WBAT group initiated standing 26 days sooner and returned to baseline walking almost 4 months sooner than those on non-weight bearing restrictions. Pain at 8 days postoperatively was significantly less for the WBAT group, but pain at the time of initial standing and walking was not significantly different between groups. In conclusion, early mobilization after PFOs in children with CP is safe, with reduced recovery time, and with decreased pain.

Assessing hope at the end of life: validation of an experience of hope scale in advanced cancer patients

OBJECTIVE

The purpose of this study was to gather validity evidence for an innovative experience of hope scale, the Hope Differential-Short (HDS), and evaluate its clinical utility for assessing hope in advanced cancer patients.

METHODS

A consecutive sampling approach was used to recruit 96 patients from an inpatient tertiary palliative care unit and three hospice settings. Each participant completed an in-person survey interview, consisting of the following measures: HDS (nine items), Herth Hope Index (HHI), hope visual analog scale (Hope-VAS) and Edmonton Symptom Assessment System (ESAS).

RESULTS

Using factor analytic procedures, a two-factor structure for the HDS was identified, consisting of authentic spirit (Factor I) and comfort (Factor II). The HDS factors had good overall internal consistency (alpha = 0.83), with Factor I (alpha = 0.83) being higher than Factor II (alpha = 0.69). The two factors positively correlated with the HHI, Hope-VAS, and one of the ESAS visual analog scales, well-being (range: 0.38 to 0.64) and negatively correlated with depression and anxiety, as measured by the ESAS (range: -0.25 to -0.42).

SIGNIFICANCE OF RESULTS

This is the first validation study of the HDS in advanced cancer patients. Its promising psychometric properties and brief patient-oriented nature provide a solid initial foundation for its future use as a clinical assessment measure in oncology and palliative care. Additional studies are warranted to gather further validity evidence for the HDS before its routine use in clinical practice.

Worrying about chronic pain. An examination of worry and problem solving in adults who identify as chronic pain sufferers

Worry is a common feature of chronic pain. The purpose of this study was to examine the extent of worry experienced by adults with chronic pain, and to explore features of problem solving associated with worry and chronic pain. A further purpose was to investigate whether there were differences in worry and problem solving for those presenting at a pain clinic for treatment, compared to those who identified as chronic pain sufferers but who were not presenting for treatment. A final purpose was to examine whether the extent of worry and problem solving attitudes helped to predict the primary clinical features of chronic pain such as intensity, disability and depressive mood. One hundred and eighty five adults with chronic pain provided completed questionnaires assessing worrying, problem solving, pain severity, disability, catastrophic thinking and depressive mood. Analyses showed that worry and problem solving approaches sampled in this study were not abnormal. Furthermore, no differences were found between the clinical and non-clinical sample for worrying and problem solving. In relation to the predictive value of worrying and problem solving, analyses revealed that only worrying had a unique contribution in explaining depressive mood. The results are discussed within a context of a model of worry and chronic pain, in which worry about chronic pain may be functioning to promote awareness of an insoluble problem.

Rotator cuff tendonitis in lymphedema: a retrospective case series

OBJECTIVES

To report rotator cuff tendonitis as a complication of lymphedema and to discuss the possible etiology and treatment options.

DESIGN

Retrospective review of 8 cases.

SETTING

University hospital outpatient clinic.

PARTICIPANTS

A total of 8 breast cancer patients with a history of lymphedema and ipsilateral shoulder pain.

INTERVENTION

Patients with lymphedema and ipsilateral shoulder pain were diagnosed with rotator cuff tendonitis if all of the following 3 tests were positive: supraspinatus test, Neers impingement test, and Hawkins impingement test. Patients diagnosed with rotator cuff tendonitis were prescribed a nonsteroidal anti-inflammatory drug (NSAID) and physical therapy (PT).

MAIN OUTCOME MEASURES

Improvement in symptoms of shoulder pain at a 4- to 6-week follow-up, as measured by visual analog scale (VAS).

RESULTS

Seven of 8 patients reported a subjective decrease in their symptoms of shoulder pain at a 4- to 6-week follow-up. The average improvement in shoulder pain as measured by VAS was a 4.5-point decrease from the original pain score given. One of 8 patients had a full-thickness supraspinatus tendon tear and required additional decongestive therapy and PT to obtain relief of symptoms.

CONCLUSIONS

Rotator cuff tendonitis is a complication of lymphedema caused by internal derangement of tendon fibers, which may be subject to impingement, functional overload, and intrinsic tendinopathy. Conservative treatment with NSAIDs and PT is a safe and effective treatment.

Visual analogue scale correlates of musculoskeletal fatigue

Visual analogue scale has been shown to reflect subjective feelings but rarely has it been used for musculoskeletal fatigue so in the present study VAS ratings were used to quantify musculoskeletal fatigue. A total of 20 students underwent a fatigue protocol (M age=21.3 yr., SD= 1.0). A series of randomized external loads at 0, 5, 10, 15, 25, 35, and 50% of the maximum voluntary contraction was generated by the BTE Primus and applied at the distal end of the dominant arm, which was sustained at the 90 degrees forward flexion position. After 60 sec. of force exertion for each loading, the subject marked the scale to reflect their extent of fatigue at the shoulder muscle. Analysis showed fatigue scores were significantly correlated with the percentages of maximum load applied (r =.73, p < or = .01). The correlation between higher external loads (25-50% maximum load) and fatigue scores was .57 (p < or = .01) and that for lower external loads (0-15% maximum load) was .44 (p < or = .01). The validity of using a visual analogue scale as a measure of musculoskeletal fatigue requires further study, particularly for a low load.

Structured interview assessment of symptoms and concerns in palliative care

OBJECTIVE

Assessment in palliative care requires a multidimensional review of physical symptoms and psychosocial concerns in a format appropriate for patients with advanced illness. In this study, we describe the initial development and validation of a structured interview for assessing common symptoms and concerns faced by terminally ill individuals.

METHOD

We constructed a 13-item Structured Interview for Symptoms and Concerns (SISC) based on a review of end-of-life issues and administered it to 69 patients receiving palliative care for advanced cancer. Along with the interview, each participant completed visual analog scales (VAS) addressing the same constructs. Test-retest and interrater reliability were determined, as was the concordance between interview ratings and VAS scores.

RESULTS

Overall, the interview items had excellent interrater reliability (intraclass correlations were > 0.90) and at least moderate temporal stability (test-retest correlations ranged from 0.50 to 0.90). Concurrent validity was evident in the good concordance between interview items and VAS measures (correlations were > 0.70). The SISC was also sensitive to individual differences between subgroups of participants who did or did not meet diagnostic criteria for anxiety or depressive disorders.

CONCLUSIONS

This study demonstrates that structured interviews provide a reliable and valid approach to assessment in palliative care and may be an appropriate alternative for some research applications.

Correlations between preprocedure mood and clinical outcome in patients undergoing coronary angioplasty

We studied the relationship between mood and mood shift immediately before percutaneous coronary intervention (PCI) and 3 end points: total ischemic burden during PCI, adverse cardiac end points (ACE) after PCI, and death by 6-month follow up. Patients (n = 119) with unstable angina or myocardial infarction completed a visual analog scale (VAS) twice before PCI; before and after a session of stress relaxation, imagery, or touch; or approximately 30 minutes apart for patients assigned to prayer or to standard care. VAS included happiness, satisfaction, calm, hope, worry, shortness of breath, fear, and sadness. We observed a significant correlation between higher hope score before PCI and lower ischemic burden. Patients who experienced ACE had significantly lower hope and happiness scores than those who did not. Patients who survived to 6 months had significantly greater increases in worry and in hope. Our data suggest correlations between simple mood assessments before PCI and clinical outcomes during and after the procedure. More study is needed to understand whether attempts to alter patient mood can affect clinical outcomes.

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.

Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in significantly less pain than the control during both walking (P <.5) and vital capacity activities (P <.1) and significantly less pain than placebo TENS during vital capacity (P <.01). TENS also produced significantly better gait speeds than the control (P <.05) and greater gait distances (P <.01) than the control and placebo TENS. Vital capacity and pain intensity at rest were not significantly different among the 3 treatments. These results suggest TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia. The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia.

Self-reports of pain intensity and direct observations of pain behavior: when are they correlated?

Meta-analytic techniques were utilized to investigate the relationship between self-reports of pain intensity and direct observations of pain behavior. Estimation of the overall effect size from 29 studies and 85 effect sizes yielded a moderately positive association, z=0.26. High variability across studies permitted a random-effects moderator analysis that determined chronicity of pain, the timing of the pain assessment, the use of global measures of pain behavior, and pain site significantly moderate the relationship between self-reports of pain intensity and direct observations of pain behavior. These findings indicate that self-reports of pain intensity and direct observations of pain behavior are more likely to be significantly related to each other when the individual being studied has acute pain (z=0.35), when the self-report of pain intensity data are collected soon after the observation of pain behavior (z=0.40), when global composite measures are used to quantify pain behavior (z=0.37), and when the person being observed suffers from chronic low back pain (z=0.30). Other factors not found to be significant moderators include: extent of observer training, relevance of the pain-inducing task, and pain behavior observation measure used. The implications of the findings for the assessment of pain are discussed.

Quality of life effects of antithrombin III in sepsis survivors: results from the KyberSept trial [ISRCTN22931023]

INTRODUCTION

Treatment of sepsis is aimed at increasing both the duration and quality of survival. A long-term focus on quality of life (QoL) in clinical trial evaluations of sepsis care should be a priority.

METHOD

QoL data were used to evaluate the effects of intravenous antithrombin III treatment for severe sepsis measured for up to 90 days during the follow-up phase of the KyberSept phase III clinical trial. A visual analog scale and a Karnofsky scale were used to measure physical, psychologic, and social QoL at regular intervals. Changes from baseline between placebo and antithrombin III groups were assessed using Wilcoxon statistical tests, with additional analyses by severity of illness and admitting diagnosis.

RESULTS

Among all sepsis survivors in the trial, there was a significant advantage on some attributes of QoL in the antithrombin III subgroup of patients who did not receive heparin as compared with the corresponding placebo group.

DISCUSSION

The present study represents the first attempt to evaluate patient QoL over a relatively long period in a large, randomized, placebo-controlled sepsis trial. Over a 90-day period, survivors of severe sepsis receiving antithrombin III experienced significant improvements as compared with placebo on several attributes of QoL. In conclusion, the present study demonstrated that clinical improvements over an extended time period with antithrombin III were complemented by improvements in QoL, particularly in social and psychologic functioning, in many patients.

The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial

BACKGROUND

Because of the widely presumed association between heart disease and psychological wellbeing, the use of so-called 'complementary' therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbe ing, which could be practicably delivered by nurses to patients in the postoperative recovery period following coronary artery bypass graft (CABG) surgery. Aim. To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.

METHOD

Twenty-five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.

RESULTS

No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA, P=0.014). Dunnett's multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.

CONCLUSIONS

These interventions appear to be effective, noninvasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.