Pain management among older people in need of help with activities of daily living

Pain and persistent pain in nursing home residents in Norway

The objective of this study was to examine the nature of pain and persistence of pain in nursing home residents. The study was carried out with 201 participants drawn from six nursing homes in Norway. The participants rated their pain on 5 different days within a 14-day period on the modified McGill Pain Questionnaire regarding the intensity and location of pain. Four patterns in the persistence of pain were extracted, with the results showing approximately 50% of the participants experiencing persistent pain of a moderate to intense level. Pain ratings and persistent pain were significantly associated with number of body areas with pain, sleeping problems, number of medical diagnoses, and number of medications. The findings of this study suggest that both persistence and fluctuation of pain within short time periods may be related to inadequacy in pain management in nursing home residents, and fill the gap in the literature regarding patterns of persistent pain in nursing home residents.

Older Adults’ Ways of Dealing With Daily Life While Living With Long-Term Musculoskeletal Pain at Home

Long-term musculoskeletal pain is a global health problem among older adults. Yet little is known about how these older adults actually deal with daily life. This study’s aim is to describe the ways these older adults dealt with daily life at home. Phenomenography is used to collect and analyze data from semistructured interviews with 19 older adults and to identify the range in which they dealt with daily life. Findings consist of an outcome space that encompassed four categories: ignore, struggle, adjust, and resign. The different ways older adults dealt with daily life when living with long-term pain at home strengthen the importance of individualized plans of care in the home and a holistic perspective. Findings contribute to enhanced understanding of a common health problem among older adults that can be used to promote quality of care and improve the quality of life of older adults.

The effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis

Pain is described as the fifth vital sign, and inadequate pain management is linked to numerous immediate and long-term negative outcomes. Venipuncture is one of the most painful medical procedures and one of the most frequently performed ones, and children and adolescents on hemodialysis are anxious about repeated venipunctures. Distraction is one of the most effective ways to relieve pain, and nurses are responsible for pain control. The purpose of this quasi-experimental study was to test the effect of programmed distraction on the pain caused by venipuncture among adolescents on hemodialysis. All of the pediatric hemodialysis centers in Tehran (three centers) were assigned to case group (one center with 21 patients) and control groups (two centers with a total of 21 patients) randomly. The Wong-Baker face pain scale was used to assess pain caused by venipuncture. Assessing of pain was done in 12 sessions in both case and control groups. Three first sessions were held without intervention (pretest) and the next nine sessions were held with distraction intervention (posttest). To cause distraction, the adolescents were asked to look at two similar pictures and tell the number of differences between them during venipuncture. Results showed that case and control groups matched in demographic variables and pain intensity. After distraction, pain intensity during venipuncture significantly decreased (p=.003); but this decrease began from the sixth session; at the five first sessions, pain intensity had not changed. This study shows the effect of distraction with a simple, inexpensive, and quick way for decreasing the pain caused by venipuncture. We recommend that the reasons of the intervention's delay in effect be assessed in future studies.

Evaluation of menstrual pain management approaches by Northeastern Anatolian adolescents

We evaluated approaches taken by Northeastern Turkish adolescents to cope with menstrual pain. The questionnaire was prepared according to the facial pain rating scale and applied to 1,408 female high school students (16.05 +/- 1.05 years of age). We investigated the characteristics of dysmenorrhea in adolescents, dysmenorrhea management strategies used by adolescents, and use of medication. We evaluated the relationships among pain duration, severity, and duration of dysmenorrhea experience using the chi-squared test. Dysmenorrhea was considered to be painful menstruation during the past three cycles and was experienced by 81.7% of subjects. It mostly occurred during the past 1-3 years (65.6%). Pain was mostly initiated a day before (38.8%) or at the beginning of (45.8%) menstrual flow and lasted for 1-3 days. It was felt in multiple locations but most commonly in the lower abdomen and lumbar region. Major symptoms associated with dysmenorrhea were sweating, low appetite, headache, distraction, nausea, vomiting, and dizziness, as well as varying degrees of pain severity. Approaches taken to deal with dysmenorrhea were: consulting a health professional (8.9%), medication (46.1%), nonmedicinal activities, and other empirical strategies (24.4%). Medication was recommended mostly by mothers (39.0%) and was taken when pain became unbearable (65.5%). More than one-third of the subjects did not know which drug they took. Major nonpharmacologic measures were: heating pad use (36.5%), sleeping (31.0%), walking (11.3%), and massaging (11.0%). Seeing a physician (p < .001), taking medication (p < .001), and applying empirical strategies to prevent dysmenorrhea (p < .01) were associated with prolonged dysmenorrhea. Medication was associated with shortening pain duration during one menstrual cycle. Except for empirical strategies to prevent dysmenorrhea, all other methods used to prevent dysmenorrhea were related to pain duration and severity. Adolescents should be encouraged to consult a physician and should be prescribed medication in addition to other measures to alleviate menstrual pain and shorten its duration. Moreover, school curriculum should be redesigned to address proper management strategies for adolescent problems. School nurses can also provide consultation services and arrange informative seminars to increase public awareness of this issue.

Use of the Chronic Pain Coping Inventory to Assess Older Adults’ Pain Coping Strategies

Little is known about the strategies that older adults use to cope with persistent pain. The purpose of this study was to describe strategies used by older, retirement community-dwelling adults to cope with persistent, noncancer pain, as assessed by the Chronic Pain Coping Inventory (CPCI), to examine the associations of these strategies with disability and depression, and to compare the 65-item and 42-item versions of the CPCI in this population. Two hundred fifty residents of 43 retirement communities in the Pacific Northwest completed baseline measures for a randomized controlled trial of a pain self-management intervention, including the CPCI and measures of demographics, comorbidity, pain-related disability, and depression. The most frequently reported strategies, as assessed by the CPCI, were Task Persistence, Pacing, and Coping Self-Statements. The least frequently used strategies were Asking for Assistance and Relaxation. Regression analyses demonstrated that coping strategies explained 26%, 19%, and 18% additional variance in physical disability, depression, and pain-related interference, respectively, after controlling for age, gender, comorbidity, and pain intensity. Internal consistency for most CPCI-65 and CPCI-42 subscales was adequate. This study clarifies strategies used by older adults to cope with persistent pain and provides preliminary validation of the CPCI in this population.

PERSPECTIVE

Findings from this study on pain coping strategies in older adults might suggest potentially useful coping strategies clinicians could explore with individual patients. Investigators can use study findings to design trials of interventions to help older adults cope more effectively with pain.

Assisting Older Adults With Orthopaedic Outpatient Acute-Pain Management

Management of acute pain by older adults with orthopaedic conditions in their community setting after surgical procedures or injury can be challenging. As older adult orthopaedic outpatients have unique requirements in their pain management, nurses and advanced practice nurses must be cognizant of these needs and intervene when needed to promote a satisfactory recovery. This article will focus on the older adults experiences of orthopaedic pain, barriers to their pain reporting and relief, and acute pain management considerations for the older adult in the home setting.