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Robitaille A, Adams M, Heckman G, Norman M, Feldman S, Robert B, Hirdes JP. Pain in Canadian Long-Term Care Homes: A Call for Action. J Am Med Dir Assoc 2024:105204. [PMID: 39142639 DOI: 10.1016/j.jamda.2024.105204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024]
Abstract
Navigating the evaluation and management of pain in long-term care homes is a complex task. Despite an extensive body of literature advocating for a paradigm shift in pain assessment and management within long-term care homes, much more remains to be done. The assessment of pain in long-term care is particularly challenging, given that a substantial proportion of residents live with some degree of cognitive impairment. Individuals living with dementia may encounter difficulties articulating the frequency and intensity of their pain, potentially resulting in an underestimation of their pain. In Canada and in the United States, the interRAI Minimum Data Set 2.0, Minimum Data Set 3.0, and the interRAI Long-Term Care Facilities assessments are administered to capture the presence and intensity of pain. These assessment instruments are used both on admission and quarterly, offering a reliable and validated method for comprehensive assessment. Nonetheless, the daily assessment and documentation of pain across long-term care homes, which is used to inform the interRAI Pain Scale, is not always consistent. The reality is that assessing pain can be inaccurate for several reasons, including the fact that it is rated by long-term care staff with diverse levels of expertise, resources, and education. This call for action explores the current approaches used in pain assessment and management within long-term care homes. The authors not only bring attention to the existing challenges but also emphasize the necessity of considering a more comprehensive assessment approach.
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Affiliation(s)
- Annie Robitaille
- Centre of Excellence, Perley Health, Ottawa, ON, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | | - Sid Feldman
- Baycrest Health Sciences, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit Robert
- Centre of Excellence, Perley Health, Ottawa, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Janssens WH, Verhoestraete P, Piers RD, Van Den Noortgate NJ. Short-Term Opioid Treatment of Acute Locomotor Pain in Older Adults: Comparison of Effectiveness and Safety between Tramadol and Oxycodone: A Randomized Trial. Geriatrics (Basel) 2024; 9:46. [PMID: 38667513 PMCID: PMC11050500 DOI: 10.3390/geriatrics9020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION We conducted a head-to-head comparison of step 2 (tramadol) and step 3 (oxycodone) of the WHO pain ladder in older adults with moderate to severe acute locomotor pain. MATERIALS AND METHODS Multi-center prospective randomized study. Patients were 70 years or older, admitted to the acute geriatric ward of three hospitals, suffering from acute moderate to severe locomotor pain, and opioid-naive. Patients were randomized into two treatment groups: tramadol versus oxycodone. The Consort reporting guidelines were used. RESULTS Forty-nine patients were included. Mean numeric rating scale (NRS) decreased significantly between day 0 and 2 of the inclusion in both groups. A sustained significant decrease in mean NRS was seen at day 7 in both groups. Nausea was significantly more prevalent in the tramadol group, with a trend towards a higher prevalence of delirium and falls and three serious adverse events in the same group. CONCLUSIONS Opioid therapy may be considered as a short-term effective treatment for moderate to severe acute locomotor pain in older adults. Oxycodone may possibly be preferred for safety reasons. These results can have implications for geriatric practice, showing that opioids for treatment of acute moderate to severe locomotor pain in older patients are effective and safe if carefully monitored for side effects. Opioid therapy may be considered as a short-term treatment for moderate to severe acute locomotor pain in older adults, if carefully monitored for (side) effects, while oxycodone may possibly be preferred for safety reasons. These results can have implications for daily practice in geriatric, orthopedic, and orthogeriatric wards, as well as in terminal care, more precisely for the treatment of moderate to severe acute locomotor pain in older adults.
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Affiliation(s)
- Wim Henri Janssens
- Department of Geriatrics, University Hospital Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium
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3
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Are nurse`s needs assessment methods robust enough to recognise palliative care needs in people with dementia? A scoping review. BMC Nurs 2022; 21:194. [PMID: 35854261 PMCID: PMC9297617 DOI: 10.1186/s12912-022-00947-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with dementia are most at risk of experiencing serious health related suffering, if they do not have a palliative care approach introduced early enough in the illness. It can be challenging for nurses to assess experienced needs of people, who are thought no longer able to self-report such as people with dementia. Assessment help to understand the care the patient and their family need promptly. It is unknown how nurses recognise holistic palliative care needs in people with dementia during routine care. METHODS Scoping review where EMBASE, MEDLINE, CINAHL, PsycInfo databases, and references were searched with an advanced search strategy, which was built on three concepts (nurses, dementia, and nursing assessment) using corresponding Medical Subject Headings. Data were charted in a piloted extraction form, based on the assessment domains within the nursing process followed by summarise and synthesise results narratively. RESULTS 37 out of 2,028 qualitative and quantitative articles published between 2000 and 2021, and relating to 2600 + nurses, were identified. Pain was sole focus of assessment in 29 articles, leaving 8 articles to describe assessment of additional needs (e.g., discomfort). Nurses working in a nursing home assess pain and other needs by observing the persons with dementia behaviour during routine care. Nurses in the acute care setting are more likely to assess symptoms with standard assessment tools at admission and evaluate symptoms by observational methods. Across settings, about one third of pain assessments are supported by person-centred pain assessment tools. Assessments were mostly triggered when the person with dementia vocalised discomfort or a change in usual behaviour was observed. Nurses rely on family members and colleagues to gain more information about needs experienced by people with dementia. CONCLUSION There is a scarcity of evidence about techniques and methods used by nurses to assess needs other than pain experienced by people with dementia. A holistic, person-centred screening tool to aid real-time observations at the bedside and used in conversations with health care professionals and families/friends, may improve need recognition other than pain, to ensure holistic needs could then be addressed timely to improve care in people with dementia.
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Alonso-Fernández M, Gillanders D, López-López A, Matías B, Losada A, González JL. An Exploration of the Psychometric Properties of the PASS-20 in Older Adults with Chronic Pain: Preliminary Development and Validity. Clin Gerontol 2022; 45:575-590. [PMID: 34047674 DOI: 10.1080/07317115.2021.1929628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Pain Anxiety Symptoms Scale (PASS-20) is well validated in adults and younger populations, but not in older adults. This study aimed to analyze the psychometric properties of the PASS-20 in Spanish older adults who experience chronic pain. METHODS Participants were 111 older adults with chronic pain living in nursing homes (mean age = 83.36; SD = 6.53; 78.6% female). Face-to-face interviews were conducted which included assessment of pain anxiety (PASS-20), chronic pain acceptance (CPAQ), depression symptoms (GDS), catastrophizing beliefs (PCS), pain severity, and sociodemographic information. An Exploratory Structural Equation Modeling (ESEM) approach was used to refine the scale. RESULTS The final scale was composed of seven items, measuring two factors that could be labeled "Internal experiences" and "Escape/Avoidance behaviors". The two factors explained 60.98% of the total variance. PASS-7 version fit properly: χ2/df = 14.57/13, CMIN/df = 1.121, CFI = 0.99, RMSEA = 0.033, TLI = 0.98, GFI = 0.96, AGFI = 0.92. Good validity indices were found and acceptable reliability results in the scale and its subscales (Chronbach´s α; Internal Experiences = 0.70; Escape/Avoidance Behaviors= 0.73; Total Scale = 0.77). CONCLUSIONS The short version of the PASS-7 has good psychometric properties. CLINICAL IMPLICATIONS The brevity of the PASS-7 increases the feasibility of this instrument which could potentially be utilized in a variety of clinical settings and research studies with older people with chronic pain samples, specially institutionalized older adults.
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Affiliation(s)
- Miriam Alonso-Fernández
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Almudena López-López
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Borja Matías
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Andres Losada
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - José Luis González
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Gallant NL, Peckham A, Marchildon G, Hadjistavropoulos T, Roblin B, Stopyn RJN. Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. BMC Geriatr 2020; 20:458. [PMID: 33167897 PMCID: PMC7650170 DOI: 10.1186/s12877-020-01758-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. METHODS Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. RESULTS Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. CONCLUSION The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
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Affiliation(s)
- Natasha L. Gallant
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004 USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Blair Roblin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Rhonda J. N. Stopyn
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
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Mallon T, Ernst A, Brettschneider C, König HH, Luck T, Röhr S, Weyerer S, Werle J, Mösch E, Weeg D, Fuchs A, Pentzek M, Kleineidam L, Heser K, Riedel-Heller S, Maier W, Wiese B, Scherer M. Prevalence of pain and its associated factors among the oldest-olds in different care settings - results of the AgeQualiDe study. BMC FAMILY PRACTICE 2018; 19:85. [PMID: 29885656 PMCID: PMC5994256 DOI: 10.1186/s12875-018-0768-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 05/21/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life. METHODS Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI). RESULTS Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings. CONCLUSIONS Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings.
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Affiliation(s)
- Tina Mallon
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Annette Ernst
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Kathrin Heser
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Griffioen C, Willems EG, Kouwenhoven SM, Caljouw MAA, Achterberg WP. Physicians' Knowledge of and Attitudes Toward Use of Opioids in Long-Term Care Facilities. Pain Pract 2016; 17:625-632. [PMID: 27739258 DOI: 10.1111/papr.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufficient pain management in vulnerable older persons living in long-term care facilities is common, and opiophobia might contribute to this. As opiophobia and its related factors have not been investigated in long-term care, this study evaluates the degree of knowledge of opioids among elderly-care physicians (ECPs) and ECP trainees, as well as their attitudes and other factors possibly influencing the clinical use of opioids in these facilities. METHODS A questionnaire was designed and distributed among ECPs and ECP trainees by email, regional symposia, and all three university training faculties for elderly-care medicine in the Netherlands. RESULTS Respondents were 324 ECPs and 111 ECP trainees. Fear of addiction did not influence the prescription of opioids. Main barriers to the clinical use of opioids were patients' reluctance to take opioids (83.3%); unknown degree of pain (79.2%); and pain of unknown origin (51.4%). ECPs' average knowledge scores were sufficient: those who felt that their knowledge of opioids was poor scored lower than those who felt that their knowledge was good. CONCLUSIONS Factors identified in this study may help provide better pain management for vulnerable older persons living in a long-term care facility. Also, more patient information on the pros and cons of opioid use is needed, as well as appropriate tools for better clinical assessment of pain in a long-term care population.
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Affiliation(s)
- Charlotte Griffioen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eva G Willems
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sanne M Kouwenhoven
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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Satghare P, Chong SA, Vaingankar J, Picco L, Abdin E, Chua BY, Subramaniam M. Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study. Pain Res Manag 2016; 2016:7852397. [PMID: 27445628 PMCID: PMC4921630 DOI: 10.1155/2016/7852397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/15/2016] [Indexed: 11/18/2022]
Abstract
Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults. Aims. The study sought to determine the prevalence, sociodemographics, and clinical correlates of pain along with association of pain with disability among older adults in Singapore. Methods. The WiSE study was a comprehensive cross-sectional, single phase, epidemiological survey conducted among the elderly aged 60 years and above and used a nationally representative sample of three main ethnic groups in Singapore: Chinese, Malays, and Indians. The survey administered 10/66 protocol pain questionnaire, sociodemographic questionnaire, health status questionnaire, World Health Organization Disability Assessment Scale (WHODAS 2.0), and Geriatric Mental State (GMS) examination. Results. A total of 2565 respondents completed the study giving a response rate of 65.5%. The prevalence of pain among the elderly aged 60 years and above is 19.5 %. Females, incomplete primary education Indians, and those diagnosed with any chronic health condition were associated with risk of pain and disability. Conclusion. Study findings showed that disability related to pain among the elderly is considerable making it a priority to reduce the morbidity and disability among the elderly with pain.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore 539747
| | | | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore 539747
| | | | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore 539747
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Babadağ B, Alparslan GB, Güleç S. The Relationship Between Pain Beliefs and Coping with Pain of Algology Patients'. Pain Manag Nurs 2015; 16:910-9. [PMID: 26320677 DOI: 10.1016/j.pmn.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/05/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Abstract
A patient's beliefs, expectations, and attitudes about coping with pain are effective on the patient's pain control. The aim of this investigation was to evaluate the correlation between pain beliefs and coping with pain in algology patients. This descriptive study was carried out with 201 patients at a University Hospital Algology Clinic between May and July 2014. The research instruments used included a Descriptive Characteristics Data Form, Pain Beliefs Questionnaire, and Pain Coping Questionnaire. Data were evaluated by descriptive statistical methods, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. According to the findings, the duration of pain in the patients ranged from 1 month to 40 years, with a mean duration of 68.37 ± 89.42 months. Patients' organic beliefs mean score was 3.97 ± 0.78 and the psychological beliefs mean score was 5.01 ± 1.01. There was a significant negative correlation between patients' organic beliefs score and the self-management (p < .001, r = -.388) and conscious cognitive interventions scores (p < .001, r = -.331); with the helplessness score (p < .001, r = .365) there was a positive correlation. There was also a positive correlation between patients' psychological beliefs score and self-management score (p < .05, r = .162). Moreover, there is significant difference between organic beliefs score and patients who use opioid analgesic. Patients who believe that their pain's origin is a organic cause, such as damage and harm in the body, cannot cope with pain and feel more helplessness. Appropriate nursing interventions for individuals' pain beliefs should be implemented to nursing care plans on pain management.
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Affiliation(s)
- Burcu Babadağ
- School of Health, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Güler Balcı Alparslan
- School of Health, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sacit Güleç
- Department of Anesthesiology and Reanimation, Eskişehir Osmangazi University, Eskisehir, Turkey
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10
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Sirsch E, Gnass I, Fischer T. [Diagnostics of pain in old age. Perspectives on a multidimensional phenomenon]. Schmerz 2015; 29:339-48. [PMID: 26238374 DOI: 10.1007/s00482-015-0026-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Old people's experience of pain differs markedly from that of younger people. Old people not only suffer from pain more often but also the pain is predominantly chronic in nature. In many cases older patients experience pain from more than one cause at any time due to multimorbidity. Against this backdrop this article examines the question of how diagnostic procedures of pain have to be specific for older patients and how these requirements are currently met in clinical practice. Diagnostic procedures in older persons need to be rooted in a biopsychosocial understanding of pain that also takes into account that the pain experience is always made up of several pain dimensions. A comprehensive understanding of pain communication also has to be taken into account as well as age-specific influences. In older persons pain assessment needs to encompass motivational affective, sensory discriminative and cognitive evaluative aspects. If pain assessment is limited to pain severity or the observation of pain behavior only, important information is lacking and important biographical, health-related, phenomenological and care-specific information cannot be used for the benefit of the patient. Different dimensions of pain cannot be used variably but need to be regarded as complementing elements; however, this approach is currently not always possible to follow through in clinical practice especially with age-related illnesses, such as dementia. Currently, only the geriatric pain interview (Geriatrisches Schmerzinterview) is available as a multidimensional tool for the assessment of pain in older people. There is a clear need for more and extended research and development of tools and processes to comprehensively assess pain in older persons.
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Affiliation(s)
- E Sirsch
- Fakultät für Pflegewissenschaft, Philosophisch-Theologische Hochschule Vallendar, PTHV gGmbH, Pallottistr. 3, 56179, Vallendar, Deutschland,
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11
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Arris SM, Fitzsimmons DA, Mawson S. Moving towards an enhanced community palliative support service (EnComPaSS): protocol for a mixed method study. BMC Palliat Care 2015; 14:17. [PMID: 25924815 PMCID: PMC4422119 DOI: 10.1186/s12904-015-0012-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The challenge of an ageing population and consequential increase of long term conditions means that the number of people requiring palliative care services is set to increase. One UK hospice is introducing new information and communication technologies to support the redesign of their community services; improve experiences of existing patients; and allow efficient and effective provision of their service to more people. Community Palliative Care Nurses employed by the hospice will be equipped with a mobile platform to improve communication, enable accurate and efficient collection of clinical data at the bedside, and provide access to clinical records at the point of care through an online digital nursing dashboard. It is believed that this will ensure safer clinical interventions, enable delegated specialist care deployment, support the clinical audit of patient care and improve patient safety and patient/carer experience. Despite current attempts to evaluate the implementation of such technology into end of life care pathways, there is still limited evidence supporting the notion that this can be sustained within services and implemented to scale. This study presents an opportunity to carry out a longitudinal evaluation of the implementation of innovative technology to provide evidence for designing more efficient and effective community palliative care services. METHODS A mixed methods approach will be used to understand a wide range of organisational, economic, and patient-level factors. The first stage of the project will involve the development of an organisational model incorporating proposed changes resulting from the introduction of new novel mobile technologies. This model will guide stage two, which will consist of gathering and analysing primary evidence. Data will be collected using interviews, focus groups, observation, routinely collected data and documents. DISCUSSION The implementation of this new approach to community-based palliative care delivery will require significant changes to established working patterns. This new service delivery model is being developed by the Hospice in collaboration with a team of international academic, industry, and clinical commissioning service improvement specialists. The findings from this initial evaluation will provide valuable baseline evidence regarding the delivery of palliative and end-of-life care services.
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Affiliation(s)
- Steven M Arris
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire, S1 4DA, UK.
| | - Deborah A Fitzsimmons
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire, S1 4DA, UK. .,School of Health Studies, Western University, London, ON, N6A 3B4, Canada.
| | - Susan Mawson
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire, S1 4DA, UK.
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Chochinov HM, Martens PJ, Prior HJ, Kredentser MS. Comparative health care use patterns of people with schizophrenia near the end of life: a population-based study in Manitoba, Canada. Schizophr Res 2012; 141:241-6. [PMID: 22910402 DOI: 10.1016/j.schres.2012.07.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The rate of health care and palliative care utilization for patients with schizophrenia near the end-of-life is currently unknown. OBJECTIVE Compare rate of health care services, including palliative care, used in the last 6-24months of life for patients with and without schizophrenia. DESIGN Using the de-identified administrative data Repository at the Manitoba Centre for Health Policy; a matched cohort study between 1995/96 and 2007/08,comparing healthcare services utilized six months to two years prior to death of all (de-identified) decedents with a diagnosis of schizophrenia >10years to decedents without a schizophrenia diagnosis. SETTING province of Manitoba, Canada (population 1.235 million). PARTICIPANTS Schizophrenia definition: ICD-9-CM 295, or ICD-10-CA code of F20, F21, F23.2, F25 in hospital or physician files, over a 12-year period 1987-1998, in the 12years prior to death for each individual. Decedents were matched (1:3) on age, sex, geography and date of death ±2months. MAIN OUTCOME MEASURES Health service utilization rates within six-months to two years prior to death. RESULTS In the last six months of life, compared to their matched cohort: decedents with schizophrenia had higher rates (52.1% vs. 24.4%, p<.00001) and number of days (89.2 vs. 40.3days, p<.0001) residing in a nursing home; had higher ambulatory visit rates to general practitioners (6.4 vs. 5.5 visits per person, p<.0001), higher rate of visits to psychiatrists (0.53 vs. 0.07 visits per person) and lower rates of seeing other specialists. They were less likely to have opioid analgesia (aRR=0.7157, p-value=0.0006) or to receive palliative care (aOR=0.48, 95% CI 0.41-0.57). CONCLUSION End-of-life care is lacking for patients with schizophrenia. Compared to their matched cohort, these patients were much more likely to die in nursing homes, less likely to see specialists (other than psychiatrists), less likely to be prescribed analgesics, and less likely to receive palliative care.
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Affiliation(s)
- Harvey M Chochinov
- Department of Psychiatry, University of Manitoba, PsycHealth Centre, PZ433-771 Bannatyne Avenue, Winnipeg, MB, Canada R3T 2N2.
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Pain prevalence and characteristics in three Dutch residential homes. Eur J Pain 2012; 12:910-6. [DOI: 10.1016/j.ejpain.2007.12.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 11/26/2007] [Accepted: 12/28/2007] [Indexed: 11/24/2022]
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Schofield P, Clarke A, Jones D, Martin D, McNamee P, Smith B. Chronic pain in later life: a review of current issues and challenges. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.41] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effects of aging present a major medical challenge in the 21st century, which will cause fundamental changes in demography. By 2031, it is estimated that 22% of the UK population will be aged over 65 years, and there will be more people in this age group than aged under 25 years. As well as implications for infrastructure and productivity, this change will alter the prevalence and impact of many illnesses and pathologies. The research priorities of many of the major funding bodies reflect this challenge. The Medical Research Council in the UK, for example, leads the Lifelong Health and Wellbeing program on behalf of all the country’s research councils. This initiative aims to identify factors that affect or improve health in later life, to inform relevant policy and practice. The Wellcome Trust lists the investigation of development, aging and chronic disease as one of its five major research challenges, and the European Commission presents the health of the aging population as one of its three overarching issues of the Health Theme in its 7th Framework Program of research. Chronic pain is a major health condition associated with aging, whose management (pharmacological and nonpharmacological) is generally unsatisfactory. The International Association for the Study of Pain designated 2006/07 as its Global Year Against Pain in Older Adults. This article reviews the relevance of existing and potential research on the assessment and management of chronic pain in older adults.
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Affiliation(s)
| | - Amanda Clarke
- Centre for Advanced Studies in Nursing (CASN), Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland
| | - Derek Jones
- Northumbria University School of Health, Community & Education Studies, Room H215, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA, UK
| | - Denis Martin
- Health & Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Blair Smith
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, Scotland, UK
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Wylie K, Nebauer M. The fragmented story of pain: a saga of economic discourse, confusion and lack of holistic assessment in the residential care of older people. Collegian 2011; 18:11-8. [PMID: 21469416 DOI: 10.1016/j.colegn.2010.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The long-standing problem of overlooked and/or undertreated pain experienced by so many older people living in Australian residential care facilities condemns these people to a life robbed of quality. Such a degree of suffering experienced by older people calls into question the pain assessment skills of staff who work in residential care. However, the problem of undetected and unresolved pain experienced by older people is not simply a skill or knowledge issue. It is much broader than that. In this paper we portray pain as likened to a story; a narrative that only the older person, as the author, can impart and one in which only they can communicate their experience of pain. Nevertheless, as opposed to seeking the older person's pain narrative, nurses attempt to measure the immeasurable. In part, their actions relate to the confusing terminology which envelops pain assessment. However, political policy and economic discourse also influences nurses' pain assessment practises to the detriment of older people and the profession of gerontological nursing. Discussion in this paper includes the experience of pain for the older person, an overview of the specific role of pain-screening tools compared with the requirements of a person-centred pain assessment, and person-centred pathways to help nurses and others interpret and heed the older person's pain story. Analysis also incorporates the argument that current and previous Federal Government funding tools for residential care subtly impact on holistic pain assessment causing confusion for caregivers and fragmentation of the older person's pain story.
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Affiliation(s)
- Kim Wylie
- University of Newcastle, School of Nursing, 14 Delaney Road, Dayboro, Queensland 4521, NSW, Australia.
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Tse M, Leung R, Ho S. Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient-centred intervention. J Adv Nurs 2011; 68:312-21. [DOI: 10.1111/j.1365-2648.2011.05738.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Gianni W, Madaio AR, Ceci M, Benincasa E, Conati G, Franchi F, Galetti G, Nieddu A, Salani B, Zuccaro SM. Transdermal buprenorphine for the treatment of chronic noncancer pain in the oldest old. J Pain Symptom Manage 2011; 41:707-14. [PMID: 21145700 DOI: 10.1016/j.jpainsymman.2010.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 06/16/2010] [Accepted: 07/08/2010] [Indexed: 11/25/2022]
Abstract
CONTEXT Chronic pain increases with age, and in the elderly, comorbidities and polypharmacotherapy make the choice of treatment for pharmacological pain control a complex matter. OBJECTIVES We conducted a multicenter, prospective, observational study to evaluate the efficacy and safety of the buprenorphine transdermal delivery system (TDS) in elderly patients with chronic noncancer pain. The aim was to assess the cognitive and behavioral status of patients during treatment. METHODS The study included 93 patients (69 women and 24 men); the mean age was 79.7 years, and in most cases, the pain was due to osteoarthritis. Almost three-quarters (74.2%) of the patients had suffered pain for more than 12 months. The treatment was buprenorphine TDS, starting from a dose of 17.5 μg/h. Outcomes were assessed using the Mini-Mental State Examination (MMSE), the 17-item Hamilton Depression scale (HAM-D 17), the Neuropsychiatric Inventory, the Barthel Index, the Short-Form Health Survey (SF-12), a verbal numeric rating scale, and the Cumulative Illness Rating Scale (CIRS). RESULTS Buprenorphine treatment was associated with a decrease in pain severity without negative effects on the central nervous system. On the HAM-D scale, there were reductions in both the psychological and somatic scores. On the MMSE, values at the beginning and end of the study were comparable. Evaluation by SF-12 showed improvements in physical and mental status. CIRS values at baseline and at the end of the study were superimposable, indirectly confirming the tolerability and safety profile of the drug. CONCLUSION Our experience confirms the analgesic activity and safety of buprenorphine TDS in the elderly. There was an improvement in mood and a partial resumption of activities, with no influence on cognitive and behavioral ability.
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Affiliation(s)
- Walter Gianni
- Geriatrics Unit, Istituto Nazionale di Ricovero e Cura per Anziani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
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Tsai YF, Liu LL, Chung SC. Pain prevalence, experiences, and self-care management strategies among the community-dwelling elderly in Taiwan. J Pain Symptom Manage 2010; 40:575-81. [PMID: 20678896 DOI: 10.1016/j.jpainsymman.2010.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 02/08/2010] [Accepted: 02/09/2010] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among community-dwelling elderly in Taiwan. A convenience sample of elderly persons (n=1054) was recruited from outpatient clinics of two hospitals in northern Taiwan. Participants' pain prevalence was 50.0%, and the average number of pain sites was 3.9 (standard deviation [SD]=5.8). Knees were the most commonly described pain site, but the most painful site was the spinal cord area. The mean pain intensity was 3.1 (SD=1.8) and pain interference was 2.8 (SD=2.1). Most participants took prescribed medications to deal with pain; doctors were the main information source for this self-care strategy. Although participants reported using various self-care pain management strategies, most still reported moderate-to-severe worst pain. Moreover, our participants identified far fewer self-care strategies than U.S. elders with chronic pain. These findings suggest that community-dwelling elders in Taiwan know little about managing pain symptoms or ascribe a different meaning to pain than their U.S. counterparts. Because health care providers play an important role in helping the elderly to manage pain, the authors recommend training health care providers about Taiwanese elders' perceptions of pain, to perform regular pain assessments, and provide current knowledge about pain assessment and pain management strategies.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
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19
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The Effects of Pain on Health-Related Quality of Life and Satisfaction With Life in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2010. [DOI: 10.1097/tgr.0b013e3181fcdc11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Crowe M, Whitehead L, Jo Gagan M, Baxter D, Panckhurst A. Self-management and chronic low back pain: a qualitative study. J Adv Nurs 2010; 66:1478-86. [PMID: 20492018 DOI: 10.1111/j.1365-2648.2010.05316.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This paper is a report of a study of the self-management strategies of people with chronic low back pain and how their healthcare professionals perceived their role in facilitating self-management. BACKGROUND Chronic low back pain is a complex disorder, challenging to treat, and associated with wide-ranging adverse consequences including physical disability, psychosocial disruption, and increased use of healthcare resources. Most clinical guidelines suggest that self-management strategies are the best treatment option. DESIGN A qualitative analysis was conducted of semi-structured interviews with 64 people identified as having chronic low back pain and 22 healthcare professionals nominated by that person. The interviews were conducted in 2008. The people with chronic low back pain were asked about their self-management strategies; healthcare professionals were asked about how they perceived their role in the person's self-management. Data were analysed using a content analysis. FINDINGS The most common strategies used by participants to manage their chronic low back pain were medication, exercise and application of heat. The nominated healthcare professionals were predominantly physiotherapists and general practitioners. Physiotherapists described exercises, particularly those aimed at improving core strength, as the main strategy that they encouraged people to use. General practitioners regarded themselves as primarily having three roles: prescription of pain medication, dispensing of sickness certificates, and referral to specialists. CONCLUSION People with chronic low back pain use self-management strategies that they have discovered to provide relief and to prevent exacerbation. The strategies reflect an active process of decision-making that combines personal experience with professional recommendations.
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Affiliation(s)
- Marie Crowe
- Centre for Postgraduate Nursing, University of Otago, Christchurch, New Zealand.
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21
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Kirby K, Dunwoody L, Millar R. What type of service provision do patients with chronic pain want from primary care providers? Disabil Rehabil 2010; 31:1514-9. [PMID: 19294547 DOI: 10.1080/09638280802639137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to explore what types of service provision patients with chronic pain wanted from their general practitioners (GP). METHOD A small scale survey measured anxiety and depression and quantified the extent to which patients wanted four different types of help from their GP (explanation and understanding, medical treatment, psychological support and information). An opportunistic sample of 155 patients (30.3% male and 69.7% female) was recruited from three general practice surgeries in the northwest region of Northern Ireland. Ninety-one participants self-reported chronic pain and there were 64 in the no pain group. RESULTS Even after statistically controlling for anxiety and depression, individuals in the chronic pain group had a greater need for emotional/psychological support and explanation and understanding from their GPs. There were no significant differences between the groups with respect to the need for more information or medical treatment. CONCLUSIONS A biopsychosocial approach should be employed in the management of chronic pain, however as this study shows, some primary care patients are still being treated within a biomedical framework. To address the unmet needs of this patient population, there is a need for clinical guidelines in the management of chronic pain in primary care settings. Limitations of the present research, with recommendations for future study are offered.
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Affiliation(s)
- Karen Kirby
- School of Psychology, University of Ulster, Londonderry, Northern Ireland, UK.
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22
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Pain and Aging: The Emergence of a New Subfield of Pain Research. THE JOURNAL OF PAIN 2009; 10:343-53. [DOI: 10.1016/j.jpain.2008.10.013] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 10/22/2008] [Accepted: 10/28/2008] [Indexed: 11/19/2022]
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Hølen JC, Saltvedt I, Fayers PM, Hjermstad MJ, Loge JH, Kaasa S. Doloplus-2, a valid tool for behavioural pain assessment? BMC Geriatr 2007; 7:29. [PMID: 18093294 PMCID: PMC2234400 DOI: 10.1186/1471-2318-7-29] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 12/19/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Doloplus-2 is used for behavioural pain assessment in cognitively impaired patients. Little data exists on the psychometric properties of the Doloplus-2. Our objectives were to test the criterion validity and inter-rater reliability of the Doloplus-2, and to explore a design for validations of behavioural pain assessment tools. METHODS Fifty-one nursing home patients and 22 patients admitted to a geriatric hospital ward were included. All were cognitively impaired and unable to self-report pain. Each patient was examined by an expert in pain evaluation and treatment, who rated the pain on a numerical rating scale. The ratings were based on information from the medical record, reports from nurses and patients (if possible) about pain during the past 24 hours, and a clinical examination. These ratings were used as pain criterion. The Doloplus-2 was administered by the attending nurse. Regression analyses were used to estimate the ability of the Doloplus-2 to explain the expert's ratings. The inter-rater reliability of the Doloplus-2 was evaluated in 16 patients by comparing the ratings of two nurses administrating the Doloplus-2. RESULTS There was no association between the Doloplus-2 and the expert's pain ratings (R2 = 0.02). There was an association (R2 = 0.54) between the expert's ratings and the Doloplus-2 scores in a subgroup of 16 patients assessed by a geriatric expert nurse (the most experienced Doloplus-2 administrator). The inter-rater reliability between the Doloplus-2 administrators assessed by the intra-class coefficient was 0.77. The pain expert's ratings were compared with ratings of two independent geriatricians in a sub sample of 15, and were found satisfactory (intra-class correlation 0.74). CONCLUSION It was challenging to conduct such a study in patients with cognitive impairment and the study has several limitations. The results do not support the validity of the Doloplus-2 in its present version and they indicate that it demands specific administration skills.
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Affiliation(s)
- Jacob C Hølen
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Geriatric Section, Medical Department, St. Olav's Hospital, Trondheim, Norway
| | - Peter M Fayers
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health, University of Aberdeen Medical School, Aberdeen, UK
| | - Marianne J Hjermstad
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, Ullevaal University Hospital HF Oslo, Norway
| | - Jon H Loge
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Palliative Medicine Unit, Ullevaal University Hospital HF Oslo, Norway
| | - Stein Kaasa
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Palliative Medicine Unit, Department of Oncology and Radiotherapy, St. Olav's Hospital, Trondheim, Norway
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Yagci N, Cavlak U, Aslan UB, Akdag B. Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults. Arch Gerontol Geriatr 2007; 45:109-19. [PMID: 17118472 DOI: 10.1016/j.archger.2006.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 09/26/2006] [Accepted: 09/29/2006] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p<0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67+/-7.16cm) than among women (18.77+/-6.59cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging.
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Affiliation(s)
- Nesrin Yagci
- Pamukkale University, School of Physical Therapy, Eski Saglik Koleji Binasi, 20100 Denizli, Turkey
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25
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Widar M, Ek AC, Ahlström G. Caring and uncaring experiences as narrated by persons with long-term pain after a stroke. Scand J Caring Sci 2007; 21:41-7. [PMID: 17428213 DOI: 10.1111/j.1471-6712.2007.00449.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to describe how persons with long-term pain after a stroke experience their care. The study is part of a larger research project concerning a group persons suffering from long-term pain after a stroke. Qualitative interviews were performed with 43 persons suffering from central poststroke pain, nociceptive pain or tension-type headache after their stroke incident. Content congruence emerged among the narratives (n = 43), and therefore the most information-rich ones (n = 23) were selected for deeper investigation by means of qualitative content analysis. The results reveal the patients' need for being respected, understood and supported, also for being given adequate time and information. Accessibility and continuity in the professional contacts and with regard to medical and physical treatment was emphasized. The participants' narratives highlight the importance of the professionals having knowledge of pain and pain management.
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Affiliation(s)
- Marita Widar
- Department of Medicine and Care, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping, and Department of Health Sciences, Orebro University, Orebro, Sweden.
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Smalbrugge M, Jongenelis LK, Pot AM, Beekman ATF, Eefsting JA. Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment--an observational cohort study. BMC Geriatr 2007; 7:3. [PMID: 17300724 PMCID: PMC1802083 DOI: 10.1186/1471-2318-7-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 02/14/2007] [Indexed: 11/20/2022] Open
Abstract
Background Pain is highly prevalent in nursing homes (NH) in several countries. Data about pain in Dutch NH's, where medical care is delivered by specifically trained NH-physicians, are not available. The aim of the present study is to determine prevalence, course, correlates, recognition and treatment of pain among Dutch NH-patients and to make a comparison with international data. Methods The study-population consisted of 350 elderly NH-patients from 14 Dutch NH's. Pain (pain-subscale Nottingham Health Profile) and clinical characteristics (gender, age, cognition, depression, anxiety, sleeping problems, morbidity and functional status) were measured at baseline and at six months. Association of pain (baseline and six months) with clinical characteristics was assessed with chi-square and multiple logistic regression analyses. Results Pain-prevalence was 68.0% (40.5% mild pain symptoms, 27.5% serious pain symptoms). 80% of the patients with pain at baseline still experienced pain at six months. Serious pain at baseline was significantly associated with depression (OR: 2.56; 95% CI: 1.34-4.89) and anxiety (OR 2.47; 95% CI: 1.22-4.99). Serious pain at six months was associated with pain at baseline (OR 18.55; 95% CI: 5.19-66.31) and depression at baseline (OR: 2.63; 95% CI:1.10-6.29). Recognition of pain by NH-physicians varied (35% to 69.7%) depending on measurement instrument and severity of pain. Analgesics were received by 64.5% (paracetamol (acetaminophen), NSAIDs, opioids). Paracetamol (acetaminophen) and opioids frequently were prescribed below daily defined doses. Conclusion Pain occurred frequently also among Dutch NH-patients and was associated with depression and anxiety. Recognition and treatment by NH-physicians proved sub-optimal. Future studies should focus on interventions to improve recognition and treatment of pain.
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Affiliation(s)
- Martin Smalbrugge
- Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
| | - Lineke K Jongenelis
- Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
| | - Anne Margriet Pot
- Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
- Trimbos-institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Aartjan TF Beekman
- Institute of Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan A Eefsting
- Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institute of Extramural Medicine (EMGO), VU University Medical Center, Amsterdam, The Netherlands
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Siciliano P, Burrage R. Chronic pain in the elderly: a continuing education program for certified nursing assistants. Geriatr Nurs 2005; 26:252-8. [PMID: 16109299 DOI: 10.1016/j.gerinurse.2005.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the greatest challenges facing nursing today is the provision of proper pain management in patients suffering from both acute and chronic pain. The purpose of this article is to provide an introduction to a continuing education program for use by registered nurse instructors in teaching certified nursing assistants (CNAs) about their role in the management of pain in elderly persons. The article includes a summary of the program content.
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Affiliation(s)
- Paula Siciliano
- University of Utah College of Nursing, Salt Lake City, Utah, USA
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Tsai YF, Wei SL, Lin YP, Chien CC. Depressive symptoms, pain experiences, and pain management strategies among residents of taiwanese public elder care homes. J Pain Symptom Manage 2005; 30:63-9. [PMID: 16043008 DOI: 10.1016/j.jpainsymman.2005.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to explore depressive symptoms, pain experiences, and pain self-care management strategies among residents of public elder care homes in Taiwan. Random sampling was used to recruit participants (n=200). In this sample, the prevalence of depressive symptoms was 49.0%. Pain prevalence was significantly higher in the depressed group (59.2%) than in the non-depressed group (43.1%). Depressed participants tended to report more severe pain intensity, worst pain, average pain, and more interference with walking than the non-depressed group. Most participants (60.0%) took prescribed medications for dealing with pain. Self was the main information source for pain management strategies. Participants reported severe bouts of pain but used limited self-care pain management strategies. Due to the limited number of health care providers in elder care homes, the authors recommend increasing knowledge about depression, pain, and pain management strategies of both institutional health care staff and residents.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China
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Hølen JC, Saltvedt I, Fayers PM, Bjørnnes M, Stenseth G, Hval B, Filbet M, Loge JH, Kaasa S. The Norwegian Doloplus-2, a tool for behavioural pain assessment: translation and pilot-validation in nursing home patients with cognitive impairment. Palliat Med 2005; 19:411-7. [PMID: 16111065 DOI: 10.1191/0269216305pm1031oa] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pain assessment is challenging in cognitively impaired (CI) patients due to inadequate self-report skills and observational ratings are an alternative. The Doloplus-2 is developed for pain assessment in the CI and rates somatic, psychomotor and psychosocial behaviours as indicators of pain. AIMS To translate the Doloplus-2 into Norwegian, to test the Doloplus-2 with regard to criterion validity and to obtain the administrators' evaluation of the clinical performance of the Doloplus-2. METHODS Nurses at three nursing homes, in collaboration with two research assistants, administered the Doloplus-2 to 59 patients with dementia. The results were compared against experienced clinicians' pain ratings. Regression analyses were performed to explore each different item's contribution to the total pain score. The administrators also completed a debriefing questionnaire. RESULTS The instrument was translated according to international guidelines. Regression analyses demonstrate that the Doloplus-2 score accounts for 62% (R2) of the expert score and that the four most informative items could explain 68% of the expert score. Analyses of the different Doloplus-2 items indicate that facial expressions explain most and social life least of the expert's pain ratings. The administrators reported that Doloplus-2 was helpful and easy to administer, but questioned the validity of the psychosocial domain. CONCLUSIONS The Norwegian Doloplus-2 demonstrates satisfactory criterion validity and clinical value in this pilot study. However, the content of the instrument needs a general re-evaluation, especially with regard to the psychosocial items.
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Affiliation(s)
- Jacob C Hølen
- Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, N-7006 Trondheim, Norway.
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Tsai YF, Tsai HH, Lai YH, Chu TL. Pain prevalence, experiences and management strategies among the elderly in taiwanese nursing homes. J Pain Symptom Manage 2004; 28:579-84. [PMID: 15589082 DOI: 10.1016/j.jpainsymman.2004.03.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2004] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to explore pain prevalence, experiences, and self-care management strategies among elderly residents of nursing homes in Taiwan. Stratified random sampling was used to recruit participants (n=150). In these elderly nursing home residents, pain prevalence was 65.3% and the average number of pain sites was 3.24 (SD=2.59). The mean pain intensity was 3.86 (SD=1.90) and pain interference was 4.30 (SD=2.28). "Aching" was the word most commonly used (77.6%) to describe pain. Most participants (54.21%) took prescribed medications for dealing with pain; doctors were the main information source for this self-care strategy. Although participants reported severe bouts of pain, they used limited self-care pain management strategies. Since health care providers play an important role in helping the elderly to manage pain, the authors recommend training nursing home staff to perform regular pain assessments and providing current knowledge about pain assessment and management strategies.
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Affiliation(s)
- Yun-Fang Tsai
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan
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Current awareness in geriatric psychiatry. Int J Geriatr Psychiatry 2003; 18:761-8. [PMID: 12931721 DOI: 10.1002/gps.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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