Descriptions of pain in elderly patients following orthopaedic surgery

Determining chronic pain data elements as a first step towards improving quality of care and research in chronic pain

Background:

Chronic pain is a significant clinical problem in the world. There is still no quite effective treatment for this pain due to its complex nature. Timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high quality clinical care and more accurate health planning. We aimed to determine minimum set of data needed as a first step in design and development of a chronic pain registry system.

Materials and Methods:

This descriptive-applied study was carried out in three phases; identifying necessary minimum data, preparing a primary minimum dataset, and surveying expertsby questionnaire.

Result:

The literature review revealed that, theprimary minimum dataset consisted of 51 elements, which were reduced to 41 after applying the experts’ opinion. This dataset covered six areas:demographic information(8 elements), initial pain assessment(12 elements), medical history (8 elements), mental health and well-being(6 elements), diagnostic measures(3elements), and diagnosis and treatment plan (4 elements).

Conclusion:

Determining minimum set of chronic pain data will be an effective step towards integrating and improving information management of patients with chronic pain. It will also allow for proper storage and retrieval of information related to these patients.

Afterpains: a comparison between active and expectant management of the third stage of labor

BACKGROUND

  Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women's experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains.

METHODS

  A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n=1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth.

RESULTS

  At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p=0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p<0.001).

CONCLUSIONS

  Active management of the third stage of labor does not provoke more intense afterpains than expectant management.

The Use of Internet Cancer Support Groups by Asian Americans and White Americans Living With Cancer

Purpose: To explore the use of Internet cancer support groups (UICSG) by Asians and Whites living with cancer and determine the factors influencing their UICSG. Design and Method: A cross-sectional Internet study among 30 Asians and 30 Whites. The instruments included (a) questions on sociodemographic and cultural factors, and disease status, (b) the Support Care Needs Survey-34 Short Form, (c) the 2003 Health Information National Trends Survey subscale on Internet usage, and (d) the UICSG Questionnaire. The data were analyzed using the Wilcoxon rank-sum test and nonparametric multiple regression analyses. Results: There was a significant ethnic difference in the UICSG, but there were no ethnic differences in general Internet use or needs for help. Across the ethnic groups, the significant factors influencing the UICSG included “self-reported ethnic identity,” “born in the United States,” and “general Internet use.” Conclusion: Nurses should consider the cultural factors that influence the UICSG.

A comparison of two pain measures for Asian American cancer patients

Although two of the most commonly used multidimensional pain scales are the McGill Pain Questionnaire-Short Form (MPQ-SF) and the Brief Pain Inventory-Short Form (BPI-SF), there has been little psychometric analysis of these tools used among ethnic minority populations. The purpose of this study was to evaluate and compare psychometric properties of these two pain scales among 119 Asian American cancer patients. The Cronbach's alpha coefficients of the MPQ-SF and the BPI-SF were high (alpha = .85-.97). The correlation coefficients of the item analyses were .12 to .88 for the MPQ-SF and .44 to .90 for the BPI-SF. Two factors were extracted for both instruments. Correlations between pain scores and the usage of pain medications were low for the MPQ-SF (r = .23-.33) and moderate for the BPI-SF (r = .40-.42). The results of this study indicated that, among Asian Americans, both the pain scales were internally consistent; some items in each instrument were redundant; and the BPI-SF is more valid than the MPQ-SF.

A comparison of two pain measures for Asian American cancer patients

Although two of the most commonly used multidimensional pain scales are the McGill Pain Questionnaire-Short Form (MPQ-SF) and the Brief Pain Inventory-Short Form (BPI-SF), little psychometric analysis of these tools has been done among ethnic minority populations. This study evaluates and compares psychometric properties of these scales among 119 Asian American cancer patients. Cronbach's alphas of the MPQ-SF and BPI-SF are high (alpha = .85 to .97). Correlation coefficients of the item analyses are .12 to .88 for the MPQ-SF and .44 to .90 for the BPI-SF. Two factors are extracted for both instruments. Correlations between pain scores and the usage of pain medications are low for the MPQ-SF ( r = .23 to .33) and moderate for the BPI-SF (r = .40 to .42). Results indicate that among Asian Americans, both pain scales are internally consistent, some items in each are redundant, and the BPI-SF is more valid than the MPQ-SF.

Expressing and responding to pain and stoicism in home-care nurse-patient interactions

Addressing pain and suffering are critical issues for home-care nurses. Pain is frequently experienced by people living at home with chronic illnesses, as well as acutely ill people discharged early from hospitals. The purpose of this qualitative ethology study was to explore and describe the interactions and experiences expressing and responding to pain in home-care nurse-patient interactions. A qualitative video ethology design was appropriate to inductively describe micropatterns of communicative behaviour in natural settings. Ten home-care nurse-patient dyads were videotaped over multiple visits. Data consisted of 31 videotaped visits (over 19 hours) and accompanying participant interviews. Recursive and cyclical qualitative analysis was used to describe the patterns of communication with which stoicism or endurance of pain and suffering was supported or challenged. Dominant patterns of interaction were concerned with: negotiating appropriate forms of stoicism; negotiating ways to express, understand and measure pain and suffering; and dealing with intractable or inflicted pain. The methodology of this study allows an in-depth view of typical nurse-patient interactions. It explores the subtle communicative expertise of nurses by investigating the types of communication used in nursing encounters and by explicating behavioural patterns of expressing and responding to suffering. Observational research of interaction-as-it-occurs must continue to better understand how nurses and patients co-construct personal identities of suffering and stoicism.

“What do you expect? You're just getting older”: A comparison of perceived osteoarthritis-related and aging-related health experiences in middle- and older-age adults

OBJECTIVE

To compare the health experiences of middle- and older-age adults with moderate osteoarthritis (OA) symptoms with experiences of individuals with no chronic health conditions. Similarities and differences in health changes, the meaning of these changes, and their impact were examined.

METHODS

Sixteen focus groups (10 OA, 6 control) were conducted with 53 women and 37 men (age 39-88 years). OA participants were recruited from practitioners' offices and The Arthritis Society, Ontario Division. Additional OA participants and controls were recruited from community centers and newspaper advertisements. All participants were asked about changes in health, the impact of these changes, and self-management strategies. Participants also completed standardized measures including demographic information; the Short Form 36; Western Ontario and McMaster Universities Osteoarthritis Index; and Disabilities of the Arm, Shoulder and Hand questionnaire.

RESULTS

Differences in the depth, breadth, and meaning of symptoms such as pain, stiffness, and fatigue were reported with little overlap between OA and control groups. OA was often seen as part of a normal aging process requiring acceptance, not treatment. However, younger OA participants reported more distress and frustration managing the disease. OA participants reported an impact of their health on work, leisure, social activities, and relationships that was described as upsetting compared with controls.

CONCLUSION

This study illuminates personal and social factors associated with OA by comparing health experiences of individuals with OA and controls. It highlights directions for future research that can improve our understanding of the needs of individuals with OA and can help link individuals' health status to the broader framework of their lives.