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131 THE ROLE OF THE NURSES IN PAIN MANAGEMENT
Topical Seminar: CUES FOR PAIN AND DISTRESS IN OTHERS for the different European countries will form an important part of the seminar. Expanding the role of the nurse, including via nurse prescribing, offers potential for members of the health care team working in pain management and for enhanced patient care. 129 EXPANDING NURSING ROLES AND DEVELOPMENT OF NURSE PRESCRIBING, REVIEW OF LITERATURE
S37 The PRO-SELF Program is an effective approach for patient education about cancer pain management. Results of the replication of this study in Norway will be available soon. This Program should be modified and tested in patients with other types of chronic pain. While some countries are providing nurses with prescriptive authority, nurses can continue to play a pivotal role in effective pain management through the provision of education that is individualized to each patient.
C.J. Seers ° . UK Abstract not available at time of printing. 130 COMPETENCIES, LEGAL AND CLINICAL REQUIREMENTS AND TRAINING FOR NURSE PRESCRIBING T.J. Towell ° . UK Abstract not available at time of printing. 131 THE ROLE OF THE NURSES IN PAIN MANAGEMENT T. Rustøen1 ° , C. Miaskowski2 . 1 Oslo University College, Oslo, Norway, 2 University of California, San Francisco, CA, USA Throughout the world, the under-treatment of chronic pain remains a significant health problem. For example, our research has shown that 24.4% of the Norwegian population experiences unrelieved chronic pain. Despite advances in our understanding of pain mechanisms and in the development of new pharmacologic approaches, patients continue to suffer unrelieved pain. Evidence from our group suggests that patients with unrelieved cancer pain take only 50% of their analgesic prescription. These data suggest that patient education is a critical component of any effective pain management plan. Nurses are in an ideal position to implement patient education programs to enhance adherence with pain treatments. One example of an effective pain education program, that was tested in the USA and is undergoing testing in Norway, is the PRO-SELF© Pain Control Program. This program provides patients with the knowledge, skills, and nursing support needed to improve pain management. It is based on self-care theory and academic detailing and was developed by researchers at the University of California, San Francisco. Specially trained nurses conducted home visits and telephone calls to educate patients and coach them to improve their pain management skills. This structured and individualized program lasted for 6 weeks. In a randomized clinical trial of the intervention compared to standard care, the Program resulted in significant decreases in pain intensity scores, significant increases in the number of appropriate analgesic prescriptions, and significant improvements in patients’ knowledge about pain management. As part of a qualitative analysis of the clinical interviews, numerous difficulties that hindered effective pain management were identified and dealt with as part of the Program. Examples of difficulties included: lack of education about the titration of analgesic medications within the parameters of the analgesic prescription; the provision of incorrect information; intolerable side effects; and difficulty managing multiple symptoms simultaneously. These difficulties were all amenable to patient education. While patients in the intervention group reported statistically and clinically significant reductions in pain intensity scores compared to patients in the standard care group, recent analyses of data from the PRO-SELF©study, using a responder analysis approach, showed that only 50% of the patients in the intervention group achieved a 30% reduction in pain. Twenty-five percent of the patients were classified as partial responders and 25% were classified as non-responders (i.e., their pain scores worsened during the intervention). Importantly, differences in a variety of outcome measures (mood, quality-of-life, pain interference) were found between responders and non-responders. This type of analysis may be useful in determining individual differences in patients’ responses to nonpharmacologic and pharmacologic interventions and could lead to more targeted interventions.
Topical Seminar: CUES FOR PAIN AND DISTRESS IN OTHERS 132 Topical Seminar Summary: CUES FOR PAIN AND DISTRESS IN OTHERS G. Crombez ° . Dept Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium Pain and disability have been mainly investigated from within an operant conditioning perspective (e.g. reinforcement of illness behaviour, modelling) or within a cognitive-appraisal model (e.g. catastrophizing). Although each of these perspectives has merits, there are also some weaknesses. There is a danger that the social context of pain is developed in isolation of other fields, e.g. social psychology and evolutionary psychology. In this topical seminar we explore the role of empathy in understanding how one is affected by seeing another in pain, and how this response may elicit distress and helping behaviour. Dr. Liesbet Goubert will provide an introduction. She will define the construct of empathy and summarize current theories, including a recently developed empathy model applied to pain. The results of empirical studies regarding the role of empathy in parents when confronted with their child in pain will be discussed. Building upon the account that empathy is an evolved function, Dr. Mogil will discuss recent findings from his laboratory strongly suggesting that even laboratory mice are capable of empathy for pain in conspecific familiars. This new model of animal empathy will allow the full power of mouse genetics and molecular biology to be brought to bear on the study of empathy. Finally, Dr. Gwenola Herbette will focus upon the diversity of reactions that may be elicited in observers. She will argue that there are differences in responding to persons experiencing acute and chronic illnesses. Whereas in acute situations people are eager to share their emotions with each other, and to listen to the suffering of another person, they often tend to avoid these in chronic situations. Dr. Herbette will review empirical evidence about stigmatization and discounting in chronic pain, and will conclude with a summary of strategies that may enhance others’ empathic reactions. 133 FACING OTHERS IN PAIN: THE ROLE OF EMPATHY L. Goubert ° . Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Background and Aims: This presentation will provide an introduction to the construct of empathy and will summarize current theories, including the recently developed empathy model applied to pain. In particular, bottom-up (e.g., facial pain expressions of the observed person in pain) and top-down factors (e.g., the observer’s dispositional empathy, catastrophic thoughts about the pain of the person in pain) influencing an observer’s cognitive, affective and behavioural empathic responses to facing another person in pain will be discussed. Further, findings will be discussed from 2 studies investigating the role of parental empathic responses in paediatric pain. Methods: Parental empathic responses to their child’s pain were investigated in (1) an experimental study using a pressure pain paradigm as pain induction method in a non-clinical sample of parents of school children (N = 53; mean age of children 11.82 years), and in (2) a questionnaire study
S37 The PRO-SELF Program is an effective approach for patient education about cancer pain management. Results of the replication of this study in Norway will be available soon. This Program should be modified and tested in patients with other types of chronic pain. While some countries are providing nurses with prescriptive authority, nurses can continue to play a pivotal role in effective pain management through the provision of education that is individualized to each patient.
C.J. Seers ° . UK Abstract not available at time of printing. 130 COMPETENCIES, LEGAL AND CLINICAL REQUIREMENTS AND TRAINING FOR NURSE PRESCRIBING T.J. Towell ° . UK Abstract not available at time of printing. 131 THE ROLE OF THE NURSES IN PAIN MANAGEMENT T. Rustøen1 ° , C. Miaskowski2 . 1 Oslo University College, Oslo, Norway, 2 University of California, San Francisco, CA, USA Throughout the world, the under-treatment of chronic pain remains a significant health problem. For example, our research has shown that 24.4% of the Norwegian population experiences unrelieved chronic pain. Despite advances in our understanding of pain mechanisms and in the development of new pharmacologic approaches, patients continue to suffer unrelieved pain. Evidence from our group suggests that patients with unrelieved cancer pain take only 50% of their analgesic prescription. These data suggest that patient education is a critical component of any effective pain management plan. Nurses are in an ideal position to implement patient education programs to enhance adherence with pain treatments. One example of an effective pain education program, that was tested in the USA and is undergoing testing in Norway, is the PRO-SELF© Pain Control Program. This program provides patients with the knowledge, skills, and nursing support needed to improve pain management. It is based on self-care theory and academic detailing and was developed by researchers at the University of California, San Francisco. Specially trained nurses conducted home visits and telephone calls to educate patients and coach them to improve their pain management skills. This structured and individualized program lasted for 6 weeks. In a randomized clinical trial of the intervention compared to standard care, the Program resulted in significant decreases in pain intensity scores, significant increases in the number of appropriate analgesic prescriptions, and significant improvements in patients’ knowledge about pain management. As part of a qualitative analysis of the clinical interviews, numerous difficulties that hindered effective pain management were identified and dealt with as part of the Program. Examples of difficulties included: lack of education about the titration of analgesic medications within the parameters of the analgesic prescription; the provision of incorrect information; intolerable side effects; and difficulty managing multiple symptoms simultaneously. These difficulties were all amenable to patient education. While patients in the intervention group reported statistically and clinically significant reductions in pain intensity scores compared to patients in the standard care group, recent analyses of data from the PRO-SELF©study, using a responder analysis approach, showed that only 50% of the patients in the intervention group achieved a 30% reduction in pain. Twenty-five percent of the patients were classified as partial responders and 25% were classified as non-responders (i.e., their pain scores worsened during the intervention). Importantly, differences in a variety of outcome measures (mood, quality-of-life, pain interference) were found between responders and non-responders. This type of analysis may be useful in determining individual differences in patients’ responses to nonpharmacologic and pharmacologic interventions and could lead to more targeted interventions.
Topical Seminar: CUES FOR PAIN AND DISTRESS IN OTHERS 132 Topical Seminar Summary: CUES FOR PAIN AND DISTRESS IN OTHERS G. Crombez ° . Dept Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium Pain and disability have been mainly investigated from within an operant conditioning perspective (e.g. reinforcement of illness behaviour, modelling) or within a cognitive-appraisal model (e.g. catastrophizing). Although each of these perspectives has merits, there are also some weaknesses. There is a danger that the social context of pain is developed in isolation of other fields, e.g. social psychology and evolutionary psychology. In this topical seminar we explore the role of empathy in understanding how one is affected by seeing another in pain, and how this response may elicit distress and helping behaviour. Dr. Liesbet Goubert will provide an introduction. She will define the construct of empathy and summarize current theories, including a recently developed empathy model applied to pain. The results of empirical studies regarding the role of empathy in parents when confronted with their child in pain will be discussed. Building upon the account that empathy is an evolved function, Dr. Mogil will discuss recent findings from his laboratory strongly suggesting that even laboratory mice are capable of empathy for pain in conspecific familiars. This new model of animal empathy will allow the full power of mouse genetics and molecular biology to be brought to bear on the study of empathy. Finally, Dr. Gwenola Herbette will focus upon the diversity of reactions that may be elicited in observers. She will argue that there are differences in responding to persons experiencing acute and chronic illnesses. Whereas in acute situations people are eager to share their emotions with each other, and to listen to the suffering of another person, they often tend to avoid these in chronic situations. Dr. Herbette will review empirical evidence about stigmatization and discounting in chronic pain, and will conclude with a summary of strategies that may enhance others’ empathic reactions. 133 FACING OTHERS IN PAIN: THE ROLE OF EMPATHY L. Goubert ° . Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Background and Aims: This presentation will provide an introduction to the construct of empathy and will summarize current theories, including the recently developed empathy model applied to pain. In particular, bottom-up (e.g., facial pain expressions of the observed person in pain) and top-down factors (e.g., the observer’s dispositional empathy, catastrophic thoughts about the pain of the person in pain) influencing an observer’s cognitive, affective and behavioural empathic responses to facing another person in pain will be discussed. Further, findings will be discussed from 2 studies investigating the role of parental empathic responses in paediatric pain. Methods: Parental empathic responses to their child’s pain were investigated in (1) an experimental study using a pressure pain paradigm as pain induction method in a non-clinical sample of parents of school children (N = 53; mean age of children 11.82 years), and in (2) a questionnaire study