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(176) Parent’s perspective of managing pain at home following tonsillectomy
P20
Abstracts
Pain in Children
Pain in the Elderly
(176) Parent’s perspective of managing pain at home following tonsillectomy
(178) Diffuse noxious inhibitory controls observed across the lifespan
K Sutters, M Savedra, C Miaskowski, S Paul, D Holdridge-Zeuner, S Waite, B Lanier; Children’s Hospital Central California, Madera, CA The purpose of this study was to describe parent’s experiences with pain relieving methods and their suggestions to other parents regarding the implementation of pain relief measures at home following tonsillectomy. Parents (N⫽79) were interviewed at home on the 4th day after the child’s surgery. Fifteen minute, audio-taped interviews, using both direct and open-ended questions, obtained information on parent’s expectations of pain, perceived effectiveness of the pain medications, use of non-pharmacologic approaches, and suggestions to other parents about pain relief measures at home following tonsillectomy. Audiotaped interviews were transcribed and independently coded by two members of the research team. Discrepancies in coding were resolved by consensus between a third member of the research team and the two original coders. Specific content within categories were quantified and reported as the number of parent responses. Nearly 50% of parents reported that their children had more pain after surgery than they expected. Most parents (93%) reported that they felt adequately prepared to manage their child’s pain. Parent satisfaction with pain relief was high and they all reported that the pain medication helped. Approximately 25% reported concerns about giving pain medicine. The most commonly used nonpharmacologic approach was taking cold things by mouth (63%). Comforting the child (49%), giving fluids (35%), and providing distraction (27%) were reported as useful. Parent’s suggestions to other parents included being prepared/knowing what to expect (21%), providing comfort (21%), and giving the pain medicine as ordered (15%). Parents underestimate the amount of pain their children will experience at home following tonsillectomy. Parental concerns regarding analgesic administration need to be addressed. The pain relieving methods that are perceived by parents to be helpful following tonsillectomy may provide clinicians with additional strategies to recommend in the relief of post-tonsillectomy pain in pediatric patients. Supported by a grant from the NINR (NR04826).
A Pare, M Donovan, A Okcular, J Saltz, L Place, K Rouisse, C Tseng, J Zipnik, J Riley, C King, A Mauderli; University of Florida, Gainesville, FL Diffuse noxious inhibitory controls (DNIC) is an endogenous pain inhibition system. DNIC is believed to evoke descending supraspinal mechanisms in such a way that pain in a local area (experimental stimulus) is inhibited by a second pain that can be experienced at another location in the body (conditioning stimulus). The purpose of this study was to examine age-related differences using a DNIC protocol. Four older female adults and three older male adults were matched according to sex and individualized temperature settings to younger adult controls. During a training session, the temperature for the remaining sessions were determined based on the heat stimulus that produced a 40-50 rating and the cold water stimulus that produced a rating of 20-30 (0-100 VAS). Participants experienced the conditioning stimuli, cold water immersion (8-16oC) of the right foot, and the experimental stimuli, thermal stimuli (44-49oC) applied to the left palm, concurrently in order to induce DNIC. Participants underwent a control session using a 23oC water bath. Each session consisted of five 60-second trials. Peak pain ratings and area under the curve (AUC) scores were summed across each of the five trials. The dependent variables were aggregated experimental condition ratings minus control session ratings. The ANOVA analysis for peak pain ratings was significant (F⫽6.347, p⫽.027) with the older subjects reporting increased pain (mean⫽ -1.6 (SD⫽4.0)) compared to younger subjects, who reported pain inhibition (5.2 (SD⫽5.9). For AUC, group differences approached significance (F⫽3.010, p⫽.115). Older adults process pain differently than younger adults. DNIC is an indicator of healthy pain inhibition. These findings suggest that older adults have reduced ability to inhibit pain, possibly because of dysfunction of their endogenous pain inhibition systems. This research was supported by a UFCD Student Summer Research Fellowship and NIH- NIDCR grant T32 DE007200.
(177) Attributes of pain in young children with sickle cell disease
Visceral Pain–Clinical
B Ely, C Dampier, D Brodecki, P O’Neal; Drexel University College of Medicine, Philadelphia, PA We report the analysis of sickle cell pain occurrence in young children (6-48 months) from prospective parental report. This study was started in 1999 and uses a longitudinal prospective design. Parents report pain occurrence, location, associated symptoms, and treatment provided during home based pain episodes in children with sickle cell disease (SCD). Pain data are collected using either daily paper diaries, calendars, or a daily electronic pager system. Serial hematologic values were also obtained at 3-4 month intervals. 551 pain days reported by parent/guardian were recorded for 30 of the 45 (25 SS, 20 SC, 29 males [65.9%]) children in the sample over the first 48 months of life. 15 of the children had no reported pain during this period. Occurrence of the first sickle cell pain day for the 30 children by year was as follows: 15 (11 SS, 4 SC) in the first 12 months of life, 5 (3 SS, 2 SC) in the second year of life, 6 (1 SS, 5 SC) in their third year of life, while the remaining 4 children (4 SS, 0 SC) had their first sickle cell pain episode between 36-48 months. Areas of pain to touch and swelling most frequently reported were: right/left foot or right/left leg. Actions taken by parents to relieve pain included providing medication 372 (67.5%) of the reported pain days. Parents also reported providing other types of help to relieve pain on 251 (45.6%) of the 551 pain days. Giving extra fluids, providing warmth (bath, holding, extra clothes) and massage were most common interventions used and reported effective. Sickle cell pain episodes occur frequently in the home setting and are assessed and managed by parents/ guardians using medication and nonpharmacologic techniques on greater than half of the days of pain. Supported by a Comprehensive Sickle Cell Grant P60-HL-70585.
(179) TENS modifies gastric myoelectrical activity, pain scores and plasma VIP, motilin and IL-6 levels in systemic sclerosis T McNearney, H Sallam, D Doshi, S Hunnicutt, J Chen; University of Texas Medical Branch, Galveston, TX We assessed transcutaneous electrical nerve stimulation (TENS) on gastric myoelectrical activity (GMA), plasma gastric peptide levels, GI symptoms and perceived functioning in systemic sclerosis (SSc) patients. Seventeen SSc patients underwent 30 min TENS, ⬎10Hz at GI acupuncture points PC6 and ST36, once, (acute TENS) and then after two weeks of TENS sessions at home for 30 min twice daily (prolonged TENS). Data collected included GMA by four channel surface electrogastrography (EGG), a GI specific symptoms questionnaire and health related SF-36. Plasma levels for vasoactive intestinal peptide (VIP), motilin and interleukin 6 (IL-6) were determined by immunoassays. Statistical analyses were performed by the Student’s t-test and Spearman Rank Order correlation. A p value ⬍0.05 was considered significant. The results were as follows: 1.) GMA response to prolonged TENS: % tachygastria and wave coupling (especially channels 2 and 3, reflecting gastric corpus) were significantly increased compared to values of baseline or acute TENS. 2.) Gastric Peptides: After acute TENS, plasma VIP and motilin levels demonstrated significant decreases compared to baseline values, generally maintained after prolonged TENS application. 3. ) Plasma IL-6 levels significantly increased after acute TENS application, compared to baseline, but were significantly lower after prolonged TENS. 4. ) The GI symptom of abdominal bloating was significantly reduced after prolonged TENS. SSc patients also reported less awakening to abdominal pain and greater control of abdominal pain (p⫽NS) after prolonged TENS. The GMA in SSc patients can potentially be conditioned to increase response to gastric stimulators, such as TENS, for enhanced gastric wave functioning. This may be reflected in improved pain scores, GI related symptoms, plasma levels of gastric peptide and IL-6. Supported by NIH SCOR Grant in Scleroderma P50AR44888(TAM, SEH), NIH Centers for Research Translation (CORT) P50AR054144 (TAM, SEH), UTMB GCRC M01RR00073 and R21 AG023951 NIH National Institute on Aging (TAM, SEH).
Abstracts
Pain in Children
Pain in the Elderly
(176) Parent’s perspective of managing pain at home following tonsillectomy
(178) Diffuse noxious inhibitory controls observed across the lifespan
K Sutters, M Savedra, C Miaskowski, S Paul, D Holdridge-Zeuner, S Waite, B Lanier; Children’s Hospital Central California, Madera, CA The purpose of this study was to describe parent’s experiences with pain relieving methods and their suggestions to other parents regarding the implementation of pain relief measures at home following tonsillectomy. Parents (N⫽79) were interviewed at home on the 4th day after the child’s surgery. Fifteen minute, audio-taped interviews, using both direct and open-ended questions, obtained information on parent’s expectations of pain, perceived effectiveness of the pain medications, use of non-pharmacologic approaches, and suggestions to other parents about pain relief measures at home following tonsillectomy. Audiotaped interviews were transcribed and independently coded by two members of the research team. Discrepancies in coding were resolved by consensus between a third member of the research team and the two original coders. Specific content within categories were quantified and reported as the number of parent responses. Nearly 50% of parents reported that their children had more pain after surgery than they expected. Most parents (93%) reported that they felt adequately prepared to manage their child’s pain. Parent satisfaction with pain relief was high and they all reported that the pain medication helped. Approximately 25% reported concerns about giving pain medicine. The most commonly used nonpharmacologic approach was taking cold things by mouth (63%). Comforting the child (49%), giving fluids (35%), and providing distraction (27%) were reported as useful. Parent’s suggestions to other parents included being prepared/knowing what to expect (21%), providing comfort (21%), and giving the pain medicine as ordered (15%). Parents underestimate the amount of pain their children will experience at home following tonsillectomy. Parental concerns regarding analgesic administration need to be addressed. The pain relieving methods that are perceived by parents to be helpful following tonsillectomy may provide clinicians with additional strategies to recommend in the relief of post-tonsillectomy pain in pediatric patients. Supported by a grant from the NINR (NR04826).
A Pare, M Donovan, A Okcular, J Saltz, L Place, K Rouisse, C Tseng, J Zipnik, J Riley, C King, A Mauderli; University of Florida, Gainesville, FL Diffuse noxious inhibitory controls (DNIC) is an endogenous pain inhibition system. DNIC is believed to evoke descending supraspinal mechanisms in such a way that pain in a local area (experimental stimulus) is inhibited by a second pain that can be experienced at another location in the body (conditioning stimulus). The purpose of this study was to examine age-related differences using a DNIC protocol. Four older female adults and three older male adults were matched according to sex and individualized temperature settings to younger adult controls. During a training session, the temperature for the remaining sessions were determined based on the heat stimulus that produced a 40-50 rating and the cold water stimulus that produced a rating of 20-30 (0-100 VAS). Participants experienced the conditioning stimuli, cold water immersion (8-16oC) of the right foot, and the experimental stimuli, thermal stimuli (44-49oC) applied to the left palm, concurrently in order to induce DNIC. Participants underwent a control session using a 23oC water bath. Each session consisted of five 60-second trials. Peak pain ratings and area under the curve (AUC) scores were summed across each of the five trials. The dependent variables were aggregated experimental condition ratings minus control session ratings. The ANOVA analysis for peak pain ratings was significant (F⫽6.347, p⫽.027) with the older subjects reporting increased pain (mean⫽ -1.6 (SD⫽4.0)) compared to younger subjects, who reported pain inhibition (5.2 (SD⫽5.9). For AUC, group differences approached significance (F⫽3.010, p⫽.115). Older adults process pain differently than younger adults. DNIC is an indicator of healthy pain inhibition. These findings suggest that older adults have reduced ability to inhibit pain, possibly because of dysfunction of their endogenous pain inhibition systems. This research was supported by a UFCD Student Summer Research Fellowship and NIH- NIDCR grant T32 DE007200.
(177) Attributes of pain in young children with sickle cell disease
Visceral Pain–Clinical
B Ely, C Dampier, D Brodecki, P O’Neal; Drexel University College of Medicine, Philadelphia, PA We report the analysis of sickle cell pain occurrence in young children (6-48 months) from prospective parental report. This study was started in 1999 and uses a longitudinal prospective design. Parents report pain occurrence, location, associated symptoms, and treatment provided during home based pain episodes in children with sickle cell disease (SCD). Pain data are collected using either daily paper diaries, calendars, or a daily electronic pager system. Serial hematologic values were also obtained at 3-4 month intervals. 551 pain days reported by parent/guardian were recorded for 30 of the 45 (25 SS, 20 SC, 29 males [65.9%]) children in the sample over the first 48 months of life. 15 of the children had no reported pain during this period. Occurrence of the first sickle cell pain day for the 30 children by year was as follows: 15 (11 SS, 4 SC) in the first 12 months of life, 5 (3 SS, 2 SC) in the second year of life, 6 (1 SS, 5 SC) in their third year of life, while the remaining 4 children (4 SS, 0 SC) had their first sickle cell pain episode between 36-48 months. Areas of pain to touch and swelling most frequently reported were: right/left foot or right/left leg. Actions taken by parents to relieve pain included providing medication 372 (67.5%) of the reported pain days. Parents also reported providing other types of help to relieve pain on 251 (45.6%) of the 551 pain days. Giving extra fluids, providing warmth (bath, holding, extra clothes) and massage were most common interventions used and reported effective. Sickle cell pain episodes occur frequently in the home setting and are assessed and managed by parents/ guardians using medication and nonpharmacologic techniques on greater than half of the days of pain. Supported by a Comprehensive Sickle Cell Grant P60-HL-70585.
(179) TENS modifies gastric myoelectrical activity, pain scores and plasma VIP, motilin and IL-6 levels in systemic sclerosis T McNearney, H Sallam, D Doshi, S Hunnicutt, J Chen; University of Texas Medical Branch, Galveston, TX We assessed transcutaneous electrical nerve stimulation (TENS) on gastric myoelectrical activity (GMA), plasma gastric peptide levels, GI symptoms and perceived functioning in systemic sclerosis (SSc) patients. Seventeen SSc patients underwent 30 min TENS, ⬎10Hz at GI acupuncture points PC6 and ST36, once, (acute TENS) and then after two weeks of TENS sessions at home for 30 min twice daily (prolonged TENS). Data collected included GMA by four channel surface electrogastrography (EGG), a GI specific symptoms questionnaire and health related SF-36. Plasma levels for vasoactive intestinal peptide (VIP), motilin and interleukin 6 (IL-6) were determined by immunoassays. Statistical analyses were performed by the Student’s t-test and Spearman Rank Order correlation. A p value ⬍0.05 was considered significant. The results were as follows: 1.) GMA response to prolonged TENS: % tachygastria and wave coupling (especially channels 2 and 3, reflecting gastric corpus) were significantly increased compared to values of baseline or acute TENS. 2.) Gastric Peptides: After acute TENS, plasma VIP and motilin levels demonstrated significant decreases compared to baseline values, generally maintained after prolonged TENS application. 3. ) Plasma IL-6 levels significantly increased after acute TENS application, compared to baseline, but were significantly lower after prolonged TENS. 4. ) The GI symptom of abdominal bloating was significantly reduced after prolonged TENS. SSc patients also reported less awakening to abdominal pain and greater control of abdominal pain (p⫽NS) after prolonged TENS. The GMA in SSc patients can potentially be conditioned to increase response to gastric stimulators, such as TENS, for enhanced gastric wave functioning. This may be reflected in improved pain scores, GI related symptoms, plasma levels of gastric peptide and IL-6. Supported by NIH SCOR Grant in Scleroderma P50AR44888(TAM, SEH), NIH Centers for Research Translation (CORT) P50AR054144 (TAM, SEH), UTMB GCRC M01RR00073 and R21 AG023951 NIH National Institute on Aging (TAM, SEH).