- Email: [email protected]
830 PREVALENCE OF PAIN BY USING NURSING DIAGNOSIS IN A PALLIATIVE CARE SETTING
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
S237
and well formulated jointly agreed treatment plans. Regular staff meetings are crucial to maintain a multidisciplinary approach. Conclusion: Implementating a multidisciplinary service requires forethought, and regular monitoring to ensure efficient management of complex patients. Communication between clinicians, administrative staff and patients is paramount.
Conclusion: The problems of pain management of end-of life patients in Georgia should be caused by lacking of: 1) legislative bases, 2) list and forms of opioids and their availability, 3) knowledge and experience of health care professionals.
827 TREATMENT OF NONCANCER CHRONIC PAIN IN OUT-PATIENT CLINICS IN RUSSIA
M. Zenz *, W. Hardinghaus, C. Muller-Busch, ¨ N. Nestler, J. Osterbrink. CertKom, Bochum, Germany
S. Erdes *, E. Galushko. Institute of Rheumatology, Moscow, Russia There are no common guidelines for treating chronic noncancer pain (CNCP) in Russia. Purpose: To study the current approaches to CNCP treatment opioid analgesics’ usage in this condition. Methods: Interviews with doctors to find out their opinion on CNCP and their real practice in this field in out-patient clinics were held. Before the interview each doctor filled 5 clinic cards/CC on patients with CNCP. 375 doctors (150 general practitioners/GP, 150 neurologists/N and 75 rheumatologists/R) were interviewed, 1875 CC were filled. Results: The doctors’ interviews showed that for severe and very severe CNCP they prescribe in 98% of the cases nonsteroidal anti-inflammatory drugs/NSAID, in 87% central analgesics/CA, in 84% muscle relaxants/MR, in 68% antidepressants, in 51% glucocorticoids, in 20% opioid analgesics/OA. The main reason to avoid the prescription of OA in 58% is a complicated process of its prescription and control, in 40% (GP 42%, N 37%, R 40%), consider that OA could be prescribed for cancer patients, in 34% (31%, 35% and 37%) they fear of drug abuse, in 20% of cases (25%, 17%, 16%) administrative barriers. According to CC data less then 80% of patients received NSAID, about 3% muscle relaxants, CA and OA, less then 1% other medicines. Summary: Theoretical knowledge and preferences of doctors do not correspond to the real clinic practice of CNCP. The majority of Russian doctors are mostly not oriented to prescribe opioid analgesics in cases of severe and very severe noncancer pain. 828 EVALUATION OF SYMPTOM CONTROL ADEQUATENESS AMONG THE END-OF-LIFE PATIENTS RECEIVING PALLIATIVE CARE IN GEORGIA T. Rukhadze *, D. Kordzaia, P. Dzotsenidze. National Cancer Centre, Palliative Care Association “Humanists’ Union”, Tbilisi, Georgia Background: As there are over 43,000 deaths per year in Georgia, over 25,000 persons per year (60%) need palliative care. Of the 7000–8000 new cancers per year, two-thirds need palliative care. Pain Relief and Palliative Care is one of the major unaddressed public health problems in Georgia. Aim of study: To evaluate the adequateness of symptoms control among the palliative care suitable patients in Georgia and analyze the ways of its improvement. Methods: Symptom control adequateness was evaluated by using of especially worked out questionnaires. 368 questionnaires filled by patients (and their family members) curried by mobile team of Palliative Care Association “Humanists’ Union” (AHU) and Palliative Care Consulting Service of National Cancer Centre (PCS) underwent to analysis. Complete relieve of symptoms was considered as an indicator for the successful control. The method of inferential statistics was used. Results: Since 2004 by the mobile team of AHU and PCS have been provided care of 587 end-of life patients in Tbilisi. Pain was revealed as the most unresolved symptom for control (p < 0.001). Its management was insufficient in 219 cases (37.3%): it was not reduced till 3–4 score (of 10-scores pain intensivity scale) in spite of usage of all available medications by medical stuff.
829 CERTIFICATION “QUALIFIED PAIN TREATMENT” IN GERMANY
The efforts in increasing the quality in clinical pain treatment in hospitals have been disappointing over the last decades. [1] On the other hand, many patients make their decision for medical institutions by the reported quality of pain treatment. These 2 extremes stimulated efforts to certificate also the quality of pain treatment in hospitals. In a first project sponsored by Mundipharma the scientific basis and the cut-off values were investigated and determined. Based on these experiences and independent from any sponsor 4 medical societies (Pain, Palliative Care, Interdisciplinary Medicine, Nursing) established a non-profit organization for certification in pain treatment, CertKom – Society for Specialized Pain Treatment [2] criteria for certification are structural quality, process quality and most important quality of performance, the last being the central issue of accreditation. Examples for structural quality are: multiprofessional working group, rules for diagnosis and treatment, for process quality: intervention criteria, patient information, prophylaxis. Quality of performance is exactly measured by NRS according to the investigated cut-offs. Up to now 21 hospitals have been accredited and 3 labs for QST. Certification for “Qualified Pain Treatment” is an important measure in the actual competition between health care providers. Certification is also possible in outpatient care, hospices, pharmacies, and laboratories. [3] This initiative represents an important step forward in improving the quality of pain treatment. The interest in this approach is rapidly increasing. A preliminary study has been supported by Mundipharma Reference(s) [1] Apfelbaum et al 2003. [2] http://www.certkom.com/ [3] Geber et al 2009
830 PREVALENCE OF PAIN BY USING NURSING DIAGNOSIS IN A PALLIATIVE CARE SETTING E. Barallat1 *, J. Canal Sotelo1 , M. Nabal2 , A. Jimenez2 , C. Sarret1 , P. Marine´ 1 , Co. ´ Palomar2 , E. Perez1 , M. Juvero2 , C. Perez-Duran2 . 1 UFISS-Cures Pal·liatives Gesti´ o de Serveis Sanitaris, Hospital Santa Maria, Lleida, Spain; 2 UFISS-CP. Hospital Universitari Arnau de Vilanova, Servei Catal` a de Salut, Lleida, Spain Aim: The main objective is to know the prevalence of cancer related pain in a support palliative care unit by using the North America Nursing Diagnosis Association (NANDA). The secondary objectives are to evaluate the most prevalent NANDA diagnosis seen in the population studied and those associated with pain. Methods: 100 consecutive palliative patients were evaluated [outpatient clinic (n = 31), accident & emergency (n = 10), inpatient unit (n = 59)] at the Hospital Universitari Arnau de Vilanova in Lleida between October 2008 and January 2009. Nursing diagnosis were obtained from the 2006 spanish translation of the NANDA. Results: 70% men. Age: Mean 68.9 years. Median 72.5 years. Main diagnosis: Lung (n = 33). Pain was diagnosed in 44 patients (26 acute, 22 chronic, 4 both). NANDA diagnosis most frequently detected were those related to altered self-care [body hygiene (n = 54), dressing (n = 49) and using the toilet (n = 44)] and tiredness (n = 46). NANDA diagnosis associated with pain were anxiety (n = 23), altered sleeping pattern (n = 22), constipation (n = 22), tiredness (n = 17) and risk of constipation (n = 17). Of those patients
S238
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
with pain, 28/43 (63%) were men and 23/44 (52.3%) were seen at the outpatient clinic and 20/44 (45.5%) at the inpatient unit. Conclusions: Pain is detected by using the NANDA diagnosis in the 44% of patients, being more frequent among men attended at the outpatient clinic. Diagnosis related to pain are similar to those seen among advanced cancer population.
had worse quality of sleep (p = 0.033). The multiple regression analysis showed that constipation was the second strongest predictor for physical HRQOL (beta = −0.193, p = 0.023). Pain was the first one (beta = −0.396, p = 0.00). Conclusion: OIC is associated worse overall, physical, emotional, psychological and cognitive quality of life.
831 ASSESSMENT OF PAIN WITH THE EDMONTON STAGING SYSTEM FOR CANCER PAIN (ESS-CP) IN A PALLIATIVE CARE UNIT
833 FACTOR STRUCTURE OF THE SPANISH VERSION OF THE TAMPA SCALE FOR KINESIOPHOBIA (TSK) IN CHRONIC AND ACUTE PAIN PATIENTS 1 1 L. Gomez ´ Perez ´ *, A.E. Lopez ´ Mart´ınez1 , G.T. Ru´ız Parraga ´ , L. Camacho-Martel1 , M.A. Alba-Castermeiro2 . 1 Departamento de Personalidad, Evaluaci´ on y Tratamiento psicol´ ogico. Universidad de M´ alaga., M´ alaga, Spain; 2 Centro de Salud Cruz de Humilladero, M´ alaga, Spain
J. Canal Sotelo1 *, M. Nabal2 , A. Sulhyak2 , Co. ´ Palomar2 , A. Jimenez2 , 1 2 1 1 E. Barallat , M. Juvero , E. Perez , P. Marine´ , C. Sarret1 . 1 UFISS-Cures Pal·liatives Gesti´ o de serveis sanitaris. Hospital Santa Maria, Lleida, Spain; 2 UFISS-CP. Hospital Universitari Arnau de Vilanova. Servei Catal` a de Salut, Lleida, Spain Aims: Main objective: to know the prevalence of pain among patients seen by a supportive palliative care team in a teaching hospital. Secondary objectives are to determine the classification of pain according the ESS-CP and to determine the prognosis related stage. Methods: We review clinical records of palliative patients seen on 2008 and focus on the ESS-CP categories: pain mechanism, pain characteristics, previous opioid dose, cognitive function, psychological distress, tolerance and past history of drug abuse. Results: 470 patients were included. Mean age 69.75 years. 296 male patients (61.1%). Main diagnosis: Lung 90 (18.6%), Colorectal 67 (13.8%). Oncological 452 (93.4%). Pain on admission: 247 (52.5%). Stage I 141 (59.5%), Stage II 28 (11.3%), Stage III 68 (27.5%), lost 10 (1.7%). Among Stage III, neuropathic pain (41) and incidental type pain (34) are the categories most seen. 66% of patients seen in the inpatient unit (oncology ward 54%). Discussion: Poor prognosis cancer pain is highly prevalent among patients with pain being the category neuropathic pain the most frequently seen. 832 PAIN AND OPIOID-RELATED CONSTIPATION HAVE SIMILAR NEGATIVE IMPACT ON HEALTH-RELATED QUALITY OF LIFE K. Leao Ferreira1,3 *, M. Kimura2,4 , M. Teixeira1 . 1 Multidisciplinary Pain Center, S˜ ao Paulo Cancer Institute, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 3 University of Guarulhos, UnG, Guarulhos, Brazil; 4 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil Aim: To analyze the relationship between the use of opioid, opioid-induced constipation (OIC), and health-related quality of life (HRQOL) and the impact of OIC on HRQOL. Methods: 125 patients with chronic cancer pain were recruited in Multidisciplinary Pain Center, Hospital das Clinicas, School of Medicine, University of S˜ao Paulo, Brazil. They completed the Brief Pain Inventory, Beck Depression Inventory (BDI), and EORTC Quality of Life Questionnaire-core 30 (QLQ-c30). Presence of constipation was defined using Roma III criteria. Constipation severity was graded on four-point categorical scale: none, mild, moderate, and severe. Results: Sixty-six patients (52.8%) were using strong or weak opioids. Of them, 40 (61.5%) had constipation. Constipation was reported as mild (16.9%,) moderate (13.8%), and severe (30.8%). The use of laxatives was reported only by 19%. Worst pain intensity was higher among those with constipation (p = 0.007). Presence of constipation was independent of gender (p = 0.96), level of education (p = 0.51), disease stage (p = 0.061), and presence of depression (p = 0.20). Constipation was associated with lack of appetite (p = 0.004), vomiting (p = 0.023), and presence of metastasis (p = 0.03). Patients with constipation had significantly lower HRQOL scores in the overall quality of life (p = 0.004), physical and role functioning (p = 0.001 and p = 0.002), emotional (p = 0.029), cognitive (p = 0.045), and social functioning (p = 0.031). They also
Background and Aims: The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed measures for assessing pain-related fear in pain patients. The TSK has been translated into different languages. However, a Spanish Version of the TSK has not been available until now. The aim of this study was to present the Spanish version of the TSK and analyse its factorial structure in two different samples: a chronic pain sample (n = 125) and a musculoskeletal acute pain sample (n = 86). Method: Patients fill out the TSK and other related measures in their clinical setting. Inter-item correlations and item-total correlations for the TSK were calculated and two Principal Component Analyses (ACP) with both varimax and oblimin rotation were conducted separately on the scores from both samples. Results: A two factor model of 11 items without reverse scored items was replicated on both samples. Given the content of the items, the factors were named “Activity Avoidance” and “Harm”. Conclusions: The model obtained was similar to that of Clark, Kori and Brockel (1996) and recently replicated by other authors, with the exception of two items (7 and 5) which were eliminated because of their low correlation with the other items. The results provide clinicians and researchers with a measure of pain-related fear for Spanish pain patients, offering the advantage of brevity. Futures studies concerning its validity are needed. 834 BRAIN ACTIVITY AND AFFECTIVE RATINGS ELICITED BY THE OBSERVATION OF PAIN EXPRESSIONS IN OTHERS ´ Munoz A.M´ı. Gonzalez ´ Roldan ´ *, M. Mart´ınez Jauand, M.A. ˜ Garc´ıa, C. Sitges, I. Cifre Leon, ´ P. Montoya. Research Institute on Health Sciences (IUNICS) University of Balearic Islands, Palma, Spain Facial expression is one of the most relevant non-verbal behaviours in the communication of pain. However, little is known about brain processing of pain expressions in comparison with other affective facial expressions. The present experiment was aimed to examine the effects of pain expression intensity on affective ratings and brain activity by recording event-related brain potentials (ERP) from twenty female healthy volunteers (aged 19–23 yrs). Participants were asked to rate the affective characteristics of 144 stimuli depicting facial expressions of pain and anger with three level of intensities (high, medium, low), as well as neutral faces. Results indicated that pain faces were judged as more unpleasant and arousing than anger faces when the intensity of facial expression was high or medium, but not when the intensity of expression was low. ERP results showed an affective modulation of the brain activity between 200 and 350 ms after stimulus onset in parietal and occipital areas, showing significant differences between pain and anger when the intensity of facial expression was medium. These findings suggest that facial expressions of pain may constitute ambiguous threat stimuli for the observer and support the specificity of pain expression in front of other negative emotions.
S237
and well formulated jointly agreed treatment plans. Regular staff meetings are crucial to maintain a multidisciplinary approach. Conclusion: Implementating a multidisciplinary service requires forethought, and regular monitoring to ensure efficient management of complex patients. Communication between clinicians, administrative staff and patients is paramount.
Conclusion: The problems of pain management of end-of life patients in Georgia should be caused by lacking of: 1) legislative bases, 2) list and forms of opioids and their availability, 3) knowledge and experience of health care professionals.
827 TREATMENT OF NONCANCER CHRONIC PAIN IN OUT-PATIENT CLINICS IN RUSSIA
M. Zenz *, W. Hardinghaus, C. Muller-Busch, ¨ N. Nestler, J. Osterbrink. CertKom, Bochum, Germany
S. Erdes *, E. Galushko. Institute of Rheumatology, Moscow, Russia There are no common guidelines for treating chronic noncancer pain (CNCP) in Russia. Purpose: To study the current approaches to CNCP treatment opioid analgesics’ usage in this condition. Methods: Interviews with doctors to find out their opinion on CNCP and their real practice in this field in out-patient clinics were held. Before the interview each doctor filled 5 clinic cards/CC on patients with CNCP. 375 doctors (150 general practitioners/GP, 150 neurologists/N and 75 rheumatologists/R) were interviewed, 1875 CC were filled. Results: The doctors’ interviews showed that for severe and very severe CNCP they prescribe in 98% of the cases nonsteroidal anti-inflammatory drugs/NSAID, in 87% central analgesics/CA, in 84% muscle relaxants/MR, in 68% antidepressants, in 51% glucocorticoids, in 20% opioid analgesics/OA. The main reason to avoid the prescription of OA in 58% is a complicated process of its prescription and control, in 40% (GP 42%, N 37%, R 40%), consider that OA could be prescribed for cancer patients, in 34% (31%, 35% and 37%) they fear of drug abuse, in 20% of cases (25%, 17%, 16%) administrative barriers. According to CC data less then 80% of patients received NSAID, about 3% muscle relaxants, CA and OA, less then 1% other medicines. Summary: Theoretical knowledge and preferences of doctors do not correspond to the real clinic practice of CNCP. The majority of Russian doctors are mostly not oriented to prescribe opioid analgesics in cases of severe and very severe noncancer pain. 828 EVALUATION OF SYMPTOM CONTROL ADEQUATENESS AMONG THE END-OF-LIFE PATIENTS RECEIVING PALLIATIVE CARE IN GEORGIA T. Rukhadze *, D. Kordzaia, P. Dzotsenidze. National Cancer Centre, Palliative Care Association “Humanists’ Union”, Tbilisi, Georgia Background: As there are over 43,000 deaths per year in Georgia, over 25,000 persons per year (60%) need palliative care. Of the 7000–8000 new cancers per year, two-thirds need palliative care. Pain Relief and Palliative Care is one of the major unaddressed public health problems in Georgia. Aim of study: To evaluate the adequateness of symptoms control among the palliative care suitable patients in Georgia and analyze the ways of its improvement. Methods: Symptom control adequateness was evaluated by using of especially worked out questionnaires. 368 questionnaires filled by patients (and their family members) curried by mobile team of Palliative Care Association “Humanists’ Union” (AHU) and Palliative Care Consulting Service of National Cancer Centre (PCS) underwent to analysis. Complete relieve of symptoms was considered as an indicator for the successful control. The method of inferential statistics was used. Results: Since 2004 by the mobile team of AHU and PCS have been provided care of 587 end-of life patients in Tbilisi. Pain was revealed as the most unresolved symptom for control (p < 0.001). Its management was insufficient in 219 cases (37.3%): it was not reduced till 3–4 score (of 10-scores pain intensivity scale) in spite of usage of all available medications by medical stuff.
829 CERTIFICATION “QUALIFIED PAIN TREATMENT” IN GERMANY
The efforts in increasing the quality in clinical pain treatment in hospitals have been disappointing over the last decades. [1] On the other hand, many patients make their decision for medical institutions by the reported quality of pain treatment. These 2 extremes stimulated efforts to certificate also the quality of pain treatment in hospitals. In a first project sponsored by Mundipharma the scientific basis and the cut-off values were investigated and determined. Based on these experiences and independent from any sponsor 4 medical societies (Pain, Palliative Care, Interdisciplinary Medicine, Nursing) established a non-profit organization for certification in pain treatment, CertKom – Society for Specialized Pain Treatment [2] criteria for certification are structural quality, process quality and most important quality of performance, the last being the central issue of accreditation. Examples for structural quality are: multiprofessional working group, rules for diagnosis and treatment, for process quality: intervention criteria, patient information, prophylaxis. Quality of performance is exactly measured by NRS according to the investigated cut-offs. Up to now 21 hospitals have been accredited and 3 labs for QST. Certification for “Qualified Pain Treatment” is an important measure in the actual competition between health care providers. Certification is also possible in outpatient care, hospices, pharmacies, and laboratories. [3] This initiative represents an important step forward in improving the quality of pain treatment. The interest in this approach is rapidly increasing. A preliminary study has been supported by Mundipharma Reference(s) [1] Apfelbaum et al 2003. [2] http://www.certkom.com/ [3] Geber et al 2009
830 PREVALENCE OF PAIN BY USING NURSING DIAGNOSIS IN A PALLIATIVE CARE SETTING E. Barallat1 *, J. Canal Sotelo1 , M. Nabal2 , A. Jimenez2 , C. Sarret1 , P. Marine´ 1 , Co. ´ Palomar2 , E. Perez1 , M. Juvero2 , C. Perez-Duran2 . 1 UFISS-Cures Pal·liatives Gesti´ o de Serveis Sanitaris, Hospital Santa Maria, Lleida, Spain; 2 UFISS-CP. Hospital Universitari Arnau de Vilanova, Servei Catal` a de Salut, Lleida, Spain Aim: The main objective is to know the prevalence of cancer related pain in a support palliative care unit by using the North America Nursing Diagnosis Association (NANDA). The secondary objectives are to evaluate the most prevalent NANDA diagnosis seen in the population studied and those associated with pain. Methods: 100 consecutive palliative patients were evaluated [outpatient clinic (n = 31), accident & emergency (n = 10), inpatient unit (n = 59)] at the Hospital Universitari Arnau de Vilanova in Lleida between October 2008 and January 2009. Nursing diagnosis were obtained from the 2006 spanish translation of the NANDA. Results: 70% men. Age: Mean 68.9 years. Median 72.5 years. Main diagnosis: Lung (n = 33). Pain was diagnosed in 44 patients (26 acute, 22 chronic, 4 both). NANDA diagnosis most frequently detected were those related to altered self-care [body hygiene (n = 54), dressing (n = 49) and using the toilet (n = 44)] and tiredness (n = 46). NANDA diagnosis associated with pain were anxiety (n = 23), altered sleeping pattern (n = 22), constipation (n = 22), tiredness (n = 17) and risk of constipation (n = 17). Of those patients
S238
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
with pain, 28/43 (63%) were men and 23/44 (52.3%) were seen at the outpatient clinic and 20/44 (45.5%) at the inpatient unit. Conclusions: Pain is detected by using the NANDA diagnosis in the 44% of patients, being more frequent among men attended at the outpatient clinic. Diagnosis related to pain are similar to those seen among advanced cancer population.
had worse quality of sleep (p = 0.033). The multiple regression analysis showed that constipation was the second strongest predictor for physical HRQOL (beta = −0.193, p = 0.023). Pain was the first one (beta = −0.396, p = 0.00). Conclusion: OIC is associated worse overall, physical, emotional, psychological and cognitive quality of life.
831 ASSESSMENT OF PAIN WITH THE EDMONTON STAGING SYSTEM FOR CANCER PAIN (ESS-CP) IN A PALLIATIVE CARE UNIT
833 FACTOR STRUCTURE OF THE SPANISH VERSION OF THE TAMPA SCALE FOR KINESIOPHOBIA (TSK) IN CHRONIC AND ACUTE PAIN PATIENTS 1 1 L. Gomez ´ Perez ´ *, A.E. Lopez ´ Mart´ınez1 , G.T. Ru´ız Parraga ´ , L. Camacho-Martel1 , M.A. Alba-Castermeiro2 . 1 Departamento de Personalidad, Evaluaci´ on y Tratamiento psicol´ ogico. Universidad de M´ alaga., M´ alaga, Spain; 2 Centro de Salud Cruz de Humilladero, M´ alaga, Spain
J. Canal Sotelo1 *, M. Nabal2 , A. Sulhyak2 , Co. ´ Palomar2 , A. Jimenez2 , 1 2 1 1 E. Barallat , M. Juvero , E. Perez , P. Marine´ , C. Sarret1 . 1 UFISS-Cures Pal·liatives Gesti´ o de serveis sanitaris. Hospital Santa Maria, Lleida, Spain; 2 UFISS-CP. Hospital Universitari Arnau de Vilanova. Servei Catal` a de Salut, Lleida, Spain Aims: Main objective: to know the prevalence of pain among patients seen by a supportive palliative care team in a teaching hospital. Secondary objectives are to determine the classification of pain according the ESS-CP and to determine the prognosis related stage. Methods: We review clinical records of palliative patients seen on 2008 and focus on the ESS-CP categories: pain mechanism, pain characteristics, previous opioid dose, cognitive function, psychological distress, tolerance and past history of drug abuse. Results: 470 patients were included. Mean age 69.75 years. 296 male patients (61.1%). Main diagnosis: Lung 90 (18.6%), Colorectal 67 (13.8%). Oncological 452 (93.4%). Pain on admission: 247 (52.5%). Stage I 141 (59.5%), Stage II 28 (11.3%), Stage III 68 (27.5%), lost 10 (1.7%). Among Stage III, neuropathic pain (41) and incidental type pain (34) are the categories most seen. 66% of patients seen in the inpatient unit (oncology ward 54%). Discussion: Poor prognosis cancer pain is highly prevalent among patients with pain being the category neuropathic pain the most frequently seen. 832 PAIN AND OPIOID-RELATED CONSTIPATION HAVE SIMILAR NEGATIVE IMPACT ON HEALTH-RELATED QUALITY OF LIFE K. Leao Ferreira1,3 *, M. Kimura2,4 , M. Teixeira1 . 1 Multidisciplinary Pain Center, S˜ ao Paulo Cancer Institute, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 3 University of Guarulhos, UnG, Guarulhos, Brazil; 4 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil Aim: To analyze the relationship between the use of opioid, opioid-induced constipation (OIC), and health-related quality of life (HRQOL) and the impact of OIC on HRQOL. Methods: 125 patients with chronic cancer pain were recruited in Multidisciplinary Pain Center, Hospital das Clinicas, School of Medicine, University of S˜ao Paulo, Brazil. They completed the Brief Pain Inventory, Beck Depression Inventory (BDI), and EORTC Quality of Life Questionnaire-core 30 (QLQ-c30). Presence of constipation was defined using Roma III criteria. Constipation severity was graded on four-point categorical scale: none, mild, moderate, and severe. Results: Sixty-six patients (52.8%) were using strong or weak opioids. Of them, 40 (61.5%) had constipation. Constipation was reported as mild (16.9%,) moderate (13.8%), and severe (30.8%). The use of laxatives was reported only by 19%. Worst pain intensity was higher among those with constipation (p = 0.007). Presence of constipation was independent of gender (p = 0.96), level of education (p = 0.51), disease stage (p = 0.061), and presence of depression (p = 0.20). Constipation was associated with lack of appetite (p = 0.004), vomiting (p = 0.023), and presence of metastasis (p = 0.03). Patients with constipation had significantly lower HRQOL scores in the overall quality of life (p = 0.004), physical and role functioning (p = 0.001 and p = 0.002), emotional (p = 0.029), cognitive (p = 0.045), and social functioning (p = 0.031). They also
Background and Aims: The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed measures for assessing pain-related fear in pain patients. The TSK has been translated into different languages. However, a Spanish Version of the TSK has not been available until now. The aim of this study was to present the Spanish version of the TSK and analyse its factorial structure in two different samples: a chronic pain sample (n = 125) and a musculoskeletal acute pain sample (n = 86). Method: Patients fill out the TSK and other related measures in their clinical setting. Inter-item correlations and item-total correlations for the TSK were calculated and two Principal Component Analyses (ACP) with both varimax and oblimin rotation were conducted separately on the scores from both samples. Results: A two factor model of 11 items without reverse scored items was replicated on both samples. Given the content of the items, the factors were named “Activity Avoidance” and “Harm”. Conclusions: The model obtained was similar to that of Clark, Kori and Brockel (1996) and recently replicated by other authors, with the exception of two items (7 and 5) which were eliminated because of their low correlation with the other items. The results provide clinicians and researchers with a measure of pain-related fear for Spanish pain patients, offering the advantage of brevity. Futures studies concerning its validity are needed. 834 BRAIN ACTIVITY AND AFFECTIVE RATINGS ELICITED BY THE OBSERVATION OF PAIN EXPRESSIONS IN OTHERS ´ Munoz A.M´ı. Gonzalez ´ Roldan ´ *, M. Mart´ınez Jauand, M.A. ˜ Garc´ıa, C. Sitges, I. Cifre Leon, ´ P. Montoya. Research Institute on Health Sciences (IUNICS) University of Balearic Islands, Palma, Spain Facial expression is one of the most relevant non-verbal behaviours in the communication of pain. However, little is known about brain processing of pain expressions in comparison with other affective facial expressions. The present experiment was aimed to examine the effects of pain expression intensity on affective ratings and brain activity by recording event-related brain potentials (ERP) from twenty female healthy volunteers (aged 19–23 yrs). Participants were asked to rate the affective characteristics of 144 stimuli depicting facial expressions of pain and anger with three level of intensities (high, medium, low), as well as neutral faces. Results indicated that pain faces were judged as more unpleasant and arousing than anger faces when the intensity of facial expression was high or medium, but not when the intensity of expression was low. ERP results showed an affective modulation of the brain activity between 200 and 350 ms after stimulus onset in parietal and occipital areas, showing significant differences between pain and anger when the intensity of facial expression was medium. These findings suggest that facial expressions of pain may constitute ambiguous threat stimuli for the observer and support the specificity of pain expression in front of other negative emotions.