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S78 (911) Perceptions of communication and involvement in cancer pain management S Hughes, C Phillips, S Ameringer, D Ewing, K Pe-Romashko, S Ward; University of Wisconsin-Madison, Madison, WI The cancer pain experience may affect both patients and their significant others (SO). Significant others may influence pain management through communication with patients about their pain, and directly or indirectly by their involvement with specific pain management activities. This analysis of baseline data from a psychoeducational cancer pain intervention study examined the (1) differences between patient and significant other perceptions of communication about pain and (2) the SO’s participation in pain management activities. The sample consisted of 128 dyads (patient and patient-selected SO) who were both asked to indicate how much they communicated about various aspects of patient’s pain management (CAP-Q) and also how involved the SO was in pain management activities (SOPI-Q). Most patient and SO subjects were female (62%, 57%), Caucasian (86%, 90%) and married (69%, 75%). Significant correlations were found between patient reports and SO estimates of patient’s pain severity (r ⫽ .39, p ⫽ .000) and frequency of moderate to severe pain (r⫽.51, p⫽.000). Patients and SOs both rated the suggestion to talk with a doctor or nurse as their most frequent communication topic. Compared to patients, SOs reported significantly higher frequency of overall communication about pain (t⫽3.08, p⫽.003), although the mean scores were relatively low for both groups. There was no significant difference in how often patients and SOs rated SO involvement. Picking up medications, talking with doctors and nurses about the patient’s pain, and helping the patient decide if and when to take pain medicine were the most frequent pain management activities performed by the SO. Because SOs are involved in important pain management activities it is critical to include them in pain management discussions.
(912) The association of race, disadvantage and advantage and the effects on chronic pain C Green, T Hart-Johnson, S Ndao-Brumblay; University of Michigan Medical School, Ann Arbor, MI Poverty is widely associated with chronic pain and poorer health outcomes. The literature suggests that neighborhood advantage (the presence of wealthy and educated persons) brings resources that may improve the health of neighborhood residents. With a large database (n⫽2834; ⱖ 18 years old, 8% black, 92% white) census data was matched with addresses. Structural equation modeling was used to examine the relative role of race, neighborhood advantage (NAd; % people ⱖ college degree, % households making ⱖ $100,000, and % households owner occupied) and neighborhood disadvantage (NDis; % of labor force unemployed, % people ⬍ high school education, and % households earning ⬍$5,000). Outcomes included McGill Pain Questionnaire (sensory, affective, and miscellaneous), Pain Disability Index (obligatory and voluntary) and Brief symptom Inventory with three factors; (emotional, psychotic, and other symptoms). Factors were successfully derived for all constructs. Black race significantly (p⬍.05) and independently predicted greater disability. NAd predicted lower obligatory and voluntary disability while NDis was not associated. Black race was associated with higher miscellaneous but not sensory or affective pain, NAd with lower sensory and miscellaneous pain and NDis with greater affective pain. The racial/ psychological symptoms relationships were complicated. For emotional disorders, race was mediated through NAd, for psychotic disorders race was significant and independent of NDis and for “other” disorders race was only associated in conjunction with the path from NAd. NAd predicted less emotional and “other” psychological disturbance while and NDis predictedmore psychotic symptoms. Race is at times independently associated with health outcomes and others only indirectly or mediationally related through SES. The assessment of NAd and NDis adds significantly to understanding the complex relationship between SES and pain-associated health outcomes. Nad appears a better predictor for variation associated with less extreme circumstances. When considering affective pain and psychotic disorders, NDis better predicts health outcomes.
Abstracts (913) Pain disparities: Race-ethnic differences in self-care R Harris, J Riley III; College of Dentistry, Gainesville, FL A recent study of experimental pain suggests expectations of pain experiences contribute to differences in response to painful stimuli in experimental settings. In addition, factors such as gender and ethnicity/ culture have also been found to have an impact on the perception of pain experiences. These expectations can be confounding factors in experimental pain research. It is therefore important to understand and relate participant expectations to experimental pain situations. As part of a larger study of healthy volunteers that examines gender and ethnic difference in response to experimental pain participants responded to a structured, open-ended interview. The participants were asked to describe past physical pain experiences and to compare their responses to those of other genders and ethnicities. Participants in the study selfidentified as belonging to one of three ethnic groups: Non-Hispanic White (n⫽23), African American (n⫽22) or Hispanic (n⫽20). Each ethnic group contained both male and female participants. Interviews were coded using Atlas-ti and analysis included a comparison of responses, themes and narratives between and among gender and ethnic groups. Differences were observed in the type of pain experiences recalled with men reporting more sports or trauma injuries and women generally reporting menstrual or somatic pain. Expectations of pain tolerance also varied by gender and ethnicity. Participant responses reflected the belief that men were expected to tolerated pain better than women, however many women in the study reported having a higher pain tolerance than their male peers. This belief was also expressed for various ethnicities. Participants often described their pain experiences in a narrative context. The unique aspects of the acute pain narratives are discussed within the context of the chronic pain narrative literature. The results of this study suggest that a qualitative research approach provides a unique understanding of cultural values and expectations that can affect experimental pain responses.
(914) Korean and American music for postoperative pain M Good, S Ahn; Pusan National University, Pusan, South Korea Studies show that music reduced postoperative pain in the US, but culturally-relevant tests of music for postoperative pain are needed in Korea. Using the Good and Moore theory of multimodal pain management and an experimental pretest-posttest design, 73 women were randomly assigned before GYN surgery; 47% to the music group and 53% to the control group. The music group chose among 5 types of music: 3 previously selected by Korean women postoperatively (ballads, religious, and popular songs) and 2 selected by an American researcher (soft, slow piano, and orchestra music). Analgesics ordered by physicians were given by: patient-controlled epidural analgesia (PCEA) (59%) or intravenous/intramuscular (IV/IM) injection (41%), which did not result in significantly different pain. After listening to an excerpt of each music type, two-thirds (62%) in the music group chose Korean-selected music and 38% chose American-selected music. Chosen music was heard during 15 minutes of rest, am and pm on postoperative days 1 and 2. The control group rested for 15 minutes. Pain was measured with sensation and distress VAS. Using MANCOVA, controlling for pretest pain, the music group had significantly less posttest pain on both days, afternoon only, resulting in 26% and 27% less pain than analgesics alone. There was no posttest difference in pain between those who chose Koreanselected music or American-selected music. If Korean music had not been offered, the majority would have been treated with a less-thanpreferred type of music, yet American music was effective for Koreans women who preferred it. Nurses should offer choice and culturally congruent options to Koreans who are patients either in Korea or other countries. Supported by an Ohio Board of Regents Research Infrastructure Grant, provided by FPB School of Nursing.
(912) The association of race, disadvantage and advantage and the effects on chronic pain C Green, T Hart-Johnson, S Ndao-Brumblay; University of Michigan Medical School, Ann Arbor, MI Poverty is widely associated with chronic pain and poorer health outcomes. The literature suggests that neighborhood advantage (the presence of wealthy and educated persons) brings resources that may improve the health of neighborhood residents. With a large database (n⫽2834; ⱖ 18 years old, 8% black, 92% white) census data was matched with addresses. Structural equation modeling was used to examine the relative role of race, neighborhood advantage (NAd; % people ⱖ college degree, % households making ⱖ $100,000, and % households owner occupied) and neighborhood disadvantage (NDis; % of labor force unemployed, % people ⬍ high school education, and % households earning ⬍$5,000). Outcomes included McGill Pain Questionnaire (sensory, affective, and miscellaneous), Pain Disability Index (obligatory and voluntary) and Brief symptom Inventory with three factors; (emotional, psychotic, and other symptoms). Factors were successfully derived for all constructs. Black race significantly (p⬍.05) and independently predicted greater disability. NAd predicted lower obligatory and voluntary disability while NDis was not associated. Black race was associated with higher miscellaneous but not sensory or affective pain, NAd with lower sensory and miscellaneous pain and NDis with greater affective pain. The racial/ psychological symptoms relationships were complicated. For emotional disorders, race was mediated through NAd, for psychotic disorders race was significant and independent of NDis and for “other” disorders race was only associated in conjunction with the path from NAd. NAd predicted less emotional and “other” psychological disturbance while and NDis predictedmore psychotic symptoms. Race is at times independently associated with health outcomes and others only indirectly or mediationally related through SES. The assessment of NAd and NDis adds significantly to understanding the complex relationship between SES and pain-associated health outcomes. Nad appears a better predictor for variation associated with less extreme circumstances. When considering affective pain and psychotic disorders, NDis better predicts health outcomes.
Abstracts (913) Pain disparities: Race-ethnic differences in self-care R Harris, J Riley III; College of Dentistry, Gainesville, FL A recent study of experimental pain suggests expectations of pain experiences contribute to differences in response to painful stimuli in experimental settings. In addition, factors such as gender and ethnicity/ culture have also been found to have an impact on the perception of pain experiences. These expectations can be confounding factors in experimental pain research. It is therefore important to understand and relate participant expectations to experimental pain situations. As part of a larger study of healthy volunteers that examines gender and ethnic difference in response to experimental pain participants responded to a structured, open-ended interview. The participants were asked to describe past physical pain experiences and to compare their responses to those of other genders and ethnicities. Participants in the study selfidentified as belonging to one of three ethnic groups: Non-Hispanic White (n⫽23), African American (n⫽22) or Hispanic (n⫽20). Each ethnic group contained both male and female participants. Interviews were coded using Atlas-ti and analysis included a comparison of responses, themes and narratives between and among gender and ethnic groups. Differences were observed in the type of pain experiences recalled with men reporting more sports or trauma injuries and women generally reporting menstrual or somatic pain. Expectations of pain tolerance also varied by gender and ethnicity. Participant responses reflected the belief that men were expected to tolerated pain better than women, however many women in the study reported having a higher pain tolerance than their male peers. This belief was also expressed for various ethnicities. Participants often described their pain experiences in a narrative context. The unique aspects of the acute pain narratives are discussed within the context of the chronic pain narrative literature. The results of this study suggest that a qualitative research approach provides a unique understanding of cultural values and expectations that can affect experimental pain responses.
(914) Korean and American music for postoperative pain M Good, S Ahn; Pusan National University, Pusan, South Korea Studies show that music reduced postoperative pain in the US, but culturally-relevant tests of music for postoperative pain are needed in Korea. Using the Good and Moore theory of multimodal pain management and an experimental pretest-posttest design, 73 women were randomly assigned before GYN surgery; 47% to the music group and 53% to the control group. The music group chose among 5 types of music: 3 previously selected by Korean women postoperatively (ballads, religious, and popular songs) and 2 selected by an American researcher (soft, slow piano, and orchestra music). Analgesics ordered by physicians were given by: patient-controlled epidural analgesia (PCEA) (59%) or intravenous/intramuscular (IV/IM) injection (41%), which did not result in significantly different pain. After listening to an excerpt of each music type, two-thirds (62%) in the music group chose Korean-selected music and 38% chose American-selected music. Chosen music was heard during 15 minutes of rest, am and pm on postoperative days 1 and 2. The control group rested for 15 minutes. Pain was measured with sensation and distress VAS. Using MANCOVA, controlling for pretest pain, the music group had significantly less posttest pain on both days, afternoon only, resulting in 26% and 27% less pain than analgesics alone. There was no posttest difference in pain between those who chose Koreanselected music or American-selected music. If Korean music had not been offered, the majority would have been treated with a less-thanpreferred type of music, yet American music was effective for Koreans women who preferred it. Nurses should offer choice and culturally congruent options to Koreans who are patients either in Korea or other countries. Supported by an Ohio Board of Regents Research Infrastructure Grant, provided by FPB School of Nursing.