- Email: [email protected]
Assessing Chronic Spine Pain: A Biobehavioral Approach for Patient Tailored Cognitive Behavioral Interventions A State of the Science
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Meeting Abstracts
pain. The purpose of this study was to identify common reasons for acute pain management consultations in an academic university practice. METHOD A retrospective IRB approved analysis of 107 de-identified acute pain consultations between April 2006 and February 2007 was performed. Of these, 100 had complete chart information available for review. A review was performed to identify the reasons for acute pain consultations. RESULTS Of the 100 pain consults performed, 95 were for uncontrolled pain that could not be effectively managed by the primary service. Of these 95 patients, 89.5% had pre-existing pain conditions, 76.8% were taking opioids pre-operatively, of which 79.4% were taking more than 20 milligrams of oxycodone or hydrocodone per day. In addition, 16.8% had recent or distant history of illicit drug or alcohol abuse. CONCLUSION A history of pre-existing pain and/or analgesic use (opioid or non opioid) prior to surgery is likely to result in uncontrolled post-operative pain. Patients who meet these criteria should be identified pre-operatively so that appropriate perioperative interventions can be initiated early, thus avoiding analgesic gaps. Results tables and demographic flowcharts are on the poster. This poster was presented at the American Society of Anesthesiologists Annual Meeting in San Francisco, CA on October 16, 2007. Poster 107:A1758.
Improving Patient Satisfaction through Patient Care Technician Pain Education Jane DeGooyer, RN, BC, MSN Mercy Medical Center, Des Moines, IA Sandra Caligiuri, RN, BC, MS; Joan Beard, RN, BC, MSN Acceptable pain management plays a significant role in patient satisfaction during hospitalization. Unmanaged pain is one of patients’ greatest fears. Ongoing dissatisfaction with this aspect of care has been reflected in the NRCþPickerÓ survey results at Mercy Medical Center, Des Moines, IA. Extensive education is provided to nurses, patients, families, and other members of the healthcare team, however there had not been an education program for the Patient Care Technician (PCT) who provides a considerable amount of hands on care. It was believed that a structured pain management education program for the PCTs would contribute to a more positive patient experience with pain management. The PCT pain education program consisted of a two-hour class that included the following topics: Introduction to project, harmful effects of uncontrolled pain, types of pain, manifestations, interventions, cultural and language aspects in pain management, role of PCT in facilitating pain management, and how to communicate with the nurse regarding patients’ pain. A laminated pocket card listing non-verbal indications of pain was provided to the PCTs.
Pre-test post-test analysis will consist of quarterly NRCþPickerÓ score data. This will consist of a one-tailed ttest for significance of the dependent variables with a level of significance of <.05. Program evaluation by the PCTs and unit nurses was completed following the presentation. Outcome data were pending. This information will direct future PCT pain education at Mercy Medical Center.
Ketamine: It’s Not Just for Sedation Anymore Katharyn Dispenza, MSN, RN, CPNP Childrens Medical Center Dallas, Dallas, TX Lynn Clark, MS, RN-BC, CPNP; Corianna Seelig-Gustafson, BSN, RN Pediatric pain management continues to be an ever evolving field. New medications and new uses of existing medications will continue to improve pain management for all patients. Low dose ketamine infusion provides an additional pain control option when opioids may not provide enough relief. Optimal pain management can be a challenge in pediatric patients who have chronic severe pain. When using opioid analgesics for pain control, analgesia must be balanced with side effects. When sedation or severe pruritus occurs, escalation of opioids is limited. If the patient’s pain remains severe, alternative methods must be implemented in order to optimize pain control.
Assessing Chronic Spine Pain: A Biobehavioral Approach for Patient Tailored Cognitive Behavioral Interventions A State of the Science Deborah Matteliano, RN, MS, ANP, FNP, BC SUNY at Buffalo, Buffalo, NY Considerable controversy exists regarding assessment and treatment of chronic spine pain (CSP), a disorder estimated to be the most costly ailment of working age adults worldwide. An expanded definition of CSP proposes that assessment of all biopsychosocial factors provides accurate predictive value to guide chronic pain treatment approaches. Cognitive behavioral treatment (CBT) is successful when tailored to biopsychosocial pain profiles. Because these factors are modifiable, they are targets for cognitive-behavioral pain management strategies. However, there has been great controversy over which of these factors to include in guiding CBT for CSP. Moreover, primary treatment of CSP does not include CBT, due to lack of easy to administer procedures and assessment tools. This literature review addresses the gap in the current literature by highlighting advancements made in the past 25 years of research regarding CSP assessment factors for profiled treatment, and systematically examines research focusing on the biopsychosocial pain profile of chronic spine pain. The question addressed is ‘‘What is the current State of the Science with regard to the biopsychosocial assessment of chronic spine pain, and what assessment factors are predictive for biopsychosocial profiled cognitive-behavioral treatment for chronic spine pain?’’ Findings reveal only three studies addressed all factors associated with biopsychosocial assessment of CSP. Psychosocial
Pain Management Nursing, Vol 10, No 1 (March), 2009: pp e1-e6
Meeting Abstracts variables are predictive of CSP outcomes, and are targets for CBT. High levels of co morbidity are present in this population, and should be addressed during treatment of CSP. The Bio-behavioral Pain Profile instrument (BPP) demonstrated superior success in assessing biopsychosocial variables for tailored CBT. For biobehavioral assessment of CSP, the evidence obtained from this review provides the basis for developing a comprehensive biopsychosocial evaluation of the CSP experience for tailoring CBT for persons suffering with CSP. Furthermore, the BPP is an easy to use tool for profiling CBT treatment options during usual nursing care.
McGill Pain Questionnaire as a Multidimensional Measure Srisuda Ngamkham, MS, RN University of Illinois Chicago College of Nursing, Chicago, IL Usha Menon, PhD, RN; Diana J. Wilkie, PhD, RN, FAAN BACKGROUND Clinical researchers continue seeking a valid measure to evaluate and control cancer pain that remains a troubling issue. Measuring neurophysiological and psychological pain of the MPQ provides comprehensive approach for cancer pain. PURPOSE The goal is to describe multidimensional experience in cancer pain. The specific objectives are to describe the dimensions of pain as measured by the MPQ and evaluate the psychometric properties of the MPQ. METHODS A systemic search of three databases (OVID, PubMed, and EBSCO) was conducted using these key words and combinations: ‘‘cancer pain,’’ ‘‘cancer-related pain,’’ ‘‘McGill Pain Questionnaire,’’ ‘‘pain pattern,’’ and ‘‘temporal pain aspect.’’ The search criteria were the research used MPQ on adult patients and published in English from 1975 to 2007. Fourteen articles retrieved through computerized searches and ten studies from manual searches were met the criteria. RESULTS This review focuses on pain location, pain quality, pain pattern, and pain intensity parts of the MPQ. Findings of 24 studies demonstrated that pain intensity and pain quality parts were the most frequently measured, whereas the other two parts were measured less. Pain intensity and pain location parts measured only the sensory dimension; pain quality measured the sensory, affective, and cognitive dimensions; and pain pattern measured sensory and behavioral dimensions. Investigators of five studies reported the test-retest reliability (0.70–0.90), inter-rater agreement (85%–86%), concurrent (0.31–0.46), and predictive validity (67%–77%). Findings of four studies are supported the MPQ as a reliable, multidimensional measure. Five studies did not report either validity or reliability, but 10 studies referred to the original reports. CONCLUSION The MPQ is an appropriate measure for evaluation the sensory, affective, cognitive, and behavioral dimensions of cancer pain.
e5
As subjective, complex experience in cancer pain, further extensive research is needed to measure pain location and pattern.
Differences in Depression, Coping Strategies, and Pain Intensity by Coping Style of Lung Cancer Patients Nusara Prasertsri, MS University of Illinois at Chicago, Chicago, IL Diana J. Wilkie, PhD, RN, FAAN AIMS Pain intensity has been shown to be affected by coping style, depression, and coping strategies in people with chronic illness, but the interrelationships of these variables have not been studied in people with lung cancer. The purpose of this study was to characterize the types of coping styles in lung cancer patients and the differences in depression, coping strategies, and subsequent sensory report of pain intensity by their coping styles. METHODS We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4 years 10.43, 88% Caucasian). We classified coping style groups based on Marlowe-Crowne Social Desirability Scale and Trait Anxiety scores. We measured other variables with the Center for Epidemiological Studies–Depression scale, Coping Strategies Questionnaire, and Visual Analogue Scale of pain intensity. RESULTS We identified four coping styles: low-anxiety (LA, n ¼ 30); high-anxiety (HA, n ¼ 32), defensive high anxiety (DHA) (n ¼ 16); and repressive (n ¼ 29). Compared to other groups, the high-anxiety group reported statistically higher mean scores for depression (HA 23.6 9.5, LA 13 9, DHA 15.6 6.8, repressive 10.2 7.3; F(3,107)¼14, p¼0.05) and catastrophizing coping strategies (HA 11.4 7.5, LA 5.7 5, DHA 9 7.7, repressive 4 6; F(3,107)¼6.9, p¼0.05) with a trend for higher mean pain intensity (HA 7.2 2.5). Although not significant, the repressive group had the lowest mean pain intensity scores (5.9 2.5) compared to the other groups (HA 7.2 2.5, LA 6.4 2.9, DHA 7 2.7). CONCLUSIONS As predicted by coping style theory and research in people with chronic illnesses, repressive coping style in people with lung cancer was associated with less depression, catastrophizing coping, and pain intensity. Understanding the influence of personality characteristics such as social desirability and trait anxiety on patients’ coping may help nurses to identify vulnerable individuals to whom they can target earlier interventions.
The Importance of a Dynamic Pain Team Shelly Reimer, RN, CRRN, BC Gundersen Lutheran Medical Center, La Crosse, WI Nancy Amann, RN, CRRN, BC A dynamic pain team is essential in providing the optimum care for a patient with a pain diagnosis. Our goal is to portray
Pain Management Nursing, Vol 10, No 1 (March), 2009: pp e1-e6
Meeting Abstracts
pain. The purpose of this study was to identify common reasons for acute pain management consultations in an academic university practice. METHOD A retrospective IRB approved analysis of 107 de-identified acute pain consultations between April 2006 and February 2007 was performed. Of these, 100 had complete chart information available for review. A review was performed to identify the reasons for acute pain consultations. RESULTS Of the 100 pain consults performed, 95 were for uncontrolled pain that could not be effectively managed by the primary service. Of these 95 patients, 89.5% had pre-existing pain conditions, 76.8% were taking opioids pre-operatively, of which 79.4% were taking more than 20 milligrams of oxycodone or hydrocodone per day. In addition, 16.8% had recent or distant history of illicit drug or alcohol abuse. CONCLUSION A history of pre-existing pain and/or analgesic use (opioid or non opioid) prior to surgery is likely to result in uncontrolled post-operative pain. Patients who meet these criteria should be identified pre-operatively so that appropriate perioperative interventions can be initiated early, thus avoiding analgesic gaps. Results tables and demographic flowcharts are on the poster. This poster was presented at the American Society of Anesthesiologists Annual Meeting in San Francisco, CA on October 16, 2007. Poster 107:A1758.
Improving Patient Satisfaction through Patient Care Technician Pain Education Jane DeGooyer, RN, BC, MSN Mercy Medical Center, Des Moines, IA Sandra Caligiuri, RN, BC, MS; Joan Beard, RN, BC, MSN Acceptable pain management plays a significant role in patient satisfaction during hospitalization. Unmanaged pain is one of patients’ greatest fears. Ongoing dissatisfaction with this aspect of care has been reflected in the NRCþPickerÓ survey results at Mercy Medical Center, Des Moines, IA. Extensive education is provided to nurses, patients, families, and other members of the healthcare team, however there had not been an education program for the Patient Care Technician (PCT) who provides a considerable amount of hands on care. It was believed that a structured pain management education program for the PCTs would contribute to a more positive patient experience with pain management. The PCT pain education program consisted of a two-hour class that included the following topics: Introduction to project, harmful effects of uncontrolled pain, types of pain, manifestations, interventions, cultural and language aspects in pain management, role of PCT in facilitating pain management, and how to communicate with the nurse regarding patients’ pain. A laminated pocket card listing non-verbal indications of pain was provided to the PCTs.
Pre-test post-test analysis will consist of quarterly NRCþPickerÓ score data. This will consist of a one-tailed ttest for significance of the dependent variables with a level of significance of <.05. Program evaluation by the PCTs and unit nurses was completed following the presentation. Outcome data were pending. This information will direct future PCT pain education at Mercy Medical Center.
Ketamine: It’s Not Just for Sedation Anymore Katharyn Dispenza, MSN, RN, CPNP Childrens Medical Center Dallas, Dallas, TX Lynn Clark, MS, RN-BC, CPNP; Corianna Seelig-Gustafson, BSN, RN Pediatric pain management continues to be an ever evolving field. New medications and new uses of existing medications will continue to improve pain management for all patients. Low dose ketamine infusion provides an additional pain control option when opioids may not provide enough relief. Optimal pain management can be a challenge in pediatric patients who have chronic severe pain. When using opioid analgesics for pain control, analgesia must be balanced with side effects. When sedation or severe pruritus occurs, escalation of opioids is limited. If the patient’s pain remains severe, alternative methods must be implemented in order to optimize pain control.
Assessing Chronic Spine Pain: A Biobehavioral Approach for Patient Tailored Cognitive Behavioral Interventions A State of the Science Deborah Matteliano, RN, MS, ANP, FNP, BC SUNY at Buffalo, Buffalo, NY Considerable controversy exists regarding assessment and treatment of chronic spine pain (CSP), a disorder estimated to be the most costly ailment of working age adults worldwide. An expanded definition of CSP proposes that assessment of all biopsychosocial factors provides accurate predictive value to guide chronic pain treatment approaches. Cognitive behavioral treatment (CBT) is successful when tailored to biopsychosocial pain profiles. Because these factors are modifiable, they are targets for cognitive-behavioral pain management strategies. However, there has been great controversy over which of these factors to include in guiding CBT for CSP. Moreover, primary treatment of CSP does not include CBT, due to lack of easy to administer procedures and assessment tools. This literature review addresses the gap in the current literature by highlighting advancements made in the past 25 years of research regarding CSP assessment factors for profiled treatment, and systematically examines research focusing on the biopsychosocial pain profile of chronic spine pain. The question addressed is ‘‘What is the current State of the Science with regard to the biopsychosocial assessment of chronic spine pain, and what assessment factors are predictive for biopsychosocial profiled cognitive-behavioral treatment for chronic spine pain?’’ Findings reveal only three studies addressed all factors associated with biopsychosocial assessment of CSP. Psychosocial
Pain Management Nursing, Vol 10, No 1 (March), 2009: pp e1-e6
Meeting Abstracts variables are predictive of CSP outcomes, and are targets for CBT. High levels of co morbidity are present in this population, and should be addressed during treatment of CSP. The Bio-behavioral Pain Profile instrument (BPP) demonstrated superior success in assessing biopsychosocial variables for tailored CBT. For biobehavioral assessment of CSP, the evidence obtained from this review provides the basis for developing a comprehensive biopsychosocial evaluation of the CSP experience for tailoring CBT for persons suffering with CSP. Furthermore, the BPP is an easy to use tool for profiling CBT treatment options during usual nursing care.
McGill Pain Questionnaire as a Multidimensional Measure Srisuda Ngamkham, MS, RN University of Illinois Chicago College of Nursing, Chicago, IL Usha Menon, PhD, RN; Diana J. Wilkie, PhD, RN, FAAN BACKGROUND Clinical researchers continue seeking a valid measure to evaluate and control cancer pain that remains a troubling issue. Measuring neurophysiological and psychological pain of the MPQ provides comprehensive approach for cancer pain. PURPOSE The goal is to describe multidimensional experience in cancer pain. The specific objectives are to describe the dimensions of pain as measured by the MPQ and evaluate the psychometric properties of the MPQ. METHODS A systemic search of three databases (OVID, PubMed, and EBSCO) was conducted using these key words and combinations: ‘‘cancer pain,’’ ‘‘cancer-related pain,’’ ‘‘McGill Pain Questionnaire,’’ ‘‘pain pattern,’’ and ‘‘temporal pain aspect.’’ The search criteria were the research used MPQ on adult patients and published in English from 1975 to 2007. Fourteen articles retrieved through computerized searches and ten studies from manual searches were met the criteria. RESULTS This review focuses on pain location, pain quality, pain pattern, and pain intensity parts of the MPQ. Findings of 24 studies demonstrated that pain intensity and pain quality parts were the most frequently measured, whereas the other two parts were measured less. Pain intensity and pain location parts measured only the sensory dimension; pain quality measured the sensory, affective, and cognitive dimensions; and pain pattern measured sensory and behavioral dimensions. Investigators of five studies reported the test-retest reliability (0.70–0.90), inter-rater agreement (85%–86%), concurrent (0.31–0.46), and predictive validity (67%–77%). Findings of four studies are supported the MPQ as a reliable, multidimensional measure. Five studies did not report either validity or reliability, but 10 studies referred to the original reports. CONCLUSION The MPQ is an appropriate measure for evaluation the sensory, affective, cognitive, and behavioral dimensions of cancer pain.
e5
As subjective, complex experience in cancer pain, further extensive research is needed to measure pain location and pattern.
Differences in Depression, Coping Strategies, and Pain Intensity by Coping Style of Lung Cancer Patients Nusara Prasertsri, MS University of Illinois at Chicago, Chicago, IL Diana J. Wilkie, PhD, RN, FAAN AIMS Pain intensity has been shown to be affected by coping style, depression, and coping strategies in people with chronic illness, but the interrelationships of these variables have not been studied in people with lung cancer. The purpose of this study was to characterize the types of coping styles in lung cancer patients and the differences in depression, coping strategies, and subsequent sensory report of pain intensity by their coping styles. METHODS We conducted a comparative, secondary data analysis of 107 lung cancer patients (73% male, mean age 61.4 years 10.43, 88% Caucasian). We classified coping style groups based on Marlowe-Crowne Social Desirability Scale and Trait Anxiety scores. We measured other variables with the Center for Epidemiological Studies–Depression scale, Coping Strategies Questionnaire, and Visual Analogue Scale of pain intensity. RESULTS We identified four coping styles: low-anxiety (LA, n ¼ 30); high-anxiety (HA, n ¼ 32), defensive high anxiety (DHA) (n ¼ 16); and repressive (n ¼ 29). Compared to other groups, the high-anxiety group reported statistically higher mean scores for depression (HA 23.6 9.5, LA 13 9, DHA 15.6 6.8, repressive 10.2 7.3; F(3,107)¼14, p¼0.05) and catastrophizing coping strategies (HA 11.4 7.5, LA 5.7 5, DHA 9 7.7, repressive 4 6; F(3,107)¼6.9, p¼0.05) with a trend for higher mean pain intensity (HA 7.2 2.5). Although not significant, the repressive group had the lowest mean pain intensity scores (5.9 2.5) compared to the other groups (HA 7.2 2.5, LA 6.4 2.9, DHA 7 2.7). CONCLUSIONS As predicted by coping style theory and research in people with chronic illnesses, repressive coping style in people with lung cancer was associated with less depression, catastrophizing coping, and pain intensity. Understanding the influence of personality characteristics such as social desirability and trait anxiety on patients’ coping may help nurses to identify vulnerable individuals to whom they can target earlier interventions.
The Importance of a Dynamic Pain Team Shelly Reimer, RN, CRRN, BC Gundersen Lutheran Medical Center, La Crosse, WI Nancy Amann, RN, CRRN, BC A dynamic pain team is essential in providing the optimum care for a patient with a pain diagnosis. Our goal is to portray
Pain Management Nursing, Vol 10, No 1 (March), 2009: pp e1-e6