- Email: [email protected]
Internet and computer databases
118
Abstracts
G06 - Internet and Computer Databases
G07 - Meta-analysis and Systematic Reviews
(1038) Using electronic diaries to manage chronic pain
(1040) Antidepressant Analgesics: A systematic review and comparative study
L. Marceau, R. Jamison, S. Scarolan; New England Research Institutes, Watertown, MA Chronic pain is a subjective syndrome that influences every aspect of a person‘s functioning. The measurement of pain and function is essential for the evaluation of methods to control pain. With the advent of palmtop computers and the ability to capture time-stamped data there has been increasing interest in the use of electronic diaries for persons with chronic pain as a way to better understand and treat the pain condition. The aim of this study was to develop a software pain diary program and an accompanying website to test and evaluate this program in comparison with a paper diary. Forty patients with chronic noncancer pain were recruited from a hospital-based pain center to participate in this study. Subjects were randomized to enter daily pain data for two weeks on an electronic diary or paper diary with similar information and crossed over to the other condition after a washout period. The electronic data was captured on the Compaq IPAC with Window CE operating system. Participants felt that the diary was easy to use, easy to fill in and felt that the questions were clear. There was a significant difference between the paper group and the electronic group regarding ease of recording data (p⬍0.05). When asked about their pain treatment, 66% of people felt that the electronic diary helped them understand their pain better compared to 42% for the paper diary. Electronic users reported more often than paper users that the diary got either their doctor or themselves to change their medications. This study of an electronic pain diary suggests that electronic record keeping of pain data may better assist chronic pain patients and their treating physicians in the management of chronic pain. Supported by NIH grant # R43 DE014797.
(1039) Improving communication during the management of cancer pain in the Internet age: An examination of the questions that breast cancer patients have about pain J. Bender, J. Hohenadel, J. Wong, J. Katz, D. Warr, A. Jadad; Centre for Global eHealth Innovation, Toronto General Hospital, University Health Network, Toronto Research indicates that patients feel more satisfied and obtain better outcomes when they are able to discuss issues of importance to them, have information on available treatments and ask pertinent questions. However, many patients with pain do not know what questions to ask or have inadequate knowledge about their health condition to formulate questions. To elicit and gain an understanding of the questions that women with breast cancer have about pain related to cancer. In-depth interviews and focus groups were conducted with a purposive sample of 18 women with pain related to breast cancer. The ethnoscience research technique was used to elicit, describe and classify patient questions about pain. Analysis of interview transcripts involved identification of themes and the development of a taxonomy to represent relationships between themes and categories. Eight main categories of questions about cancer pain were identified: questions pertaining to the cause and meaning of the pain, nature of pain, what [pain] to expect, options for pain control, impact of pain on quality of life, who and where to go to for help managing pain, desire to talk to and learn about the pain experiences of other breast cancer patients and how to describe and communicate effectively about pain. Barriers to asking questions include: inadequate knowledge, belief that the doctor knows best, feeling overwhelmed, feeling rushed, fearing the answer, belief that pain is inevitable and that pain should be endured. We confirmed that breast cancer patients have numerous questions about the experience and management of pain related to cancer. These questions will be used to develop an online system to promote active patient participation during the management of cancer pain.
C. Watson; University of Toronto, Toronto, ON This poster is a systematic review of randomized controlled trials(RCTs) and other historically-important studies of antidepressants in pain and includes acute pain, cancer pain and chronic non-malignant pain including neuropathic pain. RCTs were rated according to the criteria of Jadad and had to have a score of at least 3/5.Sixty-eight such trials were identified.Historical data has been neglected in previous reviews. There is now a large body of scientific evidence for antidepressant analgesia in a variety of pain states. The evidence is most consistent and convincing in neuropathic pain particularly diabetic neuropathy and postherpetic neuralgia.Number needed to treat data will be presented in an attempt to compare the clinical meaningfulness of this analgesia with that of anticonvulsants and opioids.
(1041) Pain relief for neonatal circumcision B. Brady-Fryer, N. Wiebe, J. Lander; University of Aberta, Edmonton, AB Circumcision is an invasive, painful procedure that elicits potentially harmful physiological, biochemical and behavioral responses in the vulnerable newborn. Interventions to prevent circumcision pain have been evaluated, but the specific and relative effectiveness of each has not been systematically assessed. To determine the safety and efficacy of interventions to relieve pain associated with neonatal circumcision. Standard methods of the Cochrane Neonatal Collaborative Review Group were followed to guide the literature search. Selection criteria were: design - randomized controlled trial; population - male term/ preterm neonates undergoing circumcision; interventions – all interventions to prevent circumcision pain; outcomes - pain as indicated by physiological, biochemical, and behavioral variables, or composite pain scores. The statistical package (RevMan 4.2) of the Cochrane Collaboration was used. For meta-analysis, a weighted means difference (fixed effects, 95% confidence intervals) was used when units were compatible, and standardized mean difference if not. Arithmetic means or totals were calculated for outcomes reported by phases of the circumcision procedure, and variances were derived using the general formula for linear combinations of variance. Heterogeneity was assessed quantitatively with the I-squared statistic. Thirty-six trials were included that involved a variety of interventions. Penile nerve blocks significantly reduced pain indicators compared with placebo, EMLA and sucrose. EMLA cream reduced pain indicators compared to placebo. Results for sucrose interventions were inconsistent. No differences were found with oral acetaminophen. No serious adverse effects of any of the interventions were identified. Details about study procedures were frequently not provided making it difficult to judge comparability between studies. Delivery of interventions was inconsistent between the studies and consequently effective wait times for penile blocks and the ideal dosage and concentration of sucrose cannot be determined, and these require further investigation. Consideration of the clinical versus statistical significance of differences in outcomes results is needed.
Abstracts
G06 - Internet and Computer Databases
G07 - Meta-analysis and Systematic Reviews
(1038) Using electronic diaries to manage chronic pain
(1040) Antidepressant Analgesics: A systematic review and comparative study
L. Marceau, R. Jamison, S. Scarolan; New England Research Institutes, Watertown, MA Chronic pain is a subjective syndrome that influences every aspect of a person‘s functioning. The measurement of pain and function is essential for the evaluation of methods to control pain. With the advent of palmtop computers and the ability to capture time-stamped data there has been increasing interest in the use of electronic diaries for persons with chronic pain as a way to better understand and treat the pain condition. The aim of this study was to develop a software pain diary program and an accompanying website to test and evaluate this program in comparison with a paper diary. Forty patients with chronic noncancer pain were recruited from a hospital-based pain center to participate in this study. Subjects were randomized to enter daily pain data for two weeks on an electronic diary or paper diary with similar information and crossed over to the other condition after a washout period. The electronic data was captured on the Compaq IPAC with Window CE operating system. Participants felt that the diary was easy to use, easy to fill in and felt that the questions were clear. There was a significant difference between the paper group and the electronic group regarding ease of recording data (p⬍0.05). When asked about their pain treatment, 66% of people felt that the electronic diary helped them understand their pain better compared to 42% for the paper diary. Electronic users reported more often than paper users that the diary got either their doctor or themselves to change their medications. This study of an electronic pain diary suggests that electronic record keeping of pain data may better assist chronic pain patients and their treating physicians in the management of chronic pain. Supported by NIH grant # R43 DE014797.
(1039) Improving communication during the management of cancer pain in the Internet age: An examination of the questions that breast cancer patients have about pain J. Bender, J. Hohenadel, J. Wong, J. Katz, D. Warr, A. Jadad; Centre for Global eHealth Innovation, Toronto General Hospital, University Health Network, Toronto Research indicates that patients feel more satisfied and obtain better outcomes when they are able to discuss issues of importance to them, have information on available treatments and ask pertinent questions. However, many patients with pain do not know what questions to ask or have inadequate knowledge about their health condition to formulate questions. To elicit and gain an understanding of the questions that women with breast cancer have about pain related to cancer. In-depth interviews and focus groups were conducted with a purposive sample of 18 women with pain related to breast cancer. The ethnoscience research technique was used to elicit, describe and classify patient questions about pain. Analysis of interview transcripts involved identification of themes and the development of a taxonomy to represent relationships between themes and categories. Eight main categories of questions about cancer pain were identified: questions pertaining to the cause and meaning of the pain, nature of pain, what [pain] to expect, options for pain control, impact of pain on quality of life, who and where to go to for help managing pain, desire to talk to and learn about the pain experiences of other breast cancer patients and how to describe and communicate effectively about pain. Barriers to asking questions include: inadequate knowledge, belief that the doctor knows best, feeling overwhelmed, feeling rushed, fearing the answer, belief that pain is inevitable and that pain should be endured. We confirmed that breast cancer patients have numerous questions about the experience and management of pain related to cancer. These questions will be used to develop an online system to promote active patient participation during the management of cancer pain.
C. Watson; University of Toronto, Toronto, ON This poster is a systematic review of randomized controlled trials(RCTs) and other historically-important studies of antidepressants in pain and includes acute pain, cancer pain and chronic non-malignant pain including neuropathic pain. RCTs were rated according to the criteria of Jadad and had to have a score of at least 3/5.Sixty-eight such trials were identified.Historical data has been neglected in previous reviews. There is now a large body of scientific evidence for antidepressant analgesia in a variety of pain states. The evidence is most consistent and convincing in neuropathic pain particularly diabetic neuropathy and postherpetic neuralgia.Number needed to treat data will be presented in an attempt to compare the clinical meaningfulness of this analgesia with that of anticonvulsants and opioids.
(1041) Pain relief for neonatal circumcision B. Brady-Fryer, N. Wiebe, J. Lander; University of Aberta, Edmonton, AB Circumcision is an invasive, painful procedure that elicits potentially harmful physiological, biochemical and behavioral responses in the vulnerable newborn. Interventions to prevent circumcision pain have been evaluated, but the specific and relative effectiveness of each has not been systematically assessed. To determine the safety and efficacy of interventions to relieve pain associated with neonatal circumcision. Standard methods of the Cochrane Neonatal Collaborative Review Group were followed to guide the literature search. Selection criteria were: design - randomized controlled trial; population - male term/ preterm neonates undergoing circumcision; interventions – all interventions to prevent circumcision pain; outcomes - pain as indicated by physiological, biochemical, and behavioral variables, or composite pain scores. The statistical package (RevMan 4.2) of the Cochrane Collaboration was used. For meta-analysis, a weighted means difference (fixed effects, 95% confidence intervals) was used when units were compatible, and standardized mean difference if not. Arithmetic means or totals were calculated for outcomes reported by phases of the circumcision procedure, and variances were derived using the general formula for linear combinations of variance. Heterogeneity was assessed quantitatively with the I-squared statistic. Thirty-six trials were included that involved a variety of interventions. Penile nerve blocks significantly reduced pain indicators compared with placebo, EMLA and sucrose. EMLA cream reduced pain indicators compared to placebo. Results for sucrose interventions were inconsistent. No differences were found with oral acetaminophen. No serious adverse effects of any of the interventions were identified. Details about study procedures were frequently not provided making it difficult to judge comparability between studies. Delivery of interventions was inconsistent between the studies and consequently effective wait times for penile blocks and the ideal dosage and concentration of sucrose cannot be determined, and these require further investigation. Consideration of the clinical versus statistical significance of differences in outcomes results is needed.