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The association between smoking and low back pain: a meta-analysis.
Shiri R, Karppinen J, Leino-Arjas P, et al.
Am J Med. 2010 Jan;123(1):87.e7-35.
OBJECTIVE: To assess the association between smoking and low back pain with meta-analysis. METHODS: We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses. RESULTS: In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32). CONCLUSIONS: Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults. Copyright 2010 Elsevier Inc. All rights reserved.
Shiri R, Karppinen J, Leino-Arjas P, et al.
Am J Med. 2010 Jan;123(1):87.e7-35.
OBJECTIVE: To assess the association between smoking and low back pain with meta-analysis. METHODS: We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses. RESULTS: In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). -
The efficacy of an educational intervention on documentation of pain management for the elderly patient with a hip fracture in t
Jackson SE.
J Emerg Nurs. 2010 Jan;36(1):10-5.
INTRODUCTION: Pain is one of the foremost reasons that patients appear in the emergency department. Documentation of pain levels may be difficult to determine because the elderly patient with a hip fracture may have an alteration in the clinical presentation because of hearing deficits, impaired cognitive functioning, or chronic disease processes. The intent of this research project was to explore the results of a staff educational intervention with evaluation of medical record documentation before and after implementation. METHODS: An educational intervention for staff included a review of hospital pain policies/protocols, documentation required, and elderly physiologic and psychological systems relating to the treatment of acute pain. Documentation was audited before and after educational intervention. RESULTS: A chi(2) test showed that there was no significant difference [chi(2) (1, N = 110), 1.48; P = .223] for the documentation for time to treatment (<60 minutes). However, a chi(2) analysis [chi(2) (1, N = 149), 8.315, P = .004] showed that there was a statistically significant difference as a result of the educational intervention for the documentation of pain levels in a timely manner after analgesic treatment. DISCUSSION: Educational interventions may be used to facilitate documentation of patient's pain. Barriers to medical recording need to be addressed to improve the proficiency of the registered nurse in the emergency department. Performance measures are entwined with competency levels for health care workers and standards of care delivery. A continuous and ongoing effort to facilitate the best practice for patients is a major initiative without an endpoint. 2010 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Jackson SE.
J Emerg Nurs. 2010 Jan;36(1):10-5.
INTRODUCTION: Pain is one of the foremost reasons that patients appear in the emergency department. Documentation of pain levels may be difficult to determine because the elderly patient with a hip fracture may have an alteration in the clinical presentation because of hearing deficits, impaired cognitive functioning, or chronic disease processes. The intent of this research project was to explore the results of a staff educational intervention with evaluation of medical record documentation before and after implementation. METHODS: An educational intervention for staff included a review of hospital pain policies/protocols, documentation required, and elderly physiologic and psychological systems relating to the treatment of acute pain. Documentation was audited before and after educational intervention. RESULTS: A chi(2) test showed that there was no significant difference [chi(2) (1, N = 110), 1. -
Long-term opioid management for chronic noncancer pain.
Noble M, Treadwell JR, Tregear SJ, et al.
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006605.
BACKGROUND: Opioid therapy for chronic noncancer pain (CNCP) is controversial due to concerns regarding long-term effectiveness and safety, particularly the risk of tolerance, dependence, or abuse. OBJECTIVES: To assess safety, efficacy, and effectiveness of opioids taken long-term for CNCP. SEARCH STRATEGY: We searched 10 bibliographic databases up to May 2009. SELECTION CRITERIA: We searched for studies that: collected efficacy data on participants after at least 6 months of treatment; were full-text articles; did not include redundant data; were prospective; enrolled at least 10 participants; reported data of participants who had CNCP. Randomized controlled trials (RCTs) and pre-post case-series studies were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted safety and effectiveness data and settled discrepancies by consensus. We used random-effects meta-analysis' to summarize data where appropriate, used the I(2) statistic to quantify heterogeneity, and, where appropriate, explored heterogeneity using meta-regression. Several sensitivity analyses were performed to test the robustness of the results. MAIN RESULTS: We reviewed 26 studies with 27 treatment groups that enrolled a total of 4893 participants. Twenty five of the studies were case series or uncontrolled long-term trial continuations, the other was an RCT comparing two opioids. Opioids were administered orally (number of study treatments groups [abbreviated as "k"] = 12, n = 3040), transdermally (k = 5, n = 1628), or intrathecally (k = 10, n = 231). Many participants discontinued due to adverse effects (oral: 22.9% [95% confidence interval (CI): 15.3% to 32.8%]; transdermal: 12.1% [95% CI: 4.9% to 27.0%]; intrathecal: 8.9% [95% CI: 4.0% to 26.1%]); or insufficient pain relief (oral: 10.3% [95% CI: 7.6% to 13.9%]; intrathecal: 7.6% [95% CI: 3.7% to 14.8%]; transdermal: 5.8% [95% CI: 4.2% to 7.9%]). Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome. All three modes of administration were associated with clinically significant reductions in pain, but the amount of pain relief varied among studies. Findings regarding quality of life and functional status were inconclusive due to an insufficient quantity of evidence for oral administration studies and inconclusive statistical findings for transdermal and intrathecal administration studies. AUTHORS' CONCLUSIONS: Many patients discontinue long-term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare.
Noble M, Treadwell JR, Tregear SJ, et al.
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006605.
BACKGROUND: Opioid therapy for chronic noncancer pain (CNCP) is controversial due to concerns regarding long-term effectiveness and safety, particularly the risk of tolerance, dependence, or abuse. OBJECTIVES: To assess safety, efficacy, and effectiveness of opioids taken long-term for CNCP. SEARCH STRATEGY: We searched 10 bibliographic databases up to May 2009. SELECTION CRITERIA: We searched for studies that: collected efficacy data on participants after at least 6 months of treatment; were full-text articles; did not include redundant data; were prospective; enrolled at least 10 participants; reported data of participants who had CNCP. Randomized controlled trials (RCTs) and pre-post case-series studies were included. -
Prevalence and characteristics of breakthrough pain in patients with head and neck cancer: a cross-sectional study.
Bhatnagar S, Upadhyay S, Mishra S.
J Palliat Med. 2010 Mar;13(3):291-5.
Abstract Background: Approximately one half to two thirds of patients with cancer-related pain experience breakthrough pain (BTP) in their daily activities. Objective: This is the first report to determine the prevalence and characteristics of BTP experienced by patients with head and neck cancer. Methods: This was a prospective cross-sectional study conducted in patients with head and neck cancer on stable doses of opioid (morphine) for at least 1 week. This study was designed as a cross-sectional study using a series of breakthrough pain questionnaires (BPQ). Results: Prevalence of BTP in our study was 48% (average of 3.85 episodes per day) of which more than 50% of episodes were of gradual onset but with severe intensity. Incident pain was predominate (50%) followed by spontaneous (25%) and end of dose failure (20%) and in 5% the nature of pain was unknown or mixed. Unlike other studies the onset of BTP in this present study with head and neck cancer was more gradual and lasted longer than 30 minutes. Conclusions: Patients with head and neck cancer do suffer a lot because of the high incidence of BTP (48%). The majority of patients suffering from BTP are not satisfied at all with the measures taken for their BTP. The majority of patients in India have head and neck cancer; we must approach this matter as a challenge and new technique and therapy should be introduced for the benefit of these patients.
Bhatnagar S, Upadhyay S, Mishra S.
J Palliat Med. 2010 Mar;13(3):291-5.
Abstract Background: Approximately one half to two thirds of patients with cancer-related pain experience breakthrough pain (BTP) in their daily activities. Objective: This is the first report to determine the prevalence and characteristics of BTP experienced by patients with head and neck cancer. Methods: This was a prospective cross-sectional study conducted in patients with head and neck cancer on stable doses of opioid (morphine) for at least 1 week. This study was designed as a cross-sectional study using a series of breakthrough pain questionnaires (BPQ). Results: Prevalence of BTP in our study was 48% (average of 3.85 episodes per day) of which more than 50% of episodes were of gradual onset but with severe intensity. Incident pain was predominate (50%) followed by spontaneous (25%) and end of dose failure (20%) and in 5% the nature of pain was unknown or mixed. -
Quantification of a methadone metabolite (EDDP) in urine: assessment of compliance.
Larson ME, Richards TM.
Clin Med Res. 2009 Dec;7(4):134-41.
OBJECTIVE: To investigate the possibility of utilizing the ratio of the methadone metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), to urine creatinine to develop a regression model that would predict drug adherence in patients prescribed methadone for either pain management or drug addiction. DESIGN: Retrospective study. SETTING: Marshfield Clinic-Lakeland Center, one of 41 regional centers that make up Marshfield Clinic, a large, private, multi-specialty healthcare institution in central Wisconsin. PARTICIPANTS: Patients receiving methadone treatment for substance abuse or chronic pain. Group 1 was an initial pilot group consisting of 7 patients who were followed for a 4-month period. Group 2 consisted of 33 patients who were followed over a 28-month period. METHODS: Age, gender, weight, height, methadone dosage, quantitative urine creatinine and EDDP levels, reported compliance/non-compliance, and relevant clinical cofactors were retrospectively abstracted from the patients' medical records. Log-log regression analyses were used to model EDDP and the EDDP/creatinine ratio from urine screening results as functions of methadone dose, and in the larger cohort (group 2), body size, gender and age. The coefficient of determination adjusted for the number of predictor terms (R(adj)(2)) was reported as a measure of model fit. RESULTS: For group 1 data, there was a significant positive relation (P<0.001) but also substantial variability (R(adj)(2) = 0.49). Adjustment for creatinine through the EDDP/creatinine ratio provided a tighter relation (R(adj)(2) = 0.95). Similarly, for group 2 data, there was a significant positive relation (P=0.001) and substantial variability (R(adj)(2) = 0.53). Adjustment for creatinine through EDDP/creatinine ratios provided a substantially stronger relation (R(adj)(2) = 0.73). Gender and age showed no evidence of association with the EDDP/creatinine ratio (P=0.60 and P=0.51, respectively). Body size was significant in the model, both when measured by body surface area and by lean body weight, and improved the prediction when added to our model (R(adj)(2) = 0.80). CONCLUSION: For the first time, urine analyses may be used to monitor methadone over- or under-use in a clinical setting, regardless of the state of patient hydration or the manipulation of a sample by addition of another substance, such as bleach, soap, or even methadone, which could render an appropriate sample inappropriate or an inappropriate sample appropriate. A similar approach may prove useful for other drug treatments, allowing for more accurate monitoring of commonly abused prescription medications.
Larson ME, Richards TM.
Clin Med Res. 2009 Dec;7(4):134-41.
OBJECTIVE: To investigate the possibility of utilizing the ratio of the methadone metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), to urine creatinine to develop a regression model that would predict drug adherence in patients prescribed methadone for either pain management or drug addiction. DESIGN: Retrospective study. SETTING: Marshfield Clinic-Lakeland Center, one of 41 regional centers that make up Marshfield Clinic, a large, private, multi-specialty healthcare institution in central Wisconsin. PARTICIPANTS: Patients receiving methadone treatment for substance abuse or chronic pain. Group 1 was an initial pilot group consisting of 7 patients who were followed for a 4-month period. Group 2 consisted of 33 patients who were followed over a 28-month period. -
A Statewide Prescription Monitoring Program Affects Emergency Department Prescribing Behaviors.
Baehren DF, Marco CA, Droz DE, et al.
Ann Emerg Med. 2009 Dec 31.
STUDY OBJECTIVE: Ohio recently instituted an online prescription monitoring program, the Ohio Automated Rx Reporting System (OARRS), to monitor controlled substance prescriptions within Ohio. This study is undertaken to identify the influence of OARRS data on clinical management of emergency department (ED) patients with painful conditions. METHODS: This prospective quasiexperimental study was conducted at the University of Toledo Medical Center Emergency Department during June to July 2008. Eligible participants included ED patients with painful conditions. Patients with acute injuries were excluded. After clinical evaluation, and again after presentation of OARRS data, providers answered a set of questions about anticipated pain prescription for the patient. Outcome measures included changes in opioid prescription and other potential factors that influenced opioid prescription. RESULTS: Among 179 participants, OARRS data revealed high numbers of narcotics prescriptions filled in the most recent 12 months (median 7; range 0 to 128). Numerous providers prescribed narcotics for patients (median 3 per patient; range 0 to 40). Patients had filled narcotics prescriptions at different pharmacies (mean [SD] 3.5 [4.4]). Eighteen providers are represented in the study. Four providers treated 63% (N=114) of the patients in the study. After review of the OARRS data, providers changed the clinical management in 41% (N=74) of cases. In cases of altered management, the majority (61%; N=45) resulted in fewer or no opioid medications prescribed than originally planned, whereas 39% (N=29) resulted in more opioid medication than previously planned. CONCLUSION: The use of data from a statewide narcotic registry frequently altered prescribing behavior for management of ED patients with complaints of nontraumatic pain. Copyright © 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Baehren DF, Marco CA, Droz DE, et al.
Ann Emerg Med. 2009 Dec 31.
STUDY OBJECTIVE: Ohio recently instituted an online prescription monitoring program, the Ohio Automated Rx Reporting System (OARRS), to monitor controlled substance prescriptions within Ohio. This study is undertaken to identify the influence of OARRS data on clinical management of emergency department (ED) patients with painful conditions. METHODS: This prospective quasiexperimental study was conducted at the University of Toledo Medical Center Emergency Department during June to July 2008. Eligible participants included ED patients with painful conditions. Patients with acute injuries were excluded. After clinical evaluation, and again after presentation of OARRS data, providers answered a set of questions about anticipated pain prescription for the patient. Outcome measures included changes in opioid prescription and other potential factors that influenced opioid prescription. -
The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties
Bennett RM, Friend R, Jones KD, et al.
Arthritis Res Ther. 2009;11:R120
Introduction: The Fibromyalgia Impact Questionnaire (FIQ) is a commonly used instrument in the evaluation of fibromyalgia (FM) patients. Over the last 18 years, since the publication of the original FIQ, several deficiencies have become apparent and the cumbersome scoring algorithm has been a barrier to widespread clinical use. The aim of this paper is to describe and validate a revised version of the FIQ: the FIQR. Methods: The FIQR was developed in response to known deficiencies of the FIQ with the help of a patient focus group. The FIQR has the same 3 domains as the FIQ (that is, function, overall impact and symptoms). It differs from the FIQ in having modified function questions and the inclusion of questions on memory, tenderness, balance and environmental sensitivity. All questions are graded on a 0–10 numeric scale. The FIQR was administered online and the results were compared to the same patient's online responses to the 36-Item Short Form Health Survey (SF-36) and the original FIQ.
Results: The FIQR was completed online by 202 FM patients, 51 rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) patients (31 RA and 20 SLE), 11 patients with major depressive disorder (MDD) and 213 healthy controls (HC). The mean total FIQR score was 56.6 ± 19.9 compared to a total FIQ score of 60.6 ± 17.8 (P < 0.03). The total scores of the FIQR and FIQ were closely correlated (r = 0.88, P < 0.001). Each of the 3 domains of the FIQR correlated well with the 3 related FIQ domains (r = 0.69 to 0.88, P < 0.01). The FIQR showed good correlation with comparable domains in the SF-36, with a multiple regression analysis showing that the three FIQR domain scores predicted the 8 SF-36 subscale scores. The FIQR had good discriminant ability between FM and the 3 other groups; total FIQR scores were HC (12.1 ± 11.6), RA/SLE (28.6 ± 21.2) and MDD (17.3 ± 11.8). The patient completion time was 1.3 minutes; scoring took about 1 minute. Conclusions: The FIQR is an updated version of the FIQ that has good psychometric properties, can be completed in less than 2 minutes and is easy to score. It has scoring characteristics comparable to the original FIQ, making it possible to compare past FIQ results with future FIQR results.
Bennett RM, Friend R, Jones KD, et al.
Arthritis Res Ther. 2009;11:R120
Introduction: The Fibromyalgia Impact Questionnaire (FIQ) is a commonly used instrument in the evaluation of fibromyalgia (FM) patients. Over the last 18 years, since the publication of the original FIQ, several deficiencies have become apparent and the cumbersome scoring algorithm has been a barrier to widespread clinical use. The aim of this paper is to describe and validate a revised version of the FIQ: the FIQR. Methods: The FIQR was developed in response to known deficiencies of the FIQ with the help of a patient focus group. The FIQR has the same 3 domains as the FIQ (that is, function, overall impact and symptoms). It differs from the FIQ in having modified function questions and the inclusion of questions on memory, tenderness, balance and environmental sensitivity. All questions are graded on a 0–10 numeric scale. -
Motives for nonmedical use of prescription opioids among high school seniors in the United States: self-treatment and beyond.
McCabe SE, Boyd CJ, Cranford JA, et al.
Arch Pediatr Adolesc Med. 2009 Aug;163(8):739-44.
OBJECTIVES: To assess motives for nonmedical use of prescription opioids among US high school seniors and examine associations between motives for nonmedical use and other substance use behaviors. DESIGN: Nationally representative samples of US high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING: Data were collected in public and private high schools. PARTICIPANTS: The sample consisted of 5 cohorts (2002-2006) of 12 441 high school seniors. MAIN OUTCOME MEASURES: Self-reports of motives for nonmedical use of prescription opioids and substance use behaviors. RESULTS: More than 1 in every 10 high school seniors reported nonmedical use of prescription opioids and 45% of past-year nonmedical users reported "to relieve physical pain" as an important motivation. The odds of heavy drinking and other drug use were lower among nonmedical users of prescription opioids motivated only by pain relief compared with nonmedical users who reported pain relief and other motives and those who reported non-pain relief motives only. The odds of medical use of prescription opioids were lower among nonmedical users who reported only non-pain relief motives compared with other types of nonmedical users. CONCLUSIONS: The findings indicate motives should be considered when working with adolescents who report nonmedical use of prescription opioids. Future efforts are needed to identify adolescents who may need appropriate pain management and those at increased risk for prescription opioid abuse.
McCabe SE, Boyd CJ, Cranford JA, et al.
Arch Pediatr Adolesc Med. 2009 Aug;163(8):739-44.
OBJECTIVES: To assess motives for nonmedical use of prescription opioids among US high school seniors and examine associations between motives for nonmedical use and other substance use behaviors. DESIGN: Nationally representative samples of US high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires. SETTING: Data were collected in public and private high schools. PARTICIPANTS: The sample consisted of 5 cohorts (2002-2006) of 12 441 high school seniors. MAIN OUTCOME MEASURES: Self-reports of motives for nonmedical use of prescription opioids and substance use behaviors. RESULTS: More than 1 in every 10 high school seniors reported nonmedical use of prescription opioids and 45% of past-year nonmedical users reported "to relieve physical pain" as an important motivation. -
Use of an algorithm applied to urine drug screening to assess adherence to an oxycontin regimen.
Couto JE, Webster L, Romney MC, et al.
J Opioid Manag. 2009 Nov-Dec;5(6):359-64.
OBJECTIVE: This study examined the ability of an algorithm applied to urine drug levels of oxycodone in healthy adult volunteers to differentiate among low, medium, and high doses of OxyContin. PARTICIPANTS AND INTERVENTIONS: Thirty-six healthy volunteers were randomized to receive 80, 160, or 240 mg of daily OxyContin to steady state while under a naltrexone blockade. During days 3 and 4 of the study, urine samples of all participants were collected, and oxycodone levels detected in the urine were obtained using a liquid chromatography-mass spectrometry (LC-MS-MS) assay. Outcome measures: The concordance was calculated for raw and adjusted LC-MS-MS urine oxycodone values within each study participant between their third and fourth day values. Also, an analysis of medians was calculated for each of the dosage groupings using Bonett-Price confidence intervals for both raw and adjusted LC-MS-MS values. RESULTS: The concordance correlation coefficient for the raw LC-MS-MS values between days 3 and 4 was 0.689 (95% confidence intervals = 0.515, 0.864), whereas the concordance correlation coefficient for the LC-MS-MS values using the algorithm (ie, normalized values) was 0.882 (95% confidence intervals = 0.808, 0.956). Because of greater variability in the raw values, some overlap was observed in the confidence intervals of the various OxyContin doses, whereas no overlap was observed in the normalized confidence intervals regardless of the application of a Bonferroni adjustment. CONCLUSIONS: In contrast to raw LC-MS-MS values, an algorithm that normalizes oxycodone urine drug levels for pH, specific gravity, and lean body mass discriminates well among all three of the daily doses of OxyContin tested (80, 160, and 240 mg), even with correcting for multiple analyses.
Couto JE, Webster L, Romney MC, et al.
J Opioid Manag. 2009 Nov-Dec;5(6):359-64.
OBJECTIVE: This study examined the ability of an algorithm applied to urine drug levels of oxycodone in healthy adult volunteers to differentiate among low, medium, and high doses of OxyContin. PARTICIPANTS AND INTERVENTIONS: Thirty-six healthy volunteers were randomized to receive 80, 160, or 240 mg of daily OxyContin to steady state while under a naltrexone blockade. During days 3 and 4 of the study, urine samples of all participants were collected, and oxycodone levels detected in the urine were obtained using a liquid chromatography-mass spectrometry (LC-MS-MS) assay. Outcome measures: The concordance was calculated for raw and adjusted LC-MS-MS urine oxycodone values within each study participant between their third and fourth day values. -
Impact of a brief intervention on patient communication and barriers to pain management: Results from a RCT
Smith MY, Duhamel KN, Egert J.
Patient Educ Couns. 2009 Dec 23.
OBJECTIVE: This study examined the impact of a brief pain communication/education intervention on patient outcomes in breast cancer. We hypothesized that our intervention would improve patient communication and reduce misconceptions ("Barriers") concerning pain management, and that patients with lower Barriers, or who perceived their physician as being more facilitative and receptive, would report better outcomes. METHODS: Female breast cancer patients with persistent pain (n=89) were randomly assigned to either a 30-min in-person pain education/communication intervention or control condition and followed for 12 weeks. RESULTS: Intervention group patients reported a significant decrease in pain Barriers but not in other outcomes. Overall, patients with lower barrier scores reported less distress and better emotional well-being. Patients who scored higher in active communication (e.g., asking questions, giving information) reported fewer Barriers and better pain relief. Individuals who perceived their physicians as being more receptive reported better pain management while those who perceived their physicians as being both more receptive and facilitative were more satisfied with their health care. CONCLUSION: A brief education/communication intervention reduced patients' Barriers to pain management but did not impact other patient outcomes. PRACTICAL IMPLICATIONS: Pain outcomes may be improved by addressing patients' pain misconceptions and emphasizing a receptive and responsive communication style. Copyright © 2009. Published by Elsevier Ireland Ltd.
Smith MY, Duhamel KN, Egert J.
Patient Educ Couns. 2009 Dec 23.
OBJECTIVE: This study examined the impact of a brief pain communication/education intervention on patient outcomes in breast cancer. We hypothesized that our intervention would improve patient communication and reduce misconceptions ("Barriers") concerning pain management, and that patients with lower Barriers, or who perceived their physician as being more facilitative and receptive, would report better outcomes. METHODS: Female breast cancer patients with persistent pain (n=89) were randomly assigned to either a 30-min in-person pain education/communication intervention or control condition and followed for 12 weeks. RESULTS: Intervention group patients reported a significant decrease in pain Barriers but not in other outcomes. Overall, patients with lower barrier scores reported less distress and better emotional well-being.
