The Effects of Self–Pain Management on the Intensity of Pain and Pain Management Methods in Arthritic Patients

The aims of this study were to investigate the effects of pain management education on the intensity of pain and frequency of utilization of pain management methods in two groups of patients with arthritis of different pathogenesis and clinical features, and to compare whether a significant difference existed between the two groups. The study was carried out between September 2007 and June 2008 on 30 female patients with gonarthrosis and 30 female patients with rheumatoid arthritis (RA) followed at the rheumatology outpatient clinic of a university hospital. Data on sociodemographic characteristics and those related with the illness were collected using a special survey. Each patient was given information about the features, causes, and treatment of the arthritis and how to cope with pain, emphasizing the importance of pain management methods. The intensity of pain and efficacy of pain management methods were assessed using the McGill Pain Questionnaire and the Pain Management Inventory at baseline and the second and sixth weeks after the education. The SPSS (v15.0) statistical package was used for statistical analysis. After education, significant improvements in pain intensity scores compared with baseline scores were observed in both groups (p < .05), and there was no significant difference between the RA and gonarthrosis groups. Among the various pain management methods, the education program led to significantly more utilization of massaging the painful area, exercising, and using complementary methods to control stress in both groups of patients, and there was no significant difference between the groups. In conclusion, the pain management education given in this study alleviated the intensity of pain and significantly increased the use of some pain management methods in both gonarthrosis and RA cases.     

Reliability and Feasibility of the Pain Assessment in Advanced Dementia Scale–Korean Version (PAINAD-K)

BackgroundThere is currently no observational instrument for assessing pain in aged patients who are unable to provide self-report in long-term care hospitals in Korea.AimsThe goal of this research was to culturally adapt and test the validity, reliability, and feasibility of the Korean version of the Pain Assessment in Advanced Dementia Scale.DesignThis was a methodologic study aiming to translate the Pain Assessment in Advanced Dementia Scale.Participants/SubjectsThe inpatients in a 270-bed LTC hospital in D metropolitan city were assessed pain levels.MethodsThe Pain Assessment in Advanced Dementia (PAINAD) Scale was used as an observation scale to assess 192 long-term care hospital patients, with observation durations of 1 and 5 minutes.ResultsThe interrater reliability (1 minute) for the scale showed substantial kappa agreement of .62, and scores for the 1- and 5-minute observations showed almost perfect agreement of .95. The criterion validity of the scale (1 minute) was high relative to the Face-Legs-Activity-Cry-Consolability (FLACC) Scale, and low compared with the numeric rating scale (NRS). Discriminant validity was established between patients with and without pain. The feasibility of the Pain Assessment in Advanced Dementia Scale–Korean Version (PAINAD-K) (1 minute) indicated low sensitivity of 41.3% and high specificity of 92.6%.ConclusionsTherefore, the PAINAD-K is a valid and reliable tool to determine the absence of pain in non-verbal aged patients.     

Assessment of Nociception and Pain in Participants in an Unresponsive or Minimally Conscious State After Acquired Brain Injury: The Relation Between the Coma Recovery Scale–Revised and the Nociception Coma Scale–Revised

Objectives

To investigate the relation between consciousness and nociceptive responsiveness (ie, Nociception Coma Scale–Revised [NCS-R]), to examine the suitability of the NCS-R for assessing nociception in participants with disorders of consciousness (DOC), and to replicate previous findings on psychometric properties of the scale.

Chronic Pain and Premature Aging – The Moderating Role of Physical Exercise

Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n = 67) and without chronic pain (n = 49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was nonsignificant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain.PerspectiveThe study suggests that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular PE in this respect as it may moderate premature ageing.     

Is it painful or not? Discriminant validity of the Behavioral Indicators of Infant Pain (BIIP) scale

OBJECTIVES: To evaluate the ability of the Behavioral Indicators of Infant Pain (BIIP) scale to discriminate between skin-breaking and nonskin breaking procedures, and to identify sensitized pain responses in preterm infants in the neonatal intensive care unit (NICU). METHODS: Sixty-nine infants born between 24 and 32 weeks gestational age were assessed at 32 weeks postconceptional age during blood collection on one day (procedure A), and then on another day during blood collection preceded by a diaper change (procedure B). Procedure order was randomized. Outcome measures were changes in BIIP coded from continuous bedside video recordings and changes in heart rate (HR). RESULTS: During blood collection (procedure A), BIIP scores (P<0.0001) and mean HR (P<0.0001) were higher than during the diaper change and higher when the infants had had a preceding diaper change (procedure B vs. procedure A) (P<0.03). HR changed from baseline to the stressors for each procedure. No differences in mean HR were observed during Lance phase between the procedure A and the B blood collection; however, HR remained elevated significantly during the Recovery phase when blood collection was preceded by the diaper change (P<0.03). DISCUSSION: The BIIP scale is reliable, accurate, and valid assessment for measuring acute pain in preterm infants in the NICU. This assessment combines the relatively most specific, anatomically based, theoretically derived indicators; and it allows evaluation of behavioral and physiologic pain responses separately.     

Translation and validation of the French Movement Imagery Questionnaire – Revised Second version (MIQ-RS)

IntroductionMotor imagery can be defined as a dynamic state during which the representation of a movement is internally rehearsed in the absence of voluntary movements. There are two strategies to mentally simulate the movements, either a visual representation of the movements (visual imagery), or kinesthetic feeling of the movement (kinetic imagery). In stroke rehabilitation, studies indicate that motor imagery associated with physical therapy results in cortical reorganization and correlative functional improvements.AimThe aim of this study is to provide to the French-speaking community a valid and reliable version of the Movement Imagery Questionnaire – Revised Second Version (MIQ-RS).MethodWe examined the test-retest, inter-rate reliability and the internal consistency of the visual and kinesthetic items of our French version of MIQ-RS in 153 healthy subjects.ResultsResults showed the internal consistency (Cronbach α = 0.90) and test-retest reliability (intraclass correlation coefficient for visual items = 0.68 and for kinesthetic items = 0.78) of the French version of MIQ-RS were satisfactory; the two-factor structure was supported by confirmatory factor analysis.ConclusionThe French version of MIQ-RS is a valid and reliable instrument in French-speaking population and therefore useful as a measure for motor imagery ability.     

Nurses’ Opinions of Pain and the Assessed Need for Pain Medication for the Elderly

The undertreatment of pain in the elderly living in nursing homes is a significant problem. In Swedish nursing homes, the registered nurse on duty is often responsible for 20-40 patients during the day with no daily contact from attending physicians. The aim of this study was to investigate the opinions of registered nurses regarding pain and the assessed need for pain medication for elderly patients using patient scenarios. Two patient scenarios were used in this study; a questionnaire and background information was provided. The scenarios consisted of one smiling patient and one grimacing patient, both with the same numeric rating scale value of pain, blood pressure, pulse rate, and respiration rate. Three questions regarding pain assessment and management followed the scenarios. The questionnaire was sent to all 128 registered nurses working daytime in elderly care in both municipal nursing homes and municipal home care in the mid-Sweden region. A total of 56 nurses participated, providing an answering frequency of 45%. Results showed that registered nurses with more experience did not have the same opinion about pain as the smiling patient and gave inadequate medication, which was not in accordance with recommendations from the county hospital and the World Health Organization.     

Comparative Effectiveness of Traditional Chinese Medicine and Psychosocial Care in the Treatment of Temporomandibular Disorders–Associated Chronic Facial Pain

This dual-site study sought to identify the appropriate role for traditional Chinese medicine (TCM; acupuncture and herbs) in conjunction with a validated psychosocial self-care (SC) intervention for treating chronic temporomandibular disorders (TMD)-associated pain. Participants with Research Diagnostic Criteria for Temporomandibular Disorders–confirmed TMD (n = 168) entered a stepped-care protocol that began with a basic TMD class. At weeks 2 and 10, patients receiving SC whose worst facial pain was above predetermined levels were reallocated by minimization to SC or TCM with experienced practitioners. Characteristic facial pain (CFP: mean of worst pain, average pain when having pain, and current pain; each visual analog scale [VAS] 0–10) was the primary outcome. Social activity interference (VAS 0–10) was a secondary outcome. Patients were monitored for safety. TCM provided significantly greater short-term (8-week) relief than SC (CFP reduction difference, −.60 [standard deviation of the estimate .26], P = .020) and greater reduction in interference with social activities (−.81 [standard deviation of the estimate .33], P = .016). In 2 of 5 treatment trajectory groups, more than two thirds of participants demonstrated clinically meaningful responses (≥30% improvement) in pain interference over 16 weeks. This study provides evidence that TMD patients referred for TCM in a community-based model will receive safe treatment that is likely to provide some short-term pain relief and improved quality of life. Similar designs may also apply to evaluations of other kinds of chronic pain. (ClinicalTrials.gov number NCT00856167).     

The Psychometric Validation of the Social Problem-Solving Inventory—Revised with UK Incarcerated Sexual Offenders

This study examined the reliability and validity of the Social Problem-Solving Inventory—Revised (SPSI-R; D’Zurilla, Nezu, & Maydeu-Olivares, 2002) with a population of incarcerated sexual offenders. An availability sample of 499 adult male sexual offenders was used. The SPSI-R had good reliability measured by internal consistency and test-retest reliability, and adequate validity. Construct validity was determined via factor analysis. An exploratory factor analysis extracted a two-factor model. This model was then tested against the theory-driven five-factor model using confirmatory factor analysis. The five-factor model was selected as the better fitting of the two, and confirmed the model according to social problem-solving theory (D’Zurilla & Nezu, 1982). The SPSI-R had good convergent validity; significant correlations were found between SPSI-R subscales and measures of self-esteem, impulsivity, and locus of control. SPSI-R subscales were however found to significantly correlate with a measure of socially desirable responding. This finding is discussed in relation to recent research suggesting that impression management may not invalidate self-report measures (e.g. Mills & Kroner, 2005). The SPSI-R was sensitive to sexual offender intervention, with problem-solving improving pre to post-treatment in both rapists and child molesters. The study concludes that the SPSI-R is a reasonably internally valid and appropriate tool to assess problem-solving in sexual offenders. However future research should cross-validate the SPSI-R with other behavioural outcomes to examine the external validity of the measure. Furthermore, future research should utilise a control group to determine treatment impact.     

Validation of the Integration of Stressful Life Experiences Scale–Short Form in a Bereaved Sample

The Integration of Stressful Life Experiences Scale (ISLES) is an assessment of meaning made of stress that has been used successfully with bereaved individuals and other vulnerable populations. Drawing upon information from 741 bereaved respondents, the present study tests the validity of the ISLES–Short Form (ISLES-SF), which is a 6-item version of the original 16-item measure. Tests of concurrent and incremental validity yielded highly similar patterns of results for the full ISLES and ISLES-SF, supporting the use of this briefer version of the scale. Results also highlighted the unique association (controlling for demographics, circumstances of the death, and prolonged grief symptoms) between greater meaning made of loss and higher levels of mental and physical health. These findings add to a growing body of literature that supports theoretical models that view meaning-making as a crucial determinant of adjustment to loss among many grievers.     

Characterization of carbapenem-resistant Acinetobacter baumannii in Brazil (2008–2011): countrywide spread of OXA-23–producing clones (CC15 and CC79)

The study investigated the genetic relationship of carbapenem-resistant Acinetobacter baumannii clinical isolated from inpatients during 2008–2011 from 11 Brazilian states. Antimicrobial susceptibility profile was determined by disc diffusion method and Etest. Polymerase chain reaction was applied for carbapenemase genes, and ISAba1. Isolates were subjected to pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) for molecular typing. Most of the isolates showed high resistance rates to antibiotics tested. The bla_OXA-51-like gene was found in all isolates, and 146 (94.2%) isolates were positive for bla_OXA-23-like. In the most OXA-23–producing isolates, the bla_OXA-23-like gene was accompanied by ISAba1. A total of 146 OXA-23–producing isolates were clustered into 28 genotypes by PFGE. Molecular analysis by MLST identified 13 sequence types (STs). The most prevalent PFGE profiles were designated as ST15 (CC15), ST1 (CC1), and ST79 (CC79). This study showed the widespread of clonal complexes of A. baumannii harboring the bla_OXA-23-like gene in different Brazilian states.     

Measuring Negative and Positive Thoughts in Children: An Adaptation of the Children’s Automatic Thoughts Scale (CATS)

The aim of this study is to describe the factor structure and psychometric properties of an extended version of the Children’s Automatic Thoughts Scale (CATS), the CATS-Negative/Positive (CATS-N/P). The CATS was originally designed to assess negative self-statements in children and adolescents. However, positive thoughts also play a major role in childhood disorders such as anxiety and depression. Therefore, positive self-statements were added to the CATS. The CATS-N/P was administered to a community sample of 554 children aged 8–18 years. The results of a confirmatory factor analysis revealed that the positive self-statements formed a separate and psychometrically sound factor. Internal and short-term test–retest reliability was good. Boys reported more hostile and positive thoughts than girls; and younger children reported more negative thoughts concerning physical threat, social threat, and failure than older children. In conclusion, the results of the current study support the use of the CATS-N/P for the measurement of positive and negative thoughts in children. The application of the CATS-N/P can facilitate further research on cognitive factors in different childhood disorders.     

The Glial–Neuronal GRK2 Pathway Participates in the Development of Trigeminal Neuropathic Pain in Rats

This study examined the role of the glial–neuronal G protein–coupled receptor kinase 2 (GRK2) pathway in the development of trigeminal neuropathic pain. Male Sprague Dawley rats, weighing 220 to 240 g, were anesthetized with ketamine (0.2 g/kg) and xylazine (0.02 g/kg). Under anesthesia, the left lower second molar was extracted, followed by the placement of a mini–dental implant to intentionally injure the inferior alveolar nerve. This injury produced mechanical allodynia along with the downregulation of neuronal GRK2 expression in the medullary dorsal horn. On the other hand, early intracisternal treatment with MDL28170, a calpain inhibitor, produced prolonged antiallodynic effects and blocked this downregulation of neuronal GRK2 expression. The intracisternal infusion of minocycline, a microglia inhibitor, and l-α-aminoadipic acid, an astrocytic specific inhibitor, also blocked the induced mechanical allodynia and downregulated neuronal GRK2 expression, respectively. Double immunofluorescence showed that the interleukin (IL)-1β and IL-1R signals colocalize with the astrocytes and neurons, respectively, in the medullary dorsal horn following an inferior alveolar nerve injury. In addition, the intracisternal infusion of an IL-1 receptor antagonist also produced antiallodynic effects and blocked the downregulation of neuronal GRK2 expression. These results suggest that the glial–neuronal GRK2 pathway is a potentially important new target for treating neuropathic pain. Moreover, the IL-1β expressed in astrocytes plays a significant role in modulating this pathway.PerspectiveThis study showed that the glial–neuronal GRK2 pathway participates in the development of trigeminal neuropathic pain in rats. These results suggest that the glial–neuronal GRK2 pathway is a potentially important new target for the treatment of neuropathic pain.     

Health-Related Profile and Quality of Life Among Nursing Home Residents: Does Pain Matter?

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents’ demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents’ physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p < .05), nursing home residents’ pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.     

Survey of Nurses’ Use of the Clinically Aligned Pain Assessment (CAPA) Tool

BackgroundLimited research is available on tools for assessing pain and its effect on function in the acute care setting.AimThis research's purpose is to describe nurses’ use of the Clinically Aligned Pain Assessment (CAPA) tool and their beliefs about its utility for assessing pain compared to the numeric rating scale (NRS) in a hospital where CAPA had been used for 6 years.DesignA cross-sectional self-report survey.MethodsNurses (N = 110) from 13 adult inpatient units in an academic center participated in this survey describing frequency of CAPA and NRS use, CAPA domains documented, and how nurses asked about pain and distinguished between categories when coding for documentation. Beliefs about the tools’ effectiveness were also reported.ResultsMost nurses used CAPA routinely for assessments; almost half used the NRS at times. They believed both tools were effective for assessment, but CAPA was more effective to determine what intervention was needed. They also believed patient report using CAPA was more likely to match the nurse's assessment; a majority reported incorporating their observations into CAPA documentation. Most asked the patient about pain without using CAPA words, although many used the specific words. Practice varied in how nurses determined which category to select in the comfort domain and which domains were assessed routinely.ConclusionsAlthough many nurses believed CAPA was effective, variation existed in how it was used to assess and document pain, increasing potential for inconsistent assessments and interpretations of pain and pain management.