Validation of the Malay Brief Pain Inventory questionnaire to measure cancer pain

The original version of the Brief Pain Inventory (BPI) was translated into a Malay version by the standard procedure and was then evaluated for its psychometric properties. Of 119 eligible patients, a total of 113 (95%) agreed to participate in this study. Ages ranged from 18 to 76 years and interviews were conducted between August, 2004 and November, 2004. The pain intensity items demonstrated high loading with one factor, whereas the pain interference items were loaded on another factor. Two factors explained 62% of the variance. Compared to the Karnofsky Performance Scale, the pain intensity scales had a moderate negative (Pearson's) correlation (-0.520, P < 0.001) and the pain interference scales had a high negative correlation (-0.732, P < 0.001), showing good concurrent validity. The coefficient alpha of both subscales demonstrated good internal consistency of the items. The intraclass correlation coefficient for the test-retest stability was 0.61 for the pain intensity scale and 0.88 for the pain interference scale. The Malay version of the BPI is a reliable and valid instrument for cancer pain assessment and is comparable with the original version of the BPI in terms of structure and psychometric properties.     

Russian Brief Pain Inventory: validation and application in cancer pain

To validate the Russian version of the Brief Pain Inventory (BPI-R) and to examine predictors of inadequate pain management, 221 Russian patients with advanced-stage hematological malignancies or solid tumors completed the BPI-R and a Russian-language Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36-R). Factor analysis of the BPI-R found two underlying constructs, pain severity and pain interference, with Cronbach alphas of 0.93 and 0.95, respectively. Concurrent validity was established by comparing BPI-R items with SF-36-R scales. The BPI-R detected significant differences in pain severity and interference levels by Eastern Cooperative Oncology Group (ECOG) performance status, supporting known-group validity. Determination of the Pain Management Index revealed that 68% of the patients were inadequately treated by World Health Organization standards. Having advanced-stage disease and not receiving chemotherapy predicted inadequate pain management in a multivariate logistic regression model. The Russian version of the BPI is psychometrically sound in its reliability and validity.     

Validation of the Brief Pain Inventory for chronic nonmalignant pain.

The Brief Pain Inventory (BPI; Cleeland and associates) has been used primarily to assess patients with cancer-related pain. Although it has been validated in many languages and is widely used, there has not yet been research published to validate its use for patients with chronic nonmalignant pain as the primary presenting problem. This study was designed to fill this gap by examining the psychometric properties of the BPI in 440 patients with chronic intractable pain referred to a chronic pain clinic at a metropolitan tertiary-care teaching hospital. Results indicated acceptable internal consistency (Cronbach alpha coefficients were.85 for the intensity items and.88 for the interference items). A factor analysis resulted in 2 distinct and independent factors, supporting the validity of the 2-factor structure of the BPI. Zero-order correlations indicated that the association with a measure of disability (the Roland-Morris Disability Questionnaire [RMDQ]) was significantly higher for BPI interference (r = 0.57) than for BPI intensity (r = 0.40, t = 5.71, P <.01) and that the correlation with BPI interference was not more than 0.80, supporting the conclusion that these scales assess related, but also distinct, dimensions. Finally, the finding that both BPI scales showed statistically significant improvement with treatment confirms the responsivity of BPI in detecting and reflecting improvement in pain over time. PERSPECTIVE: This paper validated the psychometric properties of a pain Assessment instrument (The Brief Pain Inventory) originally developed to assess cancer pain and extended its use for the chronic nonmalignant pain population. This provides an important and widely used diagnostic tool for the clinician treating chronic pain.     

Assessing the impact of breakthrough cancer pain

Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously or in relation to a specific predictable or unpredictable trigger despite relative stable and adequately controlled background pain. Breakthrough pain is a common and distinct component of cancer pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30-60minutes. Despite the self-limiting nature of breakthrough pain, it can place significant physical, psychological, and economic burdens on both patients and their carers. Patients with breakthrough pain are often less satisfied with their analgesic therapy, they have decreased functioning because of their pain, and may also experience social and psychosocial consequences, such as increased levels of anxiety and depression. Successful management of breakthrough pain is best achieved by a thorough assessment which includes determining the severity, pathophysiology, and aetiology of the pain and takes into account both background and breakthrough pains while considering whether the underlying disease, co-morbidities or precipitating events are amenable to interventions. The features of breakthrough pain and the challenges it presents to patients, their carers, and health professionals are illustrated with a case study.     

Psychometric properties of the stroke specific quality of life scale for the assessment of participation in stroke survivors using the rasch model: a preliminary study

[Purpose] The aim of the present study was to analyze the psychometric properties of the Stroke Specific Quality of Life (SS-QOL) scale for the assessment of social participation following a stroke. [Methods] A preliminary analysis was performed of the SS-QOL items that address the participation category. For this, the scoring patterns of the answers of individuals and internal consistence were determined using the Rasch model. Reliability was assessed by intraclass correlation coefficients (ICC). [Results] The reliability coefficients analyzed by the Rasch model were 0.91 for the items and 0.87 for the patients. The separation index was 3.19 for the items and 2.58 for the patients. The findings indicate that the items separated the patients into three levels of participation: low, medium, and high. Among the 26 items addressing participation, three did not fit the model. All items showed adequate reliability (ICC ≥ 0.60). [Conclusion] The Rasch analysis detected three items with erratic behavior; however, the erratic patterns of these items may be explained by individual peculiarities among the patients. These items should be monitored to determine if the problems found in the present study persist. If so, the items should also be revised or possibly even eliminated.Key words: Stroke, International classification of functioning, disability and health, Psychometrics     

The Brief Pain Inventory: pain's interference with functions is different in cancer pain compared with noncancer chronic pain

OBJECTIVES: The Brief Pain Inventory (BPI) is a highly recommended and frequently used multidimensional pain assessment tool. The BPI includes 2 dimensions: pain intensity and pain's interference with functions. Our aims were to explore how patients respond to pain interference items by comparing responses from patients who had cancer with patients who had noncancer chronic pain (NCCP), and to explore how different levels of health-related quality of life affect upon pain's interference with functions. METHODS: Three hundred patients with cancer and 286 patients with NCCP were asked to complete the BPI and the European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire (EORTC QLQ-C30). The pain interference items were indexed into total interference, interference with physical functions, and interference with psychologic functions. Regression analyses were used to explore differences in pain's interference by group, pain intensity, and a possible interaction effect between them. The analyses were adjusted for age, sex, and all EORTC QLQ-C30 scales. RESULTS: The cancer patients reported higher values of physical interference than NCCP patients with the same level of pain intensity (P<0.001). NCCP patients reported higher values of psychologic interference than cancer patients (P=0.023). For total interference, these effects eliminated each other. When adjusting for age, sex, and the EORTC QLQ-C30 subscales, the results still remained significant except that adjusting for the subscale for physical function made the group effect insignificant for physical interference (P=0.30). DISCUSSION: The results indicate that patients are unable to report isolated pain's interference using the BPI. When reporting pain's interference with physical functioning, the level of physical functioning is more important than the level of pain. Patients' diagnoses have to be taken into account when interpreting reported pain's interference with functions.     

Quality of life among older survivors of breast cancer

This study investigated the relation among perceived social support, uncertainty, and quality of life in older survivors with breast cancer. Proposed hypotheses predicted a significant positive correlation between perceived social support and quality of life, and a significant negative correlation between uncertainty and quality of life. It also was hypothesized that perceived social support and uncertainty, considered together, could explain more quality-of-life variance than either variable considered independently. A sample of 103 breast cancer survivors older than 50 years completed the Social Support Questionnaire, the Mishel Uncertainty in Illness Scale - Community Form, and the Ferrans and Powers Quality-of-Life Index - Cancer Version. Data were analyzed using Pearson product-moment correlation, t tests, analysis of variance, and stepwise multiple regression. All the hypotheses were supported. Additional findings showed significant positive correlations between age and uncertainty, and between support network size and social support. Significant negative correlations were found between age and perceived social support, and between age and size of support network. Uncertainty increased in the presence of other diseases, which were associated with poorer quality of life. The study results underscore the importance of social support in reducing illness uncertainty and improving the quality of life for older survivors of breast cancer.     

有氧运动对乳腺癌患者生活质量的影响

乳腺癌是女性最常见的恶性肿瘤之一.全世界每年新发病人数130万,死亡人数近40万[1].我国从1999～2004年,乳腺癌发病率从17/10万增加到52/10万,上升超过3倍[2].     

Ischemic compression and kinesiotherapy on chronic myofascial pain in breast cancer survivors

Objective

assess the effects of ischemic compression and kinesiotherapy on the rehabilitation of breast cancer survivors with chronic myofascial pain.

Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors

OBJECTIVES: To document the prevalence of chronic pain and to evaluate the effect of pain on quality of life (QOL) in patients 6 months or more after a stroke. DESIGN: Cross-sectional survey. SETTING: Outpatient clinic of a rehabilitation center. PARTICIPANTS: One hundred seven stroke patients (68 men, 39 women; mean age, 60.9 y) attending the outpatient clinic of a rehabilitation center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients were interviewed on pain, QOL, mood, and functional status by using the short form of the Brief Pain Inventory (BPI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Beck Depression Inventory, and Modified Barthel Index (MBI), respectively. RESULTS: Self-reported chronic pain was present in 45 patients (42%), with 32 having musculoskeletal pain and 13 central poststroke pain. It was significantly more common in patients with a shorter poststroke duration (P=.025), but was not related to the nature of stroke (infarct or bleed), age, gender, presence of depression, and MBI score. There was no difference in the SF-36 scores between patients with and without pain except for the domain of bodily pain. When compared with patients with musculoskeletal pain, patients with central poststroke pain were more likely to have sensory impairments (P=.009), higher pain scores on the question "least pain in the past 24 hours" of the BPI (P=.036), and lower scores on the vitality domain of the SF-36 (P=.042). CONCLUSION: Pain is common in chronic stroke patients, and it does not appear to have a significant effect on patients' QOL.     

Validation of the Brief Pain Inventory in a Taiwanese population

Assessment of pain in cancer patients is very important to all health care professionals. This paper describes the development of a Taiwanese version of the Brief Pain Inventory (BPI-T) and discusses its psychometric properties in Taiwan. The BPI-T was developed from the original BPI using back-translation and committee review. A total of 534 cytologically or pathologically diagnosed cancer patients in three medical centers in Taiwan were interviewed between July 1992 and October 1997. The intraclass correlation coefficient for the test-retest reliability was 0.79 for the pain severity scale and 0.81 for the pain interference scale. The explained variance for the within-scale factor analyses was larger than 60% in both scales. The coefficient alpha for the internal reliability was 0.81 for the severity scale and 0.89 for the interference scale. Confirmatory factor analysis of the BPI-T clearly identified the same two scales (severity and interference scales) in the 299 adult patients (age between 20-64) with high education (education years > 9) or patients at an early stage of disease. However, in the 235 nonadult patients with distant metastasis or low education patients with distant metastasis, the "most severe pain" item loaded more to the interference scale than the severity scale. Convergent validity of the pain severity was demonstrated by significant correlations with stage of disease (National Cancer Institute's Surveillance, Epidemiology, and End Results Program [SEER]), performance status (Eastern Cooperative Oncology Group [ECOG]), and pain interference. In conclusion, interviewer-administered BPI-T was a reliable instrument for cancer pain severity and its interference in Taiwan. Additionally, it was a valid instrument on adult cancer patients with high education or patients at an early stage of disease.     

乳腺癌生存者生活质量及相关因素的调查研究

[目的]研究乳腺癌生存者生活质量的现状并分析其影响因素,以探讨提高其生活质量的有效途径.[方法]采用问卷方法对60例乳腺癌生存者进行调查,数据分析采用描述性统计及多元线性回归分析.[结果]乳腺癌生存者整体生活质量评分不高;疾病临床分期(β=-0.294)、治疗结束时间长短(β=0.158)、病人抑郁及焦虑状况(β=-0.269及-0.332)及社会支持状况(β=0.222)均纳入乳腺癌生存者生活质量的多元回归方程.[结论]乳腺癌生存者生活质量不高,提示社区护士应关注其生活质量,并针对生活质量的相关因素给予积极干预,从而提高其生活质量,促使病人更好回归社会.     

Validation of the German version of the Brief Pain Inventory.

The Brief Pain Inventory is a comprehensive instrument for pain assessment and has been validated in several languages. A validated German version was not available until now. From March to May 1995 all outpatients of the pain clinic of the Department of Anesthesiology completed a questionnaire with the German versions of the Brief Pain Inventory (BPI) and the SF-36 quality-of-life questionnaire. The BPI was repeated after the consultation. The physician assessed the performance status score of the Eastern Cooperative Oncology Group (ECOG). The questionnaire was completed by 151 patients. Forty-two patients were excluded from evaluation for methodological reasons, so 109 patients were evaluated. As in the original version of the BPI, factor analysis showed a common factor for pain intensity and a second factor for pain-related interference with function. The comparative fit index of 0.86 confirmed this model. Responses before and after consultation correlated closely for the sum scores of the pain intensity items (Perarson correlation r = 0.976) as well as for the interference with function items (r = 0.974). Pain intensity in the BPI correlated with bodily pain in the SF-36 (r = 0.585). Sum scores of the pain interference items were higher in patients with deteriorated ECOG performance status, whereas sum scores of the intensity items were not changed. Validity and reliability of the German BPI were comparable to the original version. The BPI may be advantageous for palliative care patients, as it places only a small burden on the patient and offers easy criteria for evaluation. However, further research is needed to differentiate the impact of pain-related and disease-related interference with function on the BPI, and to find an algorithm for the evaluation of the BPI when values are missing.     

Assessing the feasibility of using acupuncture and moxibustion to improve quality of life for cancer survivors with upper body lymphoedema

PurposeWithin a three-step mixed-methods study to investigate using acupuncture and moxibustion (acu/moxa) in the management of cancer treatment-related upper body lymphoedema, Step 2 obtained preliminary data about: 1) whether acu/moxa can improve quality of life, 2) the most troublesome symptoms, and 3) adverse effects.Methods and sampleAn exploratory single-arm observational clinical study included breast (BC) and head and neck cancer (HNC) survivors with mild-to-moderate uncomplicated lymphoedema for ≥3 months, ≥3 months post active-cancer treatment, no active cancer disease, undergoing routine lymphoedema maintenance. Participants received seven individualised treatments (S1), and six optional additional treatments (S2). MYMOP, SF-36 and PANAS were administered at baseline, during each series, and at follow-up 4 and 12 weeks after end-of-treatment. The primary outcome was change in MYMOP scores at the end of each series.Key resultsOf 35 participants recruited, 30 completed S1 and S2, 3 completed S1, 2 were lost to the study. Mean MYMOP profile change scores for BC participants were 1.28 points improvement on a 7-point scale (sd = 0.93, p < 0.0001, n = 25) for S1; and 1.41 for S2 (sd = 0.94, p < 0.0001, n = 24). S1 HNC change scores were 2.29 points improvement (sd = 0.62, p < 0.0001, n = 7); and 0.94 for S2 (sd = 0.95, p = 0.06, n = 6). Changes in some SF-36 scores for BC participants were significant to 4 weeks after treatment. No serious adverse effects were reported.ConclusionThis small study suggests acu/moxa is an acceptable adjunct to usual care for cancer survivors with lymphoedema. Further rigorous research is warranted to explore the effectiveness of acu/moxa in reducing the symptom burden.     

个案管理护理实践对改善乳腺癌患者生活质量的效果研究

目的 探讨个案管理护理实践对改善乳腺癌患者生活质量的效果.方法 按所在病区将90例乳腺癌术后患者分为试验组和对照组各45例,试验组接受为期6个月的个案管理护理实践,对照组接受常规护理和随访.分别在术后第1个月、3个月和6个月进行生活质量各指标的测量,并采用重复测量方差分析和多因素方差分析,对各测量指标在半年中的变化及趋势进行统计学分析.结果 试验组患者生活质量总体优于对照组,除婚姻关系维度效果不显著外,两组在各维度3个时间点测量值间的差异均有统计学意义(P＜0.05).结论 个案管理护理实践能够改善乳腺癌患者的生活质量,针对乳腺癌患者应有条件地开展个案管理.     

Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks

BackgroundBreast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group.MethodsFifty women (aged 35–65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05).FindingsBreast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80–1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54–0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development.InterpretationImpingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.