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BACKGROUND: Limited data exist about sleep quality for patients with advanced cancer in phase 1 clinical trials. Poor sleep quality is often not captured as an adverse event, and its association with fatigue, one of the most frequently reported adverse events, is not documented routinely. This article describes sleep quality and its relation with fatigue, symptom burden, and mood in patients recruited from an early-phase clinic for targeted therapy. METHODS: Sleep, fatigue, symptom burden, and mood were assessed with the Pittsburgh Sleep Quality Index (PSQI), the Brief Fatigue Inventory, the MD Anderson Symptom Inventory (MDASI), and the Brief Profile of Mood States, respectively; the Eastern Cooperative Oncology Group (ECOG) performance status (PS) was determined from medical records. RESULTS: The sample (n = 256) was 51.2% female, 90% had an ECOG PS of 0 or 1, and the mean age was 58 ± 0.8 years. Poor sleepers (global PSQI score > 5) constituted 64% of the sample. In separate multiple regression models, poor sleepers had higher levels of fatigue (P < .001), symptom burden (P < .001), and overall mood disturbance (P < .001) than good sleepers. Also, compared with good sleepers, poor sleepers had greater fatigue-related and symptom-related interference with daily activities (all P values < .001). The MDASI disturbed-sleep item correlated well with the global PSQI score (Pearson's r = 0.679, P < .001), and this suggests its usefulness as a patient-reported outcome screener of sleep quality in early-phase clinical trials clinics. CONCLUSIONS: Poor sleep quality was a significant problem in the current study and was associated with greater fatigue, symptom burden, and mood disturbance. Sleep quality should be routinely assessed in patients with advanced cancer who are participating in early-phase clinical trials. Cancer 2016;122:3401-3409. © 2016 American Cancer Society.
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Ensaios Clínicos como Assunto , Fadiga/etiologia , Transtornos do Humor/etiologia , Neoplasias/fisiopatologia , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fadiga/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/patologia , Prevalência , Prognóstico , Transtornos do Sono-Vigília/complicações , Inquéritos e Questionários , Texas/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: The purpose of this electronic daily diary study was to examine the relation of pain to smoking and quit attempts among 34 cancer patients with pain enrolled in a smoking cessation program. METHODS: Electronic daily diary assessments of pain and smoking were collected at the end of each day for a 2-week period during smoking cessation treatment. Pain experienced throughout the day was measured on a scale from 1 to 5, from "no pain" to "pain as bad as you can imagine." Smoking was defined as the number of cigarettes smoked per day. RESULTS: Linear multilevel modeling was used in examining associations between pain and smoking. A within-person pain and smoking association was found, such that greater daily pain was linked to greater daily smoking within individuals, controlling for baseline symptoms, nicotine dependence, smoking urge, age, and gender. No between-person pain and smoking association was observed. Additionally, cancer patients with higher average pain across the 2-week assessment period were less likely to make a quit attempt (defined as a day on which participants smoked no cigarettes) during the study period. CONCLUSIONS: The findings of this study add to a nascent literature on pain and smoking by providing initial evidence that pain may be a barrier to quitting among cancer patients who smoke and have pain. Future research examining the effectiveness of integrated pain and smoking cessation treatment in this population may be warranted.
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Registros Eletrônicos de Saúde , Neoplasias/complicações , Dor/etiologia , Abandono do Hábito de Fumar , Fumar , Tabagismo , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tabagismo/complicações , Tabagismo/terapiaRESUMO
BACKGROUND: Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. The authors evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer. METHODS: Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based, interactive voice response (IVR) intervention. Women in the intervention group were called twice weekly by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients' oncologists received e-mail alerts if the reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles. RESULTS: The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention also was associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists who were treating the patients rated the intervention as only somewhat useful for improving symptom management. CONCLUSIONS: The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.
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Negro ou Afro-Americano , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/etnologia , Hispânico ou Latino , Manejo da Dor/métodos , Medição da Dor/métodos , Dor/etnologia , Automação/métodos , Neoplasias da Mama/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Pobreza , Telemedicina/métodos , Populações VulneráveisRESUMO
PURPOSE: Symptom clusters, the multiple, co-occurring symptoms experienced by cancer patients, are debilitating and affects quality of life. We assessed if a panel of immune-response genes may underlie the co-occurrence of severe pain, depressed mood, and fatigue and help identify patients with severe versus non-severe symptom clusters. METHODS: Symptoms were assessed at presentation, prior to cancer treatment in 599 newly diagnosed lung cancer patients. We applied cluster analyses to determine the patients with severe versus non-severe symptom clusters of pain, depressed mood, and fatigue. RESULTS: Two homogenous clusters were identified. One hundred sixteen patients (19 %) comprised the severe symptom cluster, reporting high intensity of pain, depressed mood, and fatigue and 183 (30 %) patients reported low intensity of these symptoms. Using Bayesian model averaging methodology, we found that of the 55 single nucleotide polymorphisms assessed, an additive effect of mutant alleles in endothelial nitric oxide synthase (-1474 T/A) (posterior probability of inclusion (PPI) = 0.78, odds ratio (OR) = 0.54, 95 % credible interval (CI) = (0.31, 0.93)); IL1B T-31C (PPI = 0.72, OR = 0.55, 95 % CI = (0.31, 0.97)); TNFR2 Met(196)Arg (PPI = 0.70, OR = 1.85, 95 % CI = (1.03, 3.36)); PTGS2 exon 10+837T > C (PPI = 0.69, OR = 0.54, 95 % CI = (0.28, 0.99)); and IL10RB Lys(47)Glu (PPI = 0.68; OR = 1.74; 95 % CI = (1.04, 2.92)) were predictive for symptom clusters. CONCLUSIONS: Genetic polymorphisms may facilitate identification of high-risk patients and development of individualized symptom therapies.
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Citocinas/genética , Depressão/genética , Fadiga/genética , Neoplasias Pulmonares/genética , Dor/genética , Receptores de Citocinas/genética , Idoso , Teorema de Bayes , Análise por Conglomerados , Citocinas/imunologia , Depressão/epidemiologia , Depressão/imunologia , Fadiga/epidemiologia , Fadiga/imunologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/imunologia , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/imunologia , Polimorfismo de Nucleotídeo Único , Receptores de Citocinas/imunologia , Fatores de Risco , SíndromeRESUMO
Cervical cancer is one of the most important disease burdens experienced by Vietnamese-American women. Human papillomavirus (HPV) is the etiological agent in almost all cases of cervical cancer. We surveyed Vietnamese-American women to determine receipt of HPV vaccine and assessed if limited English proficiency and knowledge related to HPV vaccine were associated with HPV vaccine uptake. Of the 113 Vietnamese-American women who participated in the study, 58 % (n = 68) was born in Vietnam. The mean years of residency in the United States was 12.75 years. Only 16 (14 %) reported receiving HPV vaccine and 11 (9 %) reported receiving all three shots. Thirteen women responded that they are not at all likely to receive HPV vaccine. Of the whole sample, 47 % (n = 53) reported proficiency in spoken and written English. English proficiency was significantly associated with receipt of HPV vaccine (OR = 4.4; confidence interval (95 % CI) = 1.2; 16.50; p = 0.03). Of the knowledge items, 70 % (n = 79) responded correctly that HPV increases the risk for cervical cancer. However, as many as 60 % responded incorrectly, that HPV infection can be cured with medication. The item, "People infected with HPV can be cured with medication," was the most important variable associated with receipt of HPV vaccine. Specifically, those with correct response were 3.8 times more likely to report receiving the HPV vaccine (OR = 3.8; 95 % CI = 1.1; 13.5; p = 0.04). Important public health needs are the development and evaluation of educational programs on HPV and cervical cancer that are designed for Vietnamese-American women.
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Asiático/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Idioma , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aculturação , Adulto , Feminino , Humanos , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Vietnã/etnologiaRESUMO
BACKGROUND: Effective management of symptoms in cancer patients requires early intervention. This study assessed whether the timing of referral to the Supportive Care Center (SCC) and symptom burden outcome varied by race or ethnicity in lung cancer patients who had been seen at a tertiary cancer center. METHODS: Non-Hispanic white (n = 752), Hispanic (n = 111), and non-Hispanic black (n = 117) patients with nonsmall cell lung cancer comprised this sample. Data on sociodemographic factors, stage of disease, comorbid conditions, and symptom severity (pain, depressed mood, fatigue) served as potential predictor variables. RESULTS: Whereas the mean time (15 months; median = 7 months) from initial presentation at the cancer center to referral to the SCC did not vary by race or ethnicity, we found that Hispanics and non-Hispanic blacks had higher symptom burden when they first presented at the cancer center than non-Hispanic whites. Severe pain, depressed mood, and fatigue were significant predictors for early referral (<7 months) of non-Hispanic whites, but only severe fatigue (P <.05) was predictive of early referral for Hispanics and non-Hispanic blacks. Furthermore, while the proportion of non-Hispanic white patients reporting severe pain, depressed mood, and fatigue significantly decreased (P <.001) at first follow-up visit after referral to the SCC; among Hispanics, improvement was only observed for depressed mood. No improvement in any of these symptoms was observed for non-Hispanic blacks. CONCLUSIONS: Whereas the timing of referral to supportive services did not vary by race, disparities in symptom burden outcomes persisted. Additional studies are needed to validate our findings.
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População Negra/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hispânico ou Latino/estatística & dados numéricos , Neoplasias Pulmonares/terapia , Cuidados Paliativos , Especialização , População Branca/estatística & dados numéricos , Adulto , Idoso , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/terapia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/etnologia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Prognóstico , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
BACKGROUND: Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings. OBJECTIVES: This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions. METHODS: We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research. RESULTS: Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm. CONCLUSIONS: Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.
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Pesquisa Biomédica/tendências , Educação Médica Continuada/tendências , Educação de Pós-Graduação em Medicina/tendências , Política de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Manejo da Dor/tendências , Pesquisa Biomédica/legislação & jurisprudência , Educação Médica Continuada/legislação & jurisprudência , Educação de Pós-Graduação em Medicina/legislação & jurisprudência , Etnicidade/legislação & jurisprudência , Diretrizes para o Planejamento em Saúde , Política de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/legislação & jurisprudência , Humanos , Estados UnidosRESUMO
OBJECTIVES: To determine if therapist supervision of an exercise program produced better functional outcomes in allogeneic stem cell transplant patients than a patient-directed exercise program. METHODS: Sixty-one patients who were less than 6 months post allogeneic stem cell transplant were randomly assigned to either a therapist supervised training group (supervised) or a patient-directed training group (Self-directed). Training consisted of aerobic exercises (treadmill, bicycle ergometer versus walking) and resistance exercises (free weights, weight machines versus resistive band activities). Subjects completed physical performance tests (50-foot fast walk, 6-min walk, forward reach, repeated sit-to-stand, uniped stance) and the Brief Fatigue Inventory (BFI) before and after 4 weeks of training. Pre- and post-training outcomes and group differences were analyzed by a Student t-test. RESULTS: Patients in both groups were similarly deconditioned at baseline. Training increased the 6-min walk distance and 50-foot walk in the supervised group by 12 and 14%, respectively, and increased the 6-min walk distance by 10% in the Self-directed group (p<0.05). BFI score for worst level of fatigue declined in both groups but not significantly. CONCLUSIONS: These results demonstrate that allogeneic transplant patients derive functional benefits from short-term exercise training regardless of how the training program is supervised. Determining (1) the reasons for the low participation rate (28%), (2) the patient-preferred characteristics of each exercise supervision style and (3) how best to match patient preference to exercise supervision style remain significant issues in this area of patient delivery services.
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Exercício Físico , Neoplasias/epidemiologia , Neoplasias/terapia , Relações Profissional-Paciente , Desenvolvimento de Programas , Autoeficácia , Apoio Social , Transplante de Células-Tronco/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Transplante Homólogo , Adulto JovemRESUMO
OBJECTIVES: Pain and depression frequently co-occur in patients with cancer. Although pain is a common reason for emergency department (ED) presentation by these patients, depression frequently goes unrecognised during an ED visit. In this study, we assessed the risk for depression in patients with cancer presenting to the ED for uncontrolled pain and assessed the extent to which the risk for depression was associated with survival in this population. METHODS: Participants were consecutive patients with cancer taking Schedule II opioids (n=209) who presented to the ED of a tertiary cancer centre for uncontrolled pain. Risk for depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the somatic symptoms. Survival was calculated from date of ED visit to date of death/last follow-up. RESULTS: The CES-D was completed by 197 of 209 participants (94.3%); of these, 81 of 197 (41.1%) had high risk for depression (CES-D ≥10). The mean survival time for the entire sample was 318 days (SD=33), with 84 deaths. Cox proportional hazards regression modeling showed that risk for depression and disease stage (CES-D ≥10: HR=1.75, 95% CI 1.11 to 2.78, p=0.016; disease stage: HR=2.52, 95% CI 1.20 to 5.30, p<0.001) were significant factors for survival. CONCLUSIONS: Risk for depression was prevalent and associated with survival outcomes in patients with cancer presenting to the ED with uncontrolled pain. Screening for risk for depression in the ED may identify patients who need referral for clinical assessment of depression. Diagnosis and adequate treatment could improve health outcomes and survival rates for these patients.
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Dor do Câncer/psicologia , Dor do Câncer/terapia , Depressão/psicologia , Serviços Médicos de Emergência , Neoplasias/mortalidade , Analgésicos Opioides/uso terapêutico , Dor do Câncer/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Prevalência , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
UNLABELLED: Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity. PERSPECTIVE: This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.
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Envelhecimento/fisiologia , Etnicidade/estatística & dados numéricos , Dor/epidemiologia , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , População Negra/estatística & dados numéricos , Doença Crônica , Coleta de Dados , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Seguro Saúde , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/psicologia , Medição da Dor , População , Fatores Socioeconômicos , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
The State of the Science Report by the National Cancer Institute on Symptom Management in Cancer identified gaps in understanding the epidemiology of pain, depression, and fatigue, and called for studies that will identify the extent of risk for these symptoms among those with cancer relative to other populations. Using year 2000 data from the Health and Retirement Study, a survey of a nationally representative sample of adults aged > or =50, we evaluated whether respondents with a history of cancer had excess risk for pain, depression, and fatigue compared to those without a history of cancer. We also compared clustering/co-occurrence of symptoms. Controlling for the confounding effects of comorbidities, sociodemographic, and access to care factors, respondents with a history of cancer had higher risk for fatigue (OR = 1.45; 95%CI = 1.29,1.63), depression (OR = 1.21; 95%CI = 1.06,1.37), and pain (OR = 1.15; 95%CI = 1.03,1.28). Symptom clusters were also more prevalent among those with a history of cancer (P < 0.001), with the pain-depression-fatigue cluster as most prevalent.
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Depressão/epidemiologia , Fadiga/epidemiologia , Neoplasias/epidemiologia , Dor/epidemiologia , Medição de Risco/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: One of the most challenging areas of emergency medicine practice is the management and treatment of severe and persistent pain, including cancer-related pain. Emergency departments (EDs) in the United States frequently provide care for patients with cancer and an increasing concern is the potential for opioid misuse in this patient group. The authors determined the risk for opioid misuse among ED cancer patients with pain and assessed demographic and clinical factors associated with increased misuse risk. The Texas state prescription monitoring program was also queried for evidence of multiple opioid prescriptions for comparing low- and high-risk groups. METHODS: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) was administered to assess risk for opioid misuse among cancer patients presenting to the ED of a comprehensive cancer center in the United States. Eligibility criteria included: 1) presentation for treatment of chronic cancer-related pain while taking a prescribed schedule II opioid for analgesia, 2) age of 18 years or older, 3) ability to speak English, and 4) ability to understand the study and give written informed consent. RESULTS: Of 934 ED patients screened for the study, 290 were eligible and 209 participated (72% response rate). On the basis of the recommended SOAPP-R cutoff score of 18, a total of 71 of the 209 patients (34%) were categorized as having a high risk of misuse. Of note, 15% and 4% of all patients reported past or current use of illicit substances, respectively. The total number of annual opioid prescriptions (17.8 vs. 12.6; p = 0.023) differed between the high- versus low-risk groups. Multivariable analyses showed that depression (odds ratio [OR] = 3.06, 95% confidence interval [CI] = 1.45 to 6.48; p = 0.003), poor coping (OR = 1.08, 95% CI = 1.03 to 1.13; p = 0.001), and illicit substance use (OR = 28.30, 95% CI = 2.97 to 269.24; p = 0.029) were significantly associated with high risk of opioid misuse. CONCLUSIONS: The risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible.
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Analgésicos Opioides/administração & dosagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Neoplasias/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor/tratamento farmacológico , Adulto , Idoso , Tomada de Decisão Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Fatores Socioeconômicos , Texas/epidemiologia , Estados UnidosRESUMO
PURPOSE: Previous studies found that African American and Hispanic cancer patients are at risk for undertreatment of pain. We evaluated the efficacy of a pain education intervention for underserved minority patients. PATIENTS AND METHODS: Ninety-seven underserved African American and Hispanic outpatients with cancer-related pain were enrolled onto a randomized clinical trial of pain management education. The patients in the education group received a culture-specific video and booklet on pain management. The control group received a video and booklet on nutrition. A research nurse met with each patient to review the materials. We measured changes in pain intensity and pain-related interference 2 to 10 weeks after the intervention, as well as changes in quality of life, perceived pain control, functional status, analgesics, and physician pain assessments. RESULTS: Physicians underestimated baseline pain intensity and provided inadequate analgesics for more than 50% of the sample. Although the ratings for pain intensity and pain interference decreased over time for both groups, there was no statistically significant difference between groups. Pain education did not affect quality of life, perceived pain control, or functional status. African American patients in the education but not the control group reported a significant decrease in pain worst ratings from baseline to first follow-up (P < .01), although this decrease was not maintained at subsequent assessments. CONCLUSION: Brief education had limited impact on pain outcomes for underserved minority patients, suggesting that more intensive education for patients and interventions for physicians are needed.
Assuntos
Negro ou Afro-Americano , Hispânico ou Latino , Área Carente de Assistência Médica , Manejo da Dor , Educação de Pacientes como Assunto , Analgésicos/uso terapêutico , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Fenômenos Fisiológicos da Nutrição , Dor/tratamento farmacológico , Qualidade de Vida , Fatores de Risco , Resultado do TratamentoRESUMO
UNLABELLED: Multidisciplinary treatment programs for chronic pain typically emphasize the importance of decreasing maladaptive and encouraging adaptive coping responses. The Chronic Pain Coping Inventory (CPCI), developed to assess coping strategies targeted for change in multidisciplinary pain treatment, is a 64-item instrument that contains 8 subscales: Guarding, Resting, Asking for Assistance, Relaxation, Task Persistence, Exercising/Stretching, Coping Self-Statements, and Seeking Social Support. A previous validation study with 210 patients in a Canadian academic hospital setting supported an 8-factor structure for the CPCI. The current study was undertaken to validate the CPCI among 564 veterans with a more extended history of chronic pain. Patients completed the study questionnaires before multidisciplinary treatment. A confirmatory factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. The confirmatory factor analysis results strongly supported an 8-factor model, and the regression analyses supported the predictive validity of the CPCI scales, as indicated by their association with measures of patient adjustment to chronic pain. PERSPECTIVE: This article validated the 8-factor structure of the CPCI by using a confirmatory factor analysis and a series of linear regressions. The results support the applicability and utility of the CPCI in a heterogeneous population of veterans with severe chronic pain treated in a tertiary teaching hospital. The CPCI provides an important clinical and research tool for the assessment of behavioral pain coping strategies that might have an impact on patient outcomes.
Assuntos
Adaptação Psicológica/fisiologia , Medição da Dor/métodos , Medição da Dor/normas , Dor/psicologia , Inquéritos e Questionários/normas , Atividades Cotidianas/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/psicologia , Doença Crônica/terapia , Depressão/etiologia , Depressão/psicologia , Avaliação da Deficiência , Família/psicologia , Feminino , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Clínicas de Dor/estatística & dados numéricos , Manejo da Dor , Valor Preditivo dos Testes , Psicologia , Qualidade de Vida/psicologia , Análise de Regressão , Reprodutibilidade dos Testes , Texas , Resultado do TratamentoRESUMO
UNLABELLED: Despite the high prevalence of anger and maladaptive anger management among persons with chronic pain, the association between pain and anger has received little empirical attention. The purpose of the current study was to investigate the relationship between pain and anger management style and test for the hypothesized role of self-efficacy as a moderator of this association. Five hundred sixty-four veterans with chronic pain were administered measures of pain, self-efficacy, and anger management. As expected, the results demonstrated a significant positive relationship between pain intensity and maladaptive anger management and a significant negative association between self-efficacy and maladaptive anger. Furthermore, pain intensity and the interaction of self-efficacy and pain intensity were significant predictors of maladaptive anger management. Surprisingly, patients reporting high self-efficacy and high pain intensity demonstrated more maladaptive anger management than individuals reporting high self-efficacy and low pain intensity. Patients reporting low self-efficacy demonstrated high levels of maladaptive anger management, regardless of pain intensity level. PERSPECTIVE: Maladaptive anger management is associated with pain intensity and self-efficacy beliefs. Additional research is needed to explore the interaction of pain and self-efficacy and its impact on anger management.
Assuntos
Adaptação Psicológica , Ira , Dor/psicologia , Autoeficácia , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Patients with chronic pain frequently report that changes in the weather influence their pain. This study investigated differences in the perceived influence of weather on pain among 558 chronic pain patients living in 4 cities (San Diego, California; Nashville, Tennessee; Worcester, Massachusetts; and Boston, Massachusetts) in the United States. Local climatologic data for each city were obtained from the National Climatic Data Center. All patients completed a weather questionnaire, and the information they provided was compared with demographic and weather variables. The majority of all patients believed that changes in the weather affected their pain. Pain patients who were younger and who had arthritis reported the most sensitivity to changes in weather. Weather sensitivity was unrelated to all other demographic variables and to geographic region. Cold and damp conditions were considered to influence pain the most. However, the perceived effect of weather on pain was not found to be related to regional climate. Thus, the belief that pain is worsened by living in a colder climate was not supported. An equilibrium theory of weather changes and pain is discussed. Further investigations are needed to identify the mechanisms involved in the effects of weather changes on pain.
Assuntos
Clima , Dor/etiologia , Tempo (Meteorologia) , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Estudos de Casos e Controles , Criança , Doença Crônica , Análise Discriminante , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , TennesseeRESUMO
In multiple studies cultural affiliation has been found to have an important influence on perception of and response to experimental and acute pain. Despite that evidence little work has been directed to understanding the cultural dimensions of the chronic pain experience. We present the results of a quantitative study of reported chronic pain perception in 372 chronic pain patients in six ethnic groups, who were under treatment at a multidisciplinary pain-management center. The role of ethnic and cultural experiences in the complex array of physical, cultural, psychological and social factors which influence the chronic pain experience is identified. Ethnocultural affiliation is important to chronic pain perception and response variation. In this study population the best predictors of pain intensity variation are ethnic group affiliation and locus of control (LOC) style (ethnic group identity is also a predictor of LOC style). It appears that pain intensity variation may be affected by differences in attitudes, beliefs and emotional and psychological states associated with the different ethnic groups. This study suggests a biocultural model may be useful in conceptualizing the complex interaction of biological, cultural and psychosocial factors in the process of human pain perception. Although it is likely that intense pain affects attitudes and emotions, it is also very likely that attitudes and emotions influence reported perceptions of pain intensity. Pain intensity variation in this study population is not significantly associated with diagnosis, present medication types, or types of past treatments or surgeries for pain.
Assuntos
Características Culturais , Etnicidade , Dor/psicologia , Percepção/fisiologia , Adulto , Fatores Etários , Doença Crônica , Feminino , Humanos , Controle Interno-Externo , Masculino , Massachusetts , Pessoa de Meia-Idade , Medição da Dor , Limiar da Dor , Fatores SocioeconômicosRESUMO
The present study describes the development of the Chronic Pain Self-Efficacy Scale (CPSS), a 22-item questionnaire designed to measure chronic pain patients' perceived self-efficacy to cope with the consequences of chronic pain. The CPSS and other measures of psychosocial functioning were administered to 141 consecutive patients who were referred to an outpatient multidisciplinary pain treatment program. An exploratory factor analysis of the CPSS responses identified 3 factors: self-efficacy for pain management (PSE), self-efficacy for coping with symptoms (CSE), and self-efficacy for physical function (FSE). The CPSS then was administered to a replication sample of 136 chronic pain patients. Factor analysis confirmed the 3-factor structure of the CPSS. The subscale scores derived from the factor analysis were significantly correlated with measures of depression, hopelessness, somatic preoccupation, and adaptation to the chronic pain experience. Multiple regression analyses provided further support for the concurrent and construct validity of the CPSS. The scale may aid in the evaluation of the self-efficacy beliefs of chronic pain patients.
Assuntos
Adaptação Psicológica , Artrite/psicologia , Nível de Saúde , Dor/psicologia , Adulto , Doença Crônica , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Four studies examined the reliability and validity of a behavioral observation method for the assessment of pain associated with rheumatoid arthritis (RA). The major purpose of experiment 1 was to evaluate the interobserver reliability of the observation method. Two observers recorded the frequencies of pain behaviors displayed by 20 RA patients. Each of 3 types of reliability estimates indicated that the pain behavior could be reliably observed. The purpose of experiment 2 was to examine the concurrent validity of the observation system by correlating 53 patients' self-reports of pain with the frequencies of their pain behaviors. Significant and positive correlations were found between patients' total pain behavior and 3 self-report measures of pain and functional disability. Furthermore, unlike the self-reports of pain, total pain behavior was only minimally related to self-report of depression. Experiment 3 was performed in order to assess the observation method's construct validity. Naive observers viewed video recordings of 25 RA patients and made global estimates of patients' pain severity and unpleasantness. Highly significant and positive correlations were found between these global estimates and total pain behavior. In experiment 4, the pain behaviors of 11 RA patients were recorded prior to and immediately following cognitive-behavioral treatment for the reduction of RA pain. There was a significant decrease in total pain behavior from pretreatment to posttreatment. The data indicate that the observation method provides a reliable, valid, and relatively objective measure of RA patient pain behavior. Future validation studies of the observation method are discussed.
Assuntos
Artrite Reumatoide/complicações , Dor/psicologia , Papel do Doente , Adulto , Artrite Reumatoide/psicologia , Expressão Facial , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Postura , Sons Respiratórios , Autoestimulação , Autoavaliação (Psicologia) , Gravação em VídeoRESUMO
This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. The psychological variables examined did not predict independently RA pain behavior. The rheumatoid activity index explained a significant proportion of the variance in functional status ratings and MHAQ daily function scores. Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.