Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain.

Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.

Herpes zoster and postherpetic neuralgia: the need for early intervention in the elderly.

Herpes zoster is an acute nervous system infection that commonly affects the elderly. Because the causative agent is a virus, herpes zoster is often treated symptomatically in the primary care setting. While this approach is acceptable for immunocompetent patients less than 50 years of age, it can leave older patients at greater risk of developing painful and debilitating complications such as postherpetic neuralgia. There is evidence that appropriate treatment initiated within 48 to 72 hours after the onset of the zoster eruption can decrease healing time, reduce acute pain, decrease ocular complications and may prevent the development of postherpetic neuralgia in this age group. The health care practitioner in a primary care setting is ideally placed to identify elderly clients with herpes zoster in the early stages; to consult with physicians about therapies such as steroids, antiviral agents and sympathetic nerve blocks; to monitor treatment effects; and to provide supportive therapy to those who develop postherpetic neuralgia.

Shaping health care policy.

At home and abroad, the Canadian health care system has long been regarded as one of the best in the world. However, it is facing internal and external pressures to change. There is a perception that the traditional system, with its emphasis on physician services and acute care hospital-based services, is being threatened. So, too, are the five principles--universality, accessibility, portability, comprehensiveness, and public administration--under which the system operates.

The statistical versus clinical significance debate.

There is general agreement that tests of statistical significance do not provide information about the clinical significance or practical importance of research results. Yet the concept of clinical significance has received little discussion or debate in the nursing literature. The purpose of this paper is to compare and contrast statistical and clinical significance, to provide an overview of the issues surrounding their uses as described in the methodological literature from a variety of disciplines, and to discuss some implications of these concepts for nursing research.

A test of Braden's Self-Help Model in adults with chronic pain.

PURPOSE: To test hypothesized relationships in Braden's Self-Help Model in a sample of people with idiopathic chronic pain. Testing theoretical explanations and predictions with various clinical populations under different sociocultural, economic, climatic, and health system environments provides evidence about the applicability of the underlying theory among diverse populations. DESIGN: This study was part of a larger randomized, controlled trial of a community-based nursing psycho-educational intervention: the Chronic Pain Self-Management Program (CPSMP). Pretest and posttest data were collected in 1995-1996 in Newfoundland, Canada. METHODS: Participants completed a battery of valid and reliable self-report instruments to measure pain, disability, uncertainty, resourcefulness, self-efficacy, adult role behaviors, and life satisfaction. Two tests of the self-help model were performed, the first with pretest data (N = 110) and the second with 3-month posttest data (N = 102) after half the sample had participated in the CPSMP intervention. Causal modeling path analysis was done with the Statistical Package for the Social Sciences (SPSS) program and tests of goodness-of-fit were conducted using EQS for Windows. RESULTS: Results supported the overall hypothesized pattern of relationships in the self-help model. Amounts of variance explained in the two major outcomes of the model (self-help: 42% to 53% and life quality: 45% to 47%) were consistent with results from other studies. Indices of goodness of fit showed an adequate fit of the model to the data, particularly the posttest data. CONCLUSIONS: Braden's Self-Help Model appears to be robust in a variety of clinical populations, among different settings and environmental conditions, and provides a useful framework to guide nursing psycho-educational interventions in chronic illness.

Return to work following an aquafitness and muscle strengthening program for the low back injured.

Our purpose, in this prospective clinical study, was to identify the best predictors of 2-month return to work or retraining for a group of low back injured subjects (n = 40) who completed at least 8 weeks of a community-based rehabilitation program that combined aerobic and flexibility exercise conducted in the water (aquafitness) with muscle strength and endurance training. Baseline demographic characteristics and changes in physical fitness, pain, disability, and psychological well-being during the course of program participation were compared between two groups of low back injured subjects: those who returned to work (RTW) [n = 24], and those who did not (N-RTW) [n = 16]. Subjects in both groups showed comparable improvement in measures of physical fitness at 8 weeks. However, multivariate analyses showed significant between-group differences in self-report measures. The RTW group showed significant improvement in measures of pain, disability, anxiety, and vigor while self-esteem and affect remained stable. The N-RTW group displayed no change in pain and disability variables and had significant deterioration in mean overall psychological well-being over time. The best predictors of return to work using logistic regression analyses were a first injury rather than a repeat injury to the lower back, and stability in self-esteem. Suggestions are offered for further research to examine the benefits of aquafit exercise for the low back injured, for additional interventions for those with a reinjury, and for maintaining or enhancing self-esteem as a treatment goal.

Predictors of the development of chronic pain.

The purpose of this secondary analysis was to explore the role of potential risk factors in predicting the development of chronic pain. Linear discriminant function analysis was used to derive a prediction equation that maximized the differences between a group of hospitalized patients experiencing acute pain who developed chronic pain (n = 171) and a group whose pain resolved (n = 200). Patients who developed chronic pain reported a higher pain intensity, higher anxiety and distress, less certainty that their pain would resolve, longer hospitalization, less independence in ambulation, a diagnosis of trauma, and less need for surgery. Recognition of these factors could lead to early identification of those individuals with acute pain who are at risk for developing chronic pain.