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1.
Medicine (Baltimore) ; 99(51): e23867, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371172

RESUMO

OBJECTIVE: To explore the effect of modular transitional nursing intervention on the improvement of self-management of the patients with cancer pain. METHOD: This study will be conducted from March 2021 to May 2022 at Affiliated Hospital of Beihua University. The experiment was granted through the Research Ethics Committee of Affiliated Hospital of Beihua University (4348-019). Eighty patients are analyzed in our study. The patients will be included if they are between 18 and 70 years old and are diagnosed with cancer, the pain intensity score on moderate level, the pain lasts for more than 3 days, and the patients who have signed the written informed consent. While the patients will be excluded if they have a documented history of drug or alcohol abuse, and patients with limited performance, and patients have a surgery in the past 3 days. The primary result mainly expresses as intergroup differences in self-management disorders (Barriers Questionnaire-II) associated with the cancer pain. And the secondary results include the quality of life (QOL) and pain intensity. All the analyses are implemented with SPSS for Windows Version 20.0. RESULTS: Table 1 will show the clinical outcomes between the 2 groups. CONCLUSION: A modular transitional nursing intervention appears to reduce pain in cancer patients. TRIAL REGISTRATION NUMBER: researchregistry6262.


Assuntos
Neoplasias/enfermagem , Cuidados de Enfermagem/normas , Manejo da Dor/normas , Autogestão/psicologia , Protocolos Clínicos , Humanos , Neoplasias/psicologia , Cuidados de Enfermagem/métodos , Manejo da Dor/métodos , Manejo da Dor/psicologia , Autogestão/métodos , Resultado do Tratamento
2.
JAMA ; 324(21): 2159-2160, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33258893
3.
BMJ ; 371: m4290, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328164

RESUMO

OBJECTIVE: To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions. DESIGN: Systematic review of randomised and non-randomised controlled trials. DATA SOURCES: Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. STUDY SELECTION: Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome. DATA EXTRACTION AND SYNTHESIS: Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials. RESULTS: 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05). CONCLUSIONS: These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018107099.


Assuntos
Criança Hospitalizada/psicologia , Terapia do Riso/métodos , Doença Aguda/psicologia , Ansiedade/psicologia , Ansiedade/terapia , Criança , Doença Crônica/psicologia , Fadiga/psicologia , Fadiga/terapia , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Manejo da Dor/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/psicologia , Estresse Psicológico/terapia
4.
BMJ ; 371: m4284, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33303476

RESUMO

OBJECTIVE: To investigate the effect of therapeutic suggestions played to patients through earphones during surgery on postoperative pain and opioid use. DESIGN: Blinded randomised controlled study. SETTING: Five tertiary care hospitals in Germany. PARTICIPANTS: 385 of 400 patients consecutively recruited from January to December 2018 who were to undergo surgery for 1-3 hours under general anaesthesia. In the per protocol analysis 191 patients were included in the intervention group and 194 patients in the control group. INTERVENTION: The intervention comprised an audiotape of background music and positive suggestions based on hypnotherapeutic principles, which was played repeatedly for 20 minutes followed by 10 minutes of silence to patients through earphones during general anaesthesia. Patients in the control group were assigned to a blank tape. MAIN OUTCOME MEASURES: The main outcome was dose of opioid administered by patient controlled analgesia or nurse controlled analgesia within the first postoperative 24 hours, based on regular evaluation of pain intensity on a numerical rating scale (range 0-10, with higher scores representing more severe pain). RESULTS: Compared with the control group, the intervention group required a significantly (P=0.002) lower opioid dose within 24 hours after surgery, with a median of 4.0 mg (interquartile range 0-8) morphine equivalents versus 5.3 (2-12), and an effect size (Cohen's d) of 0.36 (95% confidence interval 0.16 to 0.56). The number of patients who needed opioids postoperatively was significantly (P=0.001) reduced in the intervention group: 121 of 191 (63%, 95% confidence interval 45% to 70%) patients in the intervention group versus 155 of 194 (80%, 74% to 85%) in the control group. The number needed to treat to avoid postoperative opioids was 6. Pain scores were consistently and significantly lower in the intervention group within 24 hours after surgery, with an average reduction of 25%. No adverse events were reported. CONCLUSIONS: Therapeutic suggestions played through earphones during general anaesthesia could provide a safe, feasible, inexpensive, and non-drug technique to reduce postoperative pain and opioid use, with the potential for more general use. Based on the finding of intraoperative perception by a considerable number of patients, surgeons and anaesthetists should be careful about background noise and conversations during surgery. TRIAL REGISTRATION: German Clinical Trial Register DRKS00013800.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Geral , Musicoterapia/métodos , Dor Pós-Operatória/prevenção & controle , Sugestão , Adolescente , Adulto , Idoso , Analgesia Controlada pelo Paciente/psicologia , Feminino , Alemanha , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Manejo da Dor/psicologia , Medição da Dor , Dor Pós-Operatória/psicologia , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
5.
Nurs Clin North Am ; 55(4): 467-474, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131625

RESUMO

Guided imagery is a therapeutic approach that has been used for centuries. Through the use of mental imagery, the mind-body connection is activated to enhance an individual's sense of well-being, reduced stress, and reduced anxiety, and it has the ability to enhance the individual's immune system. There are research and data to support the use of guided imagery for these patient outcomes.


Assuntos
Imagens, Psicoterapia/métodos , Ansiedade/psicologia , Ansiedade/terapia , Fissura , Humanos , Imagens, Psicoterapia/instrumentação , Imagens, Psicoterapia/tendências , Manejo da Dor/métodos , Manejo da Dor/psicologia , Resultado do Tratamento
6.
Pain Physician ; 23(4S): S271-S282, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942787

RESUMO

BACKGROUND: Burnout has been a commonly discussed issue for the past ten years among physicians and other health care workers. A survey of interventional pain physicians published in 2016 reported high levels of emotional exhaustion, often considered the most taxing aspect of burnout. Job dissatisfaction appeared to be the leading agent in the development of burnout in pain medicine physicians in the United States. The COVID-19 pandemic has drastically affected the entire health care workforce and interventional pain management, with other surgical specialties, has been affected significantly. The COVID-19 pandemic has placed several physical and emotional stressors on interventional pain management physicians and this may lead to increased physician burnout. OBJECTIVE: To assess the presence of burnout specific to COVID-19 pandemic among practicing interventional pain physicians. METHODS: American Society of Interventional Pain Physicians (ASIPP) administered a 32 question survey to their members by contacting them via commercially available online marketing company platform. The survey was completed on www.constantcontact.com. RESULTS: Of 179 surveys sent, 100 responses were obtained. The data from the survey demonstrated that 98% of physician practices were affected by COVID and 91% of physicians felt it had a significant financial impact. Sixty seven percent of the physicians responded that in-house billing was responsible for their increased level of burnout, whereas 73% responded that electronic medical records (EMRs) were one of the causes. Overall, 78% were very concerned. Almost all respondents have been affected with a reduction in interventional procedures. 60% had a negative opinion about the future of their practice, whereas 66% were negative about the entire health care industry. LIMITATIONS: The survey included only a small number of member physicians. Consequently, it may not be generalized for other specialties or even pain medicine. However, it does represent the sentiment and present status of interventional pain management. CONCLUSION: The COVID-19 pandemic has put interventional pain practices throughout the United States under considerable financial and psychological stress. It is essential to quantify the extent of economic loss, offer strategies to actively manage provider practice/wellbeing, and minimize risk to personnel to keep patients safe.


Assuntos
Esgotamento Profissional/epidemiologia , Infecções por Coronavirus , Manejo da Dor/psicologia , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos , Satisfação no Emprego , Pessoa de Meia-Idade , Médicos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Estados Unidos
7.
BMC Health Serv Res ; 20(1): 604, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611397

RESUMO

BACKGROUND: Chronic pain is a widespread problem that is usually approached by focusing on its psychological aspects or on trying to reduce the pain from the pain generator. Patients report that they feel responsible for their pain and that they are disempowered and stigmatized because of it. Here, we explored interventional pain management from the patient's perspective to understand the process better. METHODS: A purposive sample of 19 subjects was interviewed by an independent interviewer. The interviews were transcribed into text and thematic analysis was performed. RESULTS: The subjects' perceptions covered three key themes: themselves as objects; the caregivers, including the process of tests and retests, the encounters and interactions with professionals, and the availability of the caregivers; and finally the outcomes, including the results of the tests and treatments and how these inspired them to think of other people with pain. Linking these themes, the subjects reported something best described as "gained empowerment" during interventional pain management; they were feeling heard and seen, they gained knowledge that helped them understand their problem better, they could ask questions and receive answers, and they felt safe and listened to. CONCLUSIONS: Many of the themes evolved in relation to the subjects' contact with the healthcare services they received, but when the themes were merged and structured into the model, a cohesive pattern of empowerment appeared. If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment. TRIAL REGISTRATION: Clinicaltrials.gov 2013-04-24 (Protocol ID SE-Dnr-2012-446-31 M-3, ClinicalTrials ID NCT01838603 ).


Assuntos
Atitude Frente a Saúde , Dor Crônica/terapia , Manejo da Dor/métodos , Manejo da Dor/psicologia , Pacientes/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa , Adulto Jovem
8.
PLoS One ; 15(7): e0235192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663844

RESUMO

INTRODUCTION: As marijuana use becomes more common, it is essential clinicians understand the relationship between marijuana use and health behaviors. METHODS: Using a retrospective cohort of adolescents and adults with sickle cell disease (SCD) stratified into a young (<25 years) and older cohort (> = 25 years), we conducted multiple linear regression examining relationship of marijuana use (independent variable) on each dependent variable (SCD self-management score and pain management). RESULTS: Among young cohort, 16.9% used marijuana compared to 21.8% of older cohort. The younger cohort reporting marijuana use had lower mean self-care scores (ß = -2.74;p = 0.009) and were more likely to have admissions to the hospital for pain (ß = 0.87;p = 0.047) compared to non-users. In contrast, the older cohort reporting marijuana use had more days treating pain at home (ß = 0.44;p = 0.035). CONCLUSIONS: Only a minority of patients with SCD reported lifetime marijuana use. Among those reporting marijuana use, there were different associations with self-care and health-related behaviors by age. The older cohort who endorsed marijuana use reported more days of treating pain at home, although this did not translate into increased acute care visits for pain crisis. Among youth, endorsing marijuana use was associated with worse SCD self-care.


Assuntos
Anemia Falciforme/terapia , Comportamentos Relacionados com a Saúde , Uso da Maconha/epidemiologia , Manejo da Dor/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Adulto , Fatores Etários , Anemia Falciforme/complicações , Feminino , Humanos , Masculino , Uso da Maconha/psicologia , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/psicologia , Estudos Retrospectivos , Autocuidado/psicologia , Estados Unidos , Adulto Jovem
9.
Pain Res Manag ; 2020: 7935215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32351642

RESUMO

Objectives: Socially-assistive robots (SAR) have been used to reduce pain and distress in children in medical settings. Patients who perceive empathic treatment have increased satisfaction and improved outcomes. We sought to determine if an empathic SAR could be developed and used to decrease pain and fear associated with peripheral IV placement in children. Methods: We conducted a pilot study of children receiving IV placement. Participating children were randomized to interact with (1) no robot, or a commercially available 3D printed humanoid SAR robot programmed with (2) empathy or (3) distraction conditions. Children and parents completed demographic surveys, and children used an adapted validated questionnaire to rate the robot's empathy on an 8-point Likert scale. Survey scores were compared by the t-test or chi-square test. Pain and fear were measured by self-report using the FACES and FEAR scales, and video tapes were coded using the CHEOPS and FLACC. Scores were compared using repeated measures 2-way ANOVA. This trial is registered with NCT02840942. Results: Thirty-one children with an average age of 9.6 years completed the study. For all measures, mean pain and fear scores were lowest in the empathy group immediately before and after IV placement. Children were more likely to attribute characteristics of empathy to the empathic condition (Likert score 7.24 v. 4.70; p=0.012) and to report that having the empathic vs. distraction robot made the IV hurt less (7.45 vs. 4.88; p=0.026). Conclusions: Children were able to identify SAR designed to display empathic characteristics and reported it helped with IV insertion pain and fear. Mean scores of self-reported or objective pain and fear scales were the lowest in the empathy group and the highest in the distraction condition before and after IV insertion. This result suggests empathy improves SAR functionality when used for painful medical procedures and informs future research into SAR for pain management.


Assuntos
Empatia , Manejo da Dor/métodos , Dor/prevenção & controle , Robótica , Administração Intravenosa/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Dor/etiologia , Dor/psicologia , Manejo da Dor/psicologia , Projetos Piloto , Robótica/instrumentação , Inquéritos e Questionários
10.
BMC Palliat Care ; 19(1): 66, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393231

RESUMO

BACKGROUND: The management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life. METHODS: Qualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties. RESULTS: Healthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use. CONCLUSIONS: The burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, 'outside the box' thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.


Assuntos
Pessoal de Saúde/psicologia , Sistemas de Medicação/normas , Assistência Terminal/psicologia , Adulto , Feminino , Pessoal de Saúde/tendências , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/tendências , Humanos , Entrevistas como Assunto/métodos , Masculino , Sistemas de Medicação/tendências , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/psicologia , Pesquisa Qualitativa , Assistência Terminal/métodos
12.
Am J Clin Hypn ; 62(4): 330-343, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32216629

RESUMO

The use of hypnosis to promote hypnoanalgesia has a long history and has been written about anecdotally as well as having been researched in the last several decades. Research has been both clinical in nature and, in the laboratory, trying to understand the brain physiology and processes involved. This article is not about a review of the research. It is about sharing what I have learned to do clinically using hypnosis to treat patients with persistent pain over the last 40 plus years. Due to the restraints of limited space, I can only discuss the various techniques briefly. I will describe a philosophical perspective that has served me well and driven my approach to treatment. I will discuss the concept of self-regulation training along the dimensions of Sensation, Affect, Cognition, and Behavior and share how hypnosis has been incorporated in working within each of those aspects of experiencing.


Assuntos
Dor Crônica/psicologia , Dor Crônica/reabilitação , Hipnose/métodos , Manejo da Dor/métodos , Manejo da Dor/psicologia , Humanos , Filosofia
13.
Drug Alcohol Depend ; 209: 107901, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32126454

RESUMO

BACKGROUND: The harms associated with prescription opioid abuse have become a public health crisis. There is a need for evidence-based objective markers of the risk of opioid use disorder (OUD) in patients with pain receiving opioid treatment. The objective of this study was to evaluate the independent association of tobacco use and OUD in patients with chronic non-cancer pain. METHODS: This cross-sectional naturalistic study evaluated 798 adults ≥ 18 years with chronic non-cancer pain treated with long-term opioid therapy (≥ 6 months) who either developed an OUD (cases, n = 216) or displayed no evidence of an OUD (controls, n = 582). The primary outcome was presence of OUD. In addition to current self-reported tobacco use (primary predictor), covariates included demographics, pain severity, and psychiatric history. Data were collected between November 2012 and September 2018. RESULTS: Current tobacco use independently was strongly associated with OUD [odds ratio (OR) 14.0, 95 % confidence interval (CI) 9.5-20.6, p < 0.001], and this association remained significant after adjusting for other risk factors [adjusted odds ratio (aOR) 7.6, 95 % CI 4.8-12.2, p < 0.001]. Other factors associated independently with development of OUD included age, marital status, financial status, education and pain severity. CONCLUSIONS AND RELEVANCE: Current tobacco use is significantly associated with OUD in patients with chronic pain receiving long-term opioid therapy.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/epidemiologia , Grupo com Ancestrais do Continente Europeu , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Manejo da Dor/métodos , Uso de Tabaco/epidemiologia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Manejo da Dor/psicologia , Fatores de Risco , Uso de Tabaco/psicologia , Uso de Tabaco/tendências
14.
Qual Life Res ; 29(7): 1871-1881, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32112278

RESUMO

BACKGROUND: Patients with fibromyalgia syndrome (FMS) usually display a decrease in health-related quality of life (HRQoL). This decrease in HRQoL is related to clinical pain, anxiety, and depression. This cross-sectional study analyzes the mediating role of pain-coping strategies (especially catastrophizing) in the negative relationships of pain, anxiety, depression, and HRQoL in FMS. METHODS: One hundred and thirteen women with FMS and 63 healthy women were assessed using the Short-Form Health Survey (SF-36). Participants completed self-report questionnaires to evaluate clinical pain, anxiety, depression, and pain-coping strategies. RESULTS: Pain catastrophizing was inversely associated with the physical function, general health perception, vitality, emotional role, mental health, the physical and mental general components, and the global index of HRQoL, with percentages of variance explained ranging between 9 and 18%. Cognitive distraction showed a positive association with the physical function, general health perception, vitality, emotional role, mental health, physical component, and global index of HRQoL, with percentages of variance explained ranging between 4 and 7%. Mediation analysis showed that catastrophizing mediates the negative influence of clinical pain and trait-anxiety on the physical function, general health perception, vitality, mental health, and global index of HRQoL. No mediating effect of pain catastrophizing on the relation between depression and HRQoL was observed. CONCLUSIONS: Patients with FMS exhibited markedly lower HRQoL than healthy individuals. While pain catastrophizing was inversely related to several domains of HRQL, associations were positive for cognitive distraction. Catastrophizing mediates the negative influence of clinical pain and trait-anxiety on HRQoL. Therefore, cognitive behavioral treatments focused on adaptive management and control of catastrophizing and negative emotional states may be helpful.


Assuntos
Catastrofização/psicologia , Fibromialgia/psicologia , Manejo da Dor/psicologia , Dor/psicologia , Qualidade de Vida/psicologia , Adaptação Psicológica , Adulto , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Emoções , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Manejo da Dor/métodos , Autorrelato , Inquéritos e Questionários
15.
Pain Physician ; 23(2): 209-218, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214303

RESUMO

BACKGROUND: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients' response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. OBJECTIVES: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. STUDY DESIGN: This research used a prospective, cohort, observational study design. SETTING: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. METHODS: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression Inventory-II (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. RESULTS: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. LIMITATIONS: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. CONCLUSIONS: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. KEY WORDS: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.


Assuntos
Catastrofização/psicologia , Depressão/psicologia , Osteoartrite do Joelho/psicologia , Manejo da Dor/psicologia , Dor/psicologia , Modalidades de Fisioterapia/psicologia , Adulto , Idoso , Catastrofização/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/terapia , Dor/epidemiologia , Manejo da Dor/métodos , Medição da Dor/métodos , Medição da Dor/psicologia , Estudos Prospectivos , Resultado do Tratamento , Turquia/epidemiologia
16.
J Clin Nurs ; 29(9-10): 1662-1672, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32092212

RESUMO

AIMS AND OBJECTIVE: To explore and describe healthcare practitioners' experiences of postoperative pain management to patients undergoing planned lumbar spine surgery by identifying the healthcare practitioners' behaviours, attitudes and strategies. BACKGROUND: Poorly managed postoperative pain continues to cause suffering and prolong hospital care and may affect individual and team practitioners' strategies and attitudes. The impact of these strategies and attitudes needs greater understanding. DESIGN: Descriptive qualitative study. METHODS: In-depth interviews were conducted at a university hospital in Sweden during January-March 2016 with 9 healthcare practitioners (ages: 29-61 years; gender: male 3 and female 6; professions: medical doctor 3, registered nurse 3 and physiotherapist 3; professional experience: 1.5 months to 25 years). The interviews were analysed using Braun and Clarke's thematic analysis. The study adhered to the Consolidated Criteria for Reporting Qualitative Research COREQ. RESULTS: The interviews revealed healthcare practitioners' attitudes and strategies. Three themes were identified: (a) Connecting with the person was recognised as the key component in postoperative pain management; (b) Professionalism: a balancing act, accentuated health care practitioners' duality in being both vulnerable and strong in delicate care situations; and (c) Collaboration: being constantly responsive, the necessity for healthcare practitioners to be constantly responsive to their environment. CONCLUSIONS: The findings pinpoint the need for healthcare organisations to build structures enabling practitioners to deliver adequate pain management in acknowledging the practitioners' delicate situation when facing patients in pain. RELEVANCE TO CLINICAL PRACTICE: Given the global need for postoperative pain management, our findings have international relevance. Preconceived expectations on specific pain need to be depicted and postoperative pain taken seriously to protect the patient as well as the healthcare practitioners.


Assuntos
Atitude do Pessoal de Saúde , Manejo da Dor/normas , Dor Pós-Operatória/terapia , Adulto , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/psicologia , Pesquisa Qualitativa , Suécia
17.
Wilderness Environ Med ; 31(1): 23-30, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044211

RESUMO

INTRODUCTION: Ultramarathon runners commonly endure musculoskeletal pain during endurance events. However, the effect of pain coping skills on performance has not been examined. METHODS: A prospective observational study during three 250 km (155 mi), 6 stage ultramarathons was conducted. Finish line surveys were completed after each of the four 40 km (25 mi) and one 80 km (50 mi) stages of racing. Variables gathered included pain intensity, pain coping strategy use, pain interference, finishing position (quintile), and successful race completion. RESULTS: A total of 204 participants (age 41.4±10.3 y; 73% male) reported average pain intensity of 3.9 (±2.0 SD) and worst pain intensity of 5.3 (±2.3) on a 0 to 10 scale. They used greater adaptive pain coping strategies (3.0±1.3) relative to maladaptive strategies (1.3±1.1). Worst pain and pain interference increased over each stage of the race for all runners (P<0.001), with worst pain being significantly different by finishing status (P=0.02). Although all runners endured increased pain and interference, the nonfinishers (28 [14%]) had significantly greater differences in changes in pain intensity (P<0.01) and pain interference (P<0.001). Maladaptive pain coping strategies were more common in nonfinishers; with each 1-point increase (0-6 scale), there was a 3 times increase in odds of not finishing the race. CONCLUSIONS: Although increased pain intensity and pain interference was found in all multistage ultramarathon runners, successful event completion was significantly associated with less maladaptive pain coping. Training in coping with pain may be a beneficial part of ultramarathon preparation.


Assuntos
Adaptação Psicológica , Manejo da Dor/psicologia , Dor/psicologia , Corrida/psicologia , Estresse Psicológico/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física , Estudos Prospectivos
18.
J Relig Health ; 59(2): 681-699, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31912350

RESUMO

The availability of safe and effective non-pharmacological therapies for pain is an important unmet medical need. Prayer may be considered as an effective adjunctive therapy for pain and this systematic review aims to clarify this association. Pertinent databases were searched for English language publications, dated 2000-2019. Inclusion criteria involved prayer as an on-site or personal intervention and at least one pre-specified pain-related outcome. We evaluated 411 abstracts. Nine studies met criteria. Active prayer to God emerged as a preferred beneficial intervention for religious patients undergoing surgery or a painful procedure. Prayer effect does not seem to be opioid mediated. Improved trial design will facilitate the study of prayer as an adjuvant therapy for pain.


Assuntos
Manejo da Dor/psicologia , Dor/psicologia , Religião , Espiritualidade , Humanos , Religião e Medicina
19.
Ann Fam Med ; 18(1): 15-23, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31937528

RESUMO

PURPOSE: Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain. METHODS: In this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Attention control participants received a peer-delivered general health advice program. Outcomes were changes in functional status and pain (Western Ontario and McMaster Universities Osteoarthritis Index), QOL (Short Form 12), and physiologic measures (hemoglobin A1c, systolic blood pressure, body mass index); physical activity was the explanatory outcome. RESULTS: Of 195 participants with follow-up data, 80% were women, 96% African Americans, 74% had annual income <$20,000, and 64% had high school education or less. At follow-up, compared with controls, intervention participants had greater improvement in functional status (-10 ± 13 vs -5 ± 18, P = .002), pain (-10.5 ± 19 vs -4.8 ± 21, P = .01), and QOL (4.8 ± 8.8 vs 3.8 ± 8.8, P = .001). Physiologic measures did not change significantly in either group. At 3 months, a greater proportion of intervention than control participants reported no pain or did other forms of exercise when pain prevented them from walking for exercise. CONCLUSION: This peer-delivered CBT-based intervention improved functioning, pain, QOL, and self-reported physical activity despite pain in individuals with diabetes and chronic pain. Trained community members can deliver effective CBT-based interventions in rural and under-resourced communities.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Diabetes Mellitus/terapia , Tutoria , Autogestão/educação , Idoso , Dor Crônica , Análise por Conglomerados , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/psicologia , Desempenho Físico Funcional , Qualidade de Vida , População Rural
20.
Artigo em Inglês | MEDLINE | ID: mdl-31963773

RESUMO

The study protocol of a prospective and randomized controlled trial for the assessment of the efficacy of nature activity therapy for people with Fibromyalgia (NAT-FM) is described. The primary outcome is the mean change from baseline in the Revised Fibromyalgia Impact Questionnaire (FIQR) score at post-treatment (12 weeks) and at 9 months of follow-up, and secondary outcomes are changes in the positive affect, negative affect, pain, fatigue, self-efficacy, catastrophising, and emotional regulation. A total of 160 patients with fibromyalgia will be divided into two arms: treatment-as-usual (TAU) and NAT-FM+TAU. Pre, during, post, +6, and +9 months assessments will be carried out, as well as an ecological momentary assessment (EMA) of intrasession and intersessions. Results will be subjected to a mixed group (NAT-FM+TAU vs. TAU) × phase (pre, post, +6 months, +9 months) general linear model. EMA intrasession measurements will be subjected to a 2 (pre vs. post) × 5 (type of activity) mixed-effects ANOVA. EMA between-session measurements obtained from both arms of the study will be analysed on both a time-domain and frequency-domain basis. Effect sizes and number needed to treat (NNT) will be computed. A mediation/moderation analysis will be conducted.


Assuntos
Terapia por Exercício/psicologia , Fibromialgia/terapia , Manejo da Dor/psicologia , Sistemas de Apoio Psicossocial , Terapia de Relaxamento/psicologia , Humanos , Educação de Pacientes como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha
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