A Comparison of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD).

BACKGROUND: There is currently no gold standard instrument for assessing pain in severely cognitively impaired adults who are unable to provide self-report. AIMS: To determine interrater reliability of the PACSLAC and PAINAD in assessing pain behaviors in patients with the same pain stimulus, determine the consistency of the reliable changes between and within the instruments and assess nurse preference for either instrument. DESIGN: A single-group, within-subjects repeated-measures design was implemented. SETTING: The study took place in a small suburban hospital. PARTICIPANTS/SUBJECTS: Pain levels were observed at 24, 48, and 72 hours postsurgery using two instruments: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). These instruments were selected because they are among the most commonly recommended tools for clinical use. Interrater reliability was analyzed along with reliable changes in pain for each period, and the study concluded with the nurse raters completing a preference survey. METHODS: A convenience sample of 30 patients was used with a diagnosis of severe dementia rendering the patient unable to reliably express pain, 60+ years of age, recovering from hip fracture surgery. RESULTS: Greater interrater reliability was found for the PACSLAC, with reliable change potentially affected by the type and level of pain medication. The nurses' preference for the tool was split. CONCLUSIONS: The results of this study indicate that the PACSLAC may be the more reliable tool over the PAINAD; however, rater training and familiarity with the tool is critical.

Pain in outpatients treated for breast cancer: prevalence, pharmacological treatment, and impact on quality of life.

BACKGROUND: Cancer pain is an unmitigated clinical phenomenon. Despite available guidelines, variability exists in treating cancer pain. OBJECTIVE: The objective of this study was to describe prevalence and severity of pain and the pharmacotherapy (opioid, nonopioid, adjuvant analgesics) in outpatients treated for breast cancer. Adequacy of pharmacological pain treatments, the predictors, and impact were also examined. METHODS: This descriptive study consisted of 114 chemotherapy outpatients from urban and rural settings. Pain and quality of life were self-reported by patients; treatment-related information was obtained from medical records. Based on the World Health Organization analgesic ladder, adequacy of pharmacological pain management (acceptable or inadequate analgesia) was computed using the Pain Management Index; the most potent analgesic was prescribed relative to the patient's reported pain. RESULTS: Although patients were commonly treated with traditional analgesics, more than half (52.3%) received inadequate analgesia. Those who received inadequate analgesia reported more pain, greater pain interferences (P = .003), and more symptoms (P = .043). Those who received adjuvant analgesics reported more pain, greater interference (P = .018), more symptoms (P = .032), and lower functioning (P = .029). Nonadvanced disease stages and more comorbidities were strong predictors of inadequate analgesia. CONCLUSIONS: There is a lack of congruence between the strength of analgesia and the patient's pain level. The addition of adjuvant analgesics did not reduce pain severity or improve quality of life. IMPLICATIONS FOR PRACTICE: The risks and benefits of coadministration of traditional and adjuvant analgesics need to be determined. Other treatment modalities in conjunction with pharmacological treatment are needed, considering negative effects of adjuvant analgesics on pain and quality of life.

Fatigue and disrupted sleep-wake patterns in patients with cancer: a shared mechanism.

The strong and potentially reciprocal relationship between cancer-related fatigue (CRF) and disrupted sleep-wake patterns suggests a possible shared physiologic pathway. A growing body of evidence supports this and shows that abnormalities in the 24-hour rhythm of stress-related hormones may be related to chronic fatigue and sleep disturbances. Aberrations in the hypothalamic-pituitary-adrenal (HPA) axis, the primary neuroendocrine interface responding to stress, induce important biologic and behavioral consequences. HPA aberrations have long been associated with chronic fatigue syndrome. Many overlapping symptoms exist between chronic fatigue syndrome and CRF, including sleep disruption. Therefore, in the absence of knowledge about CRF mechanisms, emerging biologic models from chronic fatigue syndrome may assist in understanding the cause of CRF. Cancer-associated stressors also may alter the circadian functions of HPA-associated neuroendocrine activities, which result in the symptoms of fatigue and disrupted sleep-wake patterns in patients with cancer. Exploring promising physiologic models furthers the knowledge about CRF and disrupted sleep and may foster hypothesis-based studies of mechanisms that underlie apparent overlapping symptoms, providing the basis for new management to improve sleep and lessen fatigue.