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Biomedical subjects

C S Cleeland

Publications and source records attributed to C S Cleeland.

At least 37 records · Page 2Linked to original sources
PubMed1998

A brief cancer pain assessment tool in Japanese: the utility of the Japanese Brief Pain Inventory--BPI-J.

Despite recognition that pain management is an important component in the treatment of Japanese cancer patients, progress in this area has been slowed by the lack of an appropriate measure of pain. In a prospective, single-institution study, a Japanese translation of the Brief Pain Inventory (BPI-J) was administered to 121 patients to assess the intensity and impact of cancer-related pain. After an analysis of the instrument's reliability and validity, this study tested the utility of the new measure in an analysis of the adequacy of analgesic prescription. Results were compared with predictive models from studies using non-Japanese patient groups. Factor analysis of the BPI items resulted in two factors, pain severity and pain interference, showing consistency with other language versions of the tool. Coefficient alphas of greater than 0.80 for the items comprising these two subscales indicate a reliable self-report pain instrument. After establishing the validity and reliability of the BPI-J, we examined possible predictors of inadequate pain management in these Japanese cancer patients. Similar to studies done in other countries, women patients and those whose pain severity was underestimated by their physician were more likely to be undermanaged for pain. The results of this study support the utility of the Japanese BPI for studies of the epidemiology of cancer pain in Japan, as well as for the assessment of pain treatment outcome in Japanese-speaking patients.

Adult↗
PubMed1997

Pain and treatment of pain in minority patients with cancer. The Eastern Cooperative Oncology Group Minority Outpatient Pain Study.

BACKGROUND: Clinics that primarily see members of ethnic minority groups have been found to provide inadequate treatment of cancer-related pain. The extent of undertreatment of pain in these patients and the factors that contribute to undertreatment are not known. OBJECTIVES: To evaluate the severity of cancer-related pain and the adequacy of prescribed analgesics in minority outpatients with cancer. DESIGN: Prospective clinical study. SETTING: Eastern Cooperative Oncology Group. PATIENTS: 281 minority outpatients with recurrent or metastatic cancer. MEASUREMENTS: Patients and physicians independently rated severity of pain, pain-related functional impairment, and pain relief obtained by taking analgesic drugs. Analgesic adequacy was determined on the basis of accepted guidelines. RESULTS: 77% of patients reported disease-related pain or took analgesics; 41% of patients reporting pain had severe pain. Sixty-five percent of minority patients did not receive guideline-recommended analgesic prescriptions compared with 50% of non-minority patients (P < 0.001). Hispanic patients in particular reported less pain relief and had less adequate analgesia. CONCLUSIONS: The awareness that minority patients do not receive adequate pain control and that better assessment of pain is needed may improve control of cancer-related pain in this patient population.

Adult↗
PubMed1996

Dimensions of the impact of cancer pain in a four country sample: new information from multidimensional scaling.

We investigated the question of how cultural and linguistic backgrounds affect relationships among ratings (reported by patients with metastatic cancer) of pain's interference with such functions as activity, mood, and sleep. Multidimensional scaling (MDS) was used to analyze ratings of pain interference from a sample consisting of four culturally and linguistically different groups from the US (n = 1106), France (n = 324), the Philippines (n = 267), and China (n = 146). Patients all completed the Brief Pain Inventory, a self-report measure of pain and its interference with function. For each of these samples, MDS solutions consistently revealed two interpretable dimensions. In all samples, one dimension represented affect and the other dimension represented activity. The dimensions were consistently interpretable across all four samples and across three levels of pain severity ('mild', 'moderate', and 'severe'). The dimensions were most prominent when pain was moderate, rather than mild (when little interference was produced) or severe (when all domains were highly interfered with). These dimensions may have utility in the study of the epidemiology of pain and of the effectiveness of pain treatment. They may also be useful in clinical assessment to describe different patterns of pain interference.

China↗
PubMed1996

The Chinese version of the Brief Pain Inventory (BPI-C): its development and use in a study of cancer pain.

We describe the development of a Chinese version of the Brief Pain Inventory (BPI-C) and demonstrate its reliability and validity. We also report the use of the BPI-C in a three hospital study of cancer pain and its treatment. As with other language versions of the BPI, factor analysis of the BPI-C items results in a two factor solution that satisfies the criteria of reproducibility, interpretability and fit in a confirmatory setting. The first factor consists of the four pain severity scales, while the seven pain interference scales comprised the second factor. The BPI-C proved to be a reliable measure of both the severity and impact of pain in patients with cancer. Coefficient alpha for the pain severity and pain interference items were 0.894 and 0.915, respectively. The sample (N = 147) was gathered at three cancer treatment hospitals in Beijing. The patients from these hospitals reported higher levels of pain severity and pain interference compared with patients in similar studies done at the time (1991-1992) in the United States and France. This was in keeping with the finding that a larger proportion (67%) of the cancer patients in these Beijing hospitals were judged to have inadequate analgesia as assessed by the Pain Management Index (PMI), an estimate of adherence to the World Health Organization (WHO) guidelines for cancer pain management.

Adolescent↗
PubMed1996

Effects of oral morphine on cold pressor tolerance time and neuropsychological performance.

We investigated the analgesic effects of escalating doses (0.214, 0.286, 0.357, and 0.429 mg/kg) of oral morphine on tolerance to painful cold pressor in a double-blind, active placebo-controlled (diphenhydramine) study in 45 normal volunteers. The highest dose of morphine administered is equivalent to the starting dose recommended by the Agency for Health Care Policy and Research for the management of cancer pain and acute postoperative pain. We assessed analgesia in terms of cold pressor tolerance time and self-reported ratings of pain intensity and unpleasantness. Subjects receiving the highest dose of oral morphine showed significantly higher tolerance time than subjects receiving diphenhydramine. Neither morphine or diphenhydramine significantly reduced ratings of pain intensity and unpleasantness. Neuropsychological testing revealed that the two highest doses of morphine impaired the episodic retrieval of a word list, but the same doses did not affect motor, perceptual, or attentional tasks.

Administration, Oral↗
PubMed1995

Multicentre study of cancer pain and its treatment in France.

OBJECTIVE: To describe the treatment of cancer pain in France and to evaluate the predictive factors for inadequate management. DESIGN: Multicentre, representative cross sectional survey. SETTING: 20 treatment centres, including cancer centres, university hospitals, state hospitals, private clinics, and one homecare setting (in which patients are supported at home). SUBJECTS: 605 patients with cancer. MAIN MEASURES: Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients' cancer characteristic, performance status, pain severity, and analgesic drugs ordered. RESULTS: 57% (340/601) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (224/325) rated their worst pain at a level that impaired their ability to function. 30% (84/279) were reported as receiving no drugs for their pain. Of the 270 patients in pain for whom information on treatment was available 51% (137/270) were not receiving adequate pain relief, according to an index based on the World Health Organisation's guidelines. French doctors were found to underestimate the severity of their patients' pain. Younger patients, patients without metastatic disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for undertreatment of their pain. CONCLUSIONS: In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.

Analgesia↗
PubMed1995

Whole head mapping of magnetic fields following painful electric finger shock.

Painful intracutaneous electric finger shock was delivered to the fifth digit of the non-dominant hand of five healthy volunteers. Whole head evoked magnetic field maps were collected and cortical localizations were calculated using local sphere equivalent current dipole fits. MRI scans were used to identify the anatomical structures where magnetic field sources were located. Anatomically, sources were identified bilaterally in the primary somatosensory region and SII-Insula regions. Additionally, frontal operculum sources were observed contralaterally in two subjects. Temporally, an initial contralateral SI activation at 40-60 ms was followed by several SII-Insula responses over the next several hundred milliseconds (ms). These SII-Insula responses were often interspersed with additional activations of the SI region. These later responses were observed in both hemispheres.

Adult↗
PubMed1994

Pain and its treatment in outpatients with metastatic cancer.

BACKGROUND AND METHODS: Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. RESULTS: Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function. CONCLUSIONS: Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.

Adult↗
PubMed1994

Pain assessment: global use of the Brief Pain Inventory.

Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.

Activities of Daily Living↗
PubMed1993

Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group.

OBJECTIVE: The Eastern Cooperative Oncology Group (ECOG) conducted a groupwide survey to determine the amount of knowledge about cancer pain and its treatment among physicians practicing in ECOG-affiliated institutions and to determine the methods of pain control being used by these physicians. DESIGN: Survey. SETTING: A questionnaire was sent to all ECOG physicians with patient care responsibilities (medical oncologists, hematologists, surgeons, and radiation therapists), practicing in university institutions, Community Clinical Oncology Program (CCOP) institutions, and Cooperative Group Outreach Programs (CGOP) institutions. MEASUREMENTS: A physician cancer pain questionnaire developed by the Pain Research Group at the University of Wisconsin was used. The questionnaire was designed to assess physicians' estimates of the magnitude of pain as a specific problem for cancer patients, their perceptions of the adequacy of cancer pain management, and their report of how they manage pain in their own practice setting. RESULTS: The study analyzed responses to 897 of 1800 surveys. In regard to the use of analgesics for cancer pain in the United States, 86% felt that the majority of patients with pain were undermedicated. Only 51% believed pain control in their own practice setting was good or very good; 31% would wait until the patient's prognosis was 6 months or less before they would start maximal analgesia. Adjuvants and prophylactic side-effect management should have been used more frequently in the treatment plan. Concerns about side-effect management and tolerance were reported as limiting analgesic prescribing. Poor pain assessment was rated by 76% of physicians as the single most important barrier to adequate pain management. Other barriers included patient reluctance to report pain and patient reluctance to take analgesics (both by 62%) as well as physician reluctance to prescribe opioids (61%). CONCLUSIONS: Professional education needs to focus on the proper assessment of pain, focus on the management of side effects, and focus on the use of adjuvant medications. A better understanding of the pharmacology of opioid analgesics is also needed. Physicians also need to educate patients to report pain and to effectively use the medications that are prescribed for pain management.

Adult↗
PubMed1992

Cancer pain in the marital system: a study of patients and their spouses.

Forty married patients with metastatic cancer, who were receiving opioid medication for cancer pain, were interviewed for this study. They were asked about their pain and its treatment, their beliefs regarding cancer pain, their concerns about opioid analgesics, their mood state, and the nature of their interaction with their spouse in relation to these issues. The spouses of these cancer patients were interviewed separately about the same issues. For example, patients who were concerned about medication side effects tended to suffer high levels of pain before requesting additional analgesics. Spouses are shown in this study to be an important support for the patient and an essential source of information regarding the patient's pain and its management. For example, although spouses were generally accurate in their estimates of the patients' pain levels, in the case of relatively stoic patients, who may underreport their pain levels, the spouses' estimates were higher than the patients'. The results also indicate that patients underestimate the distress their pain causes to their spouses and that spouses tend to downgrade their own support to the patients. Implications and limitations of these findings are discussed.

Adult↗
PubMed1991

Tonic changes in alpha power during immersion of the hand in cold water.

Phasic event-related desynchronization (ERD) of alpha activity briefly follows many types of stimulation. In order to define EEG changes resulting from longer stimulation. EEG records were made before and during hand immersion into cool and painfully cold water (cold pressor). Five minutes of 13-lead EEG records were obtained from 14 subjects for each condition. EEG frequency analysis was performed on artifact-free epochs from 60 to 240 sec following immersion. Following an initial phasic decrease in alpha power during cold water immersion, there was an augmentation of alpha power (8-12 Hz) in bilateral frontal and posterior electrodes. This augmentation was largely the result of an increase in the low alpha band (8-10 Hz). Alpha power at both central electrodes C3 and C4 changed little during cold water immersion. Cool water immersion produced less alpha power augmentation than cold water immersion. These observed changes were primarily in the high alpha band (10-12 Hz) and were larger in electrodes ipsilateral rather than contralateral to the stimulation. There was also an increase of beta bilaterally in frontal and posterior regions with cold water immersion. Our data demonstrate sustained topographic EEG responses during tonic stimulation from hand immersion in painfully cold water. These changes differ from those produced by stimulation with cool water immersion.

Adolescent↗
PubMed1990

Unaided use of pain descriptors by patients with cancer pain.

A large sample of cancer patients in pain were instructed to describe their pain using their own words. Data were collected from patients representing several primary sites. A total of 129 distinct words were used by patients to describe their pain, with each patient using an average of 1.8 words. Ten words accounted for 67% of total word usage. Grouping words by response dimension revealed a predominant use of sensory descriptors, with the majority of these comprising the category "dullness." Patients divided by high and low self-reported worst pain differed significantly across several sensory categories and in the use of evaluative words. Comparisons made between patients grouped by primary site were significant only for the use of dullness adjectives. Patients with ovarian cancer used the greatest number of dullness words. No differences were found in word usage for patients with varying pain etiologies. The results point to the need to use word descriptor lists routinely in clinical and research settings. They also suggest that cancer patients' self-reported pain intensity can be inferred from word descriptors.

Adult↗