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Biomedical subjects

C S Cleeland

Publications and source records attributed to C S Cleeland.

At least 55 records · Page 3Linked to original sources
PubMed1987

Barriers to the management of cancer pain.

Effective drugs and other pain management tools are available, yet pain due to cancer is poorly managed. This paper discusses barriers to adequate pain management and offers suggestions for overcoming them. Some barriers discussed: Patients may be reluctant to report pain or fail to take prescribed analgesics. Physicians and nurses may have a poor understanding of appropriate therapies for cancer pain and often do not communicate well with patients concerning pain.

Analgesics↗
PubMed1986

Factors influencing physician management of cancer pain.

It has been asserted that pain due to cancer is not adequately managed, and that physician attitudes may contribute to poor management. Based on responses to questionnaire items assessing attitudes that have been identified as affecting the quality of pain management, two groups of physicians were identified using cluster analysis on selected questionnaire items, and the responses of the two clusters to questions concerning their approach toward pain management were compared. With reference to reported practice, Cluster I physicians (N = 19) were willing to prescribe more potent analgesics and to do so earlier in the course of the disease as compared to Cluster II (N = 72). Cluster I members reported using more modalities of pain therapy, and more often saw scheduled analgesics as appropriate for the management of cancer pain. Groups did not differ in composition of medical specialty, nor in number of cancer patients cared for. More "liberal" attitudes toward pain management were associated with younger age and with more experience in specialized oncology units.

Adult↗
PubMed1985

Public attitudes toward cancer pain.

This study examined public attitudes toward pain associated with cancer and its treatment. A variety of issues were assessed, including the extent to which pain is associated with cancer, fear of pain as a factor in the decision to delay seeking treatment, and concerns about the use of narcotic analgesics for pain control. A statewide sample of 496 adult Wisconsin residents completed a telephone interview. It was found that cancer was perceived as an extremely painful disease relative to other medical conditions. Eighteen percent of the respondents reported that they might be reluctant to seek medical attention due to fear of pain. Concerns about disease- and treatment-related pain were rated as significant psychosocial concerns. There were multiple concerns expressed about the consequences of using narcotic analgesics for pain control. Implications for public education and patient management are discussed.

Analgesics, Opioid↗
PubMed1985

Use of biofeedback training in treatment of Raynaud's disease and phenomenon.

To assess biofeedback training in Raynaud's, we retrospectively reviewed 23 patients' records. Eleven had Raynaud's disease and 12 had Raynaud's phenomenon; 9 had recurrent digital ulcers. Patients demonstrated lower baseline digital temperatures than controls (p less than or equal to 0.001), patients with Raynaud's and scleroderma manifesting the lowest. After biofeedback training all patients elevated baseline temperatures. Patients with scleroderma and systemic lupus erythematosus had the greatest elevations. Improvement, both subjective (57%) and ulcers (44%), persisted one year after treatment. Four of 7 patients were capable of elevating digital temperatures within 5 min, 18 months after their last training session. These findings support biofeedback training as beneficial therapy in Raynaud's.

Arthritis, Rheumatoid↗
PubMed1984

The impact of pain on the patient with cancer.

Pain is one of the most feared consequences of cancer. Until recently, however, little has been known about its prevalence, severity, and impact on the patient with cancer. The presence of pain, despite efforts to treat it, represents a continued source of frustration for patients, their families, and the health care team. Although often one of the early indicators of the presence of disease, pain is not a significant problem for the majority of patients in the early stages of disease, with 5% to 10% of patients with solid tumors reporting pain at a level that interferes with mood and activity. But when metastatic disease is present, about one in three patients reports significant pain, and our data and those of others indicate that the majority of patients with end-stage disease will report pain of a severity that interferes with several aspects of the patient's quality of life. Site of tumor is also significantly related to the progression of pain. The relationship between pain intensity and depression and anxiety is examined in detail, and the treatment implications of this relationship discussed. Whereas a modest relationship between pain intensity and depression has been found across several studies, the possibility that depression is a causative factor in the pain experienced by the cancer patient may have been overemphasized. Data on the relief of pain in cancer are reported from the perspective of patients as well as the physicians and nurses who treat them. The majority of physicians and nurses specializing in cancer treatment whom we have surveyed believe that cancer patients in general are undermedicated for pain. Patient survey data indicate that only 50% of cancer patients with pain report 70% or greater pain relief with analgesic medication. Although a number of nonsystemic treatments may be useful for cancer pain management (such as nerve blocks, neurosurgery, and behavioral treatments), they are not widely available and there are few controlled studies of their effectiveness. Teaching patients to report the level of their pain on simple pain intensity scales has proven useful in monitoring the effectiveness of pain management, as well as in helping establish pain control goals for the individual patient.

Affective Symptoms↗
PubMed1984

Versatility in computer automation for biofeedback: the behavioral assessment and rehabilitative training system (BARTS).

User versatility in a system for computer-automated biofeedback training is the degree to which the assessment and training parameters may be altered by the user's employing English language or other simple code, that is, without altering the system's applications software. The Behavioral Assessment and Rehabilitative Training System (BARTS) includes a design and control program that allows for the specification of assessment and training protocols by persons who are entirely lacking in computer programming skills. This paper describes the logic for data acquisition and training that is incorporated in the BARTS, describes the parameters that must be specified in constituting unique assessment or training protocols, and illustrates the system's application in a research-oriented biofeedback clinic.

Biofeedback, Psychology↗
PubMed1984

CSF beta-endorphin and the severity of pain.

Beta-endorphin-like immunoreactivity (i beta-EP) was measured in the CSF at myelography of 24 patients suspected of vertebral disk disease. Patients made several ratings of mood and pain for the 24 hours preceding myelography. Composite scores for pain, negative mood, and positive mood were derived by factor analysis. Pain Factor scores were negatively correlated with i beta-EP (r = -0.59, p less than 0.001), indicating a possible role for i beta-EP in the perception of the severity of pain. No significant correlation was shown between Positive or Negative Mood Factor scores and CSF i beta-EP. A physiologic indicator of pain severity is discussed.

Emotions↗
PubMed1983

Emotional states and pain: intraindividual and interindividual measures of association.

The present study investigated the correlation between cancer pain severity and mood states, and addressed methodological issues involved in measuring the association between these groups of variables. Five monthly interviews were administered to 95 cancer pain patients; each interview contained four measures of pain severity and the Profile of Mood States (POMS). The relationships between the two sets of variables were assessed using both interindividual (cross-sectional) and intraindividual (within-subject) methods of correlational analysis. Both types of analyses suggested small but significant positive correlations between the pain measures and negative mood states, and inverse correlations between pain and positive mood. The data also indicated that patients reported high levels of pain but reported little mood disturbance. In addressing methodological issues, the study clarified conceptual and computational differences between the two types of correlational analyses and indicated the appropriate applications of each method.

Affective Symptoms↗
PubMed1982

The prevalence and severity of pain in cancer.

The frequency, severity, and disruptiveness of pain related by 667 cancer patients are reported. The patients, all seen at a comprehensive cancer center, had cancers of the breast, colon and rectum, prostate, or various gynecologic sites. As expected, the proportion of patients with pain varied according to primary site and according to degree of progression of the disease. Pain, when present, was often of at least moderate severity and was felt to interfere with patients' activity and enjoyment of life to a moderate to severe extent. Degree of interference with activity and enjoyment of life was greater when the pain was caused by cancer than when it had another cause. Implications of these findings for professional and lay education and for treatment are discussed.

Adult↗
PubMed1978

Hyperkinesis and food additives: testing the Feingold hypothesis.

Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect.

Child↗
PubMed1977

Motor performance after unilateral hemisphere damage in patients with tumor.

Hemispheric asymmetry of sensory-motor control has been hypothesized on the basis of clinical and experimental data, but discrepant data indicate asymmetry may vary with task requirements. To examine this possibility, the performance of normal controls and patients with right or left hemispheric tumors were compared on a variety of motor tasks of varying complexity. Group differences were significant only for the two most complex of six tasks; since these two tasks differ in quality (proximal steadiness and distal dexterity), it is unlikely that quality differences are crucial. On these tasks, the group with left hemisphere damage demonstrated bilateral impairment while the right hemisphere group's deficits were contralateral to lesion site. These results support previous data and Liepmann's hypothesis of hemispheric asymmetry of sensory-motor control. Task complexity and the more specific hypothesis of sensory-motor sequencing are important factors influencing hemispheric asymmetry of control.

Adult↗