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Biomedical subjects

Christine Miaskowski

Publications and source records attributed to Christine Miaskowski.

At least 73 records · Page 4Linked to original sources
PubMed2002

The pain experience of adolescents after acute blunt traumatic injury.

Because little is known about adolescent pain, in particular pain after blunt traumatic injury, a descriptive exploratory approach was used to examine the pain experience of adolescents after acute blunt traumatic injury in three contexts: at the scene of the accident, in the emergency department, and in the hospital setting. For the 13 adolescents (11-17 years) who experienced multiple sites of blunt unintentional injury, the majority recalled their worst pain at the scene and in the emergency department, with high, intense pain persisting into the hospital setting. Regardless of the context, adolescents recalled multiple aspects of their pain experience. Study findings have implications for the understanding and management of adolescent pain resulting from blunt traumatic injury.

Accidents, Traffic↗
PubMed2002

A 10-year review of quality improvement monitoring in pain management: recommendations for standardized outcome measures.

Quality measurement in health care is complex and in a constant state of evolution. Different approaches are necessary depending on the purpose of the measurement (e.g., accountability, research, improvement). Recent changes in health care accreditation standards are driving increased attention to measurement of the quality of pain management for improvement purposes. The purpose of this article is to determine what indicators are being used for pain quality improvement, compare results across studies, and provide specific recommendations to simplify and standardize future measurement of quality for hospital-based pain management initiatives. Pain management quality improvement monitoring experience and data from 1992 to 2001 were analyzed from 20 studies performed at eight large hospitals in the United States. Hospitals included: the University of Wisconsin Hospital and Clinics, Madison; Texas Medical Center, Houston; McAllen Medical Center, McAllen, TX; San Francisco General Hospital, San Francisco; Rush-Presbyterian-St. Luke's Medical Center and Northwestern Memorial Hospital, Chicago, IL; Memorial Sloan Kettering Cancer Center, New York; and Kaiser Sunnyside Medical Center of Kaiser Permanente Northwest, Clackamas, OR. Analyses of data led to consensus on six quality indicators for hospital-based pain management. These indicators include: the intensity of pain is documented with a numeric or descriptive rating scale; pain intensity is documented at frequent intervals; pain is treated by a route other than intramuscular; pain is treated with regularly administered analgesics, and when possible, a multimodal approach is used; pain is prevented and controlled to a degree that facilitates function and quality of life; and patients are adequately informed and knowledgeable about pain management. Although there are no perfect measures of quality, longitudinal data support the validity of a core set of indicators that could be used to obtain benchmark data for quality improvement in pain management in the hospital setting.

Activities of Daily Living↗
PubMed2002

Oncology outpatients with pain from bone metastasis require more than around-the-clock dosing of analgesics to achieve adequate pain control.

Around-the-clock (ATC) dosing of opioid analgesics is the established approach for the management of chronic cancer pain. The purposes of this study were to determine whether there were differences in pain intensity scores and pain duration between oncology outpatients who were taking opioid analgesics on an around-the-clock (ATC) compared with an as needed (PRN) basis and to determine differences in opioid prescription and consumption between the 2 groups during a period of 5 weeks. Oncology patients (n = 137) with pain from bone metastasis were recruited from 7 outpatient settings. Patients completed a demographic questionnaire and on a daily basis recorded pain intensity scores and medication intake in a diary. No significant differences in average, least, or worst pain intensity scores or number of hours per day in pain were found between the 2 groups. However, the average total opioid dose, prescribed and taken, was significantly greater for the ATC group than for the PRN group. These findings suggest the need for further investigations in the following areas: the appropriate treatments for pain related to bone metastasis, the use of various pain measures to evaluate the effectiveness of analgesic medications, and the need to evaluate how analgesics are prescribed and titrated for patients with cancer-related pain.

Journal Article↗
PubMed2002

A randomized clinical trial of the effectiveness of an acupressure device (relief brief) for managing symptoms of dysmenorrhea.

OBJECTIVES: To develop and test the safety and effectiveness of an acupressure garment (the Relief Brief) in decreasing the pain and symptom distress associated with dysmenorrhea. DESIGN: A randomized clinical trial applied a 2 (Relief Brief use or control group) x 3 (baseline and two treatment measurement occasions) mixed factorial design. PARTICIPANTS: Sixty-one (61) women with moderately severe primary dysmenorrhea were randomly assigned to the standard treatment control group or the Relief Brief acupressure device group after one pretreatment menses, with 58 women reporting the effect on their pain during two post-treatment menstrual cycles. The acupressure garment: The Relief Brief is a cotton Lycra panty brief with a fixed number of lower abdominal and lower back latex foam acupads that provide pressure to dysmenorrhea-relieving Chinese acupressure points. OUTCOME MEASURES: Menstrual pain severity (worst pain and symptom intensity), pain medication use, and adverse effects were analyzed using between-groups and repeated measures analyses of treatment effects. Statistical and clinical significance criteria were applied a priori. RESULTS: For pain measures and pain medication use, the group main effect, time main effect and group x time interaction were statistically significant. Median pain medication use, the same for both groups at baseline (6 pills per day), dropped to 2 pills per day for the Relief Brief group but remained at 6 pills for the control group at the second treatment cycle. Predicted clinical significance criteria were surpassed: almost all (90%) women wearing the Relief Brief obtained at least a 25% reduction in menstrual pain severity (a 2-3 point drop) compared to only 8% of the control group (z = 6.07; p < 0.05). Relief Brief use was associated with at least a 50% decline in menstrual pain symptom intensity in more than two thirds of the women. CONCLUSIONS: An acupressure device is an effective and safe nonpharmacologic strategy for the treatment of primary dysmenorrhea. With design modifications, it could serve as a main treatment modality for women who suffer from primary dysmenorrhea and do not wish to or cannot use the conventional pharmacologic agents. In addition, this acupressure device may serve as an adjuvant therapy to medication in more severe cases of dysmenorrhea.

Acupressure↗
PubMed2002

A research review of the current treatments for radiation-induced oral mucositis in patients with head and neck cancer.

PURPOSE/OBJECTIVES: To review the research studies on the current treatments for radiation therapy-(RT-) induced mucositis in patients with head and neck cancer. DATA SOURCES: MEDLINE search of the literature from 1966-2001. DATA SYNTHESIS: Four types of agents (i.e., antimicrobial, coating, anti-inflammatory, and cytokine-like agents) have been evaluated for the management of RT-induced oral mucositis in patients with head and neck cancer. Most of the published studies had relatively small sample sizes and used inconsistent measures to evaluate the extent and severity of oral mucositis. Therefore, definitive conclusions regarding the effectiveness of any of the agents tested in the prevention and treatment of RT-induced oral mucositis cannot be drawn. CONCLUSIONS: Oral mucositis remains the most common complication among patients with head and neck cancer. Although a number of strategies and products are being investigated and new directions are promising, the therapies tested to date have not produced consistent results. IMPLICATIONS FOR NURSING: The most effective measure to treat RT-induced mucositis in patients with head and neck cancer is frequent oral rinsing with a bland mouthwash, such as saline or a sodium bicarbonate rinse, to reduce the amount of oral microbial flora. Dental care, consistent oral assessments, and the initiation of a standardized oral hygiene protocol before the initiation of cancer treatment are the most effective approaches for oral mucositis.

Head and Neck Neoplasms↗
PubMed2002

The usefulness of a daily pain management diary for outpatients with cancer-related pain.

PURPOSE/OBJECTIVES: To describe the usefulness of daily pain management diaries to outpatients with cancer who participated in a randomized clinical trial of the PRO-SELF Pain Control Program. DESIGN: Randomized clinical trial in which a daily pain management diary was used for data collection in the control group and for data collection and nurse coaching regarding the pain management program in the intervention group. SETTING: Seven outpatient oncology settings. SAMPLE: 155 patients with pain from bone metastases and 90 family caregivers. METHODS: Content and statistical analysis of audiotaped answers to a semistructured questionnaire. MAIN RESEARCH VARIABLES: Patients' and family caregivers' perceptions of the usefulness of a daily pain management diary; specific ways in which the diary was used. FINDINGS: Patients in both the intervention (75%) and control groups (73%) found the diary useful. The diary was used to heighten awareness of pain, guide pain management behavior, enhance a sense of control, and facilitate communication. Family caregivers in both groups also reported that the diary was useful. CONCLUSIONS: The completion of a daily pain management diary is useful to patients and family caregivers and may function as an intervention for self-care. IMPLICATIONS FOR NURSING: Research-based evidence supports the importance of using a daily pain management diary in clinical practice.

Adult↗
PubMed2002

The influence of social support on breast cancer screening in a multicultural community sample.

PURPOSE/OBJECTIVES: To examine the relationship between women's reported social support and their adherence to recommended breast cancer screening guidelines. DESIGN: Descriptive, cross-sectional survey. SETTING: Community women's organizations throughout the San Francisco Bay Area. SAMPLE: 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. METHODS: Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach's alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women's organizations conducted the survey in work and community settings. MAIN RESEARCH VARIABLES: Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. FINDINGS: Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. CONCLUSIONS: Social support is associated with adherence to breast cancer screening guidelines. IMPLICATIONS FOR NURSING: Nurses should assess women's levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.

Adult↗
PubMed1995

Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women's experiences.

Postmastectomy pain (PMP), a distinctive postsurgical neuropathic pain syndrome, has been thought to be consequence of 4-6% of surgical procedures for cancer of the breast, but remains understudied and poorly documented. In this cross-sectional descriptive study, a convenience sample of 95 women who had undergone breast cancer surgery was recruited from 16 ambulatory care sites. Prevalence, characteristics, and impact of the PMP syndrome were investigated using a medical record review, a patient information questionnaire, a cancer pain questionnaire and the McGill Pain Questionnaire. A 20% prevalence rate of the PMP syndrome was found. Women experiencing the syndrome reported chronic, stable pain of long duration that began shortly after surgery. They described paroxysms of lancinating pain against a background of burning, aching, tight constriction in the axilla, medial upper arm, and/or chest that significantly interfered with the performance of daily occupational and domestic activities. Data suggest that these women were undertreated and generally obtained poor pain relief from their symptoms.

Adult↗
PubMed1995

Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy.

The efficacy of ketorolac, a non-steroidal anti-inflammatory drug, in the management of moderate to severe pain in adults, has led us to conduct a trial of this analgesic in children following tonsillectomy. Children were randomized to receive intramuscular (i.m.) ketorolac (1 mg/kg, EXP group, n = 45) or saline (CTL group, n = 42) at the completion of surgery. Intravenous (i.v.) fentanyl (0.5 micrograms/kg/dose) was administered in repeated doses postoperatively. Pain intensity was measured using both the Oucher and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) to allow for comparison between self-report and behavioral measures of pain intensity. Severity of postoperative bleeding was measured using a 4-point rating scale. The EXP group had a significant reduction in total fentanyl dose (mean: 35.9 micrograms) compared to the CTL group (mean: 48.3 micrograms, t = -2.21, P < 0.03). There was a statistically significant decrease in pre-fentanyl CHEOPS scores in the Post-Anesthesia Care Unit (PACU) in the ketorolac group (F (2, 30) = 5.34, P < 0.01), but not in the saline group (F (2.24) = 2.46, P > 0.05). In the first hour postoperatively, the CHEOPS demonstrated significant decreases in pain intensity scores in response to opioids, in both groups. In the PACU, children were unable to provide a self-report of pain intensity potentially due to a variety of factors (e.g., emergence delirium, agitation, excitement, sedation, and/or pain). However, during the remainder of the postoperative stay, the photographic scale of the Oucher was a more valid measure of pain intensity than the CHEOPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1992

Antinociceptive and motor effects of delta/mu and kappa/mu combinations of intrathecal opioid agonists.

Interactions between selective opioid agonists acting at spinal mu-, delta-, and kappa-opioid receptors were evaluated by co-administering a low-antinociceptive dose of the selective delta-agonist, DPDPE, or the selective kappa-agonist, U50,488H, with sequentially increasing doses of the selective mu-agonist, DAMGO, intrathecally. Antinociceptive synergy (i.e., a more than additive antinociceptive effect) was observed with both combinations of opioid agonists tested. The demonstration of antinociceptive synergy suggests that the subtypes of spinal opioid receptors can act, at least in part, through a common neural circuit. Since our measure of antinociception, the Randall-Selitto paw-withdrawal test, is dependent on a normally functioning motor system, we also evaluated the effects of these same combinations of opioid peptides on motor coordination using a rotarod treadmill. A low-antinociceptive dose of DPDPE or U50,488H co-administered intrathecally, with sequentially increasing doses of DAMGO, did not worsen the decrement in rotarod performance observed with the same doses of DAMGO administered as a single agent. In fact, the low-antinociceptive dose of DPDPE significantly attenuated the decrease in rotarod performance produced when the same dose of DAMGO was administered as a single agent. The results of this study suggest that intrathecal combinations of selective mu- with both delta- or kappa-selective opioid agonists can produce antinociceptive synergy without producing an increase in motor side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMedDate not supplied

Use of a pain assessment and intervention notation (P.A.I.N.) tool in critical care nursing practice: nurses' evaluations.

BACKGROUND: One of the barriers to effective pain management in critical care is the lack of systematic, comprehensive methods for assessing and treating pain. Use of a printed, standardized pain assessment and intervention tool can stimulate critical thinking and provide a framework for organizing pain assessment and management data. OBJECTIVES: The objectives of this study were to do the following: (1) describe the Pain Assessment and Intervention Notation (P.A.I.N.) tool, (2) detail critical care nurse participants' evaluations of the P.A.I.N. intervention tool when used during care of postoperative patients in pain, and (3) evaluate the tool's usefulness in practice and education. METHODS: Eleven intensive care unit (n = 7) and postanesthesia care unit (n = 4) nurses completed a questionnaire after they had used the pain tool in their clinical practices with 31 postoperative patients. RESULTS: Ten of the 11 nurses who returned an evaluation questionnaire found that the P.A.I.N. tool provided a consistent, systematic method of quantifying their assessment of patient pain and analgesic responsiveness. Five nurse participants believed that the P.A.I.N. tool improved their practice with regard to pain and sedation assessment. Three of the 11 nurses believed that the usefulness of the tool was limited because it was too detailed to be used routinely when caring for critically ill patients. All but 1 of the 11 nurses believed that the tool would have helped them earlier in their practice (ie, when they had less critical care nursing experience). CONCLUSIONS: The assessment and treatment of pain in critically ill patients are highly complex processes. This study identified many advantages of the use of a standardized, systematic approach to pain assessment and treatment by health professionals.

Adult↗
PubMedDate not supplied

Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults.

OBJECTIVES: To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain. METHODS: A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables. RESULTS: Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain. CONCLUSION: This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain.

Adult↗
PubMedDate not supplied

Trends in complete blood count values during acute painful episodes in children with sickle cell disease.

Complete blood count (CBC) values are monitored as crude indicators of the hemolytic and inflammatory processes that accompany an acute painful episode in children with sickle cell disease. As part of a larger study that examined the pain experience and pain management of hospitalized children during painful vaso-occlusive episodes, the authors examined trends in CBC values and determined whether there were relationships between these values and pain intensity scores. Children, 5 to 19 years of age, with sickle cell disease whose primary reason for admission was vasoocclusive pain were recruited for participation in the study. Once every evening from the day of admission until the day of discharge, they were asked to rate their worst and least pain using the numeric rating scale of the African American Oucher pain scale. Complete blood count values were obtained from the hospital information system on a daily basis. Parallel changes in CBC values and pain intensity scores were evident within the first 48 hours of hospitalization. However, although the inflammatory and hemolytic processes were resolving, pain persisted at moderate levels throughout the course of hospitalization.

Anemia, Sickle Cell↗