Thesis (M.A.)--York University, 2007. Graduate Programme in Kinesiology and Health Sciences. / Typescript. Includes bibliographical references (leaves 63-89). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR38773

Thesis (Ph. D.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 272-287).

Pain is a significant health issue in the paediatric oncology population. No study to date exists documenting the experience and characteristics of pain in Lebanese children with cancer. The primary aim of this research study is to identify the characteristics of the painful experience of paediatric cancer pain in Lebanese children and how pain is managed from the child’s own perspectives. A secondary aim is to assess the cross-cultural context of the Adolescent Paediatric Pain Tool (APPT) and the Functional Disability Inventory (FDI). The specific objectives that will be addressed are:1. To describe the demographic and clinical characteristics of Lebanese children experiencing cancer pain at the CCCL including: type of cancer, time since diagnosis, metastasis, and current treatment in outpatients and inpatients.2. To describe the characteristics of pain including: intensity, frequency, duration, location, and quality in Lebanese children with cancer at the CCCL. 3. To identify the major sources of pain (cancer-related, treatment-related, or procedure-related) in Lebanese children with cancer at the CCCL.4. To examine the impact of pain on activities of daily living in Lebanese children with cancer at the CCCL. 5. To determine the factors associated with the intensity of pain in Lebanese children with cancer at the CCCL. 6. To determine how pain is managed in Lebanese children with cancer at the CCCL from their own perspective. To meet the above aims and objectives a cross-sectional correlational design was used. A consecutive sample (n=62) was recruited from the Children Cancer Centre of Lebanon at the American University of Beirut Medical Centre (CCCL-AUBMC). Data was collected through face-to-face interviews using a structured questionnaire. The mean age of participants was 12.3 (SD 2.9). The mother was the primary caregiver in the majority of cases (69.4%). The overall mean intensity rating was 5.06 (SD 1.87) on a 10 cm Word Graphic Rating Scale. The majority (57.4%) of children reported a frequency of “sometimes”. The median duration of pain was two hours per pain episode. The most frequent locations were: the forehead, the abdomen, and lower back. Sensory words were most often used to qualify pain. The functional disability levels were moderate as measured by the FDI. Factors associated with overall pain intensity were: frequency, duration, location, affective words, and treatment-related pain. Time since diagnosis, treatment, surgery in the past, radiotherapy, pain duration and frequency of pain predicted pain intensity in the sample. Children reported receiving pharmacological help from nurses, and non-pharmacological measures from their mothers. The main self-initiated coping strategies used by children were behavioural avoidance and behavioural distraction. The most suggested coping strategy was stressor modification. The majority (56/62) did not expect to experience that much pain from cancer and treatment modalities.Pain assessment and management in Lebanese children with cancer are of concern. Health care professionals, policy makers, and institution stakeholders are urged to take action.

Thesis (Ph.D.) -- University of Western Sydney, Nepean, 2001. / A thesis submitted in total fulfilment of the rquirement for the degree of Doctor of Philosophy, University of Western Sydney, Nepean, 2001. Bibliography : leaves 242-269.

A dor é uma das principais causas de sofrimento humano, comprometendo a qualidade de vida das pessoas e refletindo no seu estado físico e psicossocial. Em crianças e adolescente com câncer a dor pode ser causada pela própria doença, pelo tratamento e pelos procedimentos, potencializada pelo medo, ansiedade e incerteza. Tendo em vista as múltiplas dimensões que envolvem a dor da criança e do adolescente com câncer e que a caracteriza como um fenômeno complexo, os objetivos do presente estudo são descrever as vivências dos profissionais de saúde no cuidado à criança e ao adolescente com câncer em situações de dor, durante o processo de hospitalização, e analisá-las buscando fundamentação em algumas idéias acerca da complexidade enfocadas por Edgar Morin. Nesta pesquisa, de natureza qualitativa, utilizou-se a entrevista como recurso de coleta de dados. Participaram do estudo 16 profissionais da equipe de saúde do setor de onco-hematologia pediátrica de um hospital-escola do município de Ribeirão Preto. Os dados empíricos indicam que os profissionais reconhecem a importância da avaliação da dor, mas sua operacionalização é percebida como um desafio. Apontam as limitações do uso de escalas e no manejo da dor destacam como primordial a abordagem farmacológica. Manifestam sentimentos de impotência, angústia e sofrimento com a situação de dor. Permitem também vislumbrar possibilidades apresentadas pelos próprios profissionais, tais como a composição de equipes fixas integradas em um trabalho interdisciplinar e o envolvimento da família no cuidado. Os resultados apontam ainda para a necessidade de distinguir os múltiplos enfoques dos profissionais e compor uma unidade de cuidado em que esses enfoques sejam articulados de forma a atender ao cuidado das múltiplas dimensões da dor em crianças e adolescentes com câncer. Para que essa unidade de cuidado seja viabilizada ressalta-se a necessidade de articulação de todos os profissionais envolvidos no atendimento às situações de dor da criança e do adolescente com câncer hospitalizado por meio de um projeto comum, construído conjuntamente. / Pain is one of the main causes of human suffering, affecting people’s quality of life and reflecting in their physical and psychosocial condition. In children and adolescents with cancer, pain can either be caused by the disease itself, by the treatment or by the procedures and is reinforced by fear, anxiety and uncertainty. In view of the multiple dimensions involved in pain of children and adolescents with cancer, which characterize it as a complex phenomenon, this study aims to describe the experiences of health professionals in care for children and adolescents with cancer in pain situations during the hospitalization process and analyze them on the basis of some of Edgar Morin’s ideas of complexity. This qualitative research used interviews as a data collection instrument. Study participants were 16 professionals from the pediatric blood cancer health team of a school hospital in Ribeirão Preto, Brazil. Empirical data point out that, although the professionals recognize the importance of pain evaluation, its operationalization is seen as a challenge. They point towards the limitations of using pain scales and highlight the basic importance of the pharmacological approach for pain coping. Participants show feelings of powerlessness, anguish and suffering in view of the pain situation of children and adolescents with cancer. They also disclose possibilities, such as the composition of fixed teams, integrated in an interdisciplinary service, and family involvement in care. Results also indicate the need to distinguish between multiple professional focuses and to establish a care unit that allows for the articulation of these focuses, so as to attend to the multiple pain dimensions of children and adolescents with cancer. With a view to the practicability of this care unit, we highlight the need for articulation between all professionals involved in care for pain situations in hospitalized children and adolescents with cancer, through a common and jointly constructed project.

A compreensão dos fatores relacionados à presença de dor provocada por tumores malignos na região da cabeça e do pescoço possibilita o estabelecimento de métodos diagnósticos, terapêuticos e prognósticos visando a pronta recuperação dos pacientes e melhor qualidade de vida. Um importante fator algogênico é a invasão de tecidos nervosos pelos carcinomas que pode ocorrer precocemente em níveis microscópicos ou tardiamente por disseminação pelos troncos nervosos. O objetivo deste trabalho foi estudar a presença de dor e invasão perineural microscópica em pacientes portadores de carcinomas da cabeça e do pescoço, correlacionando-as entre si e com outras variáveis clínicas e anatomopatológicas como sexo, cor, idade, intensidade da dor, índice de dor, tipo histopatológico, localização tumoral, estadiamento, infiltração óssea, tamanho do tumor e comprometimento de linfonodos. Foram estudados, através de amostra aleatória, 50 pacientes consecutivos, com diagnóstico histopatológico comprovado através de biópsia, de carcinoma na região da cabeça e do pescoço, cujo tratamento envolveu a tentativa cirúrgica de ressecção tumoral completa. No estudo foi realizada, antes do ato cirúrgico, entrevista utilizando-se uma ficha clínica padronizada elaborada especialmente para o trabalho. Outras informações foram obtidas do prontuário da instituição. Após a remoção cirúrgica o material foi enviado para o estudo anatomopatológico de rotina e depois revisado quanto à presença de invasão perineural. Esta verificação foi feita pela análise em hematoxilina-eosina e pela técnica imuno-histoquímica utilizando o anticorpo antiproteína S-100. Dos 50 pacientes analisados 36 (72%) eram do sexo masculino e 14 (28%) do sexo feminino. A idade média foi de 54,7 anos. Os leucodermas foram predominantes com 70%. Quando interrogados sobre a presença de dor nos últimos 30 dias, 27 pacientes (54%) responderam positivamente. Houve presença de invasão perineural em 20 indivíduos (40%). A investigação anatomopatológica do estadiamento tumoral mostrou maior freqüência dos carcinomas de estádio I e do tipo células escamosas moderadamente diferenciado. Quanto à localização dos tumores, houve predomínio de comprometimento em boca e laringe. Não foi encontrada diferença significativa entre pacientes com e sem dor quanto à proporção de casos onde existia invasão perineural. Não houve correlação estatística entre presença de dor e sexo, cor, idade, tipo histopatológico, envolvimento ósseo, estadiamento tumoral ou linfonodos comprometidos. Houve diferença significativa entre os locais laringe e pele, e os tamanhos T1 e T2 quanto à proporção de pacientes com dor. Não houve correlação estatística entre invasão perineural e sexo, cor, idade, EAV, PRI, tipo histológico, envolvimento ósseo, estadiamento, tamanho e nodos comprometidos. A correlação entre invasão perineural e localização do tumor mostrou diferença significativa entre laringe e pele quanto à proporção de casos com invasão perineural (p = 0,033). Foi estudada ainda, a correlação entre as variáveis semiquantitativas EAV e PRI, e, pelos coeficientes de correlação de Spearman, poderíamos afirmar que houve relação entre EAV e PRI (r= 0,934; p < 0,001). Não se pode considerar a invasão neural microscópica como fator isolado na produção de dor em cabeça e pescoço. São necessários novos trabalhos que elucidem os mecanismos desencadeadores da dor e a diferença individual do limiar de dor. Neste trabalho constatou-se diferença estatística significativa quanto à presença de dor e invasão perineural comparando-se a localização dos carcinomas em pele e laringe. / Keeping in mind a better quality of life and quick recovery for the patient, the understanding of the intervening factors related to the presence of pain caused by malignant tumors in the head and neck area makes possible to establish diagnosis, therapeutic and prognosis methods in these cases. One important algogenic factor is the invasion of the nervous tissues by the carcinomas, which can happen early in a microscopic level or lately by dissemination through nerve trunks. The aim of this work is to study the presence of pain and microscopic perineural invasion in patients bearing head and neck carcinomas, basically correlating them to each other and to other clinical and atomopathological variables i.e. sex, ethnicity, age, pain intensity, McGill index, histological type, tumor location, staging, bone infiltration, tumor size and lymph node involvement. In this work, we studied a random sample of 50 consecutive patients with confirmed histopathologic diagnosis (through biopsy) of head and neck carcinoma, whose treatment involved the attempt of complete surgical tumor resection. Before the surgical procedure, we interviewed each patient using a standard clinical questionnaire especially designed for the study. Additional information was obtained through patients medical records in the institution. After surgical resection, the material was sent for anatomopathological routine study and then checked for the presence of perineural invasion. The revision process involved analysis via both haematoxylin-eosin stain and immunohistochemical technique using S-100 anti-protein antibody. Thirty-six (72%)from 50 analysed patients were male and 14 (28%) female. The average age was 54.7 years old. White ethnicity was prevalent within 70% of the cases. When asked about the presence of pain within the previous 30 days, 27 patients (54%) answered positively. Perineural invasion was present in 20 individuals (40%). The anatomopathological investigation of tumoral staging showed a greater frequency of stage 1 carcinomas and of the moderately differentiated squamous cell type. With reference to the location of the tumors, there was a prevalence of mouth and larynx involvement. We did not find significant difference between patients with and without pain regarding cases showing perineural invasion. Likewise, there was no statistical correlation between pain presence and gender, ethnicity, age, histological type, bone involvement, tumoral staging or lymph node invasion. There was a significant difference between larynx and skin locations, and T1 and T2 sizes, regarding the proportion of patients referring pain. No statistical correlation was found between perineural invasion and gender, ethnicity, age, VAS, McGill index, histological type, bone involvement, staging, size or affected lymph nodes. The correlation between perineural invasion and tumor location showed significant difference between larynx and skin regarding the proportion of cases showing perineural invasion (p = 0.033). The correlation between McGill index and VAS semi quantitative variable was also studied, and the Spearman correlation coefficient showed a relationship between VAS and McGill index (r = 0.934; p < 0.001). Thus, one cannot consider microscopic neural invasion as an isolated factor in the production of pain in head and neck. New researches are necessary to bring to light the mechanisms that trigger pain, or the individual differences in pain threshold. This work also revealed a significant statistical difference regarding the presence of pain and perineural invasion when comparing larynx and skin carcinomas.

A dor é uma das principais causas de sofrimento humano, comprometendo a qualidade de vida das pessoas e refletindo no seu estado físico e psicossocial. Em crianças e adolescente com câncer a dor pode ser causada pela própria doença, pelo tratamento e pelos procedimentos, potencializada pelo medo, ansiedade e incerteza. Tendo em vista as múltiplas dimensões que envolvem a dor da criança e do adolescente com câncer e que a caracteriza como um fenômeno complexo, os objetivos do presente estudo são descrever as vivências dos profissionais de saúde no cuidado à criança e ao adolescente com câncer em situações de dor, durante o processo de hospitalização, e analisá-las buscando fundamentação em algumas idéias acerca da complexidade enfocadas por Edgar Morin. Nesta pesquisa, de natureza qualitativa, utilizou-se a entrevista como recurso de coleta de dados. Participaram do estudo 16 profissionais da equipe de saúde do setor de onco-hematologia pediátrica de um hospital-escola do município de Ribeirão Preto. Os dados empíricos indicam que os profissionais reconhecem a importância da avaliação da dor, mas sua operacionalização é percebida como um desafio. Apontam as limitações do uso de escalas e no manejo da dor destacam como primordial a abordagem farmacológica. Manifestam sentimentos de impotência, angústia e sofrimento com a situação de dor. Permitem também vislumbrar possibilidades apresentadas pelos próprios profissionais, tais como a composição de equipes fixas integradas em um trabalho interdisciplinar e o envolvimento da família no cuidado. Os resultados apontam ainda para a necessidade de distinguir os múltiplos enfoques dos profissionais e compor uma unidade de cuidado em que esses enfoques sejam articulados de forma a atender ao cuidado das múltiplas dimensões da dor em crianças e adolescentes com câncer. Para que essa unidade de cuidado seja viabilizada ressalta-se a necessidade de articulação de todos os profissionais envolvidos no atendimento às situações de dor da criança e do adolescente com câncer hospitalizado por meio de um projeto comum, construído conjuntamente. / Pain is one of the main causes of human suffering, affecting people’s quality of life and reflecting in their physical and psychosocial condition. In children and adolescents with cancer, pain can either be caused by the disease itself, by the treatment or by the procedures and is reinforced by fear, anxiety and uncertainty. In view of the multiple dimensions involved in pain of children and adolescents with cancer, which characterize it as a complex phenomenon, this study aims to describe the experiences of health professionals in care for children and adolescents with cancer in pain situations during the hospitalization process and analyze them on the basis of some of Edgar Morin’s ideas of complexity. This qualitative research used interviews as a data collection instrument. Study participants were 16 professionals from the pediatric blood cancer health team of a school hospital in Ribeirão Preto, Brazil. Empirical data point out that, although the professionals recognize the importance of pain evaluation, its operationalization is seen as a challenge. They point towards the limitations of using pain scales and highlight the basic importance of the pharmacological approach for pain coping. Participants show feelings of powerlessness, anguish and suffering in view of the pain situation of children and adolescents with cancer. They also disclose possibilities, such as the composition of fixed teams, integrated in an interdisciplinary service, and family involvement in care. Results also indicate the need to distinguish between multiple professional focuses and to establish a care unit that allows for the articulation of these focuses, so as to attend to the multiple pain dimensions of children and adolescents with cancer. With a view to the practicability of this care unit, we highlight the need for articulation between all professionals involved in care for pain situations in hospitalized children and adolescents with cancer, through a common and jointly constructed project.

Pain is a common symptom in cancer patients, restricts daily life activities and reduces survival time. Identification of sociodemographic, medical and psychological correlates of pain among cancer patients in Germany could help identify subgroups most in need of pain management. In this multicenter, epidemiologic cross-sectional study, we assessed pain prevalence and severity, quality of life (QoL) and psychological distress in a sample of 3,745 cancer patients across all tumor entities. In total, 37.9% patients suffered from cancer-related pain and 56.1% suffered from non-specific pain. Younger, female, less educated and unemployed patients reported pain more frequently and more severe pain (p < 0.001). Pain was associated with distress, depression, anxiety, QoL, tumor stage (p < 0.001), and time since diagnosis (p = 0.012). Pain assessment and pain management should be a routine part of cancer treatment and cancer survivorship care plans.