Thesis (Ph. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains vi, 79 p. : ill. Includes abstract. Includes bibliographical references (p. 36-40).

Thesis (Ph.D.)--Ohio University, November, 2004. / Title from PDF t.p. Includes bibliographical references (p. 145-172)

Thesis (M.S.)--Florida State University, 2006. / Advisor: Roy F. Baumeister, Florida State University, College of Arts and Sciences, Dept. of Psychology. Title and description from dissertation home page (viewed June 13, 2006). Document formatted into pages; contains v, 54 pages. Includes bibliographical references.

Introduction: Cancer incidence and prevalence rates are increasing and pain is the most frequent complication of cancer. Cancer pain can have detrimental effects on a patient's social function, mood, and quality of life. Pain is the most frequent symptom to prompt unscheduled medical care in patients with established cancer, and is an important reason for hospitalisation. There are aspects of cancer pain management which involve potentially modifiable patient and healthcare professional behaviours. Patients can have problems reporting pain, communicating about pain with healthcare professionals, using medications effectively, and getting help when problems arise. Healthcare professionals do not always assess pain adequately or prescribe optimally. The aim of this project was to develop an intervention to support patients and professionals in improving cancer pain control. Methods: An Intervention Mapping (IM) approach was taken to intervention development. Current challenges of managing cancer pain and potential solutions were investigated through systematic literature review and qualitative investigations with patients, caregivers, and professionals. The systematic literature review investigated whether patient reported measurements of pain could be collected and fed back to patients and/or healthcare professionals to improve cancer pain management, and described the components of such interventions. Medline, EMBASE, and CINAHL databases were searched from inception to identify randomised and non-randomised controlled trials. Titles, abstracts, and full text articles were dual screened, and assessed independently for risk of bias according to the Cochrane criteria by two researchers. Meta-analysis was performed for studies which reported changes in pain intensity on a zero to ten point scale, and a narrative synthesis was conducted. Qualitative semi-structured interviews with patients with cancer pain, their caregivers, and healthcare professionals and focus groups with healthcare professionals investigated current approaches to cancer pain management, and the challenges and problems experienced. Potential solutions and intervention ideas were explored, along with perceived opportunities for digital technologies to enhance cancer pain management. Qualitative data were analysed using a combination of Framework and thematic analysis. Existing literature and findings from the original qualitative research were used to model the problem, and through the Intervention Mapping approach; behaviour change theory was systematically applied to produce a digital intervention. Prototypes were pre-tested with professional stakeholders. Macmillan nurses recruited patients (with or without a caregiver) from their caseload who had cancer pain and were using strong opioids to provide early indications about the feasibility of the intervention. Nurses also recruited the patient's GP. Patients were invited to interact with the app over a four week period. Weekly patient analgesic and symptom reports were sent to their GP and nurse. At least one consultation with their Macmillan nurse was scheduled in which patient reported data could be discussed. Patients were interviewed by telephone on a weekly basis and all participants were interviewed at the conclusion of the study. All qualitative enquiries were analysed using a combination of Framework and thematic analysis. Patient generated symptom report data were analysed descriptively. Results: Literature review: Twenty nine reports of 22 unique trials of 20 interventions were included in the review. Patient reported outcome measures were used in four main ways: (1) to provide reports about pain and related symptoms to professionals (with the intention of increasing professional awareness of unrelieved symptoms); (2) to tailor patient education about self-management strategies and how to communicate about pain; (3) to prompt contact between a patient and professional when pain is above a set threshold; and (4) to link pain treatments to the severity of pain experienced by the patient via algorithmic management guidelines. Meta-analysis of 12 trials showed that average pain intensity was reduced by half a point out of ten in intervention group participants compared to controls. This result was statistically significant, mean difference -0.59 (95% CI -0.87, -0.30). Qualitative investigations with key stakeholders: Interviews were held with 14 patients, including six with their caregivers present. All patients had locally advanced or metastatic cancer. Nineteen multidisciplinary professionals took part in interviews (15 face to face and four telephone interviews), and 12 took part in one of two focus groups. Themes were organised within two categories: 'the work of managing cancer pain and its context', and 'digital tools to help with this work'. Patients gave accounts of cancer and cancer-related pain as burdensome conditions. Complete alleviation of pain was not the main goal for most patients. Pain was considered alongside functional and activity goals, overall symptom burden, and medication side effects. Professionals recognised patients' individual goals to varying extents. Most patients were regularly using digital technologies. Patients had ideas for digital pain management tools as sources of information and knowledge, to help with medicines management (particularly for reminders and prompts), and as symptom monitoring tools which could stimulate help-seeking. A key concern for all participants was that digital tools should add value over paper resources, should be simple to use, and that data presented were brief and easy to interpret. The intervention and results of early feasibility testing: A digital app was developed to help patients on strong opioids achieve personal treatment goals. The app includes a short film about pain and symptom management, and links to telephone/web-based help. The app allows easy recording of short-acting analgesic doses, linked algorithmically to help-screens. A weekly diary asks about pain, side effects, function, and medication adherence. The digital diary contains novel measures of pain, including a question about the level at which pain becomes bothersome to the individual patient. App reports are automatically shared with linked professionals so that feedback can be given. Recruiting patients with advanced symptomatic cancer was difficult. The app was feasibility tested with two patients, their linked GPs, and Macmillan nurses. Electronic patient reports were shared with linked healthcare professionals using secure NHS email. Professionals found patient reports thought-provoking. Reports were used to inform clinical encounters, and seemed to promote a shared understanding of patient symptom management goals. Conclusions: A digital intervention has been developed using a rigorous, theory-based methodological approach. There are early indications that the intervention could promote patient centred care and shared decision making in patients with cancer pain. Lessons have been learned about recruiting patients with symptomatic cancer, and the intervention is ready to be tested on a larger scale.

M.Tech. / This study compared the effectiveness of two different Chiropractic treatment protocols in the treatment of patellofemoral pain syndrome. This was done in order to establish whether or not core stabilisation exercises play a role in the treatment of patellofemoral pain syndrome. Thirty participants were used for this study. They were randomly placed into two groups namely; group 1 and group 2. Group 1 received strengthening exercises of the quadriceps muscle group and stretching exercises of the hamstring muscles. Group 2 received strengthening of the quadriceps muscle group, stretching of the hamstring muscles and core stabilisation exercises. Six treatments were administered over a period of three weeks with each participant receiving two treatments per week. Prior to the commencement of treatments one, three and six; each participant was objectively measured for quadriceps strength using the isometric dynamometer. The subjective measurements used in this study were the Numerical Pain Rating Scale and the Patellofemoral Joint Evaluation Scale, these were also completed prior to the first, third and sixth treatments. All the collected data was statistically analysed using the one-way Anova test, the Independent-t test and the Paired-t test. The statistical analysis revealed statistical differences on intra-group analysis for both groups involved especially between treatment 3 and treatment 6 for both the objective and subjective measurements. On Inter-group analysis group 2’s subjective and objective measurements improved by a larger amount than group 1’s. It was thus concluded that a combined treatment of quadriceps strengthening, hamstring stretching and core stabilisation exercises was the most effective treatment protocol in individuals suffering from patellofemoral pain syndrome.

M.Tech. (Chiropractic) / There is research to show that ischaemic compression is very effective in the treatment of myofascial trigger points (MFTP’s). It is less invasive when compared to other treatment methods such as dry needling however; according to Gulick (2010) there is a lack of randomised controlled studies with regard to standard ischaemic compression treatment protocols. This includes the appropriate amount of pressure, duration of compression or frequency of treatment (Gulick, 2010). This study was conducted in order to determine whether ischaemic compression that is applied at pain threshold would have a similar effect when compared to ischaemic compression at pain tolerance in the treatment of active rhomboid major and minor myofascial trigger points, using a hand held algometer. This study was specifically undertaken to provide more information regarding the most effective method of ischaemic compression with regard to the amount of pressure that is most suitable during treatment. The results of this study could potentially improve patient comfort and reduce pain during treatment by showing that treatment at pain threshold may be as effective as conventional ischaemic compression at pain tolerance. It was hypothesized that ischaemic compression applied at pain threshold may have a similar effect as application at pain tolerance by having a positive outcome on the subjective and objective findings in patients with active myofascial trigger points of the rhomboid major and minor muscles. Participants were recruited into the study by word of mouth as well as with the use of advertisements that were placed around the University of Johannesburg Doornfontein campus and clinic. Thirty participants that conformed to the specified limitations and diagnostic criteria were accepted to partake in this study. The participants were then placed in a random and stratified manner into two groups of 15, based on age and gender. Group A received ischaemic compression of the rhomboid major and minor muscles at pain threshold while Group B received ischaemic compression of the same muscles at pain tolerance. Ischaemic compression was administered over a 30 second duration. Each participant received 2 treatments a week for 3 weeks while a 7th and final visit served only for measurement taking.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to survey prescribers who manage patients with chronic pain to evaluate how pharmacy services are perceived to affect patients’ quality of life. METHODS: Surveys were sent to prescribers who manage patients with chronic pain. Prescribers rated pharmacy services on a scale of 0 – 5 (0 being not important at all, and 5 being extremely important) to the quality of life of patients with chronic pain. RESULTS: Surveys were completed by 23 subjects. Prescribers ranked pharmacy services as follows: the pharmacy fills opioid prescriptions for all pain conditions (mean = 4.2; SD = 1.0), the patient is able to obtain the entire quantity of pain medication (mean = 4.1; SD = 1.5), the pharmacy treats the patient as dependent on, not addicted to opioids (mean = 3.9; SD = 1.6), the pharmacy collaborates with the prescriber to manage opiate therapy (mean = 3.9; SD = 1.5), the pharmacy stocks new and recently approved pain medications (mean = 3.8; SD = 1.1), the pharmacy provides the patient with information on adverse effects of pain medications (mean = 3.8; SD = 1.5), the pharmacy is able to use manufacturer co-pay cards to minimize out-of-pocket costs (mean = 3.5; SD = 1.7), the patient can have prescriptions delivered to their home (mean = 2.1; SD = 1.8) and the patient can obtain a prescription without having to wait a specified time period determined by their pharmacy (mean = 1.8; SD = 1.5). CONCLUSION: Prescribers in this study felt that certain pharmacy services are very important in the treatment of patients with chronic pain. Pharmacies may improve patients’ quality of life in the management of their chronic pain by providing these services.

Class of 2006 Abstract / Objectives: To assess perceived efficacy and patient satisfaction at a single point in time during a course of therapy with a compounded topical formulation containing at least ketoprofen in an anhydrous gel base. Methods: Patients aged 18 and older, currently using one of the topical pain relief compounds of interest obtained from Reed’s Compounding Pharmacy in Tucson, Arizona were recruited and then interviewed (in person or by telephone) for this study. Data collected during patient interviews were recorded on a form designed solely for the purposes of this study. Interview questions pertained to the nature of the participant’s pain, their assessment of their pain both before treatment with the medication of interest and at the time of the interview, frequency and duration of patient use of the pain relief gel, disclosure of any other pain relief medications the patient was using at the time, and their overall satisfaction with the medication. Results: Interviews were conducted with a total of 50 patients with chronic pain conditions representing several different etiologies and anatomical locations. The average pain assessment score at the time of the interview (representing perceived patient pain after use of the topical pain relief compound) was significantly lower than the average before treatment pain assessment score (p<0.001). After treatment with the gel had commenced, perceived pain scores dropped by average of 3.56 units (SD 2.28), or 44%. Increased frequency of application of the topical pain relief gel was not associated with greater pain relief or changes in overall patient satisfaction with the product. A longer duration of use of the topical pain relief was also not associated with greater pain relief or overall patient satisfaction with the product. Whether or not a patient utilized other pain relief medication(s) while undergoing treatment with the topical pain relief gel had no bearing on the assessment of their pain either before use of the gel or at the time of interview. The average overall patient satisfaction with the topical pain relief compound was rated at 6.6 out of a possible 10 units (SD 3.13). Thirty-six patients (72%) rated their satisfaction with the topical medication of interest with a satisfaction score of ≥ 6, 10 patients (20%) rated their satisfaction with a score of 10 (completely satisfied), and 6 patients (12%) rated their satisfaction with a score of 0 (not at all satisfied). It was observed that the lower the perceived pain assessment score at the time of the interview (after using the gel), the greater the patient satisfaction with the product. Additionally, patients were observed to be more satisfied with the product if the difference between their perceived pain assessment scores (before and after) was greater (i.e.: greater patient satisfaction with greater pain relief). Conclusions: Treatment of chronic pain with a topical pain relief compound containing at least ketoprofen in an anhydrous gel base is associated with patient satisfaction and perceived analgesic benefits. During the one-time interview, most patients reported a significant improvement in their pain relief, and the great majority of patients were very satisfied with the compounded topical treatment they received from Reed’s Compounding Pharmacy.

This study was designed to describe the use of analgesics ordered pro re nata (PRN) in the management of acute post-operative pain. Specifically, the study purpose was to answer the following questions. What amounts and frequencies of analgesic are ordered PRN by physicians for patients in the first 48 hours following a cholecystectomy? What amounts and frequencies of analgesic are given by nurses to patients in the first 48 hours following a cholecystectomy? What is the patient's summational description of his/her pain at 24 and 48 hours following a cholecystectomy? A descriptive survey design was used. A convenience sample of 22 subjects participated in the study. These subjects met the study criteria and were scheduled for elective cholecystectomy at one of the two hospitals used. Data were gathered by auditing the charts for information pertinent to the prescriptions and administration of the analgesics and by interviewing the subjects. There was considerable variability in the amounts and frequencies of analgesics prescribed and in those given to the post-operative subjects. No routine patterns were identified. There was a significant difference in the amounts of analgesics prescribed and given between the two hospitals, the reasons for which were not explored. The decision to use the PRN-prescribed analgesics appeared to be made by the nurses but evidence of accountability taken by nurses for their role in assessing pain and evaluating the effectiveness of the analgesics was not reflected in the reviewed records. Analgesics for use in the Post-Anaesthetic Recovery Room in the immediate post-operative period were prescribed by the anaesthetists. All initial analgesics were given by the intravenous route in this setting. Subjects at Hospital B were prescribed and received considerably more analgesics (83%) than those at Hospital A. Analgesics for use on the ward were prescribed by the surgeons. All orders were for meperidine hydrochloride to be given PRN and all orders were unchanged for the 48-hour period studied. The amount of meperidine prescribed and given per intramuscular dose was usually within the 75 to 100 milligrams optimal dosage range for the drug. The meperidine was usually prescribed with a four hour interval between doses. Doses of meperidine were given with considerably longer intervals between doses than the duration of action of the drug. For the 48-hour period, the mean total amount prescribed, based on the maximum possible dosage was 1154 milligrams. The median total amount prescribed was 1050 milligrams. The mean total amount given was 625 milligrams or 54% of the prescribed amount and the median total amount given was 587 milligrams or 56% of the prescribed amount. Subjects on the ward at Hospital A were prescribed and given significantly more meperidine than those at Hospital B. The patients' summational descriptions of their pain emphasized the individuality of the pain experience. The physical sensations described were consistent with previous literature descriptions of postoperative pain. The subjective data collected reflected the difficulties and complexities of pain management. An often-stated assumption in the literature is that nurses use PRN-prescribed analgesics inappropriately in managing post-operative pain; that is, patients are uncomfortable because the analgesics are not given in adequate amounts or frequently enough. In this study, a relationship was not identified between the amounts of meperidine received by subjects and how they reported their post-operative pain. This finding suggests that the assumption, that increasing the analgesics used would increase patient comfort, requires further investigation. Based on the findings of this study, implications for postoperative pain management and nursing practice, and suggestions for further research were made. / Applied Science, Faculty of / Nursing, School of / Graduate

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