The journal of pain : official journal of the American Pain Society
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Pain is a common problem for cancer patients and can result in substantial medical costs, but little is known about the characteristics of pain that may predict these costs. This study applied telephone survey methodology to investigate the relationship between breakthrough pain (BTP) and the use of medical resources in a cancer population with pain. A nonrandom sample of 1,000 cancer patients was contacted by using standard telephone survey techniques. ⋯ The total cost of pain-related hospitalizations, emergency visits, and physician office visits was 12,000 US dollars/yr per BTP patient and 2,400 US dollars/yr per non-BTP patient. Cancer patients with BTP may sustain higher direct medical costs than patients without BTP. Implications and limitations of the study are discussed, and studies that will further clarify the relationship between BTP and medical costs are encouraged.
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Pain is a hallmark sign of sickle cell disease (SCD) with more than 80% of vaso-occlusive episodes managed at home. This study explored the pyschometric properties of a daily pain and symptom diary and compliance of caregiver report in young children with SCD during a 1- to 2-year period. Compliance for completing diary entries for the first year with 16 caregivers was 90.6% and 86.2% with 19 respondents for the first 2 years. ⋯ Scale reliability estimates were quite strong, ranging from 0.50 to 0.99 (mean, 0.85). Construct validity was supported with significant relationships between caregiver report of giving medications when SCD pain was identified (chi-square = 98.0, P < .0001) and providing other help to relieve SCD pain (chi-square = 8.36, P < .004). The results provide evidence that the Infant/Toddler Diary is a reliable, valid measure of pain and illness report by caregivers of young children with SCD.
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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. ⋯ 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.
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This study assessed a newly developed cuff pressure algometry during discrete leg skin/muscle sensitization and anesthesia. Experimental setup consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor, and an electronic visual analog scale (VAS). The first experiment assessed cuff algometry before and after selective anesthesia of the skin and the muscle under the cuff. ⋯ Intramuscular capsaicin injection decreased the pain thresholds and did not affect the slope of the SR function. Both interventions shifted the SR function to the left. The cuff algometry reliably assessed the pressure-pain SR function during muscle sensitization/desensitization and might supplement conventional pressure algometry for standardized pressure-pain function assessment.
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Recent reports indicate that several descriptors of pain sensations in the McGill Pain Questionnaire (MPQ) are difficult to classify within MPQ sensory subcategories because of incomprehension, underuse, or ambiguity of usage. Adopting the same methodology of recent studies, the rule revealed that only 6 to 18 words met criteria for the affective category and 5 of 11 words met criteria for the evaluative category, thus warranting a reduced list of words in these categories. This classification, the intensity ratings of the retained words correlated very highly with those originally reported for the MPQ. In conclusion, although the intensity ratings of MPQ affective and evaluative descriptors need no revision, selective reduction and reorganization of these descriptors can enhance the efficiency of this approach to pain assessment.