Including the Spiritual Dimension in Multimodal Pain Therapy. Development and Validation of the Spiritual Distress and Resources Questionnaire (SDRQ)

ABSTRACT Objective: to address the spiritual dimension and nursing in the light of interventions in the presence or risk of spiritual distress in cancer patients. Method: this is a reflection on the possible contributions of nursing interventions to solve the abovementioned diagnoses, particularly those resulting from practical application results. Results: nursing has interventions at its disposal for these two diagnoses, included in the Nursing Interventions Classification (NIC) and in the International Classification for Nursing Practice (ICNP®). The interventions with the best evidence level for application in cancer patients are: music therapy, guided imaging, therapeutic touch, progressive muscle relaxation, distant intercessory prayer, reminiscence therapy, affective support group and meditation. Conclusion: in view of the representativeness of the cancer patient population, as well as the importance of studies on spiritual distress problems, it is relevant to discuss spirituality in nursing, identifying interventions nurses can apply to cancer patients in clinical practice. Descriptors: nursing, spirituality, distress. RESUMO Objetivo: abordar a dimensão espiritual e a Enfermagem à luz de intervenções na presença ou risco de angustia espiritual em portadores de câncer. Método: trata-se de uma reflexão sobre as possíveis contribuições das intervenções de Enfermagem para a resolução dos diagnósticos supra descritos, em especial aquelas oriundas de resultados de aplicação prática. Resultados: a Enfermagem dispõe de intervenções para esses dois diagnósticos, contidas na Classificação de Intervenção de Enfermagem (NIC) e na Classificação Internacional para a Prática de Enfermagem (CIPE®). Dessas, as com melhor nível de evidência para serem aplicadas em pacientes com câncer são: a musicoterapia, imagem guiada, toque terapêutico, relaxamento muscular progressivo, oração intercessória à distância, terapia de reminiscências, grupo de suporte afetivo e meditação. Conclusão: diante da representatividade da população de pacientes com câncer, assim como a importância dos estudos relacionados aos problemas de espiritualidade prejudicada, é relevante a discussão do tema espiritualidade na Enfermagem, identificando intervenções passíveis de serem aplicadas por enfermeiros na prática clínica à pacientes com câncer. Descritores: Enfermagem, espiritualidade, angústia. RESUMEN Objetivo: discutir la dimensión espiritual y la enfermera a la luz de intervenciones en la presencia o riesgo de angustia espiritual en portadores de cáncer. Método: se trata de una reflexión sobre las posibles contribuciones de las intervenciones de enfermera para la resolución de los diagnósticos descritos arriba, especialmente aquellas oriundas de resultados de aplicación práctica. Resultados: la Enfermería tiene intervenciones a su disposición para esos dos diagnósticos, contenidas en la Clasificación de Intervenciones de Enfermería (NIC) y en la Clasificación Internacional para la Práctica de Enfermería (CIPE®). De esas, las con mejor nivel de evidencia para aplicación en pacientes con cáncer son: la musicoterapia, imagen guiado, toque terapéutico, relajación muscular progresiva, oración intercesora a distancia, terapia de reminiscencias, grupo de soporto afectivo y meditación. Conclusión: ante la representatividad de la población de pacientes con cáncer, además de la importancia de estudios relacionados a los problemas de espiritualidad perjudicada, es relevante la discusión del tema espiritualidad en la enfermera, identificando intervenciones pasibles de aplicación por enfermeros en la práctica clínica a pacientes con cáncer. Descriptores: enfermería, espiritualidad, angustia.

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Impact of treatment dose on patient outcomes after Interdisciplinary Multimodal Pain Therapy

10.21203/rs.3.rs-514829/v1 ◽

2021 ◽

Author(s):

Philipp Baumbach ◽

Maria Richter ◽

Johannes Schneider ◽

Ulrich Christian Smolenski ◽

Thomas Weiss ◽

...

Keyword(s):

Pain Intensity ◽

Pain Therapy ◽

Low Dose ◽

High Dose ◽

Multimodal Pain Therapy ◽

Average Pain Intensity ◽

Average Pain ◽

Interdisciplinary Multimodal Pain Therapy ◽

The Impact

Abstract Objectives The impact of duration and intensity on outcomes after Interdisciplinary Multimodal Pain Therapy (IMPT) is poorly researched. The aim of this study was to compare the effects of low dose (LD, avg. 25 hours) and high dose IMPT (HD, avg. 110 hours).Methods Patients completed pain-related questionnaires at the beginning (T1), at the end of therapy (T2) and at 3-month follow-up (T3) and were matched according to age, sex, presence of back-pain and pain-related disability at T1, resulting in 32 patients per group. Primary endpoint was the difference in pain-related disability and average pain intensity at T3 between both groups. In addition, early treatment effects and group differences at T2 were analyzed.Results Both groups showed significant improvements in pain-related disability and average pain intensity between T1 and T2. These positive effects persisted in the HD group until the 3-month follow-up, whereas outcomes in the LD group patients deteriorated and were significantly poorer compared to HD at T3.Discussion Within a widely comparable therapeutic setting, high-dose IMPT was associated with longer lasting improvements compared to low-dose IMPT in chronic pain patients, indicating that the “dose” of therapy is a relevant factor for clinical outcomes and should be further investigated.

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The descending pain modulation system predicts short term efficacy of multimodal pain therapy - an observational prospective cohort study

Postgraduate Medicine ◽

10.1080/00325481.2021.2017646 ◽

2021 ◽

Author(s):

M Sendel ◽

F Lienau ◽

D Fischer ◽

J Moll ◽

S Koch ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Pain Therapy ◽

Pain Modulation ◽

Multimodal Pain Therapy ◽

Short Term ◽

Term Efficacy ◽

Observational Prospective Cohort Study ◽

Descending Pain Modulation

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Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.001 ◽

2017 ◽

Vol 17 (1) ◽

pp. 146-149 ◽

Cited By ~ 6

Author(s):

Stephanie Wössner ◽

Kirsten Weber ◽

Anna C. Steinbeck ◽

Markus Oberhauser ◽

Matthias Feuerecker

Keyword(s):

Case Report ◽

Sciatic Nerve ◽

Regional Anaesthesia ◽

Pain Therapy ◽

Pain Syndrome ◽

Anxiety Reduction ◽

Multimodal Pain Therapy ◽

Therapeutic Concept ◽

Pain Syndromes ◽

Forefoot Amputation

AbstractBackground and purposeThe purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation.Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70–75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin.The current experiment aimed at studying effects of empathic communication, and more specifically validation, on recall during a pain test and possible mediators and moderators of this effect.MethodsA 4.5 year-old otherwise healthy girl suffered severe injuries of the right foot and lower leg during a motor vehicle accident. Due to development of severe necrosis, forefoot amputation had to be performed during the hospital stay.ResultsInitial pain therapy included paracetamol, ibuprofen, metamizol, morphine and fentanyl. With mounting pain and anxiety, regional anaesthesia of the distal sciatic nerve was administered in combination with a ketamine and morphine patient controlled analgesia pump (PCA). The peripheral blockade of the distal sciatic nerve was placed with the guidance of ultrasound and nerve stimulator. The PCA concept included a continuous basal rate combined with a bolus function. Although the regional anaesthesia was well positioned and functioning, there was inadequate pain control. The pain was described by the patient as short, highly intense and sharp sensations with intensity on the visual analogue scale (VAS) of 10 (out of 10). Furthermore, she suffered from anxiety episodes and sleep disturbance. The medical team decided to treat with pregabalin to resolve these issues while awaiting amputation (Lisfranc line). She received psychological counselling as adjunct treatment. This multimodal concept enabled an early and efficient pain reduction pre- and post-amputation and allowed for the possibility of a hospital discharge without any opioid pain medication.ConclusionThe multimodal pain therapy including pregabalin was well tolerated, safe and highly effective in this case of traumatic limb injury and subsequent amputation. The use of pregabalin allowed significant pain and anxiety reduction for the patient.ImplicationsPregabalinis frequentlyused in adult patients for severe complex pain syndromes. There are only few reports of such adjunct medication (pregabalin) in paediatric pain syndromes. These reports focus mainly on the paediatric oncologic population. The case reported here encourages physicians to consider adjunct medications when treating complex pain, which are well established in the adult population. The benefits of such therapy in complex pain and anxiety can be extended to the paediatric population in select cases. Of course, one must always take into account that many routine medications used in children are well established but are off-label use. The authors are well aware of this problem and have conducted a critical literature review prior to pregabalin administration, including the search for randomized trials examining safety and tolerability. The parents or legal guardians of a minor must be thoroughly informed and consent to such a constellation of medical treatment.

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