Randomized Clinical Trial of the Effectiveness of a Self-Care Intervention to Improve Cancer Pain Management

2004 ◽  
Vol 22 (9) ◽  
pp. 1713-1720 ◽  
Author(s):  
Christine Miaskowski ◽  
Marylin Dodd ◽  
Claudia West ◽  
Karen Schumacher ◽  
Steven M. Paul ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Management ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Randomized Clinical Trial ◽  
Standard Care ◽  
Psychoeducational Intervention ◽  
Care Group ◽  
Cancer Pain Management ◽  
Standard Care Group

Purpose This randomized clinical trial tested the effectiveness of the PRO-SELF Pain Control Program compared with standard care in decreasing pain intensity scores, increasing appropriate analgesic prescriptions, and increasing analgesic intake in oncology outpatients with pain from bone metastasis. Patients and Methods Patients were randomly assigned to the PRO-SELF intervention (n = 93) or standard care (n = 81). Patients in the standard care arm were seen by a research nurse three times and were called three times by phone between the home visits. PRO-SELF group patients were seen by specially trained intervention nurses and received a psychoeducational intervention, were taught how to use a pillbox, and were given written instructions on how to communicate with their physician about unrelieved pain and the need for changes in their analgesic prescriptions. Patients were coached during two follow-up home visits and three phone calls on how to improve their cancer pain management. Results Pain intensity scores decreased significantly from baseline (all P < .0001) in the PRO-SELF group (ie, least pain, 28.4%; average pain, 32.5%; and worst pain, 27.0%) compared with the standard care group (ie, least increased by 14.6%, average increased by 1.9%, and worst decreased by 1.2%). The percentage of patients in the PRO-SELF group with the most appropriate type of analgesic prescription increased significantly from 28.3% to 37.0% (P = .008) compared with a change from 29.6% to 32.5% in the standard care group. Conclusion The use of a psychoeducational intervention that incorporates nurse coaching within the framework of self-care can improve the management of cancer pain.

A Randomized, Clinical Trial of Education or Motivational-Interviewing-Based Coaching Compared to Usual Care to Improve Cancer Pain Management

2011 ◽  
Vol 39 (1) ◽  
pp. 39-49 ◽  
Author(s):  
Mary Laudon Thomas ◽  
Janette E. Elliott ◽  
Stephen M. Rao ◽  
Kathleen F. Fahey ◽  
Steven M. Paul ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Management ◽  
Cancer Pain ◽  
Motivational Interviewing ◽  
Usual Care ◽  
Randomized Clinical Trial ◽  
Cancer Pain Management

A Randomized Clinical Trial of the Efficacy of a Self-care Intervention to Improve Cancer Pain Management

2014 ◽  
Vol 37 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Tone Rustøen ◽  
Berit T. Valeberg ◽  
Eva Kolstad ◽  
Erik Wist ◽  
Steven Paul ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pain Management ◽  
Cancer Pain ◽  
Randomized Clinical Trial ◽  
Self Care ◽  
Cancer Pain Management ◽  
Care Intervention

scholarly journals Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial

2022 ◽  
Vol 19 (2) ◽  
pp. 870
Author(s):  
Magdalena Napiórkowska-Orkisz ◽  
Aleksandra Gutysz-Wojnicka ◽  
Mariola Tanajewska ◽  
Iwona Sadowska-Krawczenko
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Intensity ◽  
Randomized Clinical Trial ◽  
Capillary Blood ◽  
Pain Outcome ◽  
Capillary Blood Sampling

Aim: The aim of the study was to assess the severity of pain experienced by a newborn during a heel puncture for screening using the Newborn Pain Scale (NIPS), measure the heart rate and compare the effectiveness of non-pharmacological methods of pain control. Design: Randomized clinical trial. No experimental factors. The test was performed during routine screening. Surroundings: Provincial Specialist Hospital in Olsztyn. Patients/Participants: Pain was assessed in 90 full-term newborns. The newborns were rooming in with their mothers in the hospital. Interventions: Newborns were divided into three groups. Three different methods of pain relief were used: breastfeeding, 20% glucose administered orally and non-nutritional sucking. Main Outcome Measures: The primary pain outcome was measured using the NIPS and the secondary pain outcome measures (heart rate, oxygen saturation) were measured using a pulse oximeter. Results: During capillary blood sampling from the heel, most newborns, n = 56 (62.2%), experienced no pain or mild discomfort, severe pain occurred in n = 23 (25.6%) and moderate pain occurred in n = 11 (12.2%). No significant statistical differences were found between the degree of pain intensity and the intervention used to minimize the pain p = 0.24. Statistically significant relationships were demonstrated between heart rate variability and the degree of pain intensity (p = 0. 01). There were no statistically significant differences between the newborn’s pain intensity and the mother’s opinion on the effectiveness of breastfeeding in minimizing pain. Conclusions: This study did not answer the question of which pain management method used during the heel prick was statistically more effective in reducing pain. However, the results indicate that each of the non-pharmacological interventions (breastfeeding, oral glucose dosing and non-nutritive sucking) applied during heel puncture resulted in effective pain management in most of the newborns enrolled in the study. The relationship between heart rate variability and the severity of pain was confirmed. Mothers of newborns in the breastfeeding group were satisfied with the pain relief methods used in the child and the opportunity to console their newborn during painful procedures in a technologically invasive environment.

scholarly journals Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. 394-402 ◽  
Author(s):  
Ashwin Viswanathan ◽  
Aditya Vedantam ◽  
Loretta A Williams ◽  
Dhanalakshmi Koyyalagunta ◽  
Salahadin Abdi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Randomized Clinical Trial ◽  
Advanced Cancer ◽  
Standard Of Care ◽  
Controlled Clinical Trial ◽  
Level Of Evidence ◽  
Double Blind ◽  
Definitive Evidence

Abstract BACKGROUND Cancer pain, one of the most common symptoms for patients with advanced cancer, is often refractory to maximal medical therapy. A controlled clinical trial is needed to provide definitive evidence to support the use of ablative procedures such as cordotomy for patients with medically refractory cancer pain. OBJECTIVE To assess the efficacy of cordotomy for patients with unilateral advanced cancer pain using a controlled clinical trial study design. The secondary objectives are to define the patient experience of cordotomy for medically refractory cancer pain as well as to determine the utility of magnetic resonance imaging as a non-invasive biomarker for successful cordotomy. METHODS We will undertake a single-institution, double-blind, sham-controlled clinical trial of cordotomy in patients with refractory cancer pain. Patients in the cordotomy arm will undergo a percutaneous computed tomography-guided cordotomy at C1-C2, while patients in the control arm will undergo a similar procedure where the needle will not penetrate the thecal sac. The primary endpoint will be the reduction in pain intensity, as measured by the Edmonton Symptoms Assessment Scale. EXPECTED OUTCOMES We expect that patients randomized to cordotomy will have a significantly greater reduction in pain intensity than those patients randomized to the control surgical intervention. DISCUSSION This randomized clinical trial comparing cordotomy with a control intervention will provide the level of evidence necessary to determine whether cordotomy should be the standard of care intervention for patients with advanced cancer pain.

Lack of Adherence With the Analgesic Regimen: A Significant Barrier to Effective Cancer Pain Management

2001 ◽  
Vol 19 (23) ◽  
pp. 4275-4279 ◽  
Author(s):  
Christine Miaskowski ◽  
Marylin J. Dodd ◽  
Claudia West ◽  
Steven M. Paul ◽  
Debu Tripathy ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Pain Intensity ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Opioid Analgesics ◽  
Daily Basis ◽  
Pain Intensity Score ◽  
Cancer Pain Management ◽  
Analgesic Regimen

PURPOSE: To evaluate oncology outpatients’ level of adherence to their analgesic regimen during a 5-week period. PATIENTS AND METHODS: A random sample of 65 adult oncology outpatients with a Karnofsky performance status score of ≥ 50, an average pain intensity score of ≥ 2.5, and radiographic evidence of bone metastasis were recruited for this longitudinal study from seven outpatient settings. On a daily basis, patients rated their level of pain intensity and recorded pain medication intake. Adherence rates for opioid analgesics prescribed on an around-the-clock (ATC) and on an as-needed (PRN) basis were calculated on a weekly basis. RESULTS: Overall adherence rates for ATC opioid analgesics ranged from 84.5% to 90.8% and, for PRN analgesics, from 22.2% to 26.6%. No significant differences over time were found in either of these adherence rates. CONCLUSION: One factor that seems to contribute to ineffective cancer pain management is poor adherence to the analgesic regimen.

scholarly journals LO87: iPad distraction during intravenous cannulation in the pediatric emergency department: a randomized clinical trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S38-S38
Author(s):  
K. Ma ◽  
S. Ali ◽  
N. Dow ◽  
B. Vandermeer ◽  
A. Issawi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Regression Analysis ◽  
Randomized Clinical Trial ◽  
Standard Care ◽  
Linear Regression Analysis ◽  
Humanoid Robots ◽  
Care Group ◽  
Parental Anxiety ◽  
Topical Anesthetic ◽  
Pain Scores

Introduction: Intravenous (IV) cannulation is commonly performed in emergency departments (ED), often causing substantial pain and distress. Distraction has been shown to reduce child-reported pain, but there is currently little published about the effects of using iPad technology as a distraction tool. Our primary objective was to compare the reduction of pain and distress using iPad distraction (games, movies, books of the child’s choice) in addition to standard care, versus standard care alone. Methods: This randomized clinical trial, conducted at the Stollery Childrens Hospital ED, recruited children between ages 6 to 11 years requiring IV cannulation. Study arm assignment was performed using REDCaps randomization feature. Due to the nature of the intervention, blinding was not possible for the children, parents or research and ED staff, but the data analyst was blinded to intervention assignment until completion of analysis. Pain, distress, and parental anxiety were measured using the Faces Pain Scale-Revised, the Observed Scale of Behavioural Distress-Revised, and the State Trait Anxiety Inventory, respectively. The pain scores and observed behavioural distress scores were compared using the Mann-Whitney U test. Other co-variates were analyzed using a linear regression analysis. Results: A total of 85 children were enrolled, with 42 receiving iPad distraction and 43 standard care, of which 40 (95%) and 35 (81%) children received topical anesthesia, respectively (p=0.09). There were 40 girls (47.1%) with a mean age of 8.32 +/− 1.61 years. The pain scores during IV cannulation (p=0.35) and the change in pain score during the procedure compared to baseline (p=0.79) were not significantly different between the groups, nor were the observed distress scores during IV cannulation (p=0.09), or the change in observed distress during the procedure compared to baseline (p=0.44). A regression analysis showed children in both groups had greater total behavioural stress if it was their first ED visit (p=0.01), had prior hospitalization experience (p=0.04) or were admitted to hospital during this visit (p=0.007). A previous ED visit, however, was predictive of a greater increase in parental anxiety from baseline (p=0.02). When parents were asked whether they would use the same methods to manage pain for their child, parents of the iPad group were more likely to say yes than were parents of the standard care group (p=0.03). Conclusion: iPad distraction during IV cannulation in school-aged children was not found to decrease pain or distress more than standard care alone, but parents preferred its use. The effects of iPad distraction may have been over-shadowed by potent topical anesthetic effect. Future directions include exploring iPad distraction for other age groups, and studying novel technology such as virtual reality and interactive humanoid robots.

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