Deborah Dillon McDonald

Adult Patients' Postoperative Pain Descriptions and Responses to the Short-Form McGill Pain Questionnaire

This study examined the clinical usefulness of the Short-Form McGill Pain Questionnaire (SF-MPQ). Thirty postoperative patients were asked to describe their postoperative pain and were then administered the SF-MPQ. Eighteen (60%) used exact SF-MPQ sensory or affective words or synonyms to describe their postoperative pain during the interview. These results provide further evidence of the clinical relevance of the SF-MPQ sensory and affective scales. Pain descriptions by patients that go beyond pain intensity descriptions may communicate more precise information about the pain and lead to more effective pain interventions. Patients with difficulty describing their pain might be assisted by using the SF-MPQ.

Communicating End-of-Life Preferences

The purpose of this survey was to explore how adults communicate their end-of-life preferences. Face-to-face interviews were conducted with 119 community-dwelling adults who had previously engaged in conversations about their end-of-life preferences. Factors that made it easier to initiate the discussion included having personal experience with illness or death (24.4%), being straightforward (24.4%), or having someone else facilitate the discussion (11.8%). Most described vague end-of-life preferences such as not wanting any machines (41.2%) or heroics (34.5%). Although 22.7% reported using a living will to make their preferences clear, only 5.9% mentioned repeating or reinforcing their preferences. In all, 21% had discussed their end-of-life preferences with their physicians. These findings show discussions about end-of-life preferences frequently lack the clarity and detail needed by significant others and health care providers to honor the preferences. Routine dialogue with health care providers and significant others about end-of-life preferences might provide greater clarity and comfort.

Testing an instrument measuring Greek nurses' knowledge and attitudes regarding pain.

This pretest–post-test study was conducted to test the construct validity, test–retest reliability, and internal consistency of the Nurses’ Knowledge and Attitudes Survey Regarding Pain with Greek nurses. Forty-six registered nurses were randomly assigned to an expert or nonexpert group. The expert group viewed 4 translated educational videotapes about pain management. The nonexpert group received no pain education. All of the nurses completed a pretest and a post-test using a Greek translation of the Nurses’ Knowledge and Attitudes Survey Regarding Pain, with a time delay of 8 to 12 days between testing. The expert nurses learned significantly more than the nonexpert nurses from pretest to post-test, M = 9.0 and M = 1.5 items, respectively. Expert and nonexpert nurses correctly answered 51.5% and 43.3% of the pretest and 74.6% and 47.2% of the post-test questions, respectively. Test–retest reliability for the 28 nonexpert nurses was r = 0.68, P < .001. Cronbach’s alpha for the entire sample was 0.88 (n = 30) at the post-test. These results contribute to the validity and reliability of the Greek version of the Nurses’ Knowledge and Attitudes Survey Regarding Pain and provide the basis for phase II of the study, which will use the Nurses’ Knowledge and Attitudes Survey Regarding Pain to examine the state of pain management in an anticancer facility in Greece.

Older adult pain communication and the Brief Pain Inventory Short Form.

A randomized control group design with 106 community-dwelling older adults was used to test how completing the Brief Pain Inventory Short Form (BPI-SF) affected the osteoarthritis pain information reported by older adults responding to an open-ended pain question. The treatment group responded to the BPI-SF and then to the open-ended pain question. The control group responded first to the open-ended pain question, and then to the BPI-SF. Audiotaped responses to the open-ended pain question were content analyzed using 16 a priori criteria of pain information based on the American Pain Society guidelines for the management of arthritis pain. Total pain information was summed and compared between the treatment and control group. The control group reported significantly greater functional pain interference on the BPI-SF; therefore, functional pain interference was used as a covariate. Comparison of the two groups on the amount of pain information in response to the open-ended question revealed no significant group difference. Responding to the BPI-SF did not assist older adults to describe additional pain information when responding to an open-ended pain question, but responding to an open-ended pain question did significantly increase the amount of functional pain interference reported on the BPI-SF. Practitioners and researchers should be aware of the potential difference in BPI-SF functional pain interference response depending on whether pain is discussed before or after administering the BPI-SF. Discussing pain before completing the BPI-SF might prompt older adults to think more about how pain interferes with their daily life.

Assisting Older Adults to Communicate Their Postoperative Pain

An intervention assisting older adults to communicate their pain was tested in a posttest-only experiment. Thirty-eight preoperative older adults were randomly assigned to a communication group watching a videotape about communicating and managing postoperative pain or a comparison group watching a videotape about managing postoperative pain only. Pain was measured on Postoperative Days 1 and 2, and 1 and 7 days after hospital discharge by a data collector blind to the condition. The communication group reported greater pain relief and less pain interference on Postoperative Day 1. The comparison group reported greater pain relief on Postoperative Day 2 after attaining a pain interference level similar to the pain communication group. The pain communication intervention had modest effects for reducing pain interference with activities on Postoperative Day 1. Greater pain relief might be achieved when older adults and their health care providers are more knowledgeable about both pain communication and pain management.

Postoperative Pain Communication Skills for Older Adults

This study tested the effect of a preoperative pain communication intervention on older adults’ ability to obtain pain relief after a total knee arthroplasty. A posttest-only experimental design was used to compare older adults randomly assigned to (a) view a pain management and pain communication film, (b) view the pain management film only, or (c) receive standard care only. Initial method adjustments decreased potential error in the study. Adjustments included testing only total knee arthroplasty patients receiving standard physical therapy and omitting unreliable measures from the analyses. Recruitment of the standard care group was halted when differences emerged between the remaining groups. Older adults in the communication group reported significantly less sensory pain on postoperative Day 1 than older adults in the pain management only group. Teaching older adults both pain communication skills and pain management information before surgery might result in greater pain relief during the early postoperative period.

Postoperative Pain after Hospital Discharge

Thirty postoperative adults were surveyed using face-to-face interviews in their homes after hospital discharge. Participants were asked to describe their pain communication during their inpatient hospitalization and pain-related problems after discharge. This study reports the content analysis of participant responses to their pain after discharge. Eighteen (60.0%) described pain-related problems after discharge. Seven (23.3%) identified pain-related fears or complications. Six (20.0%) identified analgesic management problems. Six (20.0%) described difficulty with positioning or moving. Four (13.3%) described sleep disruption from pain. The results identify several pain-related problems encountered by postoperative patients after hospital discharge. Shortened hospital stays make effective postdischarge pain management an essential aspect of care for surgical patients. Teaching patients additional pain management skills, including when and how to communicate with health care providers when pain-related issues occur at home, may lead to more effective pain relief for patients.

Older Adults' Pain Communication During Ambulatory Medical Visits: An Exploration of Communication Accommodation Theory

The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

Older Black Adult Osteoarthritis Pain Communication

A quantitative descriptive secondary data analysis design was used to describe older black adult communication of osteoarthritis pain and the communication strategies used to convey the pain information. Pain content from 74 older black adults with persistent osteoarthritis pain was analyzed using criteria from the American Pain Society arthritis pain management guidelines that included type of pain (nociceptive/neuropathic), quality of pain, source, location, intensity, duration/time course, pain affect, effect on personal lifestyle, functional status, current pain treatments, use of recommended glucosamine sulfate, effectiveness of prescribed treatments, prescription analgesic side effects, weight management to ideal body weight, exercise regimen or physical therapy and/or occupational therapy, and indications for surgery. Communication strategies were analyzed with criteria derived from Communication Accommodation Theory that included being clear, using medical syntax, using ethnic specific syntax, being explicit, and staying on topic when discussing pain. The majority of communicated pain content included pain location, intensity, and timing. Regarding communication strategies, most of the older black adults used specific descriptions of pain and remained on topic. Fewer used explicit descriptions of pain that produced a vivid mental image, and few used medical terminology. Use of medical syntax and more explicit descriptions might improve communication about pain between health care practitioners and patients. Practitioners might assist older black adults with persistent osteoarthritis pain to communicate important clinical pain information by helping them to use relevant medical terminology and more explicit pain descriptions when discussing pain management.

Older adult osteoarthritis pain management: Results from the 2008 National Ambulatory Medical Care Survey

Purpose: To describe practitioners’ prescription of recommended initial osteoarthritis (OA) pain treatments for older adults. Data sources: A secondary data analysis was conducted with the 2008 National Ambulatory Medical Care Survey (NAMCS) that was completed by practitioners in ambulatory medical care settings. Of the 28,741 office visits, 9314 were by adult patients age 60 or older, and 871 of those visits involved a painful joint. Only 128 were also by people with practitioner‐documented OA. Of those 128 visits, 21 (16.1%) were prescribed exercise and/or acetaminophen and were not prescribed non‐steroidal anti‐inflammatory agents (NSAIDS). No complementary alternative medical treatments were prescribed. Older adults with and without documented OA had a mean of at least four office visits with the practitioner during the past year. Conclusions: OA may be under‐diagnosed, under‐reported, or overshadowed by co‐morbid medical conditions. Older adults with persistent OA pain are at increased risk for adverse events from prescribed NSAIDs. Safe and effective multimodal pain treatments need to be prescribed for older adults with persistent OA pain. Implications for practice: Referral to a rheumatologist or pain management specialist should be considered when pain intensity and/or pain interference with daily activities remains moderate or greater.Purpose: To describe practitioners’ prescription of recommended initial osteoarthritis (OA) pain treatments for older adults. Data sources: A secondary data analysis was conducted with the 2008 National Ambulatory Medical Care Survey (NAMCS) that was completed by practitioners in ambulatory medical care settings. Of the 28,741 office visits, 9314 were by adult patients age 60 or older, and 871 of those visits involved a painful joint. Only 128 were also by people with practitioner-documented OA. Of those 128 visits, 21 (16.1%) were prescribed exercise and/or acetaminophen and were not prescribed non-steroidal anti-inflammatory agents (NSAIDS). No complementary alternative medical treatments were prescribed. Older adults with and without documented OA had a mean of at least four office visits with the practitioner during the past year. Conclusions: OA may be under-diagnosed, under-reported, or overshadowed by co-morbid medical conditions. Older adults with persistent OA pain are at increased risk for adverse events from prescribed NSAIDs. Safe and effective multimodal pain treatments need to be prescribed for older adults with persistent OA pain. Implications for practice: Referral to a rheumatologist or pain management specialist should be considered when pain intensity and/or pain interference with daily activities remains moderate or greater.