Uma Monga

Sexuality and sexual adjustment of patients with chronic pain

PURPOSE To describe sexual functioning and its relationship with psychological measures in chronic pain patients. METHOD It is a self report survey with a convenience sample. Seventy consenting chronic pain patients responded to a questionnaire. Mean age was 49.9 years (range 29-74); mean pain duration was 146.7 months (range 6-624). Participants endorsed a wide variety of pain conditions. INSTRUMENTS USED: (1) Derogatis Inventory of Sexual Functioning; (2) Multidimensional Pain Inventory; (3) Center for Epidemiological Studies Depression Scale: (4) Multidimensional Health Locus of Control; (5) Hopkins Symptom Check List; (6) Vanderbilt Pain Management Inventory; (7) Coping Strategies Questionnaire. RESULTS Sixty-six per cent of patients were interested in sex, 50% were satisfied with current sexual partner and 20% considered current sexual life to be adequate. Over 70% fantasized at least once a month. Only 44% experienced normal arousal during intercourse; 33% practiced masturbation and 47% were involved in sexual intercourse or oral sex at least once a month. The majority were dissatisfied with orgasmic activities. No relationship was found between pain severity, duration, frequency and sexual functioning. A relationship was found between disability status, age and several psychological variables and various domains of sexual functioning. CONCLUSIONS; Sexual problems are common in chronic pain patients. Patients who reported symptoms of depression and distress had more sexual problems.

Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy

OBJECTIVE To determine the etiology of fatigue in prostate cancer patients undergoing radiation therapy (RT). METHODS Thirteen prescreened men (60 to 76 years in age, 58 to 130 kg in body weight) were evaluated for neuromuscular fatigue (NMF) of the tibialis anterior (TA) muscle, cardiopulmonary fatigue (CPF), and psychological-subjective fatigue (PSF) at 1 to 2 weeks before RT (Pre), at the end of 8 weeks of RT (RT), and at 5 to 6 weeks after completion of RT (Post). OUTCOME MEASURES For NMF, the TA muscle was fatigued by sustained isometric contraction at 80% of maximum voluntary contraction for 60 seconds on a force dynamometer. Neuromuscular efficiency (NME) expressed as a ratio of isometric force (in Newtons) and respective integrated electromyograms were measured. For CPF, stress testing was performed on a treadmill using the modified Bruce protocol. Piper Fatigue Scale, Beck Depression Inventory, and Epworth Sleepiness Scale were administered to evaluate PSF. DATA ANALYSIS Paired t tests, single factor analysis of variance, and nonparametric analysis. RESULTS At RT, there was a significant decline in NME of TA at the beginning (18.4%, p < .01) and the end (29.2%, p < .001) of sustained muscle contraction for 60 seconds. Post values were lower but nonsignificant in comparison with Pre values. NME recovered within 5 to 6 weeks after RT. No abnormalities were detected in CPF or PSF. No correlation was found between the decline in NME and psychological status of the patients. CONCLUSION Results provide definitive evidence of transient decline in NME in prostate cancer patients at the completion of RT. The effect seems to be specific for neuromuscular performance alone and is independent of the cardiovascular or psychological status of the patients.

Longitudinal study of quality of life in patients with localized prostate cancer undergoing radiotherapy

This study prospectively evaluated quality of life (QOL) in localized prostate cancer patients undergoing radiotherapy, and it examined the relationships between QOL, depression, fatigue, and sleep disturbance. Instruments that were used are Functional Assessment of Cancer Therapy for Prostate (FACT-P), Beck Depression Inventory (BDI), Piper Fatigue Scale (PFS), and Epworth Sleepiness Scale (ESS). We evaluated patients at preradiotherapy (PRT), midway radiotherapy (MRT), completion of radiotherapy (CRT), follow-up radiotherapy (4 to 8 wk) (FRT), and long-term follow-up radiotherapy (FRT2) (12 mo or more). Forty participants with a mean age of 67.8 yr were studied. Duration of radiotherapy was 7-8 wk. Mean long-term follow-up period post-CRT was 16.2 mo (range 12- 24 mo). All patients had clinical T1c to T2b prostate cancer. Prostate Cancer Specific (PCS) and Physical Well-Being (PWB) subscales of FACT-P, scores at MRT and CRT were significantly lower than at PRT. At FRT2, PWB scores declined further, while PCS scores increased. PFS median scores were significantly higher at CRT and at FRT2 as compared with PRT. Patients scoring higher on PFS were more likely to report a poorer QOL and PWB as measured with FACT-P questionnaire. No significant changes were noted in the BDI and ESS scores during the study periods. The PWB declined during and at CRT and worsened at FRT2. Decline in PCS subscale scores during and at CRT reflects worsening of urinary symptoms and appearance of bowel problems. The scores improved at long-term follow-up. A relationship was found to exist between physical well-being and fatigue.

Sexual Functioning in Cancer Patients

Controversy exists regarding the extent and nature of sexual problems in cancer patients. The incidence of sexual problems varies in published studies irrespective of the cancer site. Most of the studies are retrospective and descriptive in design and many do not take into account the preexisting physical, psychosocial, sexual, and marital problems. However, it is clear that sexual problems are common in cancer patients and may be caused by all the available treatment options. Management of sexual problems in this patient population has not been systematically studied. This article reviews prevalence of sexual problems that result from various treatment modalities (such as surgery, radiotherapy, and chemotherapy) and describes guidelines for management of sexuality related issues in cancer survivors.

Coital Positions and Sexual Functioning in Patients with Chronic Pain

The objectives of this study were to describe (1) coital positions adopted by chronic back pain patients, (2) and to describe sexual function as assessed by Derogatis Inventory of Sexual Functioning (DISF). In addition, patients were asked questions regarding effects of sexual intercourse on severity of pain, influence of pain over sexual functioning, and perceived factors causing sexual problems. This is a subset (45 patients) of a larger study (70 patients) describing sexual functioning. These 45 patients responded to additional questions as described above. Mean age of the patients was 55.7 years (range 36–74 years). There were 40 male patients. Twenty-five patients (56%) were married. Mean duration of pain was 145.2 months. Thirty-two patients (27 male and 5 female) were sexually active. Eighty-one percent of male and 100% of female patients, who were sexually active, preferred “male superior” position. Of those sexually active, 41% performed sexual intercourse while sitting on a chair. A majority of patients were experiencing problems in all domains of sexual functioning except for fantasy. Thirty-nine patients (87%) reported that pain extremely interfered in performing sexual intercourse. Twenty-nine patients (64%) reported worsening of pain due to sexual intercourse. Majority (n = 34) of the patients (76%) had fear of failure to perform and 25 patients (56%) reported fear of aggravating pain due to sexual activity. There is need for further research in this area.

Role of exercise to prevent fatigue and improve quality of life in localized prostate cancer patients undergoing radiation therapy

Materials/Methods: A prospective IRB approved randomized study. Twenty-one patients were assigned to a structured exercise group (n-11) or a control no exercise group (n 10). Assessments were carried out prior to starting and at the completion of radiotherapy. Instruments used included: Cardiac Fitness as measured by Metabolic Equivalents (METS); Piper Fatigue Scale (PFS); Beck Depression Inventory (BDI); and Functional Assessment of Cancer Therapy-Prostate (FACT-P). Lower extremity strength and flexibility also were assessed. Post-Pre changes within each group were assessed using paired-difference t-tests. These changes were compared between the two groups using two-sample t-tests. Each comparison was intended to stand on its own, so P-values were not adjusted for the large number of comparisons performed.