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Biomedical subjects

A H Vallerand

Publications and source records attributed to A H Vallerand.

14 recordsLinked to original sources
PubMed2004

Canadian and American self-treatment of pain: a comparison study.

INTRODUCTION: Adults frequently rely on self-treatment modalities to relieve pain that exceeds everyday kinds of pain, such as minor headaches and toothaches. Examples of self-treatment modalities include doctor-prescribed analgesics, non-prescribed over-the counter medications, herbal substances and treatments, and non-drug treatments such as heat, cold and exercise. Self-treatment is often associated with adverse affects related to the improper use of self-treatment substances and the adverse interactions they may produce when combined with other prescribed or non-prescription treatments for pain control. Many adults also use a variety of self-treatment modalities without informing their health care providers. OBJECTIVES: To explore the occurrence of pain and identify pain self-treatment modalities used by members (n = 105) of rural communities from two eastern Canadian provinces. Results of this study were compared with a rural American cohort study in order to explore similarities/differences in patterns of self-treatment of pain between the two countries. METHODS: This descriptive-exploratory study was conducted using a survey method. The design followed that used in a US study by Vallerand, Fouladbakhsh and Templin. Investigators used self-report questionnaires to identify pain self-treatment modalities, pain intensity ratings, pain interference, and the percentage of pain relief in a convenience sample of 105 participants recruited from two Canadian rural communities. Differences in mean scores between Canadian and US data were determined through t-tests. Difference between Canadian and US pain self-treatment modalities were determined using chi2 tests for significance. RESULTS: Canadians reported choosing significantly more non-pharmacological self-treatment modalities of pain control such as heat, cold, exercise/stretching, and massage than did their US counterparts (chi2 = 7.6, p = .006). US participants reported significantly higher percentages of pharmacologic modalities than Canadian participants, ie prescription medications (chi2 = 4.8, p = .03), and over-the counter medications (chi2 = 8.14, p = .004). There was no significant difference between the two countries in the number of herbal supplements taken for pain relief (chi2 = 2.47, p = .12). Canadian participants reported having significantly less pain relief from their current self-treatment regimen than US participants, (t = 13.77, p = .00). In addition, 33% of Canadian participants and 20% of US participants had not informed their primary care practitioner of their self-treatment choices. CONCLUSIONS: This study demonstrates that pain is a common experience for many North American individuals living in rural communities. Comparison of results between Canadian and US cohort studies indicate that rural Canadians may benefit from increasing their knowledge about self-treatment options of pain control. Findings showed that rural Canadians choose more non-pharmacologic self-treatment modalities and have less pain relief than rural US participants by their self-treatment choices. In addition, a significant number of Canadian and US participants had not informed their primary care provider of their self-treatment practices. Community healthcare agencies may need to improve the dissemination of information on how to combine both pharmacologic and non-pharmacologic modalities into self-treatment regimens in order to facilitate more effective pain control for some rural communities. Further study is indicated to examine how the differences found in self-treatment practices between Canadian and US cohort studies relate to the differences between Canadian and US culture and healthcare payment systems.

Journal Article↗
PubMed2000

The relationship of gender to pain.

Gender differences have been identified in the perception of pain intensity for both acute and chronic pain and with responses to analgesics. Women seem to show lower pain thresholds, a greater ability to discriminate painful sensations, higher pain ratings, and a lower tolerance for pain. Although some pain syndromes, such as facial pain, are more common in women, gender-related responses to pain are not completely consistent. The study of gender differences in relation to pain is relatively new, yet promising. This article reviews the evidence for how gender may play a role in reports of pain intensity, measurements of patient responses, and differences in response to pain therapies. Literature that addresses pain perception and response in acute and chronic nonmalignant and cancer pain states, experimentally induced pain, and responses to analgesics are reviewed in terms of their relationship to gender. Although there are conflicting results for experimental and clinical studies, there is agreement among investigators that certain factors, such as perceptual ability and physiologic mechanisms, do explain gender-related differences to pain and its treatment. Gender is an important variable and should be taken into account in both research and the clinical practice of pain management.

Analgesics↗
PubMed1998

Conscious sedation for in vitro fertilization.

OBJECTIVE: To review the principles and practice of the use of conscious sedation for IVF. DESIGN: The pertinent literature was reviewed and recommendations are provided. RESULT(S): Conscious sedation appears to be the most commonly used method of pain relief for transvaginal retrieval of oocytes. Conscious sedation does not require the presence of an anesthesiologist and can be done in freestanding clinics. Agents commonly used include opioids in combination with benzodiazepines. This combination minimizes pain, decreases anxiety, and provides sedation and some amnesia. Adjuvants such as promethazine and hydroxyzine can also be used but often are not needed. Conscious sedation is well tolerated by patients and does not require highly specialized equipment. However, there are specific safeguards that should be followed. Only a few toxicity studies have been performed, but they are reassuring because they have not found significant effects on fertilization or cleavage. CONCLUSION(S): Conscious sedation appears to be a safe and cost-effective method of providing analgesia and anesthesia for transvaginal retrieval of oocytes.

Benzodiazepines↗
PubMed1998

Development and testing of the inventory of functional status--chronic pain.

Gender differences have been identified in daily activities and the importance of specific activities. Functional status instruments do not reflect these differences and may provide a biased measurement. The purpose of this 3-phase study was to develop a reliable and valid instrument for measuring functional status in women with chronic pain. The Inventory of Functional Status--Chronic Pain (IFS-CP) measures activities primarily engaged in by women and omits from scoring those activities in which the individual does not usually participate. Content validity was established at 91.5%. Reliability and further validity testing in a sample of 204 women with chronic pain found that internal consistency ranged from 0.61 to 0.94 for item to subscale, and from 0.71 to 0.89 for subscale to total scores. Test-retest reliability was 0.93. Testing of construct validity resulted in significant correlations between functional status and pain severity, pain interference [Multiphasic Pain Inventory (MPI)], perception of pain disability [Pain and Impairment Relationship Scale (PAIRS)], and quality of life (QOL, Survey). The IFS-CP provides a means of comprehensively assessing the effects of pain on the functional status of women.

Activities of Daily Living↗
PubMed1997

Measurement issues in the comprehensive assessment of cancer pain.

OBJECTIVES: To examine issues related to the assessment of pain, symptoms and functional status in patients with cancer and the timing of assessment and appropriate tools to collect this information. DATA SOURCES: Review articles, research studies book chapters, and government guidelines pertaining to measurement issues in the assessment of cancer pain. CONCLUSIONS: Each component of the measurement process (ie, choice of an instrument to measure pain, timing and frequency of measurement measurement of symptoms accompanying pain or its treatment, and measurement of functional status) is important in developing an accurate and comprehensive assessment of cancer pain. This comprehensive assessment is a prerequisite to effective pain management. IMPLICATIONS FOR NURSING PRACTICE: For pain to be evaluated and treated effectively, regular consistent assessment of pain by the clinician is imperative. This comprehensive assessment allows the clinician to choose modalities most likely to work for the individual patient.

Activities of Daily Living↗
PubMed1995

Gender differences in pain.

Apparent gender differences have been identified in epidemiologic surveys of patients with pain and in clinical studies of responses to pain. Women are reported to have lower pain thresholds and lower pain tolerance than men have. Whether women are more willing to report pain than men are or experience pain differently than men do is unclear. However, beliefs about gender differences and pain affect nurses' decisions made regarding the treatment of pain. This article reviews the literature addressing pain in women and suggests how clinical practice is affected. Literature from Medline (1966 to 1994), CINAHL (1983 to 1994), and Psych-Lit (1967 to 1994) data bases was searched using the key words pain, gender, and sex. Comments in the manuscript reflect only those studies addressing epidemiology, experimentally-induced pain, or pain in the clinical setting. Studies describing gender differences in an animal model were not included. Limitations of space required that representative examples of studies in the major areas be included; others describing similar design and outcome were not included.

Adult↗
PubMed1995

Issues of control in patients with cancer pain.

The enhancement of patient control is frequently cited in nursing literature as an important area of nursing intervention. In this article, the concept of control, from the perspective of the patient with cancer pain, the primary family caregiver, and the home-care nurse, is discussed. Lewis identified five types of control: processual control, contingency control, cognitive control, behavioral control, and existential control. Lewis's typology of control was used as an organizing analytical framework, in this study, for interpreting the interview responses of each member of the triad. Similarities and differences in the perspectives of each member are discussed and examples of interventions that may be used to increase control in the management of pain are presented.

Community Health Nursing↗
PubMed1994

The effects of postoperative preparatory information on the clinical course following third molar extraction.

PURPOSE: Previous studies have shown that perioperative patient education providing coping strategies and/or reasonable expectations regarding the postoperative course can help lessen patient anxiety and decrease pain, complications, and recovery time. This study investigated these effects following extraction of third molars. PATIENTS AND METHODS: Forty patients scheduled to undergo surgical extraction under local anesthetic and intravenous conscious sedation were randomly assigned to one of two groups. Treatment group members were given postoperative instructions that included descriptive information regarding potential sequelae (eg, pain, edema, trismus, nausea) as well as detailed information regarding analgesic use. Control group members were given basic open-ended postoperative wound care instructions. Postoperative pain and satisfaction with pain control were recorded using visual analogue scales. Analgesic consumption was also recorded. Thirty-seven patients completed the protocol. RESULTS: Patients in the treatment group reported significantly less pain during the period from 12 to 18 hours, and at 24 hours postoperatively, but there was no significant difference in analgesic consumption between groups. Patient satisfaction with pain control was significantly greater in the treatment group. CONCLUSION: These results indicate that increasing the quantity of postoperative preparatory information significantly increases pain relief and resultant satisfaction with pain control without increasing analgesic consumption.

Adolescent↗
PubMed1994

Street addicts and patients with pain: similarities and differences.

Fear of addiction to opioid analgesics affects their use in the treatment of pain by physicians, nurses, and the lay public. Imprecise terminology and regulations has led to confusion between the image of the street addict and the patient with pain. Commonly cited definitions are presented, and a comparison of the street addict and the patient with pain is offered. Similarities and differences in terms of increasing medication requirements, tolerance, withdrawal, intoxication, and lifestyle are described. The nurse's unique position and role in influencing the continuing distinction of these terms and the subsequent treatment of the patient with pain based on this distinction are discussed.

Analgesics, Opioid↗
PubMed1991

Evaluation of the sedative combination of nitrous oxide and orally administered diazepam.

The effects of nitrous oxide/oxygen and oral diazepam, administered individually and in combination, on memory and psychomotor coordination were evaluated. Forty healthy adult volunteers (53% male) were randomly assigned to one of four conditions: (1) 100% oxygen and placebo, (2) 50% nitrous oxide/50% oxygen and placebo, (3) 100% oxygen and 20 mg diazepam, or (4) 50% nitrous oxide/50% oxygen and 20 mg diazepam. There was no significant difference between groups with respect to age or weight. Participants' performance was tested in two areas: (1) a visual recall and recognition task and (2) psychomotor coordination as indicated by performance on Trieger's modification of the Bender Gestalt Test. There was no significant difference between the effects of nitrous oxide or diazepam on memory given individually or in combination. Significant differences in psychomotor coordination were seen when comparing groups 2, 3, and 4 with group 1. However, no significant differences existed between groups 2, 3, and 4, indicating that nitrous oxide and diazepam both affect coordination but that their effects are not additive when combined in this manner. The trends in both the memory and psychomotor data suggest diazepam to have a greater effect than nitrous oxide, and the combination to have a greater effect than either agent individually. Further investigation in this area is needed.

Adult↗