Biomedical subjects

C Miaskowski

Publications and source records attributed to C Miaskowski.

At least 55 records · Page 3Linked to original sources

PubMed1997

Innovations in pharmacologic therapies.

OBJECTIVES: To describe the mechanism of action of four new neurotransmitters that may play a role in pain modulation and to review the clinical implications of these new classes of analgesics. DATA SOURCES: Research studies, proceedings, abstracts, and book chapters pertaining to new pharmacologic therapies for pain relief. CONCLUSIONS: Recent advances in our understanding of neurotransmitter and receptor physiology have provided new directions for the development and testing of analgesic compounds. NMDA antagonists and calcium channel blockers warrant investigations in humans. Additional human studies are needed of alpha 2 adrenergic agonists and GABA agonists. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of new novel classes of analgesics is important as further investigative studies will take place to determine which types of pain problems are most effectively treated by these classes of drugs.

Adrenergic alpha-Agonists↗

PubMed1997

Inadequate pain management and associated morbidity in children at home after tonsillectomy.

A telephone interview with the parents of 84 children who underwent tonsillectomy was conducted within 24 hours after discharge from an ambulatory surgery center. Parents were asked to rate the intensity of their child's pain and data were collected on the type, dose, and amount of analgesics administered, and the types of side effects the children experienced. The mean age of the children was 7 years (SD = 2.31), with an equal number of boys and girls. Overall mean pain intensity was 1.42 (SD = 0.71) and the worst pain intensity ranged from 0 to 3 (Mean = 1.93; SD = 0.83). Acetaminophen with codeine was the most common analgesic prescribed and administered. Children received an average of 3 doses in the first 24 hours after surgery. Seventy-seven percent of the parents stated that pain relief from the analgesic was adequate. Of the 23% who did not feel that pain control was adequate, only 7% contacted a physician. The majority of the children experienced restless sleep (62%), behavior changes (75%), and difficulty taking oral fluids because of complaints of pain (56%). Twenty-six percent of the children had one or more episodes of emesis. Our data suggest that children experience a significant amount of pain in the first 24 hours after tonsillectomy and that parents administer analgesics less frequently than the drugs are prescribed. In addition, children experience significant deleterious effects (i.e., poor oral fluid intake, sleep disturbance, behavioral changes, and emesis) associated with the undertreatment of pain, the analgesic administered, or the surgery itself.

Analgesics↗

PubMed1997

Differences in mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain.

The purpose of this study were to determine if there are differences in the mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain. A convenience sample of 86 family caregivers of patients with cancer-related pain and 42 caregivers of pain-free patients participated in this study. Family caregivers of patients with cancer-related pain scored significantly higher on the tension and depression subscales of the Profile of Mood States and had a significantly higher total mood disturbance score than did caregivers of pain-free patients. Although family caregivers of patients with pain had lower health status scores and higher caregiver strain scores than caregivers of pain-free patients, these differences were not statistically significant. The results of this study suggest that the presence of pain in a cancer patient adversely affect the mood states of family caregivers, particularly their level of depression and anxiety, and that health care professionals need to assess the psychological needs of family members caring for cancer patients experiencing pain.

Adult↗

PubMed1997

Measurement of neonatal responses to painful stimuli: a research review.

The measurement of neonatal responses to painful stimuli remains a significant clinical problem. Although numerous measures have been evaluated, instruments that are valid, reliable, and clinically feasible are not yet available. The purpose of this paper is to critique the studies that have been done using biochemical, physiological, and behavioral measures to evaluate neonatal responses to painful stimuli. Specific issues regarding measurement in premature and critically ill neonates are emphasized. The intent of this review and critique of the literature is to stimulate additional research into the assessment of neonatal pain.

Humans↗

PubMed1997

Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration.

OBJECTIVES: To examine the accuracy of inferences about critical care patients' pain based on physiological and behavioral indicators and to assess the relationship between registered nurse and patient pain scores and doses of opioids administered. DESIGN: Descriptive, comparative analysis. SETTING: Three intensive care units and two postanesthesia care units in two hospitals. SUBJECTS: Fourteen critical care nurses who conducted 114 pain assessments on 31 surgical patients. INTERVENTIONS: Nurses used a pain assessment and intervention notation algorithm that contained lists of behavioral and physiological indicators of pain to make inferences about a patient's pain intensity. Fourteen registered nurses completed up to five pain assessments on each patient over a 4-hr period. Following both the physiological and behavioral ratings, nurses rated the patients' pain intensity, using a 0 to 10 numeric rating scale, and they asked patients to provide a self-report of pain intensity, using a similar numeric rating scale. Nurses then administered an intravenous dose of an opioid from a sliding scale prescription. MEASUREMENTS AND MAIN RESULTS: Moderate-to-strong correlations were found between the number of behavioral indicators at times 1 through 5 and between the number of physiological indicators and nurses' ratings of the patients' pain intensity at times 1 through 4 (p < .05). Although nurses' pain ratings were consistently lower than patients' pain ratings across the five time points, these differences were not significant. The amount of opioid analgesic administered by the nurse correlated more frequently with nurses' pain ratings than with patients' self-reports of pain intensity. CONCLUSIONS: The use of a detailed, standardized pain assessment and intervention notation algorithm that incorporates behavioral and physiological indicators may assist healthcare professionals in making relatively accurate assessments of a patient's pain intensity. Further research is needed to determine the specific decision-making processes and criteria that healthcare professionals use to choose doses of analgesics to administer to critically ill patients.

Adult↗

PubMed1997

Women and pain.

The findings from research studies done to date on gender differences in responses to painful stimuli and analgesic medications suggest that men and women do respond differently to both pain and pain medication. Clinicians need to be mindful of these gender differences as they plan the care of a man or woman who is experiencing pain. Pain assessments and management strategies must be focused on the individual experiencing the pain. However, determining the mechanisms underlying the gender differences found in the studies summarized in this paper may provide insight into the use of different assessment tools and pain management strategies for men and women.

Female↗

PubMed1996

Gender difference in analgesic response to the kappa-opioid pentazocine.

Gender difference in analgesia produced by the kappa-opiate pentazocine was investigated in a model of post-operative dental pain. In a recent study [Gordon et al., Neuroscience, 69 (1995) 345-349.] evaluating interaction between the GABAB agonist baclofen and opiates with respect to postoperative analgesia we found that females receiving pentazocine for the treatment of postoperative pain showed better analgesia than did males receiving similar treatment. To follow-up this result, we evaluated for the effect of gender on analgesia produced by pentazocine administered to participants not receiving another experimental medication. The analgesic response to pentazocine in ten females was compared to that in eight males. All participants were administered pentazocine after undergoing surgery for the removal of impacted third molars. We confirm our previous finding that pentazocine produces significantly greater analgesia in females than in males; no significant difference was observed in analgesia among females in different phases of the menstrual cycle.

Adult↗

PubMed1996

Kappa-opioids produce significantly greater analgesia in women than in men.

Sex differences in human responses to nociceptive stimuli and painful pathological conditions have generally indicated that women report higher pain levels or exhibit less tolerance than men for given stimulus intensities (reviewed in ref. 1 and 2). However, studies have not evaluated sex differences in analgesic responses. We recently reported that the opioid agonist-antagonist pentazocine, which acts predominantly at kappa-receptors, produced significantly better postoperative analgesia in females than in males in patients who underwent surgery for the removal of their third molars (wisdom teeth). In the current study, we evaluated the hypothesis that this sex difference is a characteristic of kappa-opioid agonism. In order to determine whether there are sex differences associated with kappa-opioid agonism, the analgesic efficacy of two other predominantly kappa-opioid analgesics, nalbuphine and butorphanol; was compared in males and females who underwent surgery for the removal of third molar teeth. We found that both nalbuphine and butorphanol produced significantly greater analgesia in females as compared with males. Considering our earlier findings, we conclude that kappa-opioid analgesia is greater in females than in males, probably reflecting a difference in kappa-opioid-activated endogenous pain modulating circuits.

Analgesia↗

PubMed1996

Mechanisms and management of gastric cancer. A comparison between the Japanese and U.S. experiences.

While gastric cancer is on the decline in the United States, this cancer has been the leading cause of death in Japan since 1981. Although the mechanisms underlying the development of gastric cancer are not completely understood, certain epidemiological factors, particularly diet, are associated with this disease. This article presents information on the differences in disease classification, diagnostic and screening procedures, treatment approaches, and mortality statistics between the United States and Japan. In addition, the clinical manifestations of gastric cancer are summarized, and the nursing care of the patient is outlined using a nursing diagnosis format.

Aged↗

PubMed1996

Special needs related to the pain and discomfort of patients with gynecologic cancer.

Patients with gynecologic malignancies can experience pain associated with a variety of causes. Chronic pain associated with the disease or treatment presents the most problems. Chronic cancer-related pain is associated with negative mood states and a decrease in the patient's quality of life. Clinicians must conduct pain assessments on a routine basis to accurately diagnose the specific pain syndrome in patients with gynecologic cancer. An overview of how to conduct a pain assessment with such patients is provided. The etiology, clinical manifestations, and treatment strategies for the most common pain syndromes seen in patients with gynecologic cancer are reviewed. The use of nonpharmacologic interventions with this patient population is discussed.

Ascites↗

PubMed1996

An overview of bladder cancer: treatment and nursing implications.

PURPOSE/OBJECTIVES: To review the incidence, pathophysiologic mechanisms, treatment options, and nursing care of patients with bladder cancer. DATA SOURCES: Published articles, book chapters, American Cancer Society materials, and a computerized data base. DATA SYNTHESIS: Nearly 53,000 cases of bladder cancer will be diagnosed this year. Recent studies link mutations on the p53 gene and abnormalities on chromosome 9 to bladder cancer. Seventy percent of patients present with local tumors within the bladder. Surgery and intravesical chemotherapy are the most common treatments for superficial bladder cancer. Deeply invasive disease sometimes can be cured by surgery, irradiation, or a combination of treatment modalities. Early stage detection has a 91% survival rate. Prevention strategies include smoking cessation and reduction of the risk of occupational exposure to toxic chemicals. CONCLUSIONS: Bladder cancer is a prevalent disease with significant morbidity. IMPLICATIONS FOR NURSING PRACTICE: Knowledge about bladder cancer will help nurses prevent and manage the disease and its treatment complications and meet patients' psychological needs.

Combined Modality Therapy↗

PubMed1996

Randomized clinical trial of chlorhexidine versus placebo for prevention of oral mucositis in patients receiving chemotherapy.

PURPOSE/OBJECTIVES: To test the effectiveness of a nurse-initiated systematic oral hygiene teaching program-PRO-SELF: Mouth Aware (PSMA)-in conjunction with two mouthwashes (0.12% chlorhexidine or sterile water) in preventing chemotherapy-induced oral mucositis. DESIGN: Randomized, double-blind, placebo-controlled, clinical trial. SETTINGS: 23 outpatient clinics and office practices in California. SAMPLE: 222 patients who were starting a cycle of mucositis-inducing chemotherapy. METHOD: Participants were followed over three chemotherapy cycles. All patients were provided the PSMA program. Random assignment to a mouthwash occurred prior to the development of oral mucositis. Researchers used the Oral Assessment Guide to assess the patients oral cavities monthly (with the patients cycles of chemotherapy) and when patients reported any oral changes between cycles. MAIN RESEARCH VARIABLES: Type of mouthwash, incidence, days to onset, and severity of chemotherapy-induced oral mucositis. FINDINGS: No significant differences existed between the two mouthwashes in regard to incidence, days to onset, and severity of mucositis. CONCLUSIONS: Because chlorhexidine (S20 per pint) was no more effective than water, a substantial cost savings can be realized by rinsing with water. Interestingly, the PSMA program appeared to reduce the incidence of mucositis from on a prior estimate of 44% to less than 26%. IMPLICATIONS FOR NURSING PRACTICE: A nursing prescription of a systematic oral hygiene program using water as a mouth rinse is cost efficient and may be effective in preventing oral mucositis.

Adult↗

PubMed1996

Testicular cancer: a review.

PURPOSE/OBJECTIVES: To describe the pathophysiologic mechanisms, histologic and clinical staging, diagnosis, and medical and nursing management of testicular cancer. DATA SOURCES: Published studies, review articles, and Physician Data Query database. DATA SYNTHESIS: Testicular cancer is a complex disease resulting from transformation of gonadal tissues. The pathophysiologic mechanisms involve damage to tissue in utero and after birth. Orchiectomy is the treatment of choice for early-stage disease. Orchiectomy can have profound physiologic and psychological consequences for young males. Subsequent chemotherapy and radiation therapy also may have severe side effects including azoospermia, bone marrow suppression, nephrotoxicity, and pulmonary toxicity. CONCLUSIONS: Early detection of this disease results in improved patient outcomes. Patients treated with radical inguinal orchiectomy and radiation therapy have fewer long-term side effects and toxicities than patients who require more extensive surgery and chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Nursing care must focus not only on relieving the patient's physical symptoms but on helping him deal with the psychosexual issues associated with the disease and its treatment.

Humans↗

PubMed1996

Clinical judgment and management of postoperative pain in critical care patients.

BACKGROUND: Acute pain is a significant problem in critical care patients. Although many barriers to successful assessment and management of pain in critical care patients have been noted, little is known about how critical care nurses make clinical judgments when assessing and managing patients' pain. OBJECTIVE: This qualitative analysis is part of a pilot study evaluating nurses' use of a pain assessment and intervention notation algorithm in patients in critical care areas who have limited communication abilities after abdominal or thoracic surgery. METHOD: Transcribed audiotapes of nurse participants' "thinking aloud" while using the pain assessment and intervention notation algorithm were analyzed by using interpretive phenomenology. The interpretive account is based on 31 tape recordings of 14 nurses caring for 41 patients (12 patients in the ICU and 29 patients in the postanesthesia care unit). FINDINGS: The two domains of clinical judgment found were (1) assessing the patient and (2) balancing interventions. CONCLUSIONS: Many nurses' reports showed that they accurately assessed their patients' needs for analgesics. Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain. Additionally, nurses had to balance analgesic administration against the patients' hemodynamic and respiratory conditions, medical plan and prescriptions, and the desires of the patients and the patients' families.

Adult↗

PubMed1995

Enhancement of morphine analgesia by the GABAB agonist baclofen.

Opioid-GABAergic interactions for the treatment of post-operative pain were investigated in two double-blind, placebo-controlled experiments. We first studied the effect of pre-operatively administered baclofen, a GABAB receptor agonist, on the analgesia produced by intravenously administered morphine, a predominantly mu-opioid analgesic. In a separate trial, we studied the effect of baclofen on the analgesia produced by pentazocine, a predominantly kappa-opioid analgesic. While baclofen alone did not affect the level of post-operative pain, morphine analgesia was significantly enhanced by baclofen compared to placebo. In contrast, baclofen did not affect the level of pentazocine analgesia: however, females receiving pentazocine showed significantly greater analgesia than males.

Adult↗

PubMed1995

Mood states of oncology outpatients: does pain make a difference?

The purposes of this study were to determine if there were significant differences in the mood states of oncology outpatients who had cancer-related pain and those who were pain free, and to evaluate the relationships between pain intensity and duration and mood states in those patients with pain. Two hundred (54.2%) patients experienced cancer-related pain during the previous month and 169 (45.8%) patients were pain free. Those patients who experienced cancer-related pain scored significantly higher on all of the subscale scores of the Profile of Mood States, except vigor, and had a significantly higher total mood disturbance (TMD) score than did pain-free patients. In addition, the subscale scores of tension, depression, anger, fatigue, confusion, and TMD scores were moderately correlated with increases in pain intensity. Also, depression, fatigue, confusion, and TMD scores were moderately correlated with increasing duration of pain. These data suggest that there is a relationship between pain and mood in oncology outpatients and that health-care professionals need to assess for mood disturbances in this population and develop appropriate treatment strategies.

Affect↗

PubMed1995

The problem of pain in outpatients with breast cancer.

PURPOSE/OBJECTIVES: To determine the prevalence and causes of pain in a group of outpatients with breast cancer and to evaluate the effects of pain on the patient's activities of daily living (ADL), mood, and quality of life (QOL). DESIGN: Descriptive and correlational. SETTING: Sixteen outpatient facilities that are part of the Oncology Nursing Research Network. SAMPLE: A convenience sample of 97 outpatients who were actively being treated for breast cancer. METHODS: Patients completed a demographic questionnaire, a cancer pain questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale--Cancer. Patients' medical records were reviewed. MAIN RESEARCH VARIABLES: Pain intensity, pain duration, changes in ADL, changes in mood, and changes in QOL. FINDINGS: Forty-seven percent of the patients with breast cancer reported experiencing cancer-related pain. Patients with cancer-related pain had significantly higher mood disturbance scores and significantly lower QOL scores. CONCLUSIONS: Pain is a significant problem for outpatients with breast cancer that negatively affects mood, QOL, and functional status. IMPLICATIONS FOR NURSING PRACTICE: Future research is needed to determine the most effective strategies for treating pain associated with breast cancer. In addition, oncology nurses should perform ongoing assessments of patients' pain and the impact of the pain on various aspects of patients' lives.

Activities of Daily Living↗

PubMed1995

Perceptions of the mammography experience.

The 1993 projections for breast cancer indicate a morbidity of 183,000 women with a mortality rate of 18%. Mammography is one of three approaches available for the early detection of breast cancer. However, underutilization has been reported and attributed to pain associated with the procedure, the expense to the consumer, and lack of referral by physicians. Other reasons for the low utilization rates include fears on the part of the woman of a positive diagnosis, radiation, and a possible mastectomy. This study provides an analysis of the responses of a convenience sample of 272 women, aged 30-90 years, to two open-ended questions about the mammography experience. The words and phrases women used to describe the mammography experience and the sensations experienced in their breasts during mammography were subjected to content analysis. The results of this study suggest that the word descriptors women use to describe their experience during mammography are highly individualistic and may not be totally captured by numeric or descriptive rating scales of pain intensity.

Adult↗