Placebo: no relief for Ms. Mahoney's pain. Working with the patient, family, and staff to diminish pain.
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Aged↗
Biomedical subjects
Paul Arnstein
Publications and source records attributed to Paul Arnstein.
The debate over placebos in pain management. The ASPMN disagrees with a recent placebo position statement.
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Humans↗
Changing our name: for pain management nursing.
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Humans↗
Chronic neuropathic pain: issues in patient education.
Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of his or her life may be altered, including physical, emotional, and spiritual health, as well as the ability to work, and family and social relationships. Successful treatment plans require more than just pharmacotherapy. Patients often need to receive a lot of information about complex regimens related to both pharmacologic and nonpharmacologic strategies. Additionally, patients with neuropathic pain need nursing support and guidance to help them master the self-management and coping skills required to minimize pain flares, while optimizing mood and functioning. A number of specific strategies are available based on the cognitive-behavioral model. These include the ability to interpret changes in pain in a helpful way, engagement in health promoting behaviors (including diet and exercise), and the development of an action plan for coping with pain exacerbations. A central element in this approach is to help patients become experts in understanding and managing their pain, then addressing the toll it has taken on their emotions, daily activities, and important relationships. Self-initiated techniques, such as relaxation, imagery, and hypnosis, can also be used to alter the subjective experience of pain. This article presents an overview of patient education approaches useful in the management of chronic pain.
Adaptation, Psychological↗
A telomerase-immortalized primary human prostate cancer clonal cell line with neoplastic phenotypes.
Understanding of molecular genetic mechanisms underlying prostate carcinogenesis would be greatly advanced by in vitro models of prostate tumors representing primary tumors. We have successfully established a neoplastic immortalized human prostate epithelial (HPE) clonal culture derived from a primary tumor of a prostate cancer patient (RC-58T) with hTERT, the catalytic subunit of telomerase. The early passage RC-58T cells derived from a radical prostatectomy specimen of a 52-year-old white male patient was transduced through infection with a retrovirus vector expressing the hTERT for the establishment of the RC-58T/hTERT cell line. One clonal line, soft-agar derived from the RC-58T/hTERT cell line, was isolated and further characterized phenotypically and genetically. These clonal (RC-58T/hTERT SA#4) cells are currently growing well at passage 70 and exhibit transformed morphology. The RC-58T/hTERT SA#4 line expressed a high level of telomerase activity and showed anchorage-independent growth in soft agar. The clonal line like the untransduced RC-58T cells (passage 3) expressed prostate specific antigen (PSA), androgen receptor (AR), prostate stem cell antigen (PSCA), and an androgen-regulated prostate specific gene NKX3.1, P16, and cytokeratin (CK) 8. Growth is slightly stimulated by dihydrotestosterone (DHT), and lyates are immunoreactive with AR antibody by Western blot analysis. More importantly, this clonal line produced adenocarcinomas when transplanted into SCID mice. A number of chromosome alterations were observed including the loss of chromosome Y, 1q, 2p, 3p, 4q, 8p, 11p, 14p, 17p and 18q. Our results demonstrate that this primary tumor-derived HPE cell line retained its neoplastic phenotypes and its prostate specific markers and should allow elucidating molecular and genetic alterations involved in prostate cancer. This is the first documented case of an AR and PSA expressing telomerase established human prostate cancer cell line with neoplastic phenotypes from a primary tumor of a prostate cancer patient.
Animals↗
Comprehensive analysis and management of chronic pain.
Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. Addressing the physical effects of persistent pain on multiple systems and bodily functions requires combining (drug and nondrug) interventions to reduce pain and improve functioning. Targeting anxiety, depression and anger effectively can halt or even reverse the escalation of pain attributed to emotions. Recognizing belief patterns associated with distress and disability, while challenging patients to rethink the truthfulness of their perceptions is an important step in helping patients think, feel, and do better. Eliciting self-reflective narratives about the context of pain in their lives taps into the spiritual domain and initiates processes of grieving, forgiveness, and acceptance that are needed to transcend perceived limits and find new meaning in their lives. By attending to social interactions, including therapeutic relationships, chronic pain patients can become more independent and involved in family or socially meaningful activities. Combined, nurses can help patients restore joy, functioning, and a sense of purpose despite the devastating toll persistent pain has taken.
Activities of Daily Living↗
A novel neoplastic primary tumor-derived human prostate epithelial cell line.
Research into molecular and genetic mechanisms underlying prostate carcinogenesis would be greatly advanced by in vitro models of prostate tumors representing primary tumors. The generation of immortalized primary prostate cancer cells that will accurately reflect the in situ characteristics of malignant epithelium is greatly needed. We have successfully established a neoplastic immortalized human prostate epithelial (HPE) cell culture derived from a primary tumor. The RC-9 cells transduced through infection with a retrovirus vector expressing the E6 and E7 genes (E6E7) of human papilloma virus-16 (HPV-16) are currently growing well at passage 40, whereas RC-9 cells senesced at passage 7. RC-9/E6E7 cells exhibit epithelial morphology and high level of telomerase activity. More importantly, these immortalized cells produced tumors (SCID5038D) when inoculated into SCID mice. RC-9/E6E7 cells and SCID-5038D cells exhibit a high level of telomerase activity and androgen-responsiveness when treated with R1881. Expression of prostate specific antigen (PSA), androgen receptor (AR), prostate stem cell antigen (PSCA), an androgen-regulated prostate specific gene (NKX3.1), p16, cytokeratins 8, 15 and HPV-16 E6 gene was detected in both of these cells. RC-9/E6E7 and SCID5038D cells also showed growth inhibition when exposed to retinoic acid and transforming growth factor (TGF)-beta1, potent inhibitors of prostate epithelial cell growth. A number of chromosome alterations were observed including the loss of chromosomes 2p, 3p, 8p, 13, 14, 16, 17, 18, 21 and the gain of 7 and 20 in the tumor cell line (SCID5038D). These results demonstrate that this primary tumor-derived HPE cell line retained its neoplastic phenotypes and its prostate-specific markers and should allow studies to elucidate molecular and genetic alterations involved in prostate cancer. This is the first documented case of a malignant AR and PSA positive established human prostate cancer cell line from a primary tumor of a prostate cancer patient.
Animals↗
Optimizing perioperative pain management.
All nurses, regardless of specialty or practice setting, must provide effective measures to relieve their patients' pain. Uncontrolled pain can result in negative consequences, such as impaired cardiac functioning and neuroplastic changes in the spine and brain. This article discusses the problem of uncontrolled pain and perioperative nurses' role in relieving pain, including assessing pain and providing pharmacological and nonpharmacological relief.
Analgesics↗
From chronic pain patient to peer: benefits and risks of volunteering.
Peer volunteers have been used as cost-effective adjuncts to professional services in other settings and populations, but not a heterogeneous sample of patients with chronic pain. This study evaluated the transition from "patient" to "peer," identifying possible benefits or harm associated with volunteering. Peers provided descriptive data and questionnaires, including measures of pain, disability, self-efficacy, and depression before and after three periods: as a patient, during training, and while volunteering. Average pain intensity scores declined while participants were patients (7.1 to 4.2), rose slightly (5.8) before training, and dropped again after training and volunteering (4.3 and 3.6, respectively). A similar pattern was noted for disability. Depression scores continued to decline after initially dropping, and self-efficacy scores remained stable after the initial 40% rise as a patient. Two themes, "making a connection" and "a sense of purpose," emerged from the narrative data. Descriptive data provided further support that volunteering benefited both patients and peers. This study supports the viability of using peer volunteers for clinical or research endeavors. Improvements in pain, disability, and depression were reported immediately after training and after volunteering for several months without evidence of harm. Despite encountering challenges, the rewards of this altruistic endeavor outweighed any frustrations experienced by volunteers with chronic pain.
Adaptation, Psychological↗
Nurse-led pain management program: effect on self-efficacy, pain intensity, pain-related disability, and depressive symptoms in chronic pain patients.
Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if changes were significant. Z-scores were then calculated. Pearson product moment correlations were examined to test the association between changes in self-efficacy and changes in the other variables of interest. Patients in this study reported significant improvements in all scores postprogram. Self-efficacy, pain-intensity, pain-related disability, and symptoms of depression can be changed through participation in a nurse-led outpatient CBT program. In concert with results from other research on CBT pain programs this study provides further evidence that reduction in suffering and improved sense of well-being is possible even for people who have experienced pain for many years.
Activities of Daily Living↗
Effects of integrating therapeutic touch into a cognitive behavioral pain treatment program. Report of a pilot clinical trial.
The purpose of this study was to investigate the effects of offering Therapeutic Touch (TT) as an adjunct to cognitive behavioral therapy (CBT) for people with chronic pain. Patients were randomized to relaxation training (control group) or TT plus relaxation (experimental). Subsequently, all participants attended a CBT program. Preprogram and postprogram data were examined to identify patterns of change in pain intensity, self-efficacy, unitary power, disability, and perceived distress. In addition, patterns of attrition were examined. Patients in this study who were randomized to receive TT fared better in terms of enhanced self-efficacy and unitary power, as well as having lower attrition rates. Trends associated TT with less distress and disability. This pilot study suggests that offering TT as an adjunct to CBT may help to improve clinical outcomes, reduce program attrition, and promote unitary power in those who suffer with chronic pain.
Adaptation, Psychological↗
Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients.
To clarify the relationships between physical, and psychosocial components of chronic pain, a path analytic model was tested conceptualizing self efficacy as a mediator of disability. In turn, disability was hypothesized to mediate depression. This model could help explain the circumstances under which disability develops and why so many chronic pain patients become depressed. Questionnaires from 126 chronic pain patients (without prior depression) were reviewed from three pain clinics. Hypothesized and alternate models were tested using separate regression equations to identified models which best fit these data. Regression analysis supported that self efficacy partially mediates the relationship between pain intensity and disability. This model accounted for 47% of the explained variance in disability (P < 0.001). Six additional variables that were significantly related to disability in preliminary analysis, added to the explained variance in disability (R2 = 0.56), with gender and pain location paths remaining significant. In separate regression analyses, disability was found to partially mediate the relationship between pain intensity and depression (b = 0.47-0.33). This model accounted for 26% of the explained variance in depression. The addition of self efficacy to this model supported it as a stronger mediator (R2 = 0.32), and suggested that support for disability as a mediator of depression was a spurious finding. Both pain intensity and self efficacy contribute to the development of disability and depression in patients with chronic pain. Therefore, the lack of belief in ones own ability to manage pain, cope and function despite persistent pain, is a significant predictor of the extent to which individuals with chronic pain become disabled and/or depressed. Nevertheless, these mediators did not eliminate the strong impact that high pain intensity has on disability and depression. Therefore, therapy should target multiple goals, including: pain reduction, functional improvement and the enhancement of self efficacy beliefs.
Adult↗