Everyday Pain Research Articles

Exploring the link between gastrointestinal complications and over-the-counter analgesics: current issues and considerations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely used classes of drug worldwide, with as many as 8% of the global adult population taking prescription NSAIDs at any given time. It is well documented that NSAID-related gastrointestinal (GI) effects are a significant cause of morbidity and mortality. Data from Australia alone suggest that each year there may be as many as 2300 serious GI complications and 300 deaths. Risk factors for NSAID-related GI complications have been established and can be broadly divided into two groups: uncontrollable factors, which include elements such as age, gender, comorbidity, and a history of GI conditions, and controllable factors, such as the dose, type, and duration of NSAID treatment and cotherapy and possibly Helicobacter pylori infection. The increasing trend toward self-medication raises questions about the potential for GI complications with OTC doses of NSAIDs. Although there is some evidence that the frequency of GI complications with OTC doses may be less than that seen with prescription doses, it still exists. At present, there is insufficient evidence to determine the population attributable risk associated with their widespread use. Emerging data and factors that confound their interpretation are discussed. Given that the data are limited, a clear picture of the true extent of GI complications with OTC NSAIDs is not yet available. In light of our current understanding and because paracetamol continues to demonstrate a favorable side-effect profile, it remains a first-line analgesic for everyday pain.

Mammography Pain in Women Treated Conservatively for Breast Cancer

Abstract: In this study, pain during mammography in women treated conservatively for breast cancer was examined. It studied pain intensity and its relation to a variety of demographic, medical, and pain coping variables as well as to objective measures of breast compression. Ninety-nine women, treated with lumpectomy (with or without radiation) and undergoing follow-up screening mammography, were asked about strategies they use to cope with everyday pain and then were asked to report pain experienced during the mammogram. Treated and untreated breasts were rated separately and compared with a sample of 125 control women with no history of breast cancer. Women reported significantly greater pain in the treated breast (41% greater than the untreated breast and 32% greater than the control group). There was no consistent relationship between mammography pain and pain coping. Average intensity of pain at last mammogram was the best predictor of pain in both breasts. Women treated conservatively for breast cancer experience significantly greater pain during mammography of their treated breast. Radiologists and technologists can identify women at risk for a painful mammogram by asking about the pain at last mammogram. By applying pain-reducing interventions, they might be able to make the mammography experience more tolerable for these women.

Remembering an everyday pain: the role of knowledge and experience in the recall of the quality of dysmenorrhoea

The ability to describe the quality of a previous pain may be thought to be better if one had experienced that particular pain because information stored in episodic and/or semantic memory is available rather than if one had not and could only guess what the pain may be like on the basis of information stored in semantic memory. However research has shown that not only is the quality of labour pain poorly recalled by women who have given birth but also it is no better described by them than by women who have never given birth at all. In order to replicate this effect for an everyday pain, the ability to recall the quantity and the quality of dysmenorrhoea was measured in two groups of women. One group regularly experienced dysmenorrhoea, the other had never experienced it. Analysis of the pain intensity scores revealed that the ‘pain’ group reported significantly less pain 2 weeks later whereas the ‘no-pain’ group did not significantly differ in their rating over time. Analysis of the MPQ Descriptors chosen by subjects using Cohen's kappa resulted in ‘fair’ recall for both groups with no significant advantage for the ‘pain’ group. These results suggest that the episodic memory system plays a limited role in facilitating the recall of the quality of an often experienced pain. However the semantic memory system allows both previous pain sufferers and pain guessers to describe the core qualities of a pain to the same extent. Further research is required to explain why remembering the quality of a pain experience is not advantaged by episodic memory and what facilitates the transfer of a pain experience into semantic event memory.

Pain in children with significant neurological impairment.

The pain experience in the child with a significant neurological impairment is complex and confusing, and it raises many questions about the very nature of pain itself. Early work in this field suggests that the pain experience may be blunted. The neurological impairment associated with conditions such as cerebral palsy may alter the neurological system and hence the ability to comprehend and communicate pain; there is no evidence to date that this reflects true pain insensitivity or indifference. From recent work, the emerging body of evidence supports a relationship between the pain system and the motor, sensory, and autonomic systems and demonstrates how alterations to these systems may have a profound and unique impact on the pain experience. Beyond the altered neurological substrate, communication disabilities and social/environmental factors also seem to alter the pain experience. Establishing a clear pain history, including baseline information of child-specific patterns of behaviors and ongoing comparative use of this information over time, can provide clinically meaningful measures. Pain management should be directed at the underlying sources of pain and should include the analgesic ladder for everyday pain, opioids for acute/procedural pain (+/- benzodiazepine adjuvants), and antispasticity medications for high tone. With appropriate monitoring, demand and regional analgesic techniques can provide effective and safe postoperative pain control. The lack of basic and clinical knowledge in this field, however, adds another challenge to the clinician.

A Danish adaptation of the Pain Coping Questionnaire for children: preliminary data concerning reliability and validity

The aim of this study was to determine the reliability and validity of a Danish translation of the Pain Coping Questionnaire (PCQ) for children in Danish children. The PCQ was translated using a translation‐back‐translation method. The subjects were 352 healthy children and 40 children with juvenile arthritis (JA), aged 8–17 y. Sixteen of the JA children were divided into a high‐pain group (n= 7) and a low‐pain group (n= 9). The results were factor analysed using principal component analysis with varimax rotation. Clinical pain intensity was measured using visual analogue scales (VAS) from the Varni/Thompson Pediatric Pain Questionnaire. Experimental pain was induced using a cold pressor pain paradigm and outcome measures were pain intensity, pain discomfort and tolerance to cold pressor pain. A seven‐factor solution emerged as the most consistent factor structure. Four subscales, Seeking Social Support (SSS), Cognitive Distraction (CD), Externalizing (EXT) and Internalizing/Catastrophizing (INT), corresponded with the parallel subscales proposed by Reid et al. (Pain 1998; 76: 83–96). Two subscales, Positive Self‐Statements (PSS) and Behavioral Distraction (BD), were composed of four of the five items from the previously proposed subscales. One subscale, Information Seeking/Problem Solving (IP), consisted of items from two subscales proposed by Reid et al., i.e. Information Seeking and Problem Solving. Internal consistencies of the subscales were acceptable, with reliability coefficients ranging from 0.60 (BD) to 0.83 (IP) and with test‐retest reliabilities between 0.59 and 0.78. Low‐pain JA patients showed significantly higher levels of BD than High‐pain JA patients (p < 0.05). Greater utilization of PSS and BD was associated with less patient‐reported present pain and less average everyday pain (p < 0.05‐0.01), and greater utilization of INT was significantly associated with higher experimental pain intensity (p < 0.01). These preliminary findings provide support for the reliability and validity of the Danish modification of the PCQ in a Danish population and for the hypothesis that paediatric pain‐coping strategies are associated with the intensity of clinical and experimental pain.

Everyday Pain in Three‐ to Five‐Year‐Old Children in Day Care

A new event sampling instrument, the Dalhousie Everyday Pain Scale, was used to observe 50 children in six day care centres in Saskatoon for an average of 2.24 h each. The nature of minor painful incidents (eg, collisions and falls) was recorded, including distress behaviours and responses from peers and adults. Twenty‐nine children (58%) were observed to experience one or more painful incidents, producing a total of 51 incidents and yielding a median rate of incidents of 0.31 per child per hour, a rate similar to that reported in another Canadian sample. Seven of nine child response items met criteria for reliability in a subsample of incidents observed simultaneously by two observers. Rubbing the affected body part, crying and making verbal statements about the injury were the most common responses to painful incidents. Intervention by day care staff was strongly associated with children′s facial expression of distress: physical and first aid interventions were offered most frequently to children who displayed the greatest facial distress. Content analysis of observers′ records produced a classification scheme for causes of painful incidents. Twenty per cent of painful incidents were judged to be the result of deliberate actions by other children. The classification of causes may be a useful addition to the scale for application in future studies of everyday pain and injury prevention.

‘Booboos’: the study of everyday pain among young children

Three- to 7-year olds were observed in their day cares to determine the prevalence and nature of incidents of everyday pain (e.g. bumps, cuts, and scrapes). An observational checklist was used to record information on the behavioral responses of child and caregiver. The checklist showed excellent interrater reliability and supported the validity of the pain measure used. No age or sex differences in the incidence or severity of everyday pain were found. However, girls engaged more often in distress responses and received more physical comfort from adult caregivers. It was concluded that girls have a vocal response style which elicits responses from adult caregivers. No significant effect of age was found on intensity or duration of distress or on adult response, but frequency of help-seeking behaviors was found to decrease with age. Limited effects of age may be due to the age range restriction of 28–81 months. Analyses of temperament indicated that less adaptive children were more agitated prior to a pain incident. Analysis of behavioral context demonstrated that larger groups of children display a higher level of activity and individuals in the group display higher levels of agitation. Personal control of the child during a pain incident decreased within larger groups and increased with a high level of activity. Finally, it was found that children who experienced ‘booboos’ most often also responded to them most strongly, suggesting that increased exposure to this type of pain may lead to sensitization, rather than desensitization.

A review of evidence about factors affecting quality of pain management in sickle cell disease.

To assess the evidence for pharmacological, behavioural, and interpersonal influences on quality of pain management in sickle cell disease. English-language reports from the research literature up to 1995, identified using Medline, Psychlit, and the Bath Information Data Service. Studies are reviewed that (a) reported quantitative clinical outcomes for particular analgesic methods used to treat painful episodes or (b) provide data on patient factors, interpersonal treatment factors, or levels of drug dependence in relation to pain management in sickle cell disease. Findings vary on the effectiveness of longer-acting opiates, patient-controlled or continuously infused analgesia, and behavioural analgesic techniques, with better results for trials where interpersonal aspects of pain management were also addressed. Risks for poorer pain management are greatest for patients in adverse social circumstances, who are more severely affected by painful episodes and who are poorly adjusted and have less effective personal strategies for coping with pain, but the limited evidence on drug dependence indicates very low levels by comparison with risk and exposure factors. Analgesic methods and approaches should continue to be developed and evaluated, but conflicting perceptions between patients and staff about pain that is reported and analgesia that is required probably contribute most to poor pain management in sickle cell disease. Promising areas for future research include the assessment of patients' everyday pain coping styles and patterns of drug use in relation to their hospital experiences of pain management, and the evaluation of psychological interventions to improve patients' styles and strategies for coping with pain.

Pharmacologic management of acute and chronic pediatric pain.

Nurses traditionally have encountered a number of clinical problems in the area of pharmacologic management of pediatric pain. Many of the problems result from inadequate information about pediatric pain as a whole while others center around the changing knowledge base of pharmacology. This article will address 1) common everyday pediatric pain problems and their solutions, 2) clinical roadblocks encountered when requesting analgesics or a change in analgesics, 3) common analgesic errors, 4) pediatric procedure pain, 5) the causes of cancer pain and the pharmacologic approaches to them, and will provide 6) a limited amount of information concerning specific analgesics. The article also briefly discusses the pharmacologic problems encountered by nurses who deal with chronic nonmalignant pain.

The everyday pain of racism of Brazilian black women and the effect of counterintuitive ads for its reduction: a Grounded Theory study

This paper presents an explanation proposal about the meaning links that are produced when there is interaction of Brazilian women with counterintuitive ads, which show Afro-American women as protagonists of their discourses. It is a qualitative investigation oriented by the theoretical interconnection of perspectives of symbolic interactionism and mediatization studies, as basilar theoretical referential, and through the constructivist grounded theory, as a methodological approach. The results of this research enabled the articulation of the representative theoretical model “The Interaction experiences of Brazilian women with counterintuitive ad", from which this paper presents the core category “The everyday pain of racism of Brazilian black women and the effect of counterintuitive ads for its reduction”.

A land of lotus-eaters?

With the popularization of the psychotropic drugs, the author observes, a peculiar aberration has entered into public thinking: everyone nowadays expects to be happy. Pills have come to be regarded as a means to do away with the everyday anxieties and pain that have long served as spurs to human progress by leading to constructive action. This new view of unhappiness as a wholly negative and unnecessary emotion, the author suggests, is in need of reevaluation.