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How did you get into nursing? Pain
research?
I've always wanted to be a nurse, starting out as a
candy striper in high school and, after graduation,
went on to nursing school. It is what I've always wanted.
Getting into pain research is a harder, more personal
story. In the late '70s, my father had head and neck
cancer. He died in horrific pain. I knew something was
needed, but at that time didn't know what it could be.
When I finished my master's degree in nursing, I worked
with a neurologist at our hospital to develop a pain
management service for inpatients and outpatients. This
service provided care for patients with acute and chronic
pain problems.
What did you find out about gender differences of pain
perception in your research?
We were lucky to be able to evaluate how analgesics
work using an acute pain model of wisdom teeth extractions.
We worked with opiates and found that women get better
analgesic effects from those drugs than men. This work
opened up a field of research that had been previously
overlooked. Other researchers now are looking at painful
stimuli and finding that women are more sensitive to
painful stimuli.
What did you find in your research
regarding around-the-clock dosing vs. PRN for those
with chronic pain?
As part of a study that was testing the effectiveness
of a nursing intervention to improve cancer pain management,
we evaluated how well patients with cancer-related pain
adhered to their analgesic regimen. We found that if
patients were prescribed an analgesic on an around-the-clock
basis, they took 90 percent of the dose that was prescribed.
On the other hand, if patients were prescribed analgesics
on an as-needed basis, they took only 21 percent of
the total dose of pain medication. These findings were
published in the Journal of Clinical Oncology last year.
What are some of your thoughts on end-of-life
pain management?
All pain is multidimensional with physical, emotional,
spiritual, social and psychological dimensions. Palliative
care encompasses all those aspects of care.
Is it more important for some to interact with family
members and friends? Clinicians need to find the appropriate
balance between effective analgesics with minimal side
effects. Unfortunately, we have no pain medication that
is without side effects, so again, balance is the goal.
How efficient is pain assessment in
today's health care environment?
Pain education is still inadequate. In 2000, the JCAHO
said that all hospitals would be required to provide
training in pain assessment. This increased the effort
to teach about pain and treat it. Most hospitals today
have an initial assessment protocol in place. A typical
one covers:
- Description: What does it feel like?
- Location: Where is the pain?
- Severity: How bad is the pain?
- Aggravating and relieving factors: What helps? What
makes it worse?
Most institutions also have an approach for ongoing
assessment using a numeric scale (0 being no pain and
10 being the worst pain imaginable). Providers try to
judge efficacy according to that measurement.
What research studies do you anticipate?
I want to look at additional aspects of cancer pain
management and refine the work already done, especially
around multiple symptoms.
One thing we're looking into is strategies to improve
the management of pain and fatigue and sleep disruption
and experience how these affect one's quality of life.
Another study I'm anticipating is to look at pain
symptoms after breast cancer surgery.
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