Christine Miaskowski, on pain management

By Bree LeMaire MS, RN
July 10, 2003

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.