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WELL-BEING IN CHRONIC PAIN:
CONTRIBUTORY FACTORS TO MULTIDIMENSIONAL AFFECT AND PAIN SURVEY (MAPS) SUPERCLUSTER 3

Linda Bates, Denis Martin,: Hafrun Gudnundsdottir, John Ravey & Wilma Steedman. Pain Association Scotland, Cramond House, Edinburgh EH4 6NS, UK; Scottish Network for Chronic Pain Research, Queen Margaret University College, Edinburgh, EH6 8JW, UK:.University of Ulster.

Aims: To investigate the relationship between the "Well-Being" dimension described by MAPS, and other measures related to chronic pain.

Methods: In a postal survey, 16 out of 18 chronic pain sufferers, aged 25-65 (8 females), from a community-based pain management group (Pain Association Scotland) returned a composite questionnaire containing MAPS* (questionnaire derived from cluster analysis addressing the perceptual dimensions of 1. Sensory, 2. Suffering and 3. Well-being) and the following:- Pain Beliefs and Perceptions Inventory (PBPI), Chronic Pain Grade Questionnaire (CPG), SF-36 General Health Questionnaire, [Pain] Coping Strategies Questionnaire (CSQ), Pain Self-Efficacy Questionnaire (PSEQ) and Survey of Pain Attitudes -Revised (SOPA(R)). Correlation coefficients were calculated between MAPS supercluster 3 (Well-being) and all other variables.

Results: The strongest evidence for a positive correlation with MAPS Well-being (3) supercluster was found with Perceived Self-Efficacy (PSEQ); p<0.05, r =0.573, r2 =0.33. No statistically significant correlations were found apart from this. However, possible relationships were found between subclusters of "Well-Being" (notably mental and physical activities - the others being 'treatable illness', 'positive affect' and 'affiliative feelings'), and other variables.

Conclusions: The presence of a "well-being" dimension of pain, independent of sensory aspects or suffering is evident in this sample. The concept of "well-being" appears to have a definition, albeit incomplete, in terms of self-efficacy, and perceptions of being involved and active in pain management. This study has begun to address the relatively amorphous concept of "Well-Being" in MAPS, and findings will be tested as part of a larger study.

Acknowledgements: Funded by an National Lottery Charities Board Health and Social Research Grant.

* Clark, W.C. (1999); Pain, Emotion and Drug Induced Subjective States: Analysis by Multidimensional Scaling. In Encyclopaedia of Neurosciences, 2"'1 edition, (Eds.) J Adelman and B H Smith, New York, Elsvier.

EPIDEMIOLOGY OF MIGRAINE IN NOVOSIBIRSK

S.S. Pavlenko Regional Pain Medical Center. Novosibirsk, 630087. Russia

Aim of investigation: Determination of the prevalence of migraine among urban population of Western Siberia and risk factors contributing to its development.

Methods: The research was carried out by means of a poll with the use of a questionnaire that included IHS criteria for migraine and demographic, social and psychological aspects. The randomized sample included 642 citizens of Novosibirsk in the age of 18 to 84.

Results: 88.4% of respondents took part in the research. Prevalence of migraine in the sample was 7.8%, migraine with the aura, 4.2%. Among men it was 2.5% and among women, 11 6%. The average age of patients in years was 41.5±12.3, the age of disease onset was 22.7±10.3. A confident prevalence of migraine was observed among people in the age under 30, divorced, employed, non-smokers and those encountering occupational risk factors. Among the latter group the most significant were psychological stresses, hard physical labor and work related with the body being repeatedly bent downwards. A factorial analysis showed that migraine is related to social status, quality of life and divorce in the family. Fatigue, inability to relax, feeling of sadness and guilt were found playing the leading part. 85.7% of those suffering from migraine had been using medicines on the regular basis but only 43.2% of them visited the doctor. As the most frequent reasons of that were called disbelief in medical aid (34.1%) and impossibility to leave the job (27.2%). The greatest hopes for improvement were associated by patients with efficient medicines (39%) and doctor's qualification (37.3%).

Conclusions: Prevalence of migraine in Novosibirsk is the same as in most countries. The lack of efficient medicines, trained specialists and a system of specialized aid, however, leads to the decrease in quality of life and social status and economic losses.

PAIN AMONG PATIENTS WITH CANCER: AN EPIDEMIOLOGIC STUDY

L Copel, M Esteve, S Earthier, S Carayon, B Asselain, J Vedrenne
(1) Palliative and Supportive Care Unit
(2) Anaesthesiology department (1) Statistic Department
Institut Cune, 75005 Paris FRANCE

Aim of Investigation: to realise an epidemiological transversal study about pain among our cancer patients in our Comprehensive Cancer Centre

Methods: During a day on December 1999 a questionnaire was given to every patient (day care and hospitalised) asking them specific questions related to pain Out of the 731 questionnaires given 471 were analy sable

Results: 40% of the outpatients complained of pain at least one time during the last 2 weeks (142) versus 81% of the hospitalised patients (94)

In 70% of the cases they blamed the cancer for the pain The cause of the pain was different from the outpatients to the hospitalised patients respectively due to the treatment in 63% versus 55 4%, due to the progression of cancer in 18 5% versus 27 7% and both causes in 3 3% versus 9 2%, other cause in 15 2% versus 7 7% Among the outpatients only 8% were painful for more than one month versus 20% among the hospitalised patients On a Verbal Category Scale the intensity of the pain was about the same in both groups 31 4% of the outpatients had an important pain and 10% had a very important pain versus 30 2 and 11 6 among the hospitalised patients Surprisingly this pain provoked less insomnia among the hospitalised patients (38 6%) than among the outpatients (50%)

Conclusion: These results show that pain is more frequent than usually thought and had to be searched to a better care and a better quality of life ot our patients

A PROSPECTIVE SURVEY OF BREAKTHROUGH PAIN (BTP) IN CANCER PATIENTS: PATIENTS (Pts) AND MEDICAL TEAM POINT OF VIEW

M Pi Palma, P Poulain, M Filbet, F Lakdja, S Toussamt, C Minello, L Hacpille , J Bruxelle B Falissard P Pelat, and the BTP French Study Group P Brousse Hosp, 94800 VillejUlf , IGR, Villejulf , Val d Azergues Hosp, Alix Inst Bergonme Bordeaux , Centre A Vautnn, Nancy C Nicolle Hosp, Rouen Tamier Hosp Pans , Lab L Lafon, Maisons-Alfort, France

Aim of investigations: To prospectively assess characteristics of BTP in cancer pts and evaluate its incidence as viewed by medical teams

Methods: Pts treated with stable doses of long acting opioids for chronic cancer pain were asked to fill an 1 week diary, recording for each BTP episode (BTPe) the time at onset, duration, pain intensity (using a 4 item verbal rating scale-VRS), treatment and level of pain relief ( 6 item VRS) In the same Centers nurses and physicians were asked about their evaluation of BTP incidence

Results: 203 patients from 17 Centers were included, 183 were evaluable, 22 88 years of age (median 58), 81 2% had at least 1 BTPe during the week overall, 1405 BTPe were reported the mean number of episodes per day was 1 1 the mean number of days with BTPe was 3 8 and 28 5% of the patients had BTPe every day The duration of the BTPe was less than 30mm for 46 5% of the episodes Pain was rated as severe or not tolerable in 54% of the BTPe more than 70% of BTPe were treated with a specific medication pain relief was unsatisfactory in 30% of the cases In the opinion of nurses and physicians (n=197) BTP concerns 5 to 100% ot their pts (median 30%)

Conclusion: BTP is frequent and very often severe in cancer pts This problem is generally underestimated even by medical teams expenenced in pain therapy

Acknowledgements: Supported by Laboratoire L Lafon Dr di Palma is a consultant for this company

"TOWARDS A PAIN-FREE HOSPITAL" CAMPAIGN

M. Visentin e L. Trentin, Servizio di Terapia del Dolore e Cure Palliative - Ospedale S. Bortolo - U.L.S.S. 6 Vicenza (ITALY)

Aims of investigation:

1. Evaluation of the prevalence, intensity and treatment of pain in a broad cross-section of Italian hospitals.

2. Assessment of agreement between patients' perceived pain and caregivers' evaluation.

3. Assessment of caregivers' knowledge of pain and their attitudes, by means of a questionnaire.

4. Improvement of knowledge and attitudes to pain by means of an awareness campaign and training courses.

Methods: In order to gather data on the prevalence of pain all patients who have been in hospital for at least 24 hours, and who give their consent, will complete a questionnaire on a given day. The aim is to collate information on the use of analgesics and how they taken during a patient's stay in hospital; using a visual analogic scale, patients and nurses will be asked to quantify the intensity of patients' perceived pain at the moment of the survey and over the previous 24 hours.

The assessment of attitudes to and knowledge of pain will be made by means of a questionnaire, to be completed anonymously by all nurses and doctors in the hospitals taking part in the project. The psychometric features of the questionnaire have been assessed in a pilot study.

To improve knowledge and behaviour towards pain, patients and their relatives will be made to understand that pain is a symptom which must be attended to, and which must be diagnosed and treated promptly, and they will be made aware of the existence of the pain Therapy Unit in their hospital. Doctors and nurses will be given illustrative matenal to increase awareness of possible pain treatment. Conferences will be held for all caregivers and the general public.

Conclusions:

1. An Italian data base on the perception of pain in hospitals.

2. An evaluation of the prevalence and various treatments of pain in hospitals.

3. An evaluation of attitudes and knowledge of pain among caregivers.

4. An improvement in the treatment of pain in hospitals.

5. Awareness among the general public.

OPTIMISATION OF ANTI-PAIN MEDICAL ASSISTANCE IN RUSSIA

S.S. Pavlenko, G.I. Fomin, A.D. Nekrasov. Regional Pain Medical Center, Novosibirsk, 630087 Russia

Aim of investigation: To investigate the requirements for providing specialized anti-pain medical assistance and prospects for its organization in Russia.

Methods: Epidemiological study of prevalence of pain and analysis of activity of existing anti-pain medical institutions.

Results: Epidemiological study of prevalence of pain syndromes has been performed in a randomized sample of 565 persons over 18 years old from population of Novosibirsk. The pain prevalence accounted for 92,4%, whereas chronic pains did 44,1%. It was found that 57% of respondents considered ineffective the medical assistance and tried to relieve pain on their own. The main difficulties in organizing the specialized anti-pain medical assistance lie in the following.

1. Strict regulation of medical institutions by the state public health system.

2. Organization of public health service according to the nosology principle.

3. Dogmatic views of medical doctors on vertebrogemc origin of most chronic pain syndromes.

4. Lack of methods of behavioral and cognitive-behavioral therapy in somatic clinics.

5. Mentality of population connected with an aspiration for social guardianship and rental orientations.

Conclusions: The structure of specialized interdisciplinary anti-pain medical assistance should comply with the system of staged medical assistance existing in Russia. It is necessary to reorganize the available structural subdivisions and to combine them with new forms of property in public health institutions. It is also essential to provide a training for specialists in the field of pain curing.

Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 338, 351, 355, 358, 363, 368.

   

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