2 results
Spiritual well-being in patients with advanced heart and lung disease
- E. Alessandra Strada, Peter Homel, Sharon Tennstedt, J. Andrew Billings, Russell K. Portenoy
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- Journal:
- Palliative & Supportive Care / Volume 11 / Issue 3 / June 2013
- Published online by Cambridge University Press:
- 30 July 2012, pp. 205-213
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- Article
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Objective:
The purpose of this study was to evaluate levels of spiritual well-being over time in populations with advanced congestive heart failure (CHF) or chronic obstructive lung disease (COPD).
Method:In a prospective, longitudinal study, patients with CHF or COPD (each n = 103) were interviewed at baseline and every 3 months for up to 30 months. At each interview, patients completed: the basic faith subscale of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) questionnaire, the Memorial Symptom Assessment Scale (MSAS), the Rand Mental Health Inventory (MHI), the Multidimensional Index of Life Quality (MILQ), the Sickness Impact Profile (SIP), and the Short Portable Mental Health Questionnaire (SPMSQ).
Result:The mean age was 65 years, 59% were male, 78% were Caucasian, 50% were married, 29% lived alone, and there was no significant cognitive impairment. Baseline median FACIT-Sp score was 10.0 on a scale of 0–16. FACIT-Sp scores did not change over time and multivariate longitudinal analysis revealed higher scores for black patients and lower scores for those with more symptom distress on the MSAS-Global Distress Index (GDI) (both p = 0.02). On a separate multivariate longitudinal analysis, MILQ scores were positively associated with the FACIT-Sp and the MHI, and negatively associated with the MSAS-GDI and the SIP (all p-values < 0.001).
Significance of results:In advanced CHF and COPD, spiritual well-being remains stable over time, it varies by race and symptom distress, and contributes to quality of life, in combination with symptom distress, mental health and physical functioning.
26 - Neuropathic pain
- from SECTION IX - DIFFICULT PAIN PROBLEMS
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- By RICARDO A. CRUCIANI, Beth Israel Medical Center, E. ALESSANDRA STRADA, Beth Israel Medical Center, HELENA KNOTKOVA, Beth Israel Medical Center
- Edited by Eduardo D. Bruera, University of Texas, Houston, Russell K. Portenoy, Albert Einstein College of Medicine, New York
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- Book:
- Cancer Pain
- Published online:
- 06 July 2010
- Print publication:
- 12 October 2009, pp 478-505
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- Chapter
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Summary
Introduction
Effective pain management in patients with cancer is an essential component of care during active treatment, as well as in palliative and end-of-life care. Chronic pain occurs frequently in patients with cancer, with an estimated prevalence that ranges from 40% to 60%. Pain may be caused by direct tumor infiltration of neural structures or by treatment sequelae. Although the prevalence of pain in the outpatient setting is 20%–40%, it may rise to 80% for patients at the end of life. However, several prospective studies suggest adequate pain control could be achieved in 90% of patients by following the World Health Organization guidelines.
Because pain is ultimately a perceptual construct within the central nervous system (CNS), a patient's experience of pain is a result of complex somatosensory processing. Developing understanding of the physiological and biochemical processes involved in pain, combined with an appreciation of the cognitive, emotional, and cultural framework of the patient offers the best opportunity to provide treatment of underlying mechanisms and relief of suffering.
Even though most patients initially report somatic or visceral pain, they also frequently experience painful neuropathic components. Management of neuropathic pain presents a number of challenges, because it is often more resistant to conventional analgesic approaches. Mixed pain problems, in which neuropathic pain is combined with elements of somatic or visceral pain, are also common. Neuropathic pain may also signal progressive and often incurable disease.