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Verbal description of pain by patients with cancer Gagel, Mike Peter

Abstract

Researchers have demonstrated an incongruence between patients' and nurses' perceptions of pain which may lead nurses to not appreciate or heed their patients' reports of pain. Part of this problem may lie with pain assessment. This descriptive exploratory study was designed to determine what words, similes, and metaphors cancer patients use to describe their pain. The goal was to improve understanding of these patients' descriptions of pain as an essential basis for more accurate cancer pain assessment. Also, the relationship of selected demographic variables (age, level of education, mother tongue, and sex) and present pain intensity with the frequency and types of phrases containing pain descriptors were examined to determine if significant relationships existed. A convenience sample of thirty-one patients at a large cancer treatment facility was asked to describe what pain feels like. The existing database of transcribed interviews was analyzed using content analysis techniques. Coding of descriptor words and phrases was based on dimensions of the Multidimensional Model of Pain (MMP) (Ahles, Blanchard, and Ruckdeschel, 1983; McGuire, 1987). Themes also emerged during data analysis and the following items were coded: similes, metaphors, and the number of times participants expressed difficulty in describing their pain. Data analysis revealed that participants used phrases from the Affective, Behavioural, Cognitive, Physiological, and Sensory Dimensions of the MMP. The most frequently used descriptors matched those used by cancer patients in other studies. The participants spontaneously and frequently used 25 out of 73 descriptors contained in the McGill Pain Questionnaire (MPQ); they also used 26 descriptors not found in the MPQ. Participants primarily used affective and sensory words and phrases to describe their pain. Participants with Grade 12 or higher education used more affective phrases than those with less than Grade 12. Participants who were younger than 65 and those with Grade 12 or higher used more sensory phrases than their counterparts. Participants with Grade 12 or higher also used more similes. The remaining dimensions of the MMP and expressions of difficulty did not present significant differences in the use of descriptor phrases by the study participants. Relationships based on participants' sex and mother tongue were not significant. Participants also used few metaphors to describe their pain. Based on the findings of this study, recommendations for nursing were offered. Namely, attention should be given to patients' descriptions of pain. Older or less educated patients may not use as many phrases to describe pain as younger or more educated patients (even though older patients likely experience the same intensity of pain as others). Pain assessment tools may help overcome differences among patients' ability to describe pain, and nurses should implement these tools in their practice. However, for pain assessment tools to be practical, they must be easy to use and quick to administer. Revision of the descriptor portion of the McGill Pain Questionnaire based on the spontaneous descriptors used by cancer patients, is one area where nurses can contribute to the improved assessment and management of pain in patients with cancer.

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