RELATIONSHIP OF PAIN SEVERITY, DEPRESSION AND OPIOIDS RELATED SIDE EFFECTS TO FATIGUE IN CANCER PAIN POPULATION

2.50
Hdl Handle:
http://hdl.handle.net/10755/165280
Category:
Abstract
Type:
Presentation
Title:
RELATIONSHIP OF PAIN SEVERITY, DEPRESSION AND OPIOIDS RELATED SIDE EFFECTS TO FATIGUE IN CANCER PAIN POPULATION
Author(s):
Hwang, Shirley; Xia, Qi; Chang, Victor; Hoover, Donald; Srinivas, Shanti; Kasimis, Basil
Author Details:
Shirley Hwang, RN, MS, East Orange, New Jersey, USA; Qi Xia, MS; Victor Chang, MD; Donald Hoover, PhD; Shanti Srinivas, MD; Basil Kasimis, MD
Abstract:
We identified a potential causal relationship among pain, opioid side effects (SEs) and depression in relation to fatigue. We previously reported that pain, depression and other symptoms independently predicted fatigue (Hwang, JPSM; 2003:604-614). To conceptualize symptom oriented management of fatigue, we investigated causal relationships of pain, depression, SEs and KPS to fatigue in cancer pain patients before and after pain management. We used path analysis to evaluate a model in which pain, SEs and KPS were hypothesized to predict fatigue directly, and indirectly through depression at different time points. The longitudinal survey studied 195 cancer pain patients with baseline worst pain > 4/10(median age 68 yrs, range 44-87) who were managed according to AHCPR guidelines. All patients completed the Brief Pain Inventory, Brief Fatigue Inventory, Geriatric Depression Scale and an 18-item SE check list at 4 time points, one week apart. The KPS was assessed weekly. Changes in pain, fatigue, KPS, depression and SEs over time were estimated by mixed effect models. At each time point, we also performed a path analysis to test our hypothesized causal relationship model. Model adequacy was assessed by goodness-of-fit index (GFI). There were significant improvements over the three weeks in mean worst pain (8.4 to 5.1,p<0.0001), usual fatigue (5.4 to 4.2,p=0.001), depression (5.5 to 4.1, p<0.03), and KPS (64.8 to 69, p=0.0005), but mean SEs increased from 2.2 to 2.8 (p<0.0001). Usual fatigue, worst pain, depression and number of SEs correlated significantly with each other at each time point. At day 1, the path analysis found that number of SEs predicted fatigue both directly (b=0.14) and indirectly, mediated by depression, with total causal effect of 0.21, and that worst pain severity (b=0.19) and depression (b=0.28) predicted fatigue directly (GFI=0.99). At each follow-up time point, GFI for this model ranged from 0.93 to 0.98. These results elucidate persistent relationships between pain, depression, SEs and fatigue before and after pain management. In the absence of any effective pharmacological intervention, this provides a conceptual framework for fatigue management in cancer pain patients.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2005
Conference Name:
30th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Orlando, Florida, USA
Sponsors:
Funding Sources: VA HSR&amp;D-PCC 98068.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleRELATIONSHIP OF PAIN SEVERITY, DEPRESSION AND OPIOIDS RELATED SIDE EFFECTS TO FATIGUE IN CANCER PAIN POPULATIONen_GB
dc.contributor.authorHwang, Shirleyen_US
dc.contributor.authorXia, Qien_US
dc.contributor.authorChang, Victoren_US
dc.contributor.authorHoover, Donalden_US
dc.contributor.authorSrinivas, Shantien_US
dc.contributor.authorKasimis, Basilen_US
dc.author.detailsShirley Hwang, RN, MS, East Orange, New Jersey, USA; Qi Xia, MS; Victor Chang, MD; Donald Hoover, PhD; Shanti Srinivas, MD; Basil Kasimis, MDen_US
dc.identifier.urihttp://hdl.handle.net/10755/165280-
dc.description.abstractWe identified a potential causal relationship among pain, opioid side effects (SEs) and depression in relation to fatigue. We previously reported that pain, depression and other symptoms independently predicted fatigue (Hwang, JPSM; 2003:604-614). To conceptualize symptom oriented management of fatigue, we investigated causal relationships of pain, depression, SEs and KPS to fatigue in cancer pain patients before and after pain management. We used path analysis to evaluate a model in which pain, SEs and KPS were hypothesized to predict fatigue directly, and indirectly through depression at different time points. The longitudinal survey studied 195 cancer pain patients with baseline worst pain &gt; 4/10(median age 68 yrs, range 44-87) who were managed according to AHCPR guidelines. All patients completed the Brief Pain Inventory, Brief Fatigue Inventory, Geriatric Depression Scale and an 18-item SE check list at 4 time points, one week apart. The KPS was assessed weekly. Changes in pain, fatigue, KPS, depression and SEs over time were estimated by mixed effect models. At each time point, we also performed a path analysis to test our hypothesized causal relationship model. Model adequacy was assessed by goodness-of-fit index (GFI). There were significant improvements over the three weeks in mean worst pain (8.4 to 5.1,p&lt;0.0001), usual fatigue (5.4 to 4.2,p=0.001), depression (5.5 to 4.1, p&lt;0.03), and KPS (64.8 to 69, p=0.0005), but mean SEs increased from 2.2 to 2.8 (p&lt;0.0001). Usual fatigue, worst pain, depression and number of SEs correlated significantly with each other at each time point. At day 1, the path analysis found that number of SEs predicted fatigue both directly (b=0.14) and indirectly, mediated by depression, with total causal effect of 0.21, and that worst pain severity (b=0.19) and depression (b=0.28) predicted fatigue directly (GFI=0.99). At each follow-up time point, GFI for this model ranged from 0.93 to 0.98. These results elucidate persistent relationships between pain, depression, SEs and fatigue before and after pain management. In the absence of any effective pharmacological intervention, this provides a conceptual framework for fatigue management in cancer pain patients.en_GB
dc.date.available2011-10-27T12:15:43Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:15:43Z-
dc.conference.date2005en_US
dc.conference.name30th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationOrlando, Florida, USAen_US
dc.description.sponsorshipFunding Sources: VA HSR&amp;D-PCC 98068.-
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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