A placebo is an inert substance or a pseudo-therapeutic procedure believed to have no biological ... more A placebo is an inert substance or a pseudo-therapeutic procedure believed to have no biological effect on health. Perplexed researchers and clinicians have observed powerful therapeutic effects experienced by patients receiving these inactive treatments. These desirable “placebo effects” are an outgrowth of the skilled application of the therapeutic arts and the mobilization of natural, intrinsic healing powers. This article reviews how healthcare professionals can modify the environment, treatments or professional practices to add therapeutic value to their interventions while tapping into the patients’ innate ability to help comfort and heal themselves.
Pain management nursing : official journal of the American Society of Pain Management Nurses, 2004
Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of... more Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of his or her life may be altered, including physical, emotional, and spiritual health, as well as the ability to work, and family and social relationships. Successful treatment plans require more than just pharmacotherapy. Patients often need to receive a lot of information about complex regimens related to both pharmacologic and nonpharmacologic strategies. Additionally, patients with neuropathic pain need nursing support and guidance to help them master the self-management and coping skills required to minimize pain flares, while optimizing mood and functioning. A number of specific strategies are available based on the cognitive-behavioral model. These include the ability to interpret changes in pain in a helpful way, engagement in health promoting behaviors (including diet and exercise), and the development of an action plan for coping with pain exacerbations. A central element in thi...
Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. A... more Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. Addressing the physical effects of persistent pain on multiple systems and bodily functions requires combining (drug and nondrug) interventions to reduce pain and improve functioning. Targeting anxiety, depression and anger effectively can halt or even reverse the escalation of pain attributed to emotions. Recognizing belief patterns associated with distress and disability, while challenging patients to rethink the truthfulness of their perceptions is an important step in helping patients think, feel, and do better. Eliciting self-reflective narratives about the context of pain in their lives taps into the spiritual domain and initiates processes of grieving, forgiveness, and acceptance that are needed to transcend perceived limits and find new meaning in their lives. By attending to social interactions, including therapeutic relationships, chronic pain patients can become more independen...
Pain management nursing : official journal of the American Society of Pain Management Nurses, 2002
Nurses routinely use a variety of nonpharmacologic and patient education interventions designed t... more Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if...
Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost ... more Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost and related depression having a negative effect on the quality of life for patients and their families. A growing base of research supports that self-efficacy beliefs significantly contribute to the extent that a person is disabled by their chronic pain. To help explain the circumstances under which disability develops and why so many chronic pain patients become depressed a path analytic model was tested in 3 samples conceptualizing self-efficacy as a mediator of the disability and depression that results from chronic pain. One sample included patients evaluated at a major referral center and a second sample was derived from patients at a community-based primary care and specialty clinic in a non-urban center. A third sample was obtained from both of those settings, however patients in this sample were screened in a manner that excluded patients who had a history of depression prior to the onset of their pain. All patients completed questionnaires prior to an initial consultative visit with a pain specialist at one of the two outpatient pain clinics in New England. A total of 476 participants provided complete data on all model variables, met the eligibility criteria and consented to be included in the study (Tertiary Center, n ϭ 225; Community-based Clinic n ϭ 136; and combined setting with No Prior Depression, n ϭ 115). Self-efficacy was supported as a mediator and in conjunction with pain intensity contributes to over a third of the explained variance in disability and depression. Slight differences were noted in patients based on the setting, and their history of depression prior to the onset of chronic pain. These findings add to the support that the person's belief in their own abilities is a contributor to the depression and disability, that afflicts many chronic pain patients.
Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost ... more Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost and related depression having a negative effect on the quality of life for patients and their families. A growing base of research supports that self-efficacy beliefs significantly contribute to the extent that a person is disabled by their chronic pain. To help explain the circumstances under which disability develops and why so many chronic pain patients become depressed a path analytic model was tested in 3 samples conceptualizing self-efficacy as a mediator of the disability and depression that results from chronic pain. One sample included patients evaluated at a major referral center and a second sample was derived from patients at a community-based primary care and specialty clinic in a non-urban center. A third sample was obtained from both of those settings, however patients in this sample were screened in a manner that excluded patients who had a history of depression prior to the onset of their pain. All patients completed questionnaires prior to an initial consultative visit with a pain specialist at one of the two outpatient pain clinics in New England. A total of 476 participants provided complete data on all model variables, met the eligibility criteria and consented to be included in the study (Tertiary Center, n ϭ 225; Community-based Clinic n ϭ 136; and combined setting with No Prior Depression, n ϭ 115). Self-efficacy was supported as a mediator and in conjunction with pain intensity contributes to over a third of the explained variance in disability and depression. Slight differences were noted in patients based on the setting, and their history of depression prior to the onset of chronic pain. These findings add to the support that the person's belief in their own abilities is a contributor to the depression and disability, that afflicts many chronic pain patients.
The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain i... more The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain in older adults create an urgent need to unravel the complexities of chronic pain management in this population. This requires health professionals to understand both normal and pathologic changes that occur within the aging body and mind, as well as how those factors affect responses to pain and pain-relieving treatments. The medical management of pharmacologic treatment for pain in older adults is often suboptimal, ranging from failing to use analgesics for patients with considerable pain to exposing older adults to potentially life-threatening toxicities, overdoses, or drug interactions. Models for safe and effective approaches to treating pain in older adults exist, but treatments must still be tailored for each individual's needs. A growing array of targeted therapies are available for managing pain, yet two or three trials of different agents within the same drug class are often needed to optimize treatment because of the considerable variability in responses to the effects of particular medications. Older adults tend to be more vulnerable to side effects and drug interactions than their younger counterparts, owing to differences in drug distribution, metabolism, and elimination. This review delineates these vulnerabilities and informs clinicians of the strategies needed to promote safe and effective use of medications to treat pain in older adults. The goal of this paper was to review specific considerations for balancing efficacy and safety in the pharmacologic treatment of persistent pain in older adults.
A placebo is an inert substance or a pseudo-therapeutic procedure believed to have no biological ... more A placebo is an inert substance or a pseudo-therapeutic procedure believed to have no biological effect on health. Perplexed researchers and clinicians have observed powerful therapeutic effects experienced by patients receiving these inactive treatments. These desirable “placebo effects” are an outgrowth of the skilled application of the therapeutic arts and the mobilization of natural, intrinsic healing powers. This article reviews how healthcare professionals can modify the environment, treatments or professional practices to add therapeutic value to their interventions while tapping into the patients’ innate ability to help comfort and heal themselves.
Pain management nursing : official journal of the American Society of Pain Management Nurses, 2004
Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of... more Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of his or her life may be altered, including physical, emotional, and spiritual health, as well as the ability to work, and family and social relationships. Successful treatment plans require more than just pharmacotherapy. Patients often need to receive a lot of information about complex regimens related to both pharmacologic and nonpharmacologic strategies. Additionally, patients with neuropathic pain need nursing support and guidance to help them master the self-management and coping skills required to minimize pain flares, while optimizing mood and functioning. A number of specific strategies are available based on the cognitive-behavioral model. These include the ability to interpret changes in pain in a helpful way, engagement in health promoting behaviors (including diet and exercise), and the development of an action plan for coping with pain exacerbations. A central element in thi...
Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. A... more Given the pervasive effect of chronic pain, a comprehensive approach to nursing care is needed. Addressing the physical effects of persistent pain on multiple systems and bodily functions requires combining (drug and nondrug) interventions to reduce pain and improve functioning. Targeting anxiety, depression and anger effectively can halt or even reverse the escalation of pain attributed to emotions. Recognizing belief patterns associated with distress and disability, while challenging patients to rethink the truthfulness of their perceptions is an important step in helping patients think, feel, and do better. Eliciting self-reflective narratives about the context of pain in their lives taps into the spiritual domain and initiates processes of grieving, forgiveness, and acceptance that are needed to transcend perceived limits and find new meaning in their lives. By attending to social interactions, including therapeutic relationships, chronic pain patients can become more independen...
Pain management nursing : official journal of the American Society of Pain Management Nurses, 2002
Nurses routinely use a variety of nonpharmacologic and patient education interventions designed t... more Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if...
Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost ... more Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost and related depression having a negative effect on the quality of life for patients and their families. A growing base of research supports that self-efficacy beliefs significantly contribute to the extent that a person is disabled by their chronic pain. To help explain the circumstances under which disability develops and why so many chronic pain patients become depressed a path analytic model was tested in 3 samples conceptualizing self-efficacy as a mediator of the disability and depression that results from chronic pain. One sample included patients evaluated at a major referral center and a second sample was derived from patients at a community-based primary care and specialty clinic in a non-urban center. A third sample was obtained from both of those settings, however patients in this sample were screened in a manner that excluded patients who had a history of depression prior to the onset of their pain. All patients completed questionnaires prior to an initial consultative visit with a pain specialist at one of the two outpatient pain clinics in New England. A total of 476 participants provided complete data on all model variables, met the eligibility criteria and consented to be included in the study (Tertiary Center, n ϭ 225; Community-based Clinic n ϭ 136; and combined setting with No Prior Depression, n ϭ 115). Self-efficacy was supported as a mediator and in conjunction with pain intensity contributes to over a third of the explained variance in disability and depression. Slight differences were noted in patients based on the setting, and their history of depression prior to the onset of chronic pain. These findings add to the support that the person's belief in their own abilities is a contributor to the depression and disability, that afflicts many chronic pain patients.
Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost ... more Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost and related depression having a negative effect on the quality of life for patients and their families. A growing base of research supports that self-efficacy beliefs significantly contribute to the extent that a person is disabled by their chronic pain. To help explain the circumstances under which disability develops and why so many chronic pain patients become depressed a path analytic model was tested in 3 samples conceptualizing self-efficacy as a mediator of the disability and depression that results from chronic pain. One sample included patients evaluated at a major referral center and a second sample was derived from patients at a community-based primary care and specialty clinic in a non-urban center. A third sample was obtained from both of those settings, however patients in this sample were screened in a manner that excluded patients who had a history of depression prior to the onset of their pain. All patients completed questionnaires prior to an initial consultative visit with a pain specialist at one of the two outpatient pain clinics in New England. A total of 476 participants provided complete data on all model variables, met the eligibility criteria and consented to be included in the study (Tertiary Center, n ϭ 225; Community-based Clinic n ϭ 136; and combined setting with No Prior Depression, n ϭ 115). Self-efficacy was supported as a mediator and in conjunction with pain intensity contributes to over a third of the explained variance in disability and depression. Slight differences were noted in patients based on the setting, and their history of depression prior to the onset of chronic pain. These findings add to the support that the person's belief in their own abilities is a contributor to the depression and disability, that afflicts many chronic pain patients.
The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain i... more The rapidly expanding number of aged Americans and the increasing prevalence of persistent pain in older adults create an urgent need to unravel the complexities of chronic pain management in this population. This requires health professionals to understand both normal and pathologic changes that occur within the aging body and mind, as well as how those factors affect responses to pain and pain-relieving treatments. The medical management of pharmacologic treatment for pain in older adults is often suboptimal, ranging from failing to use analgesics for patients with considerable pain to exposing older adults to potentially life-threatening toxicities, overdoses, or drug interactions. Models for safe and effective approaches to treating pain in older adults exist, but treatments must still be tailored for each individual's needs. A growing array of targeted therapies are available for managing pain, yet two or three trials of different agents within the same drug class are often needed to optimize treatment because of the considerable variability in responses to the effects of particular medications. Older adults tend to be more vulnerable to side effects and drug interactions than their younger counterparts, owing to differences in drug distribution, metabolism, and elimination. This review delineates these vulnerabilities and informs clinicians of the strategies needed to promote safe and effective use of medications to treat pain in older adults. The goal of this paper was to review specific considerations for balancing efficacy and safety in the pharmacologic treatment of persistent pain in older adults.
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Papers by Paul Arnstein