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Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related symptoms in advanced colorectal cancer patients. A qualitative exit interview was conducted to understand preferences, thoughts, and feelings about the VR session.
Participants (N = 20) had stage IV colorectal cancer and moderate-to-severe pain. Participants completed a 30-min VR Blue session that visually and aurally immersed them in virtual ocean scenarios. Feasibility was assessed by accrual (N = 20), protocol adherence (≥80% completing VR Blue), and completed data (≥80% assessment completion). Acceptability was determined by patients reporting ≥80% intervention satisfaction. Safety was determined by ≥80% of patients completing the session without self-reported side effects. Measures of pain, tension, relaxation, stress, anxiety, and mood were collected before, during, and after the VR Blue session. A semi-structured qualitative interview was conducted after VR Blue to assess participants’ VR experiences.
All participants (100%) completed the VR Blue session. There was 100% data collection at the pre- and post-assessments. Satisfaction with VR Blue was high M = 3.3 (SD = 0.4) (83%). No significant side effects were reported. Pain decreased by 59% (Pre-M = 3 ; Post-M = 1 ). Tension decreased by 74% (Pre-M = 30 ; Post-M = 8 ). Relaxation improved by 38% (Pre-M = 62 ); Post-M = 86 ). Stress decreased by 68% (Pre-M = 24 ; Post-M = 8 ). Anxiety decreased by 65% (Pre-M = 20 ; Post-M = 7 ). Mood improved by 70% (Pre-M = 13 ; Post-M = 4 ). Qualitative data suggested a positive response to the VR Blue protocol.
Significance of results
This work supports the feasibility, acceptability, and safety of VR Blue for advanced colorectal cancer patients. Participants showed significant pre-post improvement in pain and pain-related symptoms hinting to the potential feasibility of VR interventions in this population. Larger, randomized trials with a control condition are needed to examine the efficacy of VR-based interventions for patients with advanced colorectal cancer and pain.
To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability.
In Phase I, we conducted interviews with 10 patient–caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability.
Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use.
Significance of results
These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.
The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pain. MCPC aims to help patients connect with valued sources of meaning in their lives (e.g., family relationships), while providing training in evidence-based cognitive and behavioral skills (e.g., guided imagery) to reduce pain.
Semi-structured interviews were conducted with 12 patients with stage IV solid tumor cancers and persistent pain. Transcripts were analyzed using methods from applied thematic analysis.
When evaluating MCPC's educational information and skills training descriptions, participants described ways in which this content resonated with their experience. Many coped with their pain and poor prognosis by relying on frameworks that provided them with a sense of meaning, often involving their personally held religious or spiritual beliefs. They also expressed a need for learning ways to cope with pain in addition to taking medication. A few participants offered helpful suggestions for refining MCPC's content, such as addressing common co-occurring symptoms of sleep disturbance and fatigue. Concerning MCPC's structure and delivery modality, most participants preferred that sessions include their family caregiver and described remote delivery (i.e., telephone or videoconference) as being more feasible than attending in-person sessions.
Significance of results
Participants were interested in an intervention that concurrently focuses on learning pain coping skills and enhancing a sense of meaning. Using remote delivery modalities may reduce access barriers (e.g., travel) that would otherwise prevent many patients from utilizing psychosocial services.
Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.
Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.
Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.
Significance of results:
Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.
Over the past 15 years, psychological interventions have emerged as a useful adjunct to medical approaches to cancer pain management. Psychological interventions offer several advantages in cancer pain management. First, they can enhance patients' sense of self-efficacy (i.e., confidence) in their own abilities to control pain. Increased self-efficacy for pain control has been linked to lower psychological distress, less interference of pain with daily activities, and improved quality of life. Second, psychological interventions teach patients skills that can be applied to many of the day-to-day challenges of living with persistent pain, such as coping with pain flares, managing emotional reactions to pain (e.g., anxiety, fear, depression), and maintaining an active and rewarding life despite having pain. Third, psychological interventions and pain medications may have synergistic effects for cancer patients and produce an array of benefits (e.g., decreased pain, improved mood, enhanced interpersonal interactions) that may not be achieved by alone. Finally, psychological interventions may offer a viable pain management option for patients who respond poorly or have difficulty tolerating pain medications.
This chapter provides an introduction to psychological approaches to managing cancer pain. The chapter is divided into three sections. The first section highlights the challenges of cancer pain. This section emphasizes the fact that psychological interventions for pain are delivered in the context of multiple ongoing challenges faced by persons having cancer pain.
Over the past four decades, approaches to the assessment of chronic pain have evolved substantially within the field of behavioural medicine. During this time, it has become apparent that what we label as ‘pain’ is the result of complex interactions among biological, psychological and social factors. The gate control theory of pain (Melzack & Wall, 1965) supports this paradigm in that it confirms that pain is a complex experience involving sensory–discriminative, evaluative–cognitive and affective–motivational components, thus emphasizing the role of the central nervous system in nociceptive perception and processing. Further, the gate control theory provides a foundation for the development and refinement of integrated pain assessment models, such as the biopsychosocial model of pain (Turk, 1996).
The biopsychosocial model of pain acknowledges that the experience of pain often is the result of physiological changes occurring after peripheral nociceptive stimulation (Turk, 1996). However, this model also emphasizes that the pain experience is modulated by individual differences in various cognitive, affective, behavioural and social factors. People with the same level of underlying nociceptive stimulation may differ in their pain experience depending on the importance of any factor at any given time during the course of the disease or condition (Asmundson & Wright, 2004). Thus, assessing pain necessitates the examination of relations among various factors across a variety of levels (Stoney & Lentino, 2000).
During the latter part of the twentieth century, Melzack (1999) proposed an expanded model of pain which further highlights the role of psychological processes in pain.
Chronic pain is a problem that affects millions of individuals every year. Much of chronic pain is associated with significant progressive degenerative disease. Such diseases include arthritis and cancer, and involve prolonged severe pain which may be only partially ameliorated through the use of analgesic medication. This chapter examines the ways in which individuals cope with chronic pain. We describe how pain coping is conceptualized and measured and discuss what has been learned about adaptive and maladaptive methods for coping with chronic pain. We conclude with an exploration of new directions for research in this area.
Coping with chronic pain
Coping has been defined as the process of managing stressful situations, either external or internal, that are viewed as taxing an individual's adaptive resources (Lazarus & Folkman, 1984). The ways in which individuals view or appraise potentially stressful situations is an important component of this process definition of coping. In chronic pain, the ways in which a patient views pain are particularly important in their reactions to pain. Individuals may view pain as unpredictable and feel very little control over pain flares. Conversely, they may view pain as a constant irritation but one that can often be dealt with successfully.
Coping with pain can be thought of as cognitions and behaviours that serve to manage or decrease the sensation of pain and distress caused by pain. Within this basic framework, researchers have formulated several models of pain-coping.
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