Pain Assessment Tools
-- submitted by Poppy --
Pain assessment tools help patients describe their pain. The pain scale is one tool commonly used to describe the intensity of the pain or how much pain the patient is feeling. The pain scales include the numerical rating scale, the visual analog scale, the categorical scale, and the pain faces scale (see figure below).
On the numerical rating scale, the person is asked to identify how much pain they are having by choosing a number from 0 (no pain) to 10 (the worst pain imaginable).
The visual analog scale is a straight line with the left end of the line representing no pain and the right end of the line representing the worst pain. Patients are asked to mark on the line where they think their pain is.
The categorical pain scale has four categories: none, mild, moderate, and severe. Patients are asked to select the category that best describes their pain.
The pain faces scale uses six faces with different expressions on each face. Each face is a person who feels happy because he or she has no pain or feels sad because he or she has some or a lot of pain. The person is asked to choose the face that best describes how he or she is feeling. This rating scale can be used by people age 3 years and older.
Numerical Scale
No pain_0_____1_____2_____3_____4_____5_____6_____7______8_____9______10 Worst Pain
Visual Analog Scale
No pain_______________________________________________________________Worst Pain
Directions: Ask the patient to indicate on the line where the pain is in relation to the two extremes. Qualification is only approximate; for example, a midpoint mark would indicate that the pain is approximately half of the worst possible pain.
Categorical Scale
None (0)
Mild (1-3)
Moderate (4-6)
Severe (7-10)
Pain Faces Scale
0 Very happy, no hurt 
2 Hurts just a little bit 
4 Hurts a little more 
6 Hurts even more 
8 Hurts a whole lot 
10 Hurts as much as you can imagine (don't have to be crying to feel this much pain) 
Chemotherapy, Radiation and Treatment Resources for Lung Cancer
-- submitted by Poppy
--
Chemotherapy:
Chemotherapy and You - This guide will help you, your family, and your friends understand chemotherapy, the use of drugs to treat cancer. It will answer many of the questions you may have about this method of cancer treatment. It also will show you how you can help yourself during chemotherapy.
Radiation:
Radiation Therapy and You - This online booklet is for patients who are receiving radiation therapy for cancer. It describes what to expect during therapy and offers suggestions for self-care during and after treatment. It explains the two most common types of radiation therapy, external radiation and internal radiation therapy. Information is included about the general effects of treatment and how to deal with specific side effects.
WebMD - The Basics of Radiation Therapy
Lung Cancer:
Lung Cancer - This online booklet provides information about some causes and ways to prevent lung cancer, and it describes the symptoms, detection, diagnosis, and treatment of this disease. Having this important information can make it easier for patients and their families to handle the challenges they face.
Lung Cancer - Finding lung cancer services and support.
American Cancer Society - Lung Cancer Resource Center - Lung cancer overview.
Controlling Pain:
CancerBackup - Controlling Pain - Feeling better- controlling pain and other symptoms.
American Cancer Society - Pain Control - This online booklet will help you learn about pain control for people with cancer. You will find out how to work with your doctors, nurses, and pharmacists to find the best method to control your pain; about different types of pain medications and nondrug methods of controlling pain; how to take your medicines safely; and how to talk with your doctors and nurses about your pain and how well the treatment is working for you.
Patient and Family Support:
Cancer Backup - Understanding cancer of the lung - Describes the various emotions that may arise in cancer patients, partners, family members and friends, in the process of trying to come to terms with a cancer diagnosis. Discussion includes the following: shock and disbelief; fear and uncertainty; denial; anger; blame and guilt; resentment; withdrawal and isolation; and learning to cope.
Taking Time: Patient and Family Support for Cancer Sufferers - Support for people with cancer and the people who care about them.
Alliance for Lung Cancer Advocacy, Support and Education - Support Groups in the United States.
Stories of Hope - Stories of hope from lung cancer survivors.
---submitted by Poppy---
Do you suffer from carpal tunnel syndrome? Carpal tunnel syndrome is one of a number of conditions in the category of repetitive strain injuries. The carpal tunnel actually is a sort of tunnel in the arm, and contains a ligament that runs from the forearm through the wrist. Carpal tunnel syndrome occurs when the ligament becomes inflamed and compresses the median nerve that runs to some of the fingers. The syndrome may cause pain in the arm and numbness and tingling in the hand and fingers. Untreated, it may lead to severely disabling muscle weakness in the hands. The ancient mind-body art of yoga may help ease your achy wrists.
In a study, people with carpal tunnel syndrome who participated in two sessions per week of Iyengar yoga classes experienced a significant decrease in their symptoms. After eight weeks, study participants experienced both a reduction in pain and an increase in grip strength.
If you suffer from carpal tunnel syndrome and would like to try yoga, be sure to speak with your doctor first. Also, find a certified yoga instructor and avoid poses that require you to bear weight on your wrists or hands.
¥ Yoga-based intervention for carpal tunnel syndrome: a randomized trial ¥ -- Garfinkel, M. S., Singhal, A., Katz, W. A., Allan, D. A., Reshetar, R., Schumacher, H. R., Jr., [i] Journal of the American Medical Association[/i]1998 Nov 11; 280(18 ):1601-1603.
For the latest thinking on how best to treat your carpal tunnel syndrome, both conservatively and with drugs and surgery, go to:
¥ Treatment for Carpal Tunnel Syndrome ¥
-- written by Hershey --
Many people on this Board know that I lived in Hong Kong for some time. I did not have the medical problems I do now. I will tell you a story of my experiences with Eastern medicine while I was living in Hong Kong.
I lived in a tri-level apartment. One day, while talking on the phone and holding a glass of soda, I fell down the stairs. The day before, the steps had been polished and I was not aware of their high polish. I was not in much pain when it happened but the pain got progressively worse during the day. I also drove while in Hong Kong and had a low-slung car. Very soon, I could not even get in the car. I called my Western doctor who said nothing could be done. She offered a prescription for pain pills and she said to sit on a float to ease the pain. She said even if my tailbone was fractured, I would just have to wait for it to heal.
I looked like a crippled, old lady and was in much discomfort. I hate taking pills. Finally, my Chinese staff could not stand to see me like that anymore and took me to a Chinese specialist. They were worried that I would have some permanent damage. They whisked me away to a part of town where few Westerners went. I was the only Western person I could see. Everyone was staring and laughing at me - it was a bit disconcerting!
My staff took me go to a small room and told me to wait. I felt like I was in a movie with incense, red curtains, etcetera.
A wizened, old woman (she must have been well over 200 years old) came in to see me (she stood straighter than I did). She felt the pulse area on my wrist. Later, after going to various Chinese doctors, I learned that they use the flow of your blood for many of their diagnoses. She did what is called "Kung Fu" massage. To me, it was bony, pointy fingers jabbing my backside. This went on for quite some time. Finally, when she had finished jabbing me, she strapped a bag of hot, pungent herbs to my backside (Let's just say that you could smell me coming!!) I was already starting to feel better. I had to visit the Chinese doctor every day for a week. I also had to drink a dark, smelly potion (it was probably hair of toad!!).
I was also given a list of foods that I could eat. In a short time, I felt great. I could walk upright that day and suffered very little after the first day of her treatment.
The Chinese believe foods have a yin/yang quality and that certain foods can upset the healing process. For instance, if you have a cold, you should not eat anything spicy, no citrus juices, nothing cold, only bland, luke-warm food. If you must have some fruit, eat an apple.
The bottom line is that Eastern practitioners think Western medicine is on the wrong track. They think Westerners mask the symptoms of disease by taking pills. Eastern practitioners think that it is essential to find the root of the problem and to work through the process. They also think we have to have a "quick fix" and do not have the patience to get well - not just feel better.
I think the best course for most things is to try to utilize the best of both worlds - Eastern and Western medicine. Sometimes, it is difficult to do in North America, as we do not have as many real Chinese doctors. I do still buy some medicines from Asia - ones that I know and have used before. I am careful to check ingredients and to use trustworthy doctors.
Fast Diagnosis and Treatment Key to Managing Rheumatoid Arthritis
- - - By Nora MacReady - - -
Early diagnosis and prompt, appropriate treatment of rheumatoid arthritis (RA) are the keys to minimizing joint and tissue damage and enhancing quality of life, according to rheumatologist Eric L. Matteson, MD. Matteson reviewed the latest RA treatment strategies in the journal Mayo Clinic Proceedings.
RA is one of the most common causes of disability, writes Matteson, an associate professor of rheumatology and internal medicine at the Mayo Clinic. "After 12 years of disease, more than 80% of patients with RA are partially disabled, and 16% are completely disabled. Life expectancy is shortened by an average of 7 years in men and 3 years in women." Matteson reports that the most common causes of decreased life expectancy associated with RA are vasculitis, or inflammation of the blood vessels; side effects of drugs, such as bleeding from a stomach ulcer; and an increased risk of infection, which may be due to the drugs suppressing the immune system. On a more optimistic note, he says that doctors now have in their armamentarium new drugs tailored to inhibit specific aspects of RA and these drugs will have a profound effect on the management of this disease.
The goals of therapy are to relieve pain, control inflammation, prevent joint destruction, and maintain normal function as long as possible, he writes. The mainstay of RA therapy should be compounds known as disease-modifying antirheumatic drugs (DMARDs), such as gold, methotrexate, or tumor necrosis factor (TNF) antagonists. Enbrel (etanercept), a TNF antagonist, is genetically engineered to decrease inflammation, which is a vital part of what causes the pain and destruction associated with RA. These drugs can reduce disability and death associated with RA and should be introduced as soon as RA has been diagnosed.
"Use of DMARDs has substantially improved disease control and the long-term outlook for patients with RA," Matteson writes. Many rheumatologists have come to view methotrexate as the "anchor therapy" for RA, thanks to its good efficacy and relatively mild side effects. In an interview seeking objective comment, John Klippel, MD, medical director of the Arthritis Foundation, states that the use of methotrexate and TNF antagonists are the two most significant advances in RA therapy in the past decade.
Steroids are potent suppressors of inflammation and can be used to control severe or widespread disease until the DMARDs take effect, which may take several weeks to months. However, steroids cause serious side effects, such as infection and increased blood sugar. Matteson recommends that they not be used alone in RA therapy and should be tapered and ultimately discontinued as soon as other agents start to work. DMARDs also can be tapered in a patient who has no active signs of disease for at least a year.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and a new class of drugs called Cox-2 inhibitors, such as Celebrex (celecoxib) and Vioxx (rofecoxib), can relieve pain and inflammation but seldom eliminate the signs and symptoms of arthritis completely. Cox-2 inhibitors are no more effective therapeutically than traditional NSAIDs, Matteson says. Their advantage is that they are associated with fewer side effects, mainly stomach bleeding. "These agents are good for people who have a high risk of stomach bleeding, such as the elderly or those with a history of [stomach] bleeding." "They are valuable adjunctive therapy." Klippel adds that they provide "a new therapeutic alternative for patients who don't respond to traditional NSAIDs."
RA is "a very treatable, manageable disease that can be successfully controlled," Matteson says. He and Klippel both state that early diagnosis and prompt initiation of treatment are the most important aspects of effective management. Says Klippel, "A decade ago we would have waited and used mild drugs until the disease was out of control. Today there is clear reason to believe that if RA is recognized and treated early, we can have a profound impact on the course of this disease."
Vital Information:
* The key to managing rheumatoid arthritis, one of the most common causes of disability, is early diagnosis and prompt, appropriate treatment.
* The mainstay of therapy should be methotrexate or tumor necrosis factor antagonists, according to one expert.
* Steroids or nonsteroidal anti-inflammatory drugs may be used in conjunction with the other drugs to treat some patients at certain times.
Medical RecordsThe following statements were found on patient's charts during a recent review of medical records. These statements were written by various health care professionals including (we're afraid) a doctor or two at several major hospitals:
"The lab test indicated abnormal lover function."
"The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately."
"Exam of genitalia reveals that he is circus sized."
"The skin was moist and dry."
"The patient had waffles for breakfast and anorexia for lunch."
"She stated that she had been constipated for most of her life until 1989 when she got a divorce."
"The patient was in his usual state of good health until his airplane ran out of gas and crashed."
"I saw your patient today, who is still under our car for physical therapy."
"The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week."
"Bleeding started in the rectal area and continued all the way to Los Angeles."
"Both breasts are equal and reactive to light and accommodation."
"She is numb from her toes down."
"Exam of genitalia was completely negative except for the right foot."
"While in the emergency room, she was examined, X-rated and sent home."
The patient was to have a bowel resection. However, he took a job as stockbroker instead."
"Coming from Detroit, this man has no children."
"When she fainted, her eyes rolled around the room."
"Examination reveals a well-developed male lying in bed with his family in no distress."
Criteria of Addiction
A diagnosis of mild dependence on a psychoactive drug is determined by meeting three of the nine criteria. Five items show moderate dependence and seven items indicate a strong dependence. (Not all nine items apply to each drug. For example, time and effort spent acquiring a drug are a significant feature of heroin addiction, but have no meaning in nicotine addiction.)1. Taking the drug more often or in larger amounts than intended.
2. Unsuccessful attempts to quit; persistent desire, craving.
3. Excessive time spent in drug seeking.
4. Feeling intoxicated at inappropriate times, or feeling withdrawal symptoms from a drug at such times.
5. Giving up other things for it.
6. Continued use, despite knowledge of harm to oneself and others.
7. Marked tolerance in which the amount needed to satisfy increases at first before leveling off.
8. Characteristic withdrawal symptoms for particular drugs.
9. Taking the drug to relieve or avoid withdrawal.
Before applying a test of the nine criteria, the expert first determines if the symptoms have persisted for at least a month or have occured repeatedly over a longer period of time.