Department of Psychology

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Open Access
Age Is Not an Impediment to Effective Use of Patient-controlled Analgesia by Surgical Patients
(Lippincott, Williams and Wilkins, 2000) Gagliese, Lucia; Jackson, Marla; Ritvo, Paul; Wowk, Adarose; Katz, Joel
Background: Obstacles to the use of patient-controlled analgesia (PCA) by elderly surgical patients have not been well-documented. Age differences in preoperative psychological factors, postoperative pain and analgesic consumption, treatment satisfaction, and concerns regarding PCA were measured to identify factors important to effective PCA use. Methods: Preoperatively, young (mean age ± SD, 39 ± 9 yr; n = 45) and older (mean age ± SD, 67 ± 8 yr; n = 44) general surgery patients completed measures of attitudes toward and expectations of postoperative pain and PCA, psychological distress, health opinions, self-efficacy, and optimism. On the first 2 postoperative days, pain at rest and with movement and satisfaction with pain control were assessed using visual analog scales. Daily opioid intake was recorded. When PCA was discontinued, satisfaction and concerns about it were assessed. Results: The older patients expected less intense pain (P ≤ 0.003) and preferred less information about (P ≤ 0.02) and involvement in (P ≤ 0.002) health care than young patients. There were no age differences with regard to pain at rest (P ≤ 0.22) or with movement (P ≤ 0.68). The older group self-administered less opioid than the young group (P ≤ 0.0001) and received PCA for more days than the young group (P ≤ 0.004). The groups did not differ in concerns about pain relief, adverse drug effects, including opioid addiction, and equipment use or malfunction. Satisfaction with PCA was high and did not differ between the groups. Conclusions: Patient-controlled analgesia use was not hindered by age differences in beliefs about postoperative pain and opioids. Younger and older patients attained comparable levels of analgesia and were equally satisfied with their pain control.
Open Access
Pain and tension are reduced among hospital nurses after on-site massage treatments: A pilot study
(Elsevier, 1999) Katz, Joel; Wowk, Adarose; Culp, Dianne
Tension and pain are common occupational hazards of modern-day nursing,especially given recent changes to the health care system. The aims of the pilot study were (1) to evaluate the feasibility of carrying out a series of eight 15-minute workplace-based massage treatments, and (2) to determine whether massage therapy reduced pain and stress experienced by nursing staff at a large teaching hospital. Twelve hospital staff (10 registered nurses and 2 nonmedical ward staff) working in a large tertiary care center volunteered to participate. participants received up to eight, workplace-based, 15-minute Swedish massage treatments provided by registered massage therapists. Pain, tension, relaxation, and the Profile of Mood States were measured before and after each massage session. Pain intensity and tension levels were significantly lower after massage (P<.01). In addition, relaxation levels and overall mood state improved significantly after treatments (P<.01). The results of this pilot study supported the feasibility of an eight-session, workplace-based, massage therapy program for pain and tension experienced by nurses working in a large teaching hospital. Further research is warranted to study the efficacy of workplace massage in reducing stress and improving overall mood.
Open Access
Postoperative Morphine Use and Hyperalgesia Are Reduced by Preoperative but Not Intraoperative Epidural Analgesia: Implications for Preemptive Analgesia and the Prevention of Central Sensitization
(Lippincott, Williams and Wilkins, 2003) Katz, Joel; Cohen, Lorenzo; Schmid, Roger; Chan, Vincent; Wowk, Adarose
Background: The aim of this study was to evaluate the postoperative morphine-sparing effects and reduction in pain and secondary mechanical hyperalgesia after preincisional or postincisional epidural administration of a local anesthetic and an opioid compared with a sham epidural control. Methods: Patients undergoing major gynecologic surgery by laparotomy were randomly assigned to three groups and studied in a double-blinded manner. Group 1 received epidural lidocaine and fentanyl before incision and epidural saline 40 min after incision. Group 2 received epidural saline before incision and epidural lidocaine and fentanyl 40 min after incision. Group 3 received a sham epidural control (with saline injected into a catheter taped to the back) before and 40 min after incision. All patients underwent surgery with general anesthesia. Results: One hundred forty-one patients completed the study (group 1, n = 45; group 2, n = 49; group 3, n = 47). Cumulative patient-controlled analgesia morphine consumption at 48 h was significantly lower (P = 0.04) in group 1 (89.8 ± 43.3 mg) than group 3 (112.5 ± 71.5 mg) but not group 2 (95.4 ± 60.2 mg), although the hourly rate of morphine consumption between 24 and 48 h after surgery was significantly lower (P < 0.0009) in group 1 (1.25 ± 0.02 mg/h) than group 2 (1.41 ± 0.02 mg/h). Twenty-four hours after surgery, the visual analog scale pain score on movement was significantly less intense (P = 0.005) in group 1 (4.9 ± 2.2 cm) than group 3 (6.0 ± 2.6 cm) but not group 2 (5.3 ± 2.5 cm), and the von Frey pain threshold near the wound was significantly higher (P = 0.03) in group 1 (6.4 ± 0.6 log mg) than in group 3 (6.1 ± 0.8 log mg) but not group 2 (6.2 ± 0.7 log mg). Conclusions: Preincisional administration of epidural lidocaine and fentanyl was associated with a significantly lower rate of morphine use, lower cumulative morphine consumption, and reduced hyperalgesia compared with a sham epidural condition. These results highlight the importance of including a standard treatment control group to avoid the problems of interpretation that arise when two-group studies of preemptive analgesia (preincisional vs. postsurgery) fail to find the anticipated effects.
Open Access
Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use
(Elsevier, 2004) Katz, Joel; Schmid, Roger; Snijdelaar, Dirk G.; Coderre, Terence; McCartney, Colin J. L.; Wowk, Adarose
The aim of the study was to evaluate post-operative pain and analgesic use after pre-operative or post-incisional i.v. fentanyl plus low dose i.v. ketamine vs. a standard treatment receiving i.v. fentanyl but not ketamine. Men undergoing radical prostatectomy under general anesthesia were randomly assigned in a double-blinded manner to one of three groups. Patients received i.v. fentanyl before incision followed by an i.v. bolus dose (0.2 ml kg−1) and an i.v. infusion (0.0025 ml kg−1 min−1) of 1 mg ml−1 ketamine (group 1) or normal saline (groups 2 and 3). Seventy minutes after incision, patients received i.v. fentanyl followed by an i.v. bolus dose (0.2 ml kg−1) and an i.v. infusion (0.0025 ml kg−1 min−1) of saline (groups 1 and 3) or ketamine (group 2). Pain, von Frey pain thresholds, and cumulative morphine consumption using patient-controlled analgesia (PCA) were assessed up to 72 h after surgery. 143 patients completed the study (group 1, n=47; group 2, n=50; group 3, n=46). Cumulative PCA morphine (mean±SD) did not differ significantly among groups (group 1, 92.3±45.9 mg; group 2, 107.2±58.4 mg; group 3, 103.6±50.4 mg; P=0.08 for groups 1 vs. 2, and groups 1 vs. 3). On day 3, the hourly rate (mean±SEM) of morphine consumption was significantly lower (P<0.0009) in group 1 (0.61±0.013 mg h−1) than group 2 (0.86±0.011 mg h−1) and group 3 (0.89±0.008 mg h−1). Pain scores and von Frey pain thresholds did not differ significantly among groups. Two-week and 6-month follow-ups did not reveal significant group differences in pain incidence, intensity, disability or mental health. Pre-operative, low-dose administration of i.v. ketamine did not result in a clinically meaningful reduction in pain or morphine consumption when compared with post-incisional administration of ketamine or a saline control condition

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