Congress Abstracts 2005

26

EXPLORING THE RELATIONSHIPS BETWEEN CANCER PAIN, ATTITUDINAL BARRIERS, AND PTSD: A DESCRIPTIVE STUDY. Mary Thomas, RN, MS, AOCN^®, Janette Elliott, RN, MS, AOCN^®, and Marilyn Douglas, RN, DNSc, FAAN, VA Palo Alto Health Care System, Palo Alto, CA; and Jeffrey Gold, PhD, University of Southern California Keck School of Medicine, Los Angeles, CA.

The impact of cancer and its treatment can evoke extreme distress, including the anxiety disorder Post Traumatic Stress Disorder (PTSD). While awareness of PTSD in this population is increasing, its impact on cancer-related pain and pain management (PM) is not known.

The purpose of this study was to investigate the impact of PTSD in the context of the cancer pain experience, and particularly, to explore the relationships between PTSD and patients’ attitudinal barriers (ABs) toward PM.

PTSD was conceptualized as a complex anxiety disorder, involving three symptom clusters: intrusive re-experiencing, avoidance/numbing, and hyper-arousal. Cancer pain was conceptualized as multidimensional (Ahles), impacted by one’s ABs to PM.

A convenience sample of 289 adults with pain related to cancer/treatment participated. Instruments with established reliability and validity were used to measure the following variables: Brief Pain Inventory (pain severity, pain relief, pain-related interference with function), Barriers Questionnaire (ABs), PTSD Check List-Civilian (PTSD), POMS (mood disturbance), and FACT-G (quality of life, QOL).

Results were analyzed using independent sample t-tests.

The sample was predominately male (88%), veteran (85%), middle aged, with a variety of cancer types; over 30% were receiving concurrent cancer therapy. In this sample, 78 patients (27%) met the DSM criteria for PTSD, yet few had a documented diagnosis of PTSD. Symptoms related to hyper-vigilance and avoidance/numbing were more prominent than those related to re-experiencing. While there was no significant difference in pain severity between those meeting criteria for PTSD and those who did not, those who were positive for PTSD had significantly greater functional interference from pain, had less pain relief, and less satisfaction with PM. Those positive for PTSD had significantly higher ABs than those negative for PTSD, and demonstrated greater mood disturbance (tension and depression), and poorer QOL (physical, social, emotional well-being). These data depict a highly significant relationship between PTSD and ABs; additional analysis is on-going to further explore this important relationship. To effectively manage cancer pain, ABs must be addressed. Findings from this study suggest that issues related to PTSD are also important in this context, and warrant further investigation and clinical intervention.