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      Symptom Burden, Medication Detriment, and Support for the Use of the 15D Health-Related Quality of Life Instrument in a Chronic Pain Clinic Population

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          Abstract

          Chronic noncancer pain is a prevalent problem associated with poor quality of life. While symptom burden is frequently mentioned in the literature and clinical settings, this research highlights the considerable negative impact of chronic pain on the individual. The 15D, a measure of health-related quality of life (HRQOL), is a user-friendly tool with good psychometric properties. Using a modified edmonton symptom assessment scale (ESAS), we examined whether demographics, medical history, and symptom burden reports from the ESAS would be related statistically to HRQOL measured with the 15D. Symptom burden, medication detriment scores, and number of medical comorbidities were significant negative predictors of 15D scores with ESAS symptom burden being the strongest predictor. Our findings highlight the tremendous symptom burden experienced in our sample. Our data suggest that heavier prescription medication treatment for chronic pain has the potential to negatively impact HRQOL. Much remains unknown regarding how to assess and improve HRQOL in this relatively heterogeneous clinical population.

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          Most cited references20

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          Validation of the Edmonton Symptom Assessment Scale.

          The Edmonton Symptom Assessment Scale (ESAS) is a nine-item patient-rated symptom visual analogue scale developed for use in assessing the symptoms of patients receiving palliative care. The purpose of this study was to validate the ESAS in a different population of patients. In this prospective study, 240 patients with a diagnosis of cancer completed the ESAS, the Memorial Symptom Assessment Scale (MSAS), and the Functional Assessment Cancer Therapy (FACT) survey, and also had their Karnofsky performance status (KPS) assessed. An additional 42 patients participated in a test-retest study. The ESAS "distress" score correlated most closely with physical symptom subscales in the FACT and the MSAS and with KPS. The ESAS individual item and summary scores showed good internal consistency and correlated appropriately with corresponding measures from the FACT and MSAS instruments. Individual items between the instruments correlated well. Pain ratings in the ESAS, MSAS, and FACT correlated best with the "worst-pain" item of the Brief Pain Inventory (BPI). Test-retest evaluation showed very good correlation at 2 days and a somewhat smaller but significant correlation at 1 week. A 30-mm visual analogue scale cutoff point did not uniformly distinguish severity of symptoms for different symptoms. For this population, the ESAS was a valid instrument; test-retest validity was better at 2 days than at 1 week. The ESAS "distress" score tends to reflect physical well-being. The use of a 30-mm cutoff point on visual analogue scales to identify severe symptoms may not always apply to symptoms other than pain.
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            Cross-sectional validity of a modified Edmonton symptom assessment system in dialysis patients: a simple assessment of symptom burden.

            Subjective symptom assessment should be a fundamental component of health-related quality of life (HRQL) assessment in end-stage renal disease (ESRD). Unfortunately, no symptom checklist has established reliability or validity in ESRD. We report the validation of a modified Edmonton Symptom Assessment System (ESAS) in 507 dialysis patients who concurrently completed the Kidney Dialysis Quality of Life-Short Form (KDQOL-SF) questionnaire. The ESAS demonstrated a mean of 7.5+/-2.5 symptoms. The symptoms reported as most severe were tiredness, well-being, appetite, and pain. The overall symptom distress score was strongly correlated with the KDQOL-SF subscales symptom/problem list (r=-0.69, P<0.01), effects of kidney disease (r=-0.52, P<0.01), and burden of kidney disease (r=-0.50, P<0.01), as well as lower RAND-12 physical health composite (PHC) (r=-0.54, P<0.01) and lower RAND-12 mental health composite (MHC) (r=-0.62, P<0.001). In the multivariate regression analysis, after controlling for potential confounding variables including comorbidity using the modified Charlson Comorbidity Index, the ESAS symptom distress score remained strongly associated with the MHC (slope=-0.82+/-0.07, P<0.01) and PHC (slope=-0.48+/-0.07, P<0.01). The ESAS symptom distress score accounted for 29% of the impairment in PHC and 39% of the impairment in MHC. The intraclass correlation coefficient for the total symptom distress score in a 1-week test-retest was 0.70, P<0.01. Symptom burden is high and adversely affects HRQL in dialysis patients. The modified ESAS is a reliable, valid, simple, and useful method for regular symptom assessment in this patient population.
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              Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians.

              The Medication Quantification Scale (MQS) is an instrument with potential clinical and research applications for quantifying medication regimen use in chronic pain populations. The MQS was developed in 1992 and updated in 1998 (MQS II) as a tool to co-quantify 3 relevant aspects of medications prescribed for chronic nonmalignant pain: drug class, dosage, and detriment (risk). This 2003 version (MQS III) is the third iteration of the scale, featuring new detriment weights determined by surveying all physician members of the American Pain Society in the United States via mail. A total of 248 physicians (18%) responded with their opinion as to the detriment of 22 mechanistically distinct medication classes. Overall, the physician ratings of detriment weight were relatively consistent (alpha = .84). The increased number of survey responses encompassed a wide range of disciplines, thus reducing discipline bias and introducing several important changes to MQS scoring. Some medication classes previously rated with low detriment weights (eg, nonsteroidal anti-inflammatory drugs) increased in detriment weight (from 2 to 3.4), whereas other classes previously given high weights (eg, "strong" opioids) received lower detriment ratings (from 5 to 3.4) in this survey. The MQS III must now be validated in clinical and research applications. The MQS is a tool to objectively quantify pain. It computes a single numeric value for a patient's pain medication profile. This number can be used by both clinicians and researchers to track pain levels through a treatment course or research study.
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                Author and article information

                Journal
                Pain Res Treat
                PRT
                Pain Research and Treatment
                Hindawi Publishing Corporation
                2090-1542
                2090-1550
                2011
                17 April 2011
                : 2011
                : 809071
                Affiliations
                1Department of Anesthesiology and Pain Medicine, 8-120 Clinical Sciences Building, University of Alberta Edmonton, AB, Canada T6G 2B7
                2School of Public Health, 3-12 University Terrace, University of Alberta, Edmonton, AB, Canada T6G 2T4
                Author notes

                Academic Editor: Howard S. Smith

                Article
                10.1155/2011/809071
                3198601
                22110932
                a9235484-116f-43c8-9ab2-5b1a2bbb6f72
                Copyright © 2011 Bruce D. Dick et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 October 2010
                : 7 January 2011
                : 19 January 2011
                Categories
                Research Article

                Anesthesiology & Pain management
                Anesthesiology & Pain management

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