UIC College of Nursing

Diana J. Wilkie, PhD , RN, FAAN, Funded Projects

Computerized PAINRelieveIt Protocol for Cancer Pain

Funding Source: National Cancer Institute

Dates: 9/15/03 – 8/31/09

Co-Investigators: Mundt, Arno J., Judge, M. Kay M., Zong, Shiping

Website: www.tneel.uic.edu/research.asp

Abstract: Unrelieved cancer pain is a major health problem. We propose a study testing PAINRelieveIt, a computerized set of tools with pain report scales, decision support for providers and multimedia education customized to the needs of the individual cancer patient. The study will be a randomized clinical trial in outpatients receiving treatments at the Univerisity of Illinois Cancer Clinic using a pre-test/post-test design to compare effects of usual-care and the computerized tool on pain outcomes. PAINRelieveIt includes electronic versions of valid and reliable scales for pain (PAINReportIt), a printed summary of the patient's pain data with decision support for providers to prescribe algorithm-based analgesic therapies (PAINConsultN), and computerized multimedia education customized to address the patient's pain management needs (PainUCope). PAINReleiveIt allows patients to describe their pain using PAINReportIt and touch-screen technology. Answers are automatically stored in an electronic database, which is then used to generate PAINConsultN and PainUCope. Post-test outcome measures will be obtained 4-weeks after the intervention. Specific aims are to: 1) Compare usual-care and PAINRelieveIt for effects on patient outcomes (pain intensity, satisfaction with pain intensity, misconceptions about pain) in a diverse sample of 300 persons with advanced stage cancer and receiving radiation and 2) Compare usual-care and PAINRelieveIt for effects on clinician outcomes (number of appropriate analgesics prescribed; clinic visit length) in a sample of radiation oncologists. We hypothesize that at 4-weeks and controlling for baseline data, the clinic visit length will be similar for the two groups but that the computerized PAINRelieveIt group will report: a) decreased scores for the current and worst pain intensity and misconceptions about pain; and b) increased level of satisfaction with pain intensity and number of appropriate analgesic prescriptions. Patients will receive usual care and complete PAINReportIt. In the experimental group, the PAINReportIt data will be used to provide clinicians with an algorithm-based list of analgesics that may be useful for improved pain control and a summary of the pain data via PAINConsultN. Additionally, in the experimental group, patients will view multimedia education via the PAINUCope program, which tailors the content to the patient's beliefs and attitudes about pain. Four weeks after the pre-test, patients will complete PAINReportIt to document outcomes. Study findings will guide future studies implementing the PAINRelieveIt program in multisite, longitudinal trial that will test the effect of this new cancer control technology on pain management in a national sample of cancer patients.

Effects & Costs of Massage in Hospice Cancer Patients

Funding Source: National Institute of Nursing Research

Dates: 9/30/05 – 6/30/10

Co-Investigators: Judith Storfjell

View Poster: PowerPoint File

Abstract: Over 80% of hospice patients experience distressing psycho-physiological symptoms that significantly impact well-being in their final days of life. Previous research demonstrated that complimentary therapies such as massage are able to alleviate symptoms for minutes to hours but none have examined longer-term effects of massage therapy or cost-effective methods of providing massage to hospice patients. We propose a randomized clinical trial (RCT) comparing usual care and usual care with five daily massage therapy sessions given by licensed massage therapists (LMP) on patient well-being outcomes including: a) symptom distress, b) pain intensity, c) mood state and d) sleep quality in a diverse group of 200 hospice patients with cancer. In a pre-test, post-test design, patients will complete computerized pain and symptom assessments. All patients will receive usual hospice care and patients randomized to the experimental group will receive daily massage therapy, Monday to Friday for one week. Outcome variable scores will be averaged over the data collection period and analyzed using NMNOVA with post hoc comparisons if significant group results are obtained. Study findings will be used to guide hospice care providers in selecting evidence-based complimentary interventions to relieve suffering of patients at the end of life. A second aim is to describe the costs of the massage intervention and compare the effects of usual hospice care and massage on hospice reimbursement and utilization costs. We hypothesize that hospice reimbursements and utilization costs will not differ. A third aim is to describe the feasibility of training 50 family caregivers of RCT patients to give massages. LMPs will train family caregivers in selected massage techniques and evaluate caregiver proficiency. Feasibility will be evaluated by: a) the number and length of massages given during the week following the RCT, b) self-report of caregiver experiences, and c) changes in strain imposed by the demands of learning and giving the massages. Descriptive statistics and content analysis will be used to evaluate feasibility of family caregivers providing massages and will be used to design a clinical effectiveness study using family members as a cost-effective alternative to LMPS.

Computerized PAINRelieveIt for Adult Sickle Cell Disease

Funding Source: National Heart Lung and Blood Institute

Dates: 7/1/06 – 6/30/10

Co-Investigators: Robert Molokie, Yogen Saunthararajah

Website: www.tneel.uic.edu/research.asp

View Poster: PowerPoint File

Abstract: Unrelieved sickle cell disease (SC) pain is a major health problem attributed in part to pain assessment difficulties and to lack of knowledge about analgesics known to be effective for pain control. We propose a two-phase longitudinal study testing three valid and reliable touch screen computerized tools: a) pain assessment data collection and summary report (PAINReportIt); b) multimedia patient education tailored to the patient's SC pain management misconceptions (PainUCope); and c) decision support for clinicians to prescribe algorithm-based analgesic therapies tailored to the patient's pain (PAINConsultN). Together, the three programs are known as PAINRelieveIt. In the first phase of the randomized clinical trial, we will use a pre-test/post-test design in 250 patients receiving care at the UIC Sickle Cell Clinic to compare the effects of usual care and PAINReportIt/PainUCope on a) patient outcomes (misconceptions about pain, analgesic adherence, and pain intensity); and b) an outpatient provider outcome (pain documentation). We hypothesize that, three months after the intervention, the computerized PAINReportIt/PainUCope group will have decreased misconceptions and pain intensity and increased analgesic adherence, pain documentation in the medical record. In the second phase, we will use a longitudinal, repeated-measures design in the same 250 sickle cell patients to compare the effects of randomly assigning their attending ED or inpatient physicians to usual care or PAINReportIt/PAINConsultN. We will compare usual care and PAINReportIt/PAINConsultN for long-term effects on a) patient outcome (pain episodes) in 250 patients at risk for ED visits or hospitalization with painful SC crisis; b) ED or inpatient provider outcomes (pain documentation; appropriateness of prescribed analgesics) in 34 UIC ED and inpatient physicians; and c) system outcomes (number of ED visits and hospital days for painful SC crisis). We hypothesize that, two years after the intervention is implemented, the PAINReportIt/PAINConsultN group will report: a) decreased pain episodes; b) increased pain documentation in the medical record and number of appropriate analgesic prescriptions; and c) decreased number of ED visits and hospital days. Findings will guide large-scale implementation of this innovation in SC care throughout the USA .

Center for End-Of-Life Transition Research (CEoLTR)

Funding Source: National Institute of Nursing Research

Dates: 09/29/07– 06/30/12

Co-Investigators: Karen Kavanaugh, Marquis Foreman, Sandra Burgener, Gail Keenan, Laura Szalacha

Abstract: The overall purpose of the Center for End-of-Life Transition Research is to advance the science of care for people facing the end-of-life transition across the life span (e.g., babies born dying, children, adults, and older adults). We will emphasize patient-centered, family-focused respectful death with planning for end-of-life care that is consistent with the patients’ and families’ values and priorities (e.g., awareness about ways people die and advance care planning) and expected death experiences (e.g., palliative care, approaching dying, and bereavement). The specific aims of this Center application are to: (1) advance nursing science related to the end-of-life transition; (2) strengthen the ethical use of qualitative and quantitative (mixed methods) methodologies by Center investigators/affiliates and train novices regarding the ethical issues in end of life research and mixed methods measurement of biobehavioral (biological, behavioral, and experiential) variables, management of data, and analysis of data; (3) expand the capacity to conduct end-of-life research with informatics solutions that contribute to high integrity processes and efficient, valid, and reliable outcomes in institutional and community-based settings; and (4) facilitate the dissemination of end-of-life research findings to the scientific and clinical communities and to the general public. Through the Center activites, we will advance the science of disparities in care at end-of-life and support research training in this area by providing core services and resources to investigators. The scientific focus is conceptually organized according to an ecologically based, health-related quality of life framework that addresses both person and environmental factors as they interact to affect respectful death outcomes for individuals and families. Studies supported by the Center will be designed to: (a) elucidate underlying physiological, experiential, and behavioral mechanisms that prognosticate or influence approaching death or bereavement; and (b) test culturally relevant interventions for death awareness and respectful death. The research supported by the Center will have a biobehavioral orientation and will include end-of life-care concepts that are measured physiologically (biologic function), experientially (symptoms, perceived health, quality of life), and behaviorally (functional status). The interaction of investigators with expertise in diverse groups of subjects will move the science of end-of-life care forward in new directions.

CaMKII as a Mechanism & Intervention Target for Sickle Cell Pain

Funding Source: National Heart Lung and Blood Institute

Dates: 09/30/09– 07/31/13

Role on the Project : co-Investigator

Principal Investigator : Zaijie (Jim) Wang

Abstract: Our long-term goal is to advance knowledge of the neural mechanisms of pain in sickle cell disease (SCD) and develop an effective pharmacologic treatment. The neurobiology of pain in SCD is poorly understood. Several transgenic/knock-out mouse models have been successfully produced and applied to study SCD. However, pain findings were only recently published that indicated increased pain sensitivity in NY1DD mice using a radiant heat tail-flick test. Strikingly, pain in these mice was age-dependent with an onset time around 6 weeks. Unfortunately, the investigators did not report other pain measurement findings or define a pain phenotype in Berkeley sickle transgenic mice, a model of a more severe form of SCD. In our own preliminary studies, we examined Berkeley sickle mice and littermate non-sickle controls in an array of pain tests that are used to study other pain types in animals. In these preliminary studies, we found the presence of tactile allodynia and thermal hyperalgesia and that spinal CaMKII expression and activity were upregulated, similar to what we observed in other mouse models of inflammatory and neuropathic pain. In the latter models, we have identified
CaMKIIa to be a critical component leading to persistent pain. We observed that spinal nerve ligation-induced pain behaviors did not develop in CaMKIIa mutant mice. Based on these encouraging data, we propose to extensively characterize pain behaviors in Berkeley mice by employing standard pain tests for spontaneous pain behaviors and those evoked by thermal or mechanical stimuli (von Frey, Hargreaves, hot-plate, tail-flick, cold allodynia) and inflammatory stimuli (formalin, complete Freund's adjuvant) from shortly after birth through adulthood or when responses plateau. Some of these pain tests are used in our ongoing human studies of SC pain using quantitative sensory testing (QST). Intentionally, these similarities will allow us to interpret findings from the SCD transgenic mouse model with consideration of findings from other mouse models of pain and human SCD pain. We will use real time PCR, immunoblotting, immunohisto-chemistry, and enzymatic kinetics methods to systematically examine the expression and activity of CaMKIIa and total CaMKII in sickle and control mice and correlate the changes in this potential biomarker with the onset of pain. To directly test the hypothesis that spinal CaMKIIa is a molecular mechanism that promotes and maintains the manifestation of chronic pain in SCD, we will conduct pharmacological studies to inhibit CaMKIIa using chemical, small interfering RNA (siRNA), and gene knockout methods. We propose to test in these pharmacological studies a clinically used orally available drug that we have found to be a CaMKII inhibitor and to reduce pain behaviors in inflammatory and neuropathic pain models. Our secondary strategy is to conduct a pilot translational study to identify safety issues and clinical potential of this CaMKII inhibitor by characterizing sensory pain in humans with quantitative sensory testing and a computerized self-report tool. The significance of this proposal is that it may ultimately lead to pharmacological interventions that target the CaMKII-pathway.