Colonoscopy is the reference method in the secondary prevention,diagnosis and,in some cases,treatment of colorectal cancer.It can often cause pain associated with embarrassment,anxiety,and physical and emotional disco...Colonoscopy is the reference method in the secondary prevention,diagnosis and,in some cases,treatment of colorectal cancer.It can often cause pain associated with embarrassment,anxiety,and physical and emotional discomfort.Pain intensity is influenced by a lot of factors,and there is a strict relationship among pain,pain perception,and mind.Several methods can be used to break the trinomial colonoscopy,pain and fear.Sedoanalgesia is recommended by several guidelines.If no sedation is offered,the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort.Other non-pharmacologic methods such as acupuncture,music,and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia.Furthermore,new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes,or the use of carbon dioxide instead of air for colon insufflation,can reduce the pain caused by colonoscopy.In the future,technical improvements such as wireless capsules or robotic probes,will probably enable to overcome the present concept of colonoscopy,avoiding the use of traditional endoscopes.However,at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified.There are several methods to reduce pain and anxiety and to break the trinomial colonoscopy,pain and fear.We must use them.展开更多
Background: To improve negative birth experiences among women who experience intense labor pain during labor, it is important to examine the relationship between fear of childbirth immediately after vaginal delivery a...Background: To improve negative birth experiences among women who experience intense labor pain during labor, it is important to examine the relationship between fear of childbirth immediately after vaginal delivery and the actual intensity of labor pain. However, previous studies have generally evaluated labor pain in a retrospective setting. Purpose: This study examined the relationship between fear of childbirth immediately after vaginal delivery and the actual labor pain intensity and accumulated labor pain intensity without pharmacological pain relief during labor in Japan. Methods: A prospective observational study was conducted between July 2015 and April 2016. Forty-seven pregnant Japanese women were available for analysis. Fear of childbirth was measured by the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version B on the third day after vaginal delivery. Participants with scores of 85 or higher were categorized in the high JW-DEQ group, having severe fear of childbirth. Labor pain intensity was examined chronologically in real time with stepwise usage of two types of Numeric Rating Scale (NRS). Accumulated labor pain intensity was calculated using the area under the curve (AUC). Results: Nine participants were in the high JW-DEQ group and eight of the nine were primiparae. Primiparae in the high JW-DEQ group experienced significantly longer duration and larger accumulated labor pain intensity between the onset of labor and 4 to 6 cm of cervical dilatation than those in the low JW-DEQ group (P = 0.024 and P = 0.021, respectively). Conclusions/Implications for Practice: The latent phase of labor was a key stage to improve fear of childbirth immediately after vaginal delivery without pharmacological pain relief among Japanese primiparae. Midwives should give assistance in the latent phase of labor by focusing on progressing labor smoothly and relieving labor pain to improve negative birth experiences.展开更多
Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and extern...Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and external factors contribute to childbirth fear, however results vary. Aim: To identify pyscho-social factors associated with childbirth fear and possible antenatal predictors of childbirth fear according to women’s parity. Method: 1410 women in second trimester and attending one of three public hospitals in south-east Queensland were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Other measures included the Edinburgh Depression Scale (EPDS), Decisional Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous mental health condition, social support and knowledge were used. Preferred mode of birth was also collected. Psycho-social factors were analysed to determine associations with childbirth fear. Multivariate analysis was used to determine predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous and 18% (n = 143/782) of multiparous women reported high fear levels. Having a mental health history, desiring a caesarean section, reporting moderate to high pain during pregnancy, having a non-supportive partner and perceiving less childbirth knowledge than peers, were associated with childbirth fear. Standard multiple regression analyses by parity determined that depression, decisional conflict, low social support and less perceived knowledge predicted levels of childbirth fear. The model explained 32.4% of variance in childbirth fear for nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors are significantly associated with childbirth fear. The identification of predictive psychosocial factors for childbirth fear indicates the importance of observing, assessing, and developing support strategies for women. Such strategies are required to decrease anxiety and depression for women during pregnancy, promote normal birth, and build social support to improve women’s feelings and positive expectations of birth.展开更多
This brief commentary attempts to provide a concise synthesis of social psychology experiments that inform an interpretation of clinical pain. From a social perspective the expression of pain is a complex phenomenon t...This brief commentary attempts to provide a concise synthesis of social psychology experiments that inform an interpretation of clinical pain. From a social perspective the expression of pain is a complex phenomenon that is greater than the patient's physiology. Numerous experiments show that pain is modulated by social andcontextual factors. These experiments point to the role of the listener as a social agent that can modulate the patient's expression. Within the clinical setting the patient's pain experience can be understood as the uncertainty of physical damage and their expression as an attempt to reduce that uncertainty. How successfully this occurs is in part dependent on the empathetic reception of the provider. Chronic pain is a state that is challenging to effectively model in humans but may persist in patients due to an inability to receive effective empathetic reception at the critical time of need(at or near onset). Rather than focusing on pain's alleviation future avenues of pain interventions may do well by turning attention to the most effective ways to impart a message that the patient will be "okay" in a genuinely empathetic manner.展开更多
文摘Colonoscopy is the reference method in the secondary prevention,diagnosis and,in some cases,treatment of colorectal cancer.It can often cause pain associated with embarrassment,anxiety,and physical and emotional discomfort.Pain intensity is influenced by a lot of factors,and there is a strict relationship among pain,pain perception,and mind.Several methods can be used to break the trinomial colonoscopy,pain and fear.Sedoanalgesia is recommended by several guidelines.If no sedation is offered,the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort.Other non-pharmacologic methods such as acupuncture,music,and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia.Furthermore,new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes,or the use of carbon dioxide instead of air for colon insufflation,can reduce the pain caused by colonoscopy.In the future,technical improvements such as wireless capsules or robotic probes,will probably enable to overcome the present concept of colonoscopy,avoiding the use of traditional endoscopes.However,at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified.There are several methods to reduce pain and anxiety and to break the trinomial colonoscopy,pain and fear.We must use them.
文摘Background: To improve negative birth experiences among women who experience intense labor pain during labor, it is important to examine the relationship between fear of childbirth immediately after vaginal delivery and the actual intensity of labor pain. However, previous studies have generally evaluated labor pain in a retrospective setting. Purpose: This study examined the relationship between fear of childbirth immediately after vaginal delivery and the actual labor pain intensity and accumulated labor pain intensity without pharmacological pain relief during labor in Japan. Methods: A prospective observational study was conducted between July 2015 and April 2016. Forty-seven pregnant Japanese women were available for analysis. Fear of childbirth was measured by the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version B on the third day after vaginal delivery. Participants with scores of 85 or higher were categorized in the high JW-DEQ group, having severe fear of childbirth. Labor pain intensity was examined chronologically in real time with stepwise usage of two types of Numeric Rating Scale (NRS). Accumulated labor pain intensity was calculated using the area under the curve (AUC). Results: Nine participants were in the high JW-DEQ group and eight of the nine were primiparae. Primiparae in the high JW-DEQ group experienced significantly longer duration and larger accumulated labor pain intensity between the onset of labor and 4 to 6 cm of cervical dilatation than those in the low JW-DEQ group (P = 0.024 and P = 0.021, respectively). Conclusions/Implications for Practice: The latent phase of labor was a key stage to improve fear of childbirth immediately after vaginal delivery without pharmacological pain relief among Japanese primiparae. Midwives should give assistance in the latent phase of labor by focusing on progressing labor smoothly and relieving labor pain to improve negative birth experiences.
文摘Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and external factors contribute to childbirth fear, however results vary. Aim: To identify pyscho-social factors associated with childbirth fear and possible antenatal predictors of childbirth fear according to women’s parity. Method: 1410 women in second trimester and attending one of three public hospitals in south-east Queensland were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Other measures included the Edinburgh Depression Scale (EPDS), Decisional Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous mental health condition, social support and knowledge were used. Preferred mode of birth was also collected. Psycho-social factors were analysed to determine associations with childbirth fear. Multivariate analysis was used to determine predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous and 18% (n = 143/782) of multiparous women reported high fear levels. Having a mental health history, desiring a caesarean section, reporting moderate to high pain during pregnancy, having a non-supportive partner and perceiving less childbirth knowledge than peers, were associated with childbirth fear. Standard multiple regression analyses by parity determined that depression, decisional conflict, low social support and less perceived knowledge predicted levels of childbirth fear. The model explained 32.4% of variance in childbirth fear for nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors are significantly associated with childbirth fear. The identification of predictive psychosocial factors for childbirth fear indicates the importance of observing, assessing, and developing support strategies for women. Such strategies are required to decrease anxiety and depression for women during pregnancy, promote normal birth, and build social support to improve women’s feelings and positive expectations of birth.
文摘This brief commentary attempts to provide a concise synthesis of social psychology experiments that inform an interpretation of clinical pain. From a social perspective the expression of pain is a complex phenomenon that is greater than the patient's physiology. Numerous experiments show that pain is modulated by social andcontextual factors. These experiments point to the role of the listener as a social agent that can modulate the patient's expression. Within the clinical setting the patient's pain experience can be understood as the uncertainty of physical damage and their expression as an attempt to reduce that uncertainty. How successfully this occurs is in part dependent on the empathetic reception of the provider. Chronic pain is a state that is challenging to effectively model in humans but may persist in patients due to an inability to receive effective empathetic reception at the critical time of need(at or near onset). Rather than focusing on pain's alleviation future avenues of pain interventions may do well by turning attention to the most effective ways to impart a message that the patient will be "okay" in a genuinely empathetic manner.
