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• The prevalence of high levels of posttraumatic stress symptoms is greatest 12 months after ICU admission. • Posttraumatic stress symptoms at 6 months were associated with ICU patient characteristics being males with longer hospital stay. • Posttraumatic stress symp 3, 6, and 12 months were associated with ICU patient characteristics being ≥ 70 years old, a lower educational level, a higher SAPS II score, and being mechanically ventilated in ICU. • Healthcare professionals can be aware that specific groups of patients may have different follow-up needs, implying that the follow-up period should exceed on year. Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. High PTSS levels (IES- R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these. [ABSTRACT FROM AUTHOR]

Intensive care unit (ICU) patients experience several symptoms, yet patterns of symptoms and their relationship with demographic and clinical characteristics have not previously been investigated. To identify and compare subgroups (i.e. latent symptom classes) of intensive ICU patients based on prevalence of co-occurring symptoms over seven days. Prospective cohort study of adult ICU patients' self-reports of five symptoms during seven days in ICU. Latent class analysis was applied to identify subgroups of ICU patients. Multicenter study with patients from six mixed ICUs in Norway. Patient Symptom Survey was used to assess five symptoms (i.e., thirst, pain, anxiousness, tiredness, shortness of breath). Among 353 included patients, median age was 63 years and 60.3 % were male. Subgroups of patients were identified in a Low class (n = 126, 35.7 %), Middle Class (n = 177, 50.1 %) and High Class (n = 50, 14.2 %) based on reporting of the prevalence of five symptoms. Patients in the Low class had a low prevalence of all symptoms. Middle Class patients had a high prevalence of thirst and tiredness and a low prevalence of pain, anxiousness and shortness of breath. The High class patients had a high prevalence of all symptoms. Symptom prevalence remained stable in the Low and Middle class over time and increased over time in the High class. There were significant differences among symptom classes in use of mechanical ventilation (p = 0.012), analgesics (p < 0.001), alpha-2 agonists (p = 0.004) and fluid restriction (p = 0.006). Patients in the High class received more of these ICU-treatments. Findings suggest that subgroups of ICU patients with distinct symptom experiences can be identified. The High prevalence class patients had consistently high levels of all symptoms across seven ICU days and received more ICU-related interventions. Some ICU patients experience a consistently high prevalence of co-occurring symptoms. Clinicians should be aware of treatment factors that could be linked to a high burden of symptoms. [ABSTRACT FROM AUTHOR]

• By using different methodological approaches, this study proved a broader understanding about pediatric postoperative pain management in PACUs in Norway • In this study we identified barriers to effective pediatric postoperative pain management on different levels • By addressing different barriers with multifaced and multileveled implementation strategies, this study showed a positive change in pediatric postoperative pain management but the difference in change between the intervention group and the control group was not statistically significant Pediatric postoperative pain is still undertreated. To assess whether educational intervention increases nurses' knowledge and improves pediatric postoperative pain management. Cluster randomized controlled trial with three measurement points (baseline T1, 1 month after intervention T2, and 6 months after intervention T3). The study was conducted in postanesthesia care units at six hospitals in Norway. Nurses working with children in the included units and children who were undergoing surgery were invited to participate in this study. Nurses were cluster randomized by units to an intervention (n = 129) or a control group (n = 129). This allocation was blinded for participants at baseline. Data were collected using "The Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain: Norwegian Version" (primary outcome), observations of nurses' clinical practice, and interviews with children. The intervention included an educational day, clinical supervision, and reminders. At baseline 193 nurses completed the survey (75% response rate), 143 responded at T2, and 107 at T3. Observations of nurses' (n = 138) clinical practice included 588 children, and 38 children were interviewed. The knowledge level increased from T1 to T3 in both groups, but there was no statistically significant difference between the groups. In the intervention group, there was an improvement between T1 and T2 in the total PNKAS-N score (70% vs. 83%), observed increase use of pain assessment tools (17% vs. 39%), and children experienced less moderate-to-severe pain. No significant difference was observed between the groups after intervention, but a positive change in knowledge and practice was revealed in both groups. Additional studies are needed to explore the most potent variables to strengthen pediatric postoperative pain management. [ABSTRACT FROM AUTHOR]

A diary written for intensive care patients might help fill in memory gaps and promote psychological recovery. In Norway intensive care diaries are mainly authored by nurses and national recommendations ensure a systematic approach to the intervention. Studies describing the patient experience of nurse-written intensive care diaries are needed. The aim of this exploratory study is to investigate patientś experience of receiving and reading a nurse-written diary. This is a cross-sectional multicentre survey among patients discharged from seven intensive care units in Norway. Among the 88 patients included, 90 % were satisfied with the diary handover process. As many as 88 % of the respondents agreed that the diary demonstrated good care, helped them realize how critically ill they had been and understand why recovery takes time (76 %), and made them grateful for surviving (74 %). One third of the respondents (30 %) reported that the diary saddened them, 6 % reported that the diary reminded them of a time in their lives they would rather forget, while 17 % reported that critical events were missing in the diary. However, nearly all patients were in favour of continuing the diary intervention (98 %). Overall, the respondents were satisfied with the nurse-written diary, the handover as well as the content, and they recommended that the intervention should be sustained. The handover of the diary should be tailored to meet the individual preferences of the patients in terms of timing and approach, since the diary intervention may not suit all patients. Improvements to the intervention could be a more complete narrative in the diary including both positive and critical events during the intensive care trajectory. [ABSTRACT FROM AUTHOR]

To review the literature on thirst in intensive care unit (ICU) patients and report potential causes, risk factors, diagnosis and measurement tools, as well as potential co-occurrence with other distressing symptoms, and the management of thirst in the ICU. A scoping review employing the Joanna Briggs Institute methodology. PubMed, MEDLINE, EMBASE and CINAHL were searched from inception to April 2024. Any type of empirical study reporting thirst or associated xerostomia in adult patients (≥18 years) admitted to an ICU or high dependency unit for more than 24 h were included. The search yielded 907 unique records, and after evaluating 65 full-text publications, 21 studies were included. Thirst intensity was addressed most often (eleven studies), whereas the experience (or quality) of thirst and the validation of a measurement instrument, were addressed in only one study. Although co-occurrence of symptoms was addressed in four studies, only one pilot study looked into the interaction of thirst with other symptoms. Intervention studies have been focussing primarily on mouth-care interventions. Thirst is a distressing symptom in the ICU, with reported high prevalence and intensity. Knowledge about its causes, interventions that incorporate minimising its risk, occurrence and intensity are limited. Health care providers should acknowledge thirst as a prominent symptom for ICU patients. They should possess knowledge on the factors that potentially evoke or aggravate thirst. Regular and timely relief of thirst by oral care with cold swabs and the application of menthol can be regarded as a first choice of intervention. [ABSTRACT FROM AUTHOR]

Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm. Evaluate the feasibility and clinical utility of this algorithm. A descriptive survey. One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway. Nurses working at the three units. A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used. Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%). Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients' pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients' pain is needed. [ABSTRACT FROM AUTHOR]

Abstract Objectives To describe the prevalence and trajectory of family caregivers' post-traumatic stress symptoms during the first year after a patient's admission to the intensive care unit and identify associations between family caregivers' background characteristics, hope and post-traumatic stress symptoms. Research methodology/designs Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed. Setting Four intensive care units in a university hospital in Norway. Main outcome measures Impact of Event Scale—Revised and Herth Hope Index. Results On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels. Conclusions Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms. [ABSTRACT FROM AUTHOR]

To measure the prevalence of anxiety and depression in intensive care patients six months after admission to an intensive care unit and to investigate which variables are associated with anxiety and depression at six months. In this cohort study, patient-reported outcome measures were collected as soon as possible upon admission and at six months. Two logistic regression models were performed to examine variables associated with reporting anxiety and depression above ≥8 at six months. Patients were recruited from six intensive care units in two Norwegian hospitals between 2018 and 2020. The Hospital Anxiety and Depression Scale. A total of 145 patients was included in the study. The patients reported a prevalence of 18.6% (n = 27) and 12.4% (n = 18) of anxiety and depression, respectively. Higher baseline anxiety scores were associated with both higher odds of reporting anxiety and depression above ≥8. Younger age was associated with higher odds of reporting anxiety, and being female was associated with lower odds of reporting depression. Several intensive care survivors reported having symptoms of anxiety and depression six months after admission to the intensive care unit. Younger age, and higher anxiety scores at baseline were variables associated with higher odds of reporting symptoms of either anxiety or depression, while being female was associated with a lower odds of reporting depression. Screening patients for anxiety and depression may help to identify vulnerable patients. Structured follow-ups with intensive care nurses in an outpatient setting may be useful to help patients to work through some of the experiences from the intensive care unit. [ABSTRACT FROM AUTHOR]

Abstract Background: Despite readily available evidence to guide practice, children continue to experience moderate to severe pain in hospital postoperatively. Reasons for this may include attitudes of nurses toward pain management and their lack of knowledge in key areas. Aims: To identify nurses' knowledge and clinical practice of pediatric postoperative pain management and whether there is a link between knowledge and practice. Design and setting: A descriptive cross-sectional study including a questionnaire and observations was conducted in postanesthesia care (recovery) units in six university hospitals in Norway. Methods: Nurses completed the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Questionnaire–Norwegian Version (PNKAS-N). We observed their clinical practices using a structured observational tool and field notes. Results: Nurses completed the PNKAS-N (n = 193) and were observed (n = 138) giving postoperative care to 266 children (70 hours per unit, 416 hours in total). The mean PNKAS-N score was 29 (standard deviation 4.2) of 40. We identified knowledge deficits, mainly in pharmacologic management, such as in risk of addiction and respiratory depression. We found that, overall, pain was assessed using validated tools in 19% of the children; this fell to 9% in children aged <5 years. More than 66% of children received an inadequate dose of morphine postoperatively. Conclusion: Nurses have knowledge deficits about pediatric pain management and do not always use their knowledge in practice, particularly in relation to pain assessment. There is a need to improve nurses' knowledge of pediatric pain management and to test interventions that support the use of that knowledge in practice. [ABSTRACT FROM AUTHOR]

Background: A growing number of studies have addressed the long-term consequences of intensive care unit (ICU) treatment, but few have studied the prevalence of chronic pain and pain characteristics longitudinally. Aims: The goal of the work described here was to investigate the prevalence and characteristics of chronic pain in ICU survivors 3 months and 1 year after ICU discharge and to identify risk factors for chronic pain 1 year after ICU discharge. Design: The design used was an explorative and longitudinal study. Setting/Patients: The patients in this work had stayed >48 hours in two mixed ICUs in Oslo University Hospital, a tertiary referral hospital. Methods: Patients completed a survey questionnaire 3 months and 1 year after ICU discharge. Pain was assessed using the Brief Pain Inventory–Short Form. Results: At 3 months after discharge, 58 of 118 ICU survivors (49.2%) reported pain, and at 1 year after discharge, 34 of 89 survivors (38.2%) reported pain. The most common sites of pain at 3 months were the shoulder and abdomen; the shoulder remained the second most common site at 1 year. There was an increase in the interference of pain with daily life at 1 year. Possible risk factors for chronic pain at 1 year were increased severity of illness, organ failure, ventilator time >12 days, and ICU length of stay >15 days. The most common sites of pain were not linked to the admission diagnosis. Conclusions: These findings may enable health care providers to improve care and rehabilitation for this patient group. [ABSTRACT FROM AUTHOR]

To describe work participation in survivors during first year after intensive care unit discharge and examine the impact of selected demographic, clinical and psychosocial factors on return to work 12 months after discharge. A predefined sub-study (prospective cohort study) of a randomised controlled trial. A Norwegian single-centre university hospital. Medical and surgical adult intensive care survivors, working/on sick leave before admission, in the intensive care unit ≥24 h, were included. Return to work three, six and 12 months after discharge, and impact of age, pre-existing comorbidities, previous serious life events, coping ability, hope and social support on return to work 12 months after discharge. Included were 284 patients, with mean age 47 years (SD 13.9) and 47 % women. One year after discharge, 69 % were back at work. In the regression analysis, with working at 12 months (yes/no) as the dependent variable, 178 patients, completing questionnaires at three as well as 12 months, were included. Lower age (OR 0.96, 95 % CI [0.93–0.99]), lower pre-existing comorbidities (OR 0.65, 95 % CI [0.43–0.97]), previous serious life events (OR 6.53, 95 % CI [2.14–19.94]), and greater hope at three months (OR 1.09, 95 % CI [1.01–1.17]) were all independently associated with higher odds of returning to work. Following intensive care, age, pre-existing comorbidities, experience of previous serious life events and hope all have a significant impact on return to work, and are important variables to consider during intensive care treatment and rehabilitation. Attention must be paid to patients with prior working capability to ensure return to work after intensive care treatment. Older adults with pre-existing comorbidities might benefit from early, individualised rehabilitation to regain previous working capacity. In addition, there is also a need to support patients' hope during and after critical illness. [ABSTRACT FROM AUTHOR]

Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients. [ABSTRACT FROM AUTHOR]

Objectives To develop a pain management algorithm for intensive care unit (ICU) patients and to evaluate the psychometric properties of the translated tools used in the algorithm. Background Many ICU patients experience pain. However, an evidence-based algorithm for pain management does not exist. Methods Literature review, expert panel, and pilot testing were used to develop the algorithm. The tools were evaluated for inter-rater reliability between two nurses. Discriminant validity was evaluated by comparing pain during turning and rest. Results An algorithm was developed. The Behavioral Pain Scale (BPS) and the Behavioral Pain Scale-Non Intubated (BPS-NI) discriminated between pain scores during turning and rest. Inter-rater reliability for the BPS varied from moderate (0.46) to very good (1.00). Inter-rater reliability for the BPS-NI varied from fair (0.21) to good (0.63). Conclusions The content of the pain management algorithm is consistent with the latest clinical practice guideline recommendations. It may be a useful tool to improve pain assessment and management in adult ICU patients. [ABSTRACT FROM AUTHOR]

Objectives To implement a pain management algorithm in intensive care units (ICU) and to evaluate nurses' level of adherence with the algorithm. Background Many ICU patients experience pain. Therefore, an evidence-based algorithm for pain management was developed. Methods A pain management algorithm was implemented in three units over three weeks. Nurses' level of adherence with the algorithm and associations between level of adherence and patient and unit characteristics over 22 weeks were evaluated using multivariate regression analysis. Results Nurses' level of adherence was 74.6%. Adherence rates were lower on the evening and night shifts compared to the day shift. Males were assessed significantly less frequently than females. Patients with “injury, poisoning, or certain other consequences of external causes” were assessed significantly less frequently than patients with “diseases of the respiratory system.” Conclusions ICU nurses can use a pain management algorithm consistently. Findings from this study suggest that a pain management algorithm is a useful tool to increase ICU nurses' adherence with pain assessment. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The overall aim of the project was to update and inform nurses of current best practice based on previously published literature to enable nurses to assess and manage breakthrough cancer pain (BTCP) and thereby to provide optimal management of BTCP. Methods: The EONS started a project in 2010 by recruiting a working group and a multidisciplinary advisory board to develop guidelines with the purpose of helping oncology nurses understand and recognise BTCP. Results: This paper presents and overview of the guideline. Key recommendations include; using an algorithm for assessment of BTCP, individualise treatment interventions, optimization of analgesia and reassessment of outcomes of interventions. Conclusions: By implementing the EONS guidelines nurses will utilise the latest available knowledge in clinical practice and the understanding and management of BTCP will improve assessment and overall management of breakthrough pain in cancer patients. [Copyright &y& Elsevier]

Abstract: Purpose: To increase our knowledge of how nurses assess breakthrough cancer pain (BTCP); and whether they find it difficult to distinguish BTCP from background pain; how they estimate the impact of BTCP on patients' daily lives, and the factors that nurses consider to induce BTCP. Variations in their use of assessment tools and their ability to distinguish between different types of pain were also examined in terms of the number of years of oncology nursing experience and the practice in different countries. Methods: In total, 1241 nurses (90% female) who care for patients with cancer, from 12 European countries, completed a survey questionnaire. Key results: Half the sample had >9 years of experience in oncology nursing. Although 39% had no pain assessment tool to help them distinguish between types of pain, 95% of those who used a tool found it useful. Furthermore, 37% reported that they had problems distinguishing background pain from BTCP. Movement was identified as the factor that most commonly exacerbated BTCP across all countries. The nurses reported that BTCP greatly interfered with patients' everyday activities, and they rated the patients' enjoyment of life as most strongly affected. The use of tools and the ability to distinguish between different pains varied between European countries and with years of experience in oncology nursing. Conclusions: The nurses reported that BTCP greatly interfered with patients' lives, and many nurses had problems distinguishing between background pain and BTCP. Nurses require more knowledge about BTCP management, and guidelines should be developed for clinical use. [Copyright &y& Elsevier]

Abstract: Context: Little is known about changes over time in multiple dimensions of the symptom experience in patients with breast cancer undergoing radiation therapy (RT). Objectives: This study evaluated for changes in and predictors of occurrence, severity, and distress of six common symptoms (lack of energy, worrying, difficulty sleeping, feeling drowsy, sweats, and pain) during RT for breast cancer. Methods: Patients (n = 188) completed the Memorial Symptom Assessment Scale before, during, and after the completion of RT, over a six-month period. Changes in symptom occurrence were evaluated using multilevel logistic regression analysis. Changes in severity and distress scores were evaluated using multilevel proportional odds ordinal logistic regression. The impact of five demographic and clinical characteristics (age, functional status, comorbidities, axillary lymph node dissection, and previous chemotherapy) was evaluated in these analyses. Results: The trajectories for occurrence, severity, and distress for the six symptoms followed similar patterns. For three of the six symptoms (lack of energy, feeling drowsy, and worrying), all three dimensions changed over time. For the other three symptoms (difficulty sleeping, sweats, and pain), no changes over time occurred for any of the symptom dimensions. The overall effect of the five covariates was to increase symptom burden across all three dimensions. Conclusion: Findings from this study provide a more complete picture of the symptom experience of women who undergo RT for breast cancer. These findings can be used to identify patients at higher risk for more severe symptoms before, during, and after RT. [Copyright &y& Elsevier]

Abstract: Purpose of the research: Breakthrough cancer pain (BTCP) is a prevalent type of pain in which the nurse can play an important role in improving patients’ pain symptoms and overall well-being. Nurses’ experience with BTCP (number of patients, and estimates of severity and frequency), the treatment of BTCP (pharmacological and nonpharmacological treatments normally used), ratings of the importance of treatment factors, and reasons given for not advising patients to take strong painkillers are presented in the present paper. Methods and sample: Nurses from 12 European countries, who cared for patients with cancer, took part in a survey. In total 1618 nurses were recruited and 1241 completed the survey questionnaire. Key results: Almost 90% of the nurses were female, and 50.4% had >9 years of experience in oncology nursing. The majority of the nurses (47%) said that a patient typically suffered from BTCP 2–3 times a day, and the severity of the pain for the patients was described as severe by 75.5%. In all, 38.4% of the nurses were unaware that medications specifically intended for treatment of BTCP exist, and 57% reported that oral opioids were normally prescribed for BTCP at their workplace. While 38% said they did not use nonpharmacological treatments for BTCP, the most common treatment approach was positional change (used by 76.6%). The treatment varied between the European countries. Conclusion: Patients do not receive the appropriate medical treatment for their BTCP. Nurses need better training about BTCP in general, and BTCP assessment and management specifically. [Copyright &y& Elsevier]

Abstract: Context: Inadequate knowledge is one barrier to effective cancer pain management. Objectives: This study''s aim was to evaluate the effects of a psychoeducational intervention (the Norwegian version of the PRO-SELF© Pain Control Program) compared with a control group in increasing patients'' knowledge of cancer pain management. Methods: Adult oncology outpatients with pain from bone metastasis of 2.5 or greater on a 0 to 10 numeric rating scale were randomized into the PRO-SELF (n =87) or control (n =92) groups. Patients completed a demographic questionnaire and the Pain Experience Scale (PES) at the beginning and end of the study to assess their knowledge and attitudes. The six-week intervention consisted of education, skills building, and nurse coaching. Mixed-model analyses with tests of a group×time interaction were done for each of the individual items and total PES scores to evaluate between-group differences in changes in knowledge over time. Results: Except for functional status, no differences were found between the PRO-SELF and control groups on any baseline demographic, clinical, or pain characteristics. Significant group×time interactions were found for all the single item and total PES scores. Compared with the control group, patients in the PRO-SELF group had significant increases in knowledge scores. Conclusion: The use of a knowledge and attitude survey, like the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. This individualized approach to education about pain management may save staff time and improve patient outcomes. [Copyright &y& Elsevier]

Abstract: Purpose of research: To determine the effect of the hope intervention (HOPE-IN) on levels of hope and psychological distress immediately (T2), 3 (T3), and 12 (T4) months following the intervention; determine the effects of the HOPE-IN on changes in patients’ level of hope after controlling for baseline levels of psychological distress; and evaluate patients’ level of satisfaction with the HOPE-IN. Methods and sample: This single group, longitudinal study recruited a community-based sample which cancer. Most of the participants (n = 195) were females, married, and had breast cancer. The HOPE-IN consisted of eight 2-h sessions conducted over 8 weeks. Data were collected on demographic and clinical characteristics, hope (Herth Hope Index), psychological distress (Impact of Event Scale (IES)), and satisfaction with the HOPE-IN. Key results: Hope scores increased significantly from T1 to T2, and then decreased slightly from T2 through T4. Both intrusion and avoidance IES scores decreased significantly from T1 to T2 and then decreased slightly from T2 to T4. The changes in hope scores remained significant even when baseline scores on intrusion were controlled for in the analyses. Baseline level of hope was negatively correlated with baseline intrusion and avoidance scores. These findings indicate that the trajectories of hope scores remained the same conditioned on intrusion or avoidance. Over 95% of the participants reported that the HOPE-IN was useful to them. Conclusions: Additional research is warranted to determine the most effective approaches to increase hope and reduce psychological distress in individuals who are living with a cancer diagnosis. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to evaluate the prevalence and characteristics of pain in patients with chronic obstructive pulmonary disease (COPD) compared to a sample from the Norwegian general population. This cross-sectional study evaluated 100 COPD patients with and without pain and 333 individuals from the Norwegian population with pain. After controlling for age and sex, a significantly higher percentage of patients with COPD (45%) reported pain than the general population (34%; P = .02). No differences were found in pain intensity scores, pain interference score, or number of pain locations between COPD patients and the general population. COPD patients reported moderate-to-severe pain located primarily in the chest, shoulders, neck, and thorax. For both groups, the most common pain treatment was analgesic use. Acupuncture/transcutaneous electrical nerve stimulation was used more frequently by COPD patients (P < .001) while physiotherapy was used more frequently by the general population (P = .007) to treat their pain. Pain is a significant problem for COPD patients. Additional research is warranted to replicate these findings and to provide a more detailed characterization of how pain changes over time and influences COPD patients’ ability to function and their quality of life. Perspective: Compared to the general population, pain is more common in patients with COPD and ranges from moderate to severe in its intensity. [Copyright &y& Elsevier]

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women''s postoperative experiences were collected with qualitative interviews in the women''s homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory–Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important. [Copyright &y& Elsevier]

Pain is a major problem in the nursing home population, with a prevalence range of 27% to 84%. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (). It has an impact on many aspects of a person''s emotional, social, and physical functioning, and on quality of life (QoL) The purpose of this study was to describe pain and QoL in a nursing home population that could self-report pain and to examine the association between QoL and pain in these patients. Pain was measured by a verbal rating scale from “no pain” to “severe pain.” Quality of life was measured by the Dementia Quality of Life Questionnaire (DQoL) consisting of five domains: self-esteem, positive affect/humor, feeling of belonging, and sense of esthetics and negative affect. Totally, 106 patients, with a mean age of 86 years (SD 6.5, range 65-102) with a Mini Mental State Examination (MMSE) score >11 were included, and 87% had mild or moderate reduced cognitive function. In total, 55% reported pain, and out of those, 55% reported mild, 29% moderate, and 16% severe pain. A significant association was found between scores on the negative affect domain and reported pain (t = 3.17; p < .01) and pain intensity (r = 0.40; p < .01). No significant associations were found between the other domains and pain. This study shows that pain has a negative effect on mood. Examining the relationship between pain and negative feelings in persons with reduced cognitive function may suggest new areas of intervention for reducing pain and negative feelings in this patient population. [Copyright &y& Elsevier]

Objective: This study evaluated the pain experiences of patients with chronic obstructive pulmonary disease (COPD). Sample: We studied 16 patients with severe COPD. Design: A semistructured interview was performed to obtain information on patients'' experiences with pain and the impact of pain on quality of life (QOL). Data were analyzed using the methodology of Kvale. Results: Three main themes emerged: incomprehensible and unbearable pain; locked in my body and shut out from the world; and the vicious COPD circle. Patients reported moderate to severe pain located primarily in the shoulders, neck, upper arms, and chest. Patients reported a number of severe symptoms occurring simultaneously, and negatively affecting each other. Vicious circles of pain, breathlessness, sleep disturbance, and anxiety were described as exerting negative effects on patients'' QOL. Conclusion: Unrelieved pain appears to be a significant problem in patients with COPD. Research is warranted to determine if pain is clustered with other symptoms, and how these symptoms affect the clinical management of COPD. [Copyright &y& Elsevier]

Abstract: Pain is a significant symptom in cancer patients. Understanding of patients' experiences in relation to pain management is important in evidence-based nursing in the field of pain. The aim of this study was to explore cancer patients'' experiences of nursing pain management during hospitalization for cancer treatment. Eighteen cancer patients participated in the study, all with advanced cancer, including skeleton metastases. The female participants all had breast cancer, and the male participants all had prostate cancer. Data were collected by in-depth interviews, and qualitative description was used to entail low-inference interpretation to reach an understanding of the essence of pain and nursing pain management. Patients found it somewhat difficult to express their expectations of nursing pain management and competencies. However, 1) being present and supportive; 2) giving information and sharing knowledge; 3) taking care of medication; and 4) recognizing the pain emerged as themes in nursing pain management. Although patients believed that nurses were caring persons, they perceived differences between nurses in the ways they handled pain management. Furthermore, some patients experienced a lack of information from nurses in relation to pain management. Although cancer patients'' experiences showed the importance of nurses in pain management, it seems that nurses should have a clearer role in cancer pain management in relation to counseling and patient education. The results from this study can increase nurses'' awareness of their role in pain management as a first step in improving pain management for patients. [Copyright &y& Elsevier]

Abstract: The pain experience of patients with heart failure (HF) and its impact on their quality of life (QOL) has not been described in sufficient detail. This study sampled patients hospitalized with HF to describe the prevalence and severity of bodily pain; evaluate differences in bodily pain related to selected demographic and disease-specific characteristics; and evaluate the effect of selected demographic, disease-specific characteristics, bodily pain, and mental health on QOL. Two items from the Medical Outcomes Study—Short Form (SF-36) were used to measure pain, and one subscale of the SF-36 was used to evaluate mental health. The Minnesota Living With Heart Failure Questionnaire was used to measure QOL. Patients with HF (n =93) had a mean age of 75 years, were predominantly male (65%), and lived alone (47.3%). Lung diseases and diabetes were the most common comorbidities; 58% were categorized as New York Heart Association (NYHA) Class III, whereas 58% of the sample was diagnosed with HF in the past four years. Of note, 85% of the patients reported pain and 42.5% said that it was in the severe or very severe range. No demographic variables were associated with pain, whereas a higher number of chronic conditions were associated with pain. SF-36 mental health and pain scores, as well as NYHA class, explained 34.1% of the variance in QOL in patients with HF. These data suggest that pain is highly prevalent and has a significant impact on the QOL of patients with HF. However, additional research is warranted to determine the specific causes and characteristics of pain in these patients. [Copyright &y& Elsevier]

Abstract: Cut-points (CP) for pain severity are useful because they may help clinicians to identify patients with clinically significant pain. However, a need exists to evaluate whether different pain severity groups differ on selected demographic, clinical, and pain characteristics, as well as on factors that may be amenable to psychoeducational interventions such as self-efficacy for pain management, coping strategies, and barriers to pain management. In this cross-sectional study of 210 oncology outpatients with pain, an optimal CP of 4 was found using ratings of average pain intensity. The variables that provided a unique contribution to the prediction of membership in the >4 CP group were gender, presence of breakthrough pain, comorbidities, barriers to pain management, and total self-efficacy for pain management. In addition, patients in the >4 CP group reported lower scores on physical, role, cognitive, and global health function. Perspective: An average pain CP of >4 could be used to screen oncology outpatients with clinically significant pain. Clinicians must consider a number of demographic, clinical, and pain characteristics as part of their pain assessment procedures. The effectiveness of psychoeducational interventions aimed at barriers and patients self-efficacy for pain management need to be tested. [Copyright &y& Elsevier]

Abstract: This study describes the prevalence and occurrence of diabetic foot ulcer (DFU) pain and the impact of DFU pain on health-related quality of life (HRQL) using generic and disease specific instruments. Data were obtained from 127 patients with DFU who were recruited from 6 hospital-based diabetic outpatient clinics. HRQL was measured using the Medical Outcome Study–Short Form (SF-36) and the Diabetes Foot Ulcer Scale (DFS). Occurrence of pain was assessed using 2 items from the DFS (ie, pain while walking and/or standing and pain during the night related to foot ulcer problems). Seventy-five percent reported some pain related to DFU and 57% reported DFU pain while walking and/or standing and also during the night. Twenty-five percent reported pain none of the time. A higher percentage of patients with pain reported having a prescription for an analgesic medication than those without pain. Patients who reported pain most or all of the time had statistically and clinically significantly poorer HRQL than those who did not report pain. These findings suggest that pain associated with DFU is a significant clinical problem. Additional research is warranted to further characterize the pain associated with DFU and its impact on patient outcomes and HRQL. Perspective: Numerous basic and clinical studies have focused on pain associated with diabetic peripheral neuropathy. Findings from this study suggest a new pain problem in patients with diabetes, namely, pain associated with foot ulcers, that warrants further investigation. [Copyright &y& Elsevier]

Abstract: The relationship between pain and quality of life (QOL) in cancer patients is complex due to the number and the diversity of factors that can influence pain and QOL. The aims of this study of oncology outpatients with pain from bone metastasis were: 1) to determine the extent to which pain characteristics (i.e., severity, duration, meaning of pain, and perceived availability and efficacy of pain relief), psychological distress (i.e., depression), physical functioning, social functioning and QOL are intercorrelated, and 2) to determine which of these variables are important predictors of QOL. A total of 157 oncology outpatients completed questionnaires that evaluated pain, QOL, depression, physical functioning, and social functioning at the time of enrollment into a randomized clinical trial that evaluated the effectiveness of a psychoeducational intervention to improve cancer pain management. Pearson product moment correlation coefficients were calculated to examine the relationships among the study variables. A blockwise, hierarchical multiple regression analysis was performed to determine which variables were the most important predictors of QOL. Meaning of pain was significantly correlated with all the other variables, in particular pain intensity and duration. The most important factors that predicted QOL were depression, social functioning, and physical functioning. Depression proved to be the most important predictor of QOL. [Copyright &y& Elsevier]

Background: Because of better health care, most people with cystic fibrosis (CF) now survive into adulthood, raising issues related to quality of life. Few studies have focused on satisfaction with broader life domains in people with CF. The aim of this article was to examine the impact of living with CF from a global quality of life perspective. Methods: The sample consisted of 86 adults with CF recruited from the Norwegian Competence Centre for Cystic Fibrosis and a control group of 1021 individuals from the general population (GP). The Norwegian version of the Quality of Life Scale was used to measure global quality of life (satisfaction with broader life domains) in both groups. Results: The mean global quality of life score was 84.88 for the CF group and 83.33 for the GP group. This difference was significant after controlling for age, sex, educational level, and marital status, indicating that people with CF have better global quality of life. The groups also differed significantly on other specific measures of life satisfaction. Persons with forced expiratory volume in 1 second values below 30% of predicted values reported the lowest mean global quality of life value. Conclusions: These results suggest the existence of a type of response shift in the CF group through changes in life standards and goals. However, people with CF who have low forced expiratory volume in 1 second values may need special attention from health care professionals on issues related to global quality of life. [Copyright &y& Elsevier]

The aim of this study was to examine to what extent demographic and disease-specific variables affected pain in cancer patients. Two to three weeks after their last hospitalization, 1,453 cancer patients completed questionnaires measuring demographic variables, quality of life, and pain (EORTC-QLQ C-30). Response rate was 72.1%. Data on type of cancer and the severity of the disease were also compiled. Sixty percent of the sample reported some pain. Type of cancer, presence of metastases, and time until death were significant predictors of experienced pain. The patients'' experience of pain was mainly associated with disease-specific variables. Sex, age, level of education, and co-habitation were not related to pain, but employment status was. The patients on disability pensions had significantly more pain than the patients who were working or studying. Special attention should be given to patients with advanced prostate cancer with a short time to live, as they reported the most pain. [Copyright &y& Elsevier]

Multiple symptoms can have a negative impact on quality of life (QoL), but there is little information about the impact of multiple symptoms on QoL of patients with colorectal cancer (CRC) during outpatient chemotherapy. Therefore, the purpose was to assess the physical and mental QoL in CRC patients over six months of chemotherapy, to evaluate the association of QoL with the presence of multiple symptoms, and to determine which demographic and clinical characteristics are associated with physical and mental QoL scores. Outpatients with CRC (N = 120) completed the Medical Outcomes Study Short Form (SF-12) and Memorial Symptom Assessment Scale (MSAS) at eight time points during six months of chemotherapy. Linear mixed models for repeated measures were used to analyse QoL over time; and its association with demographic and clinical characteristics; and with the presence of multiple symptoms (e.g., 'numbness/tingling' and 'problems with sexual interest'). The CRC patients had worse physical and mental QoL scores than the general population at all time points. Impaired physical QoL was significantly associated with psychological symptom burden (p < 0.001) and numbness/tingling (p < 0.027). Impaired mental QoL was associated with physical symptom burden (p < 0.001), with being female (p < 0.009), younger age (p < 0.024), and having problems with sexual interest (p < 0.009). Impaired QoL was associated with symptoms in CRC outpatients. This information about the symptoms and characteristics associated with worse QoL during chemotherapy may help clinicians identify and inform at-risk patients. •Impaired quality of life (QoL) was associated with symptoms in colorectal cancer (CRC) outpatients. • Impaired physical QoL was associated with psychological symptom burden and numbness/tingling. • Imparied mental QoL was associated with physical symptom burden, female sex, younger age, and problems with sexual interest. • Systematic symptom assessment reduces the risk of underestimation of the symptom burden and its impact on QoL. [ABSTRACT FROM AUTHOR]

Context: Pain management education may improve pain control for some patients, whereas individual differences exist.Objectives: To evaluate possible critical components, facilitators, and hindrances for improved knowledge about pain management, in not hospitalized adult oncology patients with pain from bone metastasis participating in a pain management intervention.Methods: This substudy is a qualitative evaluation of the PRO-SELF Pain Control Program, tested in a randomized controlled trial. During six weeks, 87 participants in the intervention group received tailored coaching encounters by a trained oncology nurse. Three encounters for each patient were audio recorded. The encounter between patient's with the largest (n = 12) and lowest (n = 8) change in knowledge about pain management from before to after the intervention was transcribed verbatim and analyzed with qualitative content analysis.Results: The critical components of the intervention were repetition of information, struggling with resistance, use of peer experiences, and keeping track of variations. Facilitators of improvement were patients' trust and preparedness to try new procedures, the patient's self-awareness and body awareness, and taking active role in own care. Difficulties in processing complex information, culturally conditioned behaviors, fear, and lack of knowledge were the most important barriers to the success of the intervention.Conclusion: Education in pain management in cancer patients requires repeated information, allowing time for overcoming resistance related to dysfunctional beliefs and fear. To facilitate the patient's involvement in their pain management, tailored and person-centered education is needed. [ABSTRACT FROM AUTHOR]

Purpose Being a parent of a very-low-birth-weight (VLBW) infant can be stressful. We aimed to describe parental hope 42 months after the birth of a VLBW infant and determine whether there is an association between hope and parenting stress with quality of life (QoL), respectively. Design and Methods Fifty-nine parents of VLBW infants completed questionnaires about hope, parenting stress and QoL. Pearson correlation coefficients (r) and linear regression models were used to examine the relationship between the selected variables. To compare groups, t -test was used and Cohen's d for effect size was calculated. Results Parents of VLBW infants were more hopeful than the general population ( p < 0.001). Parenting stress and hope were both independently associated with QoL (p < 0.001). The subgroup of parents of infants with birth weight < 1000 g had less hope ( p = 0.041) and higher parenting stress (p = 0.041) than parents of infants with birth weight 1000–1500 g. Conclusions Hope and parenting stress were both independent determinants of QoL. Parents of the presumably sickest infants had less hope and higher parenting stress than parents of VLBW infants with a birth weight over 1000 g. Hope should be further explored as a coping mechanism in parents of VLBW infants. Practice Implications The clinical implications of the strong association between hope, parenting stress and QoL remain to be determined, but reducing stress and strengthening hope seem to be important. This should be taken into account both at hospital discharge and at follow-up, especially for lower-birth-weight infants. [ABSTRACT FROM AUTHOR]

Objective: A challenging but main task for clinicians is to identify patients’ concerns related to their medical conditions. The study aim was to validate a new coding scheme for identifying patients’ cues and concerns. Methods: 12 videotaped consultations between nurses and pain patients were coded according to the Verona Coding Scheme for Emotional Sequences (VR-CoDES). During a metainterview each patient watched his/her own video interview with the researcher to confirm or disconfirm the identified cues and concerns. A directive or an open format was applied. Quantitative and qualitative data analyses were performed. Results: Patients’ confirmation in relation to the coding gave a sensitivity of 0.95 and specificity of 0.99 in the directive format and a sensitivity of 0.99 and specificity of 0.70 applying the open format. Through a qualitative analysis 83% of researcher-identified cues and concerns were validated. 17% were not confirmed or uncertain. Conclusion: The VR-CoDES seems to capture what are experienced as real concerns to patients, and proves to be a coding scheme with a high degree of ecological validity. Practice implications: The VR-CoDES provides a valid framework for detecting patients’ cues and concerns, and should be explored as a training tool to develop clinicians’ empathic accuracy. [Copyright &y& Elsevier]

Context: Intensive care unit (ICU) patients experience physical and psychological challenges related to ICU admission in the acute and recovery phases after a critical illness. Involvement of family caregivers (FCs) is essential in the patients' struggle to survive critical illness. FCs report a high symptom burden related to ICU admission. Previous research has investigated mainly single symptoms. Little is known about multiple symptom burden related to FC experiences in an ICU.Objective: This study aimed: 1) to describe the occurrence, severity, and distress related to multiple symptoms in FCs of ICU patients, and 2) to identify associations between the background characteristics and symptom burden of FCs.Methods: This cross-sectional study investigated multiple symptoms in adult FCs of ICU patients. FCs completed a self-report symptom assessment questionnaire within 2 weeks after the patient's admission to the ICU.Results: FCs (N=211) experienced a median of 9 (range 0-24) symptoms, among which, worrying (91%) was the most occurring. Severity and distress varied between symptoms. Younger age, being a spouse of an ICU patient, and having more comorbidities were significantly associated with the number of symptoms.Conclusions: FCs of ICU patients experience multiple symptoms, among which, psychological symptoms are most occurring. Age, relationship to the patient, and comorbidities were significantly associated with the number of symptoms reported by FCs. Comprehensive symptom assessment may identify FCs who are at risk of developing a high symptom burden when the patient is admitted to the ICU. [ABSTRACT FROM AUTHOR]

Context: Colorectal cancer (CRC) is one of the most common cancers worldwide. Patients with CRC may have multiple cooccurring symptoms as a result of their disease or its treatment. Little is known about potential differences in symptom burden in CRC patients scheduled to receive curative versus palliative chemotherapy (CTX).Objectives: The purposes of this study were to investigate the overall symptom burden of patients with CRC before their first CTX treatment or before the initiation of a new CTX regimen and to evaluate for differences in symptom occurrence, severity, and distress between patients with CRC who were scheduled to receive curative versus palliative CTX.Methods: Consecutive patients with CRC were recruited (n = 120), and symptoms were assessed using the Memorial Symptom Assessment Scale before the initiation of the CTX. The most common symptoms that occurred in ≥30% of the patients were evaluated. Differences in occurrence rates and severity and distress scores between the curative (n = 68) and palliative (n = 52) patient groups were evaluated using binary logistic regression and ordinal logistic regression analyses, respectively.Results: In both groups, patients reported an average of 10 cooccurring symptoms. Worrying (65%), lack of energy (59%), feeling drowsy (54%), feeling bloated (53%), pain (51%), and difficulty sleeping (50%) were the most prevalent symptoms. Problems with sexual interest had the highest severity and distress scores in both groups. For the 13 most common symptoms, no significant differences were found between the two patient groups on any of the Memorial Symptom Assessment Scale dimensions (i.e., occurrence, severity, distress).Conclusion: Regardless of the reason for CTX, CRC patients experience a large number of cooccurring symptoms. [ABSTRACT FROM AUTHOR]

Context: The symptom experience of patients with chronic obstructive pulmonary disease (COPD) is extremely complex. It is characterized by multiple co-occurring symptoms. However, very few studies have described this experience in COPD patients.Objectives: The aims of this study were to evaluate for differences in symptom occurrence rates, as well as ratings of symptom severity, frequency, and distress among patients (n = 267) with moderate, severe, and very severe COPD.Methods: The Memorial Symptom Assessment Scale was used to evaluate the multiple dimensions of the patient's symptom experience. Binary and ordinal logistic regression analyses with stage of disease as an ordinal predictor variable were used to evaluate for differences in symptom occurrence rates and ratings of symptom severity, frequency, and distress.Results: Regardless of the severity of their disease, patients reported an average of 12 co-occurring symptoms. Shortness of breath and lack of energy were the only two symptoms that differed significantly among the three disease severity groups in terms of occurrence, severity, frequency, and distress. Patients with very severe COPD reported the highest ratings for shortness of breath and lack of energy across all four symptom dimensions.Conclusion: Regardless of stage of disease, the high symptom burden identified in this study underscores the need for COPD patients to be screened for multiple co-occurring symptoms. [ABSTRACT FROM AUTHOR]

Abstract: The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of ≤4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n =224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores (P =0.04) and significantly lower ratings of overall health (P <0.0001). No differences were found between the two pain groups on any of the subscales of the CSQ, except catastrophizing (P <0.0001). Compared with the mild pain group, patients in the moderate to severe group scored significantly higher on this subscale. In addition, patients in the moderate to severe group used more passive coping strategies (P =0.02). Except for catastrophizing, the number and types of pain coping strategies used by this sample of hospitalized patients do not appear to be influenced by their pain intensity scores. Finally, when the CSQ scores of these hospitalized oncology patients were compared with those found in previous studies of oncology outpatients and patients with chronic noncancer pain, the scores were similar. [Copyright &y& Elsevier]

Context: Lung cancer surgery is among the surgical procedures associated with the highest prevalence of pain, but prospective longitudinal studies after the pain trajectory are scarce.Objectives: We aimed to describe the pain trajectory in patients undergoing surgery for primary lung cancer and investigate whether distinct groups of patients could be identified based on different pain trajectories.Methods: Patients (n = 264; 95% thoracotomies) provided data on the average and worst pain intensity, pain location, and comorbidities before, and at one month and five, nine, and 12 months after surgery. Pain profiles were analyzed by latent class mixed models.Results: The occurrence of any pain increased from 40% before surgery to 69% after one month and decreased to 56%, 57%, and 55% at five, nine, and 12 months, respectively. Latent class mixed models identified two classes both for average and worst pain; one class started low with high ratings after one month, then returning to a level slightly higher than baseline. The other class started higher with similar scores through the trajectory. Patients reporting no pain (8%) were placed in a separate class. Higher comorbidity score, preoperative use of both pain and psychotropic medicine characterized the class with overall highest pain for average and/or worst pain.Conclusion: Pain was highly prevalent after surgery, and subgroups could be identified based on different pain trajectories. Patients reported both postoperative pain and pain from chronic conditions. Knowledge about vulnerable patients and risk factors for pain is important to tailor interventions and information about pain. [ABSTRACT FROM AUTHOR]