Effects of Progressive Muscle Relaxation Techniques on Chronic Pain among Cancer Patients - Essay Example

?Proposed Research on Effects of Progressive Muscle Relaxation Techniques on Chronic Pain among Cancer Patients Table of Content Chapter 1: a. Introduction…………………………….……………………………………4 b. Background to the study…………………………………………….……………………………5 c. Aims and Objectives………………………………………………………….8 d. Statement of the proposed research………………………………………………………………………9 Chapter 2 a. Methodology…………………………………………………………………10 b. Research Strategy…………………………………………………………….11 c. Indexes and database…………………………………………………………11 d. Exclusion and Inclusion principles………………………….……………......12 Chapter 3 a. Reading and Evaluation of the study…………………………………………13 b. Data Analysis………………………………………………………………..14 c. Data Extraction………………………………………………………………14 d. Evaluation of the Study………………………………………………………20 e. Summary and conclusion………………………………………………………20 f. References…………………………………………………………………......24 g. Appendixes……………………………………………………………………..25 Chapter 1 a. Abstract The proposed research for this study will discuss the progressive muscle relaxation and its techniques along with the effect that it has on chronic pain in patients with cancer. The techniques discussed can have a significant impact on reducing and relaxing chronic pain in patients with cancer. The research for this study will be conducted through an examination of secondary research as relevant literature provides valuable information and knowledge about PMR and its impact on chronic pain. b. Introduction Pain is the eternal companion of mankind, with medical practitioners spending a great deal of their time assessing and finding ways to alleviate pain. Chronic pain is extremely common in patients with cancer, especially those who are found in stage IV of the disease (Ahles, 2005). Pain can be divided into four types basing on the levels of intensity. These are weak, moderate, sever, and very severe (Godfrey, 2005). All analgesic therapy in cancer patients is based on the use of non-narcotic, narcotic, and support (adjuvant) drugs, the use of which forms the basis of a three-step approach to pain management which was developed and proposed by the world health organization (American Cancer Society, 2006). According to American Cancer Society (2006), one third of all cancer patients suffer from moderate to severe pain related to their cancer and over 50% of patients diagnosed with cancer suffer from some form of pain. The most common types of pain related to cancer are due to the cancer tumor and the treatment (Altice & Jamison, 2009). Unlike those who suffer from chronic pain that is unrelated to cancer, those with cancer experience pain in more than on area. (Melzack (2005) noted that pain can be both acute and chronic and often varies in presentation and that such pains are associated with the consequences of changes in psychosocial relationships, decreased quality of life, and increased rates of depression, as well as in anxiety. However, patients and providers often find that pharmacologic therapy does not completely control pain associated with cancer (Altice & Jamison, 2009). Altice and Jamison (2009) advanced a notion that Pharmacologic management of pain often comes with side effects such as nausea, constipation, drowsiness, pruritus, sedation, and delirium. Altice and Jamison (2009) concluded that complementary and alternative medical (CAM) therapies, including mind-body techniques, are often sought out. Mind-body therapies are recommended in addition to pharmacological approaches for cancer patients experiencing pain. c. Background/Justification Cancer pain is a complex phenomenon that often occurs due to tumor progression and related pathology, surgery or other invasive procedures (Godfrey, 2005). Toxicities of chemotherapy and radiation can significantly contribute to that pain, as well as infection which all lead to a multidimensional model of cancer pain that can include the five components. These are (1) physiologic (organize etiology of the pain); (2) sensory (intensity, location, quality); (3) affective (depression and anxiety); (4) cognitive (the meaning attached to the pain); and (5) behavioral (activity level, analgesic intake) (Atsberger, 2005). This model is similar to the conceptual framework of acute pain and provides a foundation for nurses to use in planning and implementing pain relief strategies for cancer patients (Devine, 2003). Findings from studies that used adjunct measures such as relaxation hypnosis, operant techniques and back massage for pain relief in cancer patients are inconclusive. However, Yates (2012) reveals that on average 45% of all cancer patients engage in PMR and similar relaxation techniques to experience reductions in pain. Although pharmacologic methods continue to be the most common mode for cancer pain relief, problems may occur with continued use of analgesics which includes inadequate and inconsistent pain relief, diminishing effectiveness over time, and negative side effects. According to Ventafridda et al, (2006), found out that 52% of non-opioid users report that pain returns within a few weeks of after using these types of pain control medications. According to this study, a shift to medications with opioids was observed among the 92% of patients following inefficiency in pain reduction with 8% shifting because of poor side-effects. Over the same subject, Seers (2001) found that because of the potential complications from analgesics, there is increased emphasis on adjunct. It is therefore, noted that through the use of methods that are not based upon pharmacologic methods which were found to be advantageous in terms of connecting the mind to the body in order to use the self as a resource for pain control and management. Current models of management of acute pain are through pharmacologic interventions. Several classes of analgesic agents are currently available which include non-opioids, opioids, and agonist analgesics (Kwekkeboom , 2008). Each class acts at different sites to produce analgesia. Non-opioid analgesics (aspirin acetaminophen) and non-steroidal anti-inflammatory drugs relieve mild or moderate pain by interfering with the production of bradykinins and prostaglandins at the peripheral site of injury (Kwekkeboom, 2008). Weak opioids (codeine, oxycodone); strong opioids (fentanyl, meperidine, morphine) and agonists (buprenorphine) act by attaching to one or several opiate receptor sites (mu, kappa, sigma) on neurons in the central nervous system, thus preventing the transmission of nociceptive impulses from one neuron to the next (Astin, 2003). While reporting on this subject Kwekkeboom (2008) noted that Opioids and agonists are effective for moderate or severe pain while analgesics administers on “pm” or as needed basis often result in inadequate pain relief because of insufficient amounts of medications given arid lengthy intervals occurring between administration of pain medications. Due to these Kwekkeboom noted that other problems the practice of administering analgesics on a “pm” basis is becoming obsolete. With the rise of the opinion that pharmacologic pain management is largely ineffective in the long term, non-pharmacologic pain relief intervention (NPPRI) is becoming a vital component in a comprehensive approach to pain management. Haase (2005) while researching on NPPRI compliments found out NPPRI complements to enhance the effectiveness of analgesics and are not usually considered for their pain relief measures, but as an adjunctive to interventions. This explains why Non-pharmacologic modalities, used when used either alone or in combination with pharmacologic approaches, are very useful in the management of either acute or chronic pain. NPPRI methods are classified as cutaneous stimulation, e.g. massage/pressure and transcutaneous electrical stimulation, and cognitive behavioral e.g., relaxation techniques and biofeedback. Most NPPRI have few, if any side effects and are beneficial for individuals at risk for developing adverse effects from analgesics. Additionally, NPPRI requires that clients and families actively participate in pain management decisions. Study conducted by Godfrey (2005) showed that active participation is a significant determinant relieving pain. Moreover, the study showed that relaxation techniques create a powerful distraction, as well reduce muscle tension. Researchers contend that relaxation reduces pain by decreasing anxiety and the distress associated with pain which significantly alters the perception of pain. Relaxation techniques including PMR may also improve the effectiveness of analgesics by interrupting the cycle of pain, anxiety, and muscle tension. Effective relaxation relies to some extent on behaviors already associated with relaxing such as deep breathing; abdominal breathing, yawning or reflecting on peaceful experiences (Gansler, 2008). Theories on pain and pain management have changed dramatically in the past 2000 years since the time of Aristotle in which he contended that pain was an experience of the mind, an emotion that was associated with an increased sense of sensation in the body (Lewandowski, 2004). In the past decade, laboratory and clinical research on non-pharmacologic approaches to pain management have dramatically increased but the results although there seems to be mixed results on this. A gap remains in the literature on the effectiveness of NPPRI modalities within specific patient populations. This study focuses on determining if the PMR technique of can serve as NPPRI towards and help in relieving pain among patients with cancer. It is worth noting that the PMR is a technique specifically designed to decrease muscle tension and anxiety. It involves the systematic tensing and relaxing of various skeletal muscle groups of the body. Progressive muscle relaxation, which uses fewer muscle groups, is particularly suitable for use in the clinical setting with patients experiencing acute pain. Research is limited, however, about how to modify the techniques for use for relief of acute pain. d. Aims & Objectives This will be a research work that will set out to among other things achieve a number of purposes. First, the researcher seeks to identify the significance of progressive muscle relaxation techniques on chronic pain in cancer patients. Secondly, the proposed study would seek to determine the effectiveness of progressive muscle relaxation techniques on chronic pain in cancer patients. Additionally, the proposed study shall seek t determine the degree to which PMR techniques can be used in the relief of pain in cancer patients. Last but not least, the study shall be used to determine the gap between pharmacological treatments and the degree of pain that remains that can be eliminated through PMR. The aims and objectives outlined above are going to be the basis of this research work in several ways. For instance, objective to be achieved will determine the general realization of the completion of the research work because the purposes need to be achieved before the research can be said to have been brought to a successful end. Again, it is going to determine the research questions with which the researcher will have to work with. Finally, the purposes outlined are going to determine the type of data to collect at the data collection stage of the research work e. Statement of the Research Problem with Rationale for a Review The researcher has set out research a statement in an attempt to identifying specific considerations to make in order to achieve the objectives outlined above. The research statement of the study is said to have very close relation with the aims and objectives of the study in the sense that the research statement is going to be tackled at the literature review stage. To this end, the following the research problem is justified by means of PICO analysis which refers to Population; Intervention; Comparison; and Outcome and this is done when the population is identified through cancer patients, the Intervention is identified as Progressive Muscle Relaxation Technique (PMRT), the comparison is identified as the effect of Pharmacological and Non-pharmacological methods, and outcome is expected to be that PMRT produces a relaxation that breaks the pain-muscle-tension dynamic and facilitate chronic pain reduction through the effect of calming the patient from the tensions that increase pain episodes or chronic pain. The research aims to discuss the problem of chronic pain in cancer patients and the technique of reduction through the help of progressive muscle relaxation techniques. Through investigating previous research, the identification of concepts that support the review questions will begin to fill the gap between what is known about PMR and its effectiveness and the clinical use of PMR. f. The research Questions The researcher has set out research questions in an attempt to identifying specific considerations to make in order to achieve the purposes outlined above. The research questions are said to have very close relation with the purpose of the study in the sense that the research questions are going to be tackled at the literature review stage. To this end, the following research questions shall be considered: How can progressive muscle relaxation (PMR) techniques significantly reduce chronic pain in cancer patients? Is there a significant effect of progressive muscle relaxation on chronic pain? What degree of relief is created by PMR? How should PMR be used in conjunction with other pain management techniques, including pharmacological methods of management? Chapter Two: a. Methodology Secondary research will be used to build a framework through which the inquiry will gain meaning and definition. Through the use of grounded theory, the development of outcomes to the research will support hypotheses that emerge from the exploration of the information that comes from the data. Grounded theory allows the researcher to develop theories that are empirically extracted from real life experiences, providing for discovery to create theory rather than theory to inform discovery. (Wood, Marilynn, Janet & Kerr, 2011). Theory is then available to those who would use the concepts in order to inform them on methods of practice (Oktay, 2012). Through exploring the literature that is relevant to PMR and its uses by cancer patients as a methodology of pain management, this study will develop theories on the topic that can be used by further research in order to support the development of experimental frameworks of inquiry. b. Research Strategy The research strategy will be defined by centering inquiry on secondary data collection. Through qualitative approaches to inquiry, the study will use several approaches of collecting data which may be primary or secondary in nature, all of which will be based on a literature review. Creswell (2009) states that a qualitative study is exploratory and is intended to build a set of theories based on the discovery that occurs during the search for understanding the experience. Although literature reviews are not typical for qualitative inquiry, in this instance, the literature will serve as the voice of the participants who were the focus of inquiry in the various pieces of literature used for this review. Through exploring experience in a variety of studies, the variables will begin to emerge within the commonly found experiences. This type of study is less expensive than quantitative studies but provides the capacity for the collection of a large volume of information through which common elements will begin to emerge (Ventafridda et al, 2006). The data will be uncovered through journals, articles, and books from which the topic will be further explored. Secondary studies describe material collected without conducting primary experimental research and without the exploration of human fields (Ventafridda et al, 2006). Although some sources may be primary, when used in this study they will become reported and thus will be then defined secondary within this study. This means data collection methodology involved the use of two major approaches, which were secondary and primary data collection. Each of these is discussed as follows. The researcher shall use secondary data collection by collecting data from previous and existing research works. On the whole, secondary data refers to data that are not from the researcher’s personal sources. This means that the researcher cannot boast of being the original collector or owner of secondary data. Secondary data are not first-hand data but once the approach towards their collection is well conducted, the researcher can be assured of authentic data. To ensure such authenticity, the researcher first developed a data log. The data log involved the statement of all themes or topics that the researcher wanted to collect data on. The researcher then made a list of sources including books, internet sources, academic journals, and articles. There were about ten sources for each theme or topic at the first stage. The researcher shall then conduct detailed checks into the professional background of the various authors of the sources. Through this, there shall be two ‘best’ sources to be selected for each topic or theme. The researcher shall then collect the sources and sample from them specific materials that are useful towards the answering of the research questions posed. Choice of Index and Database Key Words In order to create the best possible search for this inquiry, key words will be used in order to frame the inquiry. The key words that will be used for this study will be: pain, PMR, cancer, NPPRI, pharmacology, analgesics, muscle massage, and pain relief. Key words were combined using the word and or through other methods of finding information through which one or more concepts framed the inquiry. Databases Used The databases that will be used for this inquiry include specialty journals, general searches to find what may not exist in those journals, and internet searches through which information will be defined as appropriate. According to Wood and Kerr (2011) “Reliability and validity in research refer specifically to the measurement of data as they will be used to answer the research questions”. Validity of the articles that are used in the review will be established through peer review and credential checks on authors for which peer review is not available, as well as through time relevance as no article used in the study would be dated past 1994 to allow for a twenty-five year gap. Articles outside of this date range were used as peripheral, but not central to the inquiry. The Search and Output The preliminary literature search created 26 results through which 6 were identified as appropriate for the review. The articles that were selected were defined and placed into a folders defining them as either quantitative or qualitative, and then grouped for the type of information that was made available through those studies. The literature was defined for its exploration of experiences with PMR and how the technique was experienced by those in the selected articles. To get the bets appropriate and efficient literature, many libraries and online data bases will be used. Certain online databases were identified as appropriate to the search: Blackwell, Ebsco, and Emerald among others provide industry specific articles that relate to the inquiry. Initially, the abstract of each journal will be evaluated for its relevance to the inquiry. b. Selection Criteria: Inclusion and Exclusion Inclusion Articles that will be included in the study will be written in English, less than twenty-five years old, and defined by both qualitative and quantitative methods of research. The topic of inquiry will be defined by the key words, with deeper exploration a possibility should the inquiry lead in unexpected directions. The inquiry will not, however, fall outside of the objectives as they have framed this study. Exclusion The articles that will be excluded from this will be those that are not written in English, those whose validity cannot be established, and those that have information that is not clearly within the scope of this investigation. In addition, those articles whose validity cannot be established will be excluded from the study. The Search and Output The preliminary literature search created 26 results through which 6 were identified as appropriate for the review. The articles that were selected were defined and placed into a folders defining them as either quantitative or qualitative, and then grouped for the type of information that was made available through those studies. The literature was defined for its exploration of experiences with PMR and how the technique was experienced by those in the selected articles. To get the bets appropriate and efficient literature, many libraries and online data bases will be used. Certain online databases were identified as appropriate to the search: Blackwell, Ebsco, and Emerald among others provide industry specific articles that relate to the inquiry. Initially, the abstract of each journal will be evaluated for its relevance to the inquiry. Reading and Evaluation of the study The articles will be studied and evaluated for their relevance with an eye to whether or not they were established through relevant, ethical, and meaningful research practices. The peer reviews on the article will be examined to lend the authors credibility as well as the credentials of those who have conducted the research. In order to qualify for this study, the articles included must be thoroughly examined for their overall validity in relationship to credibility, reliability, and validity. Critical Appraisal Critical appraisal is a method of studying and examining a research in a careful and elaborate way according to the context, in order to determine its trustworthiness. Critical appraisal also helps in determining the relevance of a research in a particular context. This method also facilitates studies which are evidence based in the field of medicine to be able to identify and utilize the research evidence in an efficient and reliable way. CASP Tool has been used for critically appraising the study sample which follows in order to best assess reliability and validity. The research of the study evaluated identifies information related to the effect of progressive muscle relaxation for the promotion of comfort and pain relief in advanced cancer patients. In this study there were 67 new admission patients selected from the oncology ward. The interventions given was relaxation training with comparisons between the control and the experimental group. Outcome was a significant reduction in subjective pain. It was a randomized control trial and the data analysis showed significant reduction in pain. The group was the same throughout the study and the group was treated equally except the treatment given to the experimental group. The participants were the same throughout the study. If analgesic treatment was not monitored, it could be a risk factor. The research had shown a significant reduction in subjective pain who had received relaxation training. (Slomon et al. 1994) a. Data Analysis In order to analyze the data that is collected from the studies that are included in this research, coded themes will emerge that can be developed into consistent ideas that answer the research questions that have been posed. Wood and Kerr (2009) suggest that coding of data should result in dividing information into “broad descriptive labels to segments of words or sentences”. This will allow for the data to form meaning in relationship to the questions of the study, the correlations between the ideas creating ideas that can be transformed into theory. Coding creates organization so that trends can be established and utilized for the overall support of the study. The data will be placed in a grid that has been coded in order to find common emerging ideas that will help to form theories that will support the overall nature of the study. The researcher’s data analysis plan shall entail two major features and these are presentation and interpretation of data. Under the presentation of data, the researcher shall make known data collected under specific themes to be built. The interpretation of data shall on the other hand involve a discussion on the data collected and the implications of the data collected. Both features of data collection shall involve the use of qualitative data analysis and quantitative data analysis. As far as qualitative data analysis is concerned, the researcher shall be at his discretion to present and interpret data. This form of data analysis shall, however, be based on empirical facts and literature presented at the literature review section. Generally, qualitative data analysis shall be suitable for use on secondary data collected through the review of related literature. Quantitative data, on the other hand shall, involve the use of mathematical and graphical presentation and interpretation of data. Some of the mathematical and graphical means to use shall include percentage table, pie charts, bar charts, frequency distribution table among others. Whenever quantitative data analysis is used, there is a generalized meaning given to the data analysis. For instance once 60% of respondents say something is good and 40% say it is bad, it becomes generally accepted that that thing is good. This will not need any special interpretation from the researcher. This is indeed one major advantage on the use of quantitative data analysis. The type of data to be analyzed quantitatively is those to be collected from the three research instruments to be used. Generally, data to be collected from the research instruments shall deal with numbers and quantum figures such as ‘how many respondents….’ This means that the researcher shall be in a position to quantify the data and, therefore, use the quantitative data analysis in this regard perfectly. Another advantage that comes with the use of quantitative analysis of data is that data analysis can easily be checked for accuracy. This is because mathematical calculations are the same everywhere around the world. Data Extraction Author Hypothesis/ question/ aim Design Methods (Population, Intervention, Comparison, Outcome-PICO) Findings Conclusion (Ackerman, 2000) (Dimeo, Thomas, Raabe-Menssen, Propper, & Mathias, (Cheung, Molassiotis and Chang, April/May 2003) The aim of the research is to use guided imagery to reduce pain and anxiety. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. research used Institutional approach Participant based quantitative study. Quantified study using participants in two groups. The study took place in a hospital setting with a sample size of 500 patients. Participant based study with two groups post operative for cancer with one group using PMR and the other using aerobics. . Fifty-nine patients participated in the study and were randomised to a control group receiving routine care (n=30) and an experimental group receiving routine care and PMRT through two teaching sessions and practice at home for the first 10 weeks” (Cheung et al 2003) Author found that there was a significant effect of using guided imagery to reduce pain and anxiety. “Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all 0.01); however, there was no significant difference” (Dimeo et al 2004) Anxiety was decreased as aspects of physical health, psychological health, social concerns, and environment were increased in the group using PMR The results conclude that pain management programs need adequate documentation to facilitate care for patients, and quality improvement activities. While physical performance was better in those taking aerobics, those in the PMR group dealt with fatigue better. PMR should be used as a practice in long term care of cancer patients as an effective and low cost method of improved quality of life for cancer patients. The literature spanning these three approaches suggests positive results, concerning their effectiveness on a variety of concerns, including reducing anxiety, relieving pain, and reducing nausea and vomiting along with other issues that are tension provoking. These techniques have been applied alone or in combination to observe effects on pain. This study will explore the impact of introduction of all three of these approaches to individuals and group environments with the intent of helping participants to combat pain and to add to pain management after a diagnosis of cancer and to approach the concept of pain relief through non-pharmacological methods (American Pain Society, 2003). The research study will add to the body of literature through looking at relaxation approaches as they are taught to individuals with the intent of offering skills to reduce stress and anxiety as it contributes to pain (American Cancer Society, 2006). The long term use of these approaches can be evaluated on the information that is provided, contributing to the overall body of knowledge on the subject as it can be used for further research. Summary and Conclusion Since the proposed research seeks at investigating the progressive muscle relaxation and its techniques along with the effect that it has on chronic pain in patients with cancer, through it, it shall become clear at the end of the study as to whether a progressive muscle relation along side with its techniques can help in reducing and relaxing chronic pain in patients with cancer. Basing on the available literature explored, it was clear that there existed a gap in part of research which entails the progressive muscle relaxation and its techniques along with the effect that it has on chronic pain in patients with cancer. The results from this proposed research shall come with a lot of significant to many people. For instance, it is a common belief that cancer patients are subjected to long pains that may last for hours and days. This implies that the result of this proposed research seeks at investigating the progressive muscle relaxation and its techniques shall be absorbed as a long term measure to deal with pains. This in particular shall significantly References Ackerman, C. (2000) Using guided imagery to reduce pain and anxiety. Home Health Care Nurse. p. 524-530. Ahles, T. (2005) Psychological approaches to the management of cancer-related pain. Seminars in Oncology Nursing. p. 141-145. Altice, N. Fn. & Jamison, G. B. (2009). 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Appendixes Appendix 1 Time Table The following of a Gantt chart is used, which is a graphical representation of a project to show how the work has been carried out; Activity Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Select a research topic and formulate a research question Meeting Supervisor and confirming the topic Reviewing literatures Formulating Abstract Formulating search strategy and methodology Submission of proposal Data Collection Data Analysis and Extraction Initial draft Feedback from supervisor Final draft Feedback from supervisor Dissertation Associated Costs: Since it is a secondary research, not much money has been spent. The only money will be spent is for acquiring data from internet and printing of relevant articles. Appendix 2 CASP tool for critical appraisal i.e.…, Randomized Control Trial Tool present at this website - http://www.cebm.net/index.aspx?o=1097 Read More