ABSTRACT
The number of patients with diabetes mellitus (DM) in Japan is increasing. Progression of DM leads to the development of diabetic peripheral neuropathy, which causes foot sensory disturbances. This study examined the effect of DM on plantar tactile point pressure sensitivity (TPPS) and identified the site with the highest threshold of plantar TPPS. The subjects were 42 DM patients (aged 71.7±8.2 years) and 122 local elderly residents (aged 72.6±4.8 years). TPPS of eight sites, including the right and left halluces, hallux and fifth toe metatarsal heads, and heels was measured using the Semmes-Weinstein monofilament test. The measurement was performed three times at each site. The results were adopted when all repeated measurements were valid. The Friedman test was used for comparison among the four sites within the same group. The Mann-Whitney U test was used for comparison of sites between groups. A significance level of 5% was adopted. The ages of the DM patients were not significantly different, but the patients had significantly higher TPPS threshold for halluces, and hallux and fifth toe metatarsal heads, compared to the local elderly residents. The TPPS threshold was highest in the heels in both the DM patients and local elderly residents. The threshold of plantar TPPS increases in DM. It is important to evaluate both the forefoot and the heels.
ABSTRACT
Background： While the number of older cancer patients increases as the society ages, the current status of the pain control is not well characterized among older patients. To improve the quality of care, it is necessary to understand the current status. Objectives： The aim of this study was to describe the pain control for older cancer patients in comparison to younger counterparts and characterize it. Methods： During four months in 2013, Aomori Prefectural Central Hospital started asking all hospitalized cancer patients about their pain every day using a standardized pain questionnaire. In addition, a questionnaire adopted to the outpatient setting was distributed to the patients who visited outpatient department of the hospital. The information about pain, quality of life (QOL) and the medical histories were included in the data analyses. Their responses were compared between outpatients versus inpatients and older ( ≥65 years) versus younger (＜65 years) patients. Results： The response rate was 57.0％. Pain management was less adequate among outpatients than among inpatients, with pain relief rate of 28.9％ for the former and 52.6％ for the latter (P＜0.001). Among outpatients, the pain relief rate for the older patients was particularly low (older：24.7％ vs younger：35.8％, P＜0.01). Conclusion： Pain management for older patients in the outpatient settings needs a particular attention for improvement. Resources should be allocated to enable better detection and relief of pain among outpatients.