Review of literature is a key step in research process. The literature review is to discover what has previously been done about the problem to be studied, what remains to be done, what methods have been employed in other research and how the results of other research in the area can be combined to develop knowledge and practice.
It is essential step; it can be done before and after selecting the problem. It can help to determine what is already known about the topic. (A.P.Jaine, 2005)
The chapter deals with review of literature, the studies reviewed have been arranged under the following sections,
Section-I: Studies related to prevalence of joint pain among post menopausal women.
Section-II: Studies related to etiological factors of joint pain among post menopausal women.
Section-III: Studies related to measurement of pain intensity.
Section-IV: Studies related to Non-pharmacological management of joint pain.
Section-V: Studies related to conceptual framework on Gate control theory.
Section-VI: Conceptual framework.
SECTION-I: STUDIES RELATED TO PREVALENCE OF JOINT PAIN AMONG POST MENOPAUSAL WOMAN:
Bardel A, Wallander MA, Wedel H, Svrdsudd K., (2000) The study was done in swedish countries with a postal questionnaire and the data collected by using random sampling technique among women in 35-64 years old, the sample size is 2.99%.The gothernburg quality of instrument used to measure the complaint score. Analysis reveals that after adjustment of the educational level, perceived health and mood, BMI, smoking habits, use of HRT has been identified. Symptoms are not only due to age but may related to stress, tension, depression and it should be decreased.
K. Aoyagi, P. Ross, C. Huang, R. Wasnich, T. Hayashi, and T. Takemoto., (2002) done the descriptive study about prevalence of joint pain regarding lifestyle factor among the Japanese women in rural area and in urban Hawaii. Survey carried out regarding present and previous pain at the specific joints for 222 women in rural Japan and 638 Japanese women in urban Hawaii aged 60-79. By using the logistic regression the prevalence of joint pain was compared. The result shows that, the prevalence of knee joint pain in Japan is 36% at ages 60-69 years to 53% at 70-79 years whereas in Hawaii 20% of women in both age groups. The Pain was more common in Japan especially at the shoulder, elbow, and ankle joints and the women in Japan were shorter and less weighed in Hawaii. The study concluded that, there is a large differences in the prevalence of pain at particular joints suggest that environmental factors responsible for joint pain.
Olaolorun FM, Lawoyin., (2003) the study done to determine the factors associated with the prevalence and distribution of menopausal symptoms among women in Ibadan. The descriptive cross sectional community based study among Nigerian women of 40 to 60 years by adopting multi stage sampling technique. The variables such as demographic, obstetric, and gynecological collected by using quantitative data and the experienced symptoms by using a structured questionnaire and it includes a standardized Menopause Rating Scale (MRS). For each respondent 11 groups of symptoms given and the score in a scale of 0-4 and the maximum score is 44. The MRS has three subscales such as somatovegetative, psychological, and urogenital and the maximum score is 16 & 22. for each respondent the each subscale and overall total score were calculated and it is the outcome of the study. If the menopausal symptom is severe the score will be higher. 1,189 women with the age of 48 to 54 years were interviewed. The results show that the common symptom among all women in this study (59%) had Joint and muscular discomfort and followed that (43.0%) had physical and mental exhaustion, (40.4%) had sexual problems (39.0%) had hot flashes.It concluded that, the menopausal symptoms was high among the women and the challenges of menopausal symptoms high who become older.
Yang D, Haines CJ, et.al., ( Nov, 2003 to Jul, 2004), done a study regarding prevalence of menopausal symptoms among Chinese women aged 40-65 years. A cross-sectional population-based study was conducted in China. In this study 9939 women were selected by multistage cluster sampling. Questionnaire prepared based on the symptoms experienced 2 months before the survey and the women were interviewed. The result shows that the age of natural menopause was 48.9 years. The most prevalent symptoms were insomnia, joint and muscle pain, dizziness and Hot flushes (in 37.2%, 35.7%, 31.5% and 17.5% of the sample, respectively). were experienced of women. The factors influenced the frequency of menopausal symptoms such as profession, education, type of menopause and the presence of physical or emotional problems. The study concluded that the prevalence of menopausal symptoms is very low among southern Chinese women.
SECTION-II: STUDIES RELATED TO ETIOLOGICAL FACTORS OF JOINT PAIN AMONG POST MENOPAUSAL WOMEN
I.P. Donald and C. Foy, (2003) they followed the general practice of population in UK for 1 year in 1998. the sample size of 4804 subjects aged 75 year and above accepted the health screening. Questionnaire administered postally by using the Elderly at Risk Rating scale. This includes one question regarding joint pain specifically. The findings reveal that 83% of people reported joint pain related to age and female gender. The factors such as mobility, energy, sadness are strongly related to pain. After 1 yr, it shows 18% had increased frequency of pain and 14% had decreased frequency of pain due to preserved indoor mobility and functional recovery. The study concludes that the joint pain is very common among older people and it is strongly associated to psychological factors. The active management of joint pain is an positive approach.
Huang C, Ross PD, Lydick E, Wasnich RD., (2003) conducted the Population-based cross-sectional study, to assess the potential factors associated with joint pain among postmenopausal women.There were Six hundred and ninety postmenopausal Japanese-American women at the age of 55-93 years were included. Data collection done by using the questionnaire, bone density was measured by using ultrasound to measure the heel and with the help of spine X-ray vertibral fracture were identified. Non-spine fractures were identified based on self-reports, and was verified using medical records. The result shows that in this cross-sectional analysis, bone density, quantitative bone ultrasound, prevalent vertebral fractures, and non-spine fracture were not associated with joint pain. The study concluded that, joint pain was prevented by avoidance of excess weight.
I.P. Donald and C. Foy., (2005) conducted the longitudinal study in an italian community based cohort among the aged 65 regarding the prevalence, characteristics and correlates of hip pain (HP) and knee pain (KP) . In an Chianti area (Tuscany, Italy) they used a baseline survey and selected the 1299 subjects aged 65+ by adopting multi stage sampling technique. Among 1299 subjects 1006 were interested to participate in the study and this population 564 were women and 442 were men aged 75-79 years for them information given. The reported pain score were recorded and for that they calculated the osteoarthritis index pain score. by using the inferential statistics regression and correlation of hip and knee pain calculted. The result shows that 11.9% participants reported of hip pain and 22.4% reported Knee Pain and 7.2% reported both conditions. The study concluded that the prevalence of knee pain was doubled of hip pain. Finally it reveals that hip pain due to poor self rated health and knee pain due to mechanical overload.
I.G. Otterness, F. Eckstein, M.D. (Jan, 2010) done the study to identify the incidence of joint pain among men and women. There is an higher rate of knee arthritis in Females than males due to the , smaller joint surfaces for women independent of height and weight. The age of 21-39 years they selected forty healthy women and 57 men with a body mass index of 16.8-32.8 were studied using magnetic resonance imaging. The right knee was scanned and proprietary software was used to determine the area of subchondral bone (cAB), mean cartilage thickness (Thc) and cartilage volume (VC) for all knee cartilage plates. Multilinear regression was used. The result shows that, cAB, ThC, and VC were larger in men than in women. The study concluded that after Correction for height and weight men have greater knee cAB,Thc,VC
M. Blagojevic, C. Jinks, A. Jeffery, Quintiles, Berkshire, K.P. Jordan (January 2010) conducted the systematic review to determine the current evidence of risk factors for knee Osteoarthritis.A systematic literature search was done by using cohort and case control studies to evaluate the onset of knee arthritis by analyzing the association of demographic, comorbid, and other patient-determined factors. They examined the heterogenity and the quality of studies assessed by adopting a scoring tool. The possible studies are pooled and give over all estimation of the association factors. The findings show that, 2233 studies screened in that 85 studies were included in the review.The main factors associated with knee Arthritis were obesity ,gender and their odd ratio were 2.63, 1.84. The study concluded the factor like BMI has been reviewed but need more longitudinal studies to investigate the association of physical occupation and knee arthritis.
SECTION-III: STUDIES RELATED TO MEASUREMENT OF PAIN INTENSITY
The hernia repair studies published in pubmed study review (1997 May; 21) taken from the existing literature examining chronic pain and health-related quality of life (HRQL). They included pre-specified inclusion/exclusion criteria. Twenty-three studies were identified and most of the studies used VAS to measure the pain levl and measure the health related quality of life Medical Outcomes Study Short-Form 36 (SF-36) were used. The study concluded that standardization is required to evaluate chronic pain.
SECTION-IV: STUDIES RELATED TO NON-PHARMACOLOGICAL MANAGEMENT OF JOINT PAIN
Cohen M, Wolfe R, Mai T, Lewis D., ( March 3, 2003) published a clinical study of camphor, glucosamine and chondroitin sulfate preparation for a topical application for long term benefits of reduction of joint pain due to arthritis of the knee. It is a single centered, randomized, double-blind, placebo-controlled trial. After assessment for the eligibility from the community with 63 subjects were chosen. Then the patient assigned randomnly to use camphor, glucosamine, and chondroitin sulfate, or a placebo. The demographic composition and illness was same for two treatment groups.The study showed that after the use of cream in the first day shows a significant difference between the two groups. The surprising result is that pain completely eliminated within 8 weeks.
Soeken KL., (Jan-Feb, 2004) conducted a study based on the systematic review and metaanalysis about the effectiveness of selected complementary and alternative medicine (CAM) therapies for relief from jointpain. Methods used,regarding articles related to pain were retrieved from acupuncture, homeopathy, herbal remedies, and selected nutritional supplements. Result shows that the pain is reduced by using acupuncture; devil's claw, chondroitin and glucosamine. The study concluded that, some of the most popular CAM therapies used for pain relief but need high quality research for herbals and homeopathy.
Carol P. Brooks, Lynda D. Woodruff, et.al., (Jan 6, 2006) conducted the Research study to improve the power grip performance the manual massage is needed. It was conducted in suburabn allied health school, with pre-test and post-test study. There are 52 volunteers participated in the study. The persons such as massage school clients, staff, faculty and students. The subjects assigned randomly and gave 5 minutesof forearm / hand massage of effleurage and friction (to either the dominant hand or nondominant hand side) 5 minutes of passive shoulder and elbow range of motion, or 5 minutes of nonintervention rest.the results show that, power grip was fatigued after 3 minutes of isometric exercise and need recovery for 5 minutes. The Statistical analyses reveals that there is a greater effect of massage than the placebo after fatigue. The study concluded that manual massage has great impact on grip performance than non massage.
Fox P, Coughlan B, Butler M, Kelleher C., (April, 2010) study was done to identify the prevalence of CAM in Ireland among the general population. They used the descriptive, quantitative design was used. The survey was taken regarding Lifestyles, Attitudes and Nutrition in 1998 (N=6539) and 2002 (N=5992). In the statistical analysis Chi (2) test used. The result shows that in 1998, 20% population visits to CAM practitioners to 27% in 2002. The study concluded that, among Irish general population Use of CAM is increasing internationally.
SECTION-V: STUDIES RELATED TO CONCEPTUAL FRAMEWORK ON GATE CONTROL THEORY
Malathi. M., (2006) conducted a study to assess the effectiveness of simple massage, French oil massage and normal labor care on labor pain among the primipara mothers in Government hospital, Erode. In the study, the researcher applied modified gate control theory for conceptual framework model. She concluded that, less stimulation of free nerve endings due to the effect of massage. So the samples are having less pain perception in the lower abdomen and lumbar region.
An unpublished dissertation, (2003) to assess the effectiveness of moist heat over dry heat application on episiotomy of primi mothers. In this study, researcher selected Gate control Theory of pain for conceptual framework. She concluded that dry heat is more effective than moist heat.
Anonymus, (2003) conducted a study to compare the extent of effectiveness of pain relief between hot and cold application in post natal woman with episiotomy in selected hospitals in Chennai. Modified Gate control theory of pain is used for conceptual framework.
An unpublished dissertation (2000) on effect of hot and cold application alternatively for perineal pain in mothers with episiotomy. In the study Gate control theory of pain was used for conceptual framework.
SECTION-VI:CONCEPTUAL FRAMEWORK ON GATE CONTROL THEORY
Polit and Hungler., (1999) state that conceptual framework is interrelated concepts on abstractions that are assembled together in some rational scheme by virtue of their relevance to a common scheme. The present study is aimed to determining the effectiveness of camphor oil application among post menopausal woman for joint pain. Conceptual framework of this study was derived from Gate control theory of pain.
GATE CONTROL THEORY OF PAIN:
The Gate control theory of pain was first postulated by Melzack and wall in 1965. The theory suggested that for pain, to pass through the gate there must be unopposed passage for nociceptive information arriving at the synapses in the substantia gelantinosa. Pain gate is also receiving impulses produced by stimulation of thermo receptors or mechano receptors transmitted via larger diameter myelinated 'A Beta ' fibres which inhibit and super impose the small diameter impulses. Many non-pharmacological procedures such as application of heat or ice, massage, vibration, TNS and movement stimulate the nerve endings connected with large diameter fibres which can produces a reduction of pain by closing the 'pain gate'.
Based on the principle of gate control theory, the following conceptual framework is developed. Methods used to reduce pain on joint by camphor oil application among post menopausal woman.
The pain impulses will be carried out by the small diameter, slow conducting 'A delta &'C', fibres. Impulses travelled through small diameter fibres will open the 'pain gate' and the person feels pain.
Post menopausal woman having more stimulation of pain reception in the joint due to decreased blood flow, joint muscle spasm or stiffness and muscle fatigue.
Travelling of pain impulses:
Normally pain impulses are traveling through small short conducting 'A delta & C' fibres. Impulses from stimulation such as massage, hot and cold application and TENS etc., will be quickly conducted by large mylinated 'A beta 'fibres.
In experimental group the post menopausal woman receiving camphor oil application, impulses will be conducted by fast conducting 'A beta' large fibers which reaches he gate of pain very quickly.
Gating mechanism:
Pain impulses are transmitted through the spinal nerve segment T11-T12 and accessory lower thoracic and upper lumbar sympathetic nerves which are travelled through 'A delta' &'C' small diameter and slow conducting amylinated fibres and reach pain gate thus woman perceives pain in the joint.
Impulses from massage traveled through fast conducting mylinated 'A beta' fibres which snapper impose small fibres and close the pain gate and also 'beta' endorphin which is released from the inter neurons at spinal cord level which also closes the gate of pain, thus the woman perceives less pain in the joint.
Nursing intervention to relieve the joint pain and increase the joint mobility
Post-menopausal women with knee joint pain
Reduced
Compare the level of knee joint pain before and after intervention
Relieves endogenous opiates like B endorphine
Not Reduced
Release of substance P (Cognitive control)
Blocking nociceptive circuit synapse
Camphor oil application
Compare the degree of knee joint mobility before and after intervention
Increased
Not increased
Gate Opened
Gate closed (inhibitory control)
To stimulate circulation
To relieve muscle spasm
To produce analgesia
Assess the degree of knee joint mobility using the Goniometer
Assess the level of knee joint pain with numerical Visual Analog Scale
Presence of knee joint pain
Presence of degree of knee joint mobility
FIGURE-2.1: CONCEPTUAL FRAMEWORK BASED ON MODIFIED GATE CONTROL THEORY OF PAIN BY MELZACK & WALL (1965) FOR THE EFFECTIVENESS OF CAMPHOR OIL APPLICATION FOR JOINT PAIN AMONG THE POST MENOPAUSAL WOMEN
SUMMARY
The chapter dealt with the conceptual framework based on Gate Control Theory of pain. It describes different steps researcher taken to reduce joint pain and increasing the joint mobility and possible outcome.
