Purpose: To examine pain experiences, coping mechanisms, and treatment approaches among postmenopausal women living with osteoarthritis in a resource-limited healthcare setting in Pakistan, and to explore how different coping styles relate to symptom burden.
Design: Cross-sectional analytical study.
Methods: Between November 2024 and April 2025, 196 postmenopausal women aged 45 years and above, each with a clinical diagnosis of osteoarthritis lasting at least 6 months, were enrolled through convenience sampling at outpatient clinics and community health centers in Lahore. Structured interviews captured demographic and clinical data, pain severity (WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) Index), and coping strategies (Pain Coping Inventory). Descriptive statistics summarized participant characteristics; the Mann-Whitney U test between Osteoarthritis duration and coping score; and the Pearson correlation assessed relationships between coping and WOMAC scores.
Results: The average age of participants was 59.8 ± 9.8 years; most were married (91.3%) and primarily homemakers (80.1%). The mean WOMAC score of 61.4 ± 18.6 reflected moderate to severe symptomatology. Scores for passive coping strategies (53.3 ± 10.0) were markedly higher than those for active strategies (27.4 ± 7.4; t = 31.2, p < .001), and greater use of active coping was linked to lower WOMAC scores (r = -0.214, p = .003). Nearly all women (91.3%) reported using analgesics-chiefly paracetamol and Non-Steroidal Anti-Inflammatory Drugs while 60% engaged in nondrug interventions such as physiotherapy, exercise, or yoga. Prolonged NSAID consumption was frequently noted despite potential adverse effects.
Conclusions: In this cross-sectional sample, passive coping predominates and corresponds with heightened pain and functional limitation. Despite heavy reliance on medication, engagement in nonpharmacologic and active coping strategies is suboptimal.
Clinical implications: Integrating culturally sensitive, psychosocial interventions-such as coping-skills training, community-based exercise programs, and patient education-and expanding access to nonpharmacologic therapies may promote active coping, reduce symptom burden, and improve quality of life in postmenopausal women with osteoarthritis in resource-limited settings.
Background: Pain is the most common and distressing symptom for children at the end of life, with management challenges causing significant distress for patients and caregivers. Patient-controlled analgesia allows self-administration of preset medication doses for breakthrough pain and has shown benefits in postoperative and chronic pain management. However, its use and effectiveness in pediatric palliative care remain unclear.
Objectives: To review and synthesize the evidence pertaining to patient-controlled analgesia use for children at the end of life.
Review methods: A scoping review used the Arksey and O'Malley Framework to identify: (1) utilization of patient-controlled analgesia, including patient groups, advantages, and proxy use; (2) implications, safety, side effects, and impact on pain; and (3) child and parental perspectives.
Results: The key finding is a lack of a clearly defined, standardized patient-controlled analgesia policy for use in children at the end of life. Much of the reviewed evidence was organization-dependent, and most related to use for children with a malignant diagnosis.
Conclusions: Further research is required involving patient-controlled analgesia use with children with a nonmalignant diagnosis, including the perspectives of children and parents. Nurses are integral team members and well-positioned to be developers of policies related to patient-controlled analgesia use in children at the end of life. This is a call to action for nurse clinicians, leaders, researchers, and educators to collaborate to identify and implement an evidence-based, effective policy.
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