Pain, Fatigue, and Sleep Disturbances in Oncology Outpatients Receiving Radiation Therapy for Bone Metastasis  Christine Miaskowski, RN, PhD, FAAN, Kathryn A. Lee, RN, PhD, FAAN  Journal of Pain and Symptom Management  Volume 17, Issue 5, Pages 320-332 (May 1999) DOI: 10.1016/S0885-3924(99)00008-1

Fig. 1 Changes in average pain intensity scores (N = 24) for two consecutive days (PM1 and PM2) and two consecutive nights (AM1 and AM2). Scores are plotted as means ± standard deviations Journal of Pain and Symptom Management 1999 17, 320-332DOI: (10.1016/S0885-3924(99)00008-1)

Fig. 2 Changes in fatigue scores (N = 24) for two consecutive days (PM1 and PM2) and two consecutive nights (AM1 and AM2). Scores are plotted as means ± standard deviations. Fatigue scores were significantly higher at the end of the day (PM1 and PM2) compared to when the patients awakened (AM1 and AM2; P = 0.0001) Journal of Pain and Symptom Management 1999 17, 320-332DOI: (10.1016/S0885-3924(99)00008-1)

Fig. 3 Patient is a 59-year-old Hispanic male with metastatic prostate cancer. His average pain intensity ranged from 2 to 5 on the 0 to 10 numeric rating scale. He was taking Percocet on an “as needed” basis. Sleep efficiency index on PM1 (12/19/95) was 24.4% with 29 awakenings. Sleep efficiency index on PM2 (12/20/95) was 8.6% with 8 awakenings (that were each approximately 53 minutes long) Journal of Pain and Symptom Management 1999 17, 320-332DOI: (10.1016/S0885-3924(99)00008-1)

Fig. 4 Patient is a 49-year-old white female with metastatic lung cancer. Her average pain intensity ranged from 2 to 3 on the 0 to 10 numeric rating scale. She was taking sustained release morphine, 30 mg every 12 hours. Sleep efficiency index on PM1 (2/15/95) was 95% with 1 awakening. Sleep efficiency index on PM2 (2/16/95) was 92.5% with 4 awakenings Journal of Pain and Symptom Management 1999 17, 320-332DOI: (10.1016/S0885-3924(99)00008-1)