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Simic K, Savic B, Knezevic NN. Pain Catastrophizing: How Far Have We Come. Neurol Int 2024; 16:483-501. [PMID: 38804476 PMCID: PMC11130925 DOI: 10.3390/neurolint16030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
The perception of pain is strongly influenced by various social, emotional, and cognitive factors. A psychological variable which has consistently been shown to exert its influence on pain is a cognitive process referred to as pain catastrophizing. Numerous studies have found it to be a strong predictor of pain intensity and disability across different clinical populations. It signifies a maladaptive response to pain marked by an exaggerated negative assessment, magnification of symptoms related to pain, and, in general, a tendency to experience marked pain-related worry, as well as experiencing feelings of helplessness when it comes to dealing with pain. Pain catastrophizing has been correlated to many adverse pain-related outcomes, including poor treatment response, unsatisfactory quality of life, and high disability related to both acute and chronic pain. Furthermore, there has been consistent evidence in support of a correlation between pain catastrophizing and mental health disorders, such as anxiety and depression. In this review, we aim to provide a comprehensive overview of the current state of knowledge regarding pain catastrophizing, with special emphasis on its clinical significance, and emerging treatment modalities which target it.
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Affiliation(s)
- Katarina Simic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
| | - Boris Savic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA; (K.S.); (B.S.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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2
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Factors Associated with Pain Treatment Satisfaction Among Patients with Chronic Non-Cancer Pain and Substance Use. J Am Board Fam Med 2021; 34:1082-1095. [PMID: 34772764 PMCID: PMC8813175 DOI: 10.3122/jabfm.2021.06.210214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION A better understanding of pain treatment satisfaction in patients with chronic noncancer pain (CNCP) and substance use is needed, especially as opioid prescribing policies are changing. We sought to identify factors associated with pain treatment satisfaction in individuals with CNCP on recent opioid therapy and prior or active substance use. METHODS An exploratory cross-sectional analysis using baseline data from a cohort study of 300 adults with CNCP receiving >20 morphine milligram equivalents of opioids for ≥3 of the preceding 12 months and prior or active substance use. Participants completed interviews, clinical assessments, urine drug screening, and medical chart review. RESULTS Participants were predominantly middle-aged (mean age 57.5 years), Black (44%), and cisgender men (60%). One-third (33%) had high, 28% moderate, and 39% low pain treatment satisfaction. Post-traumatic stress disorder (PTSD), tobacco use, past-year opioid discontinuation, and higher average pain scores were associated with lower satisfaction. HIV and prescription cannabis use were associated with higher satisfaction. CONCLUSIONS The relationship between PTSD and tobacco use with lower satisfaction should be explored to augment pain outcomes. Higher satisfaction among individuals with HIV and prescription cannabis use presents potential research areas to guide CNCP management and reduce reliance on opioid therapies.
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3
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Pereira MG, Carvalho C, Costa ECV, Leite Â, Almeida V. Quality of life in chronic pain patients: Illness- and wellness-focused coping as moderators. Psych J 2020; 10:283-294. [PMID: 33378796 DOI: 10.1002/pchj.410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/31/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
Chronic pain is a health problem that significantly influences patients' lives, causing functional, social, socioeconomic, and emotional changes that impact quality of life (QoL). The aim of this study was to evaluate which variables (e.g., psychological morbidity, illness representations, pain, and coping) contribute to QoL and to analyse the moderating role of illness- and wellness-focused coping in the relationship between pain interference and Qol, in chronic pain patients. A sociodemographic and clinical questionnaire, the Brief Illness Perception Questionnaire, the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale, the Chronic Pain Coping Inventory, the Short Form Health Survey, and the Brief Pain Inventory were completed by 103 patients with chronic pain. Greater use of wellness-focused coping and being professionally active were associated with better physical QoL. Cognitive representations and illness-focused coping contributed to physical QoL, and psychological morbidity contributed to mental QoL. Illness-focused coping and wellness-focused coping moderated the relationship between pain interference and physical QoL, but not with mental QoL. Since pain interference was positively related to psychological morbidity, and the latter was negatively related to QoL, it is extremely important to evaluate and promote patients' coping strategies that are focused on well-being to improve QoL. Results from this study underline the relevance of a multidisciplinary approach to chronic pain and the need to account for psychological morbidity and coping strategies in intervention programs to promote QoL in chronic pain patients.
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Affiliation(s)
| | - Cátia Carvalho
- School of Psychology, University of Minho, Braga, Portugal
| | - Eleonora C V Costa
- Department of Psychology, Portuguese Catholic University, Braga, Portugal
| | - Ângela Leite
- Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Gandra, Portugal
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4
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Blatyta PF, Kelly S, Sabino E, Preiss L, Mendes F, Carneiro-Proietti AB, Werneck Rodrigues DDO, Mota R, Loureiro P, Maximo C, Park M, Mendrone-Jr A, Gonçalez TT, de Almeida Neto C, Custer B. Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease. Transfusion 2020; 60:343-350. [PMID: 31804727 PMCID: PMC8010912 DOI: 10.1111/trf.15619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS Infection markers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.
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Affiliation(s)
- Paula F Blatyta
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Shannon Kelly
- Vitalant Research Institute, San Francisco, California
| | - Ester Sabino
- Instituto de Medicina Tropical da FMUSP, Sao Paulo, Brazil
| | - Liliana Preiss
- Research Triangle Institute International, Rockville, Maryland
| | | | | | | | - Rosimere Mota
- Hemominas Montes Claros, Montes Claros, Minas Gerais, Brazil
| | - Paula Loureiro
- Hemope and Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Miriam Park
- Instituto da Criança-Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cesar de Almeida Neto
- Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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5
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Irons JY, Kuipers P, Wan A, Stewart DE. Group Singing Has Multiple Benefits in the Context of Chronic Pain: An Exploratory Pilot Study. Pain Manag Nurs 2019; 21:259-264. [PMID: 31495739 DOI: 10.1016/j.pmn.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
AIMS This paper reports findings of a pilot singing intervention to assist people living with chronic pain. METHODS Pain Management Clinic outpatients participated in 10 weekly group singing sessions. Benefits of the intervention and its impact on participants' (N = 4) experiences of pain were explored qualitatively. RESULTS Three main themes comprising over 20 separate codes indicated physical, psychological, and social dimensions associated with the intervention. People with chronic pain identify multiple benefits from participating in a group singing program. CONCLUSIONS Results indicate that group singing in chronic pain settings has multiple benefits and may positively complement clinical outcomes, serving as an effective adjunct to conventional pain management care and nursing.
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Affiliation(s)
- J Yoon Irons
- Health and Social Care Research Centre, University of Derby, Derby, UK.
| | - Pim Kuipers
- Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Aston Wan
- Persistent Pain Management Service, Princess Alexandra Hospital, Metro South, Queensland Health, Brisbane, Australia
| | - Donald E Stewart
- School of Medicine, Griffith University, Brisbane, Queensland, Australia
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6
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Ng M, Hayashi K, Voon P, Shulha HP, DeBeck K, Milloy MJ, Ti L. Characterising the association between positive hepatitis C virus antibody and pain among people who inject drugs. Drug Alcohol Rev 2019; 38:639-643. [PMID: 31418953 DOI: 10.1111/dar.12969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND AIMS People who inject drugs (PWID) are a key group within the hepatitis C virus (HCV) pandemic. Chronic pain is a common condition among PWID as these individuals are often exposed to soft tissue infections due to injections and violence. This study aims to characterise the relationship between HCV exposure and pain among PWID. DESIGN AND METHODS Data were derived from three prospective cohorts of PWID in Vancouver, Canada, between December 2011 and November 2016. The primary outcome was pain severity, which was defined based on the Euroqol EQ-5D-3L pain subscale. A bivariable and multivariable ordinal generalised estimating equations model was used to quantify the association between HCV exposure and pain among participants. RESULTS One thousand and twelve of 2038 participants (50%) reported moderate/extreme pain at baseline. In total, 1473 (72%) participants were HCV-antibody positive. In unadjusted analyses, HCV exposure was positively associated with increased pain [odds ratio (OR) = 1.47; 95% confidence interval (CI): 1.20-1.81]. However, once adjusted for known confounders in multivariable analyses, HCV exposure did not remain significantly associated with increased pain (adjusted OR = 1.00; 95%CI: 0.78-1.28). DISCUSSION AND CONCLUSIONS In this sample of PWID, HCV exposure was not significantly associated with pain once other factors were considered. These various factors may explain the elevated risk of pain among PWID and should be addressed in future initiatives when managing pain among PWID with HCV exposure. Future studies should also examine whether pain changes with changes in HCV status (i.e. active vs. cleared infection).
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Affiliation(s)
- Michelle Ng
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pauline Voon
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Hennady P Shulha
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.,School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - M-J Milloy
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
| | - Lianping Ti
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada.,British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada
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7
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Lynch SM, Wilson SM, DeRycke EC, Driscoll MA, Becker WC, Goulet JL, Kerns RD, Mattocks KM, Brandt CA, Bathulapalli H, Skanderson M, Haskell SG, Bastian LA. Impact of Cigarette Smoking Status on Pain Intensity Among Veterans With and Without Hepatitis C. PAIN MEDICINE 2019; 19:S5-S11. [PMID: 30203017 DOI: 10.1093/pm/pny146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Chronic pain is a significant problem in patients living with hepatitis C virus (HCV). Tobacco smoking is an independent risk factor for high pain intensity among veterans. This study aims to examine the independent associations with smoking and HCV on pain intensity, as well as the interaction of smoking and HCV on the association with pain intensity. Design/Particpants Cross-sectional analysis of a cohort study of veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who had at least one visit to a Veterans Health Administration (VHA) primary care clinic between 2001 and 2014. Methods HCV was identified using ICD-9 codes from electronic medical records (EMRs). Pain intensity, reported on a 0-10 numeric rating scale, was categorized as none/mild (0-3) and moderate/severe (4-10). Results Among 654,841 OEF/OIF/OND veterans (median age [interquartile range] = 26 [23-36] years), 2,942 (0.4%) were diagnosed with HCV. Overall, moderate/severe pain intensity was reported in 36% of veterans, and 37% were current smokers. The adjusted odds of reporting moderate/severe pain intensity were 1.23 times higher (95% confidence interval [CI] = 1.14-1.33) for those with HCV and 1.26 times higher (95% CI = 1.25-1.28) for current smokers. In the interaction model, there was a significant Smoking Status × HCV interaction (P = 0.03). Among veterans with HCV, smoking had a significantly larger association with moderate/severe pain (adjusted odds ratio [OR] = 1.50, P < 0.001) than among veterans without HCV (adjusted OR = 1.26, P < 0.001). Conclusions We found that current smoking is more strongly linked to pain intensity among veterans with HCV. Further investigations are needed to explore the impact of smoking status on pain and to promote smoking cessation and pain management in veterans with HCV.
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Affiliation(s)
- Shaina M Lynch
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah M Wilson
- Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina.,Duke University School of Medicine, Durham, North Carolina
| | - Eric C DeRycke
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut
| | - Mary A Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Psychiatry
| | - William C Becker
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Internal Medicine
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut
| | - Melissa Skanderson
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut
| | - Sally G Haskell
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Internal Medicine
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System West Haven, Connecticut.,Department of Internal Medicine
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8
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Baria AM, Pangarkar S, Abrams G, Miaskowski C. Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans. PAIN MEDICINE 2019; 20:14-27. [PMID: 29727005 DOI: 10.1093/pm/pny058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Population Veterans with chronic noncancer pain (CNCP) are a vulnerable population whose care remains a challenge for clinicians, policy-makers, and researchers. As a result of military experience, veterans are exposed to high rates of musculoskeletal injuries, trauma, psychological stressors (e.g., post-traumatic stress disorder, depression, anxiety, substance abuse), and social factors (e.g., homelessness, social isolation, disability, decreased access to medical care) that contribute to the magnitude and impact of CNCP. In the veteran population, sound theoretical models are needed to understand the specific physiological, psychological, and social factors that influence this unique experience. Objective This paper describes an adaption of Gatchel and colleagues' biopsychosocial model of CNCP to veterans and summarizes research findings that support each component of the revised model. The paper concludes with a discussion of important implications for the use of this revised model in clinical practice and future directions for research. Conclusions The adaption of the biopsychosocial model of CNCP for veterans provides a useful and relevant conceptual framework that can be used to guide future research and improve clinical care in this vulnerable population.
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Affiliation(s)
- Ariel M Baria
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,School of Nursing
| | - Sanjog Pangarkar
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
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9
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Adams MH, Dobscha SK, Smith NX, Yarborough BJ, Deyo RA, Morasco BJ. Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy. THE JOURNAL OF PAIN 2018; 19:1074-1081. [PMID: 29705347 DOI: 10.1016/j.jpain.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/09/2018] [Accepted: 04/06/2018] [Indexed: 12/25/2022]
Abstract
The pain experience may vary greatly among individuals reporting equally high levels of pain. We sought to examine the demographic and clinical characteristics associated with pain interference in patients with high pain intensity. Among patients with chronic musculoskeletal pain who were prescribed long-term opioid therapy and who were recruited from 2 health care systems, we identified a subset who reported high pain intensity (n = 189). All individuals completed self-report assessments of clinical and demographic factors. Analyses examined characteristics associated with pain interference. Within this group of patients with high reported pain intensity, 16.4% (n = 31) had low pain interference, 39.2% (n = 74) had moderate pain interference, and 44.4% (n = 84) had high pain interference. In bivariate analyses, patients with lower pain interference had fewer symptoms of depression and anxiety, less pain catastrophizing, a better quality of life, and greater self-efficacy for managing pain. In multivariate analyses, variables most strongly associated with low pain interference, relative to high interference, were depression severity (odds ratio 0.90; 95% confidence interval 0.82-0.99) and pain self-efficacy (odds ratio 1.07; 95% confidence interval 1.02-1.12). Study results suggest that chronic pain treatments that address symptoms of depression and enhance pain self-efficacy may be prioritized, particularly among patients who are prescribed long-term opioid therapy. PERSPECTIVE This article describes the prevalence and correlates of pain interference categories (low, medium, and high) among patients with high pain intensity who are prescribed long-term opioid therapy. Findings reveal that 16.4% of participants with high pain intensity had low impairment. Multivariate analyses indicate that variables significantly associated with low pain interference were lower depression scores and greater pain self-efficacy.
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Affiliation(s)
- Melissa H Adams
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Ning X Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - Richard A Deyo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
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10
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Golden SE, Miller D, Hansen L, Peters D, Taylor-Young P. The experience of veterans with hepatitis C and acupuncture: A mixed methods pilot study. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Lovejoy TI, Dobscha SK, Turk DC, Weimer MB, Morasco BJ. Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. ACTA ACUST UNITED AC 2016; 53:25-36. [PMID: 27005461 DOI: 10.1682/jrrd.2014.10.0230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/02/2015] [Indexed: 11/05/2022]
Abstract
Patients with a history of substance use disorder (SUD) are more likely to be prescribed opioid medications for chronic pain than patients without an SUD history; however, little is known about prescription opioid therapy in populations composed exclusively of patients with SUD. This study examined correlates of prescription opioid therapy in 214 Veterans with chronic noncancer pain and an SUD history. Participants completed psychosocial questionnaires and participated in a structured mental health diagnostic interview, and medical diagnoses and opioid pharmacy data were abstracted from their Department of Veterans Affairs electronic medical records. Participants were categorized into three groups based on opioid prescriptions in the past 90 d: no opioid therapy (n = 134), short-term (<90 d) opioid therapy (n = 31), or long-term (>/= 90 d) opioid therapy (n = 49). Relative to participants prescribed no or short-term opioid therapy, participants who were prescribed long-term opioid therapy had a greater number of pain diagnoses; reported higher levels of pain severity, interference, and catastrophizing; and endorsed lower chronic pain self-efficacy. In a multivariate model, number of pain diagnoses and pain interference were associated with a greater likelihood of being prescribed long-term opioid therapy after controlling for demographic and clinical characteristics. Findings highlight the poor pain-related functioning in patients with SUD histories who are prescribed long-term opioid therapy.
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Affiliation(s)
- Travis I Lovejoy
- Mental Health and Clinical Neurosciences Division and Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR; and Department of Psychiatry, Oregon Health and Science University, Portland, OR
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12
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Chereji E, Kern S, Fuller B, Morasco BJ, Phelps A, Hauser P. Co-occurring Depression, Chronic Pain and Substance Use Disorders in People with Hepatitis C. ACTA ACUST UNITED AC 2016. [DOI: 10.2174/1874220301603010079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic infection with Hepatitis C virus (HCV) is common and can result in serious and sometimes fatal liver complications. The impact of HCV on the liver can be further complicated by medical and psychological comorbidities. Depression, substance use, and pain syndromes are frequent co-morbid conditions in people with HCV and diminish functioning, quality of life, and treatment compliance. Understanding the underlying biological mechanisms of these comorbid conditions within the context of HCV may help elucidate factors contributing to their co-occurrence, perhaps mediatedviapro-inflammatory cytokines. The current review provides a synthesis of the literature on depression, substance use disorders and chronic pain in the presence of HCV. The review includes studies conducted with both veteran and civilian populations. The implications for assessment and antiviral treatment of HCV will be considered.
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13
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Morasco BJ, Greaves DW, Lovejoy TI, Turk DC, Dobscha SK, Hauser P. Development and Preliminary Evaluation of an Integrated Cognitive-Behavior Treatment for Chronic Pain and Substance Use Disorder in Patients with the Hepatitis C Virus. PAIN MEDICINE 2016; 17:2280-2290. [PMID: 28025362 DOI: 10.1093/pm/pnw076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Individuals with the hepatitis C virus (HCV) have high rates of both chronic pain and substance use disorder (SUD). Despite high comorbidity, there are limited data available on effective methods of treatment for co-occurring chronic pain and SUD. In this study, we sought to develop and conduct preliminary testing of an integrated cognitive-behavior therapy (CBT) for chronic pain and SUD in patients with HCV. DESIGN Descriptive, including pretreatment, posttreatment, and follow-up testing. SETTING AND PATIENTS Outpatient clinic as part of one VA Medical Center. PARTICIPANTS Veterans with chronic pain, SUD, and HCV. INTERVENTION Eight-session integrated group CBT for chronic pain and SUD in patients with HCV. METHODS Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up. RESULTS Generalized estimating equations identified improvements in pain interference, reducing cravings for alcohol and other substances, and decreasing past-month alcohol and substance use. The proportion of participants who met diagnostic criteria for current SUD demonstrated a four-fold decrease over the course of the study from 24% at baseline to 15% at post-treatment and 6% at 3-month follow-up. On response to a global impression of change, 94% of participants noted improvement from baseline. CONCLUSIONS Results from this pilot study suggest that a customized CBT for patients with both chronic pain and SUD (CBT-cp.sud) may be beneficial in improving important pain and addiction-related outcomes in patients with HCV. Larger scale investigations of this intervention appear warranted.
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Affiliation(s)
- Benjamin J Morasco
- *Center to Improve Veteran Involvement in Care .,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - David W Greaves
- Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Travis I Lovejoy
- *Center to Improve Veteran Involvement in Care.,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington, Seattle, Washington
| | - Steven K Dobscha
- *Center to Improve Veteran Involvement in Care.,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Peter Hauser
- VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center, California.,Department of Psychiatry, University of California San Diego.,Department of Psychiatry and Human Behavior, University of California-Irvine, California, USA
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Hauser P, Kern S. Psychiatric and substance use disorders co-morbidities and hepatitis C: Diagnostic and treatment implications. World J Hepatol 2015; 7:1921-1935. [PMID: 26244067 PMCID: PMC4517152 DOI: 10.4254/wjh.v7.i15.1921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/01/2015] [Accepted: 07/02/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C virus (HCV) viral infection is the most common blood-borne viral infection and approximately 2%-3% of the world’s population or 170-200 million people are infected. In the United States as many as 3-5 million people may have HCV. Psychiatric and substance use disorders (SUDs) are common co-morbid conditions found in people with HCV and are factors in predisposing people to HCV infection. Also, these co-morbidities are reasons that clinicians exclude people from antiviral therapy in spite of evidence that people with HCV and co-morbid psychiatric and SUD can be safely and effectively treated. Furthermore, the neuropsychiatric side effects of interferon (IFN), until recently the mainstay of antiviral therapy, have necessitated an appreciation and assessment of psychiatric co-morbidities present in people with HCV. The availability of new medications and IFN-free antiviral therapy medication combinations will shorten the duration of treatment and exposure to IFN and thus decrease the risk of neuropsychiatric side effects. This will have the consequence of dramatically altering the clinical landscape of HCV care and will increase the number of eligible treatment candidates as treatment of people with HCV and co-morbid psychiatric and SUDs will become increasingly viable. While economically developed countries will rely on expensive IFN-free antiviral therapy, less developed countries will likely continue to use IFN-based therapies at least until such time as IFN-free antiviral medications become generic. The current manuscript discusses the efficacy and viability of treating HCV in people with psychiatric and SUDs comorbidities, the treatment of the neuropsychiatric side effects of IFN -based therapies and the impact of new medications and new treatment options for HCV that offer the promise of increasing the availability of antiviral therapy in this vulnerable population.
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Morasco BJ, Turk DC, Nicolaidis C. Psychometric Properties of the Centrality of Pain Scale. THE JOURNAL OF PAIN 2015; 16:676-81. [PMID: 25958315 DOI: 10.1016/j.jpain.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The Centrality of Pain Scale (COPS) is a recently developed patient-centered, 10-item self-report measure designed to assess how central, or dominating, in their lives individuals with chronic pain perceive pain to be. The COPS underwent initial development and validation previously; preliminary results suggested that the measure had excellent psychometric properties and that COPS scores were associated with important clinical factors. The purpose of the present study was to examine the psychometric properties of the COPS in a sample of individuals with mixed chronic pain diagnoses (N = 178) being treated at a U.S. Veterans Affairs Medical Center. Principal components analysis of COPS items revealed a single factor, and all items loaded highly. The COPS had high internal consistency (Cronbach's alpha = .902) and was significantly correlated with other measures of pain, mental health, psychological factors associated with pain, and chronic pain coping styles, suggesting convergent and divergent validity. Hierarchical linear regression analyses indicated that COPS score was independently associated with both pain severity and interference. Future research should evaluate the generalizability of the COPS in different samples, its responsiveness to treatment, and the extent to which pain centrality may be a focus of nonpharmacologic interventions for chronic pain. PERSPECTIVE We conducted psychometric testing of the COPS, a recently developed patient-centered self-report measure designed to examine how central or dominating pain is to a person's life. Study results indicated a reliable and valid measure, which was significantly associated with pain severity and interference, even after controlling for demographic and clinical factors.
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Affiliation(s)
- Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington, Seattle, Washington
| | - Christina Nicolaidis
- Regional Research Institute, School of Social Work, Portland State University, Portland, Oregon; Department of Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon
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Adams MH, Lovejoy TI, Turk DC, Dobscha SK, Hauser P, Morasco BJ. Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C. Gen Hosp Psychiatry 2015; 37:533-7. [PMID: 26265311 PMCID: PMC4630124 DOI: 10.1016/j.genhosppsych.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Depression and chronic pain are common in persons chronically infected with the hepatitis C virus (HCV), although little is known about the rate of co-occurrence or mechanisms by which they are associated. We evaluated whether pain-related anxiety mediates the relationship between depressive symptoms and pain-related physical functioning in patients with HCV. METHODS Patients with HCV (n=175) completed self-report measures assessing demographic characteristics, pain-related function and mental health. Path analyses examined direct effects of cognitive-affective and somatic symptoms of depression on pain interference and indirect effects of these relationships via four subscales of the Pain Anxiety Symptoms Scale-20. RESULTS Cognitive-affective and somatic symptoms of depression were positively and significantly related to pain interference. Pain-related anxiety mediated the relationship between both cognitive-affective and somatic symptoms of depression, and this mediation was predominantly accounted for by the escape-avoidance component of pain-related anxiety. CONCLUSIONS Findings indicate a potential mediating role of pain-related anxiety, particularly escape-avoidance anxiety, on the relationship between depression and pain interference in patients with HCV. These findings suggest that escape-avoidance anxiety may be a particularly germane target for treatment in patients with HCV and chronic pain, particularly when depression, with characteristic features of withdrawal and inhibition, is a comorbid condition.
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Affiliation(s)
- Melissa H. Adams
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Travis I. Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Peter Hauser
- VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center,Department of Psychiatry, University of California San Diego & Department of Psychiatry and Human Behavior, University of California-Irvine
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
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Morasco BJ, O'Hearn D, Turk DC, Dobscha SK. Associations Between Prescription Opioid Use and Sleep Impairment among Veterans with Chronic Pain. PAIN MEDICINE 2014; 15:1902-10. [DOI: 10.1111/pme.12472] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nilakantan A, Younger J, Aron A, Mackey S. Preoccupation in an early-romantic relationship predicts experimental pain relief. PAIN MEDICINE 2014; 15:947-53. [PMID: 24716721 DOI: 10.1111/pme.12422] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Individuals involved in the early stages of a passionate romantic relationship can be consumed by the experience and report emotional dependence and constant focus on their romantic partner. A few studies have shown that viewing pictures of a romantic partner can significantly reduce experimental pain. The strength of the effect, however, varies substantially between individuals. To study why some individuals experience significant pain reduction when looking at a picture of their partner, we examined partner preoccupation. We hypothesized that a greater degree of preoccupation in the early stages of a romantic relationship would be associated with greater analgesia during a pain induction task. METHODS Participants were shown pictures of their romantic partner or an equally attractive and familiar acquaintance while exposed to low, moderate, or high levels of thermal pain. Participants were also asked to rate how much time they spent thinking about their romantic partner during an average day. Degree of preoccupation was defined as the percentage of time participants spent thinking about their partner on an average day. RESULTS In two separate experiments, viewing pictures of a romantic partner produced an analgesic effect. The degree of pain relief was positively correlated with partner preoccupation. The results suggest that preoccupation with a romantic partner during early stage romantic love is a predictor of pain relief when viewing pictures of the beloved.
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Affiliation(s)
- Aneesha Nilakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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