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Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
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Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Ali SM, Selby DA, Bourke D, Bravo Santisteban RD, Chiarotto A, Firth J, James B, Parker B, Dixon WG, van der Veer SN. Feasibility and acceptability to use a smartphone-based manikin for daily longitudinal self-reporting of chronic pain. Digit Health 2023; 9:20552076231194544. [PMID: 37599898 PMCID: PMC10434844 DOI: 10.1177/20552076231194544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Background As management of chronic pain continues to be suboptimal, there is a need for tools that support frequent, longitudinal pain self-reporting to improve our understanding of pain. This study aimed to assess the feasibility and acceptability of daily pain self-reporting using a smartphone-based pain manikin. Methods For this prospective feasibility study, we recruited adults with lived experience of painful musculoskeletal condition. They were asked to complete daily pain self-reports via an app for 30 days. We assessed feasibility by calculating pain report completion levels, and investigated differences in completion levels between subgroups. We assessed acceptability via an end-of-study questionnaire, which we analysed descriptively. Results Of the 104 participants, the majority were female (n = 87; 84%), aged 45-64 (n = 59; 57%), and of white ethnic background (n = 89; 86%). The mean completion levels was 21 (± 7.7) pain self-reports. People who were not working (odds ratio (OR) = 1.84; 95% confidence interval (CI), 1.52-2.23) were more likely, and people living in less deprived areas (OR = 0.77; 95% CI, 0.62-0.97) and of non-white ethnicity (OR = 0.45; 95% CI, 0.36-0.57) were less likely to complete pain self-reports than their employed, more deprived and white counterparts, respectively. Of the 96 participants completing the end-of-study questionnaire, almost all participants agreed that it was easy to complete a pain drawing (n = 89; 93%). Conclusion It is feasible and acceptable to self-report pain using a smartphone-based manikin over a month. For its wider adoption for pain self-reporting, the feasibility and acceptability should be further explored among people with diverse socio-economic and ethnic backgrounds.
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Affiliation(s)
- Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - David A Selby
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- German Research Center for Artificial Intelligence (DFKI), Kaiserslautern, Germany
| | - Darryl Bourke
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Ramiro D Bravo Santisteban
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Jill Firth
- Integrated Care Centre, Pennine MSK Partnership, Oldham, UK
| | | | - Ben Parker
- Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - William G Dixon
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester NHS Foundation Trust, Manchester, UK
- Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Nunes AP, Zhao D, Jesdale WM, Lapane KL. Multiple imputation to quantify misclassification in observational studies of the cognitively impaired: an application for pain assessment in nursing home residents. BMC Med Res Methodol 2021; 21:132. [PMID: 34174838 PMCID: PMC8235835 DOI: 10.1186/s12874-021-01327-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Despite experimental evidence suggesting that pain sensitivity is not impaired by cognitive impairment, observational studies in nursing home residents have observed an inverse association between cognitive impairment and resident-reported or staff-assessed pain. Under the hypothesis that the inverse association may be partially attributable to differential misclassification due to recall and communication limitations, this study implemented a missing data approach to quantify the absolute magnitude of misclassification of pain, pain frequency, and pain intensity by level of cognitive impairment. Methods Using the 2016 Minimum Data Set 3.0, we conducted a cross-sectional study among newly admitted US nursing home residents. Pain presence, severity, and frequency is assessed via resident-reported measures. For residents unable to communicate their pain, nursing home staff document pain based on direct resident observation and record review. We estimate a counterfactual expected level of pain in the absence of cognitive impairment by multiply imputing modified pain indicators for which the values were retained for residents with no/mild cognitive impairment and set to missing for residents with moderate/severe cognitive impairment. Absolute differences (∆) in the presence and magnitude of pain were calculated as the difference between documented pain and the expected level of pain. Results The difference between observed and expected resident reported pain was greater in residents with severe cognitive impairment (∆ = -10.2%, 95% Confidence Interval (CI): -10.9% to -9.4%) than those with moderate cognitive impairment (∆ = -4.5%, 95% CI: -5.4% to -3.6%). For staff-assessed pain, the magnitude of apparent underreporting was similar between residents with moderate impairment (∆ = -7.2%, 95% CI: -8.3% to -6.0%) and residents with severe impairment (∆ = -7.2%, 95% CI: -8.0% to -6.3%). Pain characterized as “mild” had the highest magnitude of apparent underreporting. Conclusions In residents with moderate to severe cognitive impairment, documentation of any pain was lower than expected in the absence of cognitive impairment. This finding supports the hypothesis that an inverse association between pain and cognitive impairment may be explained by differential misclassification. This study highlights the need to develop analytic and/or procedural solutions to correct for recall/reporter bias resulting from cognitive impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01327-5.
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Affiliation(s)
- Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Danni Zhao
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - William M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
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The Short-Term Kinetics of sICAM-1 after Induction of Acute Experimental Pain in Healthy Volunteers. J Clin Med 2021; 10:jcm10092021. [PMID: 34065075 PMCID: PMC8125896 DOI: 10.3390/jcm10092021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Intercellular adhesion molecule-1 (ICAM-1) mediates extravasation of leukocytes, releasing proinflammatory cytokines or endogenous opioids in the inflamed tissue. Thus, ICAM-1 is a crucial component of peripheral antinociception. Previously, we demonstrated a significant correlation between the soluble form of ICAM (sICAM-1) in serum and pain intensity reported by chronic pain patients. The present study examines the role and kinetics of sICAM-1 in experimentally induced acute pain. Three groups of 10 subjects were exposed to 10 min of high (capsaicin-enhanced) or low-intensity heat pain or cold pain, respectively. Thermal stimuli were induced using a device for quantitative sensory testing. Topical capsaicin significantly increased heat pain intensity without the risk of thermal tissue damage. Pain intensity was recorded every minute during testing. sICAM-1 concentrations in serum were determined by ELISA before, immediately after, and 60 min after test termination. Among all experimental groups, sICAM-1 significantly decreased immediately after pain induction. After 60 min, sICAM-1 concentrations returned towards initial values. Interestingly, a linear correlation was found between the extent of sICAM-1 changes and the initial concentrations. Whereas high initial values led to a distinct decrease of sICAM-1, low concentrations tended to increase. There was no statistically significant correlation between levels or alterations of serum sICAM-1 and pain intensity reported by the test subjects. In contrast to our previous findings in chronic pain patients, the present results show that sICAM-1 values do not correlate with the intensity of acute experimental pain. However, we were able to detect short-term changes of sICAM-1 after induction of nociceptive thermal stimuli, suggesting that this marker is part of a demand-oriented homeostatically controlled system.
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Morrison R, Jesdale B, Dube C, Forrester S, Nunes A, Bova C, Lapane KL. Racial/Ethnic Differences in Staff-Assessed Pain Behaviors Among Newly Admitted Nursing Home Residents. J Pain Symptom Manage 2021; 61:438-448.e3. [PMID: 32882357 PMCID: PMC8094375 DOI: 10.1016/j.jpainsymman.2020.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/01/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
Abstract
CONTEXT Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented. OBJECTIVES We sought to examine racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain. METHODS We used the U.S. national Minimum Data Set 3.0 and identified 994,510 newly admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010 and 2016. Adjusted prevalence ratios (aPRs) and 95% CIs estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups. RESULTS Vocal complaints were most commonly recorded (18.3% non-Hispanic black residents, 19.3% of Hispanic residents, and 30.3% of non-Hispanic white residents). Documentation of pain behaviors was less frequent among non-Hispanic black and Hispanic residents than non-Hispanic white residents (e.g., vocal complaints: aPRBlack: 0.76; 95% CI: 0.73-0.78; with similar estimates for other pain behaviors). Non-Hispanic blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared with non-Hispanic white residents (59.3%) (aPRBlack: 0.87; 95% CI: 0.86-0.88; aPRHispanics: 0.87; 95% CI: 0.84-0.89). CONCLUSION Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic blacks and Hispanics than in non-Hispanic white residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.
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Affiliation(s)
- Reynolds Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine Dube
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
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Lapane KL, Dubé C, Hume AL, Tjia J, Jesdale BM, Pawasauskas J, Khodyakov D. Priority-Setting to Address the Geriatric Pharmacoparadox for Pain Management: A Nursing Home Stakeholder Delphi Study. Drugs Aging 2021; 38:327-340. [PMID: 33624228 DOI: 10.1007/s40266-021-00836-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence to guide clinical decision making for pain management in nursing home residents is scant. OBJECTIVE Our objective was to explore the extent of consensus among expert stakeholders regarding what analgesic issues should be prioritized for comparative-effectiveness studies of beneficial and adverse effects of analgesic regimens in nursing home residents. METHODS Two stakeholder panels (nurses only and a mix of clinicians/researchers) were engaged (n = 83). During a three-round online modified Delphi process, participants rated and commented on the need for new evidence on nonopioid analgesic regimens and opioid regimens, short-term adverse effects, long-term adverse effects, comorbid conditions, and other factors in the nursing home setting (9-point scale; 1 = not essential to 9 = very essential to obtain new evidence). The quantitative data were analyzed to determine the existence of consensus using an approach from the RAND/UCLA Appropriateness Method User's Manual. The qualitative data, consisting of participant explanations of their numeric ratings, were thematically analyzed by an experienced qualitative researcher. RESULTS For nursing home residents, evidence generation was deemed essential for opioids, gabapentin (alone or with serotonin norepinephrine reuptake inhibitors [SNRIs]), and nonsteroid anti-inflammatory drugs with SNRIs. Experts prioritized the following outcomes as essential: long-term adverse effects, including delirium, cognitive decline, and decline in activities of daily living (ADLs). Kidney disease and depression were deemed essential conditions to consider in studies of pain medications. Coprescribing analgesic regimens with benzodiazepines, sedating medications, serotonergic medications, and non-SNRI antidepressants were considered essential areas of study. Experts noted that additional study was essential in residents with moderate/severe cognitive impairment and limitations in ADLs. CONCLUSIONS Stakeholder priorities for more evidence reflect concerns related to treating medically complex residents with complex drug regimens and included long-term adverse effects, coprescribing, and sedating medications. Carefully conducted observational studies are needed to address the vast evidence gap for nursing home residents.
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Affiliation(s)
- Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Catherine Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Anne L Hume
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Jennifer Tjia
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jayne Pawasauskas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
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Santivasi WL, Partain DK, Whitford KJ. The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995) 2020; 48:37-47. [PMID: 31825689 DOI: 10.1080/21548331.2019.1703707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Take-Away Points:1. Geriatric palliative care requires integrating the disciplines of hospital medicine and palliative care in pursuit of delivering comprehensive, whole-person care to aging patients with serious illnesses.2. Older adults have unique palliative care needs compared to the general population, different prevalence and intensity of symptoms, more frequent neuropsychiatric challenges, increased social needs, distinct spiritual, religious, and cultural considerations, and complex medicolegal and ethical issues.3. Hospital-based palliative care interdisciplinary teams can take many forms and provide high-quality, goal-concordant care to older adults and their families.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Center for Palliative Medicine & Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kevin J Whitford
- Center for Palliative Medicine & Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Marttinen MK, Kautiainen H, Haanpää M, Pohjankoski H, Vuorimaa H, Hintikka J, Kauppi MJ. Pain-related factors in older adults. Scand J Pain 2019; 19:797-803. [PMID: 31085750 DOI: 10.1515/sjpain-2019-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Pain is an evident factor affecting the quality of life in all age groups. The objective was to examine the prevalence of self-reported SF-36 bodily pain and pain-related factors in community-dwelling older adults. METHODS One thousand four hundred and twenty adults aged 62-86 years self-reported SF-36 bodily pain during the previous month. For the analysis, four pain groups were formed (group I [0-45, moderate to very severe pain intensity and interference], group II [47.5-70], group III [77.5-90], and group IV [100, no pain at all]). Additional questionnaire-provided data regarding education, wealth, life habits, and morbidity, as well as clinical data were considered. RESULTS The overall pain prevalence was 78% (SF-36 bodily pain score <100). The prevalence of cohabiting, as well as the years of education and household income were found to decrease with an increasing SF-36 bodily pain score. The prevalence of a BMI of over 30 and of central obesity emerged as the highest in group I. Morbidities were found to be most prevalent in group I. CONCLUSIONS A high prevalence of intense and interfering pain was reported. Multiple factors that were found to relate to pain have previously been demonstrated to associate with social exclusion. Increasing attention should be paid to distinguishing these factors in patients with pain, as well as targeted pain assessment and measures to improve the sense of community among older adults. IMPLICATIONS There is a lack of large studies that examine a wide scale of pain-related factors in the older adult population. To distinguish subjects with multiple such factors would help medical professionals to target their attention to patients at a high risk of chronic pain.
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Affiliation(s)
- Maiju K Marttinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Heini Pohjankoski
- Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Hanna Vuorimaa
- Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland
| | - Markku J Kauppi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
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Ulbricht CM, Hunnicutt JN, Gambassi G, Hume AL, Lapane KL. Nonmalignant Pain Symptom Subgroups in Nursing Home Residents. J Pain Symptom Manage 2019; 57:535-544.e1. [PMID: 30508639 PMCID: PMC6690183 DOI: 10.1016/j.jpainsymman.2018.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 11/20/2022]
Abstract
CONTEXT Despite many nursing home residents experiencing pain, research about the multidimensional nature of nonmalignant pain in these residents is scant. OBJECTIVES To identify and describe pain symptom subgroups and to evaluate whether subgroups differed by sex. METHODS Using Minimum Data Set 3.0 data (2011-2012), we identified newly admitted nursing home residents reporting pain (n = 119,379). A latent class analysis included 13 indicators: markers for pain (i.e., severity, frequency, impacts sleep, and function) and depressive symptoms. Sex was evaluated as a grouping variable. Multinomial logistic models identified the association between latent class membership and covariates, including age and cognitive impairment. RESULTS Four latent subgroups were identified: severe (15.2%), moderate frequent (26.4%), moderate occasional with depressive symptoms (26.4%), and moderate occasional without depressive symptoms (32.0%). Measurement invariance by sex was ruled out. Depressed mood, sleep disturbances, and fatigue distinguished subgroups. Age ≥75 years was inversely associated with belonging to the severe, moderate frequent, or moderate occasional with depressive symptoms subgroups. Residents with severe cognitive impairment had reduced odds of membership in the severe pain subgroup (adjusted odds ratio [aOR]: 0.84; 95% confidence interval [CI]: 0.78-0.90) and moderate frequent pain subgroup (aOR: 0.60; 95% CI: 0.56-0.64) but increased odds in the moderate occasional pain with depressive symptoms subgroup (aOR: 1.12; 95% CI: 1.06-1.18). CONCLUSION Identifying subgroups of residents with different patterns of pain and depressive symptoms highlights the need to consider physical and psychological components of pain. Expanding knowledge about pain symptom subgroups may provide a promising avenue to improve pain management in nursing home residents.
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Affiliation(s)
- Christine M Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jacob N Hunnicutt
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts, Worcester, Massachusetts, USA
| | - Giovanni Gambassi
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Anne L Hume
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
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Pillemer K, Riffin C, Suitor JJ, Peng S, Reid MC. The Impact of Older Parents' Pain Symptoms on Adult Children. PAIN MEDICINE 2017; 18:2316-2324. [PMID: 28339638 DOI: 10.1093/pm/pnw320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Not only is persistent pain a debilitating health problem for older adults, it also may have negative effects on family relationships. Studies have documented the effects of pain on spouses and on parents of young children. However, research has not extended this line of inquiry to later life, and specifically to the impact of older parents' pain symptoms on adult children. This study addresses the question: Does older mothers' pain affect the quality of relations with offspring? Subjects and Design Using data from a survey of 678 adult children of older mothers, this article presents two analyses examining the impact of mothers' self-reported pain on emotional closeness and on tension in the adult child-parent relationship. Results Contrary to research conducted on younger families, multilevel models showed no effects on emotional closeness or tension in relationships with adult children when mothers experienced higher levels of persistent pain. This surprising finding suggests that mechanisms may exist that protect adult child caregivers from stressors that result from a relative's chronic pain. Conclusions Based on the findings of this article, further exploration of the impact of chronic pain on relations between adult children and their parents is justified. Of interest is exploration of factors that may insulate later-life intergenerational relationships from the effects of pain.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - Catherine Riffin
- Department of Human Development, Cornell University, Ithaca, New York
| | - J Jill Suitor
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - Siyun Peng
- Department of Sociology, Purdue University, West Lafayette, Indiana
| | - M C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, USA
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11
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Fernández N, Olivera NM, Keller GA, Diez RA, Di Girolamo G, Quiroga PN. Simultaneous quantitation of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene in human plasma using solid-phase extraction and gas chromatography/mass spectrometry: Method validation and application to cardiovascular safety of therapeutic doses. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2017; 31:1519-1533. [PMID: 28686794 DOI: 10.1002/rcm.7933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 06/07/2023]
Abstract
RATIONALE Several opioid analgesics have been related to the prolongation of cardiac repolarization, a condition which can be fatal. In order to establish a correct estimation of the risk/benefit balance of therapeutic doses of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene, it was necessary to develop an analytical method to determinate plasma concentrations of these opioids. METHODS Here we describe a method which incorporates strong alkaline treatment to obtain norpropoxyphene amide followed by a one-elution step solid-phase extraction, and without further derivatization. Separation and quantification were achieved by gas chromatography/electron ionization mass spectrometry (GC/EI-MS) in selected-ion monitoring mode. Quantification was performed with 500 μL of plasma by the addition of deuterated analogues as internal standards. RESULTS The proposed method has been validated in the linearity range of 25-1000 ng/mL for all the analytes, with correlation coefficients higher than 0.990. The lower limit of quantification was 25 ng/mL. The intra- and inter-day precision, calculated in terms of relative standard deviation, were 2.0-12.0% and 6.0-15.0%, respectively. The accuracy, in terms of relative error, was within a ± 10% interval. The absolute recovery and extraction efficiency ranged from 81.0 to 111.0% and 81.0 to 105.0%, respectively. CONCLUSIONS A GC/MS method for the rapid and simultaneous determination of meperidine, normeperidine, tramadol, propoxyphene and norpropoxyphene in human plasma was developed, optimized and validated. This procedure was shown to be sensitive and specific using small specimen amounts, suitable for application in routine analysis for forensic purposes and therapeutic monitoring. To our knowledge, this is the first full validation of the simultaneous determination of these opioids and their metabolites in plasma samples.
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Affiliation(s)
- Nicolás Fernández
- Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de asesoramiento toxicológico analítico (CENATOXA). Junín 956 7mo piso (C1113AAD). Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nancy Mónica Olivera
- Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de asesoramiento toxicológico analítico (CENATOXA). Junín 956 7mo piso (C1113AAD). Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Alberto Keller
- Facultad de Medicina, Segunda Cátedra de Farmacología. Paraguay 2155 16avopiso (C1221ABG), Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Roberto Alberto Diez
- Facultad de Medicina, Segunda Cátedra de Farmacología. Paraguay 2155 16avopiso (C1221ABG), Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Di Girolamo
- Facultad de Medicina, Segunda Cátedra de Farmacología. Paraguay 2155 16avopiso (C1221ABG), Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Patricia Noemí Quiroga
- Facultad de Farmacia y Bioquímica, Cátedra de Toxicología y Química Legal, Laboratorio de asesoramiento toxicológico analítico (CENATOXA). Junín 956 7mo piso (C1113AAD). Ciudad Autónoma de Buenos Aires (CABA), Universidad de Buenos Aires, Buenos Aires, Argentina
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Luchting B, Hinske LCG, Rachinger-Adam B, Celi LA, Kreth S, Azad SC. Soluble intercellular adhesion molecule-1: a potential biomarker for pain intensity in chronic pain patients. Biomark Med 2017; 11:265-276. [PMID: 28240097 DOI: 10.2217/bmm-2016-0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM Pain therapy is strongly guided by patients' self-reporting. However, when self-reporting is not an option, pain assessment becomes a challenge and may lead to undertreatment of painful conditions. Pain is a complex and multifactorial phenomenon. Recent work has connected pain pathophysiology also with the inflammatory system. We therefore hypothesized that pain intensity could be predicted by cytokine-levels. PATIENTS & METHODS In this observational, single-center study, we investigated 30 serum cytokines to predict pain intensity in a screening/follow-up set of 95 chronic pain patients and controls. We then prospectively validated soluble intercellular adhesion molecule-1 (sICAM-1)'s discriminatory capability (n = 21). RESULTS & CONCLUSION sICAM-1 was significantly associated with patient-reported pain intensity and yielded differential serum levels in patients of varying degrees of pain intensity. Changes in pain ratings over time correlated with changes in sICAM-1 levels. Our findings suggest the possibility of a clinical use of sICAM-1 as a potential biomarker for pain intensity.
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Affiliation(s)
- Benjamin Luchting
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | | | - Banafscheh Rachinger-Adam
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | - Leo Anthony Celi
- Harvard-MIT Division of Health Science & Technology, Boston, MA 02139, USA.,Intensive Care Unit, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA 02215, USA
| | - Simone Kreth
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
| | - Shahnaz Christina Azad
- Department of Anesthesiology & Pain Medicine, Clinic of the Ludwig-Maximilians University of Munich, Germany
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Kwok EYT, Au RKC, Li-Tsang CWP. The Effect of a Self-management Program on the Quality-of-Life of Community-dwelling Older Adults with Chronic Musculoskeletal Knee Pain: A Pilot Randomized Controlled Trial. Clin Gerontol 2016; 39:428-448. [PMID: 29471771 DOI: 10.1080/07317115.2016.1171818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate a 6-week self-management program on pain conducted in a mobile setting at the residences of older adult participants. METHODS In this single-blinded randomized controlled trial, 46 community-dwelling older adults with chronic knee pain were randomly assigned to the experimental (n = 19) and wait-list control groups (n = 27). The experimental group engaged in the 6-week program while the control group was only given some pamphlets on exercise and joint care. The pain level, physical functions, QOL, and self-efficacy of the participants in both groups were assessed at baseline, post-program, and at the 1-month follow-up session. Both baseline and post-program (or post-control-period assessment) data were analyzed. RESULTS The results showed that the participants in the experimental group had a higher level of self-efficacy, better performance in walking test, a higher level of quality-of-life, and less frequency of pain at the post-program follow-up as compared to the control group. The effect was maintained among the experimental group at post-4-week follow-up and further reduction in pain was detected. CONCLUSIONS The program appeared to be effective at improving the pain status, self-efficacy, functional performance, and quality-of-life of older adults. However, as the sample size was small, further study is suggested to investigate the effects of the program.
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Affiliation(s)
- Esther Y T Kwok
- a The Hong Kong Polytechnic University , Hung Hom , Hong Kong , China
| | - Ricky K C Au
- a The Hong Kong Polytechnic University , Hung Hom , Hong Kong , China
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Ko A, Harada MY, Smith EJ, Scheipe M, Alban RF, Melo N, Margulies DR, Ley EJ. Pain Assessment and Control in the Injured Elderly. Am Surg 2016. [DOI: 10.1177/000313481608201001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Elderly trauma patients may be at increased risk for underassessment and inadequate pain control in the emergency department (ED). We sought to characterize risk factors for oligoanalgesia in the ED in elderly trauma patients and determine whether it impacts outcomes in elderly trauma patients. We included elderly patients (age ≥55 years) with Glasgow Coma Scale scores 13 to 15 and Injury Severity Score (ISS) ≥9 admitted through the ED at a Level I trauma center. Patient characteristics and outcomes were compared between those who reported pain and received analgesics medication in the ED (MED) and those who did not (NO MED). A total of 183 elderly trauma patients were identified over a three-year study period, of whom 63 per cent had pain assessed via verbal pain score; of those who reported pain, 73 per cent received analgesics in the ED. The MED and NO MED groups were similar in gender, race, ED vitals, ISS, and hospital length of stay. However, NO MED was older, with higher head Abbreviated Injury Scale score and longer intensive care unit length of stay. Importantly, as patients aged they reported lower pain and were less likely to receive analgesics at similar ISS. Risk factors for oligoanalgesia may include advanced age and head injury.
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Affiliation(s)
- Ara Ko
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Megan Y. Harada
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J.T. Smith
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael Scheipe
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rodrigo F. Alban
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nicolas Melo
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel R. Margulies
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric J. Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California
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Drageset J, Eide GE, Hauge S. Symptoms of depression, sadness and sense of coherence (coping) among cognitively intact older people with cancer living in nursing homes-a mixed-methods study. PeerJ 2016; 4:e2096. [PMID: 27330859 PMCID: PMC4906642 DOI: 10.7717/peerj.2096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Symptoms of depression are often reported among patients with a cancer diagnosis. Strong sense of coherence (SOC) is shown to be associated with less depression in the general older population and among nursing homes (NH) residents in particular. Knowledge about mixed-methods perspectives that examine symptoms of depression and SOC among cognitively intact NH residents with cancer is scarce. AIM To investigate symptoms of depression and SOC among NH residents who are cognitively intact and have cancer. METHODS We used a quantitatively driven mixed-methods design with sequential supplementary qualitative components. We facilitated the collection of quantitative survey data of 60 NH residents (≥ 65 years) with cancer using the Geriatric Depression Scale (GDS) and SOC scale. The supplementary psychosocial component comprised qualitative research interviews about experiences related to depression with nine respondents from the same cohort. RESULTS In fully adjusted multiple regression analysis of the sociodemographic variables, the GDS was significantly correlated with SOC (P < 0.001). The experience of sadness was identified by the following theme: sadness. Coping with the experience of symptoms of depression was dominated by coping with sadness. CONCLUSION More than half the NH residents reported symptoms of depression, and the SOC was associated with reduced symptoms. A mixed-methods design contributed to nuanced and detailed information about the meaning of depression, and the supplementary component informs and supports the core component. To improve the situation of NH residents with cancer, more attention should be paid to the residents' experience of symptoms of depression and their SOC.
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Affiliation(s)
- Jorunn Drageset
- Faculity of Health and Social Science, Bergen University College, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Centre for Clinical Research, Western Norway Health Region Authority, Bergen, Norway
| | - Solveig Hauge
- Faculty of Health and Social Studies and Centre for Caring Research–Southern Norway, Unversity College of Southeast, Porsgrunn, Norway
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Rahmati M, Taherabadi SJ, Mehrabi M. Decreased Activity in Neuropathic Pain Form and Gene Expression of Cyclin-Dependent Kinase5 and Glycogen Synthase Kinase-3 Beta in Soleus Muscle of Wistar Male Rats. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23324. [PMID: 26290750 PMCID: PMC4537785 DOI: 10.5812/ircmj.23324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 11/18/2014] [Accepted: 03/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship between decreased activity/neuropathic pain and gene expression alterations in soleus muscle has remained elusive. OBJECTIVES In this experimental study, we investigated the effects of decreased activity in neuropathic pain form on Cyclin-Dependent Kinase 5 (CDK5) and Glycogen Synthase Kinase-3 β (GSK-3β) gene expression in soleus muscle of rats. MATERIALS AND METHODS Twelve male Wistar rats were randomly divided into three groups: (1) tight ligation of the L5 spinal nerve (SNL: n = 4); (2) sham surgery (Sham: n = 4), and (3) control (C: n = 4). The threshold to produce a withdrawal response to a mechanical and thermal stimulus was measured using von Frey filaments and radiation heat apparatus, respectively. Following 4 weeks after surgery, the left soleus muscle was removed and mRNA levels were determined by real-time Polymerase Chain Reaction (PCR). RESULTS Compared to control animals, L5 ligated animals developed mechanical and heat hypersensitivity during total period of study. Soleus muscle weight as well as CDK5 mRNA levels (less than ~ 0.4 fold) was decreased and GSK-3β mRNA levels (up to ~ 7 folds) increased in L5 ligated animals. CONCLUSIONS These results showed enhanced muscle atrophy processes following peripheral nerve damage and might provide a useful approach to study underlying muscle mechanisms associated with clinical neuropathic pain syndromes.
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Affiliation(s)
- Masoud Rahmati
- Department of Physical Education and Sport Sciences, Lorestan University, Khoram Abad, IR Iran
- Corresponding Author: Masoud Rahmati, Department of Physical Education and Sport Sciences, Lorestan University, Khoram Abad, IR Iran. Tel: +98-9124525538, Fax: +98-6614215393, E-mail:
| | - Seyed Jalal Taherabadi
- Department of Physical Education and Sport Sciences, Lorestan University, Khoram Abad, IR Iran
| | - Mahmoud Mehrabi
- Department of Physical Education and Sport Sciences, Lorestan University, Khoram Abad, IR Iran
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Oligoanalgesia in Blunt Geriatric Trauma. J Emerg Med 2015; 48:653-9. [DOI: 10.1016/j.jemermed.2014.12.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/17/2014] [Accepted: 12/21/2014] [Indexed: 11/16/2022]
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Drageset J, Corbett A, Selbaek G, Husebo BS. Cancer-related pain and symptoms among nursing home residents: a systematic review. J Pain Symptom Manage 2014; 48:699-710.e1. [PMID: 24703946 DOI: 10.1016/j.jpainsymman.2013.12.238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/14/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022]
Abstract
CONTEXT Many older nursing home (NH) residents with cancer experience pain and distressing symptoms. Although some develop cancer during their time in the institution, an increasing number are admitted during their final stages of their lives. Numerous studies have evaluated various treatment approaches, but how pain and symptoms are assessed and managed in people with cancer with and without dementia is unclear. OBJECTIVES The objective of this review was to summarize the evidence on cancer-related symptoms among NH residents with and without dementia. METHODS We systematically searched the PubMed (1946-2012), Embase (1974-2012), CINAHL (1981-2012), AgeLine, and Cochrane Library (1998-2012) databases using the search terms neoplasms, cancer, tumor, and nursing home. The inclusion criteria were studies including NH residents with a diagnosis of cancer and outcome measures including pain and cancer-related symptoms. RESULTS We identified 11 studies (cross-sectional, longitudinal, clinical trial, and qualitative studies). Ten studies investigated the prevalence and treatment of cancer-related symptoms such as vomiting, nausea, urinary tract infections, and depression. Studies clearly report a high prevalence of pain and reduced prescribing and treatment, regardless of the cognitive status. Only one small study included people with cancer and a diagnosis of dementia. Studies of new cancer diagnoses in NHs could not be identified. CONCLUSION This review clearly reports a high prevalence of pain and reduced drug prescribing and treatment among NH residents with cancer. This issue appears to be most critical among people with severe dementia, emphasizing the need for better guidance and evidence on pain assessment for these individuals.
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Affiliation(s)
- Jorunn Drageset
- Faculty for Health and Social Science, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - Geir Selbaek
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Akershus University Hospital, Lørenskog, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Ferreira M, Verloo H, Mabire C, Vieira MMS, Marques-Vidal P. Psychometric evaluation of the French version of the questionnaire attitudes towards morphine use; a cross-sectional study in Valais, Switzerland. BMC Nurs 2014; 13:1. [PMID: 24406097 PMCID: PMC4029768 DOI: 10.1186/1472-6955-13-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 01/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background In Switzerland, nurses are allowed to prescribe and administer morphine in emergency situations without a doctor. Still, nurses and other health professionals are often reluctant to prescribe and administer morphine for pain management in patients. No valid French-speaking instrument is available in Switzerland to assess the attitudes of nurses and other health professionals towards the prescription and administration of morphine. In this study, we evaluated the psychometric properties of the French version of the questionnaire “Attitudes towards morphine use”. Methods The instrument was derived from an Italian version. Forward and back translations of the questionnaire were performed. Item analysis and construct validity were assessed between April and December 2010 in a cross sectional study including five Swiss hospitals in a sample of 588 health professionals (533 nurses, mean age 38.3 ± 10.2 years). Thirty subjects participated in test-retest reliability. Results The time to complete the instrument ranged between 12 and 15 minutes and neither floor nor ceiling effect were found. The initial 24-item instrument showed an intraclass correlation (ICC) of 0.69 (95% CI: 0.64 to 0.73, P < 0.001), and a Cronbach’s α of 0.700. Factor analysis led to a six-component solution explaining 52.4% of the total variance. After excluding five items, the shortened version showed an ICC of 0.74 (95% CI, 0.70 to 0.77, P < 0.001) and a Cronbach’s α of 0.741. Factor analysis led to a five-component solution explaining 54.3% of the total variance. The five components were named “risk of addiction/dependence”; “operational reasons for not using morphine”; “risk of escalation”; “other (non-dependence) risks” and “external (non-operational) reasons”. In test-retest, the shortened instrument showed an ICC of 0.797 (95% CI, 0.630 to 0.911, P < 0.001) and a Cronbach’s α of 0.797. Conclusions The 19-item shortened instrument assessing attitudes towards the prescription and administration of morphine showed adequate content and construct validity.
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Affiliation(s)
- Maria Ferreira
- Hôpital de Sion, Avenue Grand-Champsec 80, Case Postale 736, Sion, 1951, Switzerland.
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Apinis C, Tousignant M, Arcand M, Tousignant-Laflamme Y. Can Adding a Standardized Observational Tool to Interdisciplinary Evaluation Enhance the Detection of Pain in Older Adults with Cognitive Impairments? PAIN MEDICINE 2014; 15:32-41. [DOI: 10.1111/pme.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moes JR, Holden JE. Characterizing activity and muscle atrophy changes in rats with neuropathic pain: a pilot study. Biol Res Nurs 2013; 16:16-22. [PMID: 24057222 DOI: 10.1177/1099800413502722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The study of neuropathic pain has focused on changes within the nervous system, but little research has described systemic changes that may accompany neuropathic pain. OBJECTIVE As part of a larger project characterizing the metabolic, activity, and musculoskeletal changes associated with neuropathic pain, the objective of the current study was to characterize changes in spontaneous activity and skeletal muscle mass using an established animal model of neuropathic pain, the chronic constriction injury (CCI) model. METHOD Male Sprague-Dawley rats were used in this pre- and posttest quasi-experimental study. The experimental group (n = 13) received CCI surgery, while age- and weight-matched rats received sham surgery (SHAM; n = 5). Thermal testing verified the presence of neuropathic pain. Spontaneous cage activity was measured gravimetrically prior to and following CCI (n = 4). Animals were euthanized and skeletal muscle was dissected and weighed to determine muscle atrophy. RESULTS Shorter foot withdrawal latency of the ipsilateral hind limb confirmed the presence of thermal hyperalgesia in CCI rats, a sign of neuropathic pain. Weight increased in both CCI and SHAM rats. Spontaneous activity decreased following CCI ligation. Muscles of the ipsilateral hind limb weighed significantly less than contralateral hind limb muscles in CCI rats 2 and 6 weeks after surgery. In addition, CCI rats had smaller ipsilateral hind limb muscles than SHAM rats. CONCLUSION Neuropathic pain contributes to skeletal muscle atrophy and decreases in activity in rats.
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Affiliation(s)
- Jesse R Moes
- 1Department of Nursing, Calvin College, Grand Rapids, MI, USA
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Corrado-McKeon L, Saad M, Mir T, Liberman T, Cleary T, Lu C. Treating persistent pain in the elderly: how do we proceed? ACTA ACUST UNITED AC 2013; 28:509-14. [PMID: 23906895 DOI: 10.4140/tcp.n.2013.509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe a performance improvement initiative conducted in accordance with the American Geriatrics Society (AGS) guideline regarding pharmacological management of persistent pain in older adults. SETTINGS Medical units of a tertiary care teaching hospital. PRACTICE DESCRIPTION Elderly patients were included if treated for conditions associated with persistent pain. PRACTICE INNOVATION Using three phases, the pharmacological management of persistent pain in older adults was evaluated before and after health care provider education on the AGS guideline recommendations. Educational seminars, in-service training, and handout materials focused on addressing specific shortfalls identified during the initial evaluation. MAIN OUTCOME MEASUREMENTS Appropriate use of nonsteroidal anti-inflammatory agents (NSAIDs) and cyclooxygenase-2 selective inhibitors (coxibs), utilization of proper pain assessment tools, types of opioids used, and associated adverse effects. RESULTS A total of 50 patients with comparable demographics were included in each phase. Following education, there was an improvement in the appropriate use of pain-assessment tools in cognitively impaired older adults. There was a trend toward improvement in the use of NSAIDs and coxibs, but there was no change in practice regarding the frequency of opioid use, combining long- and short-acting opioid preparations, or preventing opioid-induced constipation. CONCLUSION Although findings from this study aided in recognizing areas for improvement in the management of persistent pain in older adults, further education of health care professionals is needed to ensure the safe and effective management of persistent pain.
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Affiliation(s)
- Lauren Corrado-McKeon
- Department of Pharmacy Services, Long Island Jewish Medical Center, New Hyde Park, NY, USA.
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Abstract
Effective treatment of acute pain in older patients is a common challenge faced by emergency providers. Because older adults are at increased risk for adverse events associated with systemic analgesics, pain treatment must proceed cautiously. Essential elements to quality acute pain care include an early initial assessment for the presence of pain, selection of an analgesic based on patient-specific risks and preferences, and frequent reassessments and retreatments as needed. This article describes current knowledge regarding the assessment and treatment of acute pain in older adults.
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Affiliation(s)
- Ula Hwang
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Educational needs of health care providers working in long-term care facilities with regard to pain management. Pain Res Manag 2012; 17:341-6. [PMID: 23061085 DOI: 10.1155/2012/506352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF), with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs). OBJECTIVE To identify the educational needs of HCPs working in LTCF with regard to pain management. METHODS A qualitative research design using the nominal group technique was undertaken. Seventy-two HCPs (21 physicians⁄pharmacists, 15 occupational⁄physical therapists, 24 nurses and 21 orderlies) were recruited from three LTCF in Quebec. Each participant was asked to provide and prioritize a list of the most important topics to be addressed within a continuing education program on chronic pain management in LTCF. RESULTS Forty topics were generated across all groups, and six specific topics were common to at least three out of the four HCP groups. Educational need in pain assessment was ranked the highest by all groups. Other highly rated topics included pharmacological treatment of pain, pain neurophysiology, nonpharmacological treatments and how to distinguish pain expression from other behaviours. CONCLUSION The present study showed that despite an average of more than 10 years of work experience in LTCF, HCPs have significant educational needs in pain management, especially pain assessment. These results will help in the development of a comprehensive pain management educational program for HCPs in LTCF.
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Post hoc analyses of data from a 90-day clinical trial evaluating the tolerability and efficacy of tapentadol immediate release and oxycodone immediate release for the relief of moderate to severe pain in elderly and nonelderly patients. Pain Res Manag 2012; 16:245-51. [PMID: 22059194 DOI: 10.1155/2011/323985] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the tolerability and efficacy of tapentadol immediate release (IR) and oxycodone IR for relief of moderate to severe pain in elderly and nonelderly patients. METHODS Post hoc data analyses were conducted on a 90-day randomized, phase 3, double-blind, flexible-dose study (ClinicalTrials.gov: NCT00364546) of adults with moderate to severe lower back pain or osteoarthritis pain who received tapentadol IR 50 mg or 100 mg, or oxycodone HCl IR 10 mg or 15 mg every 4 h to 6 h as needed for pain relief. Treatment-emergent adverse events and study discontinuations were recorded. RESULTS Data from 849 patients randomly assigned (4:1 ratio) to treatment with a study drug (tapentadol IR [n=679] or oxycodone IR [n=170]) were analyzed according to age (younger than 65 years of age [nonelderly], or 65 years of age or older [elderly]) and treatment group. Among elderly patients, incidences of constipation (19.0% versus 35.6%) and nausea or vomiting (30.4% versus 51.1%) were significantly lower with tapentadol IR versus oxycodone IR (all P<0.05). Initial onsets of nausea and constipation occurred significantly later with tapentadol IR versus oxycodone IR (both P<=0.031). Tapentadol IR-treated elderly patients had a lower percentage of days with constipation than oxycodone IR-treated patients (P=0.020). For tapentadol IR- and oxycodone IR-treated elderly patients, respectively, incidences of study discontinuation due to gastrointestinal treatment-emergent adverse events were 15.8% and 24.4% (P=0.190). Tapentadol IR and oxycodone IR provided similar pain relief, with no overall age-dependent efficacy differences (mean pain scores [11-point numerical rating scale] decreased from 7.0 and 7.2 at baseline, to 4.9 and 5.2 at end point, respectively). CONCLUSIONS Tapentadol IR was safe and effective for the relief of lower back pain and osteoarthritis pain in elderly patients, and was associated with a better gastrointestinal tolerability profile than oxycodone IR.
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Park J, Hughes AK. Nonpharmacological Approaches to the Management of Chronic Pain in Community‐Dwelling Older Adults: A Review of Empirical Evidence. J Am Geriatr Soc 2012; 60:555-68. [DOI: 10.1111/j.1532-5415.2011.03846.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Juyoung Park
- School of Social Work Florida Atlantic University Boca Raton Florida
| | - Anne K. Hughes
- School of Social Work Michigan State University East Lansing Michigan
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Santini D, Fratto ME, Aapro M. Perspectives in the elderly patient: benefits and limits of bisphosphonates and denosumab. Recent Results Cancer Res 2012; 192:171-185. [PMID: 22307375 DOI: 10.1007/978-3-642-21892-7_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Skeletal metastases affect a large percentage of the cancer population and contribute to a marked decrease in their quality of life and survival, in particular in elderly population. A future end-point of bone-protecting therapy is the demonstration of its ability to prevent or improve results in the treatment of metastatic disease, enlarging their clinical indications in metastatic and osteoporotic setting with different schedules. In this chapter we will discuss on pharmacokinetic and pharmacodynamic interactions of bisphosphonates in elderly, and the preclinical and clinical evidences of anticancer activity of bone-targeted therapies will be critically described. The clinical results of new targeted therapies (such as rank/rankl/OPG inhibition) will be reported both in bone metastatic and in adjuvant settings. Finally, the prevention of cancer treatment-induced bone loss (CTIBL) represents both in young and more in old patients an emerging issue in the bone health care. For this reason, this chapter will discuss the results of current therapies in this clinical setting.
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Antón A, Montalar J, Carulla J, Jara C, Batista N, Camps C, Cassinello J, Sanz-Ortiz J, Díaz-Rubio E, Martínez C, Ledesma F, Zubillaga E. Pain in clinical oncology: patient satisfaction with management of cancer pain. Eur J Pain 2011; 16:381-9. [PMID: 22337158 DOI: 10.1002/j.1532-2149.2011.00036.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite effective analgesic therapy, inadequate pain control is frequently perceived by patients and caregivers. AIMS To assess satisfaction with management of pain in cancer patients. METHODS Between January and May 2007, a cross-sectional multicentre study was conducted in 64 Medical Oncology Departments throughout Spain. A total of 525 outpatients with oncological diseases completed a questionnaire with demographic data, characteristics and intensity of pain, and perceptions and attitudes towards pain management at the time of a routine clinical visit. Physicians also completed a questionnaire with tumour-related and treatment-related data. Cluster analysis was used to classify patients into three groups (satisfied, neither satisfied nor dissatisfied or neutral, dissatisfied) according to pain intensity and satisfaction with treatment. RESULTS Patients satisfied with their analgesic treatment (33%) had lower pain intensities and, when regularly asked about their pain, considered their physicians to be more involved in their treatment. Neither satisfied nor dissatisfied patients (neutral) (44%) had higher mean pain intensities. Two-thirds of them achieved marked relief of their pain and also thought that physicians were aware of their situation. Dissatisfied patients (23%) had moderate to severe pain intensities, and said that they were asked less frequently about their pain, and thought that their physicians were less involved in their analgesic treatment. CONCLUSION Physician-patient communication and information provided to patients are essential aspects of patient perceptions and attitudes towards control of cancer-related pain. Pain is seen as a condition that may be controlled but affects the capacity to lead a normal life.
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Affiliation(s)
- A Antón
- Service of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Argoff CE, Gloth FM. Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients. Ther Clin Risk Manag 2011; 7:393-9. [PMID: 22076115 PMCID: PMC3208405 DOI: 10.2147/tcrm.s24458] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.5% in 45.5% dimethylsulfoxide solution (D-DMSO), are approved in the US for the treatment of osteoarthritis pain. Topical NSAIDs have shown efficacy and safety in knee (DSG, D-DMSO) and hand (DSG) osteoarthritis. Analyses of data from randomized controlled trials of DSG in hand and knee osteoarthritis demonstrate significant improvement of pain and function in both younger patients (<65 years) and older patients (≥65 years) and suggest good safety and tolerability. However, long-term safety data in older patients are limited. Topical NSAIDs can ease medication administration and help address barriers to pain management in older patients, such as taking multiple medications and inability to swallow, and are a valuable option for long-term care providers.
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Affiliation(s)
- Charles E Argoff
- Albany Medical College and Comprehensive Pain Center, Albany Medical Center, Albany, NY, USA
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31
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Chan A, Malhotra C, Do YK, Malhotra R, Ostbye T. Self reported pain severity among multiethnic older Singaporeans: does adjusting for reporting heterogeneity matter? Eur J Pain 2011; 15:1094-9. [PMID: 21646030 DOI: 10.1016/j.ejpain.2011.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/18/2011] [Accepted: 05/14/2011] [Indexed: 01/21/2023]
Abstract
The objective of this paper is to test and correct for systematic differences in reporting of pain severity among older adults by age, gender, ethnic group and socio-economic status using anchoring vignettes. Data from a national survey of community-dwelling older Singaporeans (aged 60 years and over) conducted in 2009 was used. Respondents were asked to rate the severity of their own pain as well as that of others described in the vignettes on a five-point scale ranging from none to extreme. An ordered probit model was used to estimate the coefficients of the independent variables (age, gender, ethnic group, education, housing type) on self-reported pain. Reporting heterogeneity in pain severity was then corrected using a Hierarchical Ordered Probit model. The results showed that before correcting for reporting heterogeneity, women, those older, and those of Malay ethnicity reported greater severity of pain, while there was no association of reported pain severity with housing type and education. However, after correcting for reporting heterogeneity, while women and those older were found to have an even greater severity of pain than what they had reported, Malays were found to have a lower severity of pain than what they had reported. We conclude that there are systematic differences in reporting pain severity by age, gender and ethnic group. We propose that pain management may be improved if medical professionals take into account reporting heterogeneity for pain severity among various population sub-groups in Singapore.
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Affiliation(s)
- Angelique Chan
- Department of Health Services and Systems Research, Duke-NUS Graduate Medical School, 8 College Road, 169857 Singapore
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Baker TA, Buchanan NT, Small BJ, Hines RD, Whitfield KE. Identifying the Relationship Between Chronic Pain, Depression, and Life Satisfaction in Older African Americans. Res Aging 2011. [DOI: 10.1177/0164027511403159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Empirical research on the chronic pain experience of older African Americans is scarce. Here, the authors examined the influence psychosocial indicators have on the pain experience in a sample of older African Americans. Data were collected from African Americans ( N = 247) 50 to 96 years of age (69.4 ± 9.4). All participants provided self-report data on pain indicators, demographic characteristics, social (social support, locus of control, life satisfaction) variables, and depression. Those reporting higher levels of social support and depressive symptoms experienced greater pain intensity. Pain had an indirect effect on depression as mediated through life satisfaction.These findings demonstrate the need to focus more on the means to prevent and treat pain and to ameliorate its impact on social well-being, psychological functioning, and quality of life in older adults in general and older minority adults in particular.
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Hall LM, O'Lenic K. Treatment strategies to overcome end-of-dose failure with oral and transdermal opioids. J Pharm Pract 2011; 25:503-9. [PMID: 23011962 DOI: 10.1177/0897190010379719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extended-release oral and transdermal opioids are increasingly being used for the management of chronic pain. Although the dosing intervals for these products were established through controlled clinical trials, expanded use of extended-release and transdermal dosage forms has resulted in awareness that a significant number of patients with chronic pain experience loss of baseline pain control prior to the next scheduled dose. End-of-dose failure (EDF) is the term used to describe this type of pain manifestation. By recognizing potential causes of EDF, strategies may be developed to overcome its occurrence to improve patients' pain control.
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Affiliation(s)
- Levi M Hall
- Department of Pharmaceutical Services, Beaumont Hospitals, Royal Oak, MI 48073, USA.
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Affiliation(s)
- David R P Guay
- Department of experimental and clinical pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Choi JI, Kim WM, Yoon MH, Lee HG. Antiallodynic Effect of Thalidomide and Morphine on Rat Spinal Nerve Ligation-induced Neuropathic Pain. Korean J Pain 2010; 23:172-8. [PMID: 20830262 PMCID: PMC2935978 DOI: 10.3344/kjp.2010.23.3.172] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/09/2010] [Accepted: 08/09/2010] [Indexed: 11/21/2022] Open
Abstract
Background Tumor necrosis factor-alpha and other proinflammatory cytokines are becoming well recognized as key mediators in the pathogenesis of many types of neuropathic pain. Thalidomide has profound immunomodulatory actions in addition to their originally intended pharmacological actions. There has been debate on the analgesic efficacy of opioids in neuropathic pain. The aim of this study was to investigate the effect of thalidomide and morphine on a spinal nerve ligation model in rats. Methods Male Sprague-Dawley rats weighing 100-120 g were used. Lumbar (L) 5 and 6 spinal nerve ligations were performed to induce neuropathic pain. For assessment of mechanical allodynia, mechanical stimulus using von Frey filament was applied to the paw to measure withdrawal threshold. The effects of intraperitoneal thalidomide (6.25, 12.5, 25 and 50 mg/kg, respectively) and morphine (3 and 10 mg/kg, respectively) were examined on a withdrawal threshold evoked by spinal nerve ligation. Results After L5 and 6 spinal nerve ligation, paw withdrawal thresholds on the ipsilateral side were significantly decreased compared with pre-operative baseline and with those in the sham-operated group. Intraperitoneal thalidomide and morphine significantly increased the paw withdrawal threshold compared to controls and produced dose-responsiveness. Conclusions Systemic thalidomide and morphine have antiallodynic effect on neuropathic pain induced by spinal nerve ligation in rat. These results suggest that morphine and thalidomide may be alternative therapeutic approaches for neuropathic pain.
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Affiliation(s)
- Jeong Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea
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36
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Gianni W, Ceci M, Bustacchini S, Corsonello A, Abbatecola AM, Brancati AM, Assisi A, Scuteri A, Cipriani L, Lattanzio F. Opioids for the treatment of chronic non-cancer pain in older people. Drugs Aging 2010; 26 Suppl 1:63-73. [PMID: 20136170 DOI: 10.2165/11534670-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic pain occurs in 45-85% of the geriatric population and the need to treat chronic pain is growing substantially. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life, with decreased socialization, depression, sleep disturbances, cognitive impairment, disability and malnutrition. Considering these consequences, healthcare professionals should aim at improving the diagnosis and treatment of chronic pain in older persons. One of the most important limitations in achieving successful pain management is that older people are not aware that pain management options exist or medications for pain, such as opioids, have associated benefits and adverse effects. Importantly, opioids do not induce any organ failure and if adequately used at the right dosage may only present some predictable and preventable adverse effects. Treating and controlling chronic pain is essential in elderly patients in order to maintain a good quality of life and an active role in both the family and society. To date there are only a few randomized clinical trials testing opioid therapy in elderly patients, and the aim of the present review is to highlight the efficacy and tolerability of opioid use through a literature search strategy in elderly people with chronic non-cancer pain.
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Affiliation(s)
- Walter Gianni
- Unit of Geriatrics, Research Hospital of Rome, Italian National Research Centre on Aging (INRCA), Rome, Italy.
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Candiotti KA, Gitlin MC. Review of the effect of opioid-related side effects on the undertreatment of moderate to severe chronic non-cancer pain: tapentadol, a step toward a solution? Curr Med Res Opin 2010; 26:1677-84. [PMID: 20465361 DOI: 10.1185/03007995.2010.483941] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Opioids are among the most effective and potent analgesics currently available. Their utility in the management of pain associated with cancer, acute injury, or surgery is well recognized. However, extending the application of opioids to the management of chronic non-cancer pain has met with considerable resistance. This resistance is due in part to concerns related to gastrointestinal and central nervous system-related adverse events as well as issues pertaining to regulatory affairs, the development of tolerance, incorrect drug usage, and addiction. This review focuses on the incidence of opioid-related side effects and the patient and physician barriers to opioid therapy for chronic non-cancer pain. Tapentadol, a centrally acting analgesic with two mechanisms of action, micro-opioid agonism and norepinephrine reuptake inhibition, may be considered to be a partial solution to some of these issues. METHODS MEDLINE was searched for English-language articles from 1950 to February 2010 using the terms chronic non-cancer pain and opioids together and in combination with undertreatment, adherence, and compliance. RESULTS The majority of patients treated with traditional opioids experience gastrointestinal- or central nervous system-related adverse events, most commonly constipation, nausea, and somnolence. These side effects often lead to discontinuation of opioid therapy. Concerns about side effects, analgesic tolerance, dependence, and addiction limit the use of opioids for the management of chronic pain. Treatment with tapentadol appears to provide several advantages of an analgesic with a more favorable side-effect profile than the classic micro-opioid receptor agonist oxycodone (especially related to gastrointestinal tolerability). CONCLUSIONS The pervasiveness of opioid-associated side effects and concerns related to tolerance, dependence, and addiction present potential barriers to the approval and use of opioids for the management of chronic non-cancer pain. The lower incidence of opioid-associated adverse events and possibly fewer withdrawal symptoms, combined with a satisfactory analgesic profile associated with tapentadol, suggest its potential utility for the management of chronic non-cancer pain. This review will focus on the incidence of opioid-related side effects and barriers to opioid therapy that are available as English-language articles in the MEDLINE index, and as such, it is a representative but not an exhaustive review of the current literature.
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Affiliation(s)
- Keith A Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL 33101-6370, USA.
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Abstract
The burden of chronic/persistent pain is substantial for the patient and society as a whole. Although a variety of pharmacologic treatments are available, chronic/persistent pain remains inadequately treated. Many pharmacologic treatment options provide analgesic efficacy for 4 to 6 hours, requiring multiple doses for continuous pain relief. The inconvenience of multiple doses may prevent many patients from achieving adequate pain relief. Other limitations to the current pharmacologic treatment options include gastrointestinal effects, cardiovascular effects, and organ toxicity, as well as fear of abuse or addiction. The purpose of this review is to highlight the burden of chronic/persistent pain in today's society and discuss the limitations of short-acting pharmacologic therapies used in the treatment of chronic/persistent pain.
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Affiliation(s)
- Warren A Katz
- University of Pennsylvania School of Medicine, Rothman Institute, Philadelphia, Pennsylvania, USA
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39
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Planton J, Edlund BJ. Regulatory Components for Treating Persistent Pain in Long-Term Care. J Gerontol Nurs 2010; 36:49-56. [DOI: 10.3928/00989134-20100202-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 12/09/2009] [Indexed: 11/20/2022]
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Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, Psaty BM, Von Korff M. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 2010; 25:310-5. [PMID: 20049546 PMCID: PMC2842546 DOI: 10.1007/s11606-009-1218-z] [Citation(s) in RCA: 178] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 07/14/2009] [Accepted: 11/20/2009] [Indexed: 01/13/2023]
Abstract
BACKGROUND Opioids have been linked to increased risk of fractures, but little is known about how opioid dose affects fracture risk. OBJECTIVE To assess whether risk of fracture increases with opioid dose among older patients initiating sustained use of opioids for chronic non-cancer pain. DESIGN A cohort study that uses Cox proportional hazards models to compare fracture risk among current opioid users vs. persons no longer using opioids. PARTICIPANTS Members of an integrated health care plan (N = 2,341) age 60 years and older who received 3+ opioid prescriptions within a 90-day period for chronic, non-cancer pain between 2000 and 2005. MEASUREMENTS Time-varying measures of opioid use and average daily dose in morphine equivalents were calculated from automated data. Fractures were identified from automated data and then validated through medical record review. RESULTS Compared with persons not currently using opioids, opioid use was associated with a trend towards increased fracture risk (1.28 (95% CI (0.99, 1.64 )). Higher dose opioid use (>or=50 mg/day) was associated with a 9.95% annual fracture rate and a twofold increase in fracture risk (2.00 (95% CI (1.24, 3.24)). Of the fractures in the study cohort, 34% were of the hip or pelvis, and 37% were associated with inpatient care. CONCLUSIONS Higher doses (>or=50 mg/day) of opioids for chronic non-cancer pain were associated with a 2.00 increase in risk of fracture confirmed by medical record review. Clinicians should consider fracture risk when prescribing higher-dose opioid therapy for older adults.
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Abstract
SummaryThere is a high prevalence of pain in older people. Optimal assessment and management of pain in this population is challenging. The pharmacokinetics and pharmacodynamics of analgesic medications are affected by ageing and frailty, as well as by intercurrent medical conditions and their treatments. This review describes what is currently understood about the impacts of old age and frailty on the clinical pharmacology of commonly used analgesics, to provide a rational basis for the use of these medicines. In view of the wide age-related inter-individual variability in pharmacokinetics and pharmacodynamics of analgesic medications, monitoring of clinical response and adverse effects is essential to optimize pain control in older people.
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Marín Carmona JM. [Pain and unexpressed symptoms: the other dementia]. Rev Esp Geriatr Gerontol 2009; 44 Suppl 2:9-14. [PMID: 19815312 DOI: 10.1016/j.regg.2009.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 05/20/2009] [Indexed: 05/28/2023]
Abstract
Patients with advanced dementia are biologically, socially and personally highly vulnerable. The care of these patients is a challenge in terms of both the quantity of care required and qualitative aspects (the need for specific and adapted approaches). The advanced phases of dementia are characterized by severe speech impairment, loss of mobility, and feeding and nutritional alterations (in patients with severe cognitive and functional impairment). Problems of recognition and verbal expression of sensations hampers the diagnostic and therapeutic approach. This article briefly reviews the clinical characteristics of the symptoms and syndromes prevalent in these patients (pain, neuropsychiatric symptoms, delirium, epilepsy) and emphasizes the general principles for prevention and therapeutic approaches.
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Affiliation(s)
- José Manuel Marín Carmona
- Médico Especialista en Geriatría, Programa Municipal de Memoria y Demencias, Ayuntamiento de Málaga, Málaga, Spain.
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Li L, Herr K, Chen P. Postoperative Pain Assessment With Three Intensity Scales in Chinese Elders. J Nurs Scholarsh 2009; 41:241-9. [DOI: 10.1111/j.1547-5069.2009.01280.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bruckenthal P, Reid MC, Reisner L. Special Issues in the Management of Chronic Pain in Older Adults. PAIN MEDICINE 2009; 10 Suppl 2:S67-78. [DOI: 10.1111/j.1526-4637.2009.00667.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gottrup F, Jørgensen B, Karlsmark T, Sibbald RG, Rimdeika R, Harding K, Price P, Venning V, Vowden P, Jünger M, Wortmann S, Sulcaite R, Vilkevicius G, Ahokas TL, Ettler K, Arenbergerova M. Reducing wound pain in venous leg ulcers with Biatain Ibu: a randomized, controlled double-blind clinical investigation on the performance and safety. Wound Repair Regen 2009; 16:615-25. [PMID: 19128256 DOI: 10.1111/j.1524-475x.2008.00412.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Six out of 10 patients with chronic wounds suffer from persistent wound pain. A multinational and multicenter randomized double-blind clinical investigation of 122 patients compared two moist wound healing dressings: a nonadhesive foam dressing with ibuprofen (62 patients randomized to Biatain Ibu Nonadhesive Coloplast A/S) and a nonadhesive foam without ibuprofen (60 patients to Biatain Non-Adhesive-comparator). Patients were recruited from September 2005 to April 2006. The ibuprofen foam was considered successful if the pain relief on a five-point Verbal Rating Scale was higher than the comparator without compromising safety including appropriate healing rate. Additional endpoints were change in persistent wound pain between dressing changes and pain at dressing change on days 1-5 (double blind) and days 43-47 (single blind). The primary response variable, persistent pain relief, was significantly higher in the ibuprofen-foam group, as compared with the comparator on day 1-5, with a quick onset of action (p<0.05). Wound pain intensity was significantly reduced with the ibuprofen foam during day 1-5 with 40% from baseline, compared with 30% with the comparator (p<0.001). At day 43-47, the patients in the ibuprofen-foam group had a significant (p<0.05) reemergence of persistent pain and pain at dressing change (p<0.05) when the active dressing was changed to the comparator. Wound healing was similar in the ibuprofen foam and comparator group. No difference in adverse events between the comparator and the ibuprofen foam with local sustained release of low-dose ibuprofen was observed in this study. It was generally found that women reported less pain intensity than men, and pain intensity decreased with increasing age. In addition, pain intensity increased with initial pain intensity and increasing wound size. This study has demonstrated that the ibuprofen-foam dressing provided pain relief and reduced pain intensity without compromising healing or other safety parameters.
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Affiliation(s)
- Finn Gottrup
- University Centre for Wound Healing, Odense University Hospital, Odense C, Denmark.
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Santini D, Fratto ME, Galluzzo S, Vincenzi B, Tonini G. Are bisphosphonates the suitable anticancer drugs for the elderly? Crit Rev Oncol Hematol 2009; 69:83-94. [DOI: 10.1016/j.critrevonc.2008.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 07/06/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022] Open
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&NA;. Pharmacological management of uncomplicated renal colic in elderly patients requires control of acute pain and perhaps medical expulsion therapy. DRUGS & THERAPY PERSPECTIVES 2008. [DOI: 10.2165/00042310-200824070-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
The burden of chronic/persistent pain is substantial for the patient and society as a whole. Although a variety of pharmacologic treatments are available, chronic/persistent pain remains inadequately treated. Many pharmacologic treatment options provide analgesic efficacy for 4 to 6 hours, requiring multiple doses for continuous pain relief. The inconvenience of multiple doses may prevent many patients from achieving adequate pain relief. Other limitations to the current pharmacologic treatment options include gastrointestinal effects, cardiovascular effects, and organ toxicity, as well as fear of abuse or addiction. The purpose of this review is to highlight the burden of chronic/persistent pain in today's society and discuss the limitations of short-acting pharmacologic therapies used in the treatment of chronic/persistent pain.
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Impact of skeletal complications on patients' quality of life, mobility, and functional independence. Support Care Cancer 2008; 16:879-89. [PMID: 18392862 DOI: 10.1007/s00520-008-0418-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 01/30/2008] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Skeletal-related events (SREs) from malignant bone disease cause considerable morbidity and can dramatically reduce patients' quality of life. DISCUSSION Pathologic fractures often require surgical intervention and palliative radiotherapy. Thus, patients suffer impaired mobility, loss of functional independence, and diminished health-related quality of life (HRQOL). Bisphosphonates can delay the onset and reduce the incidence of SREs and have become the standard of care for the treatment of malignant bone disease; however, minimal information on the effects of bisphosphonate treatment on HRQOL is available. Targeted HRQOL assessments for patients with malignant bone disease are currently under development and are discussed herein.
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Karp JF, Rudy T, Weiner DK. Persistent pain biases item response on the Geriatric Depression Scale (GDS): preliminary evidence for validity of the GDS-PAIN. PAIN MEDICINE 2008; 9:33-43. [PMID: 18254765 DOI: 10.1111/j.1526-4637.2007.00406.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Differential item functioning (DIF) assesses the consistency of items on a metric across clinical samples in relation to the attribute being measured. We hypothesized that in older adults with persistent pain, items of the Geriatric Depression Scale (GDS) would evidence DIF based on presence or intensity of pain. DESIGN Unidimensionality was determined by factor and item analyses. DIF was tested using Rasch Modeling. We then evaluated the psychometric properties of a revised GDS (GDS-PAIN), comprised of items that did not evidence DIF. PATIENT AND SETTINGS: A total of 677 community dwelling older adults (age 65-91) participating in observational or treatment studies of low back or knee pain who endorsed at least moderate pain for at least 3 months. A total of 201 pain-free controls were included in the analysis. RESULTS Ten of the 30 items displayed significant DIF. These items were: 1) dropping activities and interests; 2) bothered by persistent thoughts; 3) often get fidgety and restless; 4) prefer to stay home; 5) do not feel full of energy; 6) do not enjoy getting up in the morning; 7) mind is not as clear as it was, 8) feel life is empty; 9) feel more problems with memory; and 10) do not find life very exciting. The modified GDS-PAIN scale did not adversely affect the psychometric properties of the scale. CONCLUSIONS The performance of the GDS is affected by pain. When unstable items are removed, the revised GDS (GDS-PAIN) appears to be psychometrically stable and maintains both internal consistency and similar correlation values with a measure of pain as the original scale.
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Affiliation(s)
- Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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