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Butera KA, Chimenti RL, Alsouhibani AM, Berardi G, Booker SQ, Knox PJ, Post AA, Merriwether EN, Wilson AT, Simon CB. Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the "Pain-Movement Interface" to Guide Research and Clinical Care for Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104486. [PMID: 38316243 PMCID: PMC11180580 DOI: 10.1016/j.jpain.2024.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the "Pain-Movement Interface" as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PERSPECTIVE: Movement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the "Pain-Movement Interface" as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.
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Affiliation(s)
- Katie A. Butera
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ali M. Alsouhibani
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew A. Post
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ericka N. Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Culture, Education, and Human Development, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Abigail T. Wilson
- School of Kinesiology & Rehabilitation Sciences, University of Central Florida, Orlando, Florida, USA
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Lozano-Meca JA, Gacto-Sánchez M, Montilla-Herrador J. Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis. Eur J Pain 2024; 28:987-996. [PMID: 38186263 DOI: 10.1002/ejp.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. MATERIALS AND METHODS A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. RESULTS Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. CONCLUSION Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. SIGNIFICANCE This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.
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Crow JA, Joseph V, Miao G, Goodin BR, Sibille KT, Cardoso J, Bartley EJ, Staud R, Fillingim RB, Booker SQ. A domain-oriented approach to characterizing movement-evoked pain. Pain Rep 2024; 9:e1158. [PMID: 38646659 PMCID: PMC11029970 DOI: 10.1097/pr9.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/04/2024] [Accepted: 02/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Movement-evoked pain (MEP) impacts a substantial proportion of US adults living with chronic pain. Evidence suggests that MEP is influenced by numerous biopsychosocial factors and mediated by mechanisms differing from those of spontaneous pain. However, both characteristic and mechanistic knowledge of MEP remain limited, hindering effective diagnosis and treatment. Objectives We asked (1) can chronic pain, functional, psychosocial, and behavioral measures be grouped into descriptive domains that characterize MEP? and (2) what relationships exist between biopsychosocial factors across multiple domains of MEP? Methods We formed 6 characteristic domains from 46 MEP-related variables in a secondary analysis of data from 178 individuals (aged 45-85 years) with knee pain. Ratings of pain during 3 functional activities (ie, Balance, Walking, Chair Stand) were used as primary MEP variables. Pearson correlations were calculated to show linear relationships between all individual domain variables. Relationships between variables were further investigated through weighted correlation network analysis. Results We observed a unique combination of pain characteristics associated with MEP apart from general pain. Notably, minutes doing physical activity were inversely associated with multiple variables within 4 of the 6 domains. Weighted correlation network analysis largely supported our classification of MEP domains. Additional interdomain relationships were observed, with the strongest existing between MEP, Mechanical Pain, and Multiple Pain Characteristics and Symptoms. Additional relationships were observed both within and between other domains of the network. Conclusion Our analyses bolster fundamental understanding of MEP by identifying relevant mechanistic domains and elucidating biopsychosocial and interdomain relationships.
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Affiliation(s)
- Joshua A. Crow
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Verlin Joseph
- College of Population Health, The University of New Mexico, Albuquerque, NM, USA
| | - Guanhong Miao
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Burel R. Goodin
- Department of Anesthesiology, School of Medicine, Washington University, St. Louis, MO, USA
| | - Kimberly T. Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Josue Cardoso
- The Pennsylvania State University, University Park, PA, USA
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Staja Q. Booker
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:985-992. [PMID: 36944266 PMCID: PMC10391587 DOI: 10.1093/pm/pnad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. DESIGN Cross-sectional analysis of an observational study. SETTING Clinical research laboratory. SUBJECTS 226 older adults with chronic LBP. METHODS This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. RESULTS Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). CONCLUSIONS Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC 27710, United States
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE 19713, United States
- Biostatistics Core, University of Delaware, Newark, DE 19713, United States
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
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McDaniel AL, Dimitrov TN, Bruehl SP, Monroe TB, Failla MD, Cowan RL, Ryan C, Anderson AR. Psychophysics of Pain: A Methodological Introduction. Pain Manag Nurs 2023; 24:442-451. [PMID: 36948969 PMCID: PMC10440278 DOI: 10.1016/j.pmn.2023.02.006] [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: 06/28/2022] [Revised: 12/29/2022] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
For over 100 years, psychophysics ..÷ the scientific study between physical stimuli and sensation ... has been successfully employed in numerous scientific and healthcare disciplines, as an objective measure of sensory phenomena. This manuscript provides an overview of fundamental psychophysical concepts, emphasizing pain and research application..÷defining common terms, methods, and procedures.Psychophysics can provide systematic and objective measures of sensory perception that can be used by nursing scientists to explore complex, subjective phenomena..÷such as pain perception. While there needs to be improved standardization of terms and techniques, psychophysical approaches are diverse and may be tailored to address or augment current research paradigms. The interdisciplinary nature of psychophysics..÷like nursing..÷provides a unique lens for understanding how our perceptions are influenced by measurable sensations. While the quest to understand human perception is far from complete, nursing science has an opportunity to contribute to pain research by using the techniques and methods available through psychophysical procedures.
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Affiliation(s)
- Aaron L McDaniel
- From The Ohio State University College of Nursing, Columbus, Ohio.
| | | | - Stephen P Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd B Monroe
- From The Ohio State University College of Nursing, Columbus, Ohio
| | | | - Ronald L Cowan
- Department of Psychiatry, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Claire Ryan
- Vanderbilt University Medical Center, Nashville, Tennessee
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Lipat AL, Peterson JA, Murillo BC, Clark DJ, Cruz-Almeida Y. Pain severity, distribution, and duration are associated with spatiotemporal gait performance in community-dwelling older adults with chronic musculoskeletal pain. Gait Posture 2023; 103:178-183. [PMID: 37236053 DOI: 10.1016/j.gaitpost.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/05/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Our current understanding of the impact of chronic pain on spatiotemporal gait performance has mainly been achieved through comparison studies between individuals with and without chronic pain. Further investigation into the relationship between specific outcome measures of chronic pain and gait may improve our understanding of the impact of pain on gait and may benefit future interventions that aim to improve mobility in this population. RESEARCH QUESTION Which pain outcome measures are associated with spatiotemporal gait performance in older adults with chronic musculoskeletal pain? METHODS This study was secondary analysis of older adult participants enrolled in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (n = 43). Pain outcome measures were obtained using self-reported questionnaires, and spatiotemporal gait analysis was conducted using an instrumented gait mat. Separate multiple linear regressions were run to determine which pain outcome measurements were associated with gait performance. RESULTS Higher pain severities were associated with shorter stride lengths (β = -0.336, p = 0.041), shorter swing times (β = -0.345, p = 0.037), and longer double support times (β = 0.342, p = 0.034). A greater number of pain sites was associated with a wider step width (β = 0.391, p = 0.024). Longer pain durations were associated with shorter double support times (β = -0.373, p = 0.022). SIGNIFICANCE The results of our study illustrate that specific pain outcomes measures are associated with specific gait impairments in community-dwelling older adults with chronic musculoskeletal pain. As such, pain severity, number of pain sites, and pain duration should be considered when developing mobility interventions in this population to reduce disability.
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Affiliation(s)
- Ania L Lipat
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA
| | - Jessica A Peterson
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA
| | - Bryce C Murillo
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA
| | - David J Clark
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL 32603, USA; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry & Behavioral Sciences, University of Florida, Gainesville, FL 32610, USA; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL 32610, USA.
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Peterson JA, Crow JA, Johnson AJ, Meng L, Rani A, Huo Z, Foster TC, Fillingim RB, Cruz-Almeida Y. Pain interference mediates the association between epigenetic aging and grip strength in middle to older aged males and females with chronic pain. Front Aging Neurosci 2023; 15:1122364. [PMID: 37032822 PMCID: PMC10077493 DOI: 10.3389/fnagi.2023.1122364] [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: 12/13/2022] [Accepted: 02/20/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Chronic pain is one of the leading causes of disability that may accelerate biological aging and reduce physical function. Epigenetic clocks provide an estimate of how the system ages and can predict health outcomes such as physical function. Physical function declines may be attributed to decreases in muscle quality due to disuse that can be measured quickly and noninvasively using grip strength. The purpose of this study was to explore the associations among self-reported pain, grip strength, and epigenetic aging in those with chronic pain. Methods Participants (57.91 ± 8.04 years) completed pain questionnaires, a blood draw and hand grip strength task. We used an epigenetic clock previously associated with knee pain (DNAmGrimAge), and used the subsequent difference of predicted epigenetic age from chronological age (DNAmGrimAge-Difference). Results Exploratory pathway analyses revealed that pain intensity mediated the association between DNAmGrimAge-difference and handgrip strength in males only (β = -0.1115; CI [-0.2929, -0.0008]) and pain interference mediated the association between DNAmGrimAge-difference and handgrip strength in males β = -0.1401; CI [-0.3400, -0.0222]), and females (β = -0.024; CI [-0.2918, -0.0020]). Discussion Chronic knee pain may accelerate epigenetic aging processes that may influence handgrip strength in older age adults. Chronic pain could be a symptom of the aging body thus contributing to declines in musculoskeletal function in later life.
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Affiliation(s)
- Jessica A. Peterson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Joshua A. Crow
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Alisa J. Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Lingsong Meng
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Asha Rani
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Zhiguang Huo
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Thomas C. Foster
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
- Genetics and Genomics Program, University of Florida, Gainesville, FL, United States
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
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Peterson JA, Staud R, Thomas PA, Goodin BR, Fillingim RB, Cruz-Almeida Y. Self-reported pain and fatigue are associated with physical and cognitive function in middle to older-aged adults. Geriatr Nurs 2023; 50:7-14. [PMID: 36640518 PMCID: PMC10316316 DOI: 10.1016/j.gerinurse.2022.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
Persistent fatigue is often reported in those with chronic musculoskeletal pain. Separately, both chronic pain and chronic fatigue contribute to physical and cognitive decline in older adults. Concurrent pain and fatigue symptoms may increase disability and diminish quality of life, though little data exist to show this. The purpose of this study was to examine associations between self-reported pain and fatigue, both independently and combined, with cognitive and physical function in middle-older-aged adults with chronic knee pain. Using a cross-sectional study design participants (n = 206, age 58.0 ± 8.3) completed questionnaires on pain and fatigue, a physical performance battery to assess physical function, and the Montreal Cognitive Assessment. Hierarchical regressions and moderation analyses were used to assess the relationship between the variables of interest. Pain and fatigue both predicted physical function (β = -0.305, p < 0.001; β = -0.219, p = 0.003, respectively), however only pain significantly predicted cognitive function (β = -0.295, p <0.001). A centered pain*fatigue interaction was a significant predictor of both cognitive function (β = -0.137, p = 0.049) and physical function (β = -0.146, p = 0.048). These findings indicate that self-reported fatigue may contribute primarily to decline in physical function among individuals with chronic pain, and less so to decline in cognitive function. Future studies should examine the impact of both cognitive and physical function decline together on overall disability and health.
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Affiliation(s)
- Jessica A Peterson
- College of Dentistry, Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, USA; College of Dentistry, Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- College of Dentistry, Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, USA; College of Medicine, Rheumatology, University of Florida, Gainesville, FL, USA
| | - Pavithra A Thomas
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; School of Medicine, Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; School of Medicine, Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B Fillingim
- College of Dentistry, Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, USA; College of Dentistry, Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- College of Dentistry, Pain Research & Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, USA; College of Dentistry, Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA; Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
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Mickle AM, Domenico LH, Tanner JJ, Terry EL, Cardoso J, Glover TL, Booker S, Addison A, Gonzalez CE, Garvan CS, Redden D, Staud R, Goodin BR, Fillingim RB, Sibille KT. Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis. FRONTIERS IN PAIN RESEARCH 2023; 4:1058476. [PMID: 36910251 PMCID: PMC9992984 DOI: 10.3389/fpain.2023.1058476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
Background and purpose We and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain. Methods Baseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions. Results Pooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain. Conclusion The incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.
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Affiliation(s)
- Angela M. Mickle
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Lisa H. Domenico
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Jared J. Tanner
- College of Public Health and Health Professionals, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Ellen L. Terry
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Josue Cardoso
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Toni L. Glover
- School of Nursing, Oakland University, Rochester, MI, United States
| | - Staja Booker
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Adriana Addison
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cesar E. Gonzalez
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cynthia S. Garvan
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David Redden
- Department of Biostatistics, School of Public Health, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roland Staud
- College of Medicine, Department of Rheumatology, University of Florida, Gainesville, FL, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roger B. Fillingim
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Kimberly T. Sibille
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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11
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Overstreet DS, Pester BD, Wilson JM, Flowers KM, Kline NK, Meints SM. The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment. Curr Pain Headache Rep 2023; 27:1-10. [PMID: 36527589 PMCID: PMC10683048 DOI: 10.1007/s11916-022-01098-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. RECENT FINDINGS Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.
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Affiliation(s)
- Demario S Overstreet
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Bethany D Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Nora K Kline
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA.
- Harvard Medical School, Boston, MA, USA.
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12
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Lenert ME, Gomez R, Lane BT, Dailey DL, Vance CGT, Rakel BA, Crofford LJ, Sluka KA, Merriwether EN, Burton MD. Translating Outcomes from the Clinical Setting to Preclinical Models: Chronic Pain and Functionality in Chronic Musculoskeletal Pain. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1690-1707. [PMID: 35325207 PMCID: PMC9527603 DOI: 10.1093/pm/pnac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022]
Abstract
Fibromyalgia (FM) is a chronic pain disorder characterized by chronic widespread musculoskeletal pain (CWP), resting pain, movement-evoked pain (MEP), and other somatic symptoms that interfere with daily functioning and quality of life. In clinical studies, this symptomology is assessed, while preclinical models of CWP are limited to nociceptive assays. The aim of the study was to investigate the human-to-model translatability of clinical behavioral assessments for spontaneous (or resting) pain and MEP in a preclinical model of CWP. For preclinical measures, the acidic saline model of FM was used to induce widespread muscle pain in adult female mice. Two intramuscular injections of acidic or neutral pH saline were administered following baseline measures, 5 days apart. An array of adapted evoked and spontaneous pain measures and functional assays were assessed for 3 weeks. A novel paradigm for MEP assessment showed increased spontaneous pain following activity. For clinical measures, resting and movement-evoked pain and function were assessed in adult women with FM. Moreover, we assessed correlations between the preclinical model of CWP and in women with fibromyalgia to examine whether similar relationships between pain assays that comprise resting and MEP existed in both settings. For both preclinical and clinical outcomes, MEP was significantly associated with mechanical pain sensitivity. Preclinically, it is imperative to expand how the field assesses spontaneous pain and MEP when studying multi-symptom disorders like FM. Targeted pain assessments to match those performed clinically is an important aspect of improving preclinical to clinical translatability of animal models.
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Affiliation(s)
- Melissa E Lenert
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Rachelle Gomez
- Inclusive and Translational Research in Pain Lab, Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Brandon T Lane
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Dana L Dailey
- Neurobiology of Pain Lab, Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Physical Therapy, Center for Health Sciences, St. Ambrose University, Davenport, Iowa, USA
| | - Carol G T Vance
- Neurobiology of Pain Lab, Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Barbara A Rakel
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen A Sluka
- Neurobiology of Pain Lab, Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ericka N Merriwether
- Inclusive and Translational Research in Pain Lab, Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
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13
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Morais CA, DeMonte LC, Bartley EJ. Regulatory Emotional Self-Efficacy Buffers the Effect of Heart Rate Variability on Functional Capacity in Older Adults With Chronic Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:818408. [PMID: 35669039 PMCID: PMC9163301 DOI: 10.3389/fpain.2022.818408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Chronic low back pain is one of the leading causes of disability globally among older adults. Prevailing research suggests that autonomic dysregulation places individuals at increased risk for chronic pain. This study examines the moderating role of emotional self-efficacy (ESE) on the relationship between heart rate variability (HRV) and pain related-outcomes, including movement-evoked pain (MEP) and physical functioning. Methods In a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA) study, a total of 58 adults (aged 60 and older) with chronic low back pain (cLBP) completed the PROMIS self-efficacy for managing emotions questionnaire and the 6-minute walk test (6 MWT) to assess functional capacity and MEP. Heart rate variability, indexed by the frequency domain, was assessed for 5 min during rest. Results For pain-related outcomes, having a lower body mass index (p = 0.03) was associated with better functional capacity on the 6MWT, while higher education level (p = 0.01) and less pain duration (p = 0.00) were correlated with lower MEP. After controlling for sex, age, and body mass index, an increase in low-frequency HRV (LF-HRV) was associated with poorer physical functioning among individuals low in ESE (b = −0.12 p = 0.03). No significant moderation effects were observed for MEP. Conclusion Our results bring attention to the degree to which ESE influences the relationship between LF-HRV and physical functioning. Interventions that enhance adaptive psychological processes such as ESE may dampen ANS dysregulation and mitigate risk for adverse pain outcomes among older adults with cLBP.
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Affiliation(s)
- Calia A. Morais
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Calia A. Morais
| | - Lucas C. DeMonte
- Department of Counseling and Higher Education, Northern Illinois University, DeKalb, IL, United States
| | - Emily J. Bartley
- Department of Community Dentistry and Behavioral Science, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
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14
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Crow JA, Fillingim RB. Working toward mechanistic pain phenotyping in osteoarthritis. Osteoarthritis Cartilage 2022; 30:495-497. [PMID: 34875376 DOI: 10.1016/j.joca.2021.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Affiliation(s)
- J A Crow
- University of Florida Pain Research and Intervention Center of Excellence, USA
| | - R B Fillingim
- University of Florida Pain Research and Intervention Center of Excellence, USA.
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15
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Cruz-Almeida Y, Johnson A, Meng L, Sinha P, Rani A, Yoder S, Huo Z, Foster TC, Fillingim RB. Epigenetic age predictors in community-dwelling adults with high impact knee pain. Mol Pain 2022; 18:17448069221118004. [PMID: 35968561 PMCID: PMC9380216 DOI: 10.1177/17448069221118004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gerontological research reveals considerable interindividual variability in aging
phenotypes, and emerging evidence suggests that high impact chronic pain may be
associated with various accelerated biological aging processes. In particular,
epigenetic aging is a robust predictor of health-span and disability compared to
chronological age alone. The current study aimed to determine whether several
epigenetic aging biomarkers were associated with high impact chronic pain in
middle to older age adults (44–78 years old). Participants (n =
213) underwent a blood draw, demographic, psychosocial, pain and functional
assessments. We estimated five epigenetic clocks and calculated the difference
between epigenetic age and chronological age, which has been previously reported
to predict overall mortality risk, as well as included additional derived
variables of epigenetic age previously associated with pain. There were
significant differences across Pain Impact groups in three out of the five
epigenetic clocks examined (DNAmAge, DNAmPhenoAge and DNAmGrimAge), indicating
that pain-related disability during the past 6 months was associated with
markers of epigenetic aging. Only DNAmPhenoAge and DNAmGrimAge were associated
with higher knee pain intensity during the past 48 h. Finally, pain
catastrophizing, depressive symptomatology and more neuropathic pain symptoms
were significantly associated with an older epigenome in only one of the five
epigenetic clocks (i.e. DNAmGrimAge) after correcting for multiple comparisons
(corrected p’s < 0.05). Given the scant literature in
relation to epigenetic aging and the complex experience of pain, additional
research is needed to understand whether epigenetic aging may help identify
people with chronic pain at greater risk of functional decline and poorer health
outcomes.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA.,Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Alisa Johnson
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
| | - Lingsong Meng
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Puja Sinha
- Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Asha Rani
- Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Sean Yoder
- 25301Molecular Genomics Core Facility, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, 3463University of Florida, Gainesville, FL, USA
| | - Thomas C Foster
- Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Center for Cognitive Aging & Memory, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA.,Department of Neuroscience, College of Medicine, 3463University of Florida, Gainesville, FL, USA.,Age-Related Memory Loss Program, McKnight Brain Foundation, 3463University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, 3463University of Florida, Gainesville, FL, USA.,Institute on Aging, 3463University of Florida, Gainesville, FL, USA.,Department of Community Dentistry & Behavioral Science, College of Dentistry, 3463University of Florida, Gainesville, FL, USA
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16
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Disease-Specific Health Disparities: A Targeted Review Focusing on Race and Ethnicity. Healthcare (Basel) 2022; 10:healthcare10040603. [PMID: 35455781 PMCID: PMC9025451 DOI: 10.3390/healthcare10040603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Background: Wide disparities in health status exist in the United States across race and ethnicity, broadly driven by social determinants of health—most notably race and ethnic group differences in income, education, and occupational status. However, disparities in disease frequency or severity remain underappreciated for many individual diseases whose distribution in the population varies. Such information is not readily accessible, nor emphasized in treatment guidelines or reviews used by practitioners. Specifically, a summary on disease-specific evidence of disparities from population-based studies is lacking. Our goal was to summarize the published evidence for specific disease disparities in the United States so that this knowledge becomes more widely available “at the bedside”. We hope this summary stimulates health equity research at the disease level so that these disparities can be addressed effectively. Methods: A targeted literature review of disorders in Pfizer’s current pipeline was conducted. The 38 diseases included metabolic disorders, cancers, inflammatory conditions, dermatologic disorders, rare diseases, and infectious targets of vaccines under development. Online searches in Ovid and Google were performed to identify sources focused on differences in disease rates and severity between non-Hispanic Whites and Black/African Americans, and between non-Hispanic Whites and Hispanics. As a model for how this might be accomplished for all disorders, disparities in disease rates and disease severity were scored to make the results of our review most readily accessible. After primary review of each condition by one author, another undertook an independent review. Differences between reviewers were resolved through discussion. Results: For Black/African Americans, 29 of the 38 disorders revealed a robust excess in incidence, prevalence, or severity. After sickle cell anemia, the largest excesses in frequency were identified for multiple myeloma and hidradenitis suppurativa. For Hispanics, there was evidence of disparity in 19 diseases. Most notable were metabolic disorders, including non-alcoholic steatohepatitis (NASH). Conclusions: This review summarized recent disease-specific evidence of disparities based on race and ethnicity across multiple diseases, to inform clinicians and health equity research. Our findings may be well known to researchers and specialists in their respective fields but may not be common knowledge to health care providers or public health and policy institutions. Our hope is that this effort spurs research into the causes of the many disease disparities that exist in the United States.
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17
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Abstract
ABSTRACT One of the most common and nuanced tasks that nurses perform is pain assessment, particularly in acute postoperative settings where frequent reassessments are needed. Most assessments are limited to obtaining a pain intensity score with little attention paid to the conditions necessitating the assessment or the factors contributing to the pain. Pain is frequently assessed during rest, but seldom during periods of movement or activity, which is a crucial omission given that acute postoperative movement-evoked pain (MEP) is intense and a common barrier to healing and restoration of function. In addition to physical limitations, MEP can impede cognitive, emotional, and social functioning in ways that can contribute to chronic pain, mood disorders, and disability. Professional and regulatory standards are moving away from a focus on pain intensity to an emphasis on its context, impact on function, and associated distress. Thus, there are many driving forces compelling nurses to integrate MEP assessments into practice to expedite the restoration of biopsychosocial functioning in postoperative patients. The authors discuss the clinical significance of a MEP assessment as well as protocols and tools for completing such assessments.
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Affiliation(s)
- Staja Booker
- Staja Booker is an assistant professor at the University of Florida College of Nursing, Gainesville, Paul Arnstein is a clinical nurse specialist for pain relief and a Connell Scholar at Massachusetts General Hospital, Boston, and Rianne van Boekel is an assistant professor and postdoctoral researcher at Radboud University Medical Center, Nijmegan, The Netherlands. Contact author: Staja Booker, . Booker has received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR076463-01). The authors and planners have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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18
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Tanner JJ, Cardoso J, Terry EL, Booker SQ, Glover TL, Garvan C, Deshpande H, Deutsch G, Lai S, Staud R, Addison A, Redden D, Goodin BR, Price CC, Fillingim RB, Sibille KT. Chronic Pain Severity and Sociodemographics: An Evaluation of the Neurobiological Interface. THE JOURNAL OF PAIN 2022; 23:248-262. [PMID: 34425249 PMCID: PMC8828699 DOI: 10.1016/j.jpain.2021.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
Chronic pain is variably associated with brain structure. Phenotyping based on pain severity may address inconsistencies. Sociodemographic groups also differ in the experience of chronic pain severity. Whether differences by chronic pain severity and/or sociodemographic groups are indicated in pain-related areas of the brain is unknown. Relations between 2 measures of chronic pain severity and brain structure via T1-weighted MRI were investigated and sociodemographic group differences explored. The observational study included 142 community-dwelling (68 non-Hispanic Black [NHB] and 74 non-Hispanic White [NHW]) adults with/at risk for knee osteoarthritis. Relationships between chronic pain severity, sociodemographic groups, and a priori selected brain structures (postcentral gyrus, insula, medial orbitofrontal, anterior cingulate, rostral middle frontal gyrus, hippocampus, amygdala, thalamus) were explored. Chronic pain severity associated with cortical thickness. NHB participants reported lower sociodemographic protective factors and greater clinical pain compared to NHWs who reported higher sociodemographic protective factors and lower clinical pain. Greater chronic pain severity was associated with smaller amygdala volumes in the NHB group and larger amygdala volumes in the NHW group. Brain structure by chronic pain stage differed between and within sociodemographic groups. Overall, chronic pain severity and sociodemographic factors are associated with pain-related brain structures. Our findings highlight the importance of further investigating social and environmental contributions in the experience of chronic pain to unravel the complex array of factors contributing to disparities. PERSPECTIVE: The study presents data demonstrating structural brain relationships with clinical pain severity, characteristic pain intensity and chronic pain stage, differ by sociodemographic groups. Findings yield insights into potential sources of previous inconsistent pain-brain relationships and highlights the need for future investigations to address social and environmental factors in chronic pain disparities research.
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Affiliation(s)
- Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida.
| | - Josue Cardoso
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Department of Behavioral Nursing Science, University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Department of Behavioral Nursing Science, University of Florida, Gainesville, Florida
| | - Toni L Glover
- School of Nursing, Oakland University, Rochester, Michigan
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Georg Deutsch
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Adrianna Addison
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida
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19
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Leemans L, Nijs J, Antonis L, Wideman TH, Bandt HD, Franklin Z, Mullie P, Moens M, Joos E, Beckwée D. Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis. Braz J Phys Ther 2022; 26:100453. [PMID: 36279767 PMCID: PMC9597124 DOI: 10.1016/j.bjpt.2022.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. OBJECTIVES The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. METHODS For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. CONCLUSIONS Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.
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Affiliation(s)
- Lynn Leemans
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Corresponding author at: Rehabilitation Research Department and Pain in Motion International Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Medicine and Physical Therapy, University Hospital Brussels, Belgium,Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Luna Antonis
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Hester den Bandt
- Pain in Motion International Research Group, Department of Physical Therapy, Human Physiology and Anatomy, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Department of Physical Therapy, University of Applied Sciences Rotterdam, Rotterdam, the Netherlands
| | - Zoe Franklin
- Department of Sport and Exercise Sciences, Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Patrick Mullie
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium,Belgian Defense, COS Well-Being, Queen Elisabeth Barracks, Evere, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Erika Joos
- Physical Medicine & Rehabilitation Department, UZ Brussel, Brussels, Belgium
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium,Department Rehabilitation Sciences and Physical Therapy
- Research Group MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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20
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain. Clin J Pain 2021; 38:241-249. [PMID: 34954729 PMCID: PMC8917081 DOI: 10.1097/ajp.0000000000001016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to self-reported and performance-based function in older adults with CLBP. MATERIALS AND METHODS This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Self-reported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates. RESULTS MeP was present in 81.3% of participants, with an average rating of 5.09 (SD=5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores (b=-0.30, t=-2.81, P=0.005) and poorer TUG performance (b=0.081, t=2.35, P=0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P>0.05). DISCUSSION Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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21
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Johnson AJ, Laffitte Nodarse C, Peraza JA, Valdes-Hernandez PA, Montesino-Goicolea S, Huo Z, Fillingim RB, Cruz-Almeida Y. Psychological profiles in adults with knee OA-related pain: a replication study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211059614. [PMID: 34900003 PMCID: PMC8664321 DOI: 10.1177/1759720x211059614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Psychological factors have been associated with knee osteoarthritis pain severity and treatment outcomes, yet their combined contribution to phenotypic heterogeneity is poorly understood. In particular, empirically derived psychological profiles must be replicated before they can be targeted or considered for treatment studies. The objectives of this study were to (1) confirm previously identified psychological profiles using unsupervised clustering methods in persons with knee osteoarthritis pain, (2) determine the replicability of profiles using supervised machine learning in a different sample, and (3) examine associations with clinical pain, brain structure, and experimental pain. Methods Participants included two cohorts of individuals with knee osteoarthritis pain recruited as part of the multisite UPLOAD1 (n = 270, mean age = 56.8 ± 7.6, male = 37%) and UPLOAD2 (n = 164, mean age = 57.73 ± 7.8, male = 36%) studies. Similar psychological constructs (e.g. optimism, coping, somatization, affect, depression, and anxiety), sociodemographic and clinical characteristics, and somatosensory function were assessed across samples. UPLOAD2 participants also completed brain magnetic resonance imaging. Unsupervised hierarchical clustering analysis was first conducted in UPLOAD1 data to derive clusters, followed by supervised linear discriminative analysis to predict group membership in UPLOAD2 data. Associations among cluster membership and clinical variables were assessed, controlling for age, sex, education, ethnicity/race, study site, and number of pain sites. Results Four distinct profiles emerged in UPLOAD1 and were replicated in UPLOAD2. Identified psychological profiles were associated with psychological variables (ps < 0.001), and clinical outcomes (ps = 0.001-0.03), indicating good internal and external validation of the cluster solution. Significant associations between psychological profiles and somatosensory function and brain structure were also found. Conclusions This study highlights the importance of considering the biopsychosocial model in knee osteoarthritis pain assessment and treatment.
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Affiliation(s)
- Alisa J Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | - Julio A Peraza
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | | | | | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, PO Box 103628, 1329 SW 16th Street, Ste 5180, Gainesville, FL 32610, USA
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22
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Booker SQ, Bartley EJ, Powell-Roach K, Palit S, Morais C, Thompson OJ, Cruz-Almeida Y, Fillingim RB. The Imperative for Racial Equality in Pain Science: A Way Forward. THE JOURNAL OF PAIN 2021; 22:1578-1585. [PMID: 34214701 PMCID: PMC9133713 DOI: 10.1016/j.jpain.2021.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022]
Abstract
Racial equity is imperative to the future and integrity of scientific inquiry. In 2020, citizens of the United States (and globally) witnessed one of the most vile and egregious experiences of police brutality and systemic racism in recent history, the public execution of a Black American man. While some may isolate this and other similar events from influencing the scientific endeavors of pain researchers, events such as this can have a direct impact on the study, lived experience, and expression of pain in Black Americans. To truly understand the biopsychosocial effects of inequality and injustice on pain disparities, we must consider the unintended consequences that our current research approaches have in limiting the reliability and validity of scientific discovery. As we reflect on our current research practices in an effort to improve pain science, this perspective article discusses ways to initiate positive change in order to advance the science of pain in more equitable ways, not just for Black Americans, but for all individuals that identify as part of an underrepresented group. PERSPECTIVE: Elimination of inequities in pain care and research requires the identification, naming, and mitigation of systemic discriminatory and biased practices that limit our understanding of pain disparities. Now is the time to divest from traditional research methods and invest in equitable and innovative approaches to support pain researchers in advancing the science and improving the lives of people with pain.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida.
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Keesha Powell-Roach
- College of Nursing, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Shreela Palit
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Calia Morais
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Osheeca J Thompson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
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23
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Study Protocol Modeling Evoked Pain in Older African Americans With Knee Osteoarthritis. Nurs Res 2021; 70:391-398. [PMID: 33951704 DOI: 10.1097/nnr.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African American (AA) older adults with knee osteoarthritis experience more severe chronic pain and advanced physical disability. One of the most prominent stimuli that provokes knee pain is movement. Research suggests that, compared to Whites, AAs report significantly higher movement-evoked pain (MEP) in the knee. However, little is known about the biopsychosocial-behavioral mechanisms underlying MEP. OBJECTIVES The aim of the study was to present a study protocol to (a) characterize the biopsychosocial-behavioral mechanisms that predict MEP in AAs with knee osteoarthritis and (b) develop a targeted, mechanism-based self-management intervention to reduce MEP and maximize movement. METHODS An observational, mixed-methods cohort study will enroll 90 AA/Black adults (ages 55-90 years) to understand intraindividual and interindividual effects on MEP. Participants will complete assessments of MEP, function and gait, biopsychosocial-behavioral questionnaires, quantitative sensory testing, and 7-day ecological momentary assessments of pain and related symptoms. For the qualitative phase, focus groups will be conducted to co-construct a mechanism-based pain self-management intervention. RESULTS We will develop phenotypes of MEP based on biopsychosocial-behavioral predictors and correlate measures of MEP with function. Our central hypothesis is that higher levels of MEP will predict lower self-reported function and poorer performance on functional tasks and that multiple biopsychosocial and behavioral factors will be associated with MEP and function. Predictors may serve as risk or protective factors for MEP and physical function. In targeting the biopsychosocial-behavioral mechanisms of MEP, we anticipate that older AAs may request that intervention components include culturally tailored self-management education, movement/physical activity training, treatment decision-making skills, coaching, spirituality, and social/kinship support. CONCLUSION Osteoarthritis is now the single most common cause of disability, mobility limitations, and persistent pain in older adults-especially AA older adults. To our knowledge, this will be the first study to systematically phenotype MEP in an older racial minority population with knee osteoarthritis and will be relevant for reducing knee pain and improving function.
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24
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Patel M, Johnson AJ, Booker SQ, Bartley EJ, Palit S, Powell-Roach K, Terry EL, Fullwood D, DeMonte L, Mickle AM, Sibille KT. Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2021; 23:25-44. [PMID: 34280570 DOI: 10.1016/j.jpain.2021.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Disparities in the experience of chronic musculoskeletal pain in the United States stem from a confluence of a broad array of factors. Organized within the National Institute on Aging Health Disparity Research Framework, a literature review was completed to evaluate what is known and what is needed to move chronic musculoskeletal pain research forward specific to disproportionately affected populations. Peer-reviewed studies published in English, on human adults, from 2000 to 2019, and conducted in the United States were extracted from PubMed and Web of Science. Articles were reviewed for key words that focused on underrepresented ethnic/race groups with chronic musculoskeletal pain applying health factor terms identified in the NIAHealth Disparity Research Framework four levels of analysis: 1) environmental, 2) sociocultural, 3) behavioral, and 4) biological. A total of 52 articles met inclusion criteria. There were limited publications specific to underrepresented ethnic/race groups with chronic musculoskeletal pain across all levels with particular research gaps under sociocultural and biological categories. Current limitations in evidence may be supplemented by a foundation of findings specific to the broader topic of "chronic pain" which provides guidance for future investigations. Study designs including a focus on protective factors and multiple levels of analyses would be particularly meritorious. PERSPECTIVE: Chronic musculoskeletal pain unequally burdens underrepresented ethnic/race groups. In order to move research forward and to systematically investigate the complex array of factors contributing toward health disparities, an organized approach is necessary. Applying the NIA Health Disparities Research Framework, an overview of the current state of evidence specific to chronic musculoskeletal pain and underrepresented ethnic/race groups is provided with future directions identified.
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Affiliation(s)
- Monika Patel
- Department of Anesthesiology, Division of Pain Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida
| | - Alisa J Johnson
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Dottington Fullwood
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida
| | - Lucas DeMonte
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Angela M Mickle
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida; Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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25
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Johnson AJ, Vasilopoulos T, Booker SQ, Cardoso J, Terry EL, Powell-Roach K, Staud R, Kusko DA, Addison AS, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:415. [PMID: 33952243 PMCID: PMC8101224 DOI: 10.1186/s12891-021-04284-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Pain is the hallmark symptom of knee osteoarthritis (OA), and varies widely across individuals. Previous research has demonstrated both fluctuating and stable pain trajectories in knee OA using various time periods. Changes in pain assessed quarterly (i.e. 3-month intervals) in knee OA are relatively unknown. The current study aimed to investigate temporal variations in pain over a one and a half year period (18 months) based on quarterly characteristic pain assessments, and to examine differences in pain patterns by sociodemographic and baseline pain characteristics. METHODS The sample included a prospective cohort of 188 participants (mean age 58 years; 63% female; 52% non-Hispanic Black) with or at risk for knee OA from an ongoing multisite investigation of ethnic/race group differences. Knee pain intensity was self-reported at baseline and quarterly over an18-month period. Baseline pain assessment also included frequency, duration, and total number of pain sites. Group-based trajectory modeling was used to identify distinct pain trajectories. Multinomial logistic regression was used to examine associations between sociodemographic characteristics, risk factors, and pain trajectory groups. RESULTS Pain trajectories were relatively stable among a sample of adults with knee pain. Four distinct pain trajectories emerged in the overall sample, with the largest proportion of participants (35.1%) classified in the moderate-high pain group. There were significant relationships between age, education, income, ethnicity/race and trajectory group; with younger, less educated, lower income, and non-Hispanic Black participants had a greater representation in the highest pain trajectory group. CONCLUSIONS Pain remained stable across a one and a half-year period in adults with or at risk for knee osteoarthritis, based on quarterly assessments. Certain sociodemographic variables (e.g. ethnicity/race, education, income, age) may contribute to an increased risk of experiencing greater pain.
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Affiliation(s)
- Alisa J. Johnson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Staja Q. Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Josue Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
| | - Ellen L. Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Daniel A. Kusko
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Adriana S. Addison
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - David T. Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Aging & Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL USA
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26
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Nishigami T, Tanaka S, Mibu A, Imai R, Wand BM. Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. Sci Rep 2021; 11:5835. [PMID: 33712725 PMCID: PMC7970993 DOI: 10.1038/s41598-021-85307-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to explore the existence of subgroups in a cohort of people with knee osteoarthritis (OA) based upon data from multiple pain-related variables and to profile identified clusters according to levels of pain intensity and knee-related disability. Three hundred and three people with knee OA were recruited. Latent profile analysis was used to confirm the optimal number of knee OA subgroups. Body mass index, radiographic knee OA severity, pain catastrophizing, pain related self-efficacy, and knee specific self-perception, were incorporated into the model. Cluster, demographic and clinical variables were compared between the resulting classes. Four distinct classes were identified. Cluster 1 (28.7%) represented early radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 2 (18.8%) showed advanced radiographic OA, and moderate pain intensity, disability and cognitive and perceptual dysfunction. Cluster 3 (34.3%) represented various levels of radiographic OA, and the lowest pain intensity, disability and cognitive and perceptual dysfunction. Cluster 4 (18.1%) represented various levels of radiographic OA, the highest disability and cognitive and perceptual dysfunction. Considering cognitive factors and disturbed body perception may help to explain the phenomenon of the discrepancy between the knee-related disability and the severity of radiographic knee OA.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1 Gakuen-tyou, Mihara, Hiroshima, 723-0053, Japan.
| | - So Tanaka
- Department of Rehabilitation, Fukuoka Orthopaedic Hospital, 2-10-50 Yanagikawachi, Minami-ku, Fukuoka, Fukuoka, 815-0063, Japan
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, 6-2-23 Morikita-machi, Higashinada-ku, Kobe, Hyogo, 658-0001, Japan
| | - Ryota Imai
- School of Rehabilitation, Osaka Kawasaki Rehabilitation University, 158 Mizuma, Kaizuka, Osaka, 597-0104, Japan
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, 32 Mouat St, Fremantle, WA, 6160, Australia
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27
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Morais CA, Fullwood D, Palit S, Fillingim RB, Robinson ME, Bartley EJ. Race Differences in Resilience Among Older Adults with Chronic Low Back Pain. J Pain Res 2021; 14:653-663. [PMID: 33727859 PMCID: PMC7955726 DOI: 10.2147/jpr.s293119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Racial minorities are disproportionally affected by pain. Compared to non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs) report higher pain intensity, greater pain-related disability, and higher levels of mood disturbance. While risk factors contribute to these disparities, little is known regarding how sources of resilience influence these differences, despite the growing body of research supporting the protective role of resilience in pain and disability among older adults with chronic pain. The current study examined the association between psychological resilience and pain, and the moderating role of race across these relationships in older adults with chronic low back pain (cLBP). Methods This is a secondary analysis of the Adaptability and Resilience in Aging Adults (ARIAA). Participants completed measures of resilience (ie, gratitude, trait resilience, emotional support), as well as a performance-based measure assessing lower-extremity function and movement-evoked pain. Results There were 45 participants that identified as non-Hispanic White (NHW) and 15 participants that identified as non-Hispanic Black (NHB). Race was a significant correlate of pain outcomes with NHBs reporting greater movement-evoked pain (r = 0.27) than NHWs. After controlling for relevant sociodemographic characteristics, measures of movement-evoked pain were similar across both racial groups, F (1, 48) = 0.31, p = 0.57. Moderation analyses revealed that higher levels of gratitude (b = −1.23, p = 0.02) and trait resilience (b = −10.99, p = 0.02) were protective against movement-evoked pain in NHWs. In contrast, higher levels of gratitude were associated with lower functional performance in NHBs (b = −0.13, p =0.02). Discussion These findings highlight racial differences in the relationship between resilience and pain-related outcomes among older adults with cLBP. Future studies should examine the potential benefits of targeted interventions that improve resilience and ameliorate pain disparities among racial minorities.
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Affiliation(s)
- Calia A Morais
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Dottington Fullwood
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
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28
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Tanner JJ, Johnson AJ, Terry EL, Cardoso J, Garvan C, Staud R, Deutsch G, Deshpande H, Lai S, Addison A, Redden D, Goodin BR, Price CC, Fillingim RB, Sibille KT. Resilience, pain, and the brain: Relationships differ by sociodemographics. J Neurosci Res 2021; 99:1207-1235. [PMID: 33606287 DOI: 10.1002/jnr.24790] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/23/2020] [Accepted: 01/03/2021] [Indexed: 12/22/2022]
Abstract
Chronic musculoskeletal (MSK) pain is disabling to individuals and burdensome to society. A relationship between telomere length and resilience was reported in individuals with consideration for chronic pain intensity. While chronic pain associates with brain changes, little is known regarding the neurobiological interface of resilience. In a group of individuals with chronic MSK pain, we examined the relationships between a previously investigated resilience index, clinical pain and functioning measures, and pain-related brain structures, with consideration for sex and ethnicity/race. A cross-sectional analysis of 166 non-Hispanic Black and non-Hispanic White adults, 45-85 years of age with pain ≥ 1 body site (s) over the past 3 months was completed. Measures of clinical pain and functioning, biobehavioral and psychosocial resilience, and structural MRI were completed. Our findings indicate higher levels of resilience associate with lower levels of clinical pain and functional limitations. Significant associations between resilience, ethnicity/race, and/or sex, and pain-related brain gray matter structure were demonstrated in the right amygdaloid complex, bilateral thalamus, and postcentral gyrus. Our findings provide compelling evidence that in order to decipher the neurobiological code of chronic pain and related protective factors, it will be important to improve how chronic pain is phenotyped; to include an equal representation of females in studies including analyses stratifying by sex, and to consider other sociodemographic factors.
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Affiliation(s)
- Jared J Tanner
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Alisa J Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Ellen L Terry
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Josue Cardoso
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Georg Deutsch
- Department of Radiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA.,Department of Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA
| | - Song Lai
- Department of Radiation Oncology & CTSI Human Imaging Core, University of Florida, Gainesville, FL, USA
| | - Adriana Addison
- Department of Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, University of Alabama, Birmingham Medical Center, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Aging and Geriatric Research, College of Medicine, UF Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Booker SQ, Herr KA, Horgas AL. A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers. Pain Manag Nurs 2021; 22:21-27. [PMID: 32948452 PMCID: PMC7886935 DOI: 10.1016/j.pmn.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest. OBJECTIVE The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, University of Florida, Gainesville, Florida.
| | - Keela A Herr
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Ann L Horgas
- College of Nursing, University of Florida, Gainesville, Florida
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Fullwood D, Means S, Merriwether EN, Chimenti RL, Ahluwalia S, Booker SQ. Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review. Clin J Pain 2021; 37:61-78. [PMID: 33093342 PMCID: PMC7708514 DOI: 10.1097/ajp.0000000000000891] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Individuals with chronic pain conditions often report movement as exacerbating pain. An increasing number of researchers and clinicians have recognized the importance of measuring and distinguishing between movement-evoked pain (MEP) and pain at rest as an outcome. This scoping review maps the literature and describes MEP measurement techniques. MATERIALS AND METHODS The scoping review utilized 6 databases to identify original studies that targeted pain or movement-related outcomes. Our search returned 7322 articles that were screened by title and abstract by 2 reviewers. The inclusion criteria focused on the measurement of MEP before, during, and after movement tasks in adults with chronic pain. Studies of children below 18 years of age or with nonhuman animals, case studies, qualitative studies, book chapters, cancer-related pain, non-English language, and abstracts with no full publish text were excluded from the study. RESULTS Results from 38 studies revealed great variation in the measurement of MEP, while almost all of the studies did not provide an explicit conceptual or operational definition for MEP. In addition, studies collectively illuminated differences in MEP compared with rest pain, movement provocation methods, and pain intensity as the primary outcome. DISCUSSION These results have clinically significant and research implications. To advance the study of MEP, we offer that consistent terminology, standardized measurement (appropriate for pain type/population), and clear methodological processes be provided in research publications. On the basis of the findings, we have put forth a preliminary definition of MEP that may benefit from the continued scholarly dialog.
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Affiliation(s)
- Dottington Fullwood
- Department of Aging and Geriatric Research, College of Medicine, The University of Florida, Gainesville, FL 32610
| | - Sydney Means
- Department of Aging and Geriatric Research, College of Medicine, The University of Florida, Gainesville, FL 32610
| | - Ericka N. Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10010
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, The University of Iowa, Iowa City, IA 52242
| | - Simar Ahluwalia
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10010
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, College of Nursing, The University of Florida, Gainesville, FL 32610
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31
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Mickle AM, Garvan C, Service C, Pop R, Marks J, Wu S, Edberg JC, Staud R, Fillingim RB, Bartley EJ, Sibille KT. Relationships Between Pain, Life Stress, Sociodemographics, and Cortisol: Contributions of Pain Intensity and Financial Satisfaction. CHRONIC STRESS 2020; 4:2470547020975758. [PMID: 33403312 PMCID: PMC7745543 DOI: 10.1177/2470547020975758] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022]
Abstract
Objective The relationship between psychosocial stress and chronic pain is bidirectional. An improved understanding regarding the relationships among chronic pain, life stress, and ethnicity/race will inform identification of factors contributing to health disparities in chronic pain and improve health outcomes. This study aims to assess relationships between measures of clinical pain, life stress, sociodemographics, and salivary cortisol levels. Methods A cross-sectional analysis involving data from 105 non-Hispanic White (NHW) and non-Hispanic Black (NHB) participants aged 45–85 years old with or at risk for knee osteoarthritis. Data included sociodemographics, clinical pain, psychosocial stress, and salivary cortisol across five time points over an approximate 12-hour period. Non-parametric correlation analysis, sociodemographic group comparisons, and regression analyses were performed. Results Clinical pain and psychosocial stress were associated with salivary cortisol levels, particularly morning waking and the evening to morning awakening slope. With the inclusion of recognized explanatory variables, the Graded Chronic Pain Scale characteristic pain intensity and financial satisfaction were identified as the primary pain and psychosocial measures associated with cortisol levels. Sociodemographic group differences were indicated such that NHB participants reported higher pain-related disability, higher levels of discrimination, lower financial and material satisfaction, and showed higher evening salivary cortisol levels compared to NHW participants. In combined pain and psychosocial stress analyses, greater financial satisfaction, lower pain intensity, and lower depression were associated with higher morning waking saliva cortisol levels while greater financial satisfaction was the only variable associated with greater evening to morning awakening slope. Conclusion Our findings show relationships among clinical pain, psychosocial stress, sociodemographic factors, and salivary cortisol levels. Importantly, with inclusion of recognized explanatory variables, financial satisfaction remained the primary factor accounting for differences in morning waking cortisol and evening to morning awakening cortisol slope in an ethnic/racially diverse group of middle aged and older adults with or at risk for knee osteoarthritis.
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Affiliation(s)
- Angela M Mickle
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community of Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Chelsea Service
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Ralisa Pop
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - John Marks
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Stanley Wu
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Jeffrey C Edberg
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland Staud
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community of Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Aging & Geriatric Research, University of Florida, Gainesville, FL, USA
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Chao YY, Zha P, Yang K, Dong X. Association between physical function and perceived stress among U.S. Chinese older adults. AMERICAN JOURNAL OF AGING SCIENCE AND RESEARCH 2020; 1:12-19. [PMID: 33135012 PMCID: PMC7595296 DOI: 10.46439/aging.1.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Physical function impairment can cause great stress to older adults.
The purpose of the study is to investigate the association between
self-reported and directly-observed physical function on perceived stress
among U.S. Chinese older adults. Methods Data were from the Population Study of Chinese Elderly in Chicago
(PINE) of 3,157 Chinese older adults who were 60 and above in the Greater
Chicago Area. Self-reported and directly-observed physical function
measures, and Perceived Stress Scale were used. Results Participants had a mean age of 72.8 ± 8.3 years old (range
60–105). Higher scores of Katz activities of daily living impairments
(odds ratio [OR]=1.77), Lawton instrumental activities of daily living
impartments (OR=1.10, p<0.01), Rosow–Breslau
index of mobility scale (OR=1.39, p<0.05), and Nagi
index of basic physical activities scale (OR=1.19,
p<0.001) were associated with higher levels of
perceived stress. In addition, higher scores of directly-observed physical
function measurements, including chair stand (OR=0.93), tandem stand
(OR=0.71, p<0.05), timed walk (OR=0.73,
p<0.001), and the overall measurement (OR= 0.87,
p<0.01) were associated with lower level of
perceived stress. Discussion Findings suggested that poor physical function was associated with
perceived stress among U.S. Chinese older adults. Longitudinal studies are
needed to obtain a more comprehensive understanding of the pathways between
physical function and perceived stress. Implications for practice Health care professionals could provide personalized physical
activity interventions to encourage older adults to engage in regular
exercise in order to maintain and promote older adults’ physical
function and psychological well-being.
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Affiliation(s)
- Ying-Yu Chao
- Clinical Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Peijia Zha
- Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Kyeongra Yang
- Associate Professor, Rutgers, the State University of New Jersey, School of Nursing, 65 Bergen Street, Room 1025E, Newark, NJ 07107, USA
| | - XinQi Dong
- Director, Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St, New Brunswick, NJ, 08901, USA
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Callahan LF, Cleveland RJ, Allen KD, Golightly Y. Racial/Ethnic, Socioeconomic, and Geographic Disparities in the Epidemiology of Knee and Hip Osteoarthritis. Rheum Dis Clin North Am 2020; 47:1-20. [PMID: 34042049 DOI: 10.1016/j.rdc.2020.09.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
It is estimated that 32.5 million US adults have clinical osteoarthritis (OA), with the most common sites being knee and hip. OA is associated with substantial individual and societal costs. Race/ethnicity, socioeconomic status (SES), and geographic variations in the prevalence of knee and hip OA are well established around the world. In addition, clinical outcomes associated with hip and knee OA differ according to race/ethnicity, SES, and geography. This variation is likely multifactorial and may also reflect country-specific differences in health care systems. The interplay between different factors, such as geography, SES, and race/ethnicity, is difficult to study.
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Affiliation(s)
- Leigh F Callahan
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA.
| | - Rebecca J Cleveland
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA
| | - Kelli D Allen
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA; Center of Innovation to Accelerate Discovery and Practice Transformation, VA Healthcare System, Durham, NC, USA
| | - Yvonne Golightly
- School of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599-7280, USA
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Pain relief for osteoarthritis through combined treatment (PROACT): Protocol for a randomized controlled trial of mindfulness meditation combined with transcranial direct current stimulation in non-Hispanic black and white adults with knee osteoarthritis. Contemp Clin Trials 2020; 98:106159. [PMID: 32992020 DOI: 10.1016/j.cct.2020.106159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
Knee osteoarthritis (OA) is a leading cause of late life pain and disability, and non-Hispanic black (NHB) adults experience greater OA-related pain and disability than non-Hispanic whites (NHWs). Recent evidence implicates psychosocial stress, cognitive-attentional processes, and altered central pain processing as contributors to greater OA-related pain and disability among NHBs. To address these ethnic/race disparities, this clinical trial will test whether a mindfulness intervention (Breathing and Attention Training, BAT) combined with transcranial direct current stimulation (tDCS) will enhance pain modulatory balance and pain-related brain function, reduce clinical pain, and attenuate ethnic differences therein, among NHBs and NHWs with knee OA. Participants will complete assessments of clinical pain, function, psychosocial measures, and quantitative sensory testing (QST), including mechanical temporal summation and conditioned pain modulation. Neuroimaging will be performed to examine pain-related brain structure and function. Then, participants will be randomized to one of four groups created by crossing two BAT conditions (Real vs. Sham) with two tDCS conditions (Real vs. Sham). Participants will then undergo five treatment sessions during which the assigned BAT and tDCS interventions will be delivered concurrently for 20 min over one week. After the fifth intervention session, participants will undergo assessments of clinical pain and function, QST and neuroimaging identical to the pretreatment measures, and monthly follow-up assessments of pain will be conducted for three months. This will be the first study to determine whether mindfulness and tDCS treatments will show additive or synergistic effects when combined, and whether treatment effects differ across ethnic/race groups.
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Vinstrup J, Jakobsen MD, Andersen LL. Perceived Stress and Low-Back Pain Among Healthcare Workers: A Multi-Center Prospective Cohort Study. Front Public Health 2020; 8:297. [PMID: 32850571 PMCID: PMC7431956 DOI: 10.3389/fpubh.2020.00297] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/04/2020] [Indexed: 01/23/2023] Open
Abstract
Objective: This study aimed to investigate the association between perceived stress and odds of low-back pain (LBP) in a population of Danish healthcare workers. Methods: Utilizing a prospective cohort design with 1-year follow-up, a total of 1,944 healthcare workers from 389 departments at 19 hospitals responded to questionnaires containing items related to lifestyle, health, and working environment. Using Cohen's Perceived Stress Scale, associations between baseline stress levels and LBP intensity (0–10 scale) at follow-up were modeled using cumulative logistic regression, accounting for clustering at the department level and adjusting for age, sex, baseline intensity of LBP, education, seniority, number of daily patient transfers, psychosocial work environment, and lifestyle factors. Results: For the entire population, moderate and high stress (reference: low stress) at baseline increased the odds of LBP at 1-year follow-up with odds ratios (ORs) of 1.39 (95% CI 1.13–1.71) and 1.99 (95% CI 1.49–2.66), respectively. Sensitivity analyses among female nurses showed similar results [i.e., OR 1.40 (95% CI 1.08–1.80) and OR 2.08 (95% CI 1.44–3.00) for moderate and high stress, respectively], while only high stress significantly increased the odds among those without LBP at baseline. Conclusions: Psychological stress increases the odds of LBP among healthcare workers. Identifying and diminishing work-related psychosocial stressors should be included in strategies that aim to prevent musculoskeletal disorders in this population.
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Affiliation(s)
- Jonas Vinstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
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36
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Johnson AJ, Sibille KT, Cardoso J, Terry EL, Powell-Roach KL, Goodin B, Staud R, Redden D, Fillingim RB, Booker SQ. Patterns and Correlates of Self-Management Strategies for Osteoarthritis-Related Pain Among Older Non-Hispanic Black and Non-Hispanic White Adults. Arthritis Care Res (Hoboken) 2020; 73:1648-1658. [PMID: 32741127 DOI: 10.1002/acr.24396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black patients (NHB) and non-Hispanic White patients (NHW) older adults with or at risk for knee OA. METHODS A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease multisite observational study, which included NHB (n = 104) and NHW (n = 98) community-dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain. RESULTS Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed that clinical and experimental pain indices, as well as coping, number of pain sites, age, and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race by type of pain management interaction effects for pain measures. CONCLUSION SM is common among older adults with or at risk for knee OA pain, and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM, highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.
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37
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Booker SQ, Herr K, Fillingim RB. The Reciprocal Relationship of Pain and Movement in African American Older Adults With Multi-Joint Osteoarthritis. Res Gerontol Nurs 2019; 13:1-11. [PMID: 31834412 DOI: 10.3928/19404921-20191202-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
Pain with movement is a common issue for older adults with osteoarthritis; however, there has been insufficient attention within populations at increased risk for disabling pain, such as African American older adults. Accordingly, using a mixed methods approach, the purpose of the current study is to describe the nature of chronic joint pain and movement and its impact on physical function in African American older adults with symptomatic osteoarthritis. The authors accrued a sample of 110 African American older adults who completed cross-sectional surveys; from this sample, the authors interviewed 18 participants. Findings suggest that patterns of movement are uniquely influenced by pain. Specifically, three dynamic themes emerged: The Impact of Pain on Movement; The Importance and Impact of Movement on Pain; and The Adaptation of Personal Behaviors to Minimize Pain With Movement. Function-focused nursing care rests on addressing challenges and opportunities that African American older adults face in maintaining healthy movement when managing osteoarthritis pain. [Research in Gerontological Nursing, xx(x), xx-xx.].
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