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Merriwether EN, Vanegas SM, Curado S, Zhou B, Mun CJ, Younger OS, Elbel B, Parikh M, Jay M. Changes in widespread pain after surgical weight loss in racialized adults: A secondary analysis from a two-year longitudinal study. THE JOURNAL OF PAIN 2024:104625. [PMID: 39002743 DOI: 10.1016/j.jpain.2024.104625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
Widespread pain is associated with reduced function and disability. Importantly, three-fourths of the approximately 42% of U.S. adults with obesity have widespread pain. Moreover, rates of adult obesity are higher and widespread outcomes are worse in racialized non-Hispanic Black and Hispanic/Latino/a/X groups, potentially exacerbating existing pain disparities. Bariatric surgery significantly reduces weight and improves pain. However, recurrent or unresolved pain after bariatric surgery can hinder weight loss or facilitate weight regain. The current study conducted a secondary analysis of a longitudinal study of predictors and mechanisms of weight loss after bariatric surgery to examine the point prevalence of widespread pain and pain trajectories 24 months post-surgery. Our secondary aim was to examine the association between weight loss and pain characteristics. Our exploratory aim was to longitudinally examine racial differences in pain trajectories after bariatric surgery. Our results showed that point prevalence decreased after bariatric surgery. Additionally, significant improvements in pain trajectories occurred within the first 3 months post-surgery with a pattern of pain reemergence beginning at 12 months post-surgery. Hispanic/Latino/a/X participants reported a higher number of painful anatomical sites before bariatric surgery, and the rate of change in this domain for this group was faster compared to the racialized non-Hispanic Black participants. These findings suggest that pain improvements are most evident during the early stages of surgical weight loss in racialized populations of adults with widespread pain. Thus, clinicians should routinely monitor patients' weight changes after bariatric surgery as they are likely to correspond to changes in their pain experiences. PERSPECTIVE: This article presents the prevalence and pain trajectories of racialized adults with widespread pain (WP) after surgical weight loss. Clinicians should evaluate changes in the magnitude and spatial distribution of pain after significant weight change in these populations so pain interventions can be prescribed with greater precision.
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Affiliation(s)
- Ericka N Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Education, Culture, and Human Development, New York University, New York, NY, USA; Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA.
| | - Sally M Vanegas
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Silvia Curado
- Department of Pathology, NYU Grossman School of Medicine, New York University, New York, NY, USA; Department of Cell Biology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Boyan Zhou
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Olivia S Younger
- Department of Physical Therapy, NYU Steinhardt School of Education, Culture, and Human Development, New York University, New York, NY, USA
| | - Brian Elbel
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA; NYU Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Manish Parikh
- Department of Surgery, NYU Grossman School of Medicine, New York University, New York, NY, USA; New York City Health and Hospitals/Bellevue Hospital Center, New York, NY, USA
| | - Melanie Jay
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA; New York Harbor Veterans Affairs, New York, NY, USA
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Fritz JM, Ford I, George SZ, Vinci de Vanegas L, Cope T, Burke CA, Goode AP. Telehealth delivery of physical therapist-led interventions for persons with chronic low back pain in underserved communities: lessons from pragmatic clinical trials. FRONTIERS IN PAIN RESEARCH 2024; 5:1324096. [PMID: 38706872 PMCID: PMC11066221 DOI: 10.3389/fpain.2024.1324096] [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: 10/18/2023] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
In this perspective, we present our experience developing and conducting two pragmatic clinical trials investigating physical therapist-led telehealth strategies for persons with chronic low back pain. Both trials, the BeatPain Utah and AIM-Back trials, are part of pragmatic clinical trial collaboratories and are being conducted with persons from communities that experience pain management disparities. Practice guidelines recommend nonpharmacologic care, and advise against opioid therapy, for the primary care management of persons with chronic low back pain. Gaps between these recommendations and actual practice patterns are pervasive, particularly for persons from racial or ethnic minoritized communities, those with fewer economic resources, and those living in rural areas including Veterans. Access barriers to evidence-based nonpharmacologic care, which is often provided by physical therapists, have contributed to these evidence-practice gaps. Telehealth delivery has created new opportunities to overcome access barriers for nonpharmacologic pain care. As a relatively new delivery mode however, telehealth delivery of physical therapy comes with additional challenges related to technology, intervention adaptations and cultural competence. The purpose of this article is to describe the challenges encountered when implementing telehealth physical therapy programs for persons with chronic low back pain in historically underserved communities. We also discuss strategies developed to overcome barriers in an effort to improve access to telehealth physical therapy and reduce pain management disparities. Inclusion of diverse and under-represented communities in pragmatic clinical trials is a critical consideration for improving disparities, but the unique circumstances present in these communities must be considered when developing implementation strategies.
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Affiliation(s)
- Julie M. Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Laura Vinci de Vanegas
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Tyler Cope
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Colleen A. Burke
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
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Fritz JM, Gibson B, Wetter DW, Del Fiol G, Solis V, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. Implement Sci Commun 2024; 5:3. [PMID: 38183154 PMCID: PMC10768478 DOI: 10.1186/s43058-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. METHODS During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. RESULTS CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. CONCLUSIONS Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04923334 . Registered June 11, 2021.
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Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA.
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Victor Solis
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
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Milani SA, Sanchez C, Kuo YF, Downer B, Al Snih S, Markides KS, Raji M. Pain and incident cognitive impairment in very old Mexican American adults. J Am Geriatr Soc 2024; 72:226-235. [PMID: 37794825 PMCID: PMC10842321 DOI: 10.1111/jgs.18618] [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: 03/10/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. METHODS Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). RESULTS Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. CONCLUSIONS Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.
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Affiliation(s)
| | - Claudia Sanchez
- John Sealy School of Medicine, University of Texas Medical Branch
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, University of Texas Medical Branch
| | - Brian Downer
- Department of Population Health & Health Disparities, University of Texas Medical Branch
| | - Soham Al Snih
- Department of Population Health & Health Disparities, University of Texas Medical Branch
| | - Kyriakos S. Markides
- Department of Population Health & Health Disparities, University of Texas Medical Branch
| | - Mukaila Raji
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch
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Fritz JM, Gibson B, Wetter DW, Fiol GD, Solis VH, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. RESEARCH SQUARE 2023:rs.3.rs-3267087. [PMID: 37790359 PMCID: PMC10543377 DOI: 10.21203/rs.3.rs-3267087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes. Results CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial registration Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334.
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Suarez ML, Angulo R, Suarez AJ, Fullwood D, Allen J, Stern MC, Flores-Rozas H, Wilkie DJ. Cognitive Testing of PAIN Report It-Spanish in Monolingual Hispanic Adults. Cancer Nurs 2023; 46:364-374. [PMID: 37607372 PMCID: PMC10232677 DOI: 10.1097/ncc.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A Spanish language computerized tool would facilitate cancer pain assessment and management for the underserved population of native Spanish speakers who do not speak or lack command of the English language. OBJECTIVE Our aim was to identify Spanish-speaking adults' understanding and interpretation of the PAIN Report It-Spanish items and instructions as well as translation and technical issues. METHODS In a cross-sectional study, 20 mostly monolingual Spanish-speaking adults engaged in 1.5- to 2-hour, audio-recorded cognitive interviews as they completed the multidimensional PAIN Report It-Spanish. Three bilingual researchers conducted content data analysis. RESULTS Sixteen women and 4 men generally understood the translated text, but some had interpretation issues regarding the 0 to 10 number scale and understanding of the pain quality descriptors. Many participants found the program easy to complete, even when they had problems in some areas. Most participants welcomed the opportunity to report pain in their native language and appreciated research to help Hispanics with the management of their pain. CONCLUSION PAIN Report It-Spanish is a valid tool to assess pain in a Spanish-speaking population. Improved orientation to the pain reporting tasks and alternate translations for several problematic/confusing Spanish words require additional study, especially among underrepresented black Hispanics and males. IMPLICATION FOR PRACTICE Findings indicate that Spanish-speaking adults (1) easily use a body outline to report their pain location, (2) may use a 0 to 10 scale differently than other individuals, and (3) may have a limited repertoire of pain quality and pattern descriptors.
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Affiliation(s)
- Marie L Suarez
- Author Affiliations: College of Nursing, University of Illinois Chicago (Dr Suarez, Mr Angulo, and Mr Suarez); Institute on Aging, University of Florida (Dr Fullwood), Gainesville; College of Pharmacy, University of Florida (Dr Allen), Gainesville; Department of Population and Public Health Sciences and Department of Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center (Dr Stern), Los Angeles, CA; College of Pharmacy, Florida Agricultural and Mechanical University (Dr Flores-Rozas), Tallahassee; and College of Nursing, University of Florida (Dr Wilkie), Gainesville
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Acosta E, Agbayani CJG, Jenkins BN, Cortes HG, Kain ZN, Fortier MA. The Impact of Primary Language Spoken on the Pain Experience of Children With Cancer. J Pediatr Hematol Oncol 2022; 44:135-141. [PMID: 35235543 DOI: 10.1097/mph.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
The purpose of the current prospective cohort study was to determine if acculturation, measured by primary language spoken, impacts the pain response of children being treated for cancer during an experimental pain task. Sixty-seven Spanish-speaking and English-speaking children ages 6 to 18 years being treated for cancer provided ratings of pain and upset severity during the completion of the cold pressor task (CPT). One week following the CPT, participants provided their recollection of average pain and upset during the CPT. Repeated measures analysis of variance revealed Spanish-speaking children reported significantly higher pain (F1,64=5.58, P=0.02) and upset (F1,64=7.69, P=0.007) ratings during the CPT compared with English-speaking children. Also, Spanish-speaking children were over 4 times as likely to remove their hands from the water before the CPT 4-minute uninformed ceiling compared with English-speaking children (P=0.002). These findings suggest that cultural and contextual factors, including the level of acculturation, are important considerations in the assessment and management of pain in children with cancer. Future research should continue to examine the mechanisms underlying the association between acculturation and the symptom experience for children receiving treatment for cancer.
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Affiliation(s)
- Erika Acosta
- UCI Center on Stress & Health
- Charles R. Drew University, Enhanced Post Baccalaureate Certificate Program, Los Angeles
| | | | - Brooke N Jenkins
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Department of Psychology, Chapman University
| | - Haydee G Cortes
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
| | - Zeev N Kain
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Pediatrics, Children's Health of Orange County (CHOC), Orange, CA
- Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Michelle A Fortier
- UCI Center on Stress & Health
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine
- Department of Psychological Science
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine
- Departments of Pediatric Psychology
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Cooper C, Green S, Hartstein A, Fergus A. The impact of pain neuroscience education in a Hispanic-American population: A mixed-methods exploratory study. Physiother Theory Pract 2022:1-14. [PMID: 35383528 DOI: 10.1080/09593985.2022.2060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown. PURPOSE Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture. METHODS Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus. RESULTS R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility. CONCLUSION While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.
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Affiliation(s)
- Christine Cooper
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Savannah Green
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Aaron Hartstein
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
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Language Use and Generation Status are Associated with Chronic Pain Differences in Mexican Americans. J Immigr Minor Health 2022; 24:342-350. [PMID: 33725221 DOI: 10.1007/s10903-021-01160-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/12/2023]
Abstract
Little is known about the pain experience of the Mexican American (MA) population. We investigated the associations between language use and generation status with chronic pain prevalence, health insurance coverage, and analgesic medication use. We examined 3373 MA respondents from the National Health and Nutrition Examination Survey. We found higher levels of English use and generation status were associated with higher odds of reporting chronic pain. For respondents reporting chronic pain, higher levels of English use and generation status were associated with higher odds of being covered by health insurance, lower odds of having a period of time last year without health insurance, and higher odds of being prescribed any analgesic medication, especially opioid medications. We found language use and generation status play a role in MAs' experience, access, and treatment of chronic pain. Patient-, provider-, and systems-level interventions may be needed to reduce these disparities.
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Mayorga NA, Manning KF, Garey L, Viana AG, Ditre JW, Zvolensky MJ. The Role of Experiential Avoidance in Terms of Fatigue and Pain During COVID-19 Among Latinx Adults. COGNITIVE THERAPY AND RESEARCH 2022; 46:470-479. [PMID: 35125558 PMCID: PMC8802248 DOI: 10.1007/s10608-022-10292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
Background Latinx persons are overrepresented in terms of 2019 Coronavirus (COVID-19) infection rates and constitute a subpopulation at increased risk for COVID-19 related physical ailments. Fatigue and pain are among the most prevalent somatic symptoms among the Latinx population; however, there is little understanding of individual difference factors that are related to fatigue and pain during COVID-19 among this health disparities population. Experiential avoidance (EA) reflects the persistent tendency to avoid aversive internal sensations. Methods The current study sought to extend past work by exploring EA in relation to fatigue severity, pain intensity, and pain disability among 182 Latinx adult persons during the COVID-19 pandemic. Results Results indicated that EA accounted for a statistically significant amount of variance across the criterion variables. Conclusions Overall, the current work provides initial empirical evidence that EA is related to greater fatigue severity and pain severity/disability among Latinx persons during COVID-19.
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Affiliation(s)
- Nubia A. Mayorga
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX USA
| | - Kara F. Manning
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX USA
| | - Andres G. Viana
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX USA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, New York, NY USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
- HEALTH Institute, University of Houston, Houston, TX USA
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX 77204 USA
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Nahin RL. Pain Prevalence, Chronicity and Impact Within Subpopulations Based on Both Hispanic Ancestry and Race: United States, 2010-2017. THE JOURNAL OF PAIN 2021; 22:826-851. [PMID: 33636375 DOI: 10.1016/j.jpain.2021.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
We provide national surveillance estimates of pain chronicity, severity and impact in adult subpopulations defined by both Hispanic Ancestry and Race. Data are from 144,434 adults who completed validated questionnaires in the 2010-2017 National Health Interview Survey asking about pain status within the last 3 (N = 84,664) or 6 months (N = 59,770). Multivariable logistic regression was used to assess the relationship between pain and ethnicity/race. Compared to White Puerto Rican participants, White participants with Central/South American and Mexican ancestry had reduced odds of reporting Category 3-4 pain and High-Impact Chronic Pain (HICP), while those of Cuban ancestry had reduced odds of only HICP - eg, White participants with Mexican ancestry had 32% lower odds of having Category 3-4 pain and 50% lower odds of having HICP. While no differences were seen between White Puerto Rican and White Non-Hispanic participants for Category 3-4 pain, White Non-Hispanics had 40% lower odds of reporting HICP. Asian Non-Hispanic and Black Non-Hispanic participants had significantly lower odds of reporting Category 3-4 pain and HICP compared to White Puerto Rican participants, eg, Black Non-Hispanic participants had 26% lower odds off having Category 3-4 pain and 42% lower odds of having HICP. Perspective: By examining pain status in discrete demographic groups based on Hispanic Ancestry and Race, this report further documents substantial difference in health status among underserved populations and provides a baseline for continuing surveillance research on pain, with the eventual goal of eliminating disparities in pain assessment and treatment.
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Affiliation(s)
- Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.
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12
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Loduca A, Müller BM, Focosi AS, Samuelian C, Yeng LT. Retrato da Dor: um caminho para entender o sofrimento do indivíduo. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo tem por objetivo verificar o sofrimento associado às dores crônicas, por meio do instrumento projetivo “Retrato da Dor”. Trata-se de um estudo descritivo, realizado com 126 pacientes com dores crônicas de diversas etiologias. As respostas foram analisadas de acordo com o método de análise de conteúdo de Bardin e testes estatísticos. Foram encontrados pacientes: que acreditam que nenhum sofrimento se compara com a sua dor (34,9%); que comparam sua dor a outras dores ou doenças já experienciadas (16,6%); e os que comparam a dor a situações de sofrimento emocional (48,4%). Este estudo evidenciou que os aspectos emocionais desempenham um papel importante na maneira como o indivíduo irá interpretar e utilizar recursos próprios para lidar com suas dores.
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Affiliation(s)
- Adrianna Loduca
- Pontifícia Universidade Católica de São Paulo, Brasil; Universidade de São Paulo, Brasil
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13
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Ortega-González M, Aguirre-Acevedo DC, Jiménez-Benítez M. Metacognitions on Pain, Functionality and Intensity of Pain in Women with Fibromyalgia. Int J Psychol Res (Medellin) 2021; 14:78-90. [PMID: 34306581 PMCID: PMC8297576 DOI: 10.21500/20112084.4897] [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: 08/05/2020] [Revised: 10/08/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
To determine the explanatory capacity of pain metacognitions and beliefs over the functionality, coping and pain intensity, following the Model of Self-Regulatory Executive Functions (S-REF) in a sample of women with fibromyalgia from Medellín and its Metropolitan Area. Method: Metacognitions Scale on Symptom Control, Pain Self-efficacy Questionnaire, Chronic Pain Catastrophizing Scale, Chronic Pain Coping Questionnaire, WHODAS 2.0 Scale, and Pain Intensity Numerical Scale. The sample was represented by 108 women between 24 and 60 years old with a diagnosis of fibromyalgia. A modeling process was carried out through an analysis of structural equations. Results: The final model fails to fit. Despite this, the analysis suggests that negative metacognitions and pain self-efficacy have an effect over the tendency to catastrophizing. The latter and the pain self-efficacy are the main mediators in the effects of functionality. The intensity of pain is not determined by the metacognitions related to it.
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Affiliation(s)
- Misleydis Ortega-González
- Grupo de Neuropsicología y Conducta, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.Universidad de AntioquiaUniversidad de AntioquiaMedellínColombia
| | - Daniel-Camilo Aguirre-Acevedo
- Grupo Académico de Epidemiología Clínica, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia. Medellín, Colombia.Universidad de AntioquiaUniversidad de AntioquiaMedellínColombia
| | - Mercedes Jiménez-Benítez
- Grupo de Investigación en Psicología Cognitiva, Departamento de Psicología. Facultad de Ciencias Sociales y Humanas. Universidad de Antioquia. Medellín, Colombia.Universidad de AntioquiaUniversidad de AntioquiaMedellínColombia
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14
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Donaldson CD, Jenkins BN, Fortier MA, Phan MT, Tomaszewski DM, Yang S, Kain ZN. Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption. J Psychosom Res 2020; 138:110251. [PMID: 32979697 PMCID: PMC8552765 DOI: 10.1016/j.jpsychores.2020.110251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/25/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Within the context of the United States opioid epidemic, some parents often fear the use of opioids to help manage their children's postoperative pain. As a possible consequence, parents often do not dispense optimal analgesic medications to their children after surgery, putting their children at risk of suffering from postsurgical pain. The objective of this research was to assess ethnicity as a predictor of both pain and opioid consumption, and to examine how Hispanic/Latinx and Non-Hispanic White parents alter their child's opioid consumption in response to significant postsurgical pain. METHODS Participants were 254 children undergoing outpatient tonsillectomy and/or adenoidectomy surgery and their parents. Longitudinal multilevel modeling examined changes in both parent-reported pain and hydrocodone/APAP consumption (mg/kg) on days 1 to 7 after surgery. RESULTS Parent reports of postoperative pain were higher in Hispanic/Latinx patients compared to their Non-Hispanic White counterparts (β = -0.15; 95% CI: -0.28, -0.01). There was also a significant interaction of ethnicity and pain on opioid consumption (β = 0.07; 95% CI: 0.01, 0.13). The relationship between parent perceived pain and opioid use was stronger for Non-Hispanic White children, suggesting that this group was more likely to consume opioids to help manage clinically significant postsurgical pain. CONCLUSIONS Hispanic/Latinx children might be at risk for undertreatment of surgical pain. Findings highlight the importance of assessing parent background and cultural beliefs as predictors of at home pain management and the potential effectiveness of tailored interventions that educate parents about monitoring and treating child postoperative pain.
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Affiliation(s)
- Candice D. Donaldson
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America
| | - Brooke N. Jenkins
- Chapman University, Department of Psychology, United States of America,University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America
| | - Michelle A. Fortier
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Sue & Bill Gross School of Nursing, United States of America
| | - Michael T. Phan
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America
| | - Daniel M. Tomaszewski
- Chapman University, School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, United States of America,University of Southern California, School of Pharmacy, Schaeffer Center for Health Policy and Economics, United States of America
| | - Sun Yang
- Chapman University, School of Pharmacy, Department of Pharmacy Practice, United States of America
| | - Zeev N. Kain
- University of California, Irvine, Center on Stress & Health, United States of America,University of California, Irvine, Department of Anesthesiology and Perioperative Care, United States of America,Corresponding author at: UCI Center on Stress & Health, 505 S. Main Street, Suite 940, Orange, CA 92868, United States of America. (Z.N. Kain)
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15
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Herbert MS, Hernandez J, Dochat C, Pittman JOE, Afari N. Ethnic Differences in the Association Between Pain and Social Support in Iraq and Afghanistan Veterans. PAIN MEDICINE 2020; 21:3066-3072. [PMID: 32022888 DOI: 10.1093/pm/pnz374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although past research has identified differences in pain between non-Latino white (NLW) and Latino persons, few studies have focused on the influence of social support. The purpose of the present study was to determine if the association between the number of social support sources and ratings of pain intensity and pain interference differed as a function of ethnicity. DESIGN Cross-sectional. SETTING Veterans Affairs San Diego Healthcare System. SUBJECTS Participants were NLW (N = 389) and Latino (N = 207) Iraq and Afghanistan veterans. METHODS Linear regression analyses were used to examine the interaction between ethnicity and number of social support sources on pain intensity and pain interference as measured by the Patient-Reported Outcomes Measurement Information System pain inventory. RESULTS The association between number of social support sources and pain intensity and interference significantly differed by ethnicity (P < 0.01 and P = 0.01, respectively). Among NLW veterans, there was a significant negative association between number of social support sources and pain intensity. Among Latino veterans, there was a significant positive association between number of social support sources and pain intensity and interference. CONCLUSIONS These findings suggest important differences between NLW and Latino Iraq and Afghanistan veterans in the association between social support and pain. Future research should examine ethnic differences in pain-specific support received from the social environment.
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Affiliation(s)
- Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | | | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - James O E Pittman
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California.,Department of Psychiatry, University of California, San Diego, California
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16
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Ng BW, Nanavaty N, Mathur VA. The influence of Latinx American identity on pain perception and treatment seeking. J Pain Res 2019; 12:3025-3035. [PMID: 31807059 PMCID: PMC6850708 DOI: 10.2147/jpr.s217866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Latinx-Americans are underserved across healthcare contexts, and racial disparities in pain management are pervasive. One potential contributor is racial bias in pain perception - including low-level implicit biases and explicitly held lay-beliefs. Delays in seeking pain treatment may compound these disparities. However, experiments testing these factors in the context of Latinx-American pain are limited, and mechanisms by which Latinx-American group-membership influences pain perception and treatment are not understood. Methods Here, Latinx-American and White-American participants read vignettes including a Latinx or White patient's pain description and numerical pain rating. Participants then rated how much pain they thought each patient was in using the same numerical scale. Participants also reported how much pain they themselves would need to experience to prompt treatment-seeking. Results In contrast to prior work identifying lay beliefs that Latinx-Americans feel less pain than White-Americans, participants in the current study revealed a bias in the opposite direction. This was largely driven, however, by Latinx-American participants, who have been under-represented in previous studies of empathy and pain perception. Latinx-Americans ascribed more pain to patients overall - irrespective of patient race - relative to White-Americans. Latinx-American participants also reported that their own pain would need to be significantly more intense before seeing a doctor. Conclusion These results suggest that, relative to White-Americans, Latinx-Americans may be more likely to believe people are in more pain than they report - or may be more perceptive of others' pain - and that they may be in more pain upon presenting to medical settings.
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Affiliation(s)
- Brandon W Ng
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Namrata Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX 77843, USA.,Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX 77843, USA
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Bakhshaie J, Rogers AH, Mayorga NA, Ditre J, Rodríguez-Cano R, Ruiz AC, Viana AG, Garza M, Lemaire C, Ochoa-Perez M, Bogiaizian D, Zvolensky MJ. Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity. J Immigr Minor Health 2019; 21:21-29. [PMID: 29460134 DOI: 10.1007/s10903-018-0715-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, Mage = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.
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Affiliation(s)
- Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Rubén Rodríguez-Cano
- Department of Psychology and Psychobiology, University of Santiago de Compostela, Galicia, Santiago de Compostela, Spain
| | - Ana C Ruiz
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | | | | | - Daniel Bogiaizian
- Psychotherapeutic Area of "Asociación Ayuda", Anxiety Disorders Clinic, Buenos Aires, Argentina
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
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Castillo CG. What the Doctors Don't See: Physicians as Gatekeepers, Injured Latino Immigrants, and Workers' Compensation System. ANTHROPOLOGY OF WORK REVIEW 2018. [DOI: 10.1111/awr.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Cornelio-Flores O, Lestoquoy AS, Abdallah S, DeLoureiro A, Lorente K, Pardo B, Olunwa J, Gardiner P. The Latino Integrative Medical Group Visit as a Model for Pain Reduction in Underserved Spanish Speakers. J Altern Complement Med 2017; 24:125-131. [PMID: 28885858 DOI: 10.1089/acm.2017.0132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chronic pain is a common problem in the United States, one for which there is a dearth of effective treatments. Nonpharmacological options are a promising alternative, especially for Spanish-speaking Latinos. This pilot study would like to assess the feasibility of an adapted Integrative Medical Group Visit (IMGV) curriculum for a Spanish-speaking Latino chronic pain population. DESIGN AND INTERVENTION We translated and adapted the curriculum of the IMGV for a Spanish-speaking Latino chronic pain population. We then tested the feasibility of using this model with two pilot groups (N = 19) using a pre-postdesign. SUBJECTS This intervention was targeted for underserved Spanish-speaking Latino patients with chronic pain. SETTINGS/LOCATION This study took place at a safety net academic teaching hospital, the Boston Medical Center, and at a community health center located in a majority Latino neighborhood, the East Boston Neighborhood Health Clinic. OUTCOME MEASURES We used the validated Spanish translations of the Patient-Reported Outcomes Measurement Information System (PROMIS-29) (short version), Personal Health Questionnaire (PHQ-8), and Perceived Stress Scale (PSS-10). We also gathered qualitative information through focus groups and in-depth interviews. RESULTS Using PROMIS measures, there was a statistically significant reduction in pain interference (p = 0.01), fatigue (p = 0.01), and depression (p = 0.01). Qualitative data also indicated the participants felt they benefited from the visits and having care in Spanish was unique. CONCLUSIONS This model offers a promising nonpharmacological option for Spanish-speaking patients with chronic pain and could offer an alternative for addressing disparities for this population.
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Affiliation(s)
| | | | - Sheila Abdallah
- 1 Department of Family Medicine, Boston Medical Center , Boston, MA
| | | | | | - Bryan Pardo
- 2 Boston University School of Medicine , Boston, MA
| | - Joseph Olunwa
- 3 Departments of Health Policy and Management, and Epidemiology, Boston University School of Public Health , Boston, MA
| | - Paula Gardiner
- 1 Department of Family Medicine, Boston Medical Center , Boston, MA
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20
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Torres CA, Thorn BE, Kapoor S, DeMonte C. An Examination of Cultural Values and Pain Management in Foreign-Born Spanish-Speaking Hispanics Seeking Care at a Federally Qualified Health Center. PAIN MEDICINE 2017; 18:2058-2069. [DOI: 10.1093/pm/pnw315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. J Anxiety Disord 2016; 43:23-31. [PMID: 27475925 DOI: 10.1016/j.janxdis.2016.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/24/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022]
Abstract
The present investigation examined the interactive effects of anxiety sensitivity and pain intensity in relation to anxious arousal, social anxiety, and depressive symptoms and disorders among 203 Latino adults with an annual income of less than $30,000 (84.4% female; Mage=38.9, SD=11.3 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and pain intensity was significantly related to increased anxious arousal, social anxiety, and depressive symptoms as well as number of depressive/anxiety disorder diagnoses. The form of the significant interactions indicated that participants reporting co-occurring higher levels of anxiety sensitivity and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and depressive symptoms as well as higher levels of depressive and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and pain intensity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.
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Hollingshead NA, Ashburn-Nardo L, Stewart JC, Hirsh AT. The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model. THE JOURNAL OF PAIN 2016; 17:513-28. [PMID: 26831836 PMCID: PMC4851887 DOI: 10.1016/j.jpain.2015.10.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/21/2015] [Accepted: 10/31/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED Although the Hispanic population is a burgeoning ethnic group in the United States, little is known about their pain-related experience. To address this gap, we critically reviewed the existing literature on pain experience and management among Hispanic Americans (HAs). We focused our review on the literature on nonmalignant pain, pain behaviors, and pain treatment seeking among HAs. Pain management experiences were examined from HA patients' and health care providers' perspectives. Our literature search included variations of the term "Hispanic" with "AND pain" in PubMed, Embase, Web of Science, ScienceDirect, and PsycINFO databases. A total of 117 studies met our inclusion criteria. We organized the results into a conceptual model with separate categories for biological and/or psychological and sociocultural and/or systems-level influences on HAs' pain experience, response to pain, and seeking and receiving pain care. We also included information on health care providers' experience of treating HA patients with pain. For each category, we identified future areas of research. We conclude with a discussion of limitations and clinical implications. PERSPECTIVE In this critical review of the literature we examined the pain and management experiences of the HA population. We propose a conceptual model, which highlights findings from the existing literature and future areas of research.
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Affiliation(s)
- Nicole A Hollingshead
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Leslie Ashburn-Nardo
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
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Maki D, Rajab E, Watson PJ, Critchley DJ. Translation, cross-cultural adaptation and psychometric properties of the Back Beliefs Questionnaire in Modern Standard Arabic. Disabil Rehabil 2016; 39:272-280. [PMID: 26963585 DOI: 10.3109/09638288.2016.1140832] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To translate and cross-culturally adapt the Back Beliefs Questionnaire (BBQ) into modern standard Arabic and examine its validity, acceptability and reliability in Arabic-speaking patients with low back pain (LBP). Method The BBQ was forward, back-translated and reviewed by an expert committee. Seventeen bilingual patients completed Arabic and English BBQs. LBP patients (n = 199) completed the Arabic BBQ. Sixty-four repeated it a week later, and 151 completed the Arabic Fear-avoidance Beliefs Questionnaire (FABQ). Results The expert committee followed advice from the developers to maintain Arabic equivalence of "back trouble(s)". Patients found the questionnaire comprehensible and acceptable. Agreement between the English and Arabic versions of the BBQ was acceptable, ICC = 0.65 (0.25-0.86). Most item-by-item agreement ranged from fair to moderate (K = 0.12-0.54). Mean (SD) of BBQ, FABQ total, work and physical activity subscales were 25.31(6.13), 44.76(19.49), 21.17(10.10) and 13.95(6.65). The BBQ correlated with the FABQ at r = -0.33, work subscale r = -0.29 and physical activity r = -0.30 (all p < 0.01). Cronbach's α = 0.73 indicated high internal consistency. Test-retest reliability was high, ICC = 0.80 (0.68-0.87). Item-by-item agreement ranged from fair to acceptable (K = 0.31-0.66). Conclusions The Arabic BBQ has good comprehensibility and acceptability, acceptable agreement with the English BBQ, high internal consistency and test-retest reliability. We recommend its use with Arabic-speaking LBP patient to determine their beliefs and attitudes about their back pain, as they have been shown to be important predictors of persistent LBP disability. Implications for Rehabilitation There are limited valid and reliable outcome measures for back pain in Arabic. The Back Beliefs Questionnaire (BBQ) is a tool that measures attitudes and beliefs about back pain. We recommend the use of our valid and reliable, translated and cross-culturally adapted tool with Arabic-speaking patients. The tool can measure attitudes and beliefs concerning the future consequences of LBP, with regards to recovery and return to work in this sample. Findings will improve back pain management options aimed at reducing back pain disability though challenging and modifying beliefs in the Middle East or with migrant populations in the West.
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Affiliation(s)
- Dana Maki
- a Division of Health and Social Care Research, Faculty of Life Sciences & Medicine , King's College London , United Kingdom
| | - Ebrahim Rajab
- b School of Medicine, Royal College of Surgeons in Ireland , Bahrain
| | - Paul J Watson
- c Department of Health Sciences , University of Leicester , Gwendolen Road , Leicester , UK
| | - Duncan J Critchley
- a Division of Health and Social Care Research, Faculty of Life Sciences & Medicine , King's College London , United Kingdom
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Olshansky E, Zender R, Kain ZN, Rosales A, Guadarrama J, Fortier MA. Hispanic parents' experiences of the process of caring for a child undergoing routine surgery: a focus on pain and pain management. J SPEC PEDIATR NURS 2015; 20:165-77. [PMID: 25816910 DOI: 10.1111/jspn.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose was to understand the processes Hispanic parents undergo in managing postoperative care of children after routine surgical procedures. DESIGN AND METHODS Sixty parents of children undergoing outpatient surgery were interviewed. Data were analyzed using grounded theory methodology. RESULTS Parents experienced five subprocesses that comprised the overall process of caring for a child after routine surgery: (a) becoming informed; (b) preparing; (c) seeking reassurance; (d) communicating with one's child; and (e) making pain management decisions. PRACTICE IMPLICATIONS Addressing cultural factors related to pain management in underserved families may instill greater confidence in managing pain.
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Affiliation(s)
- Ellen Olshansky
- Program in Nursing Science, University of California, Irvine, California, USA.,Community Engagement, Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Robynn Zender
- Institute for Clinical and Translational Science, University of California, Irvine, California, USA
| | - Zeev N Kain
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Alvina Rosales
- Department of Anesthesiology & Perioperative, University of California, Irvine School of Medicine, Irvine, California, USA
| | | | - Michelle A Fortier
- Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, California, USA
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The roles of ethnicity, sex, and parental pain modeling in rating of experienced and imagined pain events. J Behav Med 2015; 38:809-16. [PMID: 26085306 DOI: 10.1007/s10865-015-9650-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/03/2015] [Indexed: 01/21/2023]
Abstract
To investigate the association of ethnicity, sex, and parental pain modeling on the evaluation of experienced and imagined painful events, 173 healthy volunteers (96 women) completed the Prior Pain Experience Questionnaire, a 79-question assessment of the intensity of painful events, and a questionnaire regarding exposure to parental pain models. Consistent with existing literature, greater ratings of experienced pain were noted among Black versus White participants. Parental pain modeling was associated with higher imagined pain ratings, but only when the parent matched the participant's sex. This effect was greater among White and Asian participants than Black or Hispanic participants, implying ethno-cultural effects may moderate the influence of pain modeling on the evaluation of imagined pain events. The clinical implications of these findings, as well as the predictive ability of imagined pain ratings for determining future experiences of pain, should be investigated in future studies.
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Carrion IV, Cagle JG, Van Dussen DJ, Culler KL, Hong S. Knowledge About Hospice Care and Beliefs About Pain Management. Am J Hosp Palliat Care 2014; 32:647-53. [DOI: 10.1177/1049909114536023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Context: Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management. Objectives: To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics. Methods: A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management. Results: 123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are ( p <. 001) and, among those who had, more likely to have inaccurate information about it ( p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness ( p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain ( p = .07): 38% vs. 18% from non-Hispanics. Conclusion: Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist.
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Affiliation(s)
| | - John G. Cagle
- School of Social Work, University of Maryland-Baltimore, Baltimore, MD, USA
| | | | - Krystal L. Culler
- Psychology of Adult Development and Aging Program, University of Akron, Akron, OH, USA
| | - Seokho Hong
- School of Social Work, University of Maryland-Baltimore, Baltimore, MD, USA
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Gossec L, Berenbaum F, Chauvin P, Lamiraud K, Russo-Marie F, Joubert JM, Saraux A. Reporting of patient-perceived impact of rheumatoid arthritis and axial spondyloarthritis over 10 years: a systematic literature review. Rheumatology (Oxford) 2014; 53:1274-81. [PMID: 24602920 PMCID: PMC4065006 DOI: 10.1093/rheumatology/ket480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE RA and axial SpA have an important impact on patients' lives. The objective of this study was to explore the reporting of different aspects of that impact in publications, with a focus on differences between diseases and over time. METHODS A systematic literature review retrieved all articles reporting on the life impact of RA or axial radiographic SpA in adults published within the last 10 years and issued from European research. The data were classified into physical impact (including pain, functional assessment and fatigue), psychological impact (including psychological distress and coping) and social impact (including relationships, family and social life). The number of articles published over time was analysed by linear regression. RESULTS In all, 1352 abstracts were screened and 149 publications (40,056 patients) were analysed: 129 articles (86.5%) concerned RA and 16 (10.7%) concerned axial SpA. The mean number of articles reporting on the physical aspects of impact was 11.4 (s.d. 4.8) per 2-year period, but increased more than 2-fold (from 7 articles in 2001-3 to 15 in 2010-11), in particular due to recent publications on fatigue, whereas the number of articles on psychological aspects [mean 12.4 (s.d. 4.0)] decreased markedly after 2006. Publications reporting on social aspects [mean 8.2 (s.d. 4.1)] remained globally stable. CONCLUSION In the era of biologics, there is an interest in the patient-perceived life impact of RA and axial SpA in the European literature, but the impact of RA has been the subject of greater exploration. There are clearly trends over time in the reporting of impact.
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Affiliation(s)
- Laure Gossec
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.
| | - Francis Berenbaum
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Pierre Chauvin
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Karine Lamiraud
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France.UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Francoise Russo-Marie
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Jean-Michel Joubert
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
| | - Alain Saraux
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS), Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, UPMC Univ Paris 06, Department of Rheumatology, AP-HP, Saint Antoine Hospital, INSERM, UMRS 707, ESSEC Business School, Paris, THEMA, University of Cergy Pontoise, Cergy Pontoise, Fondation Arthritis, Neuilly, UCB Pharma, Colombes and Rheumatology Department, Cavale Blanche University Hospital and EA 2216, Université Bretagne Occidentale, Brest, France
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Abstract
OBJECTIVE The objective of this study is to examine the strategies used to manage chronic pain from the perspective of the individual in group interviews. METHODS Sixteen low-income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. RESULTS Participants' pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: pain-related life alterations, enduring the pain, trying different strategies, emotional suffering, and encounters with health care system/providers. DISCUSSION Findings indicated that there are opportunities for providers to improve care for low-income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self-management strategies.
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Affiliation(s)
- Dana N Rutledge
- School of Nursing, California State University, Fullerton, CA 92831, USA.
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Jimenez N, Dansie E, Buchwald D, Goldberg J. Pain among older Hispanics in the United States: is acculturation associated with pain? PAIN MEDICINE 2013; 14:1134-9. [PMID: 23718576 DOI: 10.1111/pme.12147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies suggest that acculturation may influence the experience of pain. STUDY DESIGN We conducted a cross-sectional study to estimate the association between acculturation and the prevalence, intensity, and functional limitations of pain in older Hispanic adults in the United States. METHODS SUBJECTS Participants were English- (HE) and Spanish-speaking (HS) Hispanic and non-Hispanic White (NHW) individuals aged 50 years and older who were interviewed for the Health and Retirement Study during 1998-2008. MEASURES We measured: 1) acculturation as defined by language used in interviews, and 2) the presence, intensity, and functional limitations of pain. ANALYSIS We applied logistic regression using generalized estimating equations, with NHW as the reference category. RESULTS Among 18,593 participants (16,733 NHW, 824 HE, and 1,036 HS), HS had the highest prevalence (odds ratio [OR] = 1.3; 95% confidence interval [CI = 1.1-1.4) and intensity (OR = 1.6; 95% CI = 1.4-1.9) of pain, but these differences were not significant after adjusting for age, sex, years of education, immigration status (U.S.- vs non-U.S-born), and health status (number of health conditions). Even after adjustment, HS reported the lowest levels of functional limitation (OR = 0.7; 95% CI 0.6-0.9). CONCLUSION Pain prevalence and intensity were not related to acculturation after adjusting for sociodemographic factors, while functional limitation was significantly lower among HS even after adjusting for known risk factors. Future studies should explore the reasons for this difference.
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Affiliation(s)
- Nathalia Jimenez
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
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Abstract
Adolescent oncology patients with chronic pain require holistic management using interdisciplinary care, multimodal therapies, and family-centered treatment. Adolescents are at a crucial stage of development and require unique assessment that incorporates seeking their input, valuing their opinion, and establishing a developmentally appropriate treatment plan to give them a sense of control. This article discusses the essential elements of assessment that pediatric nurse practitioners should use when evaluating chronic pain in this unique patient population. A comprehensive assessment should determine the biological, psychosocial, and developmental functioning of the patient through objective and subjective measurements. The purpose of this literature review is to outline the mainstays of evaluating pain in a vulnerable population. Ascertaining the barriers that lead to underreporting and undertreating this symptom may lead to more effective management. This article assembles concepts established in research conducted on adolescents with nonmalignant chronic pain and studies on pain in the general pediatric oncology population to assist in evaluating adolescent oncology patients with chronic pain.
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Campbell LC, Robinson K, Meghani SH, Vallerand A, Schatman M, Sonty N. Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy. THE JOURNAL OF PAIN 2012; 13:611-9. [PMID: 22560002 PMCID: PMC3958966 DOI: 10.1016/j.jpain.2012.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/07/2012] [Accepted: 02/17/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED Due to high profile initiatives at the national level, awareness of inadequate pain care affecting many groups in our society has never been greater. Nevertheless, increased awareness of pain disparities and the initiatives to address these disparities have yielded only modest progress, most notably in the form of growing appreciation that pain disparities likely result from multiple factors, including biological, psychological, environmental, health system, and cultural factors. Much less progress has been made in developing interventions that target these multiple determinants to reduce pain management disparities. In this paper we discuss key ethical and methodological challenges that undermine our capacity to investigate and develop meaningful interventions to improve pain outcomes among vulnerable populations. Key challenges in the areas of research engagement, recruitment, design, and measurement are discussed from both scientific and normative standpoints. Specific opportunities within emerging research paradigms to improve designs and measures are also discussed. Finally, we conclude with identifying potential synergies between the pain management disparities research agenda and the broader areas of clinical practice, advocacy, and policy that could help to move the field forward. PERSPECTIVE Researchers studying disparities in pain care face a number of ethical and methodological challenges that must be addressed to advance the field towards eliminating disparities. We discuss these ethical and methodological challenges and propose opportunities for paradigmatic revisions in areas of research engagement, design, measurement, advocacy, and policy.
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Affiliation(s)
- Lisa C Campbell
- Department of Psychology, East Carolina University, Greenville, North Carolina 27858, USA.
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Factors that affect the occurrence and chronicity of occupation-related musculoskeletal disorders. Best Pract Res Clin Rheumatol 2011; 25:103-15. [PMID: 21663853 DOI: 10.1016/j.berh.2011.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 11/23/2022]
Abstract
The components that affect the occurrence and chronicity of musculoskeletal disease are multifactorial. The return to work process and prevention of future chronic disability commences at the time of the initial assessment. The clinician can identify, at an early stage, patients with negative expectations of return to work and adopt a care plan oriented to functional adaptation. Medical and psychosocial treatment plans taking account of coping preferences, beliefs and practices are more likely to help prevent chronic disability. Other factors that can influence the long-term disability rate include medically discretionary or unnecessary time off work and litigation itself. Workplace factors can result in unnecessary absenteeism and poorly managed presenteeism.
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Upshur CC, Bacigalupe G, Luckmann R. "They don't want anything to do with you": patient views of primary care management of chronic pain. PAIN MEDICINE 2010; 11:1791-8. [PMID: 21029353 DOI: 10.1111/j.1526-4637.2010.00960.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care. DESIGN Qualitative analysis of 17 patient focus groups (size 3-7 participants). Groups used structured questions and were tape recorded, transcribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish. PATIENTS Convenience sample of 72 adult patients (68% female, 44% Latino, mean age=48.1 years) recruited from four diverse primary care practices in Central Massachusetts. RESULTS Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowledged feeling disrespected and distrusted, suspected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some management techniques related to the chronic disease management model to improve pain care. CONCLUSIONS Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care.
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Affiliation(s)
- Carole C Upshur
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, USA.
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