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Morris MC, Bruehl S, Rao U, Goodin BR, Karlson C, Carter C, Nag S, Huber FA, Bendinskas KG, Hidoyatov M, Kinney K, Rochelle A, Funches G. Biobehavioral Predictors of Pain Intensity, Pain Interference, and Chronic Pain Episodes: A Prospective Cohort Study of African-American Adults. THE JOURNAL OF PAIN 2024; 25:104501. [PMID: 38369220 PMCID: PMC11283993 DOI: 10.1016/j.jpain.2024.02.015] [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: 10/25/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
Racial disparities in pain experiences are well-established, with African-American (AA) adults reporting higher rates of daily pain, increased pain severity, and greater pain-related interference compared to non-Hispanic Whites. However, the biobehavioral factors that predict the transition to chronic pain among AA adults are not well understood. This prospective cohort study provided a unique opportunity to evaluate predictors of chronic pain onset among 130 AA adults (81 women), ages 18 to 44, who did not report chronic pain at their baseline assessment and subsequently completed follow-up assessments at 6- and 12-months. Outcome measures included pain intensity, pain-related interference, and chronic pain status. Comprehensive assessments of sociodemographic and biobehavioral factors were used to evaluate demographics, socioeconomic status, stress exposure, psychosocial factors, prolonged hypothalamic-pituitary-adrenal secretion, and quantitative sensory testing responses. At baseline, 30 adults (23.1%) reported a history of prior chronic pain. Over the 12-month follow-up period, 13 adults (10.0%) developed a new chronic pain episode, and 18 adults (13.8%) developed a recurrent chronic pain episode. Whereas socioeconomic status measures (ie, annual income, education) predicted changes in pain intensity over the follow-up period, quantitative sensory testing measures (ie, pain threshold, temporal summation of pain) predicted changes in pain interference. A history of chronic pain and higher depressive symptoms at baseline independently predicted the onset of a new chronic pain episode. The present findings highlight distinct subsets of biobehavioral factors that are differentially associated with trajectories of pain intensity, pain-related interference, and onset of chronic pain episodes in AA adults. PERSPECTIVE: This prospective study sought to advance understanding of biobehavioral factors that predicted pain outcomes over a 12-month follow-up period among AA adults without chronic pain at their initial assessment. Findings revealed distinct subsets of factors that were differentially associated with pain intensity, pain-related interference, and onset of chronic pain episodes.
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Affiliation(s)
- Matthew C. Morris
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for the Neurobiology of Learning and Memory, University of California – Irvine, California, USA
- Psychiatry Division, Children’s Hospital of Orange County, Orange, CA, USA
| | - Burel R. Goodin
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | - Cynthia Karlson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
- Department of Hematology and Oncology, University of Mississippi Medical Center, Jackson, MS
| | - Chelsea Carter
- School of Medicine, Meharry Medical College, Nashville, TN
| | - Subodh Nag
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Felicitas A. Huber
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | | | - Muhammad Hidoyatov
- Chemistry Department, State University of New York at Oswego, Oswego, NY
| | - Kerry Kinney
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Aubrey Rochelle
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Gaarmel Funches
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
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Matus A, Quinn R, Stawnychy MA, Thomas G, Goba M, Garo J, Gordon D, Riegel B. Social Determinants of Health are Associated with Coping of Informal Caregivers of Adults with Heart Failure. Clin Nurs Res 2024; 33:334-343. [PMID: 38288601 PMCID: PMC11188556 DOI: 10.1177/10547738231223790] [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] [Indexed: 06/20/2024]
Abstract
We explored the influence of social determinants of health (SDH) risk on stress and coping style in heart failure (HF) caregivers. In this cross-sectional study, data from 250 caregivers were analyzed. Multivariable linear regression analyses were performed to determine the extent to which SDH risk (measured using a modified PRAPARE tool (National Association of Community Health Centers), range 0-22) predicted stress (Perceived Stress Scale, 0-56) and coping style (active (0-45), avoidance (0-30), and minimization (0-30)) while accounting for caregiver burden (HF Caregiver Questionnaire (HF-CQ) 0-100). Multivariable regression analysis with backwards elimination variable selection approach was used to identify which SDH risk factors best predicted coping styles. SDH risk was significantly associated with avoidance and minimization coping styles. Each unit increase in SDH risk was associated with an increase of 0.6 ± 0.2 units (p = .0008) in avoidance and 0.7 ± 0.2 units (p < .0001) in minimization coping style. Race and "supporting others" significantly predicted avoidance coping style; scores were 3.3 ± 0.8 units greater for caregivers who were not White (p < .0001) and 1.4 ± 0.5 units greater (p < .01) for each additional person whom they supported. Race significantly predicted minimization coping style; scores were 4.4 ± 0.7 units greater for caregivers who were not White (p < .0001). Caregivers with higher SDH risk may avoid and minimize to cope with caregiving challenges.
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Affiliation(s)
- Austin Matus
- Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ryan Quinn
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Gladys Thomas
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Miatta Goba
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jenna Garo
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Deborah Gordon
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Hammett PJ, Eliacin J, Saenger M, Allen KD, Meis LA, Krein SL, Taylor BC, Branson M, Fu SS, Burgess DJ. The Association Between Racialized Discrimination in Health Care and Pain Among Black Patients With Mental Health Diagnoses. THE JOURNAL OF PAIN 2024; 25:217-227. [PMID: 37591480 DOI: 10.1016/j.jpain.2023.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
Chronic pain is a costly and debilitating problem in the United States, and its burdens are exacerbated among socially disadvantaged and stigmatized groups. In a cross-sectional study of Black Veterans with chronic pain at the Atlanta VA Health Care System (N = 380), we used path analysis to explore the roles of racialized discrimination in health care settings, pain self-efficacy, and pain-related fear avoidance beliefs as potential mediators of pain outcomes among Black Veterans with and without an electronic health record-documented mental health diagnosis. In unadjusted bivariate analyses, Black Veterans with a mental health diagnosis (n = 175) reported marginally higher levels of pain-related disability and significantly higher levels of pain interference compared to those without a mental health diagnosis (n = 205). Path analyses revealed that pain-related disability, pain intensity, and pain interference were mediated by higher levels of racialized discrimination in health care and lower pain self-efficacy among Black Veterans with a mental health diagnosis. Pain-related fear avoidance beliefs did not mediate pain outcomes. These findings highlight the need to improve the quality and effectiveness of health care for Black patients with chronic pain through the implementation of antiracism interventions within health care systems. Results further suggest that Black patients with chronic pain who have a mental health diagnosis may benefit from targeted pain management strategies that focus on building self-efficacy for managing pain. PERSPECTIVE: Racialized health care discrimination and pain self-efficacy mediated differences in pain-related disability, pain intensity, and pain interference among Black Veterans with and without a mental health diagnosis. Findings highlight the need for antiracism interventions within health care systems in order to improve the quality of care for Black patients with chronic pain. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01983228.
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Affiliation(s)
- Patrick J Hammett
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Johanne Eliacin
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Saenger
- Anesthesia Service Line, Atlanta Veterans Administration Health Care System, Decatur, Georgia; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Kumolu-Johnson T, Senbanjo IO. Prevalence and pattern of functional gastrointestinal disorders among secondary school adolescents in Lagos, Nigeria. J Trop Pediatr 2023; 70:fmad048. [PMID: 38200618 DOI: 10.1093/tropej/fmad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Limited data exist on functional gastrointestinal disorders (FGIDs) among sub-Saharan African children. This study aimed to determine FGID prevalence and pattern among secondary school adolescents in Lagos, Nigeria. METHODS This descriptive cross-sectional study was conducted among adolescents aged 10-18 years in Isolo, Lagos, Nigeria from December 2020 to March 2021. A multi-stage sampling technique was used to select a total of 696 students from four secondary schools. Data were collected using a specifically designed questionnaire, the ROME IV questionnaire (QPGS-IV), and analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. RESULTS The mean age of the adolescents was 13.6 ± 2.1. A total of 221 (31.8%) adolescents fulfilled the criteria for at least one of the FGIDs. The most common FGIDs were functional constipation (10.1%), functional dyspepsia (9.4%) and abdominal migraine (8.6%). There was no significant difference in the overall prevalence of FGIDs between age groups (p = 0.07) and genders (p = 0.949). However, the prevalence of FGID sub-types showed that abdominal migraine, irritable bowel syndrome and functional non-retentive fecal incontinence were significantly higher in the age group 10-12 years (p = 0.045, p = 0.029 and p = 0.027, respectively) while only functional vomiting was significantly higher in male compared to female (p = 0.038). CONCLUSION FGIDs are common among adolescents in Lagos, Nigeria. The pattern of FGIDs shows similarities and differences with reports from other parts of the world. Healthcare workers must be aware of these disorders to provide optimal care.
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Affiliation(s)
| | - Idowu Odunayo Senbanjo
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos 100271, Nigeria
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Dickens H, Bruehl S, Rao U, Myers H, Goodin B, Huber FA, Nag S, Carter C, Karlson C, Kinney KL, Morris MC. Cognitive-Affective-Behavioral Pathways Linking Adversity and Discrimination to Daily Pain in African-American Adults. J Racial Ethn Health Disparities 2023; 10:2718-2730. [PMID: 36352344 PMCID: PMC10166769 DOI: 10.1007/s40615-022-01449-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
The tendency to ruminate, magnify, and experience helplessness in the face of pain - known as pain catastrophizing - is a strong predictor of pain outcomes and is associated with adversity. The ability to maintain functioning despite adversity - referred to as resilience - also influences pain outcomes. Understanding the extent to which pain catastrophizing and resilience influence relations between adversity and daily pain in healthy African-American adults could improve pain risk assessment and mitigate racial disparities in the transition from acute to chronic pain. This study included 160 African-American adults (98 women). Outcome measures included daily pain intensity (sensory, affective) and pain impact on daily function (pain interference). Adversity measures included childhood trauma exposure, family adversity, chronic burden from recent stressors, and ongoing perceived stress. A measure of lifetime racial discrimination was also included. Composite scores were created to capture early-life adversity (childhood trauma, family adversity) versus recent-life adversity (perceived stress, chronic burden). Increased pain catastrophizing was correlated with increased adversity (early and recent), racial discrimination, pain intensity, and pain interference. Decreased pain resilience was correlated with increased recent-life adversity (not early-life adversity or racial discrimination) and correlated with increased pain intensity (not pain-related interference). Bootstrapped multiple mediation models revealed that relationships between all adversity/discrimination and pain outcomes were mediated by pain catastrophizing. Pain resilience, however, was not a significant mediator in these models. These findings highlight opportunities for early interventions to reduce cognitive-affective-behavioral risk factors for persisting daily pain among African-American adults with greater adversity exposure by targeting pain catastrophizing.
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Affiliation(s)
- Harrison Dickens
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for the Neurobiology of Learning and Memory, University of CA - Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
| | - Hector Myers
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Felicitas A Huber
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Subodh Nag
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Chelsea Carter
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN, USA
| | - Cynthia Karlson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Pediatrics, Hematology/Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kerry L Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Matthew C Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
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Crouch T, Sturgeon J, Guck A, Hagiwara N, Smith W, Trost Z. Race, Ethnicity, and Belief in a Just World: Implications for Chronic Pain Acceptance Among Individuals with Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:2309-2318. [PMID: 37454884 PMCID: PMC10789909 DOI: 10.1016/j.jpain.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Chronic pain acceptance is a psychological process consistently linked with improved functional outcomes. However, existing research on this construct has not considered the role of racial or ethnic background, despite growing evidence of racialized disparities in pain experience and treatment. This study aimed to examine racial differences in chronic pain acceptance, as measured by the chronic pain acceptance questionnaires (CPAQ), in a multicultural sample of individuals with chronic low back pain (N = 137-37.2% White, 31.4% Hispanic, and 31.4% Black/African American). We further sought to examine moderating effects of discrimination, pain-related perceived injustice (PI), and just world belief (JWB). Analyses consisted of cross-sectional one-way analyses of variance with Bonferroni-corrected post hoc comparisons, followed by regression models with interaction terms, main effects, and relevant covariates. Results indicated higher scores on the CPAQ for White individuals compared to Black or Hispanic individuals. Significant interactions were noted between race/ethnicity and JWB in predicting pain acceptance, after controlling for demographic and pain-related variables, such that the positive association between JWB and pain acceptance was significant for White participants only. Race/ethnicity did not show significant interactions with PI or prior racial discrimination. Findings highlight racial differences in levels of chronic pain acceptance, an adaptive pain coping response, and a stronger JWB appears to have a positive impact on pain acceptance for White individuals only. Results further confirm that members of disadvantaged racial groups may be more susceptible to poorer pain adjustment, which is the result of complex, multi-level factors. PERSPECTIVE: This study identifies racial differences in levels of pain acceptance, an adaptive psychological response to chronic pain, such that White individuals with chronic low back pain demonstrate higher levels of pain acceptance. The article further explores the impacts of intrapersonal and sociocultural variables on racial differences in pain acceptance.
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Affiliation(s)
- Taylor Crouch
- Department of Psychiatry, Virginia Commonwealth University, VA, USA
| | - John Sturgeon
- Department of Anaesthesiology, Michigan State University, MI, USA
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Ft. Worth, TX, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, VA, USA
| | - Wally Smith
- Department of Internal Medicine, Virginia Commonwealth University, VA, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, VA, USA
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Franqueiro AR, Yoon J, Crago MA, Curiel M, Wilson JM. The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review. Psychol Res Behav Manag 2023; 16:4389-4399. [PMID: 37915959 PMCID: PMC10617401 DOI: 10.2147/prbm.s410606] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic pain is a public health concern affecting over 100 million U.S. adults. Because chronic pain is multifactorial, it requires a biopsychosocial approach to understand how biological, psychological, and social factors contribute to both the development and maintenance of pain. On average, individuals with chronic pain report higher levels of emotional distress compared to pain-free individuals. Research has demonstrated that social support is associated with better pain outcomes and less emotional distress. It has been proposed that social support may improve pain outcomes by reducing the influence of stressors. However, the majority of research exploring the relationships between social support and pain-related outcomes has focused on the direct relationship between these variables, largely overlooking the process by which social support has a positive influence on pain. This narrative review synthesizes research on how chronic pain, emotional distress, and social support are highly interconnected, yet research investigating chronic pain and emotional distress within a social context is limited. We then highlight disparities in chronic pain, such that the burden of chronic pain is unequal between demographic groups. Next, we discuss existing evidence for the use of group-based interventions to address pain-related outcomes. Lastly, we summarize limitations of prior research studies and highlight gaps in the current literature. Overall, longitudinal research comprehensively investigating the distinct nuances in the measurement of social support and how these nuances relate to emotional distress and pain outcomes is needed and may provide insight into the unique needs of individuals or subgroups. Further, demographically diverse randomized controlled trials are needed to identify the process by which group-based interventions improve pain outcomes and whether these interventions are more effective for particular groups in order to personalize treatment approaches and address inequities in pain care.
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Affiliation(s)
- Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - JiHee Yoon
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Madelyn A Crago
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Marie Curiel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
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Edwards RR, Tan CO, Dairi I, Whittington AJ, Thomas JD, Campbell CM, Ross E, Taylor HA, Weisskopf M, Baggish AL, Zafonte R, Grashow R. Race differences in pain and pain-related risk factors among former professional American-style football players. Pain 2023; 164:2370-2379. [PMID: 37314441 PMCID: PMC10502895 DOI: 10.1097/j.pain.0000000000002948] [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: 12/29/2022] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023]
Abstract
ABSTRACT The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.
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Affiliation(s)
- Robert R. Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Alicia J. Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Julius Dewayne Thomas
- Department of Clinical Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Claudia M. Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar Ross
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Marc Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
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9
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Pham TV, Doorley J, Kenney M, Joo JH, Shallcross AJ, Kincade M, Jackson J, Vranceanu AM. Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag 2023; 13:473-496. [PMID: 37650756 PMCID: PMC10621777 DOI: 10.2217/pmt-2023-0032] [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: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Doorley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Martha Kenney
- Department of Anesthesiology, Duke University Medical Centre, Durham, NC 27710, USA
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amanda J Shallcross
- Wellness & Preventative Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michael Kincade
- Center for Alzheimer's Research & Treatment, Massachusetts Alzheimer's Disease Research Centre, Boston, MA 02129, USA
| | - Jonathan Jackson
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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10
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Rambachan A, Noorulhuda H, Fang MC, Bazinski M, Manuel S, Hubbard C, Prasad P. Pain Assessment Disparities by Race, Ethnicity, and Language in Adult Hospitalized Patients. Pain Manag Nurs 2023; 24:393-399. [PMID: 37147211 PMCID: PMC10954313 DOI: 10.1016/j.pmn.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/23/2023] [Accepted: 03/26/2023] [Indexed: 05/07/2023]
Abstract
AIM Nurses assess patients' pain using several validated tools. It is not known what disparities exist in pain assessment for medicine inpatients. Our purpose was to measure differences in pain assessment across patient characteristics, including race, ethnicity, and language status. METHODS Retrospective cohort study of adult general medicine inpatients from 2013 to 2021. The primary exposures were race/ethnicity and limited English proficiency (LEP) status. The primary outcomes were 1) the type and odds of which pain assessment tool nursing used and 2) the relationship between pain assessments and daily opioid administration. RESULTS Of 51,602 patient hospitalizations, 46.1% were white, 17.4% Black, 16.5% Asian, and 13.2% Latino. 13.2% of patients had LEP. The most common pain assessment tool was the Numeric Rating Scale (68.1%), followed by the Verbal Descriptor Scale (23.7%). Asian patients and patients with LEP were less likely to have their pain documented numerically. In multivariable logistic regression, patients with LEP (OR 0.61, 95% CI 0.58-0.65) and Asian patients (OR 0.74, 95% CI 0.70-0.78) had the lowest odds of numeric ratings. Latino, Multi-Racial, and patients classified as Other also had lower odds than white patients of numeric ratings. Asian patients and patients with LEP received the fewest daily opioids across all pain assessment categories. CONCLUSIONS Asian patients and patients with LEP were less likely than other patient groups to have a numeric pain assessment and received the fewest opioids. These inequities may serve as the basis for the development of equitable pain assessment protocols.
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Affiliation(s)
| | | | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, California
| | - Marilyn Bazinski
- School of Nursing, University of California, San Francisco, California
| | - Solmaz Manuel
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Colin Hubbard
- Division of Hospital Medicine, University of California, San Francisco, California
| | - Priya Prasad
- Division of Hospital Medicine, University of California, San Francisco, California
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11
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Schubiner H, Jackson B, Molina KM, Sturgeon JA, Sealy-Jefferson S, Lumley MA, Jolly J, Trost Z. Racism as a Source of Pain. J Gen Intern Med 2023; 38:1729-1734. [PMID: 36737536 PMCID: PMC10212893 DOI: 10.1007/s11606-022-08015-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/27/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI, USA.
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Benita Jackson
- Department of Psychology, Smith College, Northampton, MA, USA
- Five College Program in Culture, Health, and Science, Five College Consortium, Amherst, MA, USA
| | - Kristine M Molina
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - John A Sturgeon
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Jallicia Jolly
- Departments of Black Studies and American Studies, Amherst College, Amherst, MA, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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12
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Joyce C, Keysor J, Stevans J, Ready K, Roseen EJ, Saper RB. Beyond the pain: A qualitative study exploring the physical therapy experience in patients with chronic low back pain. Physiother Theory Pract 2023; 39:803-813. [PMID: 35086420 PMCID: PMC9325917 DOI: 10.1080/09593985.2022.2029650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/12/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic low back pain (cLBP) is a complex condition that is physically and psychologically debilitating, with vulnerable populations experiencing more severe outcomes. Physical therapy (PT) includes evidence-based treatments that can reduce disability, however the experience of PT can vary amongst different populations. Empirical evidence is largely based on majority samples that are predominantly white with high educational attainment. Little is known regarding how people from vulnerable groups (e.g. low income and racial minority) experience physical therapy treatment for low back pain. OBJECTIVE To describe the experience of physical therapy in a predominantly low-income and minority population with cLBP. METHODS This qualitative study was embedded within a randomized controlled trial for patients with cLBP in urban, underserved communities. We used a convenience sample to interview 12 participants from the 102 who participated in the PT arm of the trial and then performed thematic analysis to describe their experience. RESULTS Three major themes emerged: 1) Empowerment through education and exercise; 2) Interconnectedness to providers and other patients; and 3) Improvements in pain, body mechanics, and mood. Divergent cases were few however centered around a lack of improvement in pain or an absence of connection with the therapist. Within the first theme a prevailing sub-theme emerged that aligned with Bandura's theory of self-efficacy: 1) Mastery of experience; 2) Verbal persuasion; 3) Vicarious experience; and 4) Physiological state. CONCLUSIONS Our participants' insight highlighted the value of cognitive-emotional and interpersonal dimensions of PT. These may be particularly important components of PT in populations that have experienced systemic distrust in providers and disparities in services. Future work could use Bandura's model of self-efficacy to build a PT intervention comprised of fear-based movement exercises, interconnectedness, a strong therapeutic alliance, and mindfulness techniques.
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Affiliation(s)
- Christopher Joyce
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, 10 Lincoln Square, Worcester, MA, 01608 USA
| | - Julie Keysor
- Department of Rehabilitation Science, MGH Institute of Health Professions, 36 1 Avenue Boston, MA, 02129, USA
| | - Joel Stevans
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA, 15219 USA
| | | | - Eric J. Roseen
- Department of Rehabilitation Science, MGH Institute of Health Professions, 36 1 Avenue Boston, MA, 02129, USA
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118 USA
| | - Robert B. Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, 02118 USA
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13
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Jacob G, Faber SC, Faber N, Bartlett A, Ouimet AJ, Williams MT. A Systematic Review of Black People Coping With Racism: Approaches, Analysis, and Empowerment. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:392-415. [PMID: 36006823 PMCID: PMC10018067 DOI: 10.1177/17456916221100509] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the current research literature concerning Black people in Western societies to better understand how they regulate their emotions when coping with racism, which coping strategies they use, and which strategies are functional for well-being. A systematic review of the literature was conducted, and 26 studies were identified on the basis of a comprehensive search of multiple databases and reference sections of relevant articles. Studies were quantitative and qualitative, and all articles located were from the United States or Canada. Findings demonstrate that Black people tend to cope with racism through social support (friends, family, support groups), religion (prayer, church, spirituality), avoidance (attempting to avoid stressors), and problem-focused coping (confronting the situation directly). Findings suggest gender differences in coping strategies. We also explore the relationship between coping with physical versus emotional pain and contrast functional versus dysfunctional coping approaches, underscoring the importance of encouraging personal empowerment to promote psychological well-being. Findings may help inform mental-health interventions. Limitations include the high number of American-based samples and exclusion of other Black ethnic and national groups, which is an important area for further exploration.
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Affiliation(s)
| | | | | | - Amy Bartlett
- Department of Classics and Religious
Studies, University of Ottawa
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14
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Arnstein P, Shade M, Herr KA, Young HM, Fishman SM. Managing Older Adults' Chronic Pain: Lower-Risk Interventions. Am J Nurs 2023; 123:46-52. [PMID: 36698362 DOI: 10.1097/01.naj.0000919740.00088.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Paul Arnstein
- Paul Arnstein is a professor in the School of Nursing at the MGH Institute of Health Professions in Boston. Marcia Shade is an assistant professor in the College of Nursing at the University of Nebraska Medical Center in Omaha. Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence in the College of Nursing at the University of Iowa in Iowa City. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California Davis in Sacramento, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. Scott M. Fishman is a professor, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California Davis School of Medicine in Sacramento, where he is also director of the Center for Advancing Pain Relief. This work was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Paul Arnstein, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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15
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Hood AM, Morais CA, Fields LN, Merriwether EN, Brooks AK, Clark JF, McGill LS, Janevic MR, Letzen JE, Campbell LC. Racism exposure and trauma accumulation perpetuate pain inequities-advocating for change (RESTORATIVE): A conceptual model. AMERICAN PSYCHOLOGIST 2023; 78:143-159. [PMID: 37011166 PMCID: PMC10071409 DOI: 10.1037/amp0001042] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Anna M. Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health
| | - Calia A. Morais
- Department of Hematology and Oncology, The University of Alabama at Birmingham
| | | | - Ericka N. Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development
- Department of Medicine, NYU Grossman School of Medicine, New York University
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Jaylyn F. Clark
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Lakeya S. McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Mary R. Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Janelle E. Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
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16
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Shannonhouse L, Hong J, Fullen M, Westcott J, Mingo CA, Mize MC, Love SF. Racial Differences in the Relationship Between Pain and Suicide Desire in Older Adults. J Appl Gerontol 2022; 42:972-980. [PMID: 36540033 DOI: 10.1177/07334648221145854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Older adults are reported to die by suicide at higher rates than the general population. Suicide desire among older adults is associated with pain, and pain experiences have been found to differ based on race. To investigate the relationship between pain and suicidal desire, 437 racially diverse older adults who receive home-based services (home-delivered meals) in the Southeastern region of the United States completed standardized measures of psychological pain, chronic physical pain, and suicidal desire. Results identified race moderated the relationship between pain and suicidal desire, indicating a stronger relationship between pain and suicidal desire among Black older adults than White older adults. Chronic physical pain (i.e., emotional burden) interacted with race to predict Perceived Burdensomeness ( p = .011) and Thwarted Belongingness ( p = .032). Greater attention to pain experiences among Black older adults is warranted, considering the impact of COVID-19 on racial/ethnic minorities’ mental health.
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Affiliation(s)
| | - Jihee Hong
- University of Maryland, College Park, MD, USA
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17
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Assessing the Impact of Relationship Profile Test Scores, Self-Identified Ethnic Group, and Gender on Adult Attachment Style. J Nerv Ment Dis 2022; 210:838-849. [PMID: 36302081 DOI: 10.1097/nmd.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap in the literature in terms of using the RPT to predict attachment styles and to assess gender and ethnic group differences in RPT scores. Four samples from various treatment settings were combined to yield a heterogeneous group of ethnically diverse men and women (N = 470) with a mean age of 31.96. No gender differences were observed; however, ethnic differences were noted, with the RPT scales predicting unique variance in secure and insecure attachment styles. This study evidences the incremental validity of the RPT scales when predicting adult attachment style with consideration of ethnic group differences, which can help inform the treatment and assessment process.
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18
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Burgess DJ, Hagel Campbell E, Hammett P, Allen KD, Fu SS, Heapy A, Kerns RD, Krein SL, Meis LA, Bangerter A, Cross LJS, Do T, Saenger M, Taylor BC. Taking ACTION to Reduce Pain: a Randomized Clinical Trial of a Walking-Focused, Proactive Coaching Intervention for Black Patients with Chronic Musculoskeletal Pain. J Gen Intern Med 2022; 37:3585-3593. [PMID: 35132545 PMCID: PMC9585120 DOI: 10.1007/s11606-021-07376-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Black patients in the USA are disproportionately affected by chronic pain, yet there are few interventions that address these disparities. OBJECTIVE To determine whether a walking-focused, proactive coaching intervention aimed at addressing contributors to racial disparities in pain would improve chronic pain outcomes among Black patients compared to usual care. DESIGN Randomized controlled trial with masked outcome assessment ( Clinicaltrials.gov : NCT01983228). PARTICIPANTS Three hundred eighty Black patients at the Atlanta VA Health Care System with moderate to severe chronic back, hip, or knee pain. INTERVENTION Six telephone coaching sessions over 8-14 weeks, proactively delivered, using action planning and motivational interviewing to increase walking, or usual care. MAIN MEASURES Primary outcome was a 30% improvement in pain-related physical functioning (Roland Morris Disability Questionnaire [RMDQ]) over 6 months among Black patients, using intention-to-treat. Secondary outcomes were improvements in pain intensity and interference, depression, anxiety, global impression of change in pain, and average daily steps. KEY RESULTS The intervention did not produce statistically significant effects on the primary outcome (at 6 months, 32.4% of intervention participants had 30% improvement on the RMDQ vs. 24.7% of patients in usual care; aOR=1.61, 95% CI, 0.94 to 2.77), nor on other secondary outcomes assessed at 6 months, with the exception that intervention participants reported more favorable changes in pain relative to usual care (mean difference=-0.54, 95% CI, -0.85 to -0.23). Intervention participants also experienced a significant reduction in pain intensity and pain interference over 3 months (mean difference=-0.55, 95% CI, -0.88 to -0.22). CONCLUSIONS A novel intervention to improve chronic pain among Black patients did not produce statistically significant improvements on the primary outcome relative to usual care. More intensive efforts are likely required among this population, many of whom were economically disadvantaged and had mental health comorbidities and physical limitations. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01983228.
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Affiliation(s)
- Diana J. Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
| | - Patrick Hammett
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Kelli D. Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, NC USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Steven S. Fu
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Alicia Heapy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
- Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT USA
| | - Robert D. Kerns
- Department of Psychiatry, Yale School of Medicine, New Haven, CT USA
- Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT USA
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans Affairs Healthcare System, Ann Arbor, MI USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Laura A. Meis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
| | - Lee J. S. Cross
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
| | - Tam Do
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
| | - Michael Saenger
- Atlanta Veterans Affairs Healthcare System, Atlanta, GA USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Brent C. Taylor
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive (152), Minneapolis, MN 55417 USA
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
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19
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Bakhshaie J, Penn TM, Doorley J, Pham TV, Greenberg J, Bannon S, Saadi A, Vranceanu AM. Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review. THE JOURNAL OF PAIN 2022; 23:1697-1711. [PMID: 35644442 DOI: 10.1016/j.jpain.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.
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Affiliation(s)
- Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Terence M Penn
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tony V Pham
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tulane Medical School, New Orleans, Louisiana; Duke University Global Health Master's Program, Durham, North Carolina
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Altaf Saadi
- Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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20
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McSorley VE, Howard C, Shah RC, James BD, Boyle P, Barnes LL. The Relationship of John Henryism With Cognitive Function and Decline in Older Black Adults. Psychosom Med 2022; 84:766-772. [PMID: 35980784 PMCID: PMC9437121 DOI: 10.1097/psy.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between John Henryism, a psychological trait typified by high-effort active coping that has been associated with adverse health outcomes among Blacks, and cognitive decline. METHODS In a cohort of community-dwelling older Black adults ( N = 611), we investigated the relationship between John Henryism and cognitive decline. John Henryism was measured using the John Henryism Active Coping Scale (JHACS), a nine-item validated measure of self-reported high-effort coping (mean [standard deviation] = 16.9 [4.8]; range, 4-27). We implemented a three-step modeling process using mixed-effects models to assess the relationship between the JHACS and global cognitive function as well as five cognitive domains. We adjusted for demographics and for factors known to be associated with cognitive function and decline including vascular risk factors, discrimination, and income. RESULTS The trait of high-effort active coping was associated with lower-average cognitive function ( β = -0.07, 95% confidence interval = -0.10 to -0.03), but not with decline. The results remained after further adjustment for experiences of discrimination, income, and vascular risk factors. In domain-specific analyses, we found that the JHACS was associated with baseline levels of working memory, semantic memory, and visuospatial ability, but not decline. CONCLUSIONS These results highlight the importance of using culturally specific measures in considering the heterogeneity of cognitive health outcomes in minoritized populations. Understanding how stress responses relate to late-life cognition among older Black adults could help promote aspects of behavioral resilience along with healthful coping responses.
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Affiliation(s)
- V. Eloesa McSorley
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Howard
- Department of Psychology, Utah State Hospital
- Department Brigham Young University
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Family Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Bryan D. James
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Patricia Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
- Department Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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21
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Examining the associations between PTSD symptom clusters and alcohol-related problems in a sample of low-SES treatment-seeking Black/African American adults. J Psychiatr Res 2022; 154:261-267. [PMID: 35963024 PMCID: PMC9481727 DOI: 10.1016/j.jpsychires.2022.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often co-occur. This comorbidity negatively influences treatment outcomes, functioning, and quality of life. To better understand the relation between PTSD and AUD, research has begun to examine the influence of PTSD symptom clusters on alcohol-related problems. The current study is the first to analyze the associations between PTSD symptom clusters and alcohol consumption and AUD symptom severity in a treatment-seeking sample of Black/African American (AA) adults with co-occurring AUD and PTSD symptoms. Examination of these associations may help to facilitate greater recovery in this underserved population by identifying more precise targets for treatment. PTSD symptom clusters were identified from both the current 4-factor model identified in the DSM-5 and from a recently proposed 7-factor model. Participants were Black/AA adults (50.6% male) who endorsed trauma exposure and were seeking treatment for alcohol misuse. The majority (66%) were unemployed and almost half (45%) reported an income at or lower than $20,000. In the 4-factor model, results showed Cluster D symptoms of PTSD (i.e., negative alterations in cognitions and mood) were independently associated with alcohol consequences. Use of the 7-factor model, which divides Cluster D into symptoms of negative affect and anhedonia, further demonstrated that only anhedonic symptoms were independently associated with alcohol consequences. No symptom clusters were uniquely associated with alcohol consumption. Results suggest the absence of positive emotions, rather than the presence of negative emotions, are primarily associated with alcohol-related problems in a sample of trauma-exposed, Black/AA adults seeking treatment for alcohol misuse.
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Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients. Pain Manag Nurs 2022; 23:424-429. [PMID: 35227646 PMCID: PMC9308655 DOI: 10.1016/j.pmn.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer. DESIGN A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information. SETTINGS Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. CONCLUSIONS Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (β = 0.6859), previous toothache pain (β = 0.0960), headache pain (β = 0.0549), and stomachache pain (β = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.
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Telusca N, Gaisey JN, Woods C, Khan JS, Mackey S. Strategies to Promote Racial Healthcare Equity in Pain Medicine: A Call to Action. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1225-1230. [PMID: 35412639 DOI: 10.1093/pm/pnac057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
In the past several years, many national events have illuminated the inequities faced by the Black community in all aspects of life, including healthcare. To close the gap in healthcare equity, it is imperative that clinicians examine their practices for disparities in the treatment of minority patients and for racial injustice and take responsibility for improving any issues. As leaders in pain medicine, we can start by improving our understanding of healthcare disparities and inequities among racial and ethnic minorities and translating that knowledge into a cultural transformation to improve the care of those impacted. In this paper, we identify the areas of medicine in which pain assessment and treatment are not equitably delivered. As we acknowledge these disparities, we will highlight reasons for these incongruences in care and clarify how clinicians can act to ensure that all patients are treated equitably, with equal levels of compassion.
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Affiliation(s)
- Natacha Telusca
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Juliet N Gaisey
- Department of Anesthesia, University of California, San Francisco, California, USA
| | - Charonn Woods
- Interventional Pain, Midwest Interventional Spine Specialists, Munster, Indiana, USA
| | - James S Khan
- Department of Anesthesia and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sean Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
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Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain. Pain Rep 2022; 7:e1020. [PMID: 35924081 PMCID: PMC9296181 DOI: 10.1097/pr9.0000000000001020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Despite well-documented pain disparities among adults from non-White and Hispanic groups, less is known about pain disparities in non-White and Hispanic pediatric populations. Objectives: We compare pain and related psychosocial factors at the individual (pain intensity, pain interference, pain catastrophizing, co-occurring symptoms), social (peer relations), and systemic (health insurance) levels among Hispanic and Non-Hispanic White (NHW) youth with chronic pain. Methods: Eight hundred thirty-seven (71.4% female) Hispanic (n = 268, 32%) and NHW (n = 569, 68%) youth ages 8 to 17 years (M = 14.00; SD = 2.54) completed a survey at their initial visit to a pain clinic. Independent sample t tests investigated mean differences in psychosocial factors at the individual and social levels. Chi-squared tests investigated differences at the systemic level. Bivariate correlations for each group were compared using Fisher r-to-z transformations. Results:. Hispanic youth reported higher levels of pain intensity (t[811] = −2.75, P = 0.006). Groups did not differ in reports of other individual or social factors. Non-Hispanic White youth were more likely to have private insurance (OR, 5.66). All examined variables were significantly correlated among NHW youth. Correlations were weaker or nonsignificant among Hispanic youth. Fisher r-to-z transformations revealed these group differences to be significant. Conclusion: Hispanic youth report higher pain levels than NHW counterparts and lower likelihood of having private insurance. Pain and psychosocial factors correlate differently among the 2 groups highlighting a need to better understand the chronic pain experiences of diverse youth because models derived primarily from NHW populations may not generalize across ethnic and racial groups.
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Wilson JM, Colebaugh CA, Flowers KM, Edwards RR, Schreiber KL. Profiles of Risk and Resilience in Chronic Pain: Loneliness, Social Support, Mindfulness, and Optimism Coming out of the First Pandemic Year. PAIN MEDICINE 2022; 23:2010-2021. [PMID: 35587150 PMCID: PMC9384018 DOI: 10.1093/pm/pnac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/03/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
Objective Individuals experience chronic pain differently, not only because of different clinical diagnoses, but also because of differing degrees of influence from biopsychosocial pain modulators. We aimed to cluster patients with chronic pain into distinct subgroups based on psychosocial characteristics and pain intensity, and we subsequently examined group differences in pain-related interference approximately 1 year later. Methods In this observational, longitudinal study, patients with chronic pain (n = 94) completed validated assessments of psychosocial characteristics and pain intensity at the beginning of COVID-19–related social distancing (April to June 2020). One year later (May to June 2021), patients completed a follow-up survey with assessments of pain interference, loneliness, social support, mindfulness, and optimism. Results A cluster analysis, using psychosocial factors and pain intensity, empirically produced three patient groups: 1) psychosocial predominant (PSP), characterized by high psychosocial distress and average pain intensity; 2) pain intensity predominant (PIP), characterized by average psychosocial distress and high pain intensity; and 3) less elevated symptoms (LES), characterized by low psychosocial distress and low pain intensity. At the 1-year follow-up, patients in the PSP and PIP clusters suffered greater pain interference than patients in the LES cluster, while patients in the PSP cluster also reported greater loneliness and lower mindfulness and optimism. Conclusions An empirical psychosocial-based clustering of patients identified three distinct groups that differed in pain interference. Patients with high psychosocial modulation of pain at the onset of social distancing (the PSP cluster) suffered not only greater pain interference but also greater loneliness and lower levels of mindfulness and optimism, which suggests some potential behavioral targets for this group in the future.
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Affiliation(s)
- Jenna M Wilson
- Correspondence to: Jenna M. Wilson, PhD, Department of Anesthesiology, Perioperative, and Pain Medicine,Brigham and Women’s Hospital, 45 Francis St, Boston, MA 02115, USA. Tel: 7813673972; E-mail:
| | - Carin A Colebaugh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Terry EL, Tanner JJ, Cardoso JS, Sibille KT, Lai S, Deshpande H, Deutsch G, Price CC, Staud R, Goodin BR, Redden DT, Fillingim RB. Associations between pain catastrophizing and resting-state functional brain connectivity: Ethnic/race group differences in persons with chronic knee pain. J Neurosci Res 2022; 100:1047-1062. [PMID: 35187703 PMCID: PMC8940639 DOI: 10.1002/jnr.25018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023]
Abstract
Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting-state functional connectivity in pain-related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non-Hispanic black (NHB) compared with non-Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting-state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community-dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting-state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self-reported greater clinical pain and pain catastrophizing (ps < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting-state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting-state functional connectivity.
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Affiliation(s)
- Ellen L. Terry
- College of Nursing, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Jared J. Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Josue S. Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Kimberly T. Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
- CTSI Human Imaging Core, University of Florida, Gainesville, Florida, USA
| | - Hrishikesh Deshpande
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Georg Deutsch
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
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Resnick B, Van Haitsma K, Kolanowski A, Galik E, Boltz M, Ellis J, Behrens L, Eshraghi K, Renn CL, Dorsey SG. Invariance of the PAINAD Scale Between the Black and White Residents Living With Dementia. FRONTIERS IN PAIN RESEARCH 2022; 2:757654. [PMID: 35295523 PMCID: PMC8915686 DOI: 10.3389/fpain.2021.757654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to test the reliability and validity of the Pain Assessment in Advanced Dementia (PAINAD) and particularly consider whether or not this measure was invariant when used among the Black and White residents. Baseline data from an implementation study testing that included a sample of 553 residents, 30% of who were Black, from 55 nursing were included in this study. The Winsteps statistical program was used to perform the Rasch analysis and evaluate the reliability and validity of the measure based on internal consistency, infit and outfit statistics, mapping, and a differential item functioning (DIF) analysis. The AMOS statistical program was used for confirmatory factor analysis. The findings supported the reliability and validity of the PAINAD when used with these individuals and demonstrated that there was no evidence of invariance between the Black and White residents. All the items fit the model, but there was not a good spread of the items across the pain level of the participants. The majority of the participants (75%) were so low in pain signs or symptoms that they could not be differentiated. Based on the clinical practice and observations, it is recommended that additional items can be added to the measure such as observing the individual for evidence of resisting care, retropulsion when trying to stand, hitting or kicking when turning in bed, hitting or kicking when transferring from bed to chair, hitting or kicking when ambulating, or hitting or kicking when raising arms, less engagement with others, and decreased participation in the activities previously enjoyed.
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Affiliation(s)
- Barbara Resnick
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | | | - Ann Kolanowski
- Pennsylvania State University, University Park, PA, United States
| | - Elizabeth Galik
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Marie Boltz
- Pennsylvania State University, University Park, PA, United States
| | - Jeanette Ellis
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Liza Behrens
- Pennsylvania State University, University Park, PA, United States
| | - Karen Eshraghi
- Pennsylvania State University, University Park, PA, United States
| | - Cynthia L Renn
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Susan G Dorsey
- Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, United States
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Yang Y, Reid MC, Grol-Prokopczyk H, Pillemer K. Racial-ethnic Disparities in Pain Intensity and Interference Among Middle-aged and Older U.S. Adults. J Gerontol A Biol Sci Med Sci 2022; 77:e74-e81. [PMID: 34265049 PMCID: PMC8824568 DOI: 10.1093/gerona/glab207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aims to better understand differing pain experiences across U.S. racial/ethnic subgroups by estimating racial-ethnic disparities in both pain intensity and domain-specific pain-related interference. To address this issue, we use a nationally representative sample of non-Hispanic White, non-Hispanic Black, and Hispanic adults ages 50+ who report recently experiencing pain. METHODS Using data from the 2010 wave of the Health and Retirement Study (HRS; N = 684), we conducted a series of multivariate analyses to assess possible racial/ethnic disparities in pain intensity and 7 domains of pain interference, controlling for relevant sociodemographic variables and other health problems. RESULTS Black and Hispanic participants reported higher pain intensity than White participants after controlling for socioeconomic status (SES) and other health conditions. Both Black and Hispanic individuals reported more domain-specific pain interference in bivariate analyses. In multivariate analyses, Black (vs White) participants reported significantly higher levels of pain interference with family-home responsibilities, occupation, sexual behavior, and daily self-care. We did not find significant Hispanic-White differences in the 7 pain interference domains, nor did we find Black-White differences in 3 domains (recreation, social activities, and essential activities). CONCLUSIONS Our findings highlight the need for using multidimensional measures of pain when assessing for possible pain disparities with respect to race/ethnicity. Future studies on pain interventions should consider contextualizing the pain experience across different racial subgroups to help pain patients with diverse needs, with the ultimate goal of reducing racial/ethnic disparities in pain.
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Affiliation(s)
- Yulin Yang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Karl Pillemer
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Human Development, Cornell University, Ithaca, New York, USA
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Culture and musculoskeletal pain: strategies, challenges, and future directions to develop culturally sensitive physical therapy care. Braz J Phys Ther 2022; 26:100442. [PMID: 36209626 PMCID: PMC9550611 DOI: 10.1016/j.bjpt.2022.100442] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/13/2022] [Accepted: 08/25/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural factors are often ignored. OBJECTIVE The aims of this Masterclass is threefold: (1) to discuss cultural influences on pain, (2) to provide strategies for delivering appropriate pain education and exercises in culturally diverse people with chronic pain, and (3) to present challenges and future directions to clinicians and researchers. DISCUSSION Cultural factors have a relevant influence on the way individuals experience and manage health and illness. Thus, people with different cultural experience perceive, respond, communicate and manage their pain in different ways. In this aspect, the contents of pain education should be presented using different culturally appropriate examples, metaphors, images, and delivery methods that may enhance the impact of the message. Efforts should be made to produce and spread culturally adapted evidence-based materials and resources. In addition, a culturally sensitive approach may help to introduce patients to graded activities, so that they can apply these strategies in culturally acceptable and meaningful ways. Future studies should investigate the effectiveness of culturally-adapted interventions in pain-related outcomes in different pain conditions in patients with different cultural backgrounds.
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Bomberg H, Lorenzana D, Schlickeiser J, Dünki A, Farshad M, Eichenberger U. [Noninvasive Treatments for Acute and Chronic Back Pain]. PRAXIS 2022; 111:797-813. [PMID: 36285410 DOI: 10.1024/1661-8157/a003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
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Affiliation(s)
- Hagen Bomberg
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - David Lorenzana
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - Jannis Schlickeiser
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | - Alexandro Dünki
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | | | - Urs Eichenberger
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
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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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Fullwood D, Gomez RN, Huo Z, Cardoso JS, Bartley EJ, Booker SQ, Powell-Roach KL, Johnson AJ, Sibille KT, Addison AS, Goodin BR, Staud R, Redden DT, Fillingim RB, Terry EL. A Mediation Appraisal of Catastrophizing, Pain-Related Outcomes, and Race in Adults With Knee Osteoarthritis. THE JOURNAL OF PAIN 2021; 22:1452-1466. [PMID: 34033964 PMCID: PMC8915407 DOI: 10.1016/j.jpain.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Abstract
The current cross-sectional study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis. Furthermore, this study examined mediation at 2-year follow-up. Participants included 187 community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee osteoarthritis. Participants completed several self-reported pain-related measures and pain catastrophizing subscale at baseline and 2-year follow-up. Non-Hispanic Black (NHB) adults reported greater pain, disability, and poorer functional performance compared to their non-Hispanic White (NHW) counterparts (Ps < .05). NHB adults also reported greater catastrophizing compared to NHW adults. Mediation analyses revealed that catastrophizing mediated the relationship between ethnicity/race and pain outcome measures. Specifically, NHB individuals reported significantly greater pain and disability, and exhibited lower levels of physical function, compared to NHW individuals, and these differences were mediated by higher levels of catastrophizing among NHB persons. Catastrophizing was a significant predictor of pain and disability 2-years later in both ethnic/race groups. These results suggest that pain catastrophizing is an important variable to consider in efforts to reduce ethnic/race group disparities in chronic pain. The findings are discussed in light of structural/systemic factors that may contribute to greater self-reports of pain catastrophizing among NHB individuals. PERSPECTIVE: The current study examines whether pain catastrophizing mediates the relationship between ethnicity/race and OA-related pain, disability, and functional impairment at baseline and during a 2-year follow-up period in non-Hispanic Black and non-Hispanic White adults with knee pain. These results point to the need for interventions that target pain catastrophizing.
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Affiliation(s)
- Dottington Fullwood
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Rebecca N Gomez
- University of Florida, College of Nursing, Gainesville, Florida
| | - Zhiguang Huo
- University of Florida, Department of Biostatistics, Gainesville, Florida
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Emily J Bartley
- University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, Florida
| | | | - Alisa J Johnson
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Kimberly T Sibille
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Adriana S Addison
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida
| | - Burel R Goodin
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida
| | - Roland Staud
- University of Florida, Department of Medicine, Gainesville, Florida
| | - David T Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Ellen L Terry
- University of Florida, College of Nursing, Gainesville, Florida; University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
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Hood AM, Kölbel M, Stotesbury H, Kawadler J, Slee A, Inusa B, Pelidis M, Howard J, Chakravorty S, Height S, Awogbade M, Kirkham FJ, Liossi C. Biopsychosocial Predictors of Quality of Life in Paediatric Patients With Sickle Cell Disease. Front Psychol 2021; 12:681137. [PMID: 34594262 PMCID: PMC8476744 DOI: 10.3389/fpsyg.2021.681137] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) refers to a group of inherited blood disorders with considerable morbidity that causes severe pain, reduces life expectancy, and requires significant self-management. Acute painful episodes are the hallmark of SCD, but persistent daily pain is also highly prevalent in this population. Characterising the impact and experience of SCD-related morbidity (i.e., sleep disruption, frequent emergency department visits, cognitive dysfunction) on health-related quality of life (HRQOL) requires multiple assessment methods to best capture the underlying mechanisms. To gain a greater understanding of the effect of common symptom categories on HRQOL and to determine potential pain coping targets, the present study investigated whether demographic, socioeconomic, sleepiness, pain burden, frequency of emergency department (ED) visits, and cognition predicted HRQOL in a paediatric sample of patients with SCD. Our study was a secondary analysis of baseline assessment data of children with SCD aged 8-15 years (n = 30) in the Prevention of Morbidity in Sickle Cell Anaemia Phase 2b (POMSb2) randomised controlled clinical trial of auto-adjusting continuous positive airways pressure. Patients completed cognitive testing (IQ, Processing Speed Index, Delis-Kaplan Executive Function Scale (DKEFS) Tower, Conner's Continuous Performance Test), sleepiness (Epworth Sleepiness Scale), and HRQOL (PedsQL Sickle Cell Module) at baseline. Patients reported pain burden (Sickle Cell Pain Burden Inventory-Youth) each month over 8 visits. Caregivers provided demographic information and reported their child's executive function (Behavioural Rating Inventory of Executive Function) at baseline. Data from our analysis demonstrated that demographic factors (i.e., age, gender, level of neighbourhood deprivation) and treatment variables (i.e., hydroxyurea use) did not independently predict HRQOL, and laboratory values (i.e., haemoglobin, haematocrit, mean oxygen saturation) were not significantly correlated with HRQOL (ps > 0.05). However, sleepiness, pain burden, ED visits, and executive dysfunction independently predicted HRQOL (R 2 = 0.66) with large effects (η2 = 0.16 to 0.32). These findings identify specific, measurable symptom categories that may serve as targets to improve HRQOL that are responsive to change. This knowledge will be useful for multimodal interventions for paediatric patients with SCD that include sleep management, pain coping strategies, and executive function training.
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Affiliation(s)
- Anna M Hood
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Kölbel
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie Kawadler
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - April Slee
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Baba Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Maria Pelidis
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom.,Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Subarna Chakravorty
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Sue Height
- Paediatric Haematology, King's College Hospital NHS Trust, London, United Kingdom
| | - Moji Awogbade
- Department of Haematological Medicine, King's College Hospital NHS Trust, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Department of Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- Department of Psychology, University of Southampton, Southampton, United Kingdom.,Paediatric Psychology, Great Ormond Hospital for Children NHS Foundation Trust, London, United Kingdom
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Associations of pain catastrophizing with pain-related brain structure in individuals with or at risk for knee osteoarthritis: Sociodemographic considerations. Brain Imaging Behav 2021; 15:1769-1777. [PMID: 33095381 DOI: 10.1007/s11682-020-00372-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Compelling evidence exists that non-Hispanic blacks (NHB) engage in pain catastrophizing (negatively evaluate one's ability to cope with pain) more often than non-Hispanic whites (NHW). Functional neuroimaging studies revealed that individuals with high levels of trait pain catastrophizing show increased cerebral responses to pain in several pain-related brain regions (e.g., insula, primary somatosensory cortex [S1]), but associations between brain structure and catastrophizing remain largely unexplored. The current investigation was conducted at the University of Florida and the University of Alabama at Birmingham. Participants were 129 community-dwelling adults with or at risk of knee osteoarthritis (OA). Participants completed the pain catastrophizing subscale of the Coping Strategies Questionnaire-Revised and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain intensity subscale. Magnetic Resonance Imaging data were obtained. MANOVA and Chi-Square analyses assessed sociodemographic/clinical differences stratified by ethnicity/race. Multivariate regression analyses with insula and somatosensory cortical thickness entered as dependent variables with catastrophizing and the interaction between catastrophizing and ethnicity/race as the independent variables. Covariates include education, body mass index, study site, and WOMAC pain (ethnicity/race was an additional covariate in non-stratified analyses). There were significant interactions between ethnicity/race, pain catastrophizing, and brain structure. Higher pain catastrophizing was associated with thinner S1 bilaterally (ps < .05) in NHW, but not NHB participants with or at risk for knee OA. These results suggest that pain catastrophizing might have differing effects on pain-related central pathways and may contribute to ethnic/race group differences in individuals with or at risk for knee OA.
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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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36
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Sharma S, Ferreira-Valente A, de C Williams AC, Abbott JH, Pais-Ribeiro J, Jensen MP. Group Differences Between Countries and Between Languages in Pain-Related Beliefs, Coping, and Catastrophizing in Chronic Pain: A Systematic Review. PAIN MEDICINE 2021; 21:1847-1862. [PMID: 32044980 PMCID: PMC7553014 DOI: 10.1093/pm/pnz373] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To evaluate the extent to which pain-related beliefs, appraisals, coping, and catastrophizing differ between countries, language groups, and country economy. Design Systematic review. Methods Two independent reviewers searched 15 databases without restriction for date or language of publication. Studies comparing pain beliefs/appraisals, coping, or catastrophizing across two or more countries or language groups in adults with chronic pain (pain for longer than three months) were included. Two independent reviewers extracted data and performed the quality appraisal. Study quality was rated as low, moderate, or high using a 10-item modified STROBE checklist. Effect sizes were reported as small (0.20–0.49), medium (0.50–0.79), or large (≥0.80). Results We retrieved 1,365 articles, read 42 potential full texts, and included 10 (four moderate-quality, six low-quality) studies. A total of 6,797 adults with chronic pain (33% with chronic low back pain) were included from 16 countries. Meta-analysis was not performed because of heterogeneity in the studies. A total of 103 effect sizes were computed for individual studies, some of which indicated between-country differences in pain beliefs, coping, and catastrophizing. Of these, the majority of effect sizes for pain beliefs/appraisal (60%; eight large, eight medium, and eight small), for coping (60%; seven large, 11 medium, and 16 small), and for catastrophizing (50%; two medium, one small) evidenced statistically significant between-country differences, although study quality was low to moderate. Conclusions In 50% or more of the studies, mean scores in the measures of pain beliefs and appraisals, coping responses, and catastrophizing were significantly different between people from different countries.
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Affiliation(s)
- Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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37
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Morales ME, Yong RJ. Racial and Ethnic Disparities in the Treatment of Chronic Pain. PAIN MEDICINE 2021; 22:75-90. [PMID: 33367911 DOI: 10.1093/pm/pnaa427] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To summarize the current literature on disparities in the treatment of chronic pain. METHODS We focused on studies conducted in the United States and published from 2000 and onward. Studies of cross-sectional, longitudinal, and interventional designs were included. RESULTS A review of the current literature revealed that an adverse association between non-White race and treatment of chronic pain is well supported. Studies have also shown that racial differences exist in the long-term monitoring for opioid misuse among patients suffering from chronic pain. In addition, a patient's sociodemographic profile appears to influence the relationship between chronic pain and quality of life. Results from interventional studies were mixed. CONCLUSIONS Disparities exist within the treatment of chronic pain. Currently, it is unclear how to best combat these disparities. Further work is needed to understand why disparities exist and to identify points in patients' treatment when they are most vulnerable to unequal care. Such work will help guide the development and implementation of effective interventions.
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Affiliation(s)
- Mary E Morales
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - R Jason Yong
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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38
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Haq N, McMahan VM, Torres A, Santos GM, Knight K, Kushel M, Coffin PO. Race, pain, and opioids among patients with chronic pain in a safety-net health system. Drug Alcohol Depend 2021; 222:108671. [PMID: 33810908 PMCID: PMC8687128 DOI: 10.1016/j.drugalcdep.2021.108671] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent changes in opioid prescribing practices in the US may exacerbate disparities in opioid access among Black compared to White patients. METHODS To evaluate racial disparities in opioid prescribing and stewardship, we used baseline data collected from 2017 to 2019 for a longitudinal cohort of patients with chronic non-cancer pain and a history of illicit substance use. Sociodemographic characteristics, pain, psychological distress, substance use, and opioid prescription practices were compared between Black and White participants. We conducted multivariable logistic regression with race as the outcome. We also compared yellow flag events (opioid-related emergency department visits, illicit substances on urine drug screens, provider-documentation of concerning behaviors) by race. RESULTS Over half of participants analyzed were Black (57%) and the remainder White (43%). Participants with worse average pain in the past three months (adjusted odds ratio [AOR]:1.29, 95%CI:1.08-1.55, p = 0.006) had higher odds of being Black. Past-year injection drug use (AOR:0.39, 95%CI:0.16-0.94, p = 0.04) and a higher past-year maximum opioid dose (AOR per 10 morphine milligram equivalents (MME):0.99, 95%CI:0.98-1.00, p = 0.006) were associated with lower odds of being Black. We found no differences by race in the use of opioid stewardship measures or discontinuation of opioids based on yellow flag events. CONCLUSION Lower past-year maximum MME dose, despite higher average pain and less injection drug use, may represent bias away from prescribing opioids for chronic pain among Black patients. This could be due to unmeasured implicit provider bias or patient-level factors (e.g., utilizing non-opioid pain coping strategies or being less likely to request additional opioids).
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Affiliation(s)
- Nimah Haq
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, USA.
| | - Vanessa M McMahan
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, USA
| | - Andrea Torres
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, USA
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, USA; University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Kelly Knight
- University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Margot Kushel
- University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, USA; University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
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Keeping hope alive: Racial-ethnic disparities in distress tolerance are mitigated by religious/spiritual hope among Black Americans. J Psychosom Res 2021; 144:110403. [PMID: 33730637 PMCID: PMC8919343 DOI: 10.1016/j.jpsychores.2021.110403] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/08/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
Racial and ethnic minorities, including Blacks/African-Americans and Hispanics/Latinos,indicate lower tolerance to psychological distress (DT) and secular hope yet endorse more religious and spiritual hope than their non-Hispanic White (NHW) counterparts. Whether racial-ethnic minorities derive greater benefit from non-secular hope on the tolerance of psychological distress remains unclear. Self-reported endorsement of religious/spiritual (R/S) hope, secular hope, DT, and a number of other psychosocial, R/S and sociodemographic variables were analyzed from a nationwide survey of persons aged over 18 years (N = 2875) identifying as Black (14.2%), Hispanic (15.4%), or NHW (67.3%) using multiple regression. Overall, higher levels of both R/S and secular hope predicted greater DT. In turn, greater DT was associated with lower psychosomatic distress. Compared to NHW, the ethnic-minority groups reported lower overall levels of DT. An interaction for race-ethnicity further revealed that compared to distress intolerant NHW, Blacks/African-Americans at lower levels of DT report higher R/S and secular hope. Hispanics/Latinos were also higher on R/S and secular hope, but endorsed lower hope at higher levels of DT than the reference group. Although hope is considered a more passive form of coping, it is more frequently endorsed in marginalized ethnic-minority groups. However, compared to NHW, differences do exist in the extent to which R/S hope mitigates DT in Blacks/African-Americans compared to Hispanics/Latinos.
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Axon DR, Le D. Association of Self-Reported Functional Limitations among a National Community-Based Sample of Older United States Adults with Pain: A Cross-Sectional Study. J Clin Med 2021; 10:1836. [PMID: 33922574 PMCID: PMC8122955 DOI: 10.3390/jcm10091836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023] Open
Abstract
The characteristics of self-reported functional limitations among older United States (US) adults with pain are currently unknown. This cross-sectional study aimed to determine the characteristics associated with functional limitations among non-institutionalized older (≥50 years) US adults with pain using 2017 Medical Expenditure Panel Survey (MEPS) data. Eligible subjects were alive for the calendar year, aged ≥50 years, and experienced pain within the past four weeks. Hierarchical logistic regression models were utilized to determine significant characteristics associated with functional limitations (outcome variable; yes, no). Functional limitations included difficulty with bending, stooping, climbing stairs, grasping objects, lifting, reaching overhead, standing for long periods of time, or walking. Extrapolation of national data values was possible by adjusting for the complex MEPS design. We found approximately 22 million of the 57 million older US adults (≥50 years) who reported pain had a functional limitation in 2017. Characteristics associated with functional limitations included: gender, race, ethnicity, employment status, marital status, pain intensity, physical health, number of chronic conditions, and frequent exercise status. Knowledge of characteristics associated with functional limitations may provide an opportunity to identify and resolve gaps in patient care among this population.
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Affiliation(s)
- David R. Axon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA;
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Ross V, Detterman C, Hallisey A. Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain. J Midwifery Womens Health 2021; 66:148-160. [PMID: 33788379 DOI: 10.1111/jmwh.13224] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.
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Affiliation(s)
- Vanessa Ross
- Baystate Midwifery and Women's Health, Baystate Medical Center, Springfield, Massachusetts.,Pioneer Women's Health, Baystate Franklin Medical Center, Greenfield, Massachusetts.,Brigham and Women's Midwifery Group, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carly Detterman
- Baystate Midwifery Education Program, Baystate Medical Center, Springfield, Massachusetts
| | - Anastasia Hallisey
- Baystate Midwifery Education Program, Baystate Medical Center, Springfield, Massachusetts
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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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Alamam DM, Leaver A, Alsobayel HI, Moloney N, Lin J, Mackey MG. Low Back Pain-Related Disability Is Associated with Pain-Related Beliefs Across Divergent Non-English-Speaking Populations: Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:2974-2989. [PMID: 33624814 DOI: 10.1093/pm/pnaa430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis examined relationships between low back pain (LBP)-related disability and pain beliefs, including pain catastrophizing, pain-related fear, self-efficacy, and back pain beliefs, in non-English-speaking populations. Additionally, the effects of selected cultural factors (i.e., language/geographic area) on the strength of relationships were examined. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases were searched. Studies included observational or randomized control clinical trials. Eligible studies had to report estimates of the association between pain beliefs and disability. Pooled estimates of correlation coefficients were obtained through random-effects meta-analysis methods. RESULTS Fifty-nine studies, (n = 15,383) were included. Moderate correlations were identified between disability and pain self-efficacy (chronic LBP r = -0.51, P ≤ 0.001), between disability and pain catastrophizing (acute LBP r = 0.47, P ≤ 0.001; chronic LBP r = 0.44, P ≤ 0.001), and also between disability and pain-related fear (chronic LBP r = 0.41, P ≤ 0.001). Otherwise, weak correlations were identified between disability and most pain beliefs (range r = -0.23 to 0.35, P ≤ 0.001). Pooled correlation coefficients between disability and all pain beliefs (except the Fear Avoidance Belief Questionnaire-Work subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back pain beliefs about the nature and cause of back pain. Results were consistent across most language groups and geographic regions; few studies reported ethnicity or religion. DISCUSSION LBP-related disability was associated with pain-related beliefs, with consistency demonstrated for each pain belief construct across divergent non-English-speaking populations. Further research examining cultural factors, such as ethnicity or religion, and with a more diverse population is warranted.
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Affiliation(s)
- Dalyah M Alamam
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia.,Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew Leaver
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Hana I Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney, Australia.,THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Jianhua Lin
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Martin G Mackey
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Matic M, de Hoogd S, de Wildt SN, Tibboel D, Knibbe CA, van Schaik RH. OPRM1 and COMT polymorphisms: implications on postoperative acute, chronic and experimental pain after cardiac surgery. Pharmacogenomics 2021; 21:181-193. [PMID: 31967515 DOI: 10.2217/pgs-2019-0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Investigate the potential role of OPRM1 (mu-opioid receptor) and COMT (catechol-O-methyltransferase enzyme) polymorphisms in postoperative acute, chronic and experimental thermal pain. Methods: A secondary analysis of 125 adult cardiac surgery patients that were randomized between fentanyl and remifentanil during surgery and genotyped. Results: Patients in the fentanyl group with the COMT high-pain sensitivity haplotype required less postoperative morphine compared with the average-pain sensitivity haplotype (19.4 [16.5; 23.0] vs 34.6 [26.2; 41.4]; p = 0.00768), but not to the low-pain sensitivity group (30.1 [19.1; 37.7]; p = 0.13). No association was found between COMT haplotype and other pain outcomes or OPRM1 polymorphisms and the different pain modalities. Conclusion: COMT haplotype appears to explain part of the variability in acute postoperative pain in adult cardiac surgery patients.
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Affiliation(s)
- Maja Matic
- Department of Clinical Chemistry, Erasmus MC - University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.,Intensive Care & Department of Paediatric Surgery, Erasmus MC - University Medical Center Rotterdam, Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Sjoerd de Hoogd
- Department of Clinical Pharmacy, St Antonius Hospital, Koekoeklaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Saskia N de Wildt
- Intensive Care & Department of Paediatric Surgery, Erasmus MC - University Medical Center Rotterdam, Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.,Department of Pharmacology & Toxicology, Radboud University, Nijmegen, The Netherlands
| | - Dick Tibboel
- Intensive Care & Department of Paediatric Surgery, Erasmus MC - University Medical Center Rotterdam, Sophia Children's Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Catherijne Aj Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, Koekoeklaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Ron Hn van Schaik
- Department of Clinical Chemistry, Erasmus MC - University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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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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Booker S, Herr K, Tripp-Reimer T. Patterns and Perceptions of Self-Management for Osteoarthritis Pain in African American Older Adults. PAIN MEDICINE 2020; 20:1489-1499. [PMID: 30541043 DOI: 10.1093/pm/pny260] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore and describe older African Americans' patterns and perceptions of managing chronic osteoarthritis pain. METHODS A convergent parallel mixed-methods design incorporating cross-sectional surveys and individual, semistructured interviews. SETTING One hundred ten African Americans (≥50 years of age) with clinical osteoarthritis (OA) or provider-diagnosed OA from communities in northern Louisiana were enrolled. RESULTS Although frequency varied depending on the severity of pain, older African Americans actively used an average of seven to eight self-management strategies over the course of a month to control pain. The average number of self-management strategies between high and low education and literacy groups was not statistically different, but higher-educated adults used approximately one additional strategy than those with high school or less. To achieve pain relief, African Americans relied on 10 self-management strategies that were inexpensive, easy to use and access, and generally perceived as helpful: over-the-counter (OTC) topicals, thermal modalities, land-based exercise, spiritual activities, OTC and prescribed analgesics, orthotic and assistive devices, joint injections, rest, and massage and vitamins. CONCLUSIONS This is one of the first studies to quantitatively and qualitatively investigate the self-management of chronic OA pain in an older African American population that happened to be a predominantly higher-educated and health-literate sample. Findings indicate that Southern-dwelling African Americans are highly engaged in a range of different self-management strategies, many of which are self-initiated. Although still an important component of chronic pain self-management, spirituality was used by less than half of African Americans, but use of oral nonsteroidal anti-inflammatory drugs and opioids was relatively high.
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Affiliation(s)
- Staja Booker
- Pain Research and Intervention Center of Excellence, The University of Florida, Gainesville, Florida
| | - Keela Herr
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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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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Hamilton JB, Kweon L, Brock LUB, Moore AD. The Use of Prayer During Life-Threatening Illness: A Connectedness to God, Inner-Self, and Others. JOURNAL OF RELIGION AND HEALTH 2020; 59:1687-1701. [PMID: 30949822 DOI: 10.1007/s10943-019-00809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.
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Affiliation(s)
- Jill B Hamilton
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Leslie Kweon
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA, 30322, USA
| | | | - Angelo D Moore
- Moore and Moore Healthcare Consulting, LLC, Durham, NC, USA
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Booker SQ, Tripp-Reimer T, Herr KA. "Bearing the Pain": The Experience of Aging African Americans With Osteoarthritis Pain. Glob Qual Nurs Res 2020; 7:2333393620925793. [PMID: 32548212 PMCID: PMC7271276 DOI: 10.1177/2333393620925793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022] Open
Abstract
Studies document that osteoarthritis-related joint pain is more severe in
African American older adults, but research on the personal experience
of osteoarthritis pain self-management in this population is limited.
Using a qualitative descriptive design, our objective was to extend
our understanding of the experience of life with osteoarthritis pain.
Eighteen African Americans (50 years and older) were recruited from
Louisiana to participate in a single semi-structured, in-depth
interview. A conventional content analysis revealed that “Bearing the
pain” characterized how older African Americans dealt with
osteoarthritis. Bearing the pain comprised three actions: adjusting to
pain, sharing pain with others, and trusting God as healer. We
discovered that a metapersonal experience subsumes the complex
biopsychosocial-cultural patterns and the intricate interaction of
self, others, and God in living with and managing osteoarthritis pain.
Study findings have implications for application of more inclusive
self-management frameworks and interventions.
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Perez BA, Slover J, Edusei E, Horan A, Anoushiravani A, Kamath AF, Nelson CL. Impact of gender and race on expectations and outcomes in total knee arthroplasty. World J Orthop 2020; 11:265-277. [PMID: 32477903 PMCID: PMC7243479 DOI: 10.5312/wjo.v11.i5.265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total joint arthroplasty is one of the most common surgeries performed in the United States with total knee arthroplasty (TKA) being one of the most successful surgeries for restoring function and diminishing pain. Even with the demonstrated success of TKA and a higher prevalence of arthritis and arthritis related disability among minorities, racial and gender disparity remains a constant issue in providing care for the adult reconstruction patient. AIM To assess the role of demographics and expectations on differences in perioperative patient reported outcomes (PRO) following TKA. METHODS One hundred and thirty-three patients scheduled for primary unilateral TKA secondary to moderate to severe osteoarthritis were enrolled in this two-institution prospective study. Validated PRO questionnaires were collected at four time points. Statistical analysis was conducted to determine the impact of gender, ethnic background and expectation surveys responses to assess PRO at these time points. RESULTS Females were associated with worse preoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, and activities of daily living. African Americans were associated with worse KOOS for pain, activities of daily living, and quality of life. Despite worse preoperative scores, no difference was noted in these categories between the groups postoperatively. Additionally, all pre-operative psychometric scales were equivalent across groups except Geriatric Depression scale, which was significantly different between groups within the Race and Age Group (P < 0.05). Conversely, Pain Catastrophizing Scale, was significantly different for all subscales and total score within Age Group (P < 0.05), and the Magnification, Helplessness subscales as well as the Total score were significantly different between groups for Race and Relationship Status (P < 0.01). CONCLUSION We conclude that female and African American patients have lower preoperative KOOS scores compared to white male patients. No postoperative differences in outcomes between these groups.
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Affiliation(s)
- Brian A Perez
- Department of Orthopedics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - James Slover
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY 10016, United States
| | - Emmanuel Edusei
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY 10016, United States
| | - Annamarie Horan
- Department of Orthopedics, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Afshin Anoushiravani
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY 10016, United States
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Charles L Nelson
- Department of Orthopedics, University of Pennsylvania, Philadelphia, PA 19104, United States
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