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Guzikevits M, Gordon-Hecker T, Rekhtman D, Salameh S, Israel S, Shayo M, Gozal D, Perry A, Gileles-Hillel A, Choshen-Hillel S. Sex bias in pain management decisions. Proc Natl Acad Sci U S A 2024; 121:e2401331121. [PMID: 39102546 DOI: 10.1073/pnas.2401331121] [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: 01/29/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Abstract
In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females' pain is stereotypically judged as less intense than males' pain, we hypothesize that there may be tangible differences in pain management decisions based on patients' sex. Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and ED variables. This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients' pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males. We argue that the findings reflect an undertreatment of female patients' pain. We discuss the troubling societal and medical implications of females' pain being overlooked and call for policy interventions to ensure equal pain treatment.
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Affiliation(s)
- Mika Guzikevits
- Hebrew University Business School, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Tom Gordon-Hecker
- Department of Business Administration, Ben-Gurion University of the Negev, Be'er-Sheva 8410501, Israel
| | - David Rekhtman
- The Department of Emergency Medicine, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Shaden Salameh
- The Department of Emergency Medicine, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Salomon Israel
- Psychology department, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Moses Shayo
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Economics department, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - David Gozal
- The University of Missouri School of Medicine, Columbia, MO 65201
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701
| | - Anat Perry
- Psychology department, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Alex Gileles-Hillel
- Pediatric Pulmonology Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem 9112001, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shoham Choshen-Hillel
- Hebrew University Business School, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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Rachoin JS, Debski N, Hunter K, Cerceo E. Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis. Palliat Med Rep 2024; 5:331-339. [PMID: 39144137 PMCID: PMC11319862 DOI: 10.1089/pmr.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care. Methods We performed a retrospective analysis of the National Inpatient Sample for patients discharged from January 1, 2016, to December 31, 2019, with conditions associated with frequently terminal conditions. We recorded demographic variables, do not resuscitate (DNR) status, and palliative care (PC) status and analyzed the associations between outcomes, mortality, and length of stay (LOS). Results A total of 23,402,637 patient records were included in the study, of which 2% were DNR and PC, 5% were DNR only, and 1% was PC only. From 2016 to 2019, the percentage of patients with PC increased from 2.55% to 3.27% and DNR from 6.31% to 7.7%. Black patients were less likely to have DNR status (odds ratio [OR] 0.72 [0.71-0.72]) but had similar PC rates. Male patients were less likely to have a DNR order in place (OR 0.89 [0.89-0.89]) but more likely to be in PC (OR 1.05 [1.04-1.05]). The diagnoses with the highest association with DNR status were lung cancer (OR 4.1 [4.0-4.5]), pancreatic cancer (OR 4.6 [4.5-4.7]), and sepsis (OR 2.9 [2.9-2.9]) The diagnoses most associated with PC were lung cancer (OR 6.3 [6.2-6.4]), pancreatic cancer (OR 8.1 [7.1-8.3]), colon cancer (OR 4.9 [4.8-5.1]), and senile brain degeneration of the brain OR 6.5 [5.3-7.9]). Mortality and LOS decreased between 2016 and 2019, but hospital charges increased (p < 0.001). Black race and male gender were associated with higher inpatient mortality (OR 1.12 [1.12-1.14]), LOS, and hospital charges. Conclusion In the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nicole Debski
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Elizabeth Cerceo
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Schneider P, Lautenbacher S, Kunz M. Sex differences in facial expressions of pain: results from a combined sample. Pain 2024; 165:1784-1792. [PMID: 38334501 PMCID: PMC11247450 DOI: 10.1097/j.pain.0000000000003180] [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: 07/15/2023] [Revised: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024]
Abstract
ABSTRACT Facial expressions of pain play an important role in pain diagnostics and social interactions. Given the prominent impact of sex on various aspects of pain, it is not surprising that sex differences have also been explored regarding facial expressions of pain; however, with inconclusive findings. We aim to further investigate sex differences in facial expressions of pain by using a large, combined sample to maximize statistical power. Data from 7 previous studies of our group were merged, combining in total the data of 392 participants (male: 192, female: 200). All participants received phasic heat pain, with intensities being tailored to the individual pain threshold. Pain intensity ratings were assessed, and facial responses were manually analyzed using the Facial Action Coding. To compare facial and subjective responses between sexes, linear mixed-effects models were used, with study ID as a random effect. We found significant sex differences in facial responses, with females showing elevated facial responses to pain, although they received lower physical heat intensities (women had lower pain thresholds). In contrast, pain intensity ratings did not differ between sexes. Additionally, facial and subjective responses to pain were significantly associated across sexes, with females showing slightly stronger associations. Although variations in facial expressions of pain are very large even within each sex, our findings demonstrate that women facially communicate pain more intensively and with a better match to their subjective experience compared with men. This indicates that women might be better in using facial communication of pain in an intensity-discriminative manner.
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Affiliation(s)
- Pia Schneider
- Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
| | - Stefan Lautenbacher
- Bamberger Living Lab Dementia (BamLiD), University of Bamberg, Bamberg, Germany
| | - Miriam Kunz
- Department of Medical Psychology and Sociology, University of Augsburg, Augsburg, Germany
- Bamberger Living Lab Dementia (BamLiD), University of Bamberg, Bamberg, Germany
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Dueñas M, De Sola H, Salazar A, Esquivia A, Rubio S, Failde I. Prevalence and epidemiological characteristics of chronic pain in the Spanish population. Results from the pain barometer. Eur J Pain 2024. [PMID: 39046161 DOI: 10.1002/ejp.4705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Chronic pain (CP) is a public health problem worldwide. AIM To update the prevalence of CP and compare the clinical and social characteristics of people with CP with those with non-chronic continuous pain and a group without pain. METHODS An observational cross-sectional study was carried out in a representative sample of 7058 adults from the Spanish population. Sociodemographic data, the presence of CP and non-chronic continuous pain, characteristics of pain, limitations on activities of daily living (ADL), the presence and level of anxiety and depression (HADS), quality of life (SF-12v2) and social support (DUKE) were collected. Descriptive and bivariate analyses were performed. RESULTS The prevalence of CP was 25.9% (95% CI;24.8-26.9) and that of non-chronic continuous pain was 7.7% (95% CI;7.1-8.3). Women presented a higher prevalence of both CP (30.5% vs. 21.3%) and non-chronic continuous pain (8.8% vs. 6.6%). CP was more common in the group between 55 and 75 years old (30.6%, 95% CI = 28.6-32.6%), non-chronic continuous pain affected most the population between 18 and 34 years old (11.2%, 95% CI = 9.6-12.7%). The median duration of CP was 4 years. The lumbar was the most frequent pain site (58.1%), and 27.1% did not know the cause. A greater frequency of limitations on ADL, more anxiety and depression, and worse quality of life were shown among the subjects with CP. CONCLUSION CP affects one in four Spanish people and impairs the mental, physical and social health. Differences exist by sex and age in its frequency. Identifying subjects with non-chronic continuous pain is fundamental to prevent their pain from becoming chronic. SIGNIFICANCE STATEMENT Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Due to its high prevalence and impact on quality of life, chronic pain has become one of the main health problems nowadays. Attention must be paid to it both from a clinical and social perspective, trying to raise awareness among the population of its possible causes and consequences. In routine clinical practice, greater consideration is given to groups of people with a higher prevalence of chronic pain, such as women and people with middle age, and with no chronic pain to prevent the appearance of chronic pain.
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Affiliation(s)
- M Dueñas
- Observatory of Pain, Grünenthal Foundation-University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
- Department of Statistics and Operational Research, University of Cádiz, Puerto Real, Spain
| | - H De Sola
- Observatory of Pain, Grünenthal Foundation-University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
- Department of General Economics, Area of Sociology, University of Cádiz, Jerez de la Frontera, Spain
| | - A Salazar
- Observatory of Pain, Grünenthal Foundation-University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
- Department of Statistics and Operational Research, University of Cádiz, Puerto Real, Spain
| | - A Esquivia
- Medical Department, Grünenthal Pharma, S.A, San Blas-Canillejas, Spain
| | - S Rubio
- Market Access Department, Grünenthal Pharma, S.A, San Blas-Canillejas, Spain
| | - I Failde
- Observatory of Pain, Grünenthal Foundation-University of Cadiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cádiz, Spain
- Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain
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Puto G, Repka I, Gniadek A. Gender differences in the quantitative and qualitative assessment of chronic pain among older people. Front Public Health 2024; 12:1344381. [PMID: 38915749 PMCID: PMC11194344 DOI: 10.3389/fpubh.2024.1344381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
Background Pain, regardless of its causes, is a subjective and multidimensional experience that consists of sensory, emotional and cognitive factors that cannot be adequately captured by a single number on a pain scale. The aim of the study was to understand gender differences in the assessment of quantitative and qualitative chronic pain among older people. Methods The study used a questionnaire that included questions about demographic and social characteristics as well as the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Depression Scale (GDS-15), McGill Pain Questionnaire (MPQ). Results The pain rating index based on rank values of adjectives was higher among women than men (18.36 ± 7.81 vs. 17.17 ± 9.69, p = 0.04). The analysis of the frequency of selection of individual adjectives describing the sensory aspects of pain showed that men described the pain as "stabbing" more often than women (26.1% vs. 14.3%, p < 0.05). Women chose adjectives from the emotional category more often than men (59.8% vs. 75.4%, p < 0.05), describing the pain as "disgusting" (8.9% vs. 1.4%, p < 0.05), "unbearable" (19.6 vs. 4.3, p < 0.05). In the subjective category, there was a difference between women and men in terms of describing pain as "terrible" (23.2% vs. 7.2%, p < 0.05) and as "unpleasant" (11.6% vs. 23.3%, p < 0 0.05). Conclusion When referring to pain, women tend to employ more detailed and factual language, indicative of heightened emotional sensitivity. Men tend to use fewer words and focus on the sensory aspects of pain. Subjective aspects of pain were demonstrated by both women and men.
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Affiliation(s)
- Grażyna Puto
- Faculty of Health Sciences, Institute of Nursing and Midwifery, Jagiellonian University Medical College, Cracow, Poland
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Conway A, Li J, Rad MG, Mafeld S, Taati B. Automating sedation state assessments using natural language processing. J Nurs Scholarsh 2024. [PMID: 38532639 DOI: 10.1111/jnu.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Common goals for procedural sedation are to control pain and ensure the patient is not moving to an extent that is impeding safe progress or completion of the procedure. Clinicians perform regular assessments of the adequacy of procedural sedation in accordance with these goals to inform their decision-making around sedation titration and also for documentation of the care provided. Natural language processing could be applied to real-time transcriptions of audio recordings made during procedures in order to classify sedation states that involve movement and pain, which could then be integrated into clinical documentation systems. The aim of this study was to determine whether natural language processing algorithms will work with sufficient accuracy to detect sedation states during procedural sedation. DESIGN A prospective observational study was conducted. METHODS Audio recordings from consenting participants undergoing elective procedures performed in the interventional radiology suite at a large academic hospital were transcribed using an automated speech recognition model. Sentences of transcribed text were used to train and evaluate several different NLP pipelines for a text classification task. The NLP pipelines we evaluated included a simple Bag-of-Words (BOW) model, an ensemble architecture combining a linear BOW model and a "token-to-vector" (Tok2Vec) component, and a transformer-based architecture using the RoBERTa pre-trained model. RESULTS A total of 15,936 sentences from transcriptions of 82 procedures was included in the analysis. The RoBERTa model achieved the highest performance among the three models with an area under the ROC curve (AUC-ROC) of 0.97, an F1 score of 0.87, a precision of 0.86, and a recall of 0.89. The Ensemble model showed a similarly high AUC-ROC of 0.96, but lower F1 score of 0.79, precision of 0.83, and recall of 0.77. The BOW approach achieved an AUC-ROC of 0.97 and the F1 score was 0.7, precision was 0.83 and recall was 0.66. CONCLUSION The transformer-based architecture using the RoBERTa pre-trained model achieved the best classification performance. Further research is required to confirm the that this natural language processing pipeline can accurately perform text classifications with real-time audio data to allow for automated sedation state assessments. CLINICAL RELEVANCE Automating sedation state assessments using natural language processing pipelines would allow for more timely documentation of the care received by sedated patients, and, at the same time, decrease documentation burden for clinicians. Downstream applications can also be generated from the classifications, including for example real-time visualizations of sedation state, which may facilitate improved communication of the adequacy of the sedation between clinicians, who may be performing supervision remotely. Also, accumulation of sedation state assessments from multiple procedures may reveal insights into the efficacy of particular sedative medications or identify procedures where the current approach for sedation and analgesia is not optimal (i.e. a significant amount of time spent in "pain" or "movement" sedation states).
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Affiliation(s)
- Aaron Conway
- School of Nursing, QUT (Queensland University of Technology), Brisbane, Queensland, Australia
| | - Jack Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Goudarzi Rad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Babak Taati
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
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Keogh E, Boerner KE. Challenges with embedding an integrated sex and gender perspective into pain research: Recommendations and opportunities. Brain Behav Immun 2024; 117:112-121. [PMID: 38145854 DOI: 10.1016/j.bbi.2023.12.027] [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] [Received: 04/21/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
The focus of this article, within this BBI horizons special issue, is on sex, gender, and pain. We summarise what is currently known about sex- and gender-related variations in pain, exploring intersectional biological and psychosocial mechanisms, and highlight gaps in knowledge and understanding. Five key challenges with the exploration of sex and gender in pain research are presented, relating to: conceptual imprecision, research bias, limitations with binary descriptions, integrating sex and gender, and timely adoption/implementation of good research practice. Guidance on how to overcome such challenges is provided. Despite clear evidence for sex and gender differences in pain, there are conceptual and methodological barriers to overcome. Innovation in methods and approach can help develop more effective and tailored treatment approaches for men, women, boys, girls, and gender-diverse people.
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Affiliation(s)
- Edmund Keogh
- Bath Centre for Pain Research & Department of Psychology, University of Bath, UK.
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Bögli SY, Stretti F, Utebay D, Hitz L, Hertler C, Brandi G. Limitation of life sustaining measures in neurocritical care: sex, timing, and advance directive. J Intensive Care 2024; 12:3. [PMID: 38225647 PMCID: PMC10790395 DOI: 10.1186/s40560-023-00714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The limitation of life sustaining treatments (LLST) causes ethical dilemmas even in patients faced with poor prognosis, which applies to many patients admitted to a Neurocritical Care Unit (NCCU). The effects of social and cultural aspects on LLST in an NCCU population remain poorly studied. METHODS All NCCU patients between 01.2018 and 08.2021 were included. Medical records were reviewed for: demographics, diagnosis, severity of disease, and outcome. Advance directives (AD) and LLST discussions were reviewed evaluating timing, degree, and reason for LLST. Social/cultural factors (nationality, language spoken, religion, marital status, relationship to/sex of legal representative) were noted. Associations between these factors and the patients' sex, LLST timing, and presence of AD were evaluated. RESULTS Out of 2975 patients, 12% of men and 10.5% of women underwent LLST (p = 0.30). Women, compared to men, more commonly received withdrawal instead of withholding of life sustaining treatments (57.5 vs. 45.1%, p = 0.028) despite comparable disease severity. Women receiving LLST were older (73 ± 11.7 vs. 69 ± 14.9 years, p = 0.005) and often without a partner (43.8 vs. 25.8%, p = 0.001) compared to men. AD were associated with female sex and early LLST, but not with an increased in-hospital mortality (57.1 vs. 75.2% of patients with and without AD respectively). CONCLUSIONS In patients receiving LLST, the presence of an AD was associated with an increase of early LLST, but not with an increased in-hospital mortality. This supports the notion that the presence of an AD is primarily an expression of the patients' will but does not per se predestine the patient for an unfavorable outcome.
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Affiliation(s)
- Stefan Yu Bögli
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Federica Stretti
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Didar Utebay
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Ladina Hitz
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute for Intensive Care Medicine, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
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Therapeutic alliance impact on analgesic outcomes in a real-world clinical setting: An observational study. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2022; 72:529-545. [PMID: 36651362 DOI: 10.2478/acph-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/20/2023]
Abstract
A good therapeutic alliance is relevant for healthcare providers exposed to patients' suffering, especially since patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world interdisciplinary pain unit (PU). A cross-sectional observational study was conducted on outpatients (n = 69) using opioids on a long-term basis for the treatment of chronic non-cancer pain, where clinical pharmacologists and pharmacists advised patients about their opioid treatment. Responses to the patient-doctor relationship questionnaire (PDRQ), sociodemographic and clinical information (pain level, quality of life and hospital use) were collected, whereas pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Patients were predominantly middle-aged (75 % women, 72 % retired), experiencing moderate pain (VAS 40-70 mm) on average, and under a high morphine equianalgesic dosage (95 ± 88 mg per day, mainly tapentadol or fentanyl). Patients with better PDRQ outcomes, and therefore better therapeutic alliance, showed lower pain intensity than patients with worse PDRQ outcomes (pain intensity: high scores 60 ± 47 mm and medium scores 60 ± 45 mm vs. low scores 80 ± 75 mm, p < 0.01). Along with this, pain intensity was lower when patients affirmed that, thanks to the health-care providers, they "gained new insight", "felt better", or "felt content with their doctor's treatment". What´s more, patients who affirmed "I benefit from the treatment" experienced increased pain relief (benefit 40 ± 30 vs. non-benefit 19 ± 26 mm, p = 0.010) and improved quality of life (benefit 33 ± 25 vs. non-benefit 18 ± 16 mm, p = 0.031). However, there was a percentage of patients who did not fully understand the provided information, which is something to be taken into account to improve in clinical routine. Therapeutic alliance supported by pharmacist experts on pain management can be an effective strategy to improve analgesic outcomes. Further efforts are needed to improve communication strategies for pain management. Future directions of research should include the analysis of the role of the pharmacist in poly-professional consultations as related to the advice of patients about their medication, and the mutual trust with the patients.
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Abstract
Objective: Traditional gender norms and expectations may
disproportionately constrain in-home palliative care received by women. This
scoping review aims to canvass and evaluate the literature on gender disparities
in end of life care and explore relevant themes that could inform future
research and practice. Methods: A systematic search of MEDLINE,
OVID, COCHRANE, and EMBASE was conducted using MeSH terms palliative care,
palliative medicine, terminal care, or hospice care, combined with gender
equity, sex factors, sexism, or gender disparities. Articles were limited to
those in English (2010 to 2021), focusing on end of life care, gender roles,
patients, and caregivers. Results: Of 624 articles identified, 15
met inclusion criteria for critical appraisal using the AMSTAR checklist for
systematic reviews and NICE guidelines for quantitative and qualitative studies.
Most studies were of poor to moderate quality. Thematic analyses identified 6
major themes related to gender disparities: living situation, symptom
experience, care context, care preferences, caregiving, and coping strategies.
Conclusion: Larger scale research of better quality is needed
to fully characterize gender disparities in end of life care and understand how
physicians might mitigate these disparities by building awareness of personal
gender biases, providing support to families, educating them, and initiating
care discussions that overturn traditional and stereotypic gendered
expectations.
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Affiliation(s)
- Annette D Wong
- Department of Family Medicine, 4257Queen's University, Kingston, Ontario, Canada
| | - Susan P Phillips
- Department of Family Medicine, 4257Queen's University, Kingston, Ontario, Canada
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11
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Sex and gender differences in pain: past, present, and future. Pain 2022; 163:S108-S116. [PMID: 36099334 DOI: 10.1097/j.pain.0000000000002738] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/18/2022] [Indexed: 12/30/2022]
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Berger SE, Baria AT. Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches. FRONTIERS IN PAIN RESEARCH 2022; 3:896276. [PMID: 35721658 PMCID: PMC9201034 DOI: 10.3389/fpain.2022.896276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Pain research traverses many disciplines and methodologies. Yet, despite our understanding and field-wide acceptance of the multifactorial essence of pain as a sensory perception, emotional experience, and biopsychosocial condition, pain scientists and practitioners often remain siloed within their domain expertise and associated techniques. The context in which the field finds itself today-with increasing reliance on digital technologies, an on-going pandemic, and continued disparities in pain care-requires new collaborations and different approaches to measuring pain. Here, we review the state-of-the-art in human pain research, summarizing emerging practices and cutting-edge techniques across multiple methods and technologies. For each, we outline foreseeable technosocial considerations, reflecting on implications for standards of care, pain management, research, and societal impact. Through overviewing alternative data sources and varied ways of measuring pain and by reflecting on the concerns, limitations, and challenges facing the field, we hope to create critical dialogues, inspire more collaborations, and foster new ideas for future pain research methods.
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Affiliation(s)
- Sara E. Berger
- Responsible and Inclusive Technologies Research, Exploratory Sciences Division, IBM Thomas J. Watson Research Center, Yorktown Heights, NY, United States
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Biroli P, Bosworth S, Della Giusta M, Di Girolamo A, Jaworska S, Vollen J. Family Life in Lockdown. Front Psychol 2021; 12:687570. [PMID: 34421738 PMCID: PMC8371690 DOI: 10.3389/fpsyg.2021.687570] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
The lockdown imposed following the COVID-19 pandemic of spring 2020 dramatically changed the daily lives and routines of millions of people worldwide. We analyze how such changes contributed to patterns of activity within the household using a novel survey of Italian, British, and American families in lockdown. A high percentage report disruptions in the patterns of family life, manifesting in new work patterns, chore allocations, and household tensions. Though men have taken an increased share of childcare and grocery shopping duties, reallocations are not nearly as stark as disruptions to work patterns might suggest, and families having to reallocate duties report greater tensions. Our results highlight tightened constraints budging up against stable and gendered patterns of intra-household cooperation norms. While the long-run consequences of the COVID-19 lockdown on family life cannot be assessed at this stage, we point toward the likely opportunities and challenges.
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Affiliation(s)
- Pietro Biroli
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Steven Bosworth
- Department of Economics, University of Reading, Reading, United Kingdom
| | | | - Amalia Di Girolamo
- Department of Economics, University of Birmingham, Birmingham, United Kingdom
| | - Sylvia Jaworska
- Department of English Language and Applied Linguistics, University of Reading, Reading, United Kingdom
| | - Jeremy Vollen
- Department of Economics, University of Zurich, Zurich, Switzerland
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14
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Staats K, Christensen K, Grov EK, Husebø BS, Tranvåg O. Healthcare professionals' perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway. J Women Aging 2021; 34:567-581. [PMID: 34280081 DOI: 10.1080/08952841.2021.1946375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Municipal end-of-life care for older home-dwelling patients with cancer is a complex matter requiring healthcare professionals (HCPs) to recognize gender differences in a social, historical and organizational context. A qualitative approach was chosen to explore and identify HCPs value-based principles and organizational conditions promoting dignity-preserving care practice for these women. HCPs recognized the importance of sheltering the women's identity, their sense of being home and acknowledged their personal preferences as value-based principles, whereas creating a flexible culture of care, establishing a functional professional collaboration and developing individualized plans of care, were crucial organizational conditions influencing the practice of dignity-preserving care.
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Affiliation(s)
- Katrine Staats
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Karen Christensen
- Department of People and Technology, Centre for Health Promotion Research, Roskilde, Denmark.,Department of Sociology, University of Bergen, Bergen, Norway
| | - Ellen Karine Grov
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Bettina S Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Oscar Tranvåg
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway
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15
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Cianelli R, Villegas N, Lewis-Pierre L, Valdes B, Iriarte E. Predictors of End of Life Discussions Among Minority Older Women Living With HIV Infection. Am J Hosp Palliat Care 2020; 38:583-589. [PMID: 33213192 DOI: 10.1177/1049909120971826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among the 39,782 newly HIV diagnosed individuals in the U.S., 17% were aged 50+. Although premature aging, morbidity, and mortality are issues for older people living with HIV that threaten their quality of life, less attention has been focused on end of life (EOL) discussions. OBJECTIVES To examine predictors of EOL discussions with significant others, family members, and friends. METHODS Cross-sectional design was used for this study guided by the The Socio Ecological Model (SEM). Sample: 119 Black and 19 Hispanic women aged 50+ living with HIV. RESULTS Predictors of EOL discussions were education, living with a partner, religiosity, and pain, which were at the individual-intrapersonal level of the SEM. DISCUSSION Findings from this study have important implications for health policy makers and clinicians because they cast a bright light on the substantial continued effort that is needed to improve EOL discussions. .
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Affiliation(s)
- Rosina Cianelli
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
| | - Natalia Villegas
- 16134University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - LaToya Lewis-Pierre
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Beatriz Valdes
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Evelyn Iriarte
- 5452University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA.,Pontificia Universidad Catolica de Chile Escuela de Enfermeria, Santiago, Chile
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16
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Abstract
Pain is a major source of global suffering, with women bearing the greatest burden. Alongside biology, psychological and social factors, including gender, help explain these differences. However, there has been no direct attempt to develop a unified social psychological model of men and women's pain. By drawing on approaches to both gender and pain, a gender context model of pain is presented. It proposes that pain is partly influenced by the gender context in which it occurs, which operates at both individual and interpersonal levels. The model is used to structure an appraisal of the existing evidence around gender and pain, and explore whether the model helps explain why such variation occurs. It is argued that despite evidence for an association between gender and pain, there are empirical gaps that need to be addressed. Implications and directions for future investigations into sex, gender and pain are considered.
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Affiliation(s)
- Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
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17
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Jones J, Hughes M, Pauling J, Gooberman-Hill R, Moore AJ. What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres. BMJ Open 2020; 10:e037568. [PMID: 32532783 PMCID: PMC7295424 DOI: 10.1136/bmjopen-2020-037568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Digital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing studies have specifically reported on the qualitative patient experience of DU pain, and our current patient-reported outcome measure (PROM) does not capture the multifaceted painful experience of SSc-DU. Our aim was to examine the patient experience of SSc-DU pain. DESIGN Focus groups with people diagnosed with SSc who had experienced DUs were conducted using a topic guide developed by people with SSc, experts in SSc and experienced qualitative researchers. Focus groups were continued until data saturation had been reached. The focus groups were audio recorded, transcribed verbatim, anonymised and analysed using inductive thematic analysis. Our current study is an integration of the data from these focus groups to specifically examine the patient experience of DU pain. SETTING Three specialist scleroderma units across the UK (Bath, Manchester and London). PARTICIPANTS Four focus groups were undertaken; 29 adults (20 women, 9 men) with SSc and a spectrum of historical DUs participated. We included participants with a diverse demographic (including ethnic) background and disease-related characteristics. RESULTS Five narrative devices were identified, which encompass how people describe the pain from SSc-DUs: 'Words to express DU-associated pain', 'Descriptions of physical and psychological reactions to pain', 'Comparisons with other painful events', 'Descriptions of factors that exacerbate pain' and 'Descriptions of strategies for coping with the pain'. CONCLUSION The experience of SSc-DU pain leads to the use of graphic language and rich description by participants in the focus group setting. Existing SSc-DU outcomes do not adequately capture the patient experiences of SSc-DU pain. Our findings further highlight the multifaceted nature of SSc-DUs and will hopefully support the development of a novel PROM to assess the severity and impact of SSc-DUs.
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Affiliation(s)
- Jennifer Jones
- Health Sciences, University of Leicester, Leicester, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Hughes
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Pauling
- Department Pharmacy and Pharmacology, University of Bath, Bath, UK
- Rheumatology Department, Royal National Hospital For Rheumatic Diseases NHS Foundation Trust, Bath, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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18
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Zvolensky MJ, Kauffman BY, Bogiaizian D, Viana AG, Bakhshaie J, Rogers AH, Peraza N. Worry Among Latinx Young Adults: Relations to Pain Experience, Pain-Related Anxiety, and Perceived Health. J Racial Ethn Health Disparities 2019; 6:981-989. [PMID: 31102101 DOI: 10.1007/s40615-019-00599-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/03/2019] [Accepted: 05/06/2019] [Indexed: 01/30/2023]
Abstract
Latinx are one of the largest and most rapidly growing segments of the United States (U.S.) population that is significantly impacted by health disparities, including somatic health problems. Young Latinx adults (ages 18-25 years) are at a greater risk for being affected by such health inequalities and there is a need to understand individual-based differences that may contribute to and maintain somatic symptoms, including pain experience, pain beliefs, and perceptions of health. Thus, the current study investigated the explanatory role of worry in association between pain intensity, pain disability, pain-related anxiety, and perceived health among Latinx college students. Participants included 401 (Mage = 21 years; SD = 2.02; 83% female) Latinx students at a large, southwestern university. Results indicated that greater levels of worry were related to increased levels of pain intensity, pain disability, pain-related anxiety, and lower levels of perceived health. These findings were evident above and beyond variance accounted for by gender, age, physical functioning, and subjective social status. Overall, the results from the present investigation suggest that there is greater risk for more severe pain experiences, maladaptive beliefs regarding pain, and worse perceptions of health status among Latinx young adults who experience elevated levels of worry.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Daniel Bogiaizian
- Psychotherapeutic Area of Asociación Ayuda, Anxiety Disorders Clinic, Buenos Aires, Argentina
| | - Andres G Viana
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Natalia Peraza
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
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