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De La Rosa JS, Brady BR, Herder KE, Wallace JS, Ibrahim MM, Allen AM, Meyerson BE, Suhr KA, Vanderah TW. The unmet mental health needs of U.S. adults living with chronic pain. Pain 2024:00006396-990000000-00671. [PMID: 39073375 DOI: 10.1097/j.pain.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/13/2024] [Indexed: 07/30/2024]
Abstract
ABSTRACT Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise-just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.
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Affiliation(s)
- Jennifer S De La Rosa
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Benjamin R Brady
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States
| | - Katherine E Herder
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jessica S Wallace
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Mohab M Ibrahim
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Departments of Anesthesiology
| | - Alicia M Allen
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Beth E Meyerson
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kyle A Suhr
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Psychiatry, and
| | - Todd W Vanderah
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Pichonnaz C, Ancey C, Mbarga J, Foley RA. Patients' expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations. Disabil Rehabil 2024; 46:1776-1786. [PMID: 37128151 DOI: 10.1080/09638288.2023.2205171] [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: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations. MATERIALS AND METHODS A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities. RESULTS Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back. CONCLUSION The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.
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Affiliation(s)
- Claude Pichonnaz
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Department of Musculoskeletal Medicine, University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Céline Ancey
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Josiane Mbarga
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Rose-Anna Foley
- Department of research and development, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Otón T, Carmona L, Rivera J. Patient-journey of fibromyalgia patients: A scoping review. REUMATOLOGIA CLINICA 2024; 20:96-103. [PMID: 38395498 DOI: 10.1016/j.reumae.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system. OBJECTIVES The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up. METHODS A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on "patient journey". Results were organized using a deductive classification of themes. RESULTS Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor-patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment. CONCLUSIONS This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Javier Rivera
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Otón T, Messina OD, Fernández Ávila DG, Robles San Román M, Mata D, Arguissain C, Galindo Guzmán JM, Pérez M, Carmona L. The patient journey of fibromyalgia in Latin America. REUMATOLOGIA CLINICA 2024; 20:32-42. [PMID: 38182526 DOI: 10.1016/j.reumae.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain.
| | - Osvaldo Daniel Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Unidad Docente de postgrado en Reumatología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel G Fernández Ávila
- Unidad de Reumatología, Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Darío Mata
- DOM Centro de Reumatología, Buenos Aires, Argentina
| | | | | | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain
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Adams H, MacDonald JE, Castillo AN, Pavilanis A, Truchon M, Achille M, Côté P, Sullivan MJL. Qualitative Examination of the Experience of Perceived Injustice Following Disabling Occupational Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10154-y. [PMID: 37996720 DOI: 10.1007/s10926-023-10154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The primary objective of this study was to explore individuals' perspectives on the factors, situations or events that contributed to their perceptions of injustice following occupational injury. MATERIALS AND METHODS The study sample consisted of 30 participants (18 women, 12 men) who had submitted a time-loss claim for a work-related musculoskeletal injury. Participants with elevated scores on a measure of perceived injustice were interviewed about the factors that contributed to their sense of injustice. A thematic analysis was conducted to identify the broad classes of situations or events that participants experienced as unjust in the weeks following occupational injury. RESULTS Three dominant themes emerged from the interviews: (1) Invalidation, (2) Undeserved suffering and (3) Blame. Inductively derived subthemes reflected specific dimensions of post-injury experiences that contributed to participants' sense of injustice. CONCLUSIONS Given that suffering and invalidating communication are potentially modifiable factors, there are grounds for optimism that intervention approaches can be developed to prevent or reduce perceptions of injustice in the aftermath of debilitating injury. The development of intervention approaches that are effective in preventing or reducing perceptions of injustice holds promise of contributing to more positive recovery outcomes in individuals who have sustained debilitating work injuries.
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Affiliation(s)
- Heather Adams
- School of Social Work, Dalhousie University, Halifax, NS, Canada
| | - Judy E MacDonald
- School of Social Work, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | - Michael J L Sullivan
- Department of Psychology, McGill University, 2001 McGill College Ave, Montreal, QC, H3A 1G1, Canada.
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Hintz EA. "It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions. HEALTH COMMUNICATION 2023; 38:2501-2515. [PMID: 35694781 DOI: 10.1080/10410236.2022.2081046] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.
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Melander S. Different logics of pain: the gendered dimension of chronic pain in a relational setting. Soc Sci Med 2023; 335:116229. [PMID: 37703783 DOI: 10.1016/j.socscimed.2023.116229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
This study aims to increase our understanding of the gendered dimension of living with chronic pain within a relational context. The empirical setting for this study is Sweden, a country widely recognised for its long history of gender equality. Interview responses from 21 women and 12 men were analysed using the feminist notion of the marriage contract, outlining the terms for women and men living together in a relationship. The result shows how living with chronic pain leads to processes of grief and altered priorities. Respondents emphasize the importance of equality. However, men and women apply different logics when deciding which tasks to prioritise. Although there is no distinct pattern regarding whether or not couples share housework equally, the allocation of responsibilities appears to follow a particular pattern: men tend to prioritise their rehabilitation to become good fathers, women are grateful and prioritise the family before her own well-being. The study indicates that while attitudes and the allocation of household chores may have changed in the past few decades, the marriage contract still restricts women from employment and rehabilitation.
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Affiliation(s)
- Stina Melander
- Department of Political Science, Lund University, Sweden.
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Tweedlie L, Simonds L, Hanna P, Lui DF. A narrative exploration of identity in adults with de novo scoliosis. Health (London) 2023; 27:701-718. [PMID: 35042399 PMCID: PMC10423435 DOI: 10.1177/13634593211067892] [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] [Indexed: 11/16/2022]
Abstract
Adult de novo scoliosis is a chronic health condition characterised by a curvature in the ageing spine. It can cause debilitating back pain and significant visible differences. Yet there has been very limited research on the psychological effects of this condition, particularly around identity. Therefore, we undertook semi-structured interviews to explore the ways in which individuals with scoliosis understood their identity. Findings from narrative analysis highlight the ways in which individuals negotiate their identity in relation to their social roles, their ability to control their condition and things around them, the extent to which their condition is visible and the extent to which they experienced physical pain from their condition. This article concludes by highlighting the relationship between identity and scoliosis and offers practical implications and suggestions for future research.
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Affiliation(s)
| | | | | | - Darren F Lui
- St George’s University Hospitals NHS Foundation Trust, UK
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Toye F, Dixon S, Izett-Kay M, Keating S, McNiven A. Exploring the experiences of people with urogynaecology conditions in the UK: a reflexive thematic analysis and conceptual model. BMC Womens Health 2023; 23:431. [PMID: 37580761 PMCID: PMC10426194 DOI: 10.1186/s12905-023-02592-w] [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: 03/07/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Urogynaecological conditions, such as pelvic organ prolapse, urinary incontinence, and urinary tract infection, can have a profound impact on people's lives. The Independent Medicines and Medical Devices Safety Review highlights missed opportunities to prevent harm when patient voices are not incorporated into healthcare policy and practice. This resonates with the Women's Health Strategy for England. The National Institute for Health and Care Research (NIHR) Policy Research Programme funded this in-depth qualitative exploration of people's experiences of living with urogynaecological conditions, and of seeking healthcare treatment, to inform health and social care improvements in the UK. METHODS We conducted in-depth interviews online or by telephone (April 2021-December 2021) and used reflexive thematic analysis to develop themes that cut across urogynaecological conditions. RESULTS We spoke to seventy-four adults aged 22-84 across a range of backgrounds and lived experiences of urogynaecological conditions, including pelvic organ prolapse, urinary incontinence and persistent or recurring urinary tract infection. Eight themes were developed: [1] I get no respite from my own body; [2] I feel confined and separated; [3] I can no longer be 'me'; [4] I am constrained by stigma, shame and silence; [5] I feel fragmented and lost in the healthcare system; [6] I need to be heard, believed, and valued; [7] I need respect as an equal partner in healthcare; and [8] (Re)connected to a more open community. CONCLUSIONS High quality care focuses on the whole person rather than their body parts. Openness and candour support a shared decision-making model of care. A culture of shame can have a negative impact on access to health care and recovery.
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Affiliation(s)
- F Toye
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, OX37HE, UK.
| | - S Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - M Izett-Kay
- Department of Urogynaecology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - S Keating
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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de Barra M, Hakimy K, de Bruin M. Signalling need for care: a neglected functional role of medical treatment. Evol Med Public Health 2023; 11:363-378. [PMID: 37899938 PMCID: PMC10611421 DOI: 10.1093/emph/eoad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/07/2023] [Indexed: 10/31/2023] Open
Abstract
Background and Objectives While the primary goals of medical treatment are typically to shorten illness or relieve symptoms, we explore the idea that an important additional goal for some patients is to communicate their needs. Drawing on signalling theory, we argue that undergoing treatments can help patients legitimize their illness and thereby enable access to crucial support during convalescence. Methods and Results Four pre-registered within-subjects experiments (n = 874) show that participants are more inclined to provide care to people who undergo treatment, especially when that treatment is painful. Results show this incentivizes the use of antibiotic treatments for viral infections as well as drug treatments for mental illness. A cross-sectional study of 194 chronic pain patients shows that those who experience stigma and doubt over the legitimacy of their illness are more likely to accept aversive treatments. Furthermore, two experiments (n = 653) indicate that subtle manipulations of one's sense of social support may increase willingness to accept treatment. Conclusions and Implications These results indicate that people make decisions to provide care in part based on the presence or absence of treatment and furthermore that patients' treatment decision-making is informed by the social consequences of their choices. Signalling theory may help explain the surprising longevity of some ineffective and costly medical procedures.
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Affiliation(s)
- Mícheál de Barra
- Centre for Culture and Evolution, Brunel University London, London, UK
| | - Kawthar Hakimy
- Division of Psychology, Brunel University London, London, UK
| | - Marijn de Bruin
- Health Psychology Group, University of Aberdeen, Aberdeen, UK
- Radboud University Medical Centre, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, Netherlands
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11
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Han ZY, Chen Y, Chen YD, Sun GM, Dai XY, Yin YQ, Geng YQ. Latent characteristics and influencing factors of stigma in rheumatoid arthritis: A latent class analysis. Medicine (Baltimore) 2023; 102:e34006. [PMID: 37335640 DOI: 10.1097/md.0000000000034006] [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: 06/21/2023] Open
Abstract
To explore the latent classes of stigma in patients with rheumatoid arthritis, we analyzed the characteristics of the different categories. Adopting a convenient sampling method, socio-demographic and disease-related information from the outpatient clinics and wards of 3 tertiary care hospitals in China was collected. The Chinese version of the Internalized Stigma of Mental Illness scale-Rheumatoid Arthritis was used in this survey. Rheumatoid arthritis stigma was divided into 3 potential categories: Low Stigma-Strong Resistance (83, 41.5%), Medium Stigma-Strong Alienation (78, 39.0%), and High Stigma-Weak Resistance (39, 19.5%). Unordered multinomial logistic regression analysis showed that pain (OR = 1.540, P = .005; OR = 1.797, P < .001), elementary school education and below (OR = 4.051, P = .037), and duration of morning stiffness (OR = 0.267, P = .032) were risk factors for stigma, whereas family history was a protective factor against stigma (OR = 0.321, P = .046). Patients with longer morning stiffness, more severe pain, and less education have a greater risk of heavier stigma. Strong alienation is an early warning of heavy stigma. Resistance to stigma and family support can help patients overcome their psychological obstacles. More attention should be paid to constructing family centered support systems to help resist stigma.
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Affiliation(s)
- Zi-Yin Han
- Department of Nursing, Nanjing Medical University, Jiangning District, Nanjing, China
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yong Chen
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - You-Di Chen
- Department of Nursing, Bengbu Medical College, Bengbu, China
| | - Guo-Min Sun
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiao-Ying Dai
- Department of Rheumatology, The First Affiliated Hospital of Wannan Medical College, Wuhan, China
| | - Yue-Qin Yin
- Department of Rheumatology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Ya-Qin Geng
- Department of Nursing, Nanjing Medical University, Jiangning District, Nanjing, China
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Bengbu Medical College, Bengbu, China
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Seppälä T, Finell E, Kaikkonen S. Making sense of the delegitimation experiences of people suffering from indoor air problems in their homes. Int J Qual Stud Health Well-being 2022; 17:2075533. [PMID: 35545878 PMCID: PMC9116269 DOI: 10.1080/17482631.2022.2075533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Little is known about the delegitimation experiences of people who associate their health problems with the indoor air quality of their homes (i.e., indoor air sufferers). From other contexts, it is known that people suffering from contested illnesses frequently report delegitimation from authorities and laypersons. Therefore, we analysed delegitimation experiences among indoor air sufferers, focusing on how they explain why others delegitimize them. Method Two types of qualitative data—semi-structured interviews with eight people and essays written by 28 people—were subjected to a thematic analysis. Results Thematic analysis revealed three themes: 1) lack of understanding; 2) others’ lack of morality; and 3) social discrimination and inequality. Conclusion This study demonstrates that indoor air sufferers are vulnerable as individuals and as a group, and suggests that authorities working with people suffering from indoor air problems in homes must pay more attention to sufferers’ ability/willingness to trust people and the system responsible for their care.
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Affiliation(s)
- Tuija Seppälä
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Eerika Finell
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Suvi Kaikkonen
- Department of Finnish, University of Helsinki, Helsinki, Finland
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Nicola M, Correia H, Ditchburn G, Drummond PD. Defining pain-validation: The importance of validation in reducing the stresses of chronic pain. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:884335. [PMID: 36313220 PMCID: PMC9614309 DOI: 10.3389/fpain.2022.884335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Purpose To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.
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14
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Social network change after new-onset pain among middle-aged and old European adults. Soc Sci Med 2022; 310:115215. [PMID: 36054986 PMCID: PMC9514133 DOI: 10.1016/j.socscimed.2022.115215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study examines how onset of chronic pain affects characteristics of personal social networks among adults aged 51+ across Europe. METHODS We used population-based data from the Survey of Health, Ageing and Retirement in Europe (SHARE; 2011-2015; n = 12,647). Using a change score analysis approach, we tracked changes in personal social networks of respondents experiencing new-onset chronic pain (n = 3803) compared to pain-free counterparts (n = 8844) in 11 European countries over four years. RESULTS Overall, consistent with network activation theory, respondents with new-onset mild-to-moderate chronic pain reported increases in sizes and diversity of their personal social networks, compared to their pain-free counterparts. However, consistent with the "pain as threat to the social self" theory, respondents with new-onset moderate pain or mild-to-moderate pain reported a decrease over time in perceived satisfaction and closeness with networks, respectively. Estimates from interactions between new-onset pain severity and sex show that men with new-onset pain experienced greater decreases in network satisfaction (mild pain) and closeness (severe pain) than did women. DISCUSSION This study highlights the complex social consequences of chronic pain, which may vary based on pain severity, gender, and type of social outcome considered.
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Ekl EA, Brooks CV. Take the Day Off: Examining the Sick Role for Chronic Back Pain by Race and Gender. SOCIAL PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1177/01902725221078541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has largely overlooked the public’s willingness to validate entrance to the sick role for individuals experiencing chronic pain. To fill this gap, we conducted a survey experiment to assess how race, gender, and their intersection impact (1) the legitimation of missing work due to pain and (2) recommendations for help seeking, examining the role of both respondents and vignette characters. We find that respondent characteristics are associated with perceived acceptability of missing work due to pain, and both respondent and vignette characteristics are associated with help-seeking endorsements. White females are least likely to view pain as an acceptable excuse to miss work but are most likely to endorse help-seeking measures, while black women are recommended the most treatments for pain. We theorize how results provide evidence to counter assumptions of objectivity and linearity of the sick role and how gender and race influence the social response to pain.
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16
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Andre L, Cavers D. 'A cry in the dark': a qualitative exploration of living with cluster headache. Br J Pain 2021; 15:420-428. [PMID: 34840790 DOI: 10.1177/2049463720976695] [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: 11/16/2022] Open
Abstract
Context Cluster headache is a rare primary headache disorder said to be one of the most painful conditions in existence. Limited evidence demonstrates cluster headache patients have difficulties securing a diagnosis and poor access to services. There is a gap in research around psychosocial needs, meaning there are no evidence-based guidelines to inform optimal management of this patient group in primary care. Objectives The aim of this study is to explore the perspectives of cluster headache patients in the United Kingdom in order to suggest ways their care can be improved. Methods It is an in-depth qualitative study involving telephone interviews with 15 participants with either chronic or episodic cluster headache. Semi-structured interviews (43-58 minutes) were conducted, recorded and transcribed verbatim. Two researchers conducted thematic analysis to identify themes. Results Participants described the impact cluster headache has on their quality of life. They also felt the legitimacy of their disorder was questioned. This situation was often exacerbated by a reported lack of awareness among General Practitioners (GPs), which negatively impacted their care in terms of diagnosis and access to treatments and specialists. They attempted to control the pain through treatments and avoiding triggers, often with detrimental consequences for their social contact and mental health. Conclusion Findings indicate the need to improve the lived experience of cluster headache patients in two key areas: (1) raising awareness of the disorder and its impact among GPs, and (2) extending care beyond clinical treatment provision, supporting patients in self-management and addressing its psychosocial impact, with implications for the management of this group in primary care.
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Affiliation(s)
| | - Debbie Cavers
- Medical School, The University of Edinburgh, Edinburgh, UK
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17
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Abstract
Chronic pain is a common, costly, and consequential health problem. However, despite some important analytic contributions, sociological research on pain has not yet coalesced into a unified subfield. We present three interrelated bodies of evidence and illustrative new empirical findings using 2010 to 2018 National Health Interview Survey data to argue that pain should have a central role in sociological investigations of health. Specifically, we contend that (1) pain is a sensitive barometer of population health and well-being, (2) pain is emblematic of many contested and/or chronic conditions, and (3) pain and pain treatment reflect and have wide-ranging implications for public policy. Overall, whether pain is analyzed quantitatively or qualitatively-focusing on its distribution in the population, its social causes and consequences, or its subjective meanings for individuals-pain reflects social conditions, sociopolitical context, and health-related beliefs of a society. Pain is thus an important frontier for future sociological research.
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18
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Hall KH, Amos C, Jaye C, Young J. Successful Psychological Strategies of Experienced Chronic Fatigue Patients: A Qualitative Study. J Patient Exp 2021; 8:23743735211034962. [PMID: 34395851 PMCID: PMC8358485 DOI: 10.1177/23743735211034962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Trying to care for patients with medically unexplained symptoms (MUS) can lead to frustration and disappointment for both patients and health care professionals alike. Learning positive ways to assist patients avoids professionals collapsing into therapeutic nihilism. We sought to understand how people with such symptoms can live well despite (or even because of) their condition. Chronic fatigue was chosen as the exemplar symptom. Participants were invited to join the research if they, themselves, considered they were living well with this symptom. One-on-one interviews using an appreciative enquiry approach were performed and thematic analysis undertaken. Twelve participants were interviewed before data saturation occurred. The emotional stance or relationship a participant had with, and towards, their illness was the primary determinant underlying their interpretation of “living well.” Five major themes of this meta-theme were identified: (1) engaging with elusiveness, (2) befriending uncertainty, (3) reflecting on self, (4) living creatively, and (5) moving in stillness. Encouraging patients who are struggling with MUS to consider how they emotionally engage with their illness via these 5 positive dynamics may lead to better health outcomes for patients and happier, more fulfilled health care professionals.
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Affiliation(s)
- Katherine H Hall
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Claire Amos
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Jessica Young
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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19
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Dannecker EA, Royse LA, Vilceanu D, Warne-Griggs MD, Adib Keleh S, Stucky R, Bloom TL, Mehr DR. Perspectives of patients with chronic pain about a pain science education video. Physiother Theory Pract 2021; 38:2745-2756. [PMID: 34098844 DOI: 10.1080/09593985.2021.1934920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Patients have responded in variable ways to pain science education about the psychosocial correlates of pain. To improve the effectiveness of pain education approaches, this study qualitatively explored participants' perceptions of and responses to pain science education.Methods: We conducted a qualitative content analysis of interviews with fifteen, adult patients (73.3% female) who had recently attended a first visit to a chronic pain clinic and watched a pain science educational video.Results: Participants thought it was important to improve their and healthcare providers' understanding of their pain. They viewed the video favorably, learned information from it, and thought it could feasibly facilitate communication with their healthcare providers, but, for many participants, the video either did not answer their questions and/or raised more questions. Participants' responses to the video included negative and positive emotions and were influenced by their need for confirmation that their pain was real and personal relevance of the pain science content.Conclusion: Study results support the feasibility and value of delivering pain science education via video and increase our understanding of patients' perceptions of and responses to pain science education. The video's triggering of emotional responses warrants additional research.
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Affiliation(s)
- Erin A Dannecker
- Department of Physical Therapy, University of Missouri, Columbia, MO
| | - Lisa A Royse
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | | | | | - Shady Adib Keleh
- Department of Anesthesiology and Perioperative Medicine, One Hospital Drive, University of Missouri, Columbia, United States
| | - Renee Stucky
- Physical Medicine and Rehabilitation, University of Missouri, One Hospital Drive, University of Missouri, Columbia, MO
| | - Tina L Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, MD
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences, Columbia, MO
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20
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Khan DZ, Fitzpatrick SM, Hilton B, McNair AG, Sarewitz E, Davies BM, Kotter MR. Prevailing Outcome Themes Reported by People With Degenerative Cervical Myelopathy: Focus Group Study. JMIR Form Res 2021; 5:e18732. [PMID: 33533719 PMCID: PMC7889422 DOI: 10.2196/18732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/16/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey–36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. Objective The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. Methods Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke’s 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. Results Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. Conclusions This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM.
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Affiliation(s)
- Danyal Zaman Khan
- Academic Neurosurgery Department, University of Cambridge, Cambridge, United Kingdom
| | | | - Bryn Hilton
- Colchester Hospital University, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom
| | - Angus Gk McNair
- Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | | | - Mark Rn Kotter
- Academic Neurosurgery Department, University of Cambridge, Cambridge, United Kingdom.,Wellcome Trust & MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
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- AO Spine, Davos, Switzerland
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21
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Cheshire A, Ridge D, Clark LV, White PD. Sick of the Sick Role: Narratives of What "Recovery" Means to People With CFS/ME. QUALITATIVE HEALTH RESEARCH 2021; 31:298-308. [PMID: 33176575 PMCID: PMC7750673 DOI: 10.1177/1049732320969395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Little is known about what recovery means to those with chronic fatigue syndrome/myalgic encephalomyelitis, a poorly understood, disabling chronic health condition. To explore this issue, semi-structured interviews were conducted with patients reporting improvement (n = 9) and deterioration (n = 10) after a guided self-help intervention, and analyzed via "constant comparison." The meaning of recovery differed between participants-expectations for improvement and deployment of the sick role (and associated stigma) were key influences. While some saw recovery as complete freedom from symptoms, many defined it as freedom from the "sick role," with functionality prioritized. Others redefined recovery, reluctant to return to the lifestyle that may have contributed to their illness, or rejected the concept as unhelpful. Recovery is not always about eliminating all symptoms. Rather, it is a nexus between the reality of limited opportunities for full recovery, yet a strong desire to leave the illness behind and regain a sense of "normality."
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Affiliation(s)
| | - Damien Ridge
- University of Westminster, London,
United Kingdom
| | - Lucy V. Clark
- Queen Mary University of London,
London, United Kingdom
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22
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Pilkington K, Ridge DT, Igwesi-Chidobe CN, Chew-Graham CA, Little P, Babatunde O, Corp N, McDermott C, Cheshire A. A relational analysis of an invisible illness: A meta-ethnography of people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and their support needs. Soc Sci Med 2020; 265:113369. [DOI: 10.1016/j.socscimed.2020.113369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
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23
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Yang Y, Grol-Prokopczyk H. Chronic Pain and Friendship among Middle-Aged and Older U.S. Adults. J Gerontol B Psychol Sci Soc Sci 2020; 76:2131-2142. [PMID: 33119081 DOI: 10.1093/geronb/gbaa185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study examines how chronic pain affects friendship in later life. We test whether onset of pain leads to social network activation, as suggested by research on other health conditions (Latham- Mintus, Forth.), or whether pain-an unverifiable and often stigmatizing condition-functions as a "threat to the social self" (Karos et al., 2018). METHODS Using longitudinal data from the Health and Retirement Study (HRS; N=4,598; 2006/2008 as Time 1 and 2010/2012 as Time 2), we conducted OLS regressions with the lagged dependent variable approach to assess how new-onset chronic pain predicted (a) respondents' number of close friends and (b) their frequency of in-person meetings with friends, controlling for sociodemographic variables and health conditions. RESULTS New-onset severe pain predicted a decrease in number of friends. New-onset moderate pain, in contrast, predicted more friends and more frequent in-person meetings. (Findings were significant or marginally significant depending on model specifications.) Mild pain showed no significant association with either outcome. Pain had a greater effect on men's friendship outcomes than women's. DISCUSSION The effects of chronic pain on later-life friendships appear to depend on pain severity, and to differ between men and women. Onset of severe pain serves as a "threat to the social self," while onset of moderate pain contributes to social network activation; both associations are significantly more pronounced among men. These findings highlight the complex associations between health and social outcomes.
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Affiliation(s)
- Yulin Yang
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY
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24
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Véron C, Genevay S, Knafou Bastard M, Fleury A, Cedraschi C. Psychomotor therapy as a treatment of chronic spinal pain: A qualitative study. Complement Ther Med 2020; 56:102590. [PMID: 33197665 DOI: 10.1016/j.ctim.2020.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Psychomotor therapy is an innovative complementary approach that enhances the mind-body connection. It could have a positive effect on chronic pain syndromes but has not yet been specifically studied for spinal pain. We thus aimed to explore the experiences of chronic spinal pain patients with psychomotor therapy. DESIGN We conducted a qualitative study using semi-structured interviews. 17 patients with chronic spinal pain were recruited from a multidisciplinary spinal pain program in a rehabilitation hospital in Switzerland. Participants received psychomotor therapy as part of this care. All interviews were transcribed and thematic analysis was performed. SETTING Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland. RESULTS Four themes emerged from thematic analysis: 1) Connecting body and mind; 2) Passive individualized care; 3) Effect on mobility and well-being versus pain; and 4) Need for further care. Participants particularly appreciated the person-centered approach, relaxation and link between body and mind in the psychomotor therapy sessions. They shared positive effects of psychomotor therapy on mobility, kinesiophobia and overall well-being, rather than on pain. Finally, they would have liked more follow-up care at the end of the program. CONCLUSIONS Experiences reported by patients in this study suggest that psychomotor therapy could be a promising complementary therapy for chronic spinal pain within a biopsychosocial approach. To better understand the benefits of psychomotor therapy for chronic spinal pain, further research is needed and should consider patient-reported outcome measures such as well-being, fear-avoidance belief and disability.
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Affiliation(s)
- Claudia Véron
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Stéphane Genevay
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Maud Knafou Bastard
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Adrien Fleury
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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25
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Jaye C, Noller G, Richard L, Amos C. 'There is no sick leave at the university': how sick leave constructs the good employee. Anthropol Med 2020; 28:461-476. [PMID: 32981340 DOI: 10.1080/13648470.2020.1814988] [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: 10/23/2022]
Abstract
This paper examines the role of sick leave in constructing the identity of a good worker. The setting is a public funded New Zealand university. Within a qualitative research design, interviews were conducted with a range of employees and managers about their use and management of sick leave. Sick leave entitlements, use, and management encompass moral discourses that impact upon worker identity. Normalising discourses generated by compliance to bureaucratic demands and norms of productivity and performance in the neoliberalised workplace are constitutive to the construct of the good employee as reflected by the appropriate use and recording of sick leave. Conversely, the respectful, authentic, compliant and productive worker is constitutive of its opposite - the difficult employee. The construct of the difficult employee positions conformity and self-management of sick leave as strong moral imperatives. Managers were generally supportive of workers' efforts to self-manage sick leave with consideration for university commitments and were flexible around work hours, but this would in turn position them as deviant to institutional pathways of managing sick leave, with tensions between humanistic and authoritarian management.
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Affiliation(s)
- Chrystal Jaye
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Geoff Noller
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Lauralie Richard
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Claire Amos
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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26
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From shame to blame: institutionalising oppression through the moralisation of mental distress in austerity England. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Lane R. Expanding boundaries in psychiatry: uncertainty in the context of diagnosis-seeking and negotiation. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42 Suppl 1:69-83. [PMID: 31849066 PMCID: PMC7496635 DOI: 10.1111/1467-9566.13044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Psychiatric diagnosis has become pervasive in modern culture, exerting an increasing influence on notions of personhood, identity practices and forms of self-governing. The broadening of diagnostic categories and increasing awareness regarding popular diagnostic categories has led to an increased demand for formal diagnosis within clinical encounters. However, there is continuing 'epistemological uncertainty' (Fox 2000) surrounding these entities, in part due to their lack of associated clinical biomarkers and their 'fuzzy boundaries'. Meanwhile, this diagnostic expansion has encountered resistance from those concerned with the alleged 'over-pathologisation' of emotional distress. Drawing upon the concepts of 'diagnostic cultures' (Brinkmann 2016) and the 'looping effects of human kinds' (Hacking 1995), this article considers some of the competing forces acting upon the contested boundaries of diagnostic categories as they play out within diagnostic interactions. The study involved ethnographic observations of diagnostic encounters within several UK-based mental health clinics. By focusing on interactions where diagnosis is negotiated, findings illustrate the role played by different kinds of diagnostic uncertainty in shaping these negotiations. It is argued that diagnostic reification plays a key role in the moral categorisation of patients, particularly where there is uncertainty regarding individual diagnostic status.
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Affiliation(s)
- Rhiannon Lane
- School of Healthcare SciencesCardiff UniversityCardiffUK
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28
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Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Soc Sci Med 2020; 246:112734. [DOI: 10.1016/j.socscimed.2019.112734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023]
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29
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Stinesen BB, Sneijder P, Köke AJA, Smeets RJEM. Improving patient-practitioner interaction in chronic pain rehabilitation. Scand J Pain 2019; 19:843-853. [PMID: 31299009 DOI: 10.1515/sjpain-2019-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Stimulating patients to approach their pain from a biopsychosocial perspective is central to chronic pain rehabilitation. However, conversations between patients and their healthcare professionals about the social and psychological factors that may contribute to the continuation of pain and disability can be challenging. The current scientific literature does not sufficiently pinpoint the difficulties in patient-practitioner interaction on chronic pain, and it falls short of answering the question of how a joint exploration of the social and psychological factors that might be involved in the patient's pain and evolving disability can be enhanced. In this theoretical article, we introduce discursive psychology as a potentially valuable research perspective to gain a better understanding of the difficulties in patient-practitioner interaction in the context of chronic pain rehabilitation. Discursive psychology focuses on features of people's talk (e.g. that of patients and practitioners) and is concerned with the social practices that people perform as part of a specific interactional context. In this paper, we provide an introduction to the main theoretical notions of discursive psychology. We illustrate how discursive psychological analyses can inform our understanding of the specific sensitivities in conversations between patients with chronic pain and their practitioners. Finally, we address how a better understanding of these sensitivities offers a gateway towards improving these conversations.
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Affiliation(s)
- Baukje B Stinesen
- Research Group Cross-Media Communication in the Public Domain, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Petra Sneijder
- Research Group Cross-Media Communication in the Public Domain, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Albère J A Köke
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Zuyd University of Applied Sciences, Faculty of Health and Technology, Heerlen, The Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie, Eindhoven/Zwolle, The Netherlands
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30
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Lau ET, Tan SH, Antwertinger YJ, Hall T, Nissen LM. Counseling interactions between patients living with persistent pain and pharmacists in Australia: are we on the same page? J Pain Res 2019; 12:2441-2455. [PMID: 31496787 PMCID: PMC6689145 DOI: 10.2147/jpr.s199017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background People living with persistent pain in Australia often cannot access adequate care to manage their pain. Therefore, as the most accessible healthcare professionals, community pharmacists have an important role to play in helping to improve patient outcomes. Hence, it is important to investigate patient needs and expectations in terms of counseling interactions with pharmacists, along with pharmacists’ approach to counseling interactions with these patients. Method The nature of patient–pharmacist counseling interactions was explored with seven patients (one focus group), and 10 practicing pharmacists (two focus groups, three semi-structured interviews). The themes identified informed the development of an online survey that was advertised online to patients and pharmacists across Australia. Results A total of 95 patients and 208 pharmacists completed the survey. Overall, more than half of patients (77/95) were satisfied with the care provided by their pharmacist, but only a third (71/205) of pharmacists were satisfied with the care they provided to patients. The majority of patients (67/94) reported that pharmacists provided good information about medications. This aligned with pharmacists’ responses, as most reported focusing on medication side effects (118/188) and instructions for taking pain medication (93/183) during patient interactions. However, when asked about empathy and rapport from pharmacists, only half to two-thirds (48–61/95) of patients expressed positive views. Overall, half of the patients (39/75) wanted a caring, empathetic, respectful, and private conversation with the pharmacist, and nearly half (40/89) perceived the pharmacist's role as providing (new) information on alternative pharmacological and non-pharmacological therapies, including general advice on pain management. Conclusion There was a disparity in the nature of the interaction and information that patients wanted from pharmacists, compared to what was provided by pharmacists. Training and education may help pharmacists to better engage in patient-centered care when interacting with people living with persistent pain, thereby improving health outcomes for these patients.
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Affiliation(s)
- Esther Tl Lau
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Shirin H Tan
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.,Clinical Research Center, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Yasmin J Antwertinger
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tony Hall
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lisa M Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
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Thompson CM, Parsloe S. "I Don't Claim to Be the World's Foremost Expert, But . . . ": How Individuals "Know" Family Members Are Not Experiencing Health Issues as Severely as They Claim. QUALITATIVE HEALTH RESEARCH 2019; 29:1433-1446. [PMID: 30762486 DOI: 10.1177/1049732319827518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To understand how individuals come to "know" that their family members are not experiencing their health issues as severely as they claim, we interviewed 32 individuals (nine men and 23 women, M age = 35.28 years, SD = 9.91 years) about a family member who they believe falsifies or exaggerates his or her health condition(s). Our analyses illuminate two interlinked processes of knowledge construction: (a) developing evidentiary standards and (b) gathering evidence. In engaging these processes, participants sought two types of consistency: correspondence with external "facts" (e.g., medical information, cultural [mis]conceptions), and internal coherence (i.e., complaints were highly self-contradictory and unpredictable or were overly predictable). When initial inconsistencies made participants doubt their family member, participants gathered additional evidence, including experiential, behavioral, and interactional evidence, to test and revise their initial suspicions. We discuss the implications of this research for theory and for families coping with illness.
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Nicola M, Correia H, Ditchburn G, Drummond P. Invalidation of chronic pain: a thematic analysis of pain narratives. Disabil Rehabil 2019; 43:861-869. [PMID: 31290347 DOI: 10.1080/09638288.2019.1636888] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain. METHOD A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain. FINDINGS Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation. CONCLUSION Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.IMPLICATIONS FOR REHABILITATIONPain-invalidation can occur at the level of the self, social others, or healthcare professionals.Pain-invalidation can arise through a lack of understanding by others in the social network about having chronic pain.Pain-invalidation may be a barrier to seeking therapy for pain management and rehabilitation, and thus, efforts to identify and acknowledge invalidation experiences may be beneficial in the rehabilitation process.
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Affiliation(s)
- Melinda Nicola
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Helen Correia
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Graeme Ditchburn
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
| | - Peter Drummond
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, WA, Australia
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Roitenberg N, Shoshana A. Physiotherapists' accounts of fibromyalgia: role-uncertainty and professional shortcomings. Disabil Rehabil 2019; 43:545-552. [PMID: 31257947 DOI: 10.1080/09638288.2019.1632939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE This article examines accounts of fibromyalgia provided by physiotherapists. This qualitative study asks how physiotherapists define and understand fibromyalgia, what professional resources are available to them for treating patients, and where physiotherapists can turn when facing the scarcity of professional resources. METHOD The data were collected by means of semi-structured, in-depth, face-to-face interviews, conducted with 20 practicing physiotherapists. The physiotherapists were recruited using a purposive-sampling strategy and had extensive experience treating fibromyalgia patients (mean value: 6.5 years). The authors analyzed the interviews in accordance with the methods of thematic analysis. RESULTS The study findings expose two overarching themes: (a) fibromyalgia as an ambiguous and uncertain diagnosis: physiotherapists devalue the diagnosis, referring to it as a syndrome rooted on psychological factors; (b) role ambiguity and creativity in physiotherapy treatment: by questioning their role, physiotherapists end up focusing on illness management and developing creative treatments. CONCLUSIONS The study concludes that treating fibromyalgia patients challenges physiotherapists, mainly because of professional shortcomings. The findings highlight the necessity to train physiotherapists to respond to the needs of their patients with greater competence and less ambivalence.Implications for rehabilitationHealth providers need to acknowledge the difficulty physiotherapists are facing when providing treatment to fibromyalgia patients.Physiotherapists treating fibromyalgia should undergo special training to reduce their uncertainty and role ambiguity.Health providers should improve communication between physiotherapists and the General Practitioners referring fibromyalgia patients, to enable them to set shared evidence-based treatment goals.
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Affiliation(s)
- Neta Roitenberg
- Department of Sociology and Anthropology, University of Bar-Ilan, Ramat Gan, Israel
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de Barra M, Cownden D, Jansson F. Aversive medical treatments signal a need for support: a mathematical model. EVOLUTIONARY HUMAN SCIENCES 2019; 1:e4. [PMID: 37588405 PMCID: PMC10427312 DOI: 10.1017/ehs.2019.2] [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: 11/07/2022] Open
Abstract
Ineffective, aversive and harmful medical treatments are common cross-culturally, historically and today. Using evolutionary game theory, we develop the following model to explain their persistence. Humans are often incapacitated by illness and injury, and are unusually dependent on care from others during convalescence. However, such caregiving is vulnerable to exploitation via illness deception, whereby people feign or exaggerate illness in order to gain access to care. Our model demonstrates that aversive treatments can counter-intuitively increase the range of conditions where caregiving is evolutionarily viable, because only individuals who stand to gain substantially from care will accept the treatment. Thus, contemporary and historical "ineffective" treatments may be solutions to the problem of allocating care to people whose true need is difficult to discern.
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Affiliation(s)
| | | | - Fredrik Jansson
- Centre for Cultural Evolution, Stockholm University
- Division of Applied Mathematics, Mälardalen University
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Che X, Cash R, Chung S, Fitzgerald PB, Fitzgibbon BM. Investigating the influence of social support on experimental pain and related physiological arousal: A systematic review and meta-analysis. Neurosci Biobehav Rev 2018; 92:437-452. [DOI: 10.1016/j.neubiorev.2018.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
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Twist K, Ablett J, Wearden A, Paine P, Vasant D, Lal S, Peters S. Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis. Neurogastroenterol Motil 2018; 30:e13339. [PMID: 29575415 DOI: 10.1111/nmo.13339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal dysmotility (GID) covers a spectrum of disorders disrupting enteric neuromuscular co-ordination which, when severe, causes intractable gastrointestinal symptoms and malnutrition and is a recognized cause of chronic intestinal failure. To date, no study has provided an in-depth account of the experiences of patients with severe GID and their psychosocial needs. This study aimed to explore patients' experiences from symptom onset and the process of seeking and receiving a diagnosis. It specifically explored the psychological effect of this process and the effect on relationships. METHODS Participants (n = 20, mean age = 47.9, female n = 16, parenteral nutrition = 13) were recruited from a UK center with tertiary Neurogastroenterology and Intestinal Failure services. A qualitative exploratory design with semi-structured in-depth interviews was used. Data were analyzed using thematic analysis. KEY RESULTS Significant delays were experienced in obtaining a diagnosis. Participants reported having their mental health questioned and felt that they had to fight to prove their symptoms had a physical basis to access appropriate treatment. Although a diagnosis helped legitimize symptoms, the condition remained poorly understood by participants themselves, relatives, and health professionals. Participants discussed the impact that "feeling delegitimized" and the "lack of coherent understanding of GID" had on their relationships and mental health. CONCLUSIONS & INFERENCES The distressing experience of GID symptoms are compounded by a delay in validating symptoms and lack of coherent understanding. More knowledge of GID is needed by health professionals to speed up diagnosis and offer more coherent information. The psychological impact of a GID diagnosis should be acknowledged early to help facilitate adjustment.
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Affiliation(s)
- K Twist
- University of Manchester, Manchester, UK
| | - J Ablett
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Wearden
- University of Manchester, Manchester, UK
| | - P Paine
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - D Vasant
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Lal
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Peters
- University of Manchester, Manchester, UK
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Jaye C, Young J, Egan T, Williamson M. Moral Economy and Moral Capital in the Community of Clinical Practice. QUALITATIVE HEALTH RESEARCH 2018; 28:523-533. [PMID: 29110577 DOI: 10.1177/1049732317740347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This New Zealand study used focused ethnography to explore the activities of communities of clinical practice (CoCP) in a community-based long-term conditions management program within a large primary health care clinic. CoCP are the informal vehicles by which patient care was delivered within the program. Here, we describe the CoCP as a micro-level moral economy within which values such as trust, respect, authenticity, reciprocity, and obligation circulate as a kind of moral capital. As taxpayers, citizens who become patients are credited with moral capital because the public health system is funded by taxes. This moral capital can be paid forward, accrued, banked, redeemed, exchanged, and forfeited by patients and their health care professionals during the course of a patient's journey. The concept of moral capital offers another route into the "black box" of clinical work by providing an alternative theoretic for explaining the relational aspects of patient care.
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Affiliation(s)
| | | | - Tony Egan
- 1 University of Otago, Dunedin, New Zealand
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Abstract
OBJECTIVES Over 40% of adolescents with chronic pain report experiencing pain dismissal, which is a response from another individual that is perceived as diminishing, denying, or disbelieving an individual's report of pain. Pain dismissal by physicians often leaves patients feeling discredited, which may discourage them from seeking and receiving proper treatment for their pain. The purpose of this study was to investigate how the 4 most commonly reported types of physician pain dismissal differentially affect individuals' reactions. MATERIALS AND METHODS Emerging adults, age 18- to 25-years old (N=352, 60% female), were randomly assigned to read 1 of 4 vignettes describing patient-provider interactions that included the most commonly reported types of pain dismissal identified by previous research: denial/disbelief, minimizing, faking for secondary gain, and psychogenic. Participants answered questions regarding their reactions to the pain dismissal vignettes. RESULTS All 4 vignettes were perceived as dismissive and problematic by the majority of participants, but participants who read the psychogenic pain dismissal vignette were less dissatisfied overall with the hypothetical medical appointment than participants who read the other 3 vignettes. DISCUSSION All 4 types of physician pain dismissal were broadly perceived negatively, suggesting that the experience of pain dismissal is likely not due to patient hypersensitivity but to physician behavior. Discussion of the psychological factors associated with pain was less likely to be perceived as dismissive. Psychologists and physicians should collaborate to develop recommended language that validates patients' experiences of pain, communicates appropriate levels of empathy, and reduces the frequency of perceived physician pain dismissal.
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Tan CD. “I'm a normal autistic person, not an abnormal neurotypical”: Autism Spectrum Disorder diagnosis as biographical illumination. Soc Sci Med 2018; 197:161-167. [DOI: 10.1016/j.socscimed.2017.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
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Nichols VP, Ellard DR, Griffiths FE, Kamal A, Underwood M, Taylor SJC. The lived experience of chronic headache: a systematic review and synthesis of the qualitative literature. BMJ Open 2017; 7:e019929. [PMID: 29248887 PMCID: PMC5778309 DOI: 10.1136/bmjopen-2017-019929] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To systematically review the qualitative literature of the lived experience of people with a chronic headache disorder. BACKGROUND Chronic headaches affect 3%-4% of the population. The most common chronic headache disorders are chronic migraine, chronic tension-type headache and medication overuse headache. We present a systematic review and meta-ethnographic synthesis of the lived experience of people with chronic headache. METHODS We searched seven electronic databases, hand-searched nine journals and used a modified Critical Appraisal Skills Programme checklist to appraise study quality. Following thematic analysis we synthesised the data using a meta-ethnographic approach. RESULTS We identified 3586 unique citations; full texts were examined for 86 studies and 4 were included in the review. Included studies differed in their foci: exploring, patient-centred outcomes, chronic headache as a socially invisible disease, psychological processes mediating impaired quality of life, and the process of medication overuse. Initial thematic analysis and subsequent synthesis gave three overarching themes: 'headache as a driver of behaviour' (directly and indirectly), 'the spectre of headache' and 'strained relationships'. CONCLUSION This meta-synthesis of published qualitative evidence demonstrates that chronic headaches have a profound effect on people's lives, showing similarities with other pain conditions. There were insufficient data to explore the similarities and differences between different chronic headache disorders.
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Affiliation(s)
- Vivien P Nichols
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances E Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Atiya Kamal
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephanie J C Taylor
- Complex Intervention and Social Practice in Health Care Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Coventry, UK
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Igler EC, Defenderfer EK, Lang AC, Bauer K, Uihlein J, Davies WH. Gender differences in the experience of pain dismissal in adolescence. J Child Health Care 2017; 21:381-391. [PMID: 29110522 DOI: 10.1177/1367493517727132] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined physician-generated pain dismissal experiences in adolescence between males and females. Young adults (ages 18-24, N = 178) with chronic or recurrent pain reported at least one pain dismissal experience in adolescence and answered a series of questions regarding the experience during this time period. Females were significantly more likely to report pain dismissal and a physician as the dismisser. Males were more likely to report that the dismisser expressed hostility toward them, feeling ambivalent regarding the dismissal experience, and a desire to avoid the dismisser. Females were more likely to report a desire to plead for understanding with the dismisser. Results suggest that female adolescents are more likely to report a pain dismissal experience with physicians, raising concerns that adolescent females may receive, or at least perceive, differential treatment for their chronic pain.
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Affiliation(s)
- Eva C Igler
- 1 Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ellen K Defenderfer
- 1 Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amy C Lang
- 1 Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kathleen Bauer
- 2 Department of Educational Psychology, University of Wisconsin-Oshkosh, Oshkosh, WI, USA
| | - Julia Uihlein
- 3 Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W Hobart Davies
- 1 Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Flinkfeldt M. Wanting to work: managing the sick role in high-stake sickness insurance meetings. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1149-1165. [PMID: 28503755 DOI: 10.1111/1467-9566.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article respecifies and develops Parsons's sick role theory, focusing on the postulate that the sick person must 'want' to get well. Using conversation analysis and discursive psychology to study how the psychological term 'want' is used in high-stake, multi-professional meetings with sickness benefit claimants in Sweden, the article shows how establishing that one 'wants' to get well requires extensive interactional work. In the examined meetings, the sick person's 'want' formulations make explicit the relationship between 'wants' and illness or inabilities, thus allowing for motivational character to be established without committing to its implications, and without appearing strategic or biased. By contrast, professional parties in the meetings invoke the sick person's 'wants' either to hold them accountable, or for establishing a desired course of recovery, confirming the centrality of such 'wants' in this setting as well as the risks associated with expressing them. The article suggests that analysing psychological matters as they are oriented to by participants renders sick role theory relevant for a wide range of settings and respecifies criticism of the model.
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Robinson HS, Dagfinrud H. Reliability and screening ability of the StarT Back screening tool in patients with low back pain in physiotherapy practice, a cohort study. BMC Musculoskelet Disord 2017; 18:232. [PMID: 28569152 PMCID: PMC5452390 DOI: 10.1186/s12891-017-1553-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain (LBP) is the most common reported musculoskeletal disorder, with large prevalence numbers and high costs. Focus on early identification of patients at risk of developing chronic LBP has increased. The Keele Start Back Tool (SBT) is a questionnaire aiming at screening prognostic indicators in LBP patients, categorizing patients into risk-groups and guide treatment. The aim of this study was to explore the Norwegian version of the SBT with regard to reliability of the SBT-scoring and the screening ability in LBP patients in primary care physiotherapy. Methods LBP patients answered a package of questionnaires twice, with 1-3 days in between, containing SBT, Hannover functional ability questionnaire, pain intensity questions and demographics. The relative and absolute reliability of SBT was calculated using intraclass correlation coefficient (ICC) and the smallest detectable change respectively. Independent sample t-tests were used for group comparisons. Results Fifty-two patients with LBP. Mean age (SD) was 45 (12) years and 62% were female. The ICC (95% CI) for SBT total score and psychosocial subscore was 0.89 (0.82, 0.94) and 0.82 (0.70, 0.90) respectively. None of the participants were allocated to the high risk group. The medium risk group reported significantly more pain last week and more activity limitations than the low risk group at both test and retest (0.001 ≤ p ≤ 0.003), whereas no significant difference between the groups was found on pain now (0.05 ≤ p ≤ 0.16). Conclusions The Norwegian version of the SBT was reliable and the screening ability was good as the subgrouping of patients into risk-groups reflected the severity of their back problems. The SBT may be an applicable and useful tool in physiotherapy practice.
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Affiliation(s)
- Hilde Stendal Robinson
- Department of Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, Blindern, 0317, Oslo, Norway.
| | - Hanne Dagfinrud
- Department of Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, Blindern, 0317, Oslo, Norway
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Rebman AW, Aucott JN, Weinstein ER, Bechtold KT, Smith KC, Leonard L. Living in Limbo: Contested Narratives of Patients With Chronic Symptoms Following Lyme Disease. QUALITATIVE HEALTH RESEARCH 2017; 27:534-546. [PMID: 26631681 DOI: 10.1177/1049732315619380] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Persistent, subjective symptoms of unknown etiology following treatment for Lyme disease have been termed post- treatment Lyme disease syndrome or chronic Lyme disease (PTLDS/CLD). The objective of this study was to give primacy to the patient experience of this medically contested condition by eliciting patient illness narratives and identifying emergent issues through semistructured interviews conducted among 29 participants. We used thematic narrative analysis to identify three predominant themes: (a) Physical and social limitations lead to a "new normal" characterized by fundamental shifts of ways of being in the world, (b) disease-specific factors contribute to symptom and illness invisibility that affects social support in nuanced ways, and (c) pervasive medical uncertainty regarding PTLDS/CLD promotes an increased sense of personal responsibility for care. Similar to other contested or medically unexplained syndromes, our findings suggest that the social sequelae of PTLDS/CLD can be equally protracted as the physical effects of this illness.
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Affiliation(s)
- Alison W Rebman
- 1 Lyme Disease Research Foundation, Lutherville, Maryland, USA
- 2 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John N Aucott
- 2 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric R Weinstein
- 1 Lyme Disease Research Foundation, Lutherville, Maryland, USA
- 2 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Katherine C Smith
- 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lori Leonard
- 3 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- 4 Cornell University, Ithaca, New York, USA
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Breckons M, Bissett SM, Exley C, Araujo-Soares V, Durham J. Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study. JDR Clin Trans Res 2016; 2:48-57. [PMID: 28879244 DOI: 10.1177/2380084416679648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Affiliation(s)
- M Breckons
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S M Bissett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | - C Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J Durham
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
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‘Keep complaining til someone listens’: Exchanges of tacit healthcare knowledge in online illness communities. Soc Sci Med 2016; 166:25-32. [DOI: 10.1016/j.socscimed.2016.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/01/2016] [Accepted: 08/04/2016] [Indexed: 01/09/2023]
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Rolbiecki A, Subramanian R, Crenshaw B, Albright DL, Perreault M, Mehr D. A Qualitative Exploration of Resilience among Patients Living with Chronic Pain. ACTA ACUST UNITED AC 2016; 23:89-94. [PMID: 33500683 DOI: 10.1037/trm0000095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An estimated 100 million Americans are living with chronic pain. The majority of the chronic pain literature focuses on the biological impact of the condition and very little attention is given to patients' lived experience with chronic pain and the enactment of their resiliency. Yet, resiliency may play a critical role in patients' experience of pain intensity as well as self-efficacy to manage their pain. The main objective of this study was to explore the origin and enactment of resiliency across a sample of 12 chronic pain patients. In-depth phone interviews were conducted, and data were analyzed using thematic analysis. Results indicate that patients exhibited resiliency in four ways: (1) developing a sense of control - independently seeking information and cross-checking this information with their doctors' recommendations (2) active engagement in medical and complementary treatment; (3) establishing social connections; and (4) exhibiting pain acceptance and positive affect. This study lays the foundation to explore whether resiliency improves clinical outcomes among patients living with chronic pain. The findings support the need for clinicians to evaluate and treat chronic pain patients through the lens of resiliency.
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Affiliation(s)
| | | | | | | | | | - David Mehr
- University of Missouri, Columbia, Missouri, USA
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Patients Are Socially Excluded When Their Pain Has No Medical Explanation. THE JOURNAL OF PAIN 2016; 17:1028-35. [DOI: 10.1016/j.jpain.2016.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
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Psychological Distress in Out-Patients Assessed for Chronic Pain Compared to Those with Rheumatoid Arthritis. Pain Res Manag 2016; 2016:7071907. [PMID: 27445623 PMCID: PMC4904611 DOI: 10.1155/2016/7071907] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/02/2015] [Indexed: 01/23/2023]
Abstract
Background. Patients diagnosed with chronic pain (CP) and rheumatoid arthritis (RA) represent two samples with overlapping symptoms, such as experiencing significant pain. Objectives. To compare the level of psychological distress among patients diagnosed CP attending a specialist pain clinic with those attending a specialist RA clinic. Measures. A cross-sectional study was conducted at an academic specialist chronic pain and rheumatology clinic. Participants. 330 participants included a CP group (n = 167) and a RA group (n = 163) completed a booklet of questionnaires regarding demographic characteristics, duration, and severity of their pain. Psychological and personality variables were compared between the CP and RA participants using a Multivariate Analysis of Covariance (MANCOVA). Results. Level of psychological distress based on the subscales of the DASS (depression, anxiety, and stress), PASS (escape avoidance, cognitive anxiety, fear of pain, and physiological anxiety), and PCS (rumination, magnification, and helplessness) was significantly higher in the CP group compared to the RA group. Categorization of individuals based on DASS severity resulted in significant differences in rates of depression and anxiety symptoms between groups, with a greater number of CP participants displaying more severe depressive and anxiety symptoms. Discussion and Conclusions. This study found greater levels of psychological distress among CP individuals referred to an academic pain clinic when compared to RA patients referred to an academic rheumatology clinic.
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Hiort J, Lindau M, Löfgren M. Young pain patients’ experience in primary care. A qualitative study. NORDIC PSYCHOLOGY 2016. [DOI: 10.1080/19012276.2016.1178166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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