Predictors of psychological distress in chronic pain patients

Group Singing Has Multiple Benefits in the Context of Chronic Pain: An Exploratory Pilot Study

AIMS

This paper reports findings of a pilot singing intervention to assist people living with chronic pain.

METHODS

Pain Management Clinic outpatients participated in 10 weekly group singing sessions. Benefits of the intervention and its impact on participants' (N = 4) experiences of pain were explored qualitatively.

RESULTS

Three main themes comprising over 20 separate codes indicated physical, psychological, and social dimensions associated with the intervention. People with chronic pain identify multiple benefits from participating in a group singing program.

CONCLUSIONS

Results indicate that group singing in chronic pain settings has multiple benefits and may positively complement clinical outcomes, serving as an effective adjunct to conventional pain management care and nursing.

Partner relationships and long-term sick leave among female workers: consequences and impact on dimensions of health and return to work

Few efforts have been made to prospectively identify resources and obstacles outside work that may predict regained work ability and return to work when workers are on sick leave. This study investigates the association between partner relationships and sick leave. Our research questions were as follows: (i) What is the influence of sick leave, pain, stress and domestic strain on the quality of the dyadic partner relationship?, and (ii) What is the influence of the partner and social relationship on pain, stress, work ability, self-rated health and return to work? A cohort of female workers (n = 225) on long-term sick leave (>60 days), all in a partner relationship, at 6-month intervals completed a questionnaire based on the Quality of Dyadic Relationship (QDR) instrument, the Interview Schedule of Social Interaction (ISSI), the Work Ability Index (WAI) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Univariate and multivariate analyses of baseline and prospective data were performed. The results showed that decreased partner relationship quality was related to having major responsibility for household work despite being on sick leave, having pain and having decreased social integration. Among younger individuals on sick leave, a reduction in the quality of the partner relationship was shown already at the first (6-month) follow-up, while among middle-aged women, such a reduction was seen only at the 12-month follow-up. No dimensions of partner relationship quality at baseline were related to dimensions of return to work, either as a resource or as an obstacle. Consequently, our results show that a good relationship does not keep the woman from returning to work. Having main responsibility for household work, which implies domestic strain while on sick leave, predicts lower partner relationship quality. The practical implications are that healthcare professionals treating women on sick leave should emphasize the importance of keeping a social network as well as making sufficient adjustments at home for the relationship quality to be safeguarded. Special attention should be given to the young woman on sick leave as being on sick leave seems to influence her partner relationship considerably.

The experience of chronic back pain: Accounts of loss in those seeking help from pain clinics

BACKGROUND

This study responded to the need for greater understanding of the experiences that help to shape the worldviews of chronic back patients as they seek help from pain clinics.

AIM

To elaborate on the lived experience of chronic back pain in those actively seeking help from pain clinics.

METHODS

This was a qualitative study, based on an interpretative phenomenological approach. As part of in-depth interviews, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and eight female patients, all of whom were diagnosed as having chronic benign back pain and had recently attended one of two pain clinics as new referrals. The data were analysed thematically.

FINDINGS

Loss was one of five major themes to emerge. The narrative accounts revealed a catalogue of socio-economic and other material losses including loss of physical and mental abilities, occupational and social activities, job or role. In those of working age, these led to financial hardship and changes in interpersonal relationships, culminating in loss of self-worth, future and hope.

CONCLUSIONS

The findings suggest that material losses, as well as perceptions of loss, are prominent issues for those of working age seeking help from pain clinics for chronic back pain, and may need to be acknowledged and addressed as part of therapeutic interventions. The possibility of age-related differences in pain-related loss may be worthy of further investigation.

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients

OBJECTIVES

To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

DESIGN

Cross-sectional, correlation study.

SETTING

Orthopaedic outpatient setting in a tertiary hospital.

PARTICIPANTS

One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

MEASURES

Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

RESULTS

The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

CONCLUSIONS

This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.

Level of distress among workers undergoing work rehabilitation for musculoskeletal disorders

INTRODUCTION

Many studies have documented the high distress rates and their correlates among individuals experiencing persistent pain due to a musculoskeletal disorder (MSD). However, few have adopted a biopsychosocial perspective to understand this issue.

OBJECTIVE

The first objective of this study was to examine workers' distress levels before they start work rehabilitation and to compare it to those in a healthy population. The second objective was to assess the correlations between distress and biopsychosocial factors.

METHODS

The participants were 228 workers on sick leave due to persistent pain from an MSD and who were referred to an interdisciplinary work rehabilitation program.

RESULTS

The workers had very high distress levels compared to normative data. Also, the results of a multiple regression showed that duration of absence, high occupational stress, perception of disability, and fear of movement and (re)injury were significantly associated with distress.

CONCLUSIONS

These results highlight the importance of considering distress not only as a predictor of work disability, but as an independent outcome measure. This shift of paradigm could provide a more comprehensive approach in the understanding of workers' disability.

Accepting Pain Management or Seeking Pain Cure: An Exploration of Patients’ Attitudes to Chronic Pain

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible.

Relaxation and music reduce pain following intestinal surgery

Three nonpharmacological nursing interventions, relaxation, chosen music, and their combination, were tested for pain relief following intestinal (INT) surgery in a randomized clinical trial. The 167 patients were randomly assigned to one of three intervention groups or control and were tested during ambulation and rest on postoperative days 1 and 2. Pain sensation and distress were measured with visual analog scales (VAS). Multivariate analysis of covariance showed significantly less post-test pain in the intervention groups than in the control group on both days after rest and at three of six ambulation post-tests (p = .024-.001), resulting in 16-40% less pain. Mixed effects after ambulation were due to the large variation in pain and difficulty relaxing while returning to bed; but post hoc explorations showed effects for those with high and low pain. These interventions are recommended along with analgesics for greater postoperative relief without additional side effects.

Health-related quality of life in persons with long-term pain after a stroke

BACKGROUND

No study has, to our knowledge, previously been published on health-related quality of life (HRQoL) in a group suffering from long-term pain after a stroke.

AIM

The aim of the present study was to describe HRQoL in persons with long-term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status.

DESIGN

This study has a design combining qualitative and quantitative methods.

METHODS

Forty three participants suffering from long-term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self-report questionnaires, SF-36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used.

RESULTS

The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF-36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF-36. The men had more decreased vitality than the women.

CONCLUSION

The results show, that the participants in this study have a lower HRQoL due to their long-term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care.

RELEVANCE TO CLINICAL PRACTICE

Awareness and understanding of the patients' perceptions and transitions with regard to their life situation and suffering from long-term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons.

Assessment of chronic neuropathic pain and the use of pain tools

Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. The central role the nurse has in pain assessment and management to improve the patient's quality of life is explored. The evidence recommends that chronic pain be assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.

Coping with long-term pain after a stroke

The aim of this qualitative study was to describe pain, coping strategies, and experienced outcome of coping with long-term pain conditions after a stroke. Forty-three participants were interviewed: 15 with central post-stroke pain (CPSP), 18 with nociceptive pain, and 10 with tension-type headache. Analysis of the data was by content analysis. Pain-related problems described were incomprehensibility regarding the pain, disturbed sleep, fatigue, diminished capacity, mood changes, and stress in relationships. Different coping strategies were used; the most common were making the pain comprehensible, planning of activities, taking medications, communicating, and distractions. Changing body position, making comparison, and enduring the pain were common in central or nociceptive pain, rest and relaxation in tension-type headache. Communicating their pain gave a feeling of perplexity and resignation. Satisfaction was reported in the cases of consideration shown by others. Pain after a stroke requires specialized knowledge in order to understand the patient's experiences and to enhance coping.

Living with a chronic leg ulcer: an insight into patients' experiences and feelings

OBJECTIVES

This study sought to ascertain patient need and help health-care professionals to understand the effects of chronic leg ulceration from a patient's perspective.

METHOD

A qualitative grounded theory approach was used. A purposeful sample of eight participants (six females and two males) was selected. All were under the care of a district nurse and had over a year's history of venous leg ulceration. Data were collected by interview.

RESULTS

Five major categories developed, relating to the 'physical experience', 'loss of control', 'vision of the future', 'carer's perspective' and 'health-care professional and patient relationship'.

CONCLUSION

Although the physical and psychological effects of leg ulceration featured prominently in this study, these were heavily influenced by the relationship between the participant and the health-care professional.

New areas for psychological assessment in general health care settings: what to do today to prepare for tomorrow

Unique roles of the professional psychologist are outlined with respect to increasingly restrictive utilization practices of managed care. Suggestions of how to develop less traditional venues of practice, the types of instruments to use, and report formats, along with ways to persuade primary care physicians (PCPs), managed care organizations, and facilities to utilize psychological assessment services are provided. Medical cost offsets, cost-efficient quality of care, and models of practice are also discussed.