Social Support and Pain Outcomes After Trauma Exposure Among Older Adults: A Multicenter Longitudinal Study

Predictors of sexual satisfaction among patients with chronic pain

Objectives

Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems-such as medical conditions, pain severity, and medication side effects-affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain.

Methods

Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic.

Results

Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction.

Discussion

Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment.

Cultural engagement and prevalence of pain in socially isolated older people: a longitudinal modified treatment policy approach

Background

It remains uncertain whether cultural engagement positively influences the reduction of pain risk, particularly depending on the social isolation status. The aim of this study was to examine the impact of cultural engagement on the reduction of pain prevalence over a 6-year follow-up period among older people, particularly those experiencing different dimensions of social isolation.

Methods

This study was a prospective longitudinal study. We analysed the English Longitudinal Study of Ageing cohort, consisting of 6468 community-dwelling adults aged ≥50 years old who provided data in waves 6 (2012-2013), 7 (2014-2015), 8 (2016-2017), and 9 (2018-2019). Self-reported cultural engagement (going to museums, art galleries, exhibitions, the theatre, concerts, or the opera) measured in waves 6-8 was used as the exposure variable. Meanwhile self-reported moderate-to-severe pain in wave 9 was used as the outcome variable. Social isolation was considered in waves 6-8, and the possibility of effect modification was captured by assessing each component of the social isolation index: not married or cohabiting with a partner, fewer than monthly contact with children/other immediate family/friends, and not engaging in any organisations, religious groups, or committees.

Findings

The estimated pain prevalence was 29.2% (95% confidence interval, 28.1-30.3; reference) after adjusting for time-variant, time-invariant, and loss to follow-up factors. Cultural engagement led to a reduction in pain prevalence to 24.1% for all individuals, representing a decrease of 5.1% (95% confidence interval, 0.6-9.6; P-value, 0.03). In older people who were not married or cohabiting, cultural engagement resulted in a decrease in pain prevalence to 25.8%, a reduction of 3.4% (95% confidence interval, 0.4-6.4; P-value, 0.01). For those with less frequent contact with close family members, the pain prevalence decreased to 25.3%, a reduction of 3.9% (95% confidence interval, 0.2-7.6; P-value, 0.03). Meanwhile, other dimensions of social isolation did not show a significant reduction in pain prevalence.

Interpretation

Cultural engagement may help to reduce the risk of pain in socially isolated older adults. Those who were single or living alone and had less frequent contact with immediate family were particularly vulnerable. While cultural engagement might help certain socially isolated older people feel better, its effectiveness varies, highlighting the need for targeted interventions.

Funding

The Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number (22K17648, Ikeda).

Perceived social support partially mediates the association between childhood abuse and pain-related characteristics

Higher perceived social support has been shown to buffer the impact of negative stressful events like childhood abuse on health outcomes. Yet, the role of perceived social support as a mediator of the association between childhood abuse and pain-related characteristics is not well understood. The present study explored this premise. Patients (n = 1,542) presenting to a tertiary-care, outpatient pain clinic completed a cross-sectional survey consisting of regularly collected clinical data and validated measures. Path analysis suggested that the impact of childhood abuse on sensory and affective pain-related characteristics was partially explained by perceived emotional support. Survivors of childhood abuse display a more complex clinical pain phenotype and this extends to more negative perceptions of social support. Our findings may reflect processes whereby childhood abuse negatively impacts social relationships across the lifespan, and these negative social perceptions and relationships influence sensory and affective components of pain.

Lifetime ostracism experiences and mechanisms of pain

One social mechanism by which marginalization is enacted is via ostracism. Recent research has demonstrated ostracism's impact on physical health, but little is known about the relationship between accumulated lifetime experiences of ostracism and pain. Despite recent calls for added attention to social modulation of pain and social indicators of pain disparities, the impact of specific social factors on pain-including those of ostracism-are not well understood. Results of laboratory studies on the effects of acute ostracism experiences on pain sensitivity have been mixed. However, these studies have not considered lived and repeated experiences of ostracism, and primarily included single static measures of pain sensitivity. Additionally, inclusion and representation of the relationship between ostracism experiences and pain among people with minoritized identities are lacking in the current literature. In this study, we explored accumulated lifetime experiences of ostracism as a potential contributing factor to enhanced pain and one social mechanism by which societal inequity may create and maintain inequity in pain. We extracted measures of lifetime experiences of ostracism from six studies focused on social factors and (non-chronic) pain conducted between 2016 and 2020 (n = 505 adults). To retain and examine diversity within the sample, we used moderation and within-group analyses. Results indicate that greater experiences of lifetime ostracism are associated with lower cold pain tolerance, but not other pain measures, in the whole sample. Moderation and within-group analyses reveal opposing patterns of results between populations included in the extant literature (White participants, convenience samples) and those under-represented in the scientific literature (racialized groups, community samples). This study provides an example of a diversity science approach to examining social indicators of pain, illustrates the limited generalizability of previous studies on ostracism and pain, and highlights the need for increased representation and inclusion to understand mechanisms of pain and inequity.

The association of resilience, social connections, and internal locus of control with pain outcomes among older adults

Our objective was to investigate the hypothesis that psychological resources, including resilience, social connections, and internal locus of control, separately and in additive combinations, would be associated with selected pain outcomes: 1) days of opioid use and 2) medical/drug expenditures over 2 years. A mailed survey was sent to a stratified sample of older adults age≥65 with diagnosed back pain, osteoarthritis, and/or rheumatoid arthritis. Each of the resources was dichotomized as high/low and/or counted with equal weighting. Among respondents (N=3,131), the prevalence of mild/no and moderate/severe pain severity was 59% and 41%, respectively. As hypothesized, each resource was associated with lower levels of pain; additively, reported pain severity decreased as the number of resources increased. For moderate/severe pain, there was reduced opioid use among those with more resources; and, for mild/no pain, decreased medical/drug expenditures among those with ≥2 resources. Interventions that integrate psychological resources may enhance their effectiveness.

Assessing family social support for functional autonomy and dependence in pain: A psychometric study

Assessing family supportive responses to pain behaviors is paramount, as these may help or hinder chronic pain (CP) adjustment. Current self-report measures of pain-specific family supportive dynamics are scarce, covering a limited range of responses. To address this gap, this paper aimed at the psychometric validation of a (revised) novel measure - the Informal Social Support for Autonomy and Dependence in Pain Inventory (ISSADI-PAIN). Three-hundred and three adults participated in this study (53.3% women; M_age = 49.31), 53.5% with current CP, 20.1% with acute pain (AP) in the previous week and 26.4% with no current pain. All participants completed the revised ISSADI-PAIN. Participants reporting AP/CP in the previous week also filled out measures of pain coping/outcomes. Exploratory and confirmatory factor analyzes supported a 3-factor structure: Perceived Promotion of Dependence (PPD; 5 items; α = .82), Perceived Promotion of Autonomy-Emotional (PPA-Emot; 3 items; α = .78), PPA-instrumental (PPA-Inst; 3 items; α = .82). Higher PPD was associated with higher AP disability and less wellness-focused coping; higher PPA-Emot was associated with more wellness-focused CP coping; PPA-Inst was associated with better/worse AP/CP outcomes and more frequent use of wellness-focused CP coping. Men with AP reported more PPD than women. The revised ISSADI-PAIN is an innovative, valid, and reliable measure of relevant functions of pain-related social support, which may influence pain persistence and adaptation. PERSPECTIVE: This article presents a novel self-report measure (ISSADI-PAIN) that assesses family support for functional autonomy and dependence in pain contexts. This measure may contribute to further research on the complexities of family supportive dynamics surrounding individuals with AP/CP, clarifying their role on pain persistence and adaptation processes.

Preferred self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain. A modified Delphi study

Objectives

The plethora of self-administered questionnaires to assess positive psychosocial factors complicates questionnaire selection. This study aimed to identify and reach consensus on the most suitable self-administered questionnaires to assess resilience, optimism, pain acceptance and social support in people with pain.

Design

A three-round modified Delphi study.

Participants

Forty international experts.

Methods

In Round 1, the experts suggested questionnaires deemed appropriate to assess resilience, optimism, pain acceptance and/or social support. In Round 2, experts indicated whether they considered the suggested questionnaires to be suitable (Yes/No/Don’t know) to assess these psychosocial factors, taking into consideration content, feasibility, personal experience and the measurement properties which we provided for each questionnaire. Questionnaires that were considered suitable by the majority of experts (≥60%) were retained for Round 3. In Round 3, the suitability of each questionnaire was rated on a 0–10 Likert scale. Consensus was reached if ≥ 75% of experts rated the questionnaire ≥7.

Results

From the 67 questionnaires suggested in Round 1, one questionnaire could be recommended per domain. For resilience: Pain Resilience Scale; for optimism: Revised Version of the Life Orientation Test; for pain acceptance: 8-item and Revised Versions of the Chronic Pain Acceptance Questionnaire; for social support: Emotional Support Item Bank of the PROMIS tool. Consensus for these questionnaires was also reached in a sensitivity analysis which excluded the ratings of experts involved in the development, translation and/or validation of relevant questionnaires.

Conclusion

We advocate the use of these recommended questionnaires so data can be compared and pooled more easily.

Social Isolation and Falls Risk: Lack of Social Contacts Decreases the Likelihood of Bathroom Modification Among Older Adults With Fear of Falling

Fall prevention strategies exist, but little is known about factors that influence whether they are used. We assessed whether social isolation modifies the association between fear of falling (FOF) and bathroom environmental modification. Data were included from 2858 Medicare beneficiaries in the National Health and Aging Trends Study. FOF and social isolation were assessed at baseline (2011); new bathroom modifications were assessed 1-year post-baseline. Social network size was dichotomized as any versus no social contacts. Logistic regression assessed associations between FOF and bathroom modification. Effect modification between FOF and social isolation was assessed with multiplicative interaction terms. FOF was associated with increased odds of bathroom modification. We observed a statistically significant interaction between FOF and social isolation (p = 0.03). Among those with no social contacts, FOF was associated with reduced odds bathroom modification that did not reach statistical significance (OR 0.5, 95% CI 0.2-1.3).

Impact of COVID-19 on outcomes after trauma the impact of the COVID-19 pandemic on functional and mental health outcomes after trauma

Background

The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and mental health outcomes after trauma.

Methods

Patients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes.

Results

1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; [95% CI 0.69–3.72]; P = 0.004) and were more likely to screen positive for depression (OR 1.46; [1.02–2.09]; P = 0.03) and anxiety (OR 1.56; [1.08–2.26]; P = 0.02). There was no significant difference in functional outcomes.

Conclusions

Patients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.

Factors Associated With Health-Related Quality of Life Among Older People Exposed to the Jeju 4·3 Incident

OBJECTIVE

We explored factors associated with health-related quality of life (HRQOL), including socio-demographic and clinical characteristics, in among older people exposed to the Jeju 4·3 incident, and aimed to determine the effects of depression, posttraumatic stress disorder (PTSD) and perceived social support on HRQOL.

METHODS

We obtained data from 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident (mean age, 75.1 years), and evaluated the relationships of HRQOL with sociodemographic and clinical characteristics including posttraumatic and depressive symptoms, and perceived social support.

RESULTS

Poorer physical health, psychological health, social relationships, and environment HRQOL domain scores were strongly associated with older age, being a woman, poor socioeconomic status, and symptoms of depression and PTSD. The regression analyses indicated that, when relevant factors were controlled for, perceived social support moderated the negative association between HRQOL and psychiatric symptoms.

CONCLUSION

Our results suggest the importance of sociodemographic characteristics, in addition to psychiatric symptoms, for understanding HRQOL in older people exposed to the Jeju 4·3 incident. These results have important implications for interventions aiming to improve the HRQOL of the victims of the Jeju 4·3 incident.

Perceived social support is strongly associated with recovery after injury

BACKGROUND

The strength of one's social support network is a potentially modifiable factor that may have a significant impact on recovery after injury. We sought to assess the association between one's perceived social support (PSS) and physical and mental health outcomes 6 months to 12 months postinjury.

METHODS

Moderate to severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing physical and mental health outcomes in addition to return to work and chronic pain 6 months to 12 months postinjury. Patients were also asked to rate the strength of their PSS on a 5-point Likert scale. Multivariate linear and logistic regression models were built to determine the association between PSS and postdischarge outcome metrics.

RESULTS

Of 907 patients included in this study, 653 (72.0%) identified themselves as having very strong/strong, 182 (20.1%) as average, and 72 (7.9%) as weak/nonexistent PSS. Patients who reported a weak/nonexistent PSS were younger and were more likely to be male, Black, and to have a lower level of education than those who reported a very strong/strong PSS. After adjusting for potential confounders, patients with a weak/nonexistent PSS were more likely to have new functional limitations and chronic pain in addition to being less likely to be back at work/school and being more likely to screen positive for symptoms of posttraumatic stress disorder, depression and anxiety at 6 months to 12 months postinjury than those with a strong/very strong PSS.

CONCLUSION

Lower PSS is strongly correlated with worse functional and mental health outcome metrics postdischarge. The strength of one's social support network should be considered when trying to identify patients who are at greatest risk for poor postdischarge outcomes after injury. Our data also lend support to creating a system wherein we strive to build a stronger support network for these high-risk individuals.

LEVEL OF EVIDENCE

Prognostic/epidemiologic, level III.

Social Support is Inversely Associated with Sleep Disturbance, Inflammation, and Pain Severity in Chronic Low Back Pain

BACKGROUND

Chronic low back pain (CLBP) is a significant cause of disability, lost wages, and health care costs. Inflammatory mediators, such as interleukin 6 (IL-6), have been associated with LBP severity. Patients with CLBP commonly experience sleep disturbance, and poor sleep has been shown to increase pain severity and inflammation. In contrast, social support may benefit patients with chronic low back by reducing pain intensity and inflammation.

OBJECTIVES

The purpose of this study was to examine the influence of social support on the relationships among sleep disturbance, inflammation, and pain severity in patients with CLBP.

METHODS

In a cross-sectional study, men and women with CLBP were enrolled from an outpatient pain clinic. Participants completed psychometric instruments for social support, sleep quality, and pain severity. Blood samples were obtained for measurement of the pro-inflammatory cytokine, IL-6, by enzyme-linked immunoassay.

RESULTS

Linear regression revealed greater sleep disturbance predicted greater pain severity. In contrast, participants who reported higher social support had lower sleep disturbance and lower pain severity. Mediation analysis revealed sleep disturbance to mediate the relationship between social support and pain, such that sleep disturbance reduced the benefit of social support on pain severity. Further, greater sleep disturbance and lower social support predicted increased IL-6. However, IL-6 did not mediate the relationship between social support and pain.

DISCUSSION

The findings suggest that increased social support is associated with lower sleep disturbance, lower inflammation, and lower pain severity in patients with CLBP. Assessing the extent of social support and fostering social support as part of a comprehensive pain management program may benefit patients with CLBP. Interventions to strengthen social support systems and cultivate support from family and/or informal social networks may reduce symptom burden and improve quality of life.

Perioperative care of geriatric patients

The older population is expected to nearly double across the globe by 2050, and the baby boom cohort is expected to represent at least 20% of the US population by 2030. Geriatric patients will increasingly utilize the health-care system, and therefore surgical and perioperative care must be tailored to this sensitive group given the increased risk for perioperative complications. The literature was reviewed to highlight fundamental components of the preoperative evaluation as well as cardiac, pulmonary, and renal complications. Frailty is a multidimensional process that can lead to the physiologic effects of aging and estimates the risk of perioperative morbidity and mortality better than chronologic age alone. Health-care providers should assess a geriatric patient's cognitive status, decision-making capacity, frailty, advance care planning, medications, and anesthetic approach in a multidisciplinary fashion to ensure optimal care. The risks of postoperative cardiac, pulmonary, and renal complications should be evaluated and optimized preoperatively to reduce the potential for adverse outcomes.

A Biopsychosocial Model of Chronic Pain for Older Adults

Population

Comprehensive evaluation of chronic pain in older adults is multifaceted.

Objective and Methods

Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.

Conclusions

This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.

The association of pain locus of control with pain outcomes among older adults

Our primary objective was to 1) determine the prevalence of pain locus of control (LOC) subscales in a population of older adults with pain conditions, and 2) estimate their associated protective effects on pain outcomes. A mailed survey was sent to a stratified sample of older adults age≥65 with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis. Multivariate logistic regression modeling was used to determine the relative protective associations of positive resources, including LOC, resilience and social networks, on pain outcomes. Among respondents (N = 3,824), 31% were identified as internal; 34% as powerful others; and 35% as chance. In adjusted models, internal was associated with outcomes of lower pain severity, reduced chronic opioid use and increased physical functionality. Powerful others was partially protective; chance was associated with the poorest outcomes. Multidimensional pain programs should incorporate the enhancement of positive resources, including LOC, to maximize the effectiveness of pain management strategies.

Association of Resilience and Social Networks with Pain Outcomes Among Older Adults

Depression, stress, and poor sleep have been associated with increased pain among older adults; positive resources, such as resilience and social networks, may help to buffer the impacts of these negative attributes on pain outcomes. The primary objective was to determine the relative effects of positive resources and negative attributes on pain outcomes among older adults with diagnosed back pain, osteoarthritis, and rheumatoid arthritis. The stratified study sample was identified from older adults ages ≥65 years. Members received a survey assessing positive resources (resilience, social networks), negative attributes (depression, stress, poor sleep), and pain outcomes (severity, interference). Opioid and other medication use was determined from pharmaceutical claims. After weighting to representative distributions of pain conditions and adjusting for survey response bias, multinomial logistic regressions were used to determine the relative associations of positive and negative attributes on pain outcomes. Among survey respondents (N = 4161), prevalence of self-reported pain severity and interference for no/mild, moderate, and severe categories was 61%, 21%, and 18%, and 67%, 16%, and 17%, respectively. In bivariate models, negative attributes of depression, stress, and poor sleep had stronger associations with pain severity and interference than the moderating effects of positive resources of high resilience and diverse social networks. In fully adjusted multivariate models, the strongest associations with moderate and severe pain severity and interference remained depression, stress, and poor sleep. Based on these results, multidimensional pain management strategies should include management of negative attributes along with enhancement of positive resources for effective management of chronic pain.