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Kapos FP, Craig KD, Anderson SR, Bernardes SF, Hirsh AT, Karos K, Keogh E, Reynolds Losin EA, McParland JL, Moore DJ, Ashton-James CE. Social Determinants and Consequences of Pain: Towards Multilevel, Intersectional, and Life Course Perspectives. THE JOURNAL OF PAIN 2024:104608. [PMID: 38897311 DOI: 10.1016/j.jpain.2024.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to: 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macro-level factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider: a) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy and interpersonal conflict; b) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and c) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.
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Affiliation(s)
- Flavia P Kapos
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, United States.
| | - Kenneth D Craig
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Sónia F Bernardes
- Iscte-Lisbon University Institute, Centre for Social Research and Intervention, Lisbon, Portugal
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, United States
| | - Kai Karos
- Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | | | - Joanna L McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | - David J Moore
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire E Ashton-James
- Pain Management Research Institute, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Van Alboom M, Baert F, Bernardes SF, Verhofstadt L, Bracke P, Jia M, Musial K, Gabrys B, Goubert L. Examining the Role of Structural and Functional Social Network Characteristics in the Context of Chronic Pain: An Ego-centered Network Design. THE JOURNAL OF PAIN 2024:104525. [PMID: 38609026 DOI: 10.1016/j.jpain.2024.104525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
The well-being and functioning of individuals with chronic pain (CP) vary significantly. Social factors, such as social integration, may help explain this differential impact. Specifically, structural (network size, density) as well as functional (perceived social support, conflict) social network characteristics may play a role. However, it is not yet clear whether and how these variables are associated with each other. Objectives were to examine 1) both social network characteristics in individuals with primary and secondary CP, 2) the association between structural network characteristics and mental distress and functioning/participation in daily life, and 3) whether the network's functionality mediated the association between structural network characteristics and mental distress, respectively, functioning/participation in daily life. Using an online ego-centered social network tool, cross-sectional data were collected from 303 individuals with CP (81.85% women). No significant differences between individuals with fibromyalgia versus secondary CP were found regarding network size and density. In contrast, ANCOVA models showed lower levels of perceived social support and higher levels of conflict in primary (vs secondary) CP. Structural equation models showed that 1) larger network size indirectly predicted lower mental distress via lower levels of conflict; 2) higher network density increased mental distress via the increase of conflict levels. Network size or density did not (in)directly predict functioning/participation in daily life. The findings highlight that the role of conflict, in addition to support, should not be underestimated as a mediator for mental well-being. Research on explanatory mechanisms for associations between the network's structure, functionality, and well-being is warranted. PERSPECTIVE: This paper presents results on associations between structural (network size, density) and functional (social support, conflict) social network characteristics and well-being in the context of CP by making use of an ego-centered network design. Results suggest an indirect association between structural network characteristics and individuals with CP their mental well-being.
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Affiliation(s)
- Maité Van Alboom
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Fleur Baert
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sónia F Bernardes
- Department of Social and Organizational Psychology, School of Social Sciences and Humanities, ISCTE - University Institute of Lisbon, Lisboa, Portugal
| | - Lesley Verhofstadt
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Faculty of Political and Social Sciences, Department of Sociology, Ghent University, Ghent, Belgium
| | - Mingshan Jia
- Faculty of Engineering, University of Technology Sydney, Sydney, Australia
| | - Katarzyna Musial
- Faculty of Engineering, University of Technology Sydney, Sydney, Australia
| | - Bogdan Gabrys
- Faculty of Engineering, University of Technology Sydney, Sydney, Australia
| | - Liesbet Goubert
- Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Woods SB, Roberson PNE, Abdelkhaleq H. Family strain, but not family support, is linked to worse pain interference among midlife adults reporting new chronic pain. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:467-477. [PMID: 37410420 PMCID: PMC10770288 DOI: 10.1037/fsh0000825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife. METHOD We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain. RESULTS The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later. DISCUSSION Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sarah B. Woods
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | | | - Haneen Abdelkhaleq
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
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Lyng KD, Djurtoft C, Bruun MK, Christensen MN, Lauritsen RE, Larsen JB, Birnie KA, Stinson J, Hoegh MS, Palsson TS, Olesen AE, Arendt-Nielsen L, Ehlers LH, Fonager K, Jensen MB, Würtzen H, Poulin PA, Handberg G, Ziegler C, Moeller LB, Olsen J, Heise L, Rathleff MS. What is known and what is still unknown within chronic musculoskeletal pain? A systematic evidence and gap map. Pain 2023; 164:1406-1415. [PMID: 36602421 DOI: 10.1097/j.pain.0000000000002855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/01/2022] [Indexed: 01/06/2023]
Abstract
ABSTRACT Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no EGMs within the broad domain of chronic musculoskeletal (MSK) pain in adults. The aim of this study was to create a contemporary EGM of interventions and outcomes used for research investigating chronic MSK pain. This EGM was based on systematic reviews of interventions published in scientific journals within the past 20 years. Embase, PubMed, the Cochrane Library, and PsycINFO were used to retrieve studies for inclusion. The quality of the included reviews was assessed using AMSTAR-II. Interventions were categorised as either physical, psychological, pharmacological, education/advice, interdisciplinary, or others. Outcomes were categorised using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Of 4299 systematic reviews, 457 were included. Of these, 50% were rated critically low quality, 25% low quality, 10% moderate quality, and 15% rated high quality. Physical interventions (eg, exercise therapy) and education were the most common interventions reported in 80% and 20% of the studies, respectively. Pain (97%) and physical functioning (87%) were the most reported outcomes in the systematic reviews. Few systematic reviews used interdisciplinary interventions (3%) and economic-related outcomes (2%). This contemporary EGM revealed a low proportion of high-quality evidence within chronic MSK pain. This EGM clearly outlines the lack of high-quality research and the need for increased focus on interventions encompassing the entire biopsychosocial perspective.
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Affiliation(s)
- Kristian D Lyng
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Chris Djurtoft
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Malene K Bruun
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Mads N Christensen
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Rikke E Lauritsen
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper B Larsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kathryn A Birnie
- Departments of Anesthesiology, Perioperative, and Pain Medicine and
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jennifer Stinson
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Morten S Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thorvaldur S Palsson
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Anne E Olesen
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Lars H Ehlers
- Denmark & Nordic Institute of Health Economics, Aarhus, Denmark
| | - Kirsten Fonager
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Martin B Jensen
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Hanne Würtzen
- Department of Neuroanaesthesiology, The Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen, Denmark
| | - Patricia A Poulin
- Department of Psychology, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gitte Handberg
- Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
- Pain Center, Odense University Hospital, Odense, Denmark
| | - Connie Ziegler
- Gigtforeningen/Danish Rheumatism Association, Copenhagen, Denmark
| | - Lars B Moeller
- Foreningen af Kroniske Smerteramte og Pårørende (FAKS)/The Association for Chronic Pain Patients and Relatives, Copenhagen, Denmark
| | - Judi Olsen
- Fibromyalgi & Smerteforeningen/the Danish Fibromyalgia & Pain Association, Copenhagen, Denmark
| | - Lotte Heise
- Danish Broadcasting Corporation, Copenhagen, Denmark
| | - Michael S Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
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Okbai T, Fessehaye S, Yohannes Gebray A, Tewelde Kahsay D. Final-semester nursing studentś knowledge and attitude regarding pain management in resources limited setting. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Dourson AJ, Willits A, Raut NG, Kader L, Young E, Jankowski MP, Chidambaran V. Genetic and epigenetic mechanisms influencing acute to chronic postsurgical pain transitions in pediatrics: Preclinical to clinical evidence. Can J Pain 2022; 6:85-107. [PMID: 35572362 PMCID: PMC9103644 DOI: 10.1080/24740527.2021.2021799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/02/2022]
Abstract
Background Chronic postsurgical pain (CPSP) in children remains an important problem with no effective preventive or therapeutic strategies. Recently, genomic underpinnings explaining additional interindividual risk beyond psychological factors have been proposed. Aims We present a comprehensive review of current preclinical and clinical evidence for genetic and epigenetic mechanisms relevant to pediatric CPSP. Methods Narrative review. Results Animal models are relevant to translational research for unraveling genomic mechanisms. For example, Cacng2, p2rx7, and bdnf mutant mice show altered mechanical hypersensitivity to injury, and variants of the same genes have been associated with CPSP susceptibility in humans; similarly, differential DNA methylation (H1SP) and miRNAs (miR-96/7a) have shown translational implications. Animal studies also suggest that crosstalk between neurons and immune cells may be involved in nociceptive priming observed in neonates. In children, differential DNA methylation in regulatory genomic regions enriching GABAergic, dopaminergic, and immune pathways, as well as polygenic risk scores for enhanced prediction of CPSP, have been described. Genome-wide studies in pediatric CPSP are scarce, but pathways identified by adult gene association studies point to potential common mechanisms. Conclusions Bench-to-bedside genomics research in pediatric CPSP is currently limited. Reverse translational approaches, use of other -omics, and inclusion of pediatric/CPSP endophenotypes in large-scale biobanks may be potential solutions. Time of developmental vulnerability and longitudinal genomic changes after surgery warrant further investigation. Emergence of promising precision pain management strategies based on gene editing and epigenetic programing emphasize need for further research in pediatric CPSP-related genomics.
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Affiliation(s)
- Adam J. Dourson
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,USA
| | - Adam Willits
- Neuroscience Graduate Program, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Namrata G.R. Raut
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,USA
| | - Leena Kader
- Neuroscience Graduate Program, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Erin Young
- Neuroscience Graduate Program, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Michael P. Jankowski
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Vidya Chidambaran
- Department of Anesthesia, Division of Pain Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,USA
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Merminod G, Weber O, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Talking about chronic pain in family settings: a glimpse of older persons’ everyday realities. BMC Geriatr 2022; 22:358. [PMID: 35461217 PMCID: PMC9034600 DOI: 10.1186/s12877-022-03058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The expression of chronic pain remains a delicate matter for those older persons who suffer from this condition. If many studies highlight the difficulties of putting pain into words, scarce are those that take into account how given social networks can facilitate or prevent its expression. Based on a qualitative study that explores the communication about chronic pain in older persons’ social network, this article reports on this key issue of talking about health in later life within family settings and provides clinicians with information about the way older persons with chronic conditions perceive their everyday realities and social relations.
Methods
A multidisciplinary research team (medicine, linguistics and psychology) interviewed 49 persons with chronic pain, all from the French-speaking part of Switzerland, aged 75 and older, without any major cognitive or auditory impairments. After transcription, the interviews were analyzed by combining content and discourse analysis with social network theories.
Results
Communication about chronic pain depends significantly on the position of the interlocutors within the family structure, with a preference for direct relatives or individuals with similar difficulties. In social networks, the ability to communicate about chronic pain is both a resource (by allowing older persons to get help or by strengthening interpersonal relations) and a challenge (by threatening their autonomy, social relations or self-esteem).
Conclusions
The study shows the predominance of the nuclear family (partner, children) in communication relating specifically to the everyday management of chronic pain. This state of affairs is, nevertheless, balanced by issues of (loss of) autonomy. These findings, in line with current trends in geriatrics, could benefit future reflections on the scope and limits of including relatives in the care of older patients with chronic conditions.
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Mikkelsen HT, Haraldstad K, Helseth S, Skarstein S, Småstuen MC, Rohde G. Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents. BMC Psychol 2021; 9:128. [PMID: 34462000 PMCID: PMC8404017 DOI: 10.1186/s40359-021-00629-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background To promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy. Methods A cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses. Results Adolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%). Conclusions Our findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00629-z.
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Affiliation(s)
- Hilde Timenes Mikkelsen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Kristin Haraldstad
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Sølvi Helseth
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Siv Skarstein
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Gudrun Rohde
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
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Fritsch CG, Ferreira ML, da Silva AKF, Simic M, Dunn KM, Campbell P, Foster NE, Ferreira PH. Family-based Interventions Benefit Individuals With Musculoskeletal Pain in the Short-term but not in the Long-Term: A Systematic Review and Meta-Analysis. Clin J Pain 2021; 37:140-157. [PMID: 33177371 DOI: 10.1097/ajp.0000000000000897] [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: 05/14/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The benefits of family-based interventions for patients with musculoskeletal pain have been previously shown in individual randomized controlled trials (RCTs), but no systematic review has summarized their effects. MATERIALS AND METHODS A systematic review was conducted to assess the effectiveness of family-based interventions on clinical and biopsychosocial outcomes in people with musculoskeletal pain (PROSPERO CRD42018118442). Meta-analyses were performed for the outcomes of pain intensity, disability, mood, self-efficacy, and marital adjustment. RESULTS Of 1223 records identified, 18 reports representing 15 RCTs were included in the qualitative review and 10 in the meta-analyses. Family-based interventions were more effective to reduce pain (mean difference [MD], -3.55/100; 95% confidence intreval [CI], -4.03 to -3.06) and disability (MD, -1.51/100; 95% CI, -1.98 to -1.05) than individual-focused interventions at short-term, but not at mid term or long term. There were no effects on other outcomes. Family-based interventions were more effective to reduce pain (MD, -6.05/100; 95% CI, -6.78 to -5.33) compared with usual care only at short-term. No effects were found on disability and other outcomes. DISCUSSION There is moderate-quality evidence that family-based interventions result in small, significantly better pain and disability outcomes in the short-term compared with individual-focused interventions in patients with musculoskeletal pain. Based on low-quality evidence, family-based interventions result in small improvements on pain in the short-term compared with usual care. Future studies should review the content and optimize the mechanisms underpinning family-based interventions in musculoskeletal pain so that the approach could be further tested in adequately powered RCTs.
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Affiliation(s)
- Carolina G Fritsch
- Institute of Bone and Joint Research, the Kolling Institute, Northern Clinical School
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, the Kolling Institute, Northern Clinical School
| | - Anne K F da Silva
- Musculoskeletal Research Group, Faculty of Health Sciences, the University of Sydney, Sydney, Australia
- Faculty of Sciences and Technology, São Paulo State University, São Paulo, Brazil
| | - Milena Simic
- Faculty of Sciences and Technology, São Paulo State University, São Paulo, Brazil
| | - Kate M Dunn
- Faculty of Medicine and Health Sciences, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele
| | - Paul Campbell
- Faculty of Medicine and Health Sciences, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele
- Department of Research and Innovation, Midlands Partnership NHS Foundation Trust, St Georges Hospital, Stafford, UK
| | - Nadine E Foster
- Faculty of Medicine and Health Sciences, Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele
| | - Paulo H Ferreira
- Musculoskeletal Research Group, Faculty of Health Sciences, the University of Sydney, Sydney, Australia
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Family history of pain and risk of musculoskeletal pain in children and adolescents: a systematic review and meta-analysis. Pain 2020; 160:2430-2439. [PMID: 31188266 DOI: 10.1097/j.pain.0000000000001639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Emerging evidence suggests that musculoskeletal (MSK) pain should be viewed from a biopsychosocial perspective and consider the influence of family factors. We conducted a review with meta-analysis to provide summary estimates of effect of family history of pain on childhood MSK pain and explore whether specific family pain factors influence the strength of the association (PROSPERO CRD42018090130). Included studies reported associations between family history of pain and nonspecific MSK pain in children (age <19 years). The outcome of interest was MSK pain in children. We assessed the methodological quality using a modified version of the Quality in Prognosis Studies instrument and quality of evidence for the main analyses using the GRADE criteria. After screening of 7281 titles, 6 longitudinal and 23 cross-sectional studies were included. Moderate quality evidence from 5 longitudinal studies (n = 42,131) showed that children with a family history of MSK pain had 58% increased odds of experiencing MSK pain themselves (odds ratio [OR] 1.58, 95% confidence interval 1.20-2.09). Moderate quality evidence from 18 cross-sectional studies (n = 17,274) supported this finding (OR 2.02, 95% 1.69-2.42). Subgroup analyses showed that the relationship was robust regardless of whether a child's mother, father, or sibling experienced pain. Odds were higher when both parents reported pain compared with one ([mother OR = 1.61; father OR = 1.59]; both parents OR = 2.0). Our findings show moderate quality evidence that children with a family history of pain are at higher risk of experiencing MSK pain. Understanding the mechanism by which this occurs would inform prevention and treatment efforts.
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Effects of using text message interventions for the management of musculoskeletal pain: a systematic review. Pain 2020; 161:2462-2475. [DOI: 10.1097/j.pain.0000000000001958] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Dash GF, Feldstein Ewing SW, Murphy C, Hudson KA, Wilson AC. Contextual risk among adolescents receiving opioid prescriptions for acute pain in pediatric ambulatory care settings. Addict Behav 2020; 104:106314. [PMID: 31962289 DOI: 10.1016/j.addbeh.2020.106314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/31/2019] [Accepted: 01/10/2020] [Indexed: 12/20/2022]
Abstract
Many adults with opioid use disorder (OUD) report that their first exposure to opioids was in the course of routine pain treatment in medical care settings. Adolescents receive opioid prescriptions with frequency, but are susceptible to a constellation of unique risks in the context of pain management. This empirical study presents the first cohort of adolescents recruited from ambulatory medical care within 72 h of their receipt of opioids to treat acute pain. The primary aim was to capture a time-sensitive report of the intersection of prescription opioid receipt and contextual risks for opioid misuse related to pain experience, mental health symptoms, and substance use at the adolescent and parental levels. Data were collected from 70 14-19-year-old adolescents and their accompanying parent. Results reflected that 90% of this sample of adolescents reported 2 or more risks and 35% reported 5 or more risks for future opioid misuse. Pain catastrophizing (46%) and alcohol use (40%) and were the most common adolescent-level risk factors; mother history of chronic pain (32%) and parent anxiety (21%) were the most common parent-level risk factors. Past-week parent pain intensity showed the strongest association with adolescent past-week pain intensity; neither was associated with adolescent OUD symptoms. Adolescent pain catastrophizing most reliably predicted OUD symptoms; parent pain interference was also associated. Seventy-one percent of parents reported keeping opioids at home, a relevant risk factor for future misuse. These findings illuminate the intersection between adolescent and parental risks in the context of pediatric opioid prescribing for acute pain management, and provide initial insight into potential points of prevention early in adolescent pain treatment, including avenues by which to inform and enhance prescriber decision-making regarding factors to be weighed in adolescent candidacy for opioid therapy.
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Woods SB, Priest JB, Kuhn V, Signs T. Close relationships as a contributor to chronic pain pathogenesis: Predicting pain etiology and persistence. Soc Sci Med 2019; 237:112452. [PMID: 31398508 DOI: 10.1016/j.socscimed.2019.112452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE Chronic stress contributes to the pathogenesis of chronic pain. Yet, the role of close relationship stress in these pathways to pain is not fully understood. OBJECTIVE To delineate specific psychosocial pathways associated with chronic pain, specifically emphasizing close relationships for midlife adults. We tested whether relationship strain, relationship support, social integration, depression, anxiety, and pain severity predict chronic pain etiology and persistence over 10 years, highlighting specific associations for acute versus chronic pain. METHOD Using data from the National Survey of Midlife in the U.S. (MIDUS 2 and 3, collected in 2004-2006 and 2013-2014, respectively), we used logistic regression to test the etiology of new chronic pain (n = 1591) and persistence of pain for adults with acute (n = 352) and chronic pain (n = 367) conditions at baseline. RESULTS Of participants who reported they did not have chronic pain at baseline, the development of chronic pain 10 years later was significantly associated with baseline family strain (OR = 1.38, p < .01). For participants with acute pain at baseline, the transition of this pain to chronic a decade later was significantly associated with initial reports of pain interference (OR = 1.24, p < .001), family support (OR = 0.60, p < .05), and depression (OR = 1.20, p < .05). Persistent chronic pain was solely associated with baseline pain interference (OR = 1.21, p < .01). CONCLUSIONS Family strain is an important part of the chronic stress profile associated with chronic pain etiology, whereas family support is associated with a reduced risk of acute pain transitioning to chronic pain over time. Prioritizing family relationships in treatment approaches to pain may be an indicated, innovative approach to preventing pain development and escalation and requires systems training in healthcare.
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Affiliation(s)
- Sarah B Woods
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5920 Forest Park Rd, Suite 651, Dallas, TX 75390, USA.
| | - Jacob B Priest
- Department of Psychological and Quantitative Foundations, University of Iowa, N372 Lindquist Center, Iowa City, IA 52242, USA.
| | - Veronica Kuhn
- Graduate School of Education & Psychology, Pepperdine University, 6100 Center Dr., Los Angeles, CA 90045, USA.
| | - Tara Signs
- College of Humanities and Social Sciences, Oklahoma Baptist University, 500 West University, Shawnee, OK, 74804, USA.
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14
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Abd-Elsayed A, Grandhi R, Lawrence JP. Expectations, Coping, Cultural and Environmental Factors. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Vega E, Beaulieu Y, Gauvin R, Ferland C, Stabile S, Pitt R, Gonzalez Cardenas VH, Ingelmo PM. Chronic non-cancer pain in children: we have a problem, but also solutions. Minerva Anestesiol 2018; 84:1081-1092. [PMID: 29745621 DOI: 10.23736/s0375-9393.18.12367-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic non-cancer pain in children and adolescents has been described as "a modern public health disaster" that has generated significant medical and economic burdens within society. Seen as a disease in its own right, chronic pain has short and long-term consequences that impact not only the patient's health but also that of friends and families, due to significant parenting stress and disruptions in family life and structure. The evidence supporting pharmacological treatments and interventional procedures is limited, and no single strategy has been shown to be completely effective in children with chronic non-cancer pain. Therefore, considering the multifactorial nature of chronic pain, these patients should be treated with a multidisciplinary, balanced approach that seeks a primary outcome of improved functioning rather than of pain reduction. Using a bio-psycho-social approach, a multidisciplinary team, including a physiotherapist, nurse, social worker, psychologist, and physician, has been effective in achieving this outcome of improved functioning in children and adolescents with chronic pain. In this review, we discuss the impact, associated conditions, and evolution of chronic pain, along with the crucial role of every member of a multidisciplinary chronic pain clinic involved in the care of the children and adolescents with chronic non-cancer pain.
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Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yves Beaulieu
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rachel Gauvin
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Catherine Ferland
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Stephanie Stabile
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rebecca Pitt
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Victor H Gonzalez Cardenas
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,University Foundation for Health Sciences, Bogotá, Colombia
| | - Pablo M Ingelmo
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada - .,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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