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Wild MG, Ehde DM, Reyes MR, Fann JR, Bombardier CH. Disparities based on demographic features in the intensity and treatment of chronic pain in US patients with spinal cord injury. Arch Phys Med Rehabil 2024:S0003-9993(24)01072-4. [PMID: 38964636 DOI: 10.1016/j.apmr.2024.06.010] [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: 06/29/2023] [Revised: 05/28/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Informed by Minority Stress Theory, to investigate disparities in pain intensity, interference, and care in patients with spinal cord injuries (SCI) based on demographic features. DESIGN Cross-sectional survey SETTING: Outpatient SCI clinics in two academic medical centers in the northwestern US. PARTICIPANTS Sample of 242 SCI clinic patients who endorsed SCI-related pain, were 18-years-of-age or older, English-fluent, not diagnosed with bipolar or psychotic disorders, and able to make their own medical decisions. Participants were 74.8% male, an average of 48.5 years (range 18.1-89.8 years), 76.2% White, 31.9% privately insured, and 64.7% making less than $50,000 per year. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Exploratory analyses of screening data from a randomized controlled trial for pain treatment. Primary outcomes included pain intensity, pain interference, and the patient report of recommended pain treatments by a medical provider, tried by the patient, or that the patient would be willing to try. RESULTS More treatments recommended was associated with younger age (ρ=-0.14, 95%CI: -0.01 to -0.27, p=.03) and private insurance ((ρ=-0.15, 95%CI: 0.02 to 0.27, p=.03), while more treatments tried was associated with private insurance alone (ρ=0.20, 95%CI: 0.07 to 0.32, p=.003). Number of treatments willing to be tried was associated with lower income (ρ=-0.15, 95%CI: -0.02 to -0.28, p=.03). SCI Patients of Color (POC) reported higher pain intensity (Cohen's D = 0.41, 95%CI:0.11-0.71) and greater odds of receiving psychotherapy for pain (OR: 7.12, 95%CI: 1.25-40.46) than their White peers. CONCLUSION(S) These exploratory findings indicate differences in SCI-related pain intensity based on identifying as POC, and differences in SCI-related pain treatment modalities based on identifying as POC, age, insurance type, and income. Further work exploring differences in SCI-related pain care based on patient social identities is warranted.
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Affiliation(s)
- Marcus G Wild
- VISN 17 Center of Excellence for Research on Returning War Veterans.
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Maria R Reyes
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R Fann
- Departments of Psychiatry & Behavioral Sciences and Rehabilitation Medicine, University of Washington, Seattle
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Strand N, Gomez DA, Kacel EL, Morrison EJ, St Amand CM, Vencill JA, Pagan-Rosado R, Lorenzo A, Gonzalez C, Mariano ER, Reece-Nguyen T, Narouze S, Mahdi L, Chadwick AL, Kraus M, Bechtle A, Kling JM. Concepts and Approaches in the Management of Transgender and Gender-Diverse Patients. Mayo Clin Proc 2024; 99:1114-1126. [PMID: 38960496 DOI: 10.1016/j.mayocp.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/10/2023] [Accepted: 12/28/2023] [Indexed: 07/05/2024]
Abstract
The terms transgender and gender diverse (TGD) describe persons whose gender is different from the sex assigned to them at birth. While TGD persons have experienced a rise in cultural and social visibility in recent decades, they continue to experience significant health inequities, including adverse health outcomes and multiple barriers to accessing medical care. Transgender and gender-diverse persons are at a higher risk for pain conditions than their cisgender counterparts, but research on chronic pain management for TGD persons is lacking. Clinicians from all disciplines must be informed of best practices for managing chronic pain in the TGD population. This includes all aspects of care including history, physical examination, diagnosis, treatment, and perioperative management. Many TGD persons report delaying or avoiding care because of negative interactions with medical practitioners who do not have sufficient training in navigating the specific health care needs of TGD patients. Furthermore, TGD persons who do seek care are often forced to educate their practitioners on their specific health care needs. This paper provides an overview of existing knowledge and recommendations for physicians to provide culturally and medically appropriate care for TGD persons.
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Affiliation(s)
- Natalie Strand
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Diego Alan Gomez
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Elizabeth L Kacel
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Colt M St Amand
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA; Department of Psychology, University of Houston, TX, USA, and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer A Vencill
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert Pagan-Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Andrea Lorenzo
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Cesar Gonzalez
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA, and Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Travis Reece-Nguyen
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Stanford Children's Hospital, Palo Alto, CA, USA
| | - Samer Narouze
- Center for Pain Relief, Summa Western Reserve Hospital, Cuyahoga Falls, OH, USA
| | - Layth Mahdi
- Department of Emergency Medicine, NYP Brooklyn Methodist, Brooklyn, New York
| | - Andrea L Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Molly Kraus
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA
| | - Alexandra Bechtle
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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3
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Butera KA, Chimenti RL, Alsouhibani AM, Berardi G, Booker SQ, Knox PJ, Post AA, Merriwether EN, Wilson AT, Simon CB. Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the "Pain-Movement Interface" to Guide Research and Clinical Care for Musculoskeletal Pain Conditions. THE JOURNAL OF PAIN 2024; 25:104486. [PMID: 38316243 PMCID: PMC11180580 DOI: 10.1016/j.jpain.2024.01.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the "Pain-Movement Interface" as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PERSPECTIVE: Movement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the "Pain-Movement Interface" as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.
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Affiliation(s)
- Katie A. Butera
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ali M. Alsouhibani
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Giovanni Berardi
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew A. Post
- Department of Physical Therapy & Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
| | - Ericka N. Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Culture, Education, and Human Development, Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York, USA
| | - Abigail T. Wilson
- School of Kinesiology & Rehabilitation Sciences, University of Central Florida, Orlando, Florida, USA
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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4
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Ray BM, Kelleran KJ, Fodero JG, Harvell-Bowman LA. Examining the Relationship Between Chronic Pain and Mortality in U.S. Adults. THE JOURNAL OF PAIN 2024:104620. [PMID: 38942415 DOI: 10.1016/j.jpain.2024.104620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
Chronic pain (CP) significantly impacts quality of life and increases noncommunicable disease risk, with recent U.S. data showing a 6.3% incidence rate, surpassing diabetes, depression, and hypertension. International studies suggest higher mortality in CP populations, yet prior U.S. data are inconclusive. To investigate CP's mortality risk, we analyzed National Health Interview Survey and National Death Index data. We hypothesized that individuals with CP and high-impact CP (HICP [≥1 activity limitation]) would exhibit higher mortality rates. National Health Interview Survey provided demographics, pain reporting, lifestyle, and psychosocial data matched with National Death Index mortality records. Chi-square analyses explored the relationships between CP/HICP and demographics, lifestyle factors, psychosocial variables, and mortality. Cox proportional hazards models assessed mortality risk between groups. The weighted sample was 245,899,776; 20% reported CP and 8% HICP, both groups exhibiting higher mortality rates than pain-free individuals (CP: 5.55%, HICP: 8.79%, total: 2.82%). Hazard ratios indicated nearly double the mortality risk for CP and 2.5 times higher risk for HICP compared to those without these conditions. Adjusting for lifestyle and psychosocial factors reduced mortality risk but remained elevated compared with non-CP individuals. Heart disease, malignant neoplasms, and chronic lower respiratory diseases accounted for a higher percentage of deaths in CP cases. CP individuals showed higher rates of smoking, alcohol consumption, obesity, inactivity, depression, anxiety, emotional problems, and sleep disturbances. CP and HICP significantly influence mortality outcomes, leading to excess deaths compared with pain-free individuals. Given the relationship between pain, lifestyle, psychosocial variables, and mortality, further investigations are needed into CP causation and prevention strategies. PERSPECTIVE: This article presents evidence regarding the relationship between CP, HICP, and mortality. Additional findings are discussed regarding the impact of demographics, lifestyle, and psychosocial variables on mortality in those with versus without CP and HICP. These findings are crucial for informing future research, prevention, and healthcare management strategies.
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Affiliation(s)
- B Michael Ray
- Department of Health & Human Sciences, Bridgewater College, Bridgewater, Virginia.
| | - Kyle J Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York
| | - Jesse G Fodero
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York; Department of Orthopedics and Sports Medicine, University at Buffalo, Buffalo, New York
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5
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Stimpson JP, Park S, Rivera-González AC, Wilson FA, Ortega AN. Prevalence of Chronic Pain by Immigration Status and Latino Ethnicity. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02056-3. [PMID: 38888880 DOI: 10.1007/s40615-024-02056-3] [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: 03/14/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE The goal of this study was to evaluate the Latino paradox and healthy migrant hypotheses by estimating the association between the prevalence of chronic pain, immigration status, and Latino ethnicity. METHODS This cross-sectional study analyzed pooled data from 85,395 adult participants of the 2019-2021 National Health Interview Survey. The dependent variables were any pain and chronic pain in the past 3 months. The independent variables were immigration status (US born, naturalized citizen, non-citizen) and Latino ethnicity. RESULTS Chronic pain was prevalent for nearly a quarter of US born non-Latino adults (24%) and non-citizen non-Latino adults had the lowest prevalence at 8%. In multivariable adjusted models, US born non-Latino immigration status and ethnicity was associated with a higher probability of reporting chronic pain in the last 3 months compared to US born Latino adults (-3.0%; 95% CI = -4.4%, -1.6%), naturalized citizen non-Latino adults (-4.7%; 95% CI = -5.9%, -3.4%), naturalized citizen Latino adults (-6.7%; 95% CI = -8.5%, -4.9%), non-citizen non-Latino adults (-3.1%; 95% CI = -4.7%, -1.5%), and non-citizen Latino adults (-8.9%; 95% CI = -10.8%, -7.0%). CONCLUSION US Born non-Latino adults reported the highest prevalence of chronic pain and non-citizen Latino adults reported the lowest prevalence of chronic pain providing support for the Latino paradox and healthy migrant effect hypotheses.
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Affiliation(s)
- Jim P Stimpson
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Sungchul Park
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
| | - Alexandra C Rivera-González
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Alexander N Ortega
- Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, HI, USA
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6
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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: Toward 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 macrolevel 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 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) 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, Washington; Department of Orthopaedic Surgery & Duke Clinical Research Institute, Duke University Schoool of Medicine, Durham, North Carolina.
| | - 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, California
| | - Sónia F Bernardes
- Centre for Social Research and Intervention, Iscte-Lisbon University Institute, Lisbon, Portugal
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana
| | - Kai Karos
- Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, 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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7
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MacKenzie NE, Marbil MG, Soltani S, Lorenzetti DL, Birnie KA. A systematic review of in-person versus remotely delivered interventions for youth with chronic pain. PAEDIATRIC & NEONATAL PAIN 2024; 6:35-43. [PMID: 38863459 PMCID: PMC11163229 DOI: 10.1002/pne2.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/13/2024]
Abstract
The COVID-19 pandemic prompted a rapid shift from in-person to virtually-delivered care. Many youth with chronic pain have the ability to access care virtually; however, little is known about the efficacy of pain care for youth with chronic pain delivered virtually when compared to in-person. Such evidence is essential to guide youth in making decisions about their care, but also to inform what options health professionals present to youth. The purpose of this systematic review and meta-analysis was to examine the efficacy of interventions that are delivered in-person versus virtually for youth with chronic pain. Five databases (i.e., CINAHL, EMBASE, MEDLINE, APA PsycINFO, and Web of Science) were searched in October 2022 to identify randomized controlled trials that compare single/multimodal interventions for pediatric chronic pain delivered in-person versus virtually. A total 3638 unique studies were identified through database and other searching, two of which satisfied established criteria for inclusion in this review. Both studies compared psychological interventions delivered virtually versus in-person for youth with chronic pain and showed comparable efficacy across modalities. The planned meta-analyses could not be conducted due to different outcomes within each study that could not be combined. This systematic review highlights a critical gap in the evidence regarding the efficacy of virtually delivered interventions for youth with chronic pain. This evidence is necessary to inform treatment decisions for youth, and further research is required to develop the evidence to inform clinical interventions, especially as virtual treatments continue to be offered.
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Affiliation(s)
- Nicole E. MacKenzie
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
- Centre for Pediatric Pain ResearchIWK HealthHalifaxNova ScotiaCanada
| | | | - Sabine Soltani
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Diane L. Lorenzetti
- Health Sciences Library and Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Kathryn A. Birnie
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Anesthesiology, Perioperative and Pain Medicine, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
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Slater R, Eccleston C, Williams A, Vincent K, Linde M, Hurley M, Laughey W. Reframing pain: the power of individual and societal factors to enhance pain treatment. Pain Rep 2024; 9:e1161. [PMID: 38655237 PMCID: PMC11037735 DOI: 10.1097/pr9.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 04/26/2024] Open
Abstract
The effectiveness of analgesics can be increased if synergistic behavioural, psychological, and pharmacological interventions are provided within a supportive environment.
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Affiliation(s)
- Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Amanda Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Mattias Linde
- Norwegian Centre for Headache Research (NorHEAD), Trondheim, Norway
- Regional Migraine Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Hurley
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - William Laughey
- Health Professions Education Unit, Hull York Medical School, University of York, York, United Kingdom
- Reckitt Benckiser Healthcare Ltd, Dansom Lane South, Kingston Upon Hull, United Kingdom
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9
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Matthias MS, Myers LJ, Coffing JM, Carter JL, Daggy JK, Slaven JE, Bair MJ, Bravata DM, McGuire AB. Patterns of Opioid Prescriptions in the Veterans Health Administration for Patients With Chronic Low-Back Pain After the Onset of the COVID-19 Pandemic: A Retrospective Cohort Analysis. THE JOURNAL OF PAIN 2024; 25:104445. [PMID: 38072219 DOI: 10.1016/j.jpain.2023.12.002] [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: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023]
Abstract
The COVID-19 pandemic led to severe disruptions in health care and a relaxation of rules surrounding opioid prescribing-changes which led to concerns about increased reliance on opioids for chronic pain and a resurgence of opioid-related harms. Although some studies found that opioid prescriptions increased in the first 6 months of the pandemic, we know little about the longer-term effects of the pandemic on opioid prescriptions. Further, despite the prevalence of pain in veterans, we know little about patterns of opioid prescriptions in the Veterans Health Administration (VA) associated with the pandemic. Using a retrospective cohort of VA patients with chronic low-back pain, we examined the proportion of patients with an opioid prescription and mean morphine milligram equivalents over a 3-year period-1 year prior to and 2 years after the pandemic's onset. Analyses revealed that both measures fell during the entire observation period. The largest decrease in the odds of filling an opioid prescription occurred in the first quarter of the pandemic, but this downward trend continued throughout the observation period, albeit at a slower pace. Clinically meaningful differences in opioid prescriptions and dose over time did not emerge based on patient race or rurality; however, differences emerged between female and male veterans, with decreases in opioid prescriptions slowing more markedly for women after the pandemic onset. These findings suggest that the pandemic was not associated with short- or long-term increases in opioid prescriptions or doses in the VA. PERSPECTIVE: This article examines opioid prescribing over a 3-year period-1 year prior to and 2 years after the onset of the COVID-19 pandemic-for VA patients with chronic low-back pain. Results indicate that, despite disruptions to health care, opioid prescriptions and doses decreased over the entire observation period.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
| | - Jessica M Coffing
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
| | - Jessica L Carter
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
| | - Joanne K Daggy
- Department of Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alan B McGuire
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Department of Psychology, Indiana University Purdue University, Indianapolis, Indiana
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10
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Ricart B, Carter JS. Commentary: Increasing generalizability of parent psychosocial functioning within the context of pediatric chronic pain. J Pediatr Psychol 2024; 49:318-320. [PMID: 38511506 DOI: 10.1093/jpepsy/jsae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Brittany Ricart
- Child Psychology Doctoral Program, DePaul University, Chicago, IL, United States
- Department of Psychology, DePaul University, Chicago, IL, United States
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11
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Dominguez-Dominguez L, Campbell L, Barbini B, Fox J, Nikiphorou E, Goff L, Lempp H, Tariq S, Hamzah L, Post FA. Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV. AIDS 2024; 38:835-846. [PMID: 38265411 PMCID: PMC10994070 DOI: 10.1097/qad.0000000000003848] [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: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Social determinants of health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. DESIGN A cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18-65 years in South London, UK. METHODS Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. RESULTS Between September 2020 and January 2022, 398 participants (median age 52 years, 55% women) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. CONCLUSION We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socioeconomic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.
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Affiliation(s)
| | - Lucy Campbell
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Birgit Barbini
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
| | - Julie Fox
- Department of Infectious Diseases, King's College London
- Guy's and St Thomas’ Hospital NHS Foundation Trust
| | - Elena Nikiphorou
- Department of Rheumatology, Kings College Hospital NHS Foundation Trust
- Centre for Rheumatic Diseases
| | - Louise Goff
- Department of Nutritional Sciences, King's College London, London
- Leicester Diabetes Research Centre, Leicester
| | | | | | - Lisa Hamzah
- St George's Healthcare NHS Foundation Trust, London, UK
| | - Frank A. Post
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust
- HIV Research Group
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Kammerer E, Elliott SA, Hartling L, Basi C, Dennett L, Khangura JK, Scott SD, Candelaria P, Ruzycki S, Ali S. Pain experiences of marginalized children in the emergency department: A scoping review protocol. PLoS One 2024; 19:e0296518. [PMID: 38635744 PMCID: PMC11025926 DOI: 10.1371/journal.pone.0296518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Pain affects all children, and in hospitals across North America, this pain is often undertreated. Children who visit the emergency department (ED) experience similar undertreatment, and they will often experience a painful procedure as part of their diagnostic journey. Further, children and their caregivers who experience social injustices through marginalization are more likely to experience healthcare disparities in their pain management. Still, most of our knowledge about children's pain management comes from research focused on well-educated, white children and caregivers from a middle- or upper-class background. The aim of this scoping review is to identify, map, and describe existing research on (a) how aspects of marginalization are documented in randomized controlled trials related to children's pain and (b) to understand the pain treatment and experiences of marginalized children and their caregivers in the ED setting. METHODS AND ANALYSIS The review will follow Joanna Briggs Institute methodology for scoping reviews using the Participant, Concept, Context (PCC) framework and key terms related to children, youth, pain, ED, and aspects of marginalization. We will search Medline, Embase, PsychInfo, CINAHL, Web of Science, Cochrane Library Trials, iPortal, and Native Health Database for articles published in the last 10 years to identify records that meet our inclusion criteria. We will screen articles in a two-step process using two reviewers during the abstract and full-text screening stages. Data will be extracted using Covidence for data management and we will use a narrative approach to synthesize the data. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated in academic manuscripts, at academic conferences, and with partners and knowledge users including funders of pain research and healthcare professionals. Results of this scoping review will inform subsequent quantitative and qualitative studies regarding pain experiences and treatment of marginalized children in the ED.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Calveen Basi
- Departments of Chemistry and Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jaspreet K. Khangura
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Herron K, Bradshaw A, Liptrot M, Wieringa G, Mathews K, Wiles J, Johnson S. Moving pain management programmes into the digital age: development and evaluation of an online PMP for people with chronic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1337734. [PMID: 38638532 PMCID: PMC11024331 DOI: 10.3389/fpain.2024.1337734] [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: 11/13/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction In response to Coronovirus Disease (COVID-19) health care restrictions, the pain management programme delivered group treatment digitally (OPMP). We aimed to: 1) evaluate pain related outcomes of the OPMP, 2) evaluate patient satisfaction and qualitive feedback of the OPMP and 3) compare OPMP outcomes with the pre-pandemic face to face (F2F) PMP outcomes. Methods Age, gender, pain duration, occupational status, referral information and patient satisfaction data were collected. Pre- and post-treatment pain related outcomes were compared by calculating mean difference, benchmarking with effect size (Cohen's d) and determining clinically significant change (CSC) for OPMP and F2F PMP. Results Two-hundred and thirty-seven patients provided outcome data, with 60 completing the OPMP and 177 completing the F2F PMP. OPMP patients were 10 years younger than the F2F PMP (44.8 vs 53.3), more were female (6.5:1 vs 2.8:1), more were working (45% vs 27%) and fewer were retired (3% vs 17%). The OPMP showed improvements comparable to the F2F PMP. Large effect size was reported across all outcome domains including objective physical outcomes. Eighty-one percent of OPMP patients were 'extremely likely' to recommend the programme but just over 50% of patients felt F2F would provide greater clinical benefits. Conclusion The results support that OPMP is effective for carefully selected patients following a multidisciplinary team assessment however more complex cases still require F2F PMP.
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Affiliation(s)
- Katie Herron
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Alison Bradshaw
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Liptrot
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Gina Wieringa
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kerry Mathews
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - John Wiles
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Selina Johnson
- The Pain Management Programme, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Life Sciences, The University of Liverpool, Liverpool, United Kingdom
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14
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Connoy L, Solomon M, Longo R, Sud A, Katz J, Dale C, Stanley M, Webster F. Attending to Marginalization in The Chronic Pain Literature: A Scoping Review. Can J Pain 2024; 8:2335500. [PMID: 38831969 PMCID: PMC11146439 DOI: 10.1080/24740527.2024.2335500] [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: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 06/05/2024]
Abstract
Background There has been a recent and, for many within the chronic pain space, long-overdue increase in literature that focuses on equity, diversity, inclusion, and decolonization (EDI-D) to understand chronic pain among people who are historically and structurally marginalized. Aims In light of this growing attention in chronic pain research, we undertook a scoping review of studies that focus on people living with chronic pain and marginalization to map how these studies were carried out, how marginalization was conceptualized and operationalized by researchers, and identify suggestions for moving forward with marginalization and EDI-D in mind to better support people living with chronic pain. Methods We conducted this scoping review using critical analysis in a manner that aligns with dominant scoping review frameworks and recent developments made to scoping review methodology as well as reporting guidelines. Results Drawing on 67 studies, we begin with a descriptive review of the literature followed by a critical review that aims to identify fissures within the field through the following themes: (1) varying considerations of sociopolitical and socioeconomic contexts, (2) conceptual conflations between sex and gender, and (3) differing approaches to how people living with chronic pain and marginalization are described. Conclusion By identifying strengths and limitations in the research literature, we aim to highlight opportunities for researchers to contribute to a more comprehensive understanding of marginalization in chronic pain experiences.
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Affiliation(s)
- Laura Connoy
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michelle Solomon
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Riana Longo
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meagan Stanley
- Western Libraries, Western University, London, Ontario, Canada
| | - Fiona Webster
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
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Fereydooni S, Lorenz K, Azarfar A, Luckett T, Phillips JL, Becker W, Giannitrapani K. Identifying provider, patient and practice factors that shape long-term opioid prescribing for cancer pain: a qualitative study of American and Australian providers. BMJ Open 2024; 14:e082033. [PMID: 38514141 PMCID: PMC10961503 DOI: 10.1136/bmjopen-2023-082033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. METHODS We conducted a secondary analysis of the raw semistructured interview data gathered from 42 prescribers who participated in one of two aligned concurrent qualitative studies in the USA and Australia. We conducted a two-part analysis of the interview: first identifying all factors influencing long-term prescribing and second open coding-related content for themes. RESULTS Factors that influence long-term opioid prescribing for cancer-related pain clustered under three key domains (patient-related, provider-related and practice-related factors) each with several themes. Domain 1: Patient factors related to provider-patient continuity, patient personality, the patient's social context and patient characteristics including racial/ethnic identity, housing and socioeconomic status. Domain 2: Provider-related factors centred around provider 'personal experience and expertise', training and time availability. Domain 3: Practice-related factors included healthcare interventions to promote safer opioid practices and accessibility of quality alternative pain therapies. CONCLUSION Despite the differences in the contexts of the two countries, providers consider similar patient, provider and practice-related factors when long-term prescribing opioids for patients with cancer. Some of these factors may be categorised as cognitive biases that may intersect in an already disadvantaged patient and exacerbate disparities in the treatment of their pain. A more systematic understanding of these factors and how they impact the quality of care can inform appropriate interventions.
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Affiliation(s)
| | - Karl Lorenz
- Stanford University, Stanford, California, USA
| | - Azin Azarfar
- University of Florida, Gainesville, Florida, USA
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology, Sydney, New South Wales, Australia
| | - William Becker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Karleen Giannitrapani
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Brady B, Pang SM, Dennis S, Chipchase L, Liamputtong P, Jennings M, Tcharkhedian E, Andary T, Pavlovic N, Zind M, Middleton P, Boland R. "IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain. Musculoskeletal Care 2024; 22:e1874. [PMID: 38423991 DOI: 10.1002/msc.1874] [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: 02/04/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit. METHODS A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n = 45) or Australian-born (n = 45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview. RESULTS Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7 years), with an overall mean symptom duration of 10 years (SD 9.0). At 6 months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'. CONCLUSIONS Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.
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Affiliation(s)
- Bernadette Brady
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sheng Min Pang
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Dennis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lucy Chipchase
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Pranee Liamputtong
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew Jennings
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Elise Tcharkhedian
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Toni Andary
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
- School of Medical Sciences, UNSW Medical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natalie Pavlovic
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Marguerite Zind
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Paul Middleton
- Liverpool Hospital, Liverpool, New South Wales, Australia
- South Western Emergency Research Institute (SWERI), The Ingham Institute, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia
- The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, New South Wales, Australia
| | - Robert Boland
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia
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17
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Yang Y, Sims KD, Lane NE, Duchowny KA, Torres JM. Perceived Neighborhood Characteristics and Later-Life Pain Outcomes: Evidence From the Health and Retirement Study. J Aging Health 2024; 36:246-256. [PMID: 37349863 PMCID: PMC10739572 DOI: 10.1177/08982643231185382] [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] [Indexed: 06/24/2023]
Abstract
Objectives: This study examines whether perceived neighborhood characteristics relate to pain outcomes among middle-aged and older adults. Methods: Data were from the Health and Retirement Study (2006-2014; n = 18,814). Perceived neighborhood characteristics were physical disorder, social cohesion, safety, and social ties. We fitted adjusted generalized estimating equation models to evaluate prevalence, incidence, and recovery of moderate-to-severe limiting pain 2 years later. Results: The mean age of our sample was 65.3 years; 54.6% were female and 24.2% reported moderate-to-severe limiting pain at baseline. Positive neighborhood characteristics were associated with low prevalence (e.g., prevalence ratio [PR]: .71 for disorder) and reduced incidence (e.g., PR: .63 for disorder) of moderate-to-severe limiting pain. Positive neighborhood characteristics were associated with a high recovery rate from moderate-to-severe limiting pain (e.g., PR = 1.15 for safety), though the 95% CIs for disorder and cohesion crossed the null. Discussion: Neighborhood characteristics may be important determinants in predicting pain in later life.
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Affiliation(s)
- Yulin Yang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kate A. Duchowny
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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18
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Keogh E, Boerner KE. Challenges with embedding an integrated sex and gender perspective into pain research: Recommendations and opportunities. Brain Behav Immun 2024; 117:112-121. [PMID: 38145854 DOI: 10.1016/j.bbi.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
The focus of this article, within this BBI horizons special issue, is on sex, gender, and pain. We summarise what is currently known about sex- and gender-related variations in pain, exploring intersectional biological and psychosocial mechanisms, and highlight gaps in knowledge and understanding. Five key challenges with the exploration of sex and gender in pain research are presented, relating to: conceptual imprecision, research bias, limitations with binary descriptions, integrating sex and gender, and timely adoption/implementation of good research practice. Guidance on how to overcome such challenges is provided. Despite clear evidence for sex and gender differences in pain, there are conceptual and methodological barriers to overcome. Innovation in methods and approach can help develop more effective and tailored treatment approaches for men, women, boys, girls, and gender-diverse people.
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Affiliation(s)
- Edmund Keogh
- Bath Centre for Pain Research & Department of Psychology, University of Bath, UK.
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19
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Ray BM, Washington L, Thompson BL, Kelleran K. An exploration of low back pain beliefs held by health care professionals in Northern America. Musculoskeletal Care 2024; 22:e1877. [PMID: 38520493 DOI: 10.1002/msc.1877] [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: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Prior research demonstrated that people in the United States and Canada (Northern America) hold predominantly biomedical beliefs about Low back pain (LBP); such beliefs were attributed to healthcare professionals (HCP). Further investigation is needed to understand HCP' LBP beliefs, preferred management strategies, and sources of beliefs. METHODS Participants were recruited via social media to complete a qualitative cross-sectional online survey. The survey was distributed to assess LBP beliefs in a U.S. and Canadian-based clinician population. Participants answered questions about the cause of LBP, reasons for recurrence or persistence, use of imaging, management strategies, and sources of beliefs. Responses were analysed using an inductive thematic analysis. RESULTS One hundred and sixty three participants were included, reporting multiple causes for LBP. However, many references were anchored to biological problems. When psychological variables were mentioned, it typically involved patient blaming. Like prior research studies, minimal attention was given to societal and environmental influences. Management strategies often aligned with guideline care except for the recommendation of inappropriate imaging and a reliance on passive interventions. CONCLUSIONS These findings align with prior research studies on general population beliefs, demonstrating a preference for biological causes of LBP. Further updates are needed for clinical education, while future studies should seek to assess the translation of clinician beliefs into clinical practice and health system constraints.
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Affiliation(s)
- B Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Leah Washington
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, Virginia, USA
| | - Bronwyn Lennox Thompson
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand, USA
| | - Kyle Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, New York, USA
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20
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Cerda IH, Therond A, Moreau S, Studer K, Donjow AR, Crowther JE, Mazzolenis ME, Lang M, Tolba R, Gilligan C, Ashina S, Kaye AD, Yong RJ, Schatman ME, Robinson CL. Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review. Curr Pain Headache Rep 2024; 28:83-94. [PMID: 38175490 DOI: 10.1007/s11916-023-01205-3] [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] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape. RECENT FINDINGS Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.
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Affiliation(s)
- Ivo H Cerda
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Alexandra Therond
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Cambridge, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | | | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Maria Emilia Mazzolenis
- Paulson School of Engineering and Applied Sciences, John A, Harvard University, Boston, MA, USA
| | - Min Lang
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Christopher Gilligan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sait Ashina
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - R Jason Yong
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Tsui JI, Rossi SL, Cheng DM, Bendiks S, Vetrova M, Blokhina E, Winter M, Gnatienko N, Backonja M, Bryant K, Krupitsky E, Samet JH. Pilot RCT comparing low-dose naltrexone, gabapentin and placebo to reduce pain among people with HIV with alcohol problems. PLoS One 2024; 19:e0297948. [PMID: 38408060 PMCID: PMC10896547 DOI: 10.1371/journal.pone.0297948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND To estimate the effects on pain of two medications (low-dose naltrexone and gabapentin) compared to placebo among people with HIV (PWH) with heavy alcohol use and chronic pain. METHODS We conducted a pilot, randomized, double-blinded, 3-arm study of PWH with chronic pain and past-year heavy alcohol use in 2021. Participants were recruited in St. Petersburg, Russia, and randomized to receive daily low-dose naltrexone (4.5mg), gabapentin (up to 1800mg), or placebo. The two primary outcomes were change in self-reported pain severity and pain interference measured with the Brief Pain Inventory from baseline to 8 weeks. RESULTS Participants (N = 45, 15 in each arm) had the following baseline characteristics: 64% male; age 41 years (SD±7); mean 2 (SD±4) heavy drinking days in the past month and mean pain severity and interference were 3.2 (SD±1) and 3.0 (SD±2), respectively. Pain severity decreased for all three arms. Mean differences in change in pain severity for gabapentin vs. placebo, and naltrexone vs. placebo were -0.27 (95% confidence interval [CI] -1.76, 1.23; p = 0.73) and 0.88 (95% CI -0.7, 2.46; p = 0.55), respectively. Pain interference decreased for all three arms. Mean differences in change in pain interference for gabapentin vs. placebo, and naltrexone vs. placebo was 0.16 (95% CI -1.38, 1.71; p = 0.83) and 0.40 (95% CI -1.18, 1.99; p = 0.83), respectively. CONCLUSION Neither gabapentin nor low-dose naltrexone appeared to improve pain more than placebo among PWH with chronic pain and past-year heavy alcohol use. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT4052139).
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Affiliation(s)
- Judith I. Tsui
- Department of Medicine, Division of General Internal Medicine University of Washington School of Medicine/Harborview Medical Center, Seattle, Washington, United States of America
| | - Sarah L. Rossi
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts, United States of America
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, Unites States of America
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts, United States of America
| | | | | | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts, United States of America
| | - Miroslav Backonja
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Evgeny Krupitsky
- Pavlov University, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts, United States of America
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
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22
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Matthias MS, Bolla AL, Bair SM, Adams J, Eliacin J, Burgess DJ, Hirsh AT. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): a Qualitative Analysis of a Tailored Coaching Program for Black Patients with Chronic Pain. J Gen Intern Med 2024; 39:222-228. [PMID: 37726645 PMCID: PMC10853119 DOI: 10.1007/s11606-023-08410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Racial inequities in pain treatment are well-documented and persist despite national priorities focused on health equity. The COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) intervention was a patient-centered, tailored intervention aimed at improving health equity by targeting patient activation-the knowledge and confidence to manage one's health. COOPERATE led to significant and sustained increases in patient activation, significant short-term increases in communication self-efficacy (confidence to communicate with clinicians), and more intervention participants experienced clinically significant (≥ 30%) reductions in pain at 3 months than control group participants. OBJECTIVE To understand how participants experienced the intervention, including their perspectives on its effects on their health and healthcare experiences. DESIGN Semi-structured qualitative interviews. PARTICIPANTS Black veterans with chronic pain who participated in the COOPERATE intervention. KEY RESULTS Participants described acquiring new tools and cultivating skills to use in their clinic visits, including preparing for their visit (writing an agenda, listing questions); asking focused, effective questions; and expressing concerns and communicating goals, values, and preferences. Participants indicated that by putting these tools to use, they felt more confident and able to take ownership of their own pain care; for some, this led to better pain management and improved pain. Participants expressed mixed views of disparities in pain care, with some believing race and racism did not play a role in their care, while others valued being part of an intervention that helped equip them with tools to exercise autonomy over their healthcare. CONCLUSIONS Black patients with chronic pain described gaining greater confidence to self-manage and communicate with their clinicians after participating in the COOPERATE intervention. With its focus on empowering individuals, the COOPERATE intervention represents a promising approach to help advance equity in pain care.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA.
- Regenstrief Institute, Indianapolis, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
| | - Arya L Bolla
- Regenstrief Institute, Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
| | | | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
- Regenstrief Institute, Indianapolis, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, USA
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, USA
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23
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Matthias MS, Daggy JK, Perkins AJ, Adams J, Bair MJ, Burgess DJ, Eliacin J, Flores P, Myers LJ, Menen T, Procento P, Rand KL, Salyers MP, Shanahan ML, Hirsh AT. Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial. Pain 2024; 165:365-375. [PMID: 37733487 DOI: 10.1097/j.pain.0000000000003021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Racialized disparities in chronic pain care are well-documented and persist despite national priorities focused on health equity. Similar disparities have been observed in patient activation (ie, having the knowledge, confidence, and skills to manage one's health). As such, interventions targeting patient activation represent a novel approach to addressing and reducing disparities in pain care. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity is a randomized controlled trial of a 6-session telephone-delivered intervention to increase patient activation for Black patients with chronic pain. Two hundred fifty Black patients from a Midwestern Veterans Affairs medical center were randomized to the intervention or attention control. The primary outcome was patient activation; secondary outcomes included communication self-efficacy, pain, and psychological functioning. Outcomes were assessed at baseline and at 3 (primary endpoint), 6, and 9 months (sustained effects). Analyses used an intent-to-treat approach. Compared with baseline, patient activation increased 4.6 points at 3 months (versus +0.13 in control group, 95% CI: 0.48, 7.34; P = 0.03). These improvements in the intervention group were sustained, with +7 from baseline at 6 months and +5.77 at 9 months, and remained statistically significant from the control group. Communication self-efficacy increased significantly relative to the control group from baseline to 3 months. Pain intensity and interference improved at 3 months, but differences were not significant after adjusting for multiple comparisons. Most other secondary outcomes improved, but group differences were not statistically significant after controlling for multiple comparisons. Results suggest that increasing patient activation is a potentially fruitful path toward improving pain management and achieving health equity.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Diana J Burgess
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Mackenzie L Shanahan
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
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24
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Bernhofer EI. Attending to the Moral Meaning of Pain. Pain Manag Nurs 2024; 25:29-33. [PMID: 37926633 DOI: 10.1016/j.pmn.2023.10.003] [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: 08/21/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
In addition to a physical and emotional experience, pain is also a morally infused experience with deep, often subconscious, meaning for many sufferers. Whether justified or not, for many people, pain may represent loss, judgement, unworthiness, abandonment, punishment, and even existential suffering and thoughts of death. The moral meaning of pain is what influences the associated experiences of stigma, loneliness, and guilt that contribute to suffering. It is why nurses and other healthcare practitioners have long adhered to a moral obligation to treat those with pain, implying a duty to attempt to make right the wrong of undeserved suffering. Yet the moral meaning of pain is rarely discussed and is often overlooked when establishing a relationship with and a treatment plan for a person with pain. It is the unattended moral meaning of pain that may contribute to unnecessary suffering, futile treatment, and even moral dilemmas in establishing care. In this paper, I explore the definition of morality itself, the moral meaning of pain, and its implications for care. I discuss how moral pluralism in contemporary society contributes to various moral perceptions that influence a person's pain experience and how their pain is treated. Finally, I make the case that using a narrative approach to intentionally look for moral meaning in an individual's pain story may reveal opportunities for more effective pain management options.
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Affiliation(s)
- Esther I Bernhofer
- Frances Payne Bolton School of Nursing, Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
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25
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Yamada T, Yajima H, Takayama M, Imanishi K, Takakura N. Corrugator Muscle Activity Associated with Pressure Pain in Adults with Neck/Shoulder Pain. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:223. [PMID: 38399511 PMCID: PMC10890133 DOI: 10.3390/medicina60020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: No studies have reported corrugator muscle activity associated with pain in people with pain. This study aimed to develop an objective pain assessment method using corrugator muscle activity with pressure pain stimulation to the skeletal muscle. Methods: Participants were 20 adults (a mean ± SD age of 22.0 ± 3.1 years) with chronic neck/shoulder pain. Surface electromyography (sEMG) of corrugator muscle activity at rest (baseline) and without and with pressure pain stimulation applied to the most painful tender point in the shoulder was recorded. Participants evaluated the intensity of the neck/shoulder pain and the sensory and affective components of pain with pressure stimulation using a visual analogue scale (VAS). The percentages of integrated sEMG (% corrugator activity) without and with pressure pain stimulation to the baseline integrated sEMG were compared, and the relationships between the % corrugator activity and the sensory and affective components of pain VAS scores were evaluated. Results: Without pressure stimulation, an increase in corrugator muscle activity due to chronic neck/shoulder pain was not observed. The % corrugator activity with pressure pain stimulation was significantly higher than that without stimulation (p < 0.01). A significant positive correlation between corrugator muscle activity and the affective components of pain VAS scores with pressure stimulation was found (ρ = 0.465, p = 0.039) and a tendency of positive correlation was found for the sensory component of pain VAS scores (ρ = 0.423, p = 0.063). Conclusions: The increase in corrugator muscle activity with pressure pain stimulation to the tender point in adults with chronic neck/shoulder pain was observed, although increased corrugator muscle activity resulting from the chronic neck/shoulder pain was not. These findings suggest that corrugator muscle activity with pressure pain stimulation can be a useful objective indication for tender point sensitivity assessment in the skeletal muscle with pain.
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Affiliation(s)
| | | | | | | | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan; (T.Y.); (H.Y.); (M.T.); (K.I.)
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26
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Mescouto K, Olson RE, Costa N, Evans K, Dillon M, Walsh K, Jensen N, Hodges PW, Lonergan K, Weier M, Setchell J. Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia. J Health Serv Res Policy 2024; 29:12-21. [PMID: 37553877 DOI: 10.1177/13558196231193862] [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: 08/10/2023]
Abstract
OBJECTIVES Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. METHODS Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. RESULTS Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. CONCLUSIONS Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.
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Affiliation(s)
- Karime Mescouto
- Postdoctoral Research Fellow, RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca E Olson
- Associate Professor, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Nathalia Costa
- Lecturer in Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Adjunct Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kerrie Evans
- Group Chief Education and Research Officer, Healthia Limited, Brisbane, QLD, Australia
- Senior Research Fellow, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Miriam Dillon
- PhD Candidate, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Kelly Walsh
- Senior Physiotherapist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Niamh Jensen
- Clinical Psychologist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Paul W Hodges
- Professor & NHMRC Leadership Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Megan Weier
- Senior Lecturer, Centre for Social Impact, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Setchell
- Senior Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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27
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Mescouto K, Olson RE, Costa N, Evans K, Dillon M, Jensen N, Walsh K, Weier M, Lonergan K, Hodges PW, Setchell J. 'Engaging on a slightly more human level': A qualitative study exploring the care of individuals with back pain in a multidisciplinary pain clinic. Health (London) 2024; 28:161-182. [PMID: 36433763 DOI: 10.1177/13634593221127817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Chronic low back pain is characterised by multiple and overlapping biological, psychological, social and broader dimensions, affecting individuals' lives. Multidisciplinary pain services have been considered optimal settings to account for the multidimensionality of chronic low back pain but have largely focused on cognitive and behavioural aspects of individuals' pain. Social dimensions are usually underexplored, considered outside or beyond healthcare professionals' scope of practice. Employing Actor Network Theorist Mol's concept multiplicity, our aim in this paper is to explore how a pain service's practices bring to the fore the social dimensions of individuals living with low back pain. Drawing on 32 ethnographic observations and four group exchanges with the service's clinicians, findings suggest that practices produced multiple enactments of an individual with low back pain. Although individuals' social context was present and manifested during consultations at the pain service (first enactment: 'the person'), it was often disconnected from care and overlooked in 'treatment/management' (second enactment: 'the patient'). In contrast, certain practices at the pain service not only provided acknowledgement of, but actions towards enhancing, individuals' social contexts by adapting rules and habits, providing assistance outside the service and shifting power relations during consultations (third enactment: 'the patient-person'). We therefore argue that different practices enact different versions of an individual with low back pain in pain services, and that engagement with individuals' social contexts can be part of a service's agenda.
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Affiliation(s)
| | | | - Nathalia Costa
- The University of Queensland, Australia
- The University of Sydney, Australia
| | | | | | - Niamh Jensen
- Metro South Health Pain Rehabilitation Centre, Australia
| | - Kelly Walsh
- Metro South Health Pain Rehabilitation Centre, Australia
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28
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Coady A, Godard R, Holtzman S. Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain. J Health Psychol 2024; 29:52-64. [PMID: 37565664 PMCID: PMC10757395 DOI: 10.1177/13591053231191919] [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] [Indexed: 08/12/2023] Open
Abstract
Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.
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29
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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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30
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DiBiase J. Social Workers as Leaders for Facilitating Trauma-Informed Palliative Care in the Outpatient Palliative Care Clinic. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:296-308. [PMID: 37768197 DOI: 10.1080/15524256.2023.2262157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Palliative care social workers are trained to identify how trauma manifests over the course of serious and chronic illness. This expertise can guide patients and team members to ensure a trauma-informed experience of care. This paper identifies the growth of outpatient palliative care clinics as an opportunity for palliative care social workers to emphasize this clinical skill set and assume a leadership role in the implementation of trauma-informed practices early in the trajectory of serious illness.
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Affiliation(s)
- Jennifer DiBiase
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai Beth Israel Hospital, New York, New York, USA
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31
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Upsdell A, Fia'ali'i J, Lewis GN, Terry G. Health and illness beliefs regarding pain and pain management of New Zealand resident Sāmoan community leaders: A qualitative interpretive study based on Pasifika paradigms. Health Promot J Austr 2023. [PMID: 37749071 DOI: 10.1002/hpja.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/27/2023] Open
Abstract
ISSUE ADDRESSED Ethnic disparities in chronic pain exist in Aotearoa New Zealand, including a greater impact of pain, less access to chronic pain services and less benefit from treatment for Pasifika people. This study investigated Sāmoan health perceptions and beliefs in relation to pain and how it is managed. METHODS An interpretive descriptive study was undertaken involving interviews with nine Sāmoan key informants from Aotearoa New Zealand. Interviews explored their beliefs in relation to interpretations of pain and experiences of and preferences for pain management. Interviews were recorded and transcribed. Data were analysed using thematic analysis. RESULTS Four main themes were constructed from the data. Pain is interpreted holistically described the attribution of pain to many causes, without limitation to physiological explanations. Stoicism is a character virtue described the predominant belief that pain should be endured without display or complaint. Strength in connectivity described the inherent pain coping strategies that are present within Sāmoan communities. To improve healthcare is to nurture vā described the disconnect Sāmoan people feel from healthcare services and the need to foster relationships to improve health delivery. CONCLUSIONS Sāmoan people have beliefs and perceptions about pain and its management that extend beyond traditional Western interpretations. While pain is often endured using traditional strengths within the 'āīga (family) and community, the Sāmoan community faces challenges in receiving healthcare from mainstream pain services. SO WHAT?: Clinicians need to foster stronger relationships with Sāmoan individuals and their 'āīga and appreciate the wider psychosocial context of pain, including spirituality.
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Affiliation(s)
- Angela Upsdell
- Chronic Pain Service, Te Whatu Ora Counties-Manukau, Auckland, New Zealand
| | - Jessee Fia'ali'i
- Chronic Pain Service, Te Whatu Ora Counties-Manukau, Auckland, New Zealand
| | - Gwyn N Lewis
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Gareth Terry
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Haines S, Savic M, Nielsen S, Carter A. Opioid-related policy changes: Experiences and perspectives from people who use opioids to manage non-cancer chronic pain. Drug Alcohol Rev 2023; 42:1482-1492. [PMID: 37254597 PMCID: PMC10946843 DOI: 10.1111/dar.13683] [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: 08/10/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION People who use prescription opioids to manage non-cancer chronic pain are particularly vulnerable to opioid-related policy change. This study aims to better understand what prescription opioids provide this population, what concerns they have in the context of new and changing opioid policies, such as the recently implemented prescription drug monitoring program in Victoria, Australia, their experiences of prescription opioid use, chronic pain and what they would like their healthcare to look like. METHODS Semi-structured interviews were conducted with 30 people who use opioids to manage chronic non-cancer pain. RESULTS Prescription opioids played an important role in supporting quality of life and mental health. However, experiences of stigma and lack of empathy from healthcare providers were common. Participants sought accurate information about their medications and expressed a desire for shared decision-making in healthcare. DISCUSSION AND CONCLUSION Prescription opioids can play an important role in pain management as well as social and psychological functioning for people living with non-cancer chronic pain. Opioid-related policy changes to medication availability need to consider the potential impacts that reducing, limiting or discontinuing opioids may have on this population. Including the voices of people who use prescription opioids to manage non-cancer chronic pain in respectful, compassionate and meaningful ways.
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Affiliation(s)
- Sarah Haines
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
| | - Michael Savic
- Turning Point, Eastern HealthMelbourneAustralia
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Adrian Carter
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
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Pandey M, Paluck E, Maierhoffer S, Rude D, Oakes L, Marwah R. Lessons learned from the chronic pain clinic: a qualitative study of the perspectives of healthcare providers. Pain Manag 2023; 13:457-471. [PMID: 37650758 DOI: 10.2217/pmt-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Aim: The chronic pain clinic (CPC) was established to address chronic non-cancer pain and opioid-related harm. Materials & methods: Employing community participatory research design First Nation Metis representatives, clinicians and a researcher collectively agreed to document lessons learned from healthcare providers' perspective, 1 year post-clinic-implementation. 17 individual interviews were conducted. Results: Thematic analysis revealed that a multidisciplinary team offered client-centered care, education, counseling and multimodal treatment options. Medication reviews and case management ensured patient safety. Communication and education of community providers enhanced pain management capacity ensuring safe opioid prescribing. Evidence-based best practices were implemented through system-level monitoring. Access to Indigenous healing strategies provided culturally responsive spiritual care upon request. Conclusion: The multidisciplinary and multimodal CPC care model effectively manages chronic non-cancer pain.
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Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Elan Paluck
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Shelly Maierhoffer
- Chronic pain clinic, 1056 Albert Street, Regina, Saskatchewan, S4R 2P8, Canada
| | - Darlene Rude
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; since 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
| | - Larry Oakes
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; since 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
| | - Radhika Marwah
- Chronic pain clinic, 1056 Albert Street, Regina, Saskatchewan, S4R 2P8, Canada
- Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, S4P 2S5, Canada
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Hung PSP, Byeon AG, Noorani A, Walker MR, Lorello GR, Hodaie M. Sex differences in patient journeys to diagnosis, referral, and surgical treatment of trigeminal neuralgia: implications for equitable care. J Neurosurg 2023; 139:463-471. [PMID: 36585864 DOI: 10.3171/2022.11.jns221191] [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: 05/30/2022] [Accepted: 11/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is an orofacial pain disorder that is more prevalent in females than males. Although an increasing number of studies point to sex differences in chronic pain, how sex impacts TN patients' journeys to care has not been previously addressed. This study sought to investigate sex differences in patients' journeys to diagnosis, referral, and treatment of TN within a large national context. METHODS Patients with classic TN (n = 100; 50 females and 50 males) were randomly selected through chart reviews at the largest surgical treatment center for TN in Canada for a cross-sectional study. Statistical tests, including Welch's t-test, the chi-square test, Pearson's correlations, and analyses of covariance, were conducted with Python. RESULTS Key discrepancies between sexes in access to care were identified. Females had a significantly longer referral time interval (average 53.2 months vs 20.4 months, median 27.5 months vs 11.0 months, p = 0.018) and total time interval (average 121.1 months vs 67.8 months, median 78.0 months vs 45.2 months, p = 0.018) than males, despite reporting higher pain intensity at referral. Although medically intolerant patients had a significantly shorter referral time interval than medically tolerant patients (average 13.0 months vs 41.0 months, median 6.0 months vs 17.0 months, p < 0.001), medically tolerant females had a significantly longer referral time interval than medically tolerant males (average 59.9 months vs 21.7 months, median 30.0 months vs 12.0 months, p = 0.017). No statistically significant differences were detected between the sexes for diagnostic time interval (average 63.3 months vs 43.0 months, median 24.0 months vs 24.0 months, p = 0.263) or treatment time interval (average 4.6 months vs 4.7 months, median 4.0 months vs 3.0 months, p = 0.986). CONCLUSIONS Critical sex differences in patients' journeys to TN surgical treatment were identified, with females enduring considerably longer referral timelines and expressing significantly greater pain intensity than males at referral. Taken together, our findings suggest the presence of unconscious bias and discrimination against females and highlight the need for expediting TN treatment referral for female TN patients.
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Affiliation(s)
| | - Alana G Byeon
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Alborz Noorani
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
- 2MD Program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Matthew R Walker
- 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Gianni R Lorello
- 4Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada
- 5Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
- 6The Wilson Centre, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
- 7Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
- 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- 8Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and
- 9Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Hudson M, Johnson MI. Perspectives on emotional memory images and the persistence of pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1217721. [PMID: 37564631 PMCID: PMC10410568 DOI: 10.3389/fpain.2023.1217721] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Multiple influences prevent recovery from pain. Our viewpoint is that non-conscious emotional memory images (EMIs) triggers outdated stress responses contributing to the intractability of pain. In this perspectives article we explore the concept that EMIs contribute to the persistence of pain. We contend that psychophysiological "stress" responses, resulting from first-time, novel and unprecedented pernicious or adverse events form EMIs within very short time frames (split-second learning). Subsequently, these EMIs are re-triggered in daily living, "re-playing" stress responses. We postulate that EMIs continually "raise the alarm" to socio-ecological stimuli by re-triggering the HPA-axis and amplifying neural input associated with threat, fear, anxiety, and pain, creating a debilitating state of psychophysiological dis-ease. We position the EMI within a philosophical debate on the nature and locus of memory and explain how the EMI, irrespective of whether it is a "thing" or a metaphor, can create a basis of understanding for the client to grasp. We describe a therapeutic approach (Split-Second Unlearning) to "clear" EMIs and the "stickiness" of pain and help people embark on a healing journey. This involves surveillance of clients for micro-expression(s) signifying an in-the-moment stress response, representative of the presence of an EMI, and encouraging the client to become a curious observer within/of their own experience. This helps the client detach their EMI from its stress response. We contend that this occurs rapidly without the need to get bogged down in a whole-life narrative. We advocate further exploration of our EMI model of dis-ease in the context of intractable pain.
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Affiliation(s)
- Matt Hudson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
- Mind Help Limited, Durham, United Kingdom
| | - Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
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Nanavaty N, Walsh KT, Boring BL, Ganesan A, Carter-Sowell AR, Mathur VA. Acute Ostracism-Related Pain Sensitization in the Context of Accumulated Lifetime Experiences of Ostracism. THE JOURNAL OF PAIN 2023; 24:1229-1239. [PMID: 36842734 DOI: 10.1016/j.jpain.2023.02.021] [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: 10/05/2022] [Revised: 01/25/2023] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
Ostracism (ie, being ignored/excluded) is a form of social adversity that powerfully impacts health and well-being. While laboratory research indicates that experimentally manipulated experiences of ostracism impact pain, findings have been mixed. Prior investigations have not considered moderating or main effects of individual histories of ostracism, and have been limited in the scope of their pain testing. In this study, participants without current pain reported lifetime experiences of ostracism prior to a laboratory visit where they were randomized to experience either a single episode of ostracism (ie, acute ostracism) or control condition that was immediately followed by quantitative sensory testing. Results indicate that the experimental effect of a single episode of ostracism on pain ratings, after-sensations, and temporal summation of pain is moderated by lifetime ostracism; no main effects were found. For individuals with histories of more lifetime ostracism, encountering a single episode of ostracism led to greater pain sensitization relative to the control condition, whereas no experimental effect was observed for individuals with little lifetime exposure to ostracism. These findings indicate that acute experiences of ostracism may be accompanied by periods of hyperalgesia for people who are chronically ostracized, implicating ostracism as a potential social moderator of pain sensitization. People who are stigmatized may therefore experience enhanced pain burden with repeated and accumulating experiences of ostracism. PERSPECTIVE: Results suggest that in the context of accumulated lifetime experiences of ostracism, single experiences of ostracism evoke central sensitization. In this way, ostracism may function to trigger central sensitization and shape socially- and societally-determined patterns of pain burden and disparity.
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Affiliation(s)
- N Nanavaty
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - K T Walsh
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - B L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - A Ganesan
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - A R Carter-Sowell
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Diversity Science Research Cluster, College Station, Texas
| | - V A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Diversity Science Research Cluster, College Station, Texas; Texas A&M Institute for Neuroscience, College Station, Texas.
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Nguyen LH, Dawson JE, Brooks M, Khan JS, Telusca N. Disparities in Pain Management. Anesthesiol Clin 2023; 41:471-488. [PMID: 37245951 DOI: 10.1016/j.anclin.2023.03.008] [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: 05/30/2023]
Abstract
Health disparities in pain management remain a pervasive public health crisis. Racial and ethnic disparities have been identified in all aspects of pain management from acute, chronic, pediatric, obstetric, and advanced pain procedures. Disparities in pain management are not limited to race and ethnicity, and have been identified in multiple other vulnerable populations. This review targets health care disparities in the management of pain, focusing on steps health care providers and organizations can take to promote health care equity. A multifaceted plan of action with a focus on research, advocacy, policy changes, structural changes, and targeted interventions is recommended.
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Affiliation(s)
- Lee Huynh Nguyen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Jessica Esther Dawson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Meredith Brooks
- Department of Anesthesiology, Cook Children's Health Care System, Texas Christian University School of Medicine, Fort Worth, TX, USA
| | - James S Khan
- Department of Anesthesia and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Natacha Telusca
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA.
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Mottiar M, Burchell D, MacCormick H. Equity, Diversity, and Inclusion in anesthesiology: a primer. Can J Anaesth 2023; 70:1075-1089. [PMID: 37341898 DOI: 10.1007/s12630-023-02504-4] [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: 04/01/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE This continuing professional development module aims to elucidate the current demographics of anesthesiology in Canada and the experience of anesthesiologists from equity-seeking groups. This module will also identify and describe factors impacting the health care experience of patients from equity-seeking groups who receive perioperative, pain, and obstetric care. PRINCIPAL FINDINGS In recent years, discrimination based on sex, gender, race, ethnicity, sexual orientation, ability, other demographic factors, and the intersection of these identities have gained greater attention not only in our society at large but also within medicine and anesthesiology. The stark consequences of this discrimination for both anesthesiologists and patients from equity-seeking groups have become clearer in recent years, although the full scope of the problem is not fully understood. Data regarding the demographics of the national anesthesia workforce are lacking. Literature describing patient perspectives of various equity-seeking groups is also sparse, although increasing. Health disparities impacting people who are racialized, women, LGBTQIA+, and/or living with disability are also present in the perioperative context. CONCLUSION Discrimination and inequity persist in the Canadian health care system. It is incumbent upon us to actively work against these inequities every day to create a kinder and more just health care system in Canada.
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Affiliation(s)
- Miriam Mottiar
- Department of Anesthesiology & Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
- Division of Palliative Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital, 501 Smyth Rd, Room 1401, Ottawa, ON, K1H 8L6, Canada.
| | - Drew Burchell
- Women's & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Hilary MacCormick
- Women's & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Bailey NGN, Knott R, Grenier G, Craig KD, Kramer JLK. Physical pain among Indigenous Peoples in Canada: a scoping review. Can J Anaesth 2023; 70:1047-1063. [PMID: 37341897 DOI: 10.1007/s12630-023-02461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Pain is a multifaceted experience shaped by various factors including context of pain, previous life events, and ongoing ethnocultural circumstances. Moreover, the definition of pain is inconsistent across cultures. Western medicine views physical pain (e.g., associated with a bone fracture) and nonphysical mental pain (e.g., depression) as two distinct conditions. Indigenous perspectives are often more wholistic, encompassing mental, spiritual, emotional, and physical hurt. The subjective nature of pain invites ample opportunity for discrimination in both its assessment and management. As such, it is important to consider Indigenous perspectives of pain in research and clinical practice. To investigate which aspects of Indigenous pain knowledge are currently considered by Western research, we conducted a scoping review of the literature on pain in Indigenous Peoples of Canada. SOURCE In June 2021, we searched nine databases and downloaded 8,220 papers after removal of duplicates. Two independent reviewers screened abstracts and full-text articles. PRINCIPLE FINDINGS Seventy-seven papers were included in the analysis. Using grounded theory, five themes emerged: pain measures/scales (n = 7), interventions (n = 13), pharmaceuticals (n = 17), pain expression/experiences (n = 45), and pain conditions (n = 70). CONCLUSION This scoping review shows that there is a paucity of research on pain measurement in Indigenous Peoples of Canada. This finding is concerning in light of numerous studies reporting that Indigenous Peoples experience their pain as ignored, minimized, or disbelieved. Furthermore, a clear disconnect emerged between pain expression in Indigenous Peoples and assessment in medical professionals. We hope that this scoping review will serve to translate current knowledge to other non-Indigenous academics and to initiate meaningful collaboration with Indigenous partners. Future research led by Indigenous academics and community partners is critically needed to better address pain needs in Canada.
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Affiliation(s)
- Nicole G N Bailey
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
| | - Robbie Knott
- Indigenous Research Support Initiative, The University of British Columbia, Vancouver, BC, Canada
| | - Georgia Grenier
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Kenneth D Craig
- Department of Psychology, Faculty of Arts, The University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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Illueca M, Bradshaw YS, Carr DB. Spiritual Pain: A Symptom in Search of a Clinical Definition. JOURNAL OF RELIGION AND HEALTH 2023; 62:1920-1932. [PMID: 36083524 PMCID: PMC9461389 DOI: 10.1007/s10943-022-01645-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
We conducted a literature search to identify and compare definitions of the experiential dimension of spiritual pain. Key databases were searched, up to the year 2021 inclusive, for papers with a definition of "spiritual" or "existential" pain/distress in a clinical setting. Of 144 hits, seven papers provided theoretical definitions/descriptions; none incorporated clinical observations or underlying pathophysiological constructs. Based on these findings, we propose a new definition for "spiritual pain" as a "self-identified experience of personal discomfort, or actual or potential harm, triggered by a threat to a person's relationship with God or a higher power." Our updated definition can inform future studies in pain assessment and management.
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Affiliation(s)
- Marta Illueca
- The Episcopal Diocese of Delaware, 913 Wilson Rd, Wilmington, DE, 19806, USA.
| | - Ylisabyth S Bradshaw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Daniel B Carr
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
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Pandey M, Smith L, MacZek N, Tomkins A, Sasakamoose J. Indigenous birth support worker (IBSW) program evaluation: a qualitative analysis of program workers and clients' perspectives. BMC Pregnancy Childbirth 2023; 23:367. [PMID: 37259049 DOI: 10.1186/s12884-023-05695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The Indigenous Birth Support Worker (IBSW) Program provides Indigenous women with respectful, culturally safe, and trauma-informed care and supports women and families during labor and delivery. Located in the Jim Pattison Children's Hospital (JPCH) Maternal Care Centre in Saskatoon, Saskatchewan, Canada, the program served 1023 clients between December 2019 and January 2021. METHODS The study objective was to explore the perspectives of the IBSWs and program clients one year post-implementation. The research plan was developed in collaboration with the IBSW program director and manager, IBSWs, and partners from the First Nation and Métis Health departments within the health region. A focus group with four IBSWs and individual interviews with ten clients who received services were conducted using a qualitative research design. RESULTS Thematic analysis revealed that clients greatly appreciated and respected the IBSWs' cultural support and their compassionate, nonjudgmental, and safe care. IBSWs emphasized the importance of culturally safe and client-centered treatment, more effective pain management solutions, and that relationships with Elders and community healthcare personnel should be built and strengthened to improve pregnancy and postnatal care delivery. IBSWs desire to work with community healthcare providers to provide prenatal care and build relationships before delivery. IBSWs advocated for collaborative cooperation with community healthcare professionals and rural healthcare teams to enable a smooth care flow to and from communities. CONCLUSION The Indigenous Birth Support Worker (IBSW) Program provides safe and client-centred care to Indigenous women during pregnancy, labour, and postpartum, consistent with the six principles proposed by BC perinatal services. IBSWs advocate for and assist Indigenous women in obtaining quality healthcare, provide traditional and cultural support, and positively affect mental health. However, the evaluation has revealed that healthcare provider insensitivity towards Indigenous clients persists. There is a need for greater role clarity and collaboration with healthcare practitioners to ensure evidence-based healthcare of the highest standard. This requires a commitment to addressing systemic issues and implementing broader calls to action and justice proposed by the Truth and Reconciliation Commission Calls to Action, the Missing and Murdered Indigenous Women and Girls Calls for Justice, and the United Nations Declaration on the Rights of Indigenous Peoples. The IBSW program offers vital support to Indigenous women during childbirth, but it must be viewed in the context of ongoing colonialism and the need for reconciliation and decolonization, requiring genuine collaboration with Indigenous peoples.
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Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, SK, S4S 0A5, Canada
| | - Leanne Smith
- Maternal and Child Incentive Care Unit, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, S7K 0M7, Canada
| | - Nicole MacZek
- Maternal and Child Incentive Care Unit, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, S7K 0M7, Canada
| | - Angela Tomkins
- Maternal and Child Incentive Care Unit, Jim Pattison Children's Hospital, Saskatchewan Health Authority, Saskatoon, SK, S7K 0M7, Canada
| | - JoLee Sasakamoose
- Faculty of Education, University of Regina, 3737 Wascana Parkway 380 Education Building Regina, Saskatoon, SK, S4S 0A2, Canada.
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Altun A, Brown H, Sturgiss E, Russell G. Experiences of Assyrian refugee women seeking care for chronic pain: a qualitative study. Int J Equity Health 2023; 22:83. [PMID: 37158876 PMCID: PMC10169379 DOI: 10.1186/s12939-023-01891-w] [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: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Refugee women exhibit some of the highest rates of chronic pain yet the diversity and challenges of health care systems across countries pose numerous challenges for refugee women trying to access quality health care. OBJECTIVE We sought to explore the experiences of Assyrian refugee women seeking care for chronic pain. METHODS Semi-structured interviews (face-to-face and virtual) were undertaken with 10 Assyrian women of refugee background living in Melbourne, Australia. Audio recordings and field notes of interviews were collected and themes were identified using a phenomenological approach. Women were required to be conversant in English or Arabic and willing to use a translator if necessary. RESULTS We identified five major themes of women's experiences accessing care for chronic pain: (1) the story of pain; (2) the experience of help seeking in Australia and home country; (3) factors shaping the ability to access appropriate care; (4) support seeking systems; and (5) influence of culture and gender roles. CONCLUSION Exploring refugee women's experience of seeking care for chronic pain reinforces the need to explore hard to reach population's perspectives in research and helps to understand how vectors of disadvantage may intersect. For successful integration into health care systems of host countries, particularly for complex conditions such as chronic pain, there is a need to work with women community members to develop programs that are culturally aligned to enhance access pathways to care.
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Affiliation(s)
- Areni Altun
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | | | - Elizabeth Sturgiss
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | - Grant Russell
- Department of General Practice, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Schubiner H, Jackson B, Molina KM, Sturgeon JA, Sealy-Jefferson S, Lumley MA, Jolly J, Trost Z. Racism as a Source of Pain. J Gen Intern Med 2023; 38:1729-1734. [PMID: 36737536 PMCID: PMC10212893 DOI: 10.1007/s11606-022-08015-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/27/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Howard Schubiner
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI, USA.
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
| | - Benita Jackson
- Department of Psychology, Smith College, Northampton, MA, USA
- Five College Program in Culture, Health, and Science, Five College Consortium, Amherst, MA, USA
| | - Kristine M Molina
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - John A Sturgeon
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Jallicia Jolly
- Departments of Black Studies and American Studies, Amherst College, Amherst, MA, USA
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Booker SQ, Baker TA, Esiaka D, Minahan JA, Engel IJ, Banerjee K, Poitevien M. A historical review of pain disparities research: Advancing toward health equity and empowerment. Nurs Outlook 2023; 71:101965. [PMID: 37023670 PMCID: PMC11198876 DOI: 10.1016/j.outlook.2023.101965] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND PURPOSE This theory-guided review draws on 30 years of published data to examine and interrogate the current and future state of pain disparities research. METHODS Using the Hierarchy of Health Disparity Research framework, we synthesize and present an overview of "three generations" of pain disparities scholarship, while proposing directions for adopting a "fourth generation" that redefines, explains, and theorizes future pain disparities research in a diverse society. DISCUSSION Prior research has focused on describing the scope of disparities, and throughout the historical context of human existence, racialized groups have been subjected to inadequate pain care. It is imperative that research not only illuminates existing problems but also provides solutions that can be implemented and sustained across varying social milieus. CONCLUSION We must invest in new theoretical models that expand on current perspectives and ideals that position all individuals at the forefront of justice and equity in their health.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, The University of Florida, Gainesville, FL.
| | - Tamara A Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Darlingtina Esiaka
- Department of Family Medicine and Community Health, Rutgers University, Newark, NJ
| | | | - Ilana J Engel
- Department of Psychology, The University of Kansas, Lawrence, KS
| | - Kasturi Banerjee
- Department of Psychology, The University of Kansas, Lawrence, KS
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Parvez E, Chu M, Kirkwood D, Doumouras A, Levine M, Bogach J. Patient reported symptom burden amongst immigrant and Canadian long-term resident women undergoing breast cancer surgery. Breast Cancer Res Treat 2023; 199:553-563. [PMID: 37081175 PMCID: PMC10119005 DOI: 10.1007/s10549-023-06938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Immigrants are susceptible to marginalization due to social isolation, economic disadvantage and systemic bias. Our goal was to compare symptom burden between immigrant and long-term resident women undergoing breast cancer surgery in Ontario, Canada. METHODS A population-level retrospective cohort-study using administrative databases was conducted. Women who underwent surgery for newly diagnosed breast cancer and were treated at regional cancer centers between 2010 and 2016 were included. The primary outcome was a moderate or severe (≥ 4) symptom score on the Edmonton Symptom Assessment System Scale (ESAS). RESULTS There were 12,250 (87.2%) long-term Canadian residents and 1,806(12.8%) immigrants. Immigrants were younger (mean age 53 vs. 61 years); had a higher proportion residing in a lowest income quintile neighbourhood (22.2% vs 15.4%); were less often on a primary-care physician roster (83.7% vs. 90.4%); and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p < 0.01). The proportion of women with scores ≥ 4 was significantly higher amongst immigrant women for 7/9 symptom categories; with the largest differences for depression (24.9% vs. 20.2%, p < 0.01) and pain (28.0% vs. 22.4%, p < 0.01). On multivariable regression analysis, immigration status was associated with scores ≥ 4 for pain (OR 1.13, 95% CI 1.02-1.23). There was an association between moderate/severe pain and region of origin, but not length of stay in Canada or immigration class. CONCLUSIONS This is the first study comparing symptom burden amongst immigrant and non-immigrant women with breast cancer at a population-level. Immigrant women with breast cancer undergoing surgery were found to have a higher burden of pain.
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Affiliation(s)
- Elena Parvez
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Hamilton Health Sciences, Juravinski Hospital and Cancer Center, Hamilton, ON, Canada.
- Juravinski Hospital and Cancer Center, 711 Concession St. B3-155, Hamilton, ON, L8V 1C3, Canada.
| | - Megan Chu
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Aristithes Doumouras
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Mark Levine
- Hamilton Health Sciences, Juravinski Hospital and Cancer Center, Hamilton, ON, Canada
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jessica Bogach
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Juravinski Hospital and Cancer Center, Hamilton, ON, Canada
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Aaron RV, McGill LS, Finan PH, Wegener ST, Campbell CM, Mun CJ. Determining Profiles of Pain-Specific and General Emotion Regulation Skills and Their Relation to 12-Month Outcomes Among People With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:667-678. [PMID: 36503109 PMCID: PMC10079591 DOI: 10.1016/j.jpain.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
Difficulties with pain-specific emotion regulation (ER; eg, pain catastrophizing, pain acceptance) are associated with poor pain outcomes. Less is known about how general ER relates to pain outcomes, or the extent to which pain-specific and general ER interact. In a sample (N = 1,453) of adults with chronic pain, the current study used latent profile analysis to identify subgroups of people with distinct pain-specific and general ER profiles, and determined how subgroup membership at baseline related to pain severity, pain interference, depression and anxiety symptoms at 12-month follow-up. Four groups were identified: 1) general ER difficulties only (29.6%); 2) pain-specific and general ER difficulties (26.3%); 3) skillful pain-specific and general ER (24.6%); 4) pain-specific ER difficulties only (19.4%). Controlling for auto-correlation and demographic covariates, those with pain-specific and general ER difficulties had the worst outcomes in all domains. Membership to other groups did not differentiate between pain severity or interference outcomes; those skillful in pain-specific and general ER had the lowest depression and anxiety symptoms at 12 months. General ER difficulties are common among adults with chronic pain and raise relative risk when paired with pain-specific ER difficulties. Findings offer potential directions for individualizing pain psychology treatment. PERSPECTIVE: This article shows that people with chronic pain have different sets of strengths and difficulties when it comes to regulating emotions related and/or unrelated to the experience of pain itself. Understanding an individual's unique constellation of emotion regulation skills and difficulties might help personalize the psychological treatment of pain.
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Affiliation(s)
- Rachel V Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Lakeya S McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Edson College of Nursing and Health Innovation, Arizona State University, Pheonix, Arizona
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Webster F, Connoy L, Sud A, Rice K, Katz J, Pinto AD, Upshur R, Dale C. Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization. THE JOURNAL OF PAIN 2023; 24:437-448. [PMID: 36252618 DOI: 10.1016/j.jpain.2022.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual. PERSPECTIVE: This article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.
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Affiliation(s)
- Fiona Webster
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Connoy
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Humber River Hospital, Toronto, Ontario, Canada
| | - Kathleen Rice
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health, Toronto, Ontario, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Matthias MS, Burgess DJ, Eliacin J. Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study. J Gen Intern Med 2023; 38:1024-1029. [PMID: 36376625 PMCID: PMC9663172 DOI: 10.1007/s11606-022-07884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to significant disruptions in healthcare and rapid increases in virtual healthcare delivery. The full effects of these shifts remain unknown. Understanding effects of these disruptions is particularly relevant for patients with chronic pain, which typically requires consistent engagement in treatment to maximize benefit, and for Black patients, given documented racial disparities in pain treatment and telehealth delivery. OBJECTIVE To understand how Black patients with chronic pain experienced pandemic-related changes in healthcare delivery. DESIGN In-depth, semi-structured qualitative interviews PARTICIPANTS: Black veterans with chronic pain. KEY RESULTS Participants described decreased ability to self-manage their chronic pain, obtain nonpharmacological services such as physical therapy, see their primary care providers, and schedule surgery. Most did not believe telehealth met their needs, describing feeling inadequately assessed for their pain and noting that beyond renewing prescriptions, telehealth visits were not that useful. Some believed their communication with their providers suffered from a lack of in-person contact. Others, however, were willing to accept this tradeoff to prevent possible exposure to COVID-19, and some appreciated the convenience of being able to access healthcare from home. CONCLUSIONS Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic's onset. Given existing disparities and likely persistence of virtual care, research on the longer-term effects of virtual pain care for Black patients is needed.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Indianapolis, IN, USA.
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Ray BM, Kelleran KJ, Eubanks JE, Nan N, Ma C, Miles D. Relationship between Physical Activity and Pain in U.S. Adults. Med Sci Sports Exerc 2023; 55:497-506. [PMID: 36318739 DOI: 10.1249/mss.0000000000003078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE We sought to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, PA levels, health care seeking behaviors, and impact of pain on daily activities and work. METHODS We conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hypothesized those dealing with pain were less likely to meet PA guidelines. The PA levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling. RESULTS Of 31,568, 46% were men and 53.99% women with mean age of 52.27 yr (±17.31 yr). There were 12,429 (39.37%) participants that reported pain on some days, 2761 (8.75%) on most days, and 4661 (14.76%) every day. The odds of engaging in PA decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared with no pain. Importantly, PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating two times lower odds of reporting pain when compared with those not meeting the PA guidelines. CONCLUSIONS There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain. In addition, the odds of participating in PA decreased based on pain frequency reporting. These are important findings for clinicians, highlighting the need for assessing PA not only for those dealing with pain but also as a potential risk factor for minimizing development of chronic pain.
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Affiliation(s)
- Billy Michael Ray
- Department of Health and Human Sciences, Bridgewater College, Bridgewater, VA
| | - Kyle J Kelleran
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY
| | - James E Eubanks
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nan Nan
- Department of Biostatistics, University at Buffalo, Buffalo, NY
| | - Changxing Ma
- Department of Biostatistics, University at Buffalo, Buffalo, NY
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Mickle AM, Domenico LH, Tanner JJ, Terry EL, Cardoso J, Glover TL, Booker S, Addison A, Gonzalez CE, Garvan CS, Redden D, Staud R, Goodin BR, Fillingim RB, Sibille KT. Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis. FRONTIERS IN PAIN RESEARCH 2023; 4:1058476. [PMID: 36910251 PMCID: PMC9992984 DOI: 10.3389/fpain.2023.1058476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
Background and purpose We and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain. Methods Baseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions. Results Pooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain. Conclusion The incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.
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Affiliation(s)
- Angela M. Mickle
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Lisa H. Domenico
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Jared J. Tanner
- College of Public Health and Health Professionals, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Ellen L. Terry
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Josue Cardoso
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Toni L. Glover
- School of Nursing, Oakland University, Rochester, MI, United States
| | - Staja Booker
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Adriana Addison
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cesar E. Gonzalez
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cynthia S. Garvan
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David Redden
- Department of Biostatistics, School of Public Health, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roland Staud
- College of Medicine, Department of Rheumatology, University of Florida, Gainesville, FL, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roger B. Fillingim
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Kimberly T. Sibille
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
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