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De Lucia A, Donisi V, Pasini I, Polati E, Del Piccolo L, Schweiger V, Perlini C. Perspectives and Experiences on eHealth Solutions for Coping With Chronic Pain: Qualitative Study Among Older People Living With Chronic Pain. JMIR Aging 2024; 7:e57196. [PMID: 39235831 DOI: 10.2196/57196] [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: 02/08/2024] [Revised: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Chronic noncancer pain (CNCP) is a major health issue among the older population, affecting multiple aspects of individual functioning. Recently, the use of eHealth solutions has been proposed in supporting chronic pain self-management even among older adults, although some barriers have emerged. Few qualitative studies, with none conducted in Mediterranean countries, have explored older people's experiences and perceptions regarding the types of strategies used to cope with chronic pain and eHealth tools for chronic pain management. OBJECTIVE This study's objectives were to explore the perspectives and experiences of older adults regarding the coping strategies used to manage chronic pain, the use of digital technologies in everyday life, and the potentiality and barriers in using those technologies for health and pain management. METHODS A multimethod approach (ie, self-report questionnaires and a semistructured interview) has been adopted targeting older adults (ie, those who are aged 65 to 80 years and presenting different types of CNCP) who are attending a pain therapy center in Italy. Qualitative answers were analyzed using thematic analysis. RESULTS Overall, participants reported using a variety of pain coping strategies; however, they showed an attitude of resignation to their CNCP condition. Nearly 70% (12/18) of the interviewees referred to using digital technologies for purposes related to health and pain management, mostly involving very basic management activities. The participants' opinions on the useful functions that need to be incorporated in eHealth tools for chronic pain management have been categorized into four themes: (1) specific pain self-management skills, (2) support in organizing various health-related aspects, (3) sharing experiences with others, and (4) increasing pain-related personal knowledge. Conversely, the following potential barriers to adopting eHealth tools emerged: (1) computer illiteracy, (2) negative effects or risks, (3) impersonal interaction, and (4) physical limitations. CONCLUSIONS The use of eHealth solutions still seems low, often being accompanied by a perceived lack of digital skills or attitude among a sample of older adults from Italy with CNCP. Before introducing innovative eHealth solutions, it would be of primary importance to take action to enhance, on the one hand, self-efficacy in pain management and, on the other, the digital literacy level among older people.
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Affiliation(s)
- Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Polati
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vittorio Schweiger
- Anesthesiology, Intensive Care and Pain Therapy Center, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Holmes A, Wang W, Chang YP. Psychosocial Characteristics by Pain Presence and Limitations Among Older Adults. J Gerontol Nurs 2024; 50:27-34. [PMID: 38959509 DOI: 10.3928/00989134-20240618-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE To compare psychosocial outcomes of older adults according to pain experience. METHOD Using cross-sectional 2021 data from the National Health and Aging Trends Study, we examined psychosocial characteristics in older adults (N = 3,376) divided into three groups: no pain, pain without activity limitations, and activity-limiting pain. RESULTS In multiple regression models, older adults with activity-limiting pain compared to those without pain had significantly higher depression, anxiety, and fear of falling, as well as reduced positive affect, self-realization, self-efficacy, resilience, and social participation. Older adults with non-activity-limiting pain had significantly higher social participation than those without pain, but no differences in self-realization, self-efficacy, or resilience. CONCLUSION Pain is strongly associated with all psychosocial outcomes, especially in older adults with activity-limiting pain. Future research should examine the impact of self-realization, self-efficacy, resilience, and social participation on activity limitations. [Journal of Gerontological Nursing, 50(7), 27-34.].
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Petrini L, Arendt-Nielsen L. Pain catastrophizing in the elderly: An experimental pain study. Scand J Pain 2024; 24:sjpain-2023-0035. [PMID: 38452201 DOI: 10.1515/sjpain-2023-0035] [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: 03/16/2023] [Accepted: 11/29/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Pain catastrophizing in the aging population has not been studied in great detail. Existing investigations have reported conflicting results on the effects of age on pain catastrophizing in relation to pain responses. This study investigated the relationship between pain catastrophizing, and its individual components (rumination, magnification, and helplessness), and the responses to standardized experimental pain stimuli in old and young, healthy adults. METHODS Sixty-six volunteers (32 old: 65-87, 18 females; 34 young: 20-35, 17 females) participated in the study. Pain catastrophizing including the components of rumination, magnification, and helplessness was assessed with the pain catastrophizing scale (PCS). Experimental pain was induced by applying predefined pressure stimulations to the trapezius muscle. Pain intensity and unpleasantness were assessed using numerical rating scales. Pain catastrophizing levels and pain responses were statistically compared between the two age groups. RESULTS Elderly individuals reported significantly (p = 0.028) lower scores of pain catastrophizing (Med = 5; interquartile range [IQR] = 14) than younger individuals; this difference was driven by the significantly lower components of rumination (Med = 2; IQR = 4; p = 0.017) and helplessness (Med = 2; IQR = 7; p = 0.049). A larger proportion of young (57.8%) rated pain catastrophizing at high levels, with scores above the 75th percentile (Med = 20). Additionally, elderly reported the lowest pain intensity (Med = 5; p = 0.034) and pain unpleasantness (Med = 4.5; p = 0.011) responses to the experimental pressure stimuli. In the elderly group, pain unpleasantness was positively and significantly associated with pain catastrophizing (r s = 0.416, p = 0.021), rumination (r s = 0.42, p = 0.019), and helplessness (r s = 0.434, p = 0.015), respectively. No associations were found in the young group. CONCLUSIONS Elderly reported lower PCSs than young adults. Rumination and helplessness were reduced in the elderly group. The elderly population showed positive correlations between catastrophizing levels and pain unpleasantness to standardized pressure pain stimuli. Results supported the view that elderly possess resilience over specific domains of pain catastrophizing that could counteract pain perception due to physiological decline.
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Affiliation(s)
- Laura Petrini
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9220, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Selma Lagerløfs Vej 249, DK-9220, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Selma Lagerløfs Vej 249, DK-9220, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Abebe AB, Ayele TA, Miller J. Evaluating the validity of the Amharic Brief Pain Inventory among people with chronic primary musculoskeletal pain in Ethiopia. BMC Musculoskelet Disord 2022; 23:875. [PMID: 36131337 PMCID: PMC9490988 DOI: 10.1186/s12891-022-05833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Brief Pain Inventory (BPI) is a multidimensional pain assessment tool used to evaluate pain severity and pain interference. The BPI has been translated and validity estimated across multiple languages and patient populations for clinical and research settings. This study aimed to assess the reliability and validity of Amharic BPI test scores among patients with chronic primary musculoskeletal pain living in Ethiopia. METHODS This study had two parts: cognitive interviews and psychometric testing. An expert committee reviewed the Amharic BPI, and fifteen participants participated in the cognitive interviews. The results from the cognitive interviews were evaluated, and the committee approved recommendations for the tool prior to psychometric testing. Two hundred and sixty-nine patients were recruited from three sites for the psychometric testing. The results were summarised using descriptive statistics. Cronbach's alpha was calculated to estimate the internal consistency. To assess test-retest reliability, the intraclass coefficient was examined, and a Bland-Altman plot was created. Construct validity was determined using confirmatory factor analysis by testing BPI's previously suggested two or three-factor dimensionalities. Convergent validity was assessed by estimating the correlation between the Amharic BPI and SF-36 subscales. RESULTS The Amharic BPI scores showed a good internal consistency using a 2-factor model with α = 0.89 for pain severity and α = 0.91 for pain interference. Good internal consistency was also observed in the 3-factor model, with α = 0.89 for pain severity, α = 0.84 for activity interference, and α = 0.86 for affective interference items. The test-retest reliability testing resulted in an ICC = 0.82 for pain severity and ICC = 0.90 for the pain interference. The severity scale had the highest correlation with bodily pain subscale of the SF-36 at r = - 0.44, and the interference scale with Physical functioning scale of SF-36 at r = - 0.63. Confirmatory factor analysis support rating Amharic BPI using a two-factor approach. CONCLUSIONS Our findings showed that Amharic BPI scores demonstrate internal consistency, test-retest reliability, and construct validity among patients with chronic primary musculoskeletal pain in Ethiopia. Accordingly, the tool can be used in clinical practice or research in similar settings.
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Affiliation(s)
- Abey Bekele Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. .,Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Peñacoba C, Ecija C, Velasco L, Catala P, Suso-Ribera C. The paradox of wellbeing: what happens among women with fibromyalgia? The effect of cognitive fusion. Aging Ment Health 2022; 26:1829-1836. [PMID: 34524947 DOI: 10.1080/13607863.2021.1977238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our study examined the 'paradox of wellbeing' among women with fibromyalgia and the role of cognitive fusion on wellbeing in relation to age. METHODS A total of 228 women diagnosed with fibromyalgia according to the American College of Rheumatology criteria were included. In order to explore the conditional effects of age in the moderation analyzes, as recommended in the PROCESS Macro, the 16th, 50th, and 84th percentiles were calculated. These percentiles define three age groups that we will call younger (from 30 to 53 years), middle-aged (from 54 to 60 years) and older women (from 61 to 78 years). RESULTS We found a 'paradox of wellbeing' among fibromyalgia patients which has not yet been reported: the older the patients, the higher scores on hedonic (positive affect) and eudaimonic (activities engagement) wellbeing. A moderation effect of age was found in the relationship between cognitive fusion and wellbeing (cognitive fusion showed negative associations with positive affect and activities engagement but not among older patients). CONCLUSION Our study underscores the need of personalized interventions for fibromyalgia patients to improve their wellbeing. Especially in younger and middle-aged patients, it would be of interest interventions in cognitive defusion through Acceptance and Commitment Therapy (ACT).
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Affiliation(s)
- Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid,Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
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Alonzi S, Perry LM, Lewson AB, Mossman B, Silverstein MW, Hoerger M. Fear of Palliative Care: Roles of Age and Depression Severity. J Palliat Med 2022; 25:768-773. [PMID: 34762507 PMCID: PMC9081062 DOI: 10.1089/jpm.2021.0359] [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] [Accepted: 10/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Palliative care is underutilized due in part to fear and misunderstanding, and depression might explain variation in fear of palliative care. Objective: Informed by the socioemotional selectivity theory, we hypothesized that older adults with cancer would be less depressed than younger adults, and subsequently less fearful of utilizing palliative care. Setting/Subjects: Patients predominately located in the United States with heterogeneous cancer diagnoses (n = 1095) completed the Patient-Reported Outcomes Information System (PROMIS) Depression scale and rated their fear of palliative care using the Palliative Care Attitudes Scale (PCAS). We examined the hypothesized intercorrelations, followed by a bootstrapped analysis of indirect effects in the PROCESS macro for SPSS. Results: Participants ranged from 26 to 93 years old (mean [M] = 60.40, standard deviation = 11.45). The most common diagnoses were prostate (34.1%), breast (23.3%), colorectal (17.5%), skin (15.3%), and lung (13.5%) cancer. As hypothesized, older participants had lower depression severity (r = -0.20, p < 0.001) and were less fearful of palliative care (r = -0.11, p < 0.001). Participants who were more depressed were more fearful of palliative care (r = 0.21, p < 0.001). An indirect effect (β = -0.04, standard error = .01, 95% confidence interval: -0.06 to -0.02) suggested that depression severity may account for up to 40% of age-associated differences in fear of palliative care. Conclusions: Findings indicate that older adults with cancer are more likely to favor palliative care, with depression symptom severity accounting for age-related differences. Targeted interventions among younger patients with depressive symptoms may be helpful to reduce fear and misunderstanding and increase utilization of palliative care.
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Affiliation(s)
- Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M. Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Ashley B. Lewson
- Department of Psychology, Indiana University—Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | | | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center, New Orleans, Louisiana, USA
- Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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You DS, Ziadni MS, Hettie G, Darnall BD, Cook KF, Von Korff MR, Mackey SC. Comparing Perceived Pain Impact Between Younger and Older Adults With High Impact Chronic Pain: A Cross-Sectional Qualitative and Quantitative Survey. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:850713. [PMID: 35465295 PMCID: PMC9030949 DOI: 10.3389/fpain.2022.850713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 01/19/2023]
Abstract
High impact chronic pain (HICP) is a recently proposed concept for treatment stratifying patients with chronic pain and monitoring their progress. The goal is to reduce the impact of chronic pain on the individual, their family, and society. The US National Pain Strategy defined HICP as the chronic pain associated with substantial restrictions on participation in work, social, and self-care activities for at least 6 months. To understand the meaning and characteristics of HICP from the younger (<65 years old) and older adults (≥65 years old) with chronic pain, our study examined patients' perceived pain impact between the two age groups. We also characterize the degree of pain impact, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), between adults and older adults with HICP. We recruited patients at a tertiary pain clinic. The survey included open-ended questions about pain impact, the Graded Chronic Pain Scale-Revised to identify patients' meeting criteria for HICP, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) 8-item PI short form (v.8a). A total of 55 younger adults (65.5% women, 72.7% HICP, mean age = 55.0 with SD of 16.2) and 28 older adults (53.6% women, 64.3% HICP, mean age = 72.6 with SD of 5.4) with chronic pain participated in this study. In response to an open-ended question in which participants were asked to list out the areas of major impact pain, those with HICP in the younger group most commonly listed work, social activity, and basic physical activity (e.g., walking and standing); for those in the older group, basic physical activity, instrumental activity of daily living (e.g., housework, grocery shopping), and participating in social or fun activity for older adults with HICP were the most common. A 2 × 2 ANOVA was conducted using age (younger adults vs. older adults) and HICP classification (HICP vs. No HICP). A statistically significant difference was found in the PROMIS-PI T-scores by HICP status (HICP: M = 58.4, SD = 6.3; No HICP: M = 67.8, SD = 6.3), but not by age groups with HICP. In conclusion, perceived pain impacts were qualitatively, but not quantitatively different between younger and older adults with HICP. We discuss limitations and offer recommendations for future research.
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Affiliation(s)
- Dokyoung S. You
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maisa S. Ziadni
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gabrielle Hettie
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beth D. Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Michael R. Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sean C. Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,*Correspondence: Sean C. Mackey
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Bijoux Leist J, Leist TP. Multiple sclerosis: relationship between locus of control and quality of life in persons with low versus high disability. Health Psychol Behav Med 2022; 10:316-334. [PMID: 35309243 PMCID: PMC8933035 DOI: 10.1080/21642850.2022.2050373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Health Locus of Control (HLOC) is the degree to which individuals believe that their health outcomes are controlled by ‘external’ factors – environmental forces, chance, fate, other people, or some higher power – or by ‘internal’ factors – their own behavior or action. Most of the literature on HLOC associates an Internal Health Locus of Control (IHLOC) to pro-health behaviors and better health outcomes. However, a few studies also suggest that in chronic illnesses, an External Health Locus of Control (EHLOC) could be beneficial with respect to pro-health behaviors and perceptions of Quality of Life (QoL), challenging assumptions about what leads to the most effective psychological coping in the face of difficult circumstances. Multiple sclerosis (MS) is a chronic immune condition of the central nervous system and the most frequent cause of non-traumatic disability in young adults, often despite treatment. Method: The primary goal of this non-experimental, cross-sectional, quantitative study of 89 individuals with MS was to explore the HLOC of individuals with MS, and to identify whether holding an EHLOC positively impacts the MS patients’ perceived QoL while taking into consideration their level of disability. Results: This research found that individuals with higher disability scores tended to hold more EHLOC beliefs, and that there was a significant correlation between QoL and holding EHLOC beliefs. Conclusion: This study was able to capture the importance of control beliefs in the QoL of individuals with MS with higher disability. The clinical implications of the findingare explored and areas for further research are suggested.
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Affiliation(s)
- Judith Bijoux Leist
- Department of Counseling Psychology, West Chester University, West Chester, PA, USA
| | - Thomas P Leist
- Comprehensive MS Center, Thomas Jefferson University, Philadelphia, PA, USA
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Tsur N. Chronic Pain Personification Following Child Abuse: The Imprinted Experience of Child Abuse in Later Chronic Pain. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2516-NP2537. [PMID: 32713232 DOI: 10.1177/0886260520944529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Child abuse has been shown to increase the risk for chronic pain. The illness personification theory implies that individuals tend to ascribe humanlike characteristics to chronic pain, and that this personification is embedded in the way they cope with their chronic condition. Recent findings demonstrate that individuals who experienced interpersonal violence tend to personify chronic pain in a way that resonates with past abusive experience. Although findings prevail to the link between trauma and the experience of the body, the personification of chronic pain among individuals who experienced child abuse has not been examined before. This article includes two studies that tested whether child abuse is implicated in abusive chronic pain personification in a young adult female sample (Study 1) and among females who experienced child abuse (Study 2). In both studies, self-report measures of child abuse, posttraumatic stress (PTS) symptoms, complex posttraumatic symptoms (disturbances of self-organization [DSO]), and abusive chronic pain personification were administered. Structural equation modeling was utilized to assess the hypotheses. The findings of the two studies showed a significant association between child abuse and pain personification. Whereas PTS symptoms did not mediate this link (Study 1), DSO symptoms mediated this association (Study 2). The findings of these studies support the understanding that the experience of interpersonal violence is engraved in the experience of the body, as reflected in abusive chronic pain personification. Disturbances in self-organization seem to underlie this process, thus pertaining to the link between the experience of the body, self, and interpersonal trauma.
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Valdes-Hernandez PA, Montesino-Goicolea S, Hoyos L, Porges EC, Huo Z, Ebner NC, Woods AJ, Cohen R, Riley JL, Fillingim RB, Cruz-Almeida Y. Resting-state functional connectivity patterns are associated with worst pain duration in community-dwelling older adults. Pain Rep 2021; 6:e978. [PMID: 34901680 PMCID: PMC8660002 DOI: 10.1097/pr9.0000000000000978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An individual's chronic pain history is associated with brain morphometric alterations; but little is known about the association between pain history and brain function. OBJECTIVES This cross-sectional study aimed at determining how worst musculoskeletal pain intensity (WPINT) moderated the association between worst musculoskeletal pain duration (WPDUR) and brain resting-state magnetic resonance imaging functional connectivity (RSFC) in community-dwelling older adults (60-94 years, 75% females, 97% right-handed). METHODS Resting-state magnetic resonance imaging functional connectivity between region of interests was linearly regressed on WPDUR and WPINT. Predictions were compared with a control group's average RSFC (61-85 years, 47% females, 95% right-handed). RESULTS Three significant patterns emerged: (1) the positive association between WPDUR and RSFC between the medial prefrontal cortex, in the anterior salience network (SN), and bilateral lateral Brodmann area 6, in the visuospatial network (VSN), in participants with more severe chronic pain, resulting in abnormally lower RSFC for shorter WPDUR; (2) the negative association between WPDUR and RSFC between right VSN occipitotemporal cortex (lateral BA37 and visual V5) and bilateral VSN lateral Brodmann area 6, independently of WPINT, resulting in abnormally higher and lower RSFC for shorter and longer WPDUR, respectively; and (3) the positive association between WPDUR and the left hemisphere's salience network-default mode network connectivity (between the hippocampus and both dorsal insula and ventral or opercular BA44), independently of WPINT, resulting in abnormally higher RSFC for longer WPDUR. CONCLUSION Musculoskeletal effects on brain functional networks of general healthy individuals could accumulate until being observable at older ages. Results invite to examinations of these effects' impact on function and memory.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Lorraine Hoyos
- University of Central Florida, Department of Clinical Sciences, Orlando, Florida, USA
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Natalie C. Ebner
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, Florida, USA
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Budge C, Taylor M, Mar M, Hansen C, Fai F. Chronic pain: good management of practical pain control strategies is associated with being older, more health activated and having better mental health. J Prim Health Care 2021; 12:225-234. [PMID: 32988444 DOI: 10.1071/hc19066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 12/08/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic pain affects a large proportion of the adult population and people in pain need to learn how to manage it in order to maintain quality of life. AIM This study aimed to examine how well people with long-term conditions make use of self-management strategies to control their pain, and to identify personal attributes associated with a higher degree of success. METHODS People with chronic pain who participated in the first phase of a longitudinal long-term conditions study in the MidCentral region made up the study sample (N=326, response rate 21%). They completed a questionnaire by mail or online, which included items on pain management, general health, patient activation, experiences with general practice and demographics. RESULTS Pain control strategies were managed fairly well overall. Taking pain medication and avoiding caffeine, alcohol, heavy meals and exercise before bed were managed best, whereas sleep, relaxation breathing and remaining socially active were managed least well. A multiple regression analysis found higher scores on patient activation, self-rated overall pain management at home, mental health and older age (≥75 years) to be associated with better management. DISCUSSION This study identified pain control strategies that are managed well, and less well, outside of a specific intervention. Results highlight topics for discussion in consultations and identify areas where general practice could provide better self-management support, such as sleep and exercise. Better overall pain control strategy management was most strongly associated with patient activation; that is, a combination of knowledge, skills and confidence to manage health and health care that is amenable to intervention. Improving the level of activation in people with long-term conditions may enhance their use of pain control strategies.
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Affiliation(s)
- Claire Budge
- THINK Hauora, 200 Broadway Avenue, Palmerston North 4410, New Zealand; and Corresponding author.
| | - Melanie Taylor
- THINK Hauora, 200 Broadway Avenue, Palmerston North 4410, New Zealand
| | - Materoa Mar
- Te Tihi o Ruahine Whanau Ora Alliance, 200 Broadway Avenue, Palmerston North 4410, New Zealand
| | - Chiquita Hansen
- THINK Hauora, 200 Broadway Avenue, Palmerston North 4410, New Zealand
| | - Folole Fai
- MidCentral DHB, PO Box 2075, Palmerston North 4410, New Zealand
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Ellingson R, Wilson R, Bisson EJ, Goldie CL. Investigating Specialized Chronic Pain Care Among Emerging Adults. Pain Manag Nurs 2021; 23:188-195. [PMID: 34217609 DOI: 10.1016/j.pmn.2021.05.013] [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: 01/25/2021] [Revised: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AIMS: To investigate characteristics of emerging adults accessing a specialized chronic non-cancer pain clinic and describe interventions offered and utilized by this group. DESIGN A retrospective chart review was conducted of emerging adults and middle-aged adults with chronic pain receiving care over a six-month period. SETTING A chronic pain clinic in Southeastern Ontario. PARTICIPANTS 82 participants comprised of 41 emerging adults (aged 18-29) and 41 middle-aged adults (aged 30-64) METHODS: Groups were matched on sex and number of pain sites. Demographic and pain characteristics, interventions, referrals, and clinic utilization were examined using bivariate and multivariate analysis. RESULTS Emerging adults reported lower pain severity scores (t(80) = -2.15, p = .035), were more likely to receive referrals for additional consultation and/or diagnostic investigations (X2(1, n = 82) = 4.97, p = .026) and to have at least one psychology visit (X2 = 7.29, p = .007). Moreover, emerging adults with higher depression scores were more likely to see a psychologist (OR 1.23, 95% CI 1.014-1.492). CONCLUSIONS Pain presentation and care patterns differed between emerging adults and middle-aged adults. Increased use of non-pharmacologic interventions in emerging adults may reflect differences in pain presentations as well as clinician's sensitivity to emerging adult's particular developmental needs but further research is needed. Further research is needed to contribute to nurses' understanding of the quality and efficacy of pain management approaches.
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Affiliation(s)
- Rachel Ellingson
- From the *Queen's University, School of Nursing, Kingston, Ontario, Canada, 82 Barrie Street, Kingston, Ontario, Canada.
| | - Rosemary Wilson
- Queen's University, School of Nursing; KHSC Chronic Pain Clinic Kingston, Ontario, Canada
| | - Etienne J Bisson
- Kingston Health Sciences Centre-Hotel Dieu Hospital site, Chronic Pain Clinic, Kingston, Ontario, Canada
| | - Catherine L Goldie
- From the *Queen's University, School of Nursing, Kingston, Ontario, Canada, 82 Barrie Street, Kingston, Ontario, Canada
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13
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Chen AT. Interactions between affect, cognition, and information behavior in the context of fibromyalgia. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Annie T. Chen
- Biomedical Informatics and Medical Education UW Medicine South Lake Union Seattle Washington USA
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14
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Axon DR, Le D. Predictors of pain severity among community-dwelling older adults with pain in the United States: Findings from a cross-sectional, retrospective study using 2017 Medical Expenditure Panel Survey. Medicine (Baltimore) 2021; 100:e26011. [PMID: 34011100 PMCID: PMC8137030 DOI: 10.1097/md.0000000000026011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The purpose of this study was to determine predictors of pain severity among older United States (US) adults with pain.This cross-sectional, retrospective study utilized 2017 Medical Expenditure Panel Survey data. Eligible participants were alive for the calendar year, aged ≥50 years, and reported pain in the past 4 weeks. Hierarchical logistic regression models, adjusting for the survey design, were used to identify significant predictors of pain severity (i.e., extreme/quite a bit or moderate/little pain).An estimated 14,250,534 adults aged ≥50 with pain reported extreme/quite a bit of pain. Many variables were associated with extreme/quite a bit of pain, including: age 50 to 64 vs ≥65 years (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI] = 1.22-1.82); males vs females (AOR = 0.80, 95% CI = 0.67-0.95); white race vs others (AOR = 0.75, 95% CI = 0.61-0.92); married vs other marital status (AOR = 1.31, 95% CI = 1.08-1.57); income <200% vs ≥200% federal poverty level (AOR = 1.30, 95% CI = 1.06-1.60); employed vs unemployed (AOR = 0.47, 95% CI = 0.37-0.60); limitation vs no limitation (AOR = 2.64, 95% CI = 2.09-3.33); 0, 1, 3, or 4 vs ≥5 chronic conditions (AOR ranged from 0.39 for 0 conditions to 0.77 for 4 conditions); excellent/very good or good vs fair/poor perceived physical health status (AOR ranged from 0.28 for excellent/very good to 0.40 for good); smokers vs non-smokers (AOR = 1.56, 95% CI = 1.27-1.93); exercise versus no exercise (AOR = 0.74, 95% CI = 0.62-0.88); and South vs West census region (AOR = 1.34, 95% CI = 1.04-1.74).This study found several characteristics could predict pain severity among older US adults who reported extreme/quite a bit of pain. These characteristics may guide specific areas of focus to improve patients' pain management.
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Affiliation(s)
- David R. Axon
- Department of Pharmacy Practice & Science
- Center for Health Outcomes and Pharmacoeconomic Research, University of Arizona College of Pharmacy, Tucson, Arizona
| | - Darlena Le
- Department of Pharmacy Practice & Science
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15
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Newman AK, Morais CA, Van Dyke BP, Thorn BE. An Initial Psychometric Evaluation of the Pain Concepts Questionnaire in a Low-SES Setting. THE JOURNAL OF PAIN 2021; 22:57-67. [DOI: 10.1016/j.jpain.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/31/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
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16
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Ghandehari O, Gallant NL, Hadjistavropoulos T, Williams J, Clark DA. The Relationship Between the Pain Experience and Emotion Regulation in Older Adults. PAIN MEDICINE 2020; 21:3366-3376. [PMID: 32488250 DOI: 10.1093/pm/pnaa135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the relationship of emotion regulation strategies (i.e., emotional suppression and reappraisal) with pain catastrophizing, fear of pain, pain intensity, worry, and depression as function of age in samples of older and younger adults. DESIGN Cross-sectional design using validated questionnaires. SETTING Participants resided in the community. They completed validated measures using online questionnaires. SUBJECTS Two-hundred fifty-seven older adults and 254 younger adults with chronic pain participated. METHODS Participants completed validated questionnaires of emotion regulation strategies, pain-related functioning and mental health. RESULTS Emotion regulation varied as a function of age and gender. Among our chronic pain sample, older adult males reported lower use of reappraisal and suppression than younger adult males, while older adult females reported higher use of reappraisal than younger adult females. Emotional suppression was positively related to pain catastrophizing, pain intensity, worry, and depression. Reappraisal was negatively related to depression and worry. Interestingly, age showed a positive relationship with fear of pain, pain catastrophizing, worry, depression, and pain intensity, while gender was related to fear of pain and worry. Finally, emotional reappraisal partially mediated the relationship between the affective dimensions of pain intensity and pain catastrophizing among older adults. CONCLUSIONS Our results indicate that reappraisal strategies are important for older and younger adults with chronic pain, pointing to the necessity of considering these strategies when working clinically with such populations. However, given our findings as well as those in the literature, gender should also be considered.
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Affiliation(s)
- Omeed Ghandehari
- Department of Psychology, University of Regina, Regina, SK, Canada.,Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Natasha L Gallant
- Department of Psychology, University of Regina, Regina, SK, Canada.,Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, SK, Canada.,Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Jaime Williams
- Department of Psychology, University of Regina, Regina, SK, Canada.,Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - David A Clark
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
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17
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Talwar R, Dobbs RW, Stambakio H, Lin G, Tasian GE, Ziemba JB. A Longitudinal Cohort Study of Pain Intensity and Interference After Ureteroscopy for Nephrolithiasis Without Postoperative Opioids. Urology 2020; 147:81-86. [PMID: 33049231 DOI: 10.1016/j.urology.2020.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To better understand the degree and time to resolution of pain in the postoperative period, we captured patient-reported pain intensity and interference prospectively in patients following ureteroscopy for nephrolithiasis. MATERIALS AND METHODS Adults undergoing ureteroscopy for renal/ureteral stones from 11/2018 to 1/2020 were eligible for inclusion. All received nonopioid postoperative pain control. Patients prospectively completed Patient-Reported Outcome Measurement Information System-Pain Intensity and Patient-Reported Outcome Measurement Information System-Pain Interference instruments preoperatively on postoperative day (POD) 0 and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US population, mean = 50) with changes of 5 (0.5 standard deviation) considered clinically significant. RESULTS A total of 126 patients completed enrollment at POD 0 (POD 1 = 74, POD 7 = 61, POD 14 = 47). Compared to US means, intensity and interference were significantly different at all time point comparisons (Wilcoxon rank test; all P <.001) except intensity at POD 7 (P = .09) and interference at POD 14 (P = .12). For both, there was a significant difference at each time comparison (repeated measures ANOVA; all P <.05). Increasing age was predictive of lower intensity (Confidence Interval (CI): -0.31 to -0.04; P = .012) and interference (CI: -0.36 to -0.06; P =.01) at POD 1. The presence of a postoperative stent was predictive of higher intensity (CI: 0.68-10.81; P = .03) and interference (CI: 0.61-12.96; P = .03) at POD 7. Increasing age remained a predictor of lower interference at POD 1 on multivariable analysis (CI: -0.46 to -0.01; P = .03). CONCLUSION Pain intensity and interference are elevated immediately, but intensity normalizes by POD 7, while interference remains elevated until POD 14. Age and indwelling ureteral stent influence both intensity and interference.
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Affiliation(s)
- Ruchika Talwar
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA.
| | - Ryan W Dobbs
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Lin
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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Nawai A, Foust JB, Shi L, You T, Leveille SG. Is pain catastrophizing associated with poor mobility performance and falls in older adults? Arch Gerontol Geriatr 2020; 91:104219. [PMID: 32771882 PMCID: PMC9124526 DOI: 10.1016/j.archger.2020.104219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pain catastrophizing has been associated with pain intensity and mobility limitations in adults, and may be associated with mobility problems among older adults with chronic pain. This study examined the associations between pain catastrophizing and pain characteristics, and physical performance in older people. METHODS The MOBILIZE Boston Study II (MBS) included 354 adults aged ≥70 years, living in the Boston area, originally enrolled in the MBS I from 2005-2008. Pain catastrophizing was measured using the 13-item Pain Catastrophizing Scale (PCS), with scores ranging from 13-65. Pain severity and pain interference were assessed by subscales of the Brief Pain Inventory. Pain distribution was classified as none, single site, and multisite. Mobility performance was assessed using the Short Physical Performance Battery (SPPB). Falls were assessed prospectively using monthly fall calendar postcards. RESULTS One-fourth of all participants (24 %) had high scores on the PCS (score>30). PCS was inversely associated with age and was greater among those with osteoarthritis, depression, or anxiety (p-value<0.05). PCS score was associated with global measures of pain including pain severity (p-value = 0.01), pain interference (p-value = 0.004) and multisite pain compared to no pain (p-value = 0.006). After adjusting for confounders, PCS was not associated with mobility and fall in this older population. CONCLUSION Although pain catastrophizing is prevalent in older adults with chronic pain, it was not associated with mobility or falls in older people. Further research is needed to determine possible long-term effects of pain catastrophizing on chronic pain and functioning in older adults.
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Affiliation(s)
- Ampicha Nawai
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Boromarajonani College of Nursing, Chiang Mai, Thailand.
| | - Janice B Foust
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Ling Shi
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Tongjian You
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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19
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Ferreira-Valente A, Queiroz-Garcia I, Pais-Ribeiro J, Jensen MP. Pain Diagnosis, Pain Coping, and Function in Individuals with Chronic Musculoskeletal Pain. J Pain Res 2020; 13:783-794. [PMID: 32368132 PMCID: PMC7184761 DOI: 10.2147/jpr.s236157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Research supports a role for coping responses in adjustment to chronic pain. However, it is likely that some coping responses play a larger role in adjustment to pain for some individuals than others. The identification of the factors that moderate the association between coping responses and pain-related outcomes has important clinical implications. This study sought to determine if musculoskeletal pain diagnosis moderates the associations between eight pain-coping responses and both pain and function. Patients and Methods A non-probabilistic sample of 323 persons with different chronic musculoskeletal pain conditions completed measures of pain intensity, physical function, psychological function, and pain-coping responses. Results With only one exception, the frequency of use of pain-coping responses was not associated with pain diagnosis. Statistically significant moderation effects of pain diagnosis on the association between coping and pain outcomes were found for two coping responses: 1) support seeking when predicting pain intensity, and 2) resting when predicting both physical and psychological function. Conclusion The findings indicate that coping responses tend to play a similar role in patients' pain and function across different musculoskeletal pain conditions, with some important exceptions. If the findings are found to replicate in other samples, they would have important implications for determining when psychosocial pain treatments might (and when they might not) need to be adapted for specific diagnostic groups.
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Affiliation(s)
- Alexandra Ferreira-Valente
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal.,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Inês Queiroz-Garcia
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal
| | - José Pais-Ribeiro
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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20
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Boggero IA, Rojas Ramirez MV, King CD. Cross-Sectional Associations of Fatigue Subtypes with Pain Interference in Younger, Middle-Aged, and Older Adults with Chronic Orofacial Pain. PAIN MEDICINE 2020; 21:1961-1970. [DOI: 10.1093/pm/pnaa092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractObjectiveMental, emotional, physical, and general fatigue, as well as vigor, have each been associated with pain interference—defined as pain-related disruption of social, recreational, and work-related activities—in patients with chronic orofacial pain (COFP). The objectives of the current study were to compare levels of these fatigue subtypes across younger, middle-aged, and older patients with COFP and test the associations between fatigue subtypes and pain interference in these age groups.DesignA cross-sectional cohort design was used.SettingParticipants self-reported fatigue subtypes (Multidimensional Fatigue Symptom Inventory–Short Form), pain interference (West Haven–Yale Multidimensional Pain Inventory), pain intensity (visual analog scale), pain duration (months), depression (Symptom Checklist 90–Revised), and sleep quality (Pittsburgh Sleep Quality Index) at their initial appointment at a tertiary orofacial pain clinic.SubjectsSixty younger (age 18–39), 134 middle-aged (age 40–59), and 51 older (age 60–79) COFP patients provided data for the study.MethodsAnalysis of variance was used to compare levels of fatigue subtypes between the age groups. Regression with dummy-coding was used to test if the relationship between fatigue subtypes and pain interference varied by age.ResultsOlder COFP patients reported less general fatigue and more vigor than younger or middle-aged adults. Fatigue subtypes were each associated with greater pain interference, but associations became nonsignificant after controlling for depression, sleep, and pain intensity/duration. Age group–by–fatigue subtype interactions were not observed.ConclusionsManaging fatigue may be important to reduce pain interference in COFP populations and may be accomplished in part by improving depression and sleep.
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Affiliation(s)
- Ian A Boggero
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, Kentucky
| | - Marcia V Rojas Ramirez
- Division of Oral Diagnosis, Oral Medicine, and Oral Radiology, College of Dentistry, University of Kentucky, Lexington, Kentucky
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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21
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Miaskowski C, Blyth F, Nicosia F, Haan M, Keefe F, Smith A, Ritchie C. A Biopsychosocial Model of Chronic Pain for Older Adults. PAIN MEDICINE 2019; 21:1793-1805. [DOI: 10.1093/pm/pnz329] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Population
Comprehensive evaluation of chronic pain in older adults is multifaceted.
Objective and Methods
Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.
Conclusions
This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.
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Affiliation(s)
| | - Fiona Blyth
- School of Medicine, The University of Sydney, Sydney, Australia
| | - Francesca Nicosia
- School of Medicine, University of California, San Francisco, California
| | - Mary Haan
- School of Medicine, University of California, San Francisco, California
| | - Frances Keefe
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alexander Smith
- School of Medicine, University of California, San Francisco, California
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California
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A Concept Analysis of Coping with Chronic Pain in Older Adults. Pain Manag Nurs 2019; 20:563-571. [DOI: 10.1016/j.pmn.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/02/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
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Soylu C, Ozekes BC. Psychometric Properties of the Future Time Perspective Scale for the Turkish Population: Age Differences in Predictors of Time Perspective. Int J Aging Hum Dev 2019; 91:85-106. [PMID: 30897919 DOI: 10.1177/0091415019836108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the psychometric properties of the Turkish version of the Future Time Perspective Scale (FTPS-T) and examine age-group differences in the predictors of respondents' future time perspective. Data were collected from a sample of 202 young adults (aged 18-28 years) and 127 community-dwelling older adults (aged 60-86 years). The internal consistency and test-retest methods were employed to assess the reliability of the FTPS-T, and the FTPS-T's validity was assessed using construct- and criterion-related validity. The reliability and validity analyses demonstrated that the FTPS-T had satisfactory psychometric properties. Multiple regression analyses revealed that the strongest predictor of future time perspective in young adults was subjective psychological health, whereas chronological and subjective (i.e., physical) ages were stronger predictors among older adults. These findings indicate that subjective variables shape the perceptions of a lifetime, and the results are discussed in the context of socioemotional selectivity theory.
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Affiliation(s)
- Cem Soylu
- 37509 Department of Psychology, Faculty of Arts, Ege University, Izmir, Turkey
| | - Banu C Ozekes
- 37509 Department of Psychology, Faculty of Arts, Ege University, Izmir, Turkey
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Regev I, Nuttman-Shwartz O. Coping Styles and Aggregate Coping Styles: Responses of Older Adults to a Continuous Traumatic Situation. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2018.1560900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Irit Regev
- School of Social Work, Sapir College, D.N. Hof Ashkelon, Israel
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25
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Slack MK, Chavez R, Trinh D, de Dios DV, Lee J. An observational study of pain self-management strategies and outcomes: does type of pain, age, or gender, matter? Scand J Pain 2018; 18:645-656. [PMID: 29995638 DOI: 10.1515/sjpain-2018-0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/20/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Acute pain is differentiated from chronic pain by its sudden onset and short duration; in contrast, chronic pain is characterized by a duration of at least several months, typically considered longer than normal healing time. Despite differences in definition, there is little information on how types of self-management strategies or outcomes differ when pain is chronic rather than acute. Additionally, age and gender are thought to be related to types of strategies used and outcomes. However, strategies used and outcomes can be influenced by level of education, socioeconomic status, occupation, and access to the health care system, which can confound associations to type of pain, age or gender. The purpose of this study was to examine the association of strategies used for pain self-management and outcomes with type of pain, acute or chronic, age, or gender in a socioeconomically homogenous population, pharmacists. Methods Pharmacists with acute or chronic pain and a valid email completed an on-line questionnaire on demographic characteristics, pain characteristics, pharmacological and non-pharmacological strategies for managing pain, and outcomes (e.g. pain intensity). Univariate analysis was conducted by stratifying on type of pain (acute or chronic), then stratifying on gender (men vs. women) and age (younger vs. older). The a priori alpha level was 0.05. Results A total of 366 pharmacists completed the questionnaire, 212 with acute pain (average age=44±12.1; 36% men) and 154 with chronic pain (average age=53±14.0; 48% men). The chronic pain group reported substantially higher levels of pain before treatment, level of post-treatment pain, level of pain at which sleep was possible, and goal pain levels (effect sizes [ES's]=0.37-0.61). The chronic pain group were substantially more likely to use prescription non-steroidal anti-inflammatory medications (NSAIDS), opioids, and non-prescription pain relievers (ES's=0.29-0.80), and non-medical strategies (ES's=0.56-0.77). Participants with chronic pain also were less confident (ES=0.54) and less satisfied (ES=0.52). In contrast, there were no differences within either the acute or chronic pain groups related to gender and outcomes. In the acute pain group, there also were no gender differences related to management strategies. However, younger age in the acute pain group was associated with use of herbal remedies and use of rest. Within the chronic pain group, men were more likely to use NSAIDS and women more likely to use hot/cold packs or massage while older participants were more likely to use massage. Variability in post-treatment level of pain and percent relief was high in all groups (coefficient of variation=25%-100%). Conclusions The differences between acute and chronic pain were substantial and included differences in demographic characteristics, pain characteristics, management strategies used, and outcomes. In contrast, few associations between age and gender with either management strategies or outcomes were identified, although the variability was high. Implications When managing or researching pain management, acute pain should be differentiated from chronic pain. Because of the substantial variability within the gender and age groups, an individual approach to pain management irrespective of age and gender may be most useful.
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Affiliation(s)
- Marion K Slack
- Department of Pharmacy Practice and Science, University of Arizona, 1295 N. Martin, P.O. Box 210202, Tucson, Pima County, AZ 85721, USA, Phone: +520.626.1099
| | - Ramon Chavez
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Pima County, AZ, USA
| | - Daniel Trinh
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Pima County, AZ, USA
| | - Daniel Vergel de Dios
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Pima County, AZ, USA
| | - Jeannie Lee
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, Pima County, AZ, USA
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Ghodraty Jabloo V, Alibhai SMH, Fitch M, Tourangeau AE, Ayala AP, Puts MTE. Antecedents and Outcomes of Uncertainty in Older Adults With Cancer: A Scoping Review of the Literature. Oncol Nurs Forum 2018. [PMID: 28632247 DOI: 10.1188/17.onf.e152-e167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential.
. LITERATURE SEARCH MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging.
. DATA EVALUATION Extracted data included research aims; research design or analysis approach; sample size; mean age; type, stage, and duration of cancer; type and duration of treatment; uncertainty scale; and major results.
. SYNTHESIS Of 2,584 articles initially identified, 44 studies (30 qualitative, 12 quantitative, and 2 mixed-methods) were included. Evidence tables were developed to organize quantitative and qualitative data. Descriptive numeric and thematic analyses were used to analyze quantitative results and qualitative findings, respectively. Outcomes were reported under four main categories. CONCLUSIONS Uncertainty is an enduring and common experience in cancer survivorship. Uncertainty is affected by a number of demographic and clinical factors and affects quality of life (QOL) and psychological well-being.
. IMPLICATIONS FOR PRACTICE Uncertainty should be considered a contributing factor to psychological well-being and QOL in older adults with cancer. Nurses are in a unique position to assess negative effects of uncertainty and manage these consequences by providing patients with information and emotional support.
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The Relationship Between Structural and Functional Brain Changes and Altered Emotion and Cognition in Chronic Low Back Pain Brain Changes. Clin J Pain 2018; 34:237-261. [DOI: 10.1097/ajp.0000000000000534] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Brown RL, Richman JA, Rospenda KM. Economic Stressors and Psychological Distress: Exploring Age Cohort Variation in the Wake of the Great Recession. Stress Health 2017; 33:267-277. [PMID: 27530455 DOI: 10.1002/smi.2705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/26/2016] [Accepted: 07/10/2016] [Indexed: 11/10/2022]
Abstract
This study examined processes linking age cohort, economic stressors, coping strategies and two indicators of psychological distress (i.e. depressive symptoms and anxiety symptoms). Structural equation models were conducted utilizing data from a national survey that was undertaken in order to understand life change consequences of the period of economic downturn from 2007 to 2009 known as the Great Recession. Findings revealed that the associations between economic stressors and symptoms of both depression and anxiety were significantly greater for members of the millennial cohort compared with baby boomers. These effects are partly explained by the greater tendency of members of the baby boomer cohort to use active coping strategies. These findings clarify the circumstances in which age matters most for the associations among economy-related stressors, coping strategies and psychological well-being. They highlight how difficult economic circumstances influence the availability of coping strategies and, in turn, psychological well-being-and differently for younger and older age cohorts. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Judith A Richman
- Department of Psychiatry and Department of Epidemiology, University of Illinois-Chicago, USA
| | - Kathleen M Rospenda
- Department of Psychiatry and Department of Epidemiology, University of Illinois-Chicago, USA
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Validation of the French Version of the "Patterns of Activity Measure" in Patients with Chronic Musculoskeletal Pain. Pain Res Manag 2017; 2017:6570394. [PMID: 28255261 PMCID: PMC5309399 DOI: 10.1155/2017/6570394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
Background. The “Patterns of Activity Measure” (POAM-P) is a self-administered questionnaire that assesses “avoidance”, “pacing” and “overdoing” activity patterns in chronic pain patients. Objectives. To adapt the POAM-P to French (“POAM-P/F”) and test its validity and reliability in Chronic Musculo-Skeletal Pain patients (CMSP). Methods. We followed the recommended procedure for translation of questionnaires. Five hundred and ninety five inpatients, admitted to a tertiary rehab center in the French-speaking part of Switzerland for chronic pain after orthopedic trauma, were included (sex ratio M/F = 4.36, mean age 43 ± 12). Face, content and criterion validities, internal consistency and reliability were assessed. Data included: TAMPA Scale for Kinesiophobia (TSK), Chronic Pain Coping Inventory (CPCI), Pain Catastrophizing Scale (PCS), Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS). Results. Face and content validities were checked during the translation process. Correlations between POAM-P/F-avoidance and TSK, POAM-P/F-pacing and CPCI-pacing, POAM-P/F-overdoing and CPCI-task persistence were highly significant (r > 0.3, p < 10−2). The three subscales demonstrated excellent homogeneity (Cronbach's alpha coefficients > 0.8) and test-retest reliability (Intraclass Correlation Coefficients > 0.8). They correlated very differently with the other scales. Discussion and Conclusion. The three POAM-P/F subscales clearly assess different behaviors in CMSP. The POAM-P/F is a suitable questionnaire for classifying French speaking CMSP into avoiders, pacers or overdoers.
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DiNapoli EA, Craine M, Dougherty P, Gentili A, Kochersberger G, Morone NE, Murphy JL, Rodakowski J, Rodriguez E, Thielke S, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping. PAIN MEDICINE 2016; 17:64-73. [PMID: 26768183 DOI: 10.1093/pm/pnv055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. METHODS A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice. RESULTS We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management. CONCLUSIONS To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
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Affiliation(s)
- Elizabeth A DiNapoli
- *Mental Illness Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Michael Craine
- VA Eastern Colorado Healthcare System, Denver, Colorado Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado
| | - Paul Dougherty
- Canandaigua VA Medical Center, Canandaigua, New York New York Chiropractic College, Seneca Falls, New York
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gary Kochersberger
- Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, University of Rochester, Rochester, New York
| | - Natalia E Morone
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Murphy
- James A. Haley Veterans' Hospital, Tampa, Florida University of South Florida, Tampa, Florida
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric Rodriguez
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Feinstein AB, Sturgeon JA, Darnall BD, Dunn AL, Rico T, Kao MC, Bhandari RP. The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. THE JOURNAL OF PAIN 2016; 18:144-154. [PMID: 27825857 DOI: 10.1016/j.jpain.2016.10.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/29/2016] [Accepted: 10/16/2016] [Indexed: 11/15/2022]
Abstract
Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed. PERSPECTIVE This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.
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Affiliation(s)
- Amanda B Feinstein
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and Stanford Children's Health, Palo Alto, California.
| | - John A Sturgeon
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
| | - Ashley L Dunn
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and Stanford Children's Health, Palo Alto, California
| | - Tom Rico
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
| | - Ming C Kao
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, Palo Alto, California
| | - Rashmi P Bhandari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and Stanford Children's Health, Palo Alto, California
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Who is healthy? Aspects to consider when including healthy volunteers in QST--based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. Pain 2016; 156:2203-2211. [PMID: 26075963 DOI: 10.1097/j.pain.0000000000000227] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Clinical and human experimental pain studies often include so-called "healthy" controls in investigations of sensory abnormalities, using quantitative sensory testing (QST) as an outcome measure. However, the criteria for what is considered "healthy" vary among the different studies and between study centers and investigators, partly explaining the high variability of the results. Therefore, several aspects should be considered during inclusion of healthy volunteers in QST-based trials to have homogenous groups of healthy controls with less variability between human experimental studies, so that results are less likely to be false negative or false positive because of subject-related factors. The EUROPAIN and NEUROPAIN consortia aimed to define factors influencing the variability in selection of healthy subjects in QST-based studies before the start of both projects and to give recommendations how to minimize it based on the current literature and expertise of the participants. The present suggestions for inclusion criteria of healthy volunteers into QST-based trials describe a 2-level approach including standardized questionnaires enabling the collection of relevant information on sociodemographic data, medical history, current health status, coping strategies in dealing with pain, and the motivation of the volunteer to participate in the study. These suggestions are believed to help researchers interpret their results in comparison with others and improve the quality of clinical studies including healthy volunteers as controls or in human experimental pain studies. They aim to reduce any confounding factors. Furthermore, the acquired information will allow post hoc analyses of variance for different potential influencing factors.
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Brown RL. The Influence of Stressor Exposure and Psychosocial Resources on the Age-Anger Relationship. J Aging Health 2016; 28:1465-1487. [PMID: 26823387 DOI: 10.1177/0898264315624900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examined the processes linking age, stressor exposure, psychosocial coping resources, and two dimensions of anger proneness (i.e., experienced anger and expressed anger). METHOD Longitudinal change regression analysis of data from a two-wave community panel study including a sample of people aged 18 to 93 ( N = 1,473) is performed. RESULTS Age is significantly associated with declines in both experienced anger and expressed anger over the 3-year study period. These associations are substantially mediated by the lower levels of chronic stressors and discrimination-related stressors experienced among older adults. In contrast, self-esteem amplifies the association between age and expressed anger. DISCUSSION These findings clarify the circumstances in which age matters most for changes over time in the experience and expression of anger. They highlight how certain forms of stressor exposure and psychosocial resources are linked with anger proneness and in ways that vary by age.
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Audulv Å, Packer T, Hutchinson S, Roger KS, Kephart G. Coping, adapting or self-managing - what is the difference? A concept review based on the neurological literature. J Adv Nurs 2016; 72:2629-2643. [PMID: 27272388 DOI: 10.1111/jan.13037] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to report: (1) an analysis of the concepts of coping, adaptation and self-management in the context of managing a neurological condition; and (2) the overlap between the concepts. BACKGROUND The three concepts are often confused or used interchangeably. Understanding similarities and differences between concepts will avoid misunderstandings in care. The varied and often unpredictable symptoms and degenerative nature of neurological conditions make this an ideal population in which to examine the concepts. DESIGN Concept analysis. DATA SOURCES Articles were extracted from a large literature review about living with a neurological condition. The original searches were conducted using SCOPUS, EMBASE, CINAHL and Psych INFO. Seventy-seven articles met the inclusion criteria of: (1) original article concerning coping, adaptation or self-management of a neurological condition; (2) written in English; and (3) published between 1999-2011. METHODS The concepts were examined according to Morse's concept analysis method; structural elements were then compared. RESULTS Coping and adaptation to a neurological condition showed statistically significant overlap with a common focus on internal management. In contrast, self-management appears to focus on disease-controlling and health-related management strategies. Coping appears to be the most mature concept, whereas self-management is least coherent in definition and application. CONCLUSION All three concepts are relevant for people with neurological conditions. Healthcare teams need to be cautious when using these terms to avoid miscommunication and to ensure clients have access to all needed interventions. Viewing the three concepts as a complex whole may be more aligned with client experience.
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Affiliation(s)
- Åsa Audulv
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Hutchinson
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kerstin S Roger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Brown RL, Richman JA, Rospenda KM. Economic stressors and alcohol-related outcomes: exploring age cohort differences. Addict Behav 2015; 51:193-6. [PMID: 26291290 DOI: 10.1016/j.addbeh.2015.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study examined processes linking age cohort, economic stressors, coping strategies and two drinking-related outcomes (i.e., past-month drinking and problematic drinking). METHODS Structural equation models were conducted utilizing data from a national survey. RESULTS Findings revealed the associations between economic stressors and both past-month drinking and problematic drinking were significantly greater for members of the millennial cohort compared to baby boomers. These effects are partly explained by the lesser tendency of members of the millennial cohort to use collective, politically-focused coping strategies. DISCUSSION These findings clarify the circumstances in which age matters most for the associations among economy-related stressors, coping strategies and drinking-related outcomes. They highlight how difficult economic circumstances influence the availability of coping strategies and, in turn, alcohol consumption - and differently for younger and older age cohorts.
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Miró J, Gertz KJ, Carter GT, Jensen MP. Pain Location and Functioning in Persons With Spinal Cord Injury. PM R 2014; 6:690-7. [DOI: 10.1016/j.pmrj.2014.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 01/05/2014] [Accepted: 01/09/2014] [Indexed: 01/22/2023]
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Abstract
BACKGROUND The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers' ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill-defined construct. OBJECTIVES To conduct a formal concept analysis of the term 'pacing'. METHODS A standardized concept analysis process (including literature scoping to identify all uses of the concept, analysis to determine defining attributes of the concept and identification of model, borderline and contrary cases) was used to determine what the concept of pacing does and does not represent within the current evidence base. RESULTS A conceptual model including the core attributes of action, time, balance, learning and self-management emerged. From these attributes, an evidence-based definition for pacing was composed and distributed to stakeholders for review. After consideration of stakeholder feedback, the emergent definition of pacing was finalized as follows: "Pacing is an active self-management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities". CONCLUSION The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research.
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Affiliation(s)
- Kathryn Jamieson-Lega
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
| | - Robyn Berry
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
| | - Cary A Brown
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta
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Miró J, Gertz KJ, Carter GT, Jensen MP. Chronic pain in neuromuscular disease: pain site and intensity differentially impacts function. Phys Med Rehabil Clin N Am 2012; 23:895-902. [PMID: 23137744 DOI: 10.1016/j.pmr.2012.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The importance of pain extent (ie, number of body areas with pain) and pain site as factors contributing to dysfunction in persons with chronic, slowly progressive neuromuscular disease (NMD), remains poorly understood. This article discusses the importance of assessing pain site in addition to global pain intensity in patients with chronic, slowly progressive NMD. The importance of addressing pain at multiple sites will have a major impact on future studies assessing interventions to treat pain in this patient population.
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Affiliation(s)
- Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Centre de Recerca en Avaluació i Mesura del Comportament, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
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Carter GT, Miró J, Ted Abresch R, El-Abassi R, Jensen MP. Disease Burden in Neuromuscular Disease. Phys Med Rehabil Clin N Am 2012; 23:719-29. [DOI: 10.1016/j.pmr.2012.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE The aim of this study was to examine the influence of sex and disability on catastrophizing, pain intensity, and pain interference in individuals with a spinal cord injury or multiple sclerosis. DESIGN A cross-sectional survey design was used. Two hundred forty-eight community-dwelling adults with a physical disability (spinal cord injury, n = 124; multiple sclerosis, n = 124) and chronic pain completed measures of demographic and clinical characteristics, pain intensity and interference, psychologic functioning, and pain catastrophizing. RESULTS Men reported marginally greater catastrophizing (P < 0.10) than did the women across both disability groups; however, there was no significant difference in catastrophizing between the disability groups. Catastrophizing was the only significant predictor of pain intensity in the multivariate regression analysis, with greater catastrophizing associated with greater pain. Pain intensity and catastrophizing were the only significant variables in the regression analyses predicting pain interference and psychologic functioning; as hypothesized, greater pain intensity and catastrophizing were associated with more pain interference and poorer psychologic functioning. There was also a trend (P < 0.10) for women, relative to men, to have a stronger association between catastrophizing and pain interference. CONCLUSIONS These findings are consistent with a biopsychosocial conceptualization of pain and functioning in individuals with chronic pain secondary to a physical disability. In addition, these data suggest that assessment and treatment (when indicated) of catastrophizing should be a regular part of the clinical management of these patients.
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Bierman A. Pain and depression in late life: mastery as mediator and moderator. J Gerontol B Psychol Sci Soc Sci 2011; 66:595-604. [PMID: 21808069 PMCID: PMC3155032 DOI: 10.1093/geronb/gbr070] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 05/30/2011] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examines how mastery mediates and moderates the relationship between pain and depression among older adults, as well as the extent to which these processes differ by the timing of pain in late life, while utilizing statistical methods that comprehensively control for time-stable confounds. METHODS Data are derived from multiple observations of adults aged 65 years and older in the Washington, DC, metropolitan area over a 4-year period. Fixed effects models are used to control for time-stable influences. RESULTS With all time-stable influences controlled, pain is positively related to symptoms of depression, although this relationship is substantially reduced in comparison with a model in which all time-stable confounds are not held constant. Mastery does not mediate this relationship because pain is not significantly related to mastery once time-stable factors are taken into account. Mastery buffers the relationship between pain and depression, but only for elders later in late life. DISCUSSION This study suggests that a synthesis of stress process and life course perspectives is critical for understanding how pain influences depression in late life. However, research that does not comprehensively control for time-stable factors may overestimate the consequences of pain for older adults.
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Affiliation(s)
- Alex Bierman
- Department of Sociology, University of Calgary, Calgary, AB Canada T2N 1N4.
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Abstract
Major advances in the fields of medical science and physiology, molecular genetics, biomedical engineering, and computer science have provided individuals with muscular dystrophy (MD) with more functional equipment, allowing better strategies for improvement of quality of life. These advances have also allowed a significant number of these patients to live much longer. As progress continues to change management, it also changes patients' expectations. A comprehensive medical and rehabilitative approach to management of aging MD patients can often fulfill expectations and help them enjoy an enhanced quality of life.
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Widerström-Noga E, Finlayson ML. Aging with a Disability: Physical Impairment, Pain, and Fatigue. Phys Med Rehabil Clin N Am 2010; 21:321-37. [DOI: 10.1016/j.pmr.2009.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abresch RT, Carter GT, Han JJ, McDonald CM. New clinical end points in rehabilitation medicine: tools for measuring quality of life. Am J Hosp Palliat Care 2010; 26:483-92. [PMID: 19923631 DOI: 10.1177/1049909109352656] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traditional clinical end points in rehabilitation medicine have centered on objective measures of human performance, including quantitative muscle strength testing, functional independence measurements (FIM), and timed motor performance (TMP). However, it is now increasingly recognized that health-related quality of life (HRQoL) is a valid clinical end point. Health-related quality of life is a broad concept involving an individual's physical health, psychological state, personal beliefs, and interpersonal and social support relationships. The goals for this article are to show the value of performing HRQoL measurements and briefly describe methods used to assess quality of life (QoL).
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Affiliation(s)
- Richard T Abresch
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, CA 95616, USA.
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Engel JM, Kartin D, Carter GT, Jensen MP, Jaffe KM. Pain in youths with neuromuscular disease. Am J Hosp Palliat Care 2010; 26:405-12. [PMID: 19820205 DOI: 10.1177/1049909109346165] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To examine the prevalence and characteristics of pain in children with neuromuscular disease (NMD), 42 youths with NMD underwent a comprehensive evaluation including a detailed intake interview and structured questionnaire that included demographic and functional data. Youths who reported chronic pain were further queried about pain characteristics, locations, and intensity using an 11-point numerical rating scale and a modified Brief Pain Inventory (BPI). The sample consisted of 24 males (57%) and 18 females (43%), ages ranging from 9 to 20 years (M = 14.8, SD = 2.96). Participants included 14 (37%) with Duchenne muscular dystrophy, 6 (14%) with myotonic dystrophy, 2 (5%) with Becker dystrophy, 2 (5%) with limb-girdle dystrophy, 2 (5%) with congenital muscular dystrophy, 1 (2%) facioscapulohumeral, and 15 (36%) were classified as ''other NMD.'' Twenty-one (50%) were ambulatory; 26 (62%) used power wheelchairs/scooters, 9 (2%) used manual wheelchairs, 3 (.07%) used crutches/canes, and 1 (2%) used a walker. A total of 23 (55%) of the youths reported having chronic pain. Current pain intensity was 1.30 (range = 0-6), mean pain intensity over the past week was 2.39 (range = 0-7), mean pain duration was 8.75 hours (SD = 12.84). Pain in the legs was most commonly reported and 83% reported using pain medications. This study indicates that chronic pain is a significant problem in youths with NMD. These data strongly support making comprehensive pain assessment and management an integral part of the standard of care for youths with NMD.
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Affiliation(s)
- Joyce M Engel
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences in pain and psychological functioning in persons with limb loss. THE JOURNAL OF PAIN 2010; 11:79-86. [PMID: 19734105 PMCID: PMC2818017 DOI: 10.1016/j.jpain.2009.06.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/30/2009] [Accepted: 06/05/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Sex differences in pain are frequently reported in the literature. However, less is known about possible sex differences in the experience of pain secondary to a disability. The current study explored these issues in persons with limb loss (n = 335, 72% men) who were recruited as part of a postal survey. Participants provided ratings of phantom limb pain (PLP), residual limb pain (RLP), and general pain intensity. Participants also completed measures of pain-related interference, catastrophizing, coping, and beliefs. Results indicated that a greater proportion of males than females (86% vs 77%, respectively) reported the presence of PLP; however, this difference was no longer prominent when cause of limb loss was controlled. No sex differences were found in the presence of RLP, or in average intensity ratings of PLP or RLP. In contrast, females reported greater overall average pain intensity and interference than males. Females also endorsed significantly greater catastrophizing, use of certain pain-coping strategies, and beliefs related to several aspects of pain. This study did not find prominent sex differences in pain specific to limb loss. However, several sex differences in the overall biopsychosocial experience of pain did emerge that are consistent with the broader literature. PERSPECTIVE The current study contributes to the literature on sex differences in the experience of pain. Although males and females with limb loss did not significantly differ in their disability-specific pain, sex differences in their broader experience of pain were significant and are worthy of future clinical and empirical attention.
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Affiliation(s)
- Adam T Hirsh
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195-6490, USA.
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