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Benes LL, Keefe FJ, DeBar LL. Treating Persistent Pain: A Nurse Co-Led, Interdisciplinary Model for Primary Care. Pain Manag Nurs 2022; 23:728-736. [PMID: 35922272 PMCID: PMC9771916 DOI: 10.1016/j.pmn.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The public health crisis of chronic pain has only increased in recognition since the Institute of Medicine's (IOM) Relieving Pain in America (2011) called for a cultural transformation in the way pain is viewed, treated, and put forward specific recommendations for action. The National Pain Strategy (NPS) provides a roadmap for putting these recommendations into practice. We implemented a program that placed nurses and behavioral specialists at the head of an interdisciplinary team utilizing best practices. In this program, nurses enacted the NPS recommendations to advance care for patients with persistent pain on long-term opioid treatment. This program promoted professional growth in nurses along with fostering success for patients. Compared with patients receiving usual care, patients in the program achieved greater reductions in pain severity, pain-related disability, and pain-related functional interference and reported greater satisfaction with pain-related care and primary care services. This article will detail the NPS-aligned practice approaches these nurses and their teams used, describe the training for the nurses, and speak to opportunities to enhance the nurse's capacity for this role in hopes of providing a model for the future implementation of an NPS-based approach by nurses.
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Affiliation(s)
| | - Frank J Keefe
- Duke University, School of Medicine, Durham, North Carolina
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Janevic M, Robinson-Lane SG, Courser R, Brines E, Hassett AL. A Community Health Worker-Led Positive Psychology Intervention for African American Older Adults With Chronic Pain. THE GERONTOLOGIST 2022; 62:1369-1380. [PMID: 35394525 PMCID: PMC9579460 DOI: 10.1093/geront/gnac010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Experiencing structural racism over the life course contributes to disproportionate pain-related disability among African American older adults. Positive STEPS, delivered by community health workers, is a culturally congruent chronic pain self-management intervention that incorporates positive psychology principles and gives attention to social determinants of pain and pain management. RESEARCH DESIGN AND METHODS We conducted a randomized pilot trial among older adults with chronic musculoskeletal pain in an underserved, primarily African American community (Detroit, Michigan). The 7-week intervention included weekly telephone sessions with a community health worker; web-based videos teaching pain self-management skills; positive activities (e.g., Life Review, Gratitude Jar); and use of wearable activity trackers. Outcomes were measured at baseline and 8-week follow-up. We assessed participant retention, engagement, and satisfaction. RESULTS Study completers (n = 46; 90% retention) were 93% African American, 89% female, mean 72 years, and completed 5.7 of 7 sessions. Intervention participants versus controls showed greater improvement in PROMIS Pain Interference (4.3-point T-score decrease vs. 0.4-point increase; p = .01) and the Pain Self-Efficacy Questionnaire (p = .007). Furthermore, compared with controls, significantly more intervention participants reported "better" or "much better" global functioning (86% vs. 25%; p = .000) and pain (67% vs. 21%; p = .003) since baseline. Improvements in physical functioning, social participation, and resilience were noted, but differences were not significant. Participant feedback on the intervention was overwhelmingly positive. DISCUSSION AND IMPLICATIONS A community health worker-led chronic pain self-management intervention combining positive activities with self-management skills training demonstrated the potential to enhance pain-related functioning among a vulnerable group of older adults. CLINICAL TRIAL NUMBER NCT04321239.
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Affiliation(s)
- Mary Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rebecca Courser
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth Brines
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Souza LAF, Pereira LV, de Moura LA, Díaz LJR, da Cruz DDALM, Aparecido Da Silva J. Structural validity of the Chronic Pain Coping Inventory-Brazilian version. PLoS One 2021; 16:e0246294. [PMID: 33556089 PMCID: PMC7870154 DOI: 10.1371/journal.pone.0246294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background The Chronic Pain Coping Inventory (CPCI) has been widely used to measure coping with pain, however, the psychometric properties of the Brazilian CPCI are unknown. Aim To verify the validity and reliability of the CPCI-Brazilian version. Materials and methods A sample of 705 outpatients with chronic pain participated in the study. Cronbach’s alpha, corrected item-total correlations, and confirmatory factor analysis were performed, using the method of Diagonally Weighted Least Squares. Results Construct validity was supported with a factor loading range of 0.36–0.90 (9 factors) corroborating original loads. The final model had adequate fit with items 42 and 54 excluded, D.F = 2174, TLI = 0.96; CFI = 0.96 and RMSEA = 0.051(p = 0.067). Eight of the nine CPCI scales showed satisfactory reliability (Cronbach’s alpha ranged from 0.70 to 0.92). The Relaxation scale obtained a low alpha value (0.53). Conclusion The CPCI-Brazilian version, after exclusion of items 42 and 54, is valid to measure chronic pain coping in Brazilian adults.
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Affiliation(s)
| | | | | | | | | | - José Aparecido Da Silva
- Department of Psychology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
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Griesemer I, Hausmann LR, Arbeeva L, Campbell LC, Cené CW, Coffman CJ, Keefe FJ, Oddone EZ, Somers TJ, Allen KD. Discrimination Experiences and Depressive Symptoms among African Americans with Osteoarthritis Enrolled in a Pain Coping Skills Training Randomized Controlled Trial. J Health Care Poor Underserved 2021; 32:145-155. [PMID: 33678687 PMCID: PMC10513122 DOI: 10.1353/hpu.2021.0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
African Americans are more likely than members of other racial groups to report perceived discrimination in health care settings, and discrimination is linked to depression. Using data from a randomized controlled trial of pain coping skills training (PCST) for African Americans with osteoarthritis (N=164), we evaluated the interaction between discrimination experiences and experimental condition (PCST or control group) in linear regression models predicting depressive symptoms. There was a significant interaction between personal discrimination and experimental condition on depressive symptoms (interaction term coefficient: b=-3.2, 95% CI [- 6.4, - .02], p=.05). Discrimination was associated with depressive symptoms among those in the control group but not among those who received PCST. Participation in a PCST intervention may have reduced the association between discrimination experiences and depressive symptoms among participants in this sample. Future research should explore whether interventions aimed at teaching coping skills may be effective in ameliorating the harmful mental health effects of perceived discrimination.
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Dharmasri CJ, Griesemer I, Arbeeva L, Campbell LC, Cené CW, Keefe FJ, Oddone EZ, Somers TJ, Allen KD. Acceptability of telephone-based pain coping skills training among African Americans with osteoarthritis enrolled in a randomized controlled trial: a mixed methods analysis. BMC Musculoskelet Disord 2020; 21:545. [PMID: 32795282 PMCID: PMC7427940 DOI: 10.1186/s12891-020-03578-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/06/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) disproportionately impacts African Americans compared to Caucasians, including greater pain severity. The Pain Coping Skills Training for African Americans with Osteoarthritis (STAART) study examined a culturally enhanced Pain Coping Skills Training (CST) program among African Americans with OA. This mixed methods study evaluated the acceptability of the Pain CST program among STAART participants. METHODS STAART was a randomized controlled trial evaluating the effectiveness of an 11-session, telephone-based pain CST program, compared to a usual care control group. Participants were from the University of North Carolina and Durham Veterans Affairs Healthcare Systems. The present analyses included 93 participants in the CST group who completed a questionnaire about experiences with the program. Descriptive statistics of the questionnaire responses were calculated using SAS software. Thematic analysis was applied to open-response data using Dedoose software. RESULTS Participants' mean rating of overall helpfulness of the pain CST program for managing arthritis symptoms was 8.0 (SD = 2.2) on a scale of 0-10. A majority of participants reported the program made a positive difference in their experience with arthritis (83.1%). Mean ratings of helpfulness of the specific skills ranged from 7.7 to 8.8 (all scales 0-10). Qualitative analysis of the open-response data identified four prominent themes: Improved Pain Coping, Mood and Emotional Benefits, Improved Physical Functioning, and experiences related to Intervention Delivery. CONCLUSIONS The high ratings of helpfulness demonstrate acceptability of this culturally enhanced pain CST program by African Americans with OA. Increasing access to cognitive-behavioral therapy-based programs may be a promising strategy to address racial disparities in OA-related pain and associated outcomes. TRIAL REGISTRATION NCT02560922 , registered September 25, 2015.
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Affiliation(s)
- Chamara J. Dharmasri
- grid.410711.20000 0001 1034 1720Department of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Ida Griesemer
- grid.410711.20000 0001 1034 1720Department of Health Behavior, University of North Carolina, Chapel Hill, NC USA
| | - Liubov Arbeeva
- grid.410711.20000 0001 1034 1720Department of Medicine, University of North Carolina, Chapel Hill, NC USA ,grid.410711.20000 0001 1034 1720Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Bldg, CB# 7280, Chapel Hill, NC 27599 USA
| | - Lisa C. Campbell
- grid.255364.30000 0001 2191 0423Department of Psychology, East Carolina University, Greenville, NC USA
| | - Crystal W. Cené
- grid.410711.20000 0001 1034 1720Department of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Francis J. Keefe
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Science, Duke University, Durham, NC USA
| | - Eugene Z. Oddone
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health System, Durham, NC USA ,grid.189509.c0000000100241216Department of Medicine, Duke University Medical Center, Durham, NC USA
| | - Tamara J. Somers
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Science, Duke University, Durham, NC USA
| | - Kelli D. Allen
- grid.410711.20000 0001 1034 1720Department of Medicine, University of North Carolina, Chapel Hill, NC USA ,grid.410711.20000 0001 1034 1720Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Bldg, CB# 7280, Chapel Hill, NC 27599 USA ,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health System, Durham, NC USA
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Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial. Pain 2020; 160:1297-1307. [PMID: 30913165 PMCID: PMC6719680 DOI: 10.1097/j.pain.0000000000001525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
African Americans bear a disproportionate burden of osteoarthritis (OA), but they have been underrepresented in trials of behavioral interventions for pain. This trial examined a culturally tailored pain coping skills training (CST) program, compared to a wait list control group, among 248 African Americans with knee or hip OA. The pain CST program involved 11 telephone-based sessions over 3 months. Outcomes were assessed at baseline, 3 months (primary), and 9 months, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary outcome), WOMAC total score and function subscale, PROMIS Pain Interference, Short-Form 12 Mental and Physical Composite Subscales, Coping Strategies Questionnaire-Total Coping Attempts, Pain Catastrophizing Scale, Patient Health Questionnaire-8, Arthritis Self-Efficacy Scale, and Patient Global Impression of Arthritis Symptom Change. Linear mixed models were fit for all outcomes. There were no significant between-group differences in WOMAC pain score at 3 months (-0.63 [95% confidence interval -1.45, 0.18]; P = 0.128) or 9 months (-0.84 [95% confidence interval -1.73, 0.06]; P = 0.068). Among secondary outcomes, at 3 months, there were significant differences, in favor of the CST group, for Coping Strategies Questionnaire Total Coping Attempts, Pain Catastrophizing Scale, Arthritis Self-Efficacy, and Patient Global Impression of Arthritis Symptom Change (P < 0.01). Coping Strategies Questionnaire Total Coping Attempts, Arthritis Self-Efficacy, and Patient Global Assessment Change were also significantly improved at 9 months in the CST group, compared with wait list (P < 0.01). The culturally tailored pain CST program did not significantly reduce pain severity but did improve key measures of pain coping and perceived ability to manage pain among African Americans with OA.
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Devan H, Perry MA, van Hattem A, Thurlow G, Shepherd S, Muchemwa C, Grainger R. Do pain management websites foster self-management support for people with persistent pain? A scoping review. PATIENT EDUCATION AND COUNSELING 2019; 102:1590-1601. [PMID: 30981410 DOI: 10.1016/j.pec.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/10/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality. METHODS Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification. RESULTS Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites. CONCLUSIONS The review identified 27 contemporary pain management websites that could be used for self-management skills training. PRACTICE IMPLICATIONS Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Greg Thurlow
- School of Physiotherapy, University of Otago, New Zealand
| | - Sam Shepherd
- School of Physiotherapy, University of Otago, New Zealand
| | - Carol Muchemwa
- School of Physiotherapy, University of Otago, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Meints SM, Cortes A, Morais CA, Edwards RR. Racial and ethnic differences in the experience and treatment of noncancer pain. Pain Manag 2019; 9:317-334. [PMID: 31140916 PMCID: PMC6587104 DOI: 10.2217/pmt-2018-0030] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
The burden of pain is unequal across racial and ethnic groups. In addition to racial and ethnic differences in the experience of pain, there are racial and ethnic disparities in the assessment and treatment of pain. In this article, we provide a nonexhaustive review of the biopsychosocial mechanistic factors contributing to racial and ethnic differences in both the experience and treatment of pain. Using a modified version of the Socioecological Model, we focus on patient-, provider- and system-level factors including coping, perceived bias and discrimination, patient preferences, expectations, patient/provider communication, treatment outcomes and healthcare access. In conclusion, we provide psychosocial factors influencing racial and ethnic differences in pain and highlight future research targets and possible solutions to reduce these disparities.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alejandro Cortes
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Calia A Morais
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham & Women’s Hospital, Harvard Medical School, Chestnut Hill, MA 02467, USA
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Pain coping skills training for African Americans with osteoarthritis study: baseline participant characteristics and comparison to prior studies. BMC Musculoskelet Disord 2018; 19:337. [PMID: 30227841 PMCID: PMC6145122 DOI: 10.1186/s12891-018-2249-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background The Pain Coping Skills Training for African Americans with OsteoaRTthritis (STAART) trial is examining the effectiveness of a culturally enhanced pain coping skills training (CST) program for African Americans with osteoarthritis (OA). This disparities-focused trial aimed to reach a population with greater symptom severity and risk factors for poor pain-related outcomes than previous studies. This paper compares characteristics of STAART participants with prior studies of CST or cognitive behavioral therapy (CBT)-informed training in pain coping strategies for OA. Methods A literature search identified 10 prior trials of pain CST or CBT-informed pain coping training among individuals with OA. We descriptively compared characteristics of STAART participants with other studies, in 3 domains of the National Institutes of Minority Health and Health Disparities’ Research Framework: Sociocultural Environment (e.g., age, education, marital status), Biological Vulnerability and Mechanisms (e.g, pain and function, body mass index), and Health Behaviors and Coping (e.g., pain catastrophizing). Means and standard deviations (SDs) or proportions were calculated for STAART participants and extracted from published manuscripts for comparator studies. Results The mean age of STAART participants, 59 years (SD = 10.3), was lower than 9 of 10 comparator studies; the proportion of individuals with some education beyond high school, 75%, was comparable to comparator studies (61–86%); and the proportion of individuals who are married or living with a partner, 42%, was lower than comparator studies (62–66%). Comparator studies had less than about 1/3 African American participants. Mean scores on the Western Ontario and McMaster Universities Osteoarthritis Index pain and function scales were higher (worse) for STAART participants than for other studies, and mean body mass index of STAART participants, 35.2 kg/m2 (SD = 8.2), was higher than all other studies (30–34 kg/m2). STAART participants’ mean score on the Pain Catastrophizing scale, 19.8 (SD = 12.3), was higher (worse) than other studies reporting this measure (7–17). Conclusions Compared with prior studies with predominantly white samples, STAART participants have worse pain and function and more risk factors for negative pain-related outcomes across several domains. Given STAART participants’ high mean pain catastrophizing scores, this sample may particularly benefit from the CST intervention approach. Trial registration NCT02560922 Electronic supplementary material The online version of this article (10.1186/s12891-018-2249-6) contains supplementary material, which is available to authorized users.
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