Pain coping skills training for African Americans with osteoarthritis study: baseline participant characteristics and comparison to prior studies

Attending to Marginalization in The Chronic Pain Literature: A Scoping Review

Background

There has been a recent and, for many within the chronic pain space, long-overdue increase in literature that focuses on equity, diversity, inclusion, and decolonization (EDI-D) to understand chronic pain among people who are historically and structurally marginalized.

Aims

In light of this growing attention in chronic pain research, we undertook a scoping review of studies that focus on people living with chronic pain and marginalization to map how these studies were carried out, how marginalization was conceptualized and operationalized by researchers, and identify suggestions for moving forward with marginalization and EDI-D in mind to better support people living with chronic pain.

Methods

We conducted this scoping review using critical analysis in a manner that aligns with dominant scoping review frameworks and recent developments made to scoping review methodology as well as reporting guidelines.

Results

Drawing on 67 studies, we begin with a descriptive review of the literature followed by a critical review that aims to identify fissures within the field through the following themes: (1) varying considerations of sociopolitical and socioeconomic contexts, (2) conceptual conflations between sex and gender, and (3) differing approaches to how people living with chronic pain and marginalization are described.

Conclusion

By identifying strengths and limitations in the research literature, we aim to highlight opportunities for researchers to contribute to a more comprehensive understanding of marginalization in chronic pain experiences.

Intra-articular injection of bone marrow aspirate concentrate (mesenchymal stem cells) in KL grade III and IV knee osteoarthritis: 4 year results of 37 knees

Cell based therapies are increasingly used and results of bone marrow aspirate concentrate (BMAC) show encouraging short- to middle term results, superior to hyaluronic acid and platelet rich plasma (PRP). Most studies describe patients with mild to moderate arthritis and results of patients with KL III and IV osteoarthritis of the knee are limited to short term evaluations. Hence, the aim of this prospective study was to investigate the mid-term outcome of BMAC injections in patients with severe osteoarthritis of the knee. The BMAC was retrieved from the iliac crest as previously published with the "reorientation technique" from the iliac crest in supine position in analgosedation and injected into the patients' osteoarthritic knees. Patients were followed-up for 4 years. WOMAC, IKDC, SF 36 and walking distance were measured in a total of 37 participants. There was an improvement of IKDC and WOMAC from the first year onwards and a significant improvement beginning from year 2 up to the mid-term follow-up: IKDC increased significantly from 56 ± 12 (range 34-81) to 73 ± 13 (range 45-100), p < 0.001. WOMAC decreased significantly from 40 ± 23 (range 6-96) to 18 ± 18 (range 0-67), p < 0.001. 35 of 37 knees improved regarding IKDC and WOMAC score from the first to the last follow-up. Not a single protheses had to be implanted. Elaborate statistical analysis was done to exclude covariates and confounders (age, time, BMI,…). In summary, this is the first study on BMAC injections into 37 osteoarthritic knees with a 4-year follow up showing significant improvements in IKDC and WOMAC scores, and with a 95% success rate and significant improvement in walking distance.Clinical relevance Describes the 4-year outcome of BMAC injections for knees with severe osteoarthritis.

Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial

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.

Black American older adults' motivation to engage in osteoarthritis treatment recommendations for pain self-management: A mixed methods study

BACKGROUND

Osteoarthritis is a long-term condition, and four core treatments are recommended to minimize the interference of pain and symptoms on their daily function. However, older Black Americans have traditionally been at a disadvantage in regard to knowledge of and engagement in chronic disease self-management and self-care. Surprisingly, minimal research has addressed understanding motivational factors key to self-management behaviors. Thus, it is important to understand if older Black Americans' self-management is supported by current recommendations for the management of symptomatic osteoarthritis and what factors limit or motivate engagement in recommended treatments.

OBJECTIVE

Our objectives are to: (1) identify stage of engagement in four core recommended treatments for osteoarthritis, (2) describe the barriers and motivators to these recommended treatments, and (3) construct an understanding of the process of pain self-management motivation.

DESIGN

A mixed-methods concurrent parallel design.

SETTING

Participants were recruited from communities in northern Louisiana, USA.

PARTICIPANTS

Black Americans (≥50 years of age) with clinical osteoarthritis and/or provider-diagnosed osteoarthritis were enrolled. One hundred ten participants completed the study, and 18 of these individuals were also interviewed individually.

METHODS

Data were collected using in-person surveys and interviews. Over a period of 11 months, close- and open-ended surveys and in-depth interviews were conducted with participants. Descriptive statistics describe utilization/engagement level as well as barriers and motivators of recommended treatments for non-surgical osteoarthritis. Content and thematic analyses of interviews summarized perspectives on the process and role of motivation in pain self-management.

RESULTS

Overall, engagement levels in treatments ranged from very low to high. Over 55% of older Black Americans were actively engaged in two of the recommended treatments: land-based exercise and strength training. Major motivators included reduction in pain and stiffness and maintenance of mobility and good health. The majority of participants were not using water-based exercise and self-management education. Primary barriers were lack of access, time, and knowledge of resources.

CONCLUSIONS

In order to maximize the benefits of osteoarthritis pain self-management, older Black Americans must be equipped with the motivation, resources, information and skills, and time to engage in recommended treatment options. Their repertoire of behavioral self-management did not include two key treatments and is inconsistent with what is recommended, predominantly due to barriers that are difficult to overcome. In these cases, motivation alone is not optimal in promoting self-management. Providers, researchers, and community advocates should work collaboratively to expand access to self-management resources, particularly when personal and community motivation are high.

Racial and ethnic differences in the experience and treatment of noncancer pain

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.