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De La Rosa JS, Brady BR, Herder KE, Wallace JS, Ibrahim MM, Allen AM, Meyerson BE, Suhr KA, Vanderah TW. The unmet mental health needs of U.S. adults living with chronic pain. Pain 2024:00006396-990000000-00671. [PMID: 39073375 DOI: 10.1097/j.pain.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/13/2024] [Indexed: 07/30/2024]
Abstract
ABSTRACT Previous research suggests that individuals with mental health needs and chronic pain may be less likely to use mental health treatment compared with those with mental health needs only. Yet, few studies have investigated the existence of population-level differences in mental health treatment use. We analyzed data from the National Health Interview Survey (n = 31,997) to address this question. We found that chronic pain was associated with end-to-end disparities in the mental health journeys of U.S. adults: (1) Those living with chronic pain are overrepresented among U.S. adults with mental health needs; (2) among U.S. adults with mental health needs, those living with chronic pain had a lower prevalence of mental health treatment use; (3) among U.S. adults who used mental health treatment, those living with chronic pain had a higher prevalence of screening positive for unremitted anxiety or depression; (4) among U.S. adults living with both chronic pain and mental health needs, suboptimal mental health experiences were more common than otherwise-just 44.4% of those living with mental health needs and co-occurring chronic pain reported use of mental health treatment and screened negative for unremitted anxiety and depression, compared with 71.5% among those with mental health needs only. Overall, our results suggest that U.S. adults with chronic pain constitute an underrecognized majority of those living with unremitted anxiety/depression symptoms and that the U.S. healthcare system is not yet adequately equipped to educate, screen, navigate to care, and successfully address their unmet mental health needs.
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Affiliation(s)
- Jennifer S De La Rosa
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Benjamin R Brady
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States
| | - Katherine E Herder
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jessica S Wallace
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Mohab M Ibrahim
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Departments of Anesthesiology
| | - Alicia M Allen
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Beth E Meyerson
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Kyle A Suhr
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Psychiatry, and
| | - Todd W Vanderah
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Tsai PF, Edison JL, Wang CH, Gramlich MW, Manning KQ, Deshpande G, Bashir A, Sefton J. Characteristics of patients with myofascial pain syndrome of the low back. Sci Rep 2024; 14:11912. [PMID: 38789439 PMCID: PMC11126576 DOI: 10.1038/s41598-024-61319-5] [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: 10/17/2023] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The objective of this study is to determine characteristics of patients with myofascial pain syndrome (MPS) of the low back and the degree to which the low back pain in the patients examined can be attributed to MPS. Twenty-five subjects with myofascial trigger point(s) [MTrP(s)] on the low back participated in this cross-sectional study. The location, number, and type of selected MTrPs were identified by palpation and verified by ultrasound. Pain pressure threshold, physical function, and other self-reported outcomes were measured. Significant differences were found in Group 1 (Active), 2 (Latent), 3 (Atypical, no twitching but with spontaneous pain), and 4 (Atypical, no twitching and no spontaneous pain) of participants in the number of MTrPs, current pain, and worst pain in the past 24 h (p = .001-.01). There were interaction effects between spontaneous pain and twitching response on reports of physical function, current pain, and worst pain (p = .002-.04). Participants in Group 3 reported lower levels of physical function, and higher levels of current pain and worst pain compared to those in Group 4. Participants in Group 1 and 2 had similar levels of physical function, current pain, and worst pain. The number of MTrPs is most closely associated with the level of pain. Spontaneous pain report seems to be a decisive factor associated with poor physical function; however, twitching response is not.
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Affiliation(s)
- Pao-Feng Tsai
- College of Nursing, Auburn University, 710 S Donahue Dr, Auburn, AL, 36849, USA.
| | | | | | | | | | - Gopikrishna Deshpande
- Auburn University Neuroimaging Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, United States
- Department of Psychological Sciences, Auburn University, Auburn, AL, United States
- Alabama Advanced Imaging Consortium, Birmingham, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Heritage Science and Technology, Indian Institute of Technology, Hyderabad, India
| | - Adil Bashir
- Samuel Ginn College of Engineering, Auburn University, Auburn, AL, USA
| | - JoEllen Sefton
- School of Kinesiology, Auburn University, Auburn, AL, USA
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Antoine LH, Tanner JJ, Mickle AM, Gonzalez CE, Kusko DA, Watts KA, Rumble DD, Buchanan TL, Sims AM, Staud R, Lai S, Deshpande H, Phillips B, Buford TW, Aroke EN, Redden DT, Fillingim RB, Goodin BR, Sibille KT. Greater socioenvironmental risk factors and higher chronic pain stage are associated with thinner bilateral temporal lobes. Brain Behav 2023; 13:e3330. [PMID: 37984835 PMCID: PMC10726852 DOI: 10.1002/brb3.3330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Previous research indicates ethnic/race group differences in pain and neurodegenerative diseases. Accounting for socioenvironmental factors reduces ethnic/race group differences in clinical and experimental pain. In the current study sample, we previously reported that in individuals with knee pain, ethnic/race group differences were observed in bilateral temporal lobe thickness, areas of the brain associated with risk for Alzheimer's disease, and related dementias. The purpose of the study was to determine if socioenvironmental factors reduce or account for previously observed ethnic/race group differences and explore if a combined effect of socioenvironmental risk and chronic pain severity on temporal lobe cortices is evident. METHODS Consistent with the prior study, the sample was comprised of 147 adults (95 women, 52 men), 45-85 years of age, who self-identified as non-Hispanic Black (n = 72) and non-Hispanic White (n = 75), with knee pain with/at risk for osteoarthritis. Measures included demographics, health history, pain questionnaires, cognitive screening, body mass index, individual- and community-level socioenvironmental factors (education, income, household size, marital and insurance status, and area deprivation index), and brain imaging. We computed a summative socioenvironmental risk index. RESULTS Regression analyses showed that with the inclusion of socioenvironmental factors, the model was significant (p < .001), and sociodemographic (ethnic/race) group differences were not significant (p = .118). Additionally, findings revealed an additive stress load pattern indicating thinner temporal lobe cortices with greater socioenvironmental risk and chronic pain severity (p = .048). IMPLICATIONS Although individual socioenvironmental factors were not independent predictors, when collectively combined in models, ethnic/race group differences in bilateral temporal lobe structures were not replicated. Further, combined socioenvironmental risk factors and higher chronic pain severity were associated with thinner bilateral temporal lobes.
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Affiliation(s)
- Lisa H. Antoine
- Department of PsychologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jared J. Tanner
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Angela M. Mickle
- Pain Research & Intervention Center of ExcellenceUniversity of FloridaGainesvilleFloridaUSA
- Department of Physical Medicine & RehabilitationUniversity of FloridaGainesvilleFloridaUSA
| | - Cesar E. Gonzalez
- Department of PsychologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Daniel A. Kusko
- Department of PsychologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kristen Allen Watts
- Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Deanna D. Rumble
- Department of Psychology and CounselingUniversity of Central ArkansasConwayArkansasUSA
| | - Taylor L. Buchanan
- Center for Exercise MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andrew M. Sims
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Roland Staud
- Department of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Song Lai
- Department of Radiation OncologyUniversity of FloridaGainesvilleFloridaUSA
| | | | - Brandis Phillips
- Department of Accounting & FinanceNorth Carolina A&T State UniversityGreensboroNorth CarolinaUSA
| | - Thomas W. Buford
- Department of Medicine − Division of Gerontology, Geriatrics, and Palliative CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Birmingham/Atlanta Geriatric Research, Education, and Clinical CenterBirmingham VA Medical CenterBirminghamAlabamaUSA
| | - Edwin N. Aroke
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - David T. Redden
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of ExcellenceUniversity of FloridaGainesvilleFloridaUSA
- Department of Community of Dentistry and Behavioral SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Burel R. Goodin
- Department of PsychologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of AnesthesiologyWashington University, Washington University Pain CenterSt. LouisMissouriUSA
| | - Kimberly T. Sibille
- Pain Research & Intervention Center of ExcellenceUniversity of FloridaGainesvilleFloridaUSA
- Department of Physical Medicine & RehabilitationUniversity of FloridaGainesvilleFloridaUSA
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Hanson ER, Quist HE, Mintert JS, Arshad M, Friedman BL, Pleasant A, Monico-Cristales NS, Tillman R, Mehelis M, Karnik A, Sonder A, Mardian AS. Program Evaluation: exploring health disparities that impact chronic pain referrals within a VA Health Care System. FRONTIERS IN PAIN RESEARCH 2023; 4:1110554. [PMID: 37228808 PMCID: PMC10204586 DOI: 10.3389/fpain.2023.1110554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The present Program Evaluation study examines sociodemographic characteristics of Veterans in the Phoenix VA Health Care System who have back pain, and specifically the likelihood of those characteristics being associated with a referral to the Chronic Pain Wellness Center (CPWC) in the year 2021. We examined the following characteristics: Race/ethnicity, gender, age, mental health diagnosis, substance use disorder diagnosis, and service-connected diagnosis. Methods Our study used cross sectional data from the Corporate Data Warehouse for 2021. 13624 records had complete data for the variables of interest. Univariate and multivariate logistic regression was used to determine the likelihood of patients' being referred to the Chronic Pain Wellness Center. Results The multivariate model found under-referral to be significant for younger adults and for patients who identified as Hispanic/Latinx, Black/African American, or Native American/Alaskan. Those with depressive disorders and opioid use disorders, on the other hand, were found to be more likely to be referred to the pain clinic. Other sociodemographic characteristics were not found to be significant. Discussion Study limitations include the use of cross-sectional data, which cannot determine causality, and the inclusion of patients only if the ICD-10 codes of interest were recorded for an encounter in 2021 (i.e., a prior history of a particular diagnosis was not captured). In future efforts, we plan to examine, implement, and track the impact of interventions designed to mitigate these identified disparities in access to chronic pain specialty care.
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Affiliation(s)
- Eric R. Hanson
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Heidi E. Quist
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Jeffrey S. Mintert
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mahreen Arshad
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Brittany L. Friedman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Alexandra Pleasant
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | | | - Rhonda Tillman
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Mark Mehelis
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anita Karnik
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Anais Sonder
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
| | - Aram S. Mardian
- Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
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Gondré-Lewis MC, Abijo T, Gondré-Lewis TA. The Opioid Epidemic: a Crisis Disproportionately Impacting Black Americans and Urban Communities. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01384-6. [PMID: 36068482 PMCID: PMC9447354 DOI: 10.1007/s40615-022-01384-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
The heroin epidemic has existed for decades, but a sharp rise in opioid overdose deaths (OODs) jolted the nation in the mid-twenty-teens and continues as a major health crisis to this day. Although the new wave of OODs was initially approached as a rural problem impacting a White/Caucasian demographic, surveillance records suggest severe impacts on African Americans and urban-dwelling individuals, which have been largely underreported. The focus of this report is on specific trends in OOD rates in Black and White residents in states with a significant Black urban population and declared as hotspots for OOD: (Maryland (MD), Illinois (IL), Michigan (MI), and Pennsylvania (PA)), and Washington District of Columbia (DC). We compare OODs by type of opioid, across ethnicities, across city/rural demographics, and to homicide rates using 2013-2020 data acquired from official Chief Medical Examiners' or Departments of Health (DOH) reports. With 2013 or 2014 as baseline, the OOD rate in major cities (Baltimore, Chicago, Detroit, Philadelphia) were elevated two-fold over all other regions of their respective state. In DC, Wards 7 and 8 OODs were consistently greater than other jurisdictions, until 2020 when the rate of change of OODs increased for the entire city. Ethnicity-wise, Black OOD rates exceeded White rates by four- to six-fold, with fentanyl and heroin having a disproportionate impact on Black opioid deaths. This disparity was aggravated by its intersection with the COVID-19 pandemic in 2020. African Americans and America's urban dwellers are vulnerable populations in need of social and political resources to address the ongoing opioid epidemic in under-resourced communities.
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Affiliation(s)
- Marjorie C Gondré-Lewis
- Developmental Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington D.C., 20059, USA
| | - Tomilowo Abijo
- Developmental Neuropsychopharmacology Laboratory, Department of Anatomy, Howard University College of Medicine, Washington D.C., 20059, USA
| | - Timothy A Gondré-Lewis
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20814, USA
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