A prognostic approach to defining chronic pain: application to knee pain in older adults

A prognostic approach to defining chronic pain has been proposed as an alternative to traditional definitions based on retrospective duration of pain. While this new approach performs well in low back pain (LBP), headache and orofacial pain, it is not known whether it translates to regional pain syndromes with an underlying pathological component, such as osteoarthritis (OA). We investigated the performance of this approach in a population-based cohort of older adults reporting knee pain, with a spectrum of radiographic knee OA. 676 adults (50 years+) attended a research clinic and were followed up at 18 months and 3 years. Risk scores were calculated using pain intensity, pain duration, pain-related activity, number of pain sites and depressive symptoms, measured at baseline and at 18 months. These scores were used to determine the probability of future clinically significant knee pain, defined as Chronic Pain Grade II-IV, at 18 months and at 3 years using logistic regression. Cut-points on the risk score were applied to determine groups at intermediate (probability >or=0.2), possible (>or=0.5) and probable (>or=0.8) risk of clinically significant knee pain. Discriminative ability of the risk scores, determined by area under the ROC curve, was high (0.78-0.82), varied little by radiographic severity and was superior to pain duration alone. The derived cut-points suggested a lower threshold for each of the risk groups than the previous LBP work. This prognostic approach to defining chronic pain appears to translate well to knee pain. Different cut-points for defining risk groups may be needed for different pain syndromes.     

Self-management intervention for chronic pain in older adults: A randomised controlled trial

This study compared an outpatient pain self-management (PSM) program, using cognitive-behavioural therapy and exercises, with 2 control conditions in 141 chronic pain patients aged > 65 years. Results immediately posttreatment indicated that relative to the Exercise-Attention Control (EAC) group, the PSM group was significantly improved on measures of pain distress, disability, mood, unhelpful pain beliefs, and functional reach. The mean effect size for these gains was 0.52 (range: 0.44–0.68). By 1-month follow-up, relative to the EAC group, the PSM group remained better on most measures. At the 1-month follow-up, relative to a Waiting List (usual care) (WL) group, the PSM group was significantly improved on measures of pain distress, disability, and unhelpful pain beliefs. The mean effect size for these variables was 0.69 (range: 0.56–0.83). Relative to the WL group, the EAC group made no significant gains on any of the measured variables. At 1-month follow-up, the mean proportion of reliably improved cases (across outcome variables) was 41% (range: 16–60%) for the PSM group, twice that of those who met this criterion in the 2 control conditions (and this difference was statistically significant). Similarly, significantly more (44%) of the PSM group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive-behavioural therapy-based PSM was more effective than exercises and usual care.     

Nurses' experiences of caring for the older adult in the emergency department: A focused ethnography

The purpose of this study was to explore nurses' experience of caring for the older adult within the ED. This focused ethnographic study used a combination of semi-structured interviews and non-participant observation. Seven registered nurses participated, detailing their experiences of caring for the older adult in the ED. Data were transcribed verbatim and analyzed thematically. Findings revealed three themes: the culture, which focused on priority setting and throughput of patients, lack of fit between the older adult and the ED, and managing lack of fit. Nurses relied on a default orientation of priority setting, recognizing this put the older adult at risk of substandard care. Lack of fit was accentuated by the need to ‘puzzle through’ atypical presentations of many older adults. It is concluded that consideration needs to be given on how to mitigate lack of fit and how to support nurses to give the care the older adult requires.     

Correlates and consequences of chronic pain in older adults

Chronic pain is a frequent challenge to older adults' coping skills. Despite the widespread occurrence of chronic geriatric pain, no comprehensive body of literature on this topic exists. Instead, research on chronic pain is scattered across disciplines and is perceived as inaccessible by scientists. We completed a comprehensive review and qualitative analysis of the geriatric chronic pain literature since 1990 and found 314 articles on this topic that reported. North American research. Physical, social, and psychologic variables associated with chronic pain and the elderly were mentioned in just over half (53%) of the articles. However, both psychosocial causes and consequences of chronic pain were understudied. Only 16% of the articles had social variables (gender, race, and age) as their primary interest; 27% focused on psychologic or psychiatric issues, with half including depression as the variable of interest. An analysis of the articles' content suggests that research on chronic pain in later life would be substantially improved if a more structured and comprehensive approach were used that combined the study of psychosocial issues with that of physical pain. Researchers and clinicians with a global understanding of chronic pain might help improve quality of life for older adults.     

Adapting principles of chronic pain self-management to the workplace

Purpose: To evaluate the extent to which the principles of chronic pain or illness self-management (SM) programs might be adapted to focus on the workplace concerns of adults with persistent or recurrent pain and lead to new workplace intervention opportunities. Method: Eight SM programs were selected as representative evidence-based programs and then compared to extract common instructional elements. Elements were analyzed for potential application to four workplace problem domains identified by workers with pain: activity interference, negative self-perceptions, interpersonal challenges, and the inflexibility of work. Results: Of 24 instructional elements, 17 were shared by at least half of the SM programs. Instructional elements judged to be best suited for dealing with workplace concerns included those focused on reducing pain and discomfort, making informed decisions, communicating effectively, and dealing with thoughts and feelings. However, aspects of the workplace that may alter the feasibility or effectiveness of SM strategies include the level of physical demands and limitations, job leeway, and the nature of workplace roles and relationships. Conclusions: Principles and methods of SM intervention programs are generally well suited to address pain-related problems in the workplace, but tailoring of messages may be necessary to incorporate the unique organizational, physical, and social aspects of work into psycho-educational programs.

Implications for Rehabilitation

• Chronic pain is a growing problem among working age adults that can contribute to workplace difficulties and disability.

• Pain self-management interventions applying psycho-educational techniques are generally well-suited for dealing with workplace problems.

• Pain self-management interventions may reduce pain and discomfort in the workplace, help with job-related problem-solving and decision-making, provide methods for communicating needs effectively, and deal with negative thoughts and feelings at work.

• Applying existing pain self-management techniques in the workplace requires that some changes be made to incorporate the unique organizational, physical, and social aspects of the workplace.

     

The effect of race in older adults presenting for chronic pain management: a comparative study of black and white Americans.

In an aging society, chronic pain will increasingly have a significant impact on successful aging. Chronic pain may further differentially affect racial and ethnic minorities while diminishing their health and quality of life. This study addresses the potential differential effects of chronic pain cross-culturally in older Americans. A retrospective analysis of a group of subjects presenting for chronic pain management in a tertiary care multidisciplinary pain center was performed. This comparative study of black and white American adults (N [equals] 2040) was done to determine whether there were differences in (1). psychologic functioning, (2). pain characteristics, (3). pain disability, and (4). comorbidities. The black American population had more depressive symptoms and symptoms of posttraumatic stress disorder when compared with the white Americans. These results suggest that chronic pain adversely affects the quality of life and health status of black Americans to a greater extent than white Americans before initial presentation for treatment at a multidisciplinary pain center. This study of older Americans with chronic pain showed significant differences in pain and health status based on race. It further demonstrates a difference in the chronic pain experience based on race in older Americans.     

Assisting older adults to communicate their postoperative pain

An intervention assisting older adults to communicate their pain was tested in a posttest-only experiment. Thirty-eight preoperative older adults were randomly assigned to a communication group watching a videotape about communicating and managing postoperative pain or a comparison group watching a videotape about managing postoperative pain only. Pain was measured on Postoperative Days 1 and 2, and 1 and 7 days after hospital discharge by a data collector blind to the condition. The communication group reported greater pain relief and less pain interference on Postoperative Day 1. The comparison group reported greater pain relief on Postoperative Day 2 after attaining a pain interference level similar to the pain communication group. The pain communication intervention had modest effects for reducing pain interference with activities on Postoperative Day 1. Greater pain relief might be achieved when older adults and their health care providers are more knowledgeable about both pain communication and pain management.     

Portable EEG monitoring for older adults with dementia and chronic pain - A feasibility study

Given the reduced ability of people with dementia to self-report pain, this study examined the feasibility of using a portable electroencephalography (EEG) headband (MUSE 2) as a pain measurement tool for long-term care residents with dementia. Ten minutes of resting-state EEG was acquired by MUSE 2 from people with dementia experiencing ongoing pain (n = 3) and without current pain (n = 1) over three days. The MUSE 2 was acceptable and feasible for use in people with dementia while challenges regarding software, data collection and analysis in using this device are reported. Compared to the resident not experiencing pain, EEG signals of residents with ongoing pain showed different EEG patterns, and this could be a potential biomarker to support pain measurement in people with dementia. Further research with larger sample size is warranted to verify study results.     

Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis

The relationship between subacromial pain syndrome (SAPS) and altered scapular movement has been previously reported. The purpose of this review was to determine the effect of interventions that focus on addressing scapular components to improve shoulder pain, function, shoulder range of motion (ROM), and muscle strength in adults with SAPS. Databases searched in September 2016 were: PubMed, the Cochrane Central Register of Controlled Trials [Central], EMBASE [via Ovid] and PEDro. All studies selected for this review were randomized controlled trials. In total, six studies met the inclusion criteria and were included in the meta-analyses. In adults with SAPS, scapular focused interventions significantly improved pain with activities (MD [95% CI] = ?0.88 [?1.19 to ?0.58], I² 43%) and shoulder function (?11.31 [?17.20 to ?5.41] I² 65%) in the short term. No between-group difference in shoulder pain and function were found at follow up (4 weeks). A between-group difference in shoulder abduction ROM in the short term only was found (12.71 [7.15 to 18.26]°, I² 36%). No between-group difference in flexion ROM, supraspinatus muscle strength, pectoralis minor length or forward shoulder posture were found. In conclusion, in adults with SAPS, scapular focused interventions can improve short-term shoulder pain and function.     

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: A feasibility study

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age = 80.6 years; SD = 8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES] = 0.33) were noted for participants completing 19–24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.