Indicators of need for occupational therapy in patients with chronic pain: occupational therapists' focus groups

This study explores occupational therapists' (OT) perceptions of indicators for occupational therapy interventions among patients with chronic pain. An exploratory design was applied to six focus groups of OTs (n = 25) for data collection. Analysis was performed using content analysis through identification of meaning units, codes, categories and themes. Limitations of occupational performance was a major theme that included participant restrictions caused by physical, emotional and environmental barriers. Five subthemes of need were identified: 1) pain behaviour that prevented engagement in activities; 2) lack of knowledge about pain mechanisms and strategies to deal with pain; 3) occupational imbalance in work, leisure and home; 4) emotional stress and depression due to pain; and 5) physical or environmental strain resulting in limitations in occupational performance. Because of the variety and the diverse trends of approaches towards interventions for patients with chronic pain that exist in different cultures and settings, this study should be replicated in other contexts to increase the transferability of the findings. Copyright © 2009 John Wiley & Sons, Ltd.     

Management of pain in older people within the nursing home: a preliminary study

The provision of continuing care for older people has largely shifted from the hospital setting to the community, and nursing homes increasingly provide support for older people, many of whom exhibit multiple pathology and complex health and social care needs. However, the quality of pain management within this setting has been identified as an issue of concern. It has been estimated that approximately two-thirds of people aged 65 years and over experience chronic pain, and that the prevalence of chronic pain in nursing home residents is between 45% and 80%. However, there exist a number of barriers to the identification and management of chronic pain among older people resident in nursing homes, including sensory impairments in older people themselves and educational deficits among professionals. Such barriers need to be overcome if pain management is to be improved. The present study involved administering a pre-piloted postal questionnaire to the managers of 121 nursing homes within a geographically defined area. Sixty-eight (56%) were completed and returned. The questionnaire broadly covered the following: prevalence of chronic pain and use of interventions; assessment and management strategies; education and training; and communication barriers. Overall, 37% of nursing home residents were identified as experiencing chronic non-malignant pain (pain lasting longer than 3 months not caused by cancer) and 2% were reported as experiencing chronic malignant pain (pain lasting for more than 3 months caused by cancer). Paracetamol was identified as the most 'often' used analgesia for both pain modalities. Sixty-nine per cent of nursing homes did not have a written policy regarding pain management and 75% did not use a standardised pain assessment tool. Forty-four per cent of nursing homes provided education or training sessions for qualified staff and 34% provided this for care assistants. Forty per cent of qualified staff and 85% of care assistants had no specialist knowledge regarding the management of pain in older people. The present study confirms the need for the development of effective pain management strategies underpinned by appropriate training and education in order to meet the particular needs of older people.     

Opportunities for prevention of 'clinically significant' knee pain: results from a population-based cross sectional survey

BACKGROUND: There is little UK-based evidence on the prevalence and predictors of knee pain associated with disability across all adult ages. We aimed to estimate the prevalence of 'clinically significant' knee pain, identify and assess the population impact of independent risk factors, and estimate levels of healthcare need. METHODS: A cross-sectional survey of three general practice populations was conducted. Adults (n = 5752) were mailed a screening questionnaire (phase I). Those reporting predominant or isolated knee pain were sent a detailed questionnaire (phase II), with a further sub-sample invited for clinical examination (phase III). Logistic regression was used to identify independent risk factors and population attributable fractions were calculated. RESULTS: The 1 month period prevalence of 'all reported' knee pain was 19 per cent, of which about a third was disabling and a fifth intense and disabling. Obesity, deprivation and South Asian ethnicity were each associated with a 3-4-fold increased risk of knee pain with disability (after age/sex adjustment). The attributable fraction estimate for raised body mass index (BMI) was 36 per cent (27-44 per cent) - the population impact of being overweight was greater than that of being obese. Thirteen per cent of all adults reported a previous primary care consultation, 7 per cent reported previous secondary care referral for knee pain, and 4.5 per cent (2.7-6.2 per cent) of the adult population were currently receiving or in need of specialist treatment. CONCLUSION: The high population impact of being overweight (BMI 25-29) or obese (BMI 30 or more) has implications for primary prevention. The estimates of previous healthcare usage, and of levels of met and unmet need, are useful for healthcare planning.     

Analysis on chronic pain management: Focus on the Italian network

The Italian Law 38/2010, ‘Dispositions to guarantee access to Palliative Care and Pain Management’ orders that the health care systems of Italian regions create dedicated structures for palliative care and pain therapies, according to a specific organizational model called ‘Hub‐Spoke’, to ensure the diagnostic‐therapeutic continuity of patients affected by chronic pain (CP). The aim of our study was to investigate the Italian pain therapy network, 8 years following the approval of the Law. We sent a questionnaire to the national health representatives operating in CP management. The main result emerging from the analysis concerns the management of mini‐invasive procedures, showing that 93.2% of the responding facilities carry out invasive procedures, 6.8% do not perform them and that 100% of the facilities belonging to 12 regions provided these procedures, while in eight regions more than 80%. Finally, only 38.5% of facilities declared to have a shared protocol with the relevant territorial facilities in order to guarantee the process of care and assistance of patients affected by CP. In conclusion, our study demonstrated the efficacy of the organizational model in most of the responding facilities, although the territorial management of patients after their hospital discharge should be strengthened.     

Objective evidence of severe disease: opioid use in chronic pain

Treating chronic pain presents numerous challenges. First, assessing patients with chronic pain is complicated by the lack of objective measures of pain itself. Chronic pain guidelines already developed by national organizations rely on careful history taking rather than objective measures. Second, opioids are an accepted element of chronic pain management, but their use is tempered by risks of overdose, dependency, and the potential for diversion. This essay proposes a new standard for the use of long-term opioids for chronic pain: the presence or absence of objective evidence of severe disease. This standard, which supports responsible prescribing of opioids, is one that clinicians can understand and apply when considering prescribing long-term opioids for chronic pain. Until we have measures of pain itself, we should insist upon objective evidence of severe disease before prescribing opioids for chronic pain.     

Occupational therapists' experience of working with immigrant clients in mental health care

Abstract

Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, “the challenges of the multicultural therapeutic journey—a journey on a winding road” was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice.     

Chronic pain in the classroom: teachers' attributions about the causes of chronic pain

BACKGROUND: School absenteeism and other impairments in school function are significant problems among children with chronic pain syndromes; yet, little is known about how chronic pain is perceived in the school setting. The purpose of this study was to examine teachers' attributions about the causes of chronic pain in adolescent students. METHODS: Classroom teachers (n = 260) read vignettes describing a hypothetical student with limb pain. They were presented with a list of possible physical and psychological causes for the pain and asked to identify the causes to which they attributed the pain. Vignettes varied by the presence or absence of (1) documented medical evidence for the pain and (2) communication from the medical team. Teachers also responded to questions assessing their responses to the student in terms of support for academic accommodations and sympathy for the student. RESULTS: Teachers tended to endorse a dualistic (ie, either physical or psychological) model for pain rather than a biopsychosocial model. Documented medical evidence supporting the pain was the most influential factor affecting teachers' attributions about chronic pain. Teachers who attributed the pain to physical causes-either in isolation or in combination with psychological causes-responded more positively toward the student. CONCLUSIONS: Many teachers lack a biopsychosocial framework through which to understand chronic pain syndromes in students. How chronic pain is described to school personnel may affect how teachers understand the pain and respond to it.     

整体疼痛评估量表在老年慢性疼痛护理的应用

目的 分析比较整体疼痛评估量表及修订版的面部表情疼痛量表,在老年慢性疼痛患者护理管理模式中的应用效果,探讨整体疼痛评估量表在疼痛科病房疼痛护理管理质量中的作用及量表的信度和效度评价.方法 选取2014年6月-2015年6月在疼痛科病房住院治疗的年龄≥60岁的老年慢性疼痛患者60例,平均分为试验组及对照组,其中试验组30例疼痛患者采用整体评估量表结合疼痛护理常规流程进行护理,对照组30例运用疼痛患者修订版的面部表情疼痛量表结合疼痛护理常规流程进行护理,动态评估患者疼痛情况,比较两组患者住院总天数、止痛药使用减少率、疼痛缓解程度及疼痛管理满意度.结果 采用整体疼痛评估量表护理模式的患者住院总天数、止痛药使用率小于采用修订版的面部表情疼痛量表护理模式的患者,差异具有统计学意义(P＜0.05);且在疼痛缓解程度及疼痛管理满意度指标上大于采用修订版的面部表情疼痛量表护理模式的患者,两者差异均具有统计学意义(P＜0.05).结论 将整体疼痛评估量表应用于疼痛科疼痛护理管理模式中,使疼痛护理管理标准化、规范化、质量化,提高患者的疼痛控制质量,有效减少患者住院天数及止痛药的使用频率,增加疼痛缓解程度及疼痛管理满意度,有助于提高疼痛护理管理水平.     

Occupational low back pain: Recovery curves and factors associated with disability

Review of the literature shows significant variation in the rates of recovery from an episode of low back pain (LBP). Two hundred and seven workers filing a “First Report of Injury” form with the Vermont Department of Labor and Industry were contacted 3 months post-injury to determine time until first return-to-work, work status, lost workdays, and factors such as pain intensity and satisfaction with health care. Overall, 69.4% of the workers had first returned to work within 1 week, 85.9% within 1 month, and 93.7% by 3 months. Three months post-injury, 8.7% of these workers were not working (disabled) due to their LBP. On a scale of 0–10, the disabled reported substantially more pain in the past few days (p=.0001) and a higher level of “worst pain since injury” (p=.004). Those disabled were less likely to feel they had received the right treatment for their LBP (p=.05). Researchers and clinicians need a clear understanding of recovery curves to assess the effectiveness of any interventions.     

Structuring health needs assessments: the medicalisation of health visiting

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting.     

Living with opioids: A qualitative study with patients with chronic low back pain

BackgroundOpioids are one of the most prescribed treatments for chronic pain (CP). However, their long‐term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects.ObjectiveTo explore the experiences of people with chronic non‐malignant low back pain in Spain undergoing long‐term treatment with opioids.DesignQualitative study.Setting and participantsWe conducted 15 semi‐structured interviews at the Pain Clinic with persons taking opioid treatment.MethodsThe interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework.Main resultsWe developed one overarching theme—Living with opioids: dependence and autonomy while seeking relief—and three categories: The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long‐term relationship; and What opioids cannot fix.DiscussionThe long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long‐term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long‐term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients.ConclusionsPatients'' experiences should be considered to a greater extent by health‐care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP.     

Validity Testing of the Quality of Life Scale,Swedish Version: Focus Group Interviews of Women with Fibromyalgia

Focus group interviews were used to examine validity of the Quality of Life Scale, Swedish version (QOLS‐S) for use with women with fibromyalgia. Five interviews with 18 women with fibromyalgia were completed. The opening question was “What does quality of life mean to you?” Later, participants were asked to respond to questions about the specific domains and items in the QOLS‐S. The transcribed interviews were analysed, and categories were identified. Opinions concerning domains and items in the QOLS‐S were linked to domains of the QOLS‐S. Four categories emerged from the opening question: finances, to be an active person and participate in society, relations with others, and health. Overall, the women's perceptions of quality of life were congruent with the domains of QOLS‐S. However, further attention should be given to the translation of certain items and apparent overlaps in some items indicate that they can be combined. Also, the instrument needs to be scrutinized from a cultural perspective because some items in the “social, community and civic activities” domain were not endorsed by the participants. Copyright © 2012 John Wiley & Sons, Ltd.