The psycho‐social dimension of pain and health‐related quality of life in the oldest old

Background: Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health‐related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce. Aims: The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho‐social) and health‐related quality of life as well as to compare sex and age groups in people aged 80 years and over. Methods: In this cross‐sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho‐social dimension of pain was measured using the Multidimensional Pain Inventory–Swedish language version (MPI‐S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health‐related quality of life was measured using the Short Form Health Survey‐12 (SF‐12). Results: Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI‐S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80–85 years had higher pain severity than those aged ≥86. Participants with a lower health‐related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life. Conclusions: Older people with prolonged pain suffered from a low health‐related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people’s physical, mental and social health.     

Fracture‐related hip pain in elderly patients with proximal femoral fracture after discharge from stationary treatment

Background: Proximal femoral fracture is a common condition in the elderly but very little is known about fracture‐related hip pain in these patients after discharge from stationary treatment. Aims: To identify risk factors associated with persistent hip pain in elderly hip‐fracture patients. Methods: We analysed data from a large observational study, evaluating the health care situation of hip‐fracture patients between January 2002 and September 2003 in Germany. For this analysis, we focused on a sub‐sample of patients who were 65 years or older, had sustained an isolated proximal femoral fracture and had undergone surgical intervention. A telephone interview was conducted 6–12 months after discharge. Pain intensity, pain‐related disability and severity of chronic pain were measured using the Graded Chronic Pain Scale (GCPS). Multivariate linear regression methods were applied to test hospital patient data for their value in predicting post‐hospitalisation presence of fracture‐related pain. Results: In total, 1541 patients (mean age 78.4, 76.1% female) were enrolled in this analysis. The prevalence of fracture‐related hip pain was 13.4% (206/1541). Among these 206 patients, 57.3% had pain intensity scores ≥50, 65.0% had pain disability scores ≥50, and the severity of chronic pain (Grades 1–4) was assessed as follows: (1) 34.0%, (2) 19.4%, (3) 31.5%, (4) 15.1%. The clinical variables age, weight and operative procedure were found to be predictive of post‐hospitalisation fracture‐related pain. Conclusions: This analysis shows that a substantial percentage of elderly patients with proximal femoral fracture suffer intense fracture‐related hip pain after stationary treatment.     

Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity.

OBJECTIVES: The objectives of this study were to investigate pain cognitions and quality of life of chronic pain patients referred to a multi-disciplinary university pain management clinic and to search for predictors of quality of life. METHODS: A heterogeneous group of 1208 chronic pain patients referred to the Maastricht university hospital pain clinic participated in this cross-sectional study. At the initial assessment, all patients completed a set of questionnaires on demographic variables, cause, location, pain intensity (McGill pain questionnaire, MPQ), pain coping and beliefs (pain coping and cognition list, PCCL), pain catastrophising (pain catastrophising scale, PCS) and eight dimensions of quality of life (Rand-36). RESULTS: The results showed that the present sample of heterogeneous pain patients reported low quality of life on each domain and significantly lower scores than has been found in previous studies with other Dutch chronic pain populations. Patients with low back pain and multiple pain localisations experienced most functional limitations. Women reported more pain, more catastrophising thoughts about pain, more disability and lower vitality and general health. When tested in a multiple regression analysis, pain catastrophising turned out to be the single most important predictor of quality of life. Especially social functioning, vitality, mental health and general health are significantly associated with pain catastrophising. CONCLUSIONS: Patients from a multi-disciplinary university pain clinic experience strikingly low quality of life, whereby low back pain patients and patients with multiple pain localisations have the lowest quality of life. Pain catastrophising showed the strongest association with quality of life, and stronger than pain intensity.     

Prevalence of chronic pain with neuropathic characteristics in the general population

We conducted a large nationwide postal survey to estimate the prevalence of chronic pain with or without neuropathic characteristics in the French general population. A questionnaire aimed at identifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration and body locations, was sent to a representative sample of 30,155 subjects. The DN4 questionnaire was used to identify neuropathic characteristics. Of the questionnaires, 24,497 (81.2%) were returned and 23,712 (96.8%) could be assessed. Seven thousand five hundred and twenty-two respondents reported chronic pain (prevalence=31.7%; [95%CI: 31.1-32.3]) and 4709 said the pain intensity was moderate to severe (prevalence=19.9%; [95%CI: 19.5-20.4]). Neuropathic characteristics were reported by 1631 respondents with chronic pain (prevalence=6.9%; [95%CI: 6.6-7.2]), which was moderate to severe in 1209 (prevalence=5.1% [95%CI: 4.8-5.4]). A higher prevalence of chronic pain with neuropathic characteristics was associated with middle age (50-64 years), manual professions and those living in rural areas. It was more frequently located in the lower limbs and its intensity and duration were higher in comparison with chronic pain without neuropathic characteristics. This large national population-based study indicates that a significant proportion of chronic pain patients report neuropathic characteristics. We identified distinctive socio-demographic profile and clinical features indicating that chronic pain with neuropathic characteristics is a specific health problem.     

Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain.

The aim of the present study was to assess, compare, and correlate the pain response to an experimental pain stimulus (hyperalgesia to pressure pain threshold (PPT) measured from different body sites), the pain intensity (VAS) of the habitual pain, and quality of life parameters (SF-36) in groups of females with chronic non-malignant pain syndromes. Forty female pain patients with fibromyalgia/whiplash (n = 10), endometriosis (n = 10), low back pain (n = 10), or rheumatoid arthritis (n = 10), as well as 41 age-matched healthy female controls participated in the study. The fibromyalgia/whiplash patients scored significantly higher (p < 0.04) VAS ratings (median rating = 7.0) than the endometriosis (6.0), low back pain (6.0), and rheumatoid arthritis (3.5) patients. All fours patient groups had significantly lower PPTs at all sites as compared with controls. The fibromyalgia/whiplash patients experienced the highest influence of pain on their overall health status, particularly vitality, social function, emotional problems, and mental health. A significant negative correlation was found between VAS rating and quality of life (p < 0.04). Significant correlation (p < 0.05) was found between pressure hyperalgesia measured at lowest PPT sites and the impairment of SF-36 physical function as well as mental health parameters. This study demonstrates significant generalised pressure hyperalgesia in four groups of chronic pain patients, correlations between degree of pressure hyperalgesia and impairment of some quality of life parameters, and increased pain intensity of the ongoing pain is associated with decreased quality of life.     

Pre‐operative pain and sensory function in groin hernia

BackgroundAlthough persistent postherniotomy occurs in 5–10% of patients, pathogenic mechanisms remain debatable. Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic mechanism.AimsTo investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area.MethodsPatients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds]) and assessments were correlated to patients’ reports of intensity and frequency of spontaneous pain in the groin area.ResultsForty-two patients were examined, whereof one was excluded since no hernia was found intraoperatively. Mechanical pain threshold was inversely correlated with spontaneous pain intensity (rho = ?0.413, p = 0.049), indicating a paradoxical association between level of mechanical pain threshold and magnitude of spontaneous pain. No other sensory modality was significantly correlated to pain intensity. New/increased pain during repetitive pinprick stimulation (wind-up) was seen in 3 patients (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (p < 0.04), but with numerically very small differences (Δ = 0.4 °C, range 0.1–0.7 °C).ConclusionPre-operative groin hernia pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain.     

Recommendations for measuring health‐related quality of life in children on anticoagulation

Bruce AK, Bauman ME, Jones S, Massicotte MP, Monagle P. Recommendations for measuring health‐related quality of life in children on anticoagulation. J Thromb Haemost 2012; 10: 2596–8.     

Lifestyle and health‐related quality of life in Asian patients with total hip arthroplasties

Total hip arthroplasty reduces pain and restores physical function in patients with hip joint problems. This study examined lifestyle and health‐related quality of life before and after total hip arthroplasty in Japanese and Chinese patients. Two hospitals in China recruited 120 patients and 120 Japanese patients matched by age and operative status were drawn from a prospective cohort database. Oxford Hip Score, EuroQol, and characteristics of Asian lifestyle and attitudes toward the operation were assessed. There were no differences between patients from the two countries in quality‐of‐life‐scale scores: postoperative patients had significantly better quality‐of‐life scores than preoperative patients in both countries. In China, patients who reported that living at home was inconvenient had significantly worse Oxford Hip Scores than those who did not. Mean scores for anxiety items concerning possible dislocation and durability of the implant were significantly higher in Japanese than in Chinese subjects. Our findings suggest that providing information about housing conditions and lifestyles would result in improved quality of life and reduced anxiety in patients with implanted joints.     

Narrative review of health‐related quality of life and its predictors among patients with coronary heart disease

This paper summarizes the empirical evidence concerning health‐related quality of life (HRQoL) of patients with coronary heart disease (CHD) and attempts to identify its significant predictors. A systematic search of the literature from 2002 to 2012 was conducted using seven electronic databases (CINAHL, ScienceDirect, Medline, Scopus, PsycINFO, PubMed and Web of Science) using the search terms ‘HRQoL’. ‘CHD’, ‘social support’, ‘depression’, ‘anxiety’, ‘psychosocial factors’, ‘sociodemographic factors’, ‘clinical factors’ and ‘predictors’. A total of 1052 studies were retrieved, of which 24 articles were included in this review. Previous studies have consistently demonstrated the negative impact of CHD on HRQoL, citing three major types of predictive factors: sociodemographic, clinical and psychosocial factors. Studies have also highlighted the advantageous use of HRQoL as a gauge for treatment satisfaction and efficacy. There are, however, few studies that collectively investigate the relationship among concepts such as HRQoL, anxiety and depression, social support, and sociodemographic and clinical factors in relation to CHD. This review highlights the need to conduct further study on HRQoL of patients with CHD in the Asian context. Such research will promote patient‐centric care and improved patient satisfaction through incorporation of the concept of HRQoL into clinical practice.     

慢性失眠患者失眠程度、抑郁情绪与生活质量的相关性

目的 通过探讨慢性失眠患者失眠严重程度、抑郁情绪与生活质量的相关性,评估影响患者生活质量的主要因素.方法 连续收集126例成年慢性失眠患者,根据失眠严重程度指数量表(ISI)得分分为亚临床、中度、重度失眠三组,根据贝克抑郁问卷(BDI)得分分为伴和不伴抑郁两组,用SF-36健康调查量表(SF-36)评分,分别对生活质量进行比较.结果 失眠程度重的患者SF-36(除机体疼痛外)得分低(P<0.01);伴有抑郁情绪的患者SF-36(除机体疼痛外)得分低(P<0.05);相关性分析得出ISI得分与SF-36(除机体疼痛外)得分呈负相关(P<0.05),BDI得分与SF-36得分呈显著负相关(P<0.01);控制BDI变量偏相关分析,ISI得分与SF-36(生理功能、生理职能、总体健康、活力和生理健康)得分呈负相关(P<0.05);控制ISI变量偏相关分析,BDI得分与SF-36得分(除生理机能和机体疼痛外)呈显著负相关(P<0.01).结论 慢性失眠患者失眠严重程度与生活质量相关,但与慢性失眠相关的抑郁情绪起到主要作用,这提示慢性失眠治疗中应注重改善患者情绪问题.     

Psychosocial predictors and correlates for chronic post‐surgical pain (CPSP) – A systematic review

Chronic post‐surgical pain (CPSP) is a serious problem. Incidence as high as 50% has been reported, depending on type of surgery undergone. Because the etiology of chronic pain is grounded in the bio‐psychosocial model, physical, psychological, and social factors are implicated in the development of CPSP. Biomedical factors such as pre‐operative pain, severe acute post‐operative pain, modes of anesthesia, and surgical approaches have been extensively examined, therefore this systematic review focuses on psychosocial elements. A systematic search was performed using the PubMed, PsychINFO, Embase, and Cochrane Databases. Fifty relevant publications were selected from this search, in which psychosocial predictors for and correlates to CPSP were identified. The level of evidence was assessed for each study, and corresponding score points were awarded for ease of comparison. The grade of association with CPSP for each predictor/correlate was then determined. Depression, psychological vulnerability, stress, and late return to work showed likely correlation with CPSP (grade of association=1). Other factors were determined to have either unlikely (grade of association=3) or inconclusive (grade of association=2) correlations. In addition, results were examined in light of the type of surgery undergone. This review is intended as a first step to develop an instrument for identifying patients at high risk for CPSP, to optimize clinical pain management.     

个体化疼痛管理对癌痛患者生活质量的影响与效果评价

目的探讨疼痛管理对提高疼痛患者生活质量的效果,为完善疼痛管理方案提供依据。方法选取2014年3月至2015年3月肿瘤科疼痛患者80例分为对照组40例,观察组40例。对照组实施常规疼痛治疗与护理,观察组在常规治疗护理基础上实施个体化疼痛管理,比较两组患者住院期间的疼痛状况、生活质量。结果观察组患者入院14d疼痛状况、生活质量明显优于对照组,差异有统计学意义(P0.05)。结论对癌症疼痛患者实施疼痛管理,能够改善疼痛患者的疼痛状况,提高疼痛患者的生活质量,值得临床推广。     

Flow experience and health‐related quality of life in community dwelling elderly Japanese

This study was performed to investigate the relationship between mental state (especially flow experience [Flow Experience Checklist of Ishimura]) health‐related quality of life (Medical Outcome Study 8‐Item Short‐Form Health Survey), and stress (salivary amylase concentrations). The subjects were 119 healthy elderly persons living in rural areas who participated in a “meeting for the elderly” at a nursing home in Kagawa Prefecture, Japan. The subjects were classified into apathetic, anxious, relaxed, and flow groups. It was found that physical health was significantly better when performing important daily activities in the group who experienced flow and the relaxed group than in the group that was in an apathetic state. However, no significant relationship was observed between the degree of flow experience and stress. The present findings suggested that interventions which make the activities of daily life either “high‐challenge, high‐skill” situations or “low‐challenge, high‐skill” situations could have a positive influence on the physical health of community‐living elderly Japanese. A longitudinal study should be performed in the future.     

Comparison of health‐related quality of life and emotional distress among Chinese cancer survivors

The purpose of this study is to compare health‐related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy—General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.     

晚期肿瘤病人疼痛控制状况及其生活质量的研究

目的了解晚期肿瘤病人的疼痛控制状况及其生活质量状况。方法采用一般资料及疾病相关情况、疼痛相关情况、疼痛强度量表、疼痛治疗指数、疼痛信念及简明健康状况调查表对北京市5所三级甲等医院的202例住院晚期肿瘤疼痛病人进行调查。结果 202例晚期肿瘤病人中,应用止痛药治疗189例(93.56%),按时用药133例(65.84%),对止痛效果表示满意165例(81.68%),对于疼痛相关知识了解的仅20例(9.90%),疼痛治疗不足48例(23.76%),疼痛强度评分为(4.66±2.25)分,疼痛信念总均分为(2.41±0.98)分,生活质量各维度得分低于国内常模。疼痛控制组病人的生理机能、躯体疼痛、精神健康3个维度得分均高于疼痛未控制组(P<0.01或P<0.05)。结论晚期肿瘤病人疼痛控制状况不佳,生活质量较差,而疼痛控制有助于改善晚期肿瘤病人的生活质量。