The Relation of Post-Traumatic Stress Symptoms to Depression and Pain in Patients With Accident-Related Chronic Pain

Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in patients with a history of accident-related chronic pain and depression. However, little is known regarding the influence of PTSD in contributing to the affective distress, pain experience, and disability associated with chronic pain in this population. This study used structural equation modeling to examine 3 models that assess these relations in a sample of chronic pain patients with accident-related pain. Subjects were assessed for pain experience, depressive symptoms, anxiety, PTSD symptoms, pain disability, and relevant demographic variables. Pearson correlations indicated that symptoms of depression were significantly related to more severe pain, disability, and PTSD symptoms. PTSD symptoms were significantly associated with higher disability. The model of best fit indicated that after controlling for the influence of anxiety on the dependent measures, PTSD symptoms have a direct influence on severity of depressive symptoms, whereas depressive symptoms have a direct influence on pain intensity and an indirect impact on pain intensity by way of their effect on disability. These data point to the importance of unresolved PTSD symptoms in contributing to the level of depression, pain, and disability exhibited by chronic pain patients and highlight the need to consider directed and primary treatment of PTSD in pain rehabilitation programs.PerspectiveThis study highlights the impact of symptoms of PTSD on levels of depression, disability, and pain in patients with pain secondary to physical injury. Our results suggest that pain rehabilitation programs provide directed interventions for PTSD symptoms among this population to improve pain treatment outcomes.     

Primary Care Depression Screening: Relationship to Chronic Pain and Gender

Depression is a subjective illness that often goes undiagnosed and untreated. As the first point of contact for patients, primary care clinics should screen patients regularly for depression. This study evaluated annual depression screening in a rural primary care clinic and relationships among depression, chronic pain, and gender. Using the Patient Health Questionnaire—9 (PHQ-9), a convenience sample of 53 men and 49 women were screened for depression. Twenty-eight percent of patients scored positively for depression. Relationships among depression, chronic pain management, and gender surfaced in the results.     

Health Care Utilization and Costs Associated With Pediatric Chronic Pain

The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR]?=?2.01, 95% confidence interval [CI] = 1.62–2.47; P?<?.001), complementary and alternative medicine (OR?=?2.32, 95% CI = 1.79–3.03; P?<?.001), and emergency care (OR?=?1.62, 95% CI = 1.29–2.02; P?<?.001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use.

Hip Symptoms,Physical Performance,and Health Status in Older Adults With Chronic Low Back Pain: A Preliminary Investigation

Objectives

To determine (1) whether there are differences in the prevalence of clinical hip symptoms between older adults with and without chronic low back pain (CLBP); and (2) whether coexisting hip symptoms are associated with worse physical performance and poorer health-related quality of life (HRQOL).

Improvement in the Spatial Distribution of Pain,Somatic Symptoms,and Depression After a Weight Loss Intervention

Weight loss is known to improve pain localized to weight-bearing joints but it is not known how weight loss affects the spatial distribution of pain and associated somatic symptoms like fatigue. We sought to determine if weight loss using a low-calorie diet improves pain, affect, and somatic symptoms commonly associated with chronic pain conditions in an observational study. We also documented changes in inflammatory markers in serum before and after weight loss. Participants were 123 obese individuals undergoing a 12- to 16-week calorie restriction weight loss intervention. The spatial distribution of pain, symptom severity (eg, fatigue, sleep difficulties), depression, and total fibromyalgia scale scores were measured before and after weight loss. Pain (P?=?. 022), symptom severity (P?=?.004), depression (P?<?.001), and fibromyalgia scores (P?=?.004) improved after weight loss; men showed greater improvement than women on somatic symptoms and fibromyalgia scores (both P?<?.01). Those who lost at least 10% of body weight showed greater improvement than those who lost <10%. Levels of the regulatory cytokine interleukin-10 increased after the intervention (P?=?.002). Weight loss may improve diffuse pain and comorbid symptoms commonly seen in chronic pain participants.

Antipsychotics for Acute and Chronic Pain in Adults

ContextThe role of antipsychotics as adjuvant analgesics is a subject of long-standing controversy. Antipsychotics have been used to treat chronic pain (e.g., chronic headache, fibromyalgia, and painful diabetic neuropathy). With atypical antipsychotics, a new class of antipsychotics, with fewer extrapyramidal side effects and additional benefits, may be available.ObjectivesThis review aimed to assess analgesic efficacy and adverse effects of antipsychotics in acute or chronic pain.MethodsRandomized controlled trials of adults prescribed any dose of oral antipsychotics for acute or chronic pain, describing subjective pain assessment as either the primary or a secondary outcome, were included in this review.ResultsWe included 11 studies involving a total number of 770 participants. Data from five randomized, double-blind studies showed beneficial effects of antipsychotics in the treatment of acute and chronic pain. Because of the clinical heterogeneity of painful conditions studied and significant statistical heterogeneity, the intended meta-analysis was omitted. The most frequently reported adverse effects were extrapyramidal (i.e., involuntary movements, parkinsonism, and akathisia) and sedating effects.ConclusionBecause of limitations in the available evidence, further research is needed to understand whether antipsychotics are effective for acute or chronic pain or specific pain conditions.     

Care Seeking for Pain in Young Adults with Sickle Cell Disease

In individuals with sickle cell disease (SCD), recognizing the cues to an acute pain episode and responding appropriately are important. The purpose of this mixed-methods pilot study is to identify preliminary factors that influence care seeking for pain in young adults with SCD. Responses were received from 69 young adults with SCD, age 18-35 years. The majority of respondents (88%) wait until the pain intensity is an average of 8.7 (± 1.2) on a scale of 1 to 10 before seeking care. Prominent themes influencing care seeking for pain include: trying to treat pain at home, avoiding the emergency department because of past treatment experiences, the desire to avoid admission to the hospital, and the importance of time in the lives of the young adults with SCD. Young adults with SCD need additional support from family and healthcare providers in order to make timely, appropriate decisions regarding care seeking.     

A Test of Braden's Self-Help Model in Adults with Chronic Pain

Purpose: To test hypothesized relationships in Braden's Self-Help Model in a sample of people with idiopathic chronic pain. Testing theoretical explanations and predictions with various clinical populations under different sociocultural, economic, climatic, and health system environments provides evidence about the applicability of the underlying theory among diverse populations.
Design: This study was part of a larger randomized, controlled trial of a community-based nursing psycho-educational intervention: the Chronic Pain Self-Management Program (CPSMP). Pretest and posttest data were collected in 1995–1996 in Newfoundland, Canada.
Methods: Participants completed a battery of valid and reliable self-report instruments to measure pain, disability, uncertainty, resourcefulness, self-efficacy, adult role behaviors, and life satisfaction. Two tests of the self-help model were performed, the first with pretest data (N=110) and the second with 3-month posttest data (N=102) after half the sample had participated in the CPSMP intervention. Causal modeling path analysis was done with the Statistical Package for the Social Sciences (SPSS) program and tests of goodness-of-fit were conducted using EQS for Windows.
Results: Results supported the overall hypothesized pattern of relationships in the self-help model. Amounts of variance explained in the two major outcomes of the model (self-help: 42% to 53% and life quality: 45% to 47%) were consistent with results from other studies. Indices of goodness of fit showed an adequate fit of the model to the data, particularly the posttest data.
Conclusions: Braden's Self-Help Model appears to be robust in a variety of clinical populations, among different settings and environmental conditions, and provides a useful framework to guide nursing psycho-educational interventions in chronic illness.     

Prevalence,Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China

BackgroundChronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults.AimsOur aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China.DesignCross-sectional design.SettingsCommunity settings.Participants/SubjectsA total of 1219 community-dwelling adults aged 60 years or older.MethodsData on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained.ResultsAmong 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands.ConclusionsCP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.     

A Concept Analysis of Coping with Chronic Pain in Older Adults

ObjectivesThere is no consensus on the definition of coping with chronic pain in older adults. The lack of a definition affects communication in interdisciplinary care, limits assessments of coping in clinical practice, and influences the development of knowledge on the subject. The aim of this paper is to report on a concept analysis of coping with chronic pain in older adults and to construct a definition of the concept.DesignA concept analysis was conducted.Data sourcesA literature search was conducted in the CINAHL, MEDLINE, PsycINFO, and PubMed databases.Review methodsRodgers’ evolutionary method was used for the concept analysis.ResultsThe search yielded 32 articles. Surrogate terms included “living with pain,” “pain management,” “managing pain,” “self-management,” “adapting to pain,” “dealing with pain,” and “adjustment to pain.” Related concepts were categorized under methods of coping, pain relief, and seeking help. The following definition, which takes into consideration the antecedents, attributes, and consequences of coping with chronic pain, was constructed: “Dealing with chronic pain is a process in which various attitudes and beliefs can result in the making of changes in daily life and activities. An action to adopt coping strategies is required, so self-involvement is needed. However, demographic characteristics, physical factors, psychological factors, social factors, relevant knowledge about one's own conditions and coping, and factors related to coping strategies affect how older adults deal with chronic pain. The actions that they choose to deal with chronic pain could lead to positive and/or negative outcomes.”ConclusionsCoping with chronic pain involves more than the use of coping strategies. This analysis provides suggestions on clinical assessments and interventions. The concept of coping with chronic pain requires continual development.     

Dissociation and Posttraumatic Stress Symptoms in Patients With Chronic Pain

The present study examined the number and frequency of dissociative experiences reported by patients with chronic pain and the association between dissociation and emotional distress in this population. The mean Dissociative Experiences Scale (DES) score obtained by patients with chronic pain was comparable to mean DES scores obtained by persons diagnosed with affective disorders, eating disorders, personality disorders, and schizophrenia. Based on their median DES score, patients with chronic pain reported more frequent dissociation than did normal adults and persons diagnosed with alcohol use disorders, specific phobias, and agoraphobic avoidance. Traumatized patients with chronic pain evidenced significantly more frequent dissociation than did nontraumatized patients, the traumatized group reporting dissociative experiences as occurring 17% of the time and the nontraumatized group reporting dissociative experiences as occurring 11% of the time. DES absorption, depersonalization, and amnesia scores accounted for 21% of the variance in posttraumatic stress symptoms reported by patients with chronic pain. Findings are discussed in terms of their implications for assessment and cognitive–behavioral management of traumatic stress responding in persons with chronic pain.     

Depression in Chronic Pain Patients: Prevalence and Measurement

This study aimed to: (1) determine prevalence of depression in patients referred to specialist pain services using the Structured Clinical Interview (SCID) diagnostic interview, (2) compare results on the Beck Depression Inventory II (BDI-II) with the SCID to determine the utility of the BDI-II as a screening tool in this population.
Thirty-six participants were recruited, mainly women, with a mean age = 47.83 years (standard deviation = 12.85 years), who were heterogeneous with regard to their pain. All completed the BDI-II and SCID. The SCID diagnosed 26 (72%) cases of depression. BDI-II scores showed 31 (86%) that reported at least mild depression. Agreement between BDI-II scores over threshold for mild depression and SCID diagnosis were assessed by Cohen's kappa (= 0.6). ROC analysis for BDI-II scores against SCID diagnosis gave a large area under the curve (0.97, 95% confidence interval 0.93 to 1.02), suggesting BDI-II is an excellent screen for this population, although the curve was unusual in that sensitivity was high even when the false positive rate was zero. ROC analysis suggested 22 or above as an optimum cut-off score for depression on the BDI-II—higher than for a general population sample.
It has been suggested that the BDI overestimates incidence of depression in pain patients, but this study confirmed through diagnostic interview the very high incidence of depression in this population. It is therefore questionable whether there is value in screening referrals for depression. When using BDI-II for screening, audit or evaluation purposes with a pain clinic population, we suggest a cut-off of 22 or above.     

Chronic Musculoskeletal Pain and Foot Reaction Time in Older Adults

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation.PerspectiveThis study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.     

Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial

ObjectivesThe purpose of this study was to determine whether baseline self-efficacy, fear of pain with movement (kinesiophobia), or change in either were associated with clinically important improvement in disability among older adults with chronic low back pain after 12 weeks of chiropractic spinal manipulation (CSM) and exercise.MethodsThis secondary analysis used randomized trial data from community-dwelling adults aged 65 years or older with chronic spinal disability who received non-pharmacological treatment of CSM and exercise. Those with ≥30% reduction in the Oswestry Disability Index (ODI) after 12 weeks of treatment were considered responders to care. Psychosocial measures included the Pain Self-Efficacy Questionnaire (PSEQ) and the Tampa Scale of Kinesiophobia (TSK). Logistic regression–assessed associations were between psychosocial, demographic, and low back predictors and 30% ODI improvement.ResultsThere were 176 community-dwelling older adults included in this analysis. Mean age was 71 years, 59.7% were women; 176 (96.7%) had complete data. Baseline disability (ODI = 26.1 ± 9.3) and back pain (5.0 ± 1.9, 0-10 scale) were moderate. Baseline PSEQ reflected higher self-efficacy (47.7 ± 7.8, 0-60 scale) with minimal kinesiophobia (TSK 34.3 ± 5.2, 17-68 scale). Seventy-two (40.9%) achieved 30% reduction in ODI (mean –5.4 ± 7.9) after 12 weeks of treatment. Mean self-efficacy improvement was clinically important (2.5 ± 6.5 points); kinesiophobia (–2.7 ± 4.4 points) and LBP (–1.6 points) also improved. Baseline PSEQ and percent improvement in PSEQ and TSK were associated with response to treatment in univariate regression analyses but not in multiple regression models that included low back predictors. LBP duration >4 years negatively impacted recovery.ConclusionsAmong this sample of older adults who received chiropractic manipulation and exercise, baseline self-efficacy and improvements in self-efficacy and kinesiophobia were individually associated with clinically important reductions in disability post-intervention, although not in adjusted models when LBP duration was included.