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Kırca K, Özveren H, Karabey T. Evaluation of Future Nurses' Beliefs and Fears About Pain: A Descriptive and Correlational Study. J Eval Clin Pract 2025; 31:e70058. [PMID: 40329435 PMCID: PMC12056220 DOI: 10.1111/jep.70058] [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: 08/07/2024] [Revised: 01/21/2025] [Accepted: 02/27/2025] [Indexed: 05/08/2025]
Abstract
BACKGROUND How nurses manage pain and their decisions to treat it depend on their attitudes, beliefs, and misconceptions about pain. Therefore, the first step to promoting positive behaviour change in nurses is to determine their attitudes, beliefs, fears, knowledge, and behaviour towards pain management. Nurses with negative or false beliefs about pain are likely to provide inadequate pain management and care. Nursing students are the nurses of tomorrow who will play a key role in pain management and treatment. This study aimed to evaluate nursing students' beliefs and fears about pain. METHODS This descriptive and correlational study was carried out on 342 nursing students of a university in Türkiye. Data were collected using an individual information form, the Fear of Pain Questionnaire-III (FPQ-III), and the Pain Beliefs Questionnaire (PBQ). RESULTS The mean scores of the participants from FPQ-III, Severe Pain, Minor Pain, Medical Pain subscales were 83.71 ± 19.14, 32.54 ± 7.97, 24.48 ± 6.89 and 26.68 ± 7.92, respectively. The participants' mean scores on the Organic Beliefs and Psychological Beliefs subscales were 3.50 ± 0.72 and 4.60 ± 0.96, respectively. There was a positive correlation between FPQ-III and PBQ scores. The psychological belief subscale explained only 2.1% of the total change in the fear of pain score (R2 = 0.021, p < 0.05). CONCLUSION Participants had high 'psychological beliefs' and 'severe pain' scores. It may be recommended to use interactive education methods such as case-based teaching for students to learn effective methods of coping with pain and realise their own beliefs and attitudes. Establishing simulation laboratories where students can experience all pain-related processes is also important in gaining knowledge and skills on pain management.
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Affiliation(s)
- Kamile Kırca
- Nursing DepartmentFaculty of Health SciencesKırıkkale UniversityKırıkkaleTurkey
| | - Hüsna Özveren
- Nursing DepartmentFaculty of Health SciencesKırıkkale UniversityKırıkkaleTurkey
| | - Tuba Karabey
- Department of Emergency Aid and Disaster ManagementFaculty of Health SciencesTokat Gaziosmanpaşa UniversityTokatTurkey
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Alberts NM, Leisenring W, Whitton J, Stratton K, Jibb L, Flynn J, Pizzo A, Brinkman TM, Birnie K, Gibson TM, McDonald A, Ford J, Olgin JE, Nathan PC, Stinson JN, Armstrong GT. Characterization of chronic pain, pain interference, and daily pain experiences in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Pain 2024; 165:2530-2543. [PMID: 38981063 PMCID: PMC11474984 DOI: 10.1097/j.pain.0000000000003284] [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: 02/09/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Although survivors of childhood cancer are at an increased risk, little is known about the prevalence of chronic pain, associated interference, and daily pain experiences. Survivors (N = 233; mean age = 40.8 years, range 22-64 years; mean time since diagnosis = 32.7 years) from the Childhood Cancer Survivor Study completed pain and psychosocial measures. Survivors with chronic pain completed 2-week, daily measures assessing pain and psychological symptoms using mHealth-based ecological momentary assessment. Multivariable-modified Poisson and linear regression models estimated prevalence ratio estimates (PR) and mean effects with 95% confidence intervals (CI) for associations of key risk factors with chronic pain and pain interference, respectively. Multilevel mixed models examined outcomes of daily pain and pain interference with prior day symptoms. Ninety-six survivors (41%) reported chronic pain, of whom 23 (24%) had severe interference. Chronic pain was associated with previous intravenous methotrexate treatment (PR = 1.6, 95% CI 1.1-2.3), respiratory (PR = 1.8, 95% CI 1.2-2.5), gastrointestinal (PR = 1.6, 95% CI 11.0-2.3), and neurological (PR = 1.5, 95% CI 1.0-2.1) chronic health conditions, unemployment (PR = 1.4, 95% CI 1.0-1.9) and clinically significant depression and anxiety (PR = 2.9, 95% CI 2.0-4.2), as well as a diagnosis of childhood Ewing sarcoma or osteosarcoma (PR = 1.9, 95% CI 1.0-3.5). Higher pain interference was associated with cardiovascular and neurological conditions, unemployment and clinical levels of depression and/or anxiety, and fear of cancer recurrence. For male, but not female survivors, low sleep quality, elevated anxiety, and elevated depression predicted high pain intensity and interference the next day. A substantial proportion of childhood cancer survivors experience chronic pain and significant associated interference. Chronic pain should be routinely evaluated, and interventions are needed.
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Affiliation(s)
- Nicole M. Alberts
- St. Jude Children's Research Hospital, Memphis, TN, United States
- Concordia University, Montréal, QC, Canada
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jillian Whitton
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Kayla Stratton
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Lindsay Jibb
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Jessica Flynn
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Alex Pizzo
- Concordia University, Montréal, QC, Canada
| | - Tara M. Brinkman
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Todd M. Gibson
- St. Jude Children's Research Hospital, Memphis, TN, United States
- National Cancer Institute, Rockville, MD, United States
| | - Aaron McDonald
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - James Ford
- St. Jude Children's Research Hospital, Memphis, TN, United States
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Karakuş S, Sarıtaş S. Pain Beliefs, Coping Approaches, and Related Factors in Nursing Students. Cureus 2024; 16:e60454. [PMID: 38883058 PMCID: PMC11179726 DOI: 10.7759/cureus.60454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives Pain, a common human experience, is also experienced by nursing students, and pain beliefs, thoughts, and behaviors toward pain play an important role in coping with pain. There is insufficient data about the relationship between pain beliefs and pain coping strategies. Thus, this study aims to reveal the relationship between pain beliefs and pain coping approaches of nursing students and affecting factors. Methods A descriptive, cross-sectional, and correlational design was used, and the data were collected with respondent characteristics form, the Numerical Rating Scale (NRS) and the Pain Beliefs Questionnaire (PBQ), by researchers from 380 nursing students in the nursing department. Results Nursing students who used non-pharmacological interventions to cope with pain had higher levels of psychological belief (PBQ-P) scores (4.97±0.86) than organic belief (PBQ-O) scores (3.90±0.71) and the difference was statistically significant (p<0.001). According to the multivariate linear regression analysis results, nursing students' gender, utilizing non-pharmacological interventions, and NRS scores affected PBQ-P scores by 87.1% (R2=0.871) and PBQ-O scores by 81.0% (R2=0.810). Conclusions As can be seen from the results of this study, the higher psychological beliefs of nursing students who use non-pharmacological interventions to cope with pain are an example of this situation. In light of the information in this study, it should be taken into consideration that both psychological and organic beliefs have a strong relationship with pain intensity and pain coping approaches. Nursing students, the nurses of tomorrow, should be aware of the impact of psychological and organic beliefs on individuals' pain experiences and coping approaches and should take this into account when planning nursing care.
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Affiliation(s)
- Seçkin Karakuş
- Nursing, Erzincan Binali Yildirim University, Erzincan, TUR
| | - Serdar Sarıtaş
- Medical Biology, Malatya Turgut Ozal University, Malatya, TUR
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de Matos MO, Bernardes SF. Helpful social support for chronic pain in long-term care residents: "With a little help I manage on my own". Nurs Open 2023; 10:6326-6335. [PMID: 37306327 PMCID: PMC10415998 DOI: 10.1002/nop2.1881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS AND OBJECTIVES To understand older adults' experiences of receiving formal pain-related social support and to identify which caregivers' responses are perceived as (un)helpful to chronic pain adjustment. BACKGROUND Chronic pain is highly prevalent in long-term care residents, negatively impacting their psychological, physical and social functioning. However, research has lacked to address the extent to which residents' experiences with staff responses, to their pain, may influence chronic pain outcomes. DESIGN Qualitative study. METHODS Twenty-nine older adults (7 men, 22 women, Mage = 87.7) were interviewed online through semi-structured interviews, and a thematic analysis was conducted. COREQ guidelines were followed. RESULTS Two main themes emerged: (1) support during a pain crisis aiming at its relief and (2) support with daily activities because of pain to overcome pain interference. Findings indicate pain-related support is helpful when residents feel their psychological and functional autonomy is protected, and the interactions convey connection and intimacy. Furthermore, residents actively try to shape the support to be received. Also, gender roles and expectations seem to influence pain-related supportive interactions. CONCLUSION Pain-related social support may contribute to the maintenance of older adults' health status and autonomy, ensuring a fulfilling and healthy aging process despite chronic pain. RELEVANCE TO CLINICAL PRACTICE Findings can inform effective pain-related care practices in long-term care, regarding (1) how residents can shape the support they need; (2) which kind of support should be provided, and (3) how caregivers and organizations should provide pain-related support. PATIENT OR PUBLIC CONTRIBUTION Older adults who participated in the study were recruited from 3 long-term care facilities in Lisbon, in which they resided for longer than 3 months, had persistent/intermittent pain for more than 3 months; were able to maintain a conversation, recollect real episodes, and to fully provide informed consent to participate.
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Affiliation(s)
- Marta Osório de Matos
- Iscte‐Instituto Universitário de Lisboa and Centro de Investigação e Intervenção Social (CIS_Iscte)LisbonPortugal
| | - Sónia Figueira Bernardes
- Iscte‐Instituto Universitário de Lisboa and Centro de Investigação e Intervenção Social (CIS_Iscte)LisbonPortugal
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Chen T, Or CK. Perceptions of a machine learning-based lower-limb exercise training system among older adults with knee pain. Digit Health 2023; 9:20552076231186069. [PMID: 37426581 PMCID: PMC10328003 DOI: 10.1177/20552076231186069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023] Open
Abstract
Objective To facilitate the older adults with knee pain to perform exercises and improve knee health, we proposed the design of a machine learning-based system for lower-limb exercise training that features three main components: video demonstration of exercises, real-time movement feedback, and tracking of exercise progress. At this early stage of design, we aimed to examine the perceptions of a paper-based prototype among older adults with knee pain and investigate the factors that may influence their perceptions of the system. Methods A cross-sectional survey of the participants' (N = 94) perceptions of the system was conducted using a questionnaire, which assessed their perceived effects of the system, perceived ease of use of the system, attitude toward the system, and intention to use the system. Ordinal logistic regression was conducted to examine whether the participants' perceptions of the system were influenced by their demographic and clinical characteristics, physical activity level, and exercise experience. Results The participants' responses to the perception statements exhibited consensus agreement (≥ 75%). Age, gender, duration of knee pain, knee pain intensity, experience with exercise therapy, and experience with technology-supported exercise programs were significantly associated with the participants' perceptions of the system. Conclusions Our results demonstrate that the system appears promising for use by older adults to manage their knee pain. Therefore, it is needed to develop a computer-based system and further investigate its usability, acceptance, and clinical effectiveness.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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Gülnar E, Özveren H, Tüzer H, Yılmazer T. An Investigation of Pain Beliefs, Pain Coping, and Spiritual Well-Being in Surgical Patients. JOURNAL OF RELIGION AND HEALTH 2022; 61:4028-4038. [PMID: 34269958 DOI: 10.1007/s10943-021-01340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
This study investigated pain beliefs, pain coping, and spiritual well-being in surgical patients. The study adopted a cross-sectional, descriptive, and correlational research design. The sample consisted of 213 voluntary patients admitted to a surgery clinic between April and November 2019. Data were collected using a demographic characteristics questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 item (FACIT-Sp-12), the Pain Beliefs Questionnaire (PBQ), and the Pain Coping Questionnaire (PCQ). Number, percentage, mean, and Spearman's correlation were used for analysis. Participants had a total FACIT-Sp-12 score of 25.99 ± 8.43. They had a mean PBQ "organic beliefs" and "psychological beliefs" subscale score of 4.44 ± 0.64 and 4.96 ± 0.68, respectively. They had a mean PCQ "self-management," "helplessness," "conscious coping attempts," and "medical remedies" subscale score of 15.83 ± 6.15, 9.41 ± 4.63, 8.72 ± 3.66, and 7.46 ± 5.33, respectively. Spiritual well-being was weakly and positively (r = 0.445, p < 0.000) correlated with self-management and moderately and negatively correlated (r = - 0.528, p < 0.000) with helplessness. Participants with higher organic and psychological beliefs had lower spiritual well-being. The results indicate that nurses should evaluate both pain and spiritual well-being in patients.
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Affiliation(s)
- Emel Gülnar
- Faculty of Health Sciences, Nursing Department, Kırıkkale University, Kırıkkale, Turkey.
| | - Hüsna Özveren
- Faculty of Health Sciences, Nursing Department, Kırıkkale University, Kırıkkale, Turkey
| | - Hilal Tüzer
- Faculty of Health Sciences, Nursing Department, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Tuba Yılmazer
- Faculty of Health Sciences, Nursing Department, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Sex and gender differences in pain: past, present, and future. Pain 2022; 163:S108-S116. [PMID: 36099334 DOI: 10.1097/j.pain.0000000000002738] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/18/2022] [Indexed: 12/30/2022]
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Şimşek Ş, Oymak Soysal AN, Kaş Özdemir A. Association between Pain Intensity, Pain Belief, and Coping Strategies in Older Adults. Exp Aging Res 2022; 49:244-251. [PMID: 35848597 DOI: 10.1080/0361073x.2022.2101304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This study aimed to determine the relation between pain, pain belief, and coping strategies and the interaction effect of pain belief and coping stretegies on pain intensity in older adults living in Denizli. 601 older adults (68.32 ± 8.28 years) with good cognitive function participated in current study. Pain intensity, pain beliefs and coping strategies were assessed with Geriartric Pain Measure (GPM), Pain Beliefs Scale (PBS) and Pain Coping Inventory (PCI), respectively. Mean pain intensity of older adults was 53.6 ± 21 (0-99.96). There was a statistically significant difference in passive coping strategies between older adults with mild, moderate, and severe pain (p < .001). As organic pain belief and active coping strategies increase, the pain intensity decreases in older adults living in Denizli.
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Affiliation(s)
- Şule Şimşek
- Saraykoy Vocational School, Department of Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ayşe Nur Oymak Soysal
- Saraykoy Vocational School, Department of Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Atiye Kaş Özdemir
- Saraykoy Vocational School, Department of Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Hamina A, Muller AE, Clausen T, Skurtveit S, Hesse M, Tjagvad C, Thylstrup B, Odsbu I, Zoega H, Jónsdóttir HL, Taipale H. Prescription opioids among older adults: ten years of data across five countries. BMC Geriatr 2022; 22:429. [PMID: 35578167 PMCID: PMC9112605 DOI: 10.1186/s12877-022-03125-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Opioid use has increased globally in the recent decade. Although pain remains a significant problem among older adults, susceptibility to opioid-related harms highlights the importance of careful opioid therapy monitoring on individual and societal levels. We aimed to describe the trends of prescription opioid utilisation among residents aged ≥65 in all Nordic countries during 2009-2018. METHODS We conducted cross-sectional measurements of opioid utilisation in 2009-2018 from nationwide registers of dispensed drugs in Denmark, Finland, Iceland, Norway, and Sweden. The measures included annual opioid prevalence, defined daily doses (DDDs) per 1000 inhabitants per day (DIDs), and morphine milligram equivalents (MMEs) per user per day. RESULTS From 2009 to 2018, an average of 808,584 of adults aged ≥65 used opioids yearly in all five countries; an average annual prevalence of 17.0%. During this time period, the prevalence decreased in Denmark, Norway, and Sweden due to declining codeine and/or tramadol use. Iceland had the highest opioid prevalence in 2009 (30.2%), increasing to 31.7% in 2018. In the same period, DIDs decreased in all five countries, and ranged from 28.3 in Finland to 58.5 in Denmark in 2009, and from 23.0 in Finland to 54.6 in Iceland in 2018. MMEs/user/day ranged from 4.4 in Iceland to 19.6 in Denmark in 2009, and from 4.6 in Iceland to 18.8 in Denmark in 2018. In Finland, Norway, and Sweden, MMEs/user/day increased from 2009 to 2018, mainly due to increasing oxycodone utilisation. CONCLUSIONS The stable or decreasing opioid utilisation prevalence among a majority of older adults across the Nordic countries coincides with an increase in treatment intensity in 2009-2018. We found large cross-national differences despite similarities across the countries' cultures and healthcare systems. For the aged population, national efforts should be placed on improving pain management and monitoring future trends of especially oxycodone utilisation.
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Affiliation(s)
- A. Hamina
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - A. E. Muller
- grid.418193.60000 0001 1541 4204Division of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - T. Clausen
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - S. Skurtveit
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway ,grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - M. Hesse
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - C. Tjagvad
- grid.5510.10000 0004 1936 8921Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, PO Box 1171, 0218 Oslo, Norway
| | - B. Thylstrup
- grid.7048.b0000 0001 1956 2722Center for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - I. Odsbu
- grid.418193.60000 0001 1541 4204Department of Mental Disorders, Division of Mental and Physical Health, the Norwegian Institute of Public Health, Oslo, Norway
| | - H. Zoega
- grid.1005.40000 0004 4902 0432Centre for Big Data Research in Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia ,grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - H. L. Jónsdóttir
- grid.14013.370000 0004 0640 0021Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - H. Taipale
- grid.9668.10000 0001 0726 2490School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.466951.90000 0004 0391 2072Niuvanniemi Hospital, Kuopio, Finland
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Merminod G, Weber O, Semlali I, Terrier A, Decosterd I, Rubli Truchard E, Singy P. Talking about chronic pain in family settings: a glimpse of older persons’ everyday realities. BMC Geriatr 2022; 22:358. [PMID: 35461217 PMCID: PMC9034600 DOI: 10.1186/s12877-022-03058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The expression of chronic pain remains a delicate matter for those older persons who suffer from this condition. If many studies highlight the difficulties of putting pain into words, scarce are those that take into account how given social networks can facilitate or prevent its expression. Based on a qualitative study that explores the communication about chronic pain in older persons’ social network, this article reports on this key issue of talking about health in later life within family settings and provides clinicians with information about the way older persons with chronic conditions perceive their everyday realities and social relations.
Methods
A multidisciplinary research team (medicine, linguistics and psychology) interviewed 49 persons with chronic pain, all from the French-speaking part of Switzerland, aged 75 and older, without any major cognitive or auditory impairments. After transcription, the interviews were analyzed by combining content and discourse analysis with social network theories.
Results
Communication about chronic pain depends significantly on the position of the interlocutors within the family structure, with a preference for direct relatives or individuals with similar difficulties. In social networks, the ability to communicate about chronic pain is both a resource (by allowing older persons to get help or by strengthening interpersonal relations) and a challenge (by threatening their autonomy, social relations or self-esteem).
Conclusions
The study shows the predominance of the nuclear family (partner, children) in communication relating specifically to the everyday management of chronic pain. This state of affairs is, nevertheless, balanced by issues of (loss of) autonomy. These findings, in line with current trends in geriatrics, could benefit future reflections on the scope and limits of including relatives in the care of older patients with chronic conditions.
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Pudalov LR, Krause SJ, Heinberg LJ, Hogue O. Refractory Chronic Pain and Obesity: Promising Implications for Multidisciplinary Pain Rehabilitation. PAIN MEDICINE 2021; 22:2290-2297. [PMID: 33565599 DOI: 10.1093/pm/pnab055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Individuals with obesity frequently contend with chronic pain, but few studies address the clinical impact of coordinated pain services on this population. The current study addresses this topic by comparing the effectiveness of a comprehensive pain rehabilitation program for patients with and without obesity. METHODS A retrospective analysis of registry data was conducted. Obesity was considered as one of three weight groups, based on the following body mass index cutoffs: normal weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2), and obese (> 30 kg/m2). These groups were compared on the Pain Severity Ratings (PSR) Scale, the Pain Disability Index (PDI), and the Depression, Anxiety, Stress Scales-Short Form (DASS-SF). RESULTS Groups differed on baseline pain disability and depression. Patients with obesity had higher scores on both the PDI (P = .028) and the DASS-SF depression subscale (P = .006). Contrary to the hypothesis, after controlling for baseline score and sex there were no significant differences between weight groups with regards to PSR, PDI, or any DASS-SF subscale at discharge. At 1-year follow-up, individuals who were overweight and obese had significantly more anxiety compared to individuals whose weight was in the normal range. CONCLUSIONS Multidisciplinary pain rehabilitation programs appear to be an effective treatment intervention for patients who have concomitant chronic pain and obesity, to a degree comparable to patients who have chronic pain but do not contend with obesity. Implications for program development, clinical interventions, and future research are discussed.
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Affiliation(s)
| | - Steven J Krause
- Case Western Reserve University, Department of Psychiatry, Cleveland, Ohio
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Department of Psychiatry and Psychology, Cleveland, Ohio
| | - Olivia Hogue
- Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, Ohio, USA
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Higgins C, Smith BH, Colvin L. Examination of the clinical factors associated with attendance at emergency departments for chronic pain management and the cost of treatment relative to that of other significant medical conditions. Pain 2021; 162:886-894. [PMID: 33021568 DOI: 10.1097/j.pain.0000000000002098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
ABSTRACT Little is known about risk factors for emergency department (ED) attendance for chronic pain (CP) management and the relative service burden. We examined ED utilisation in patients with CP, identified risk factors associated with attendance for chronic musculoskeletal pain (CMP), and estimated the comparative cost of treatment. The study cohort comprised a random sample of 3700 adults from the general population in Tayside, Scotland. Linked regional extracts, spanning a 12-month period, were obtained from national registers, providing information on ED attendances, community-dispensed prescribing, and outpatient clinic attendances. The National Health Service Scotland Cost Book was used to ascertain the current average cost of an ED attendance (£130; ∼$167). All-cause ED attendance was higher in those with CP (68.5%; n = 252) than without (29.3%; n = 967). In the entire cohort, more patients attended the ED for the treatment of CMP than for any other medical condition (n = 119; 32.3% of those with CP). Risk factors for ED attendance for CMP were: recent analgesic dose decreases (OR = 4.55); and transitioning from opioid to nonopioid analgesics (OR = 5.08). Characteristics protective of ED attendance for CMP were: being in receipt of strong opioids (OR = 0.21); transitioning from nonopioid to opioid analgesics (OR = 0.25); recent analgesic dose increases (OR = 0.24); and being prescribed tricyclic antidepressants (OR = 0.10), benzodiazepines (OR = 0.46), or hypnotics (OR = 0.45). Chronic musculoskeletal pain was one of the most expensive conditions to treat (£17,680 [∼$22,668] per annum), conferring a substantial burden on ED services. Improved understanding of the risk/protective factors could inform healthcare redesign to reduce avoidable ED attendances for CMP management.
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Affiliation(s)
- Cassie Higgins
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, United Kingdom
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Smith S, Carragher L. Prioritization and management of calls from older people to GP out-of-hours services. Int J Qual Health Care 2021; 33:6126507. [PMID: 33528500 DOI: 10.1093/intqhc/mzab021] [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: 10/13/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. OBJECTIVE The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. METHODS An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. RESULTS Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. CONCLUSION Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.
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Affiliation(s)
- Suzanne Smith
- NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Road, Dundalk, County Louth A91K584, Ireland
| | - Lucia Carragher
- NetwellCASALA, The Bright Room, Dundalk Institute of Technology, Dublin Road, Dundalk, County Louth A91K584, Ireland
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14
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Schofield P, Dunham M, Martin D, Bellamy G, Francis SA, Sookhoo D, Bonacaro A, Hamid E, Chandler R, Abdulla A, Cumberbatch M, Knaggs R. Evidence-based clinical practice guidelines on the management of pain in older people – a summary report. Br J Pain 2020; 16:6-13. [PMID: 35111309 PMCID: PMC8801690 DOI: 10.1177/2049463720976155] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The objective of this study is to develop an update of the evidence-based guidelines for the management of pain in older people. Design: Review of evidence since 2010 using a systematic and consensus approach is performed. Results: Recognition of the type of pain and routine assessment of pain should inform the use of specific environmental, behavioural and pharmacological interventions. Individualised care plans and analgesic protocols for specific clinical situations, patients and health care settings can be developed from these guidelines. Conclusion: Management of pain must be considered as an important component of the health care provided to all people, regardless of their chronological age or severity of illness. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with adverse effects of treatment and the potential for drug interactions.
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15
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Esses G, Deiner S, Ko F, Khelemsky Y. Chronic Post-Surgical Pain in the Frail Older Adult. Drugs Aging 2020; 37:321-329. [PMID: 32297246 DOI: 10.1007/s40266-020-00761-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall quality of life. It is increasingly recognized as a public health issue but there is a need to improve our understanding of the disease process as well as the appropriate treatment and prevention. Frailty, delirium, and cognition influence post-operative outcomes in older adults and have been implicated in the development of chronic post-surgical pain. Further research must be conducted to fully understand the role they play in the occurrence of chronic post-surgical pain in the older adult. Additionally, careful attention must be given to the physiologic, cognitive, and comorbidity differences between the older adult and the general population. This is critical for elucidating the proper chronic post-surgical pain treatment and prevention strategies to ensure that the older adult undergoing surgical intervention will have an appropriate and desirable post-operative outcome.
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Affiliation(s)
- Gary Esses
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA.
| | - Stacie Deiner
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
| | - Fred Ko
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
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16
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A Concept Analysis of Coping with Chronic Pain in Older Adults. Pain Manag Nurs 2019; 20:563-571. [DOI: 10.1016/j.pmn.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/02/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
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17
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Pancorbo-Hidalgo PL, Bellido-Vallejo JC. Psychometric Evaluation of the Nursing Outcome Knowledge: Pain Management in People with Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234604. [PMID: 31766312 PMCID: PMC6926491 DOI: 10.3390/ijerph16234604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/27/2022]
Abstract
Pain has a major impact on health and quality of life. Since the level of knowledge of painful conditions can influence how these are addressed and managed, assessing this knowledge in patients becomes crucial. As a result, it is necessary to have culturally adapted and validated instruments that specifically measure patients' knowledge of chronic pain management. The objective of this study was to carry out the Spanish cultural adaptation and the validation of the outcome Knowledge: Pain Management of the Nursing Outcomes Classification (NOC) in patients with chronic pain, defined as extent of understanding conveyed about causes, symptoms, and treatment of pain. A three-stage study was designed: 1) translation and cultural adaptation through an expert panel, 2) content validation, 3) clinical validation. This study provides nurses with a Spanish version of this scale adapted to their context, as well as a set of structured indicators to measure patients' knowledge about chronic pain. The results indicated that the culturally adapted Spanish version of the outcome Knowledge: Pain Management had a high level of content validity (CVI = 0.92), with 27 indicators being distributed between two factors. This version has been shown to be reliable in terms of inter-observer agreement (κ = 0.79) and internal consistency (α = 0.95). In conclusion, Knowledge: Pain Management has been shown to be reliable and valid to measure knowledge of chronic pain.
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Affiliation(s)
- Pedro Luis Pancorbo-Hidalgo
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain;
| | - José Carlos Bellido-Vallejo
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain;
- Jaén University Hospital, Avenida del Ejército Español 10, 23007 Jaén, Spain
- Correspondence: ; Tel.: +34-676-179-283
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18
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C Evans M, Bazargan M, Cobb S, Assari S. Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3894. [PMID: 31615105 PMCID: PMC6843192 DOI: 10.3390/ijerph16203894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults. OBJECTIVE This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles. METHODS A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis. RESULTS Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity. CONCLUSION The results may help with the health promotion of economically disadvantaged AA older adults in urban areas.
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Affiliation(s)
- Meghan C Evans
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
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19
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Stephens G, O'Neill S, Clifford C, Cuff A, Forte F, Hawthorn C, Littlewood C. Greater trochanteric pain syndrome in the UK National Health Service: A multicentre service evaluation. Musculoskeletal Care 2019; 17:390-398. [PMID: 31469233 DOI: 10.1002/msc.1419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Gareth Stephens
- The Royal Orthopaedic Hospital Birmingham UK
- Primary Care Centre versus Arthritis, Research Institute for Primary Care and Health SciencesKeele University Staffordshire UK
| | | | | | - Andrew Cuff
- Wakefield Musculoskeletal Service, Trinity Medical Centre Wakefield UK
| | - Felipe Forte
- Sandwell and West Birmingham NHS Hospitals West Bromwich UK
| | | | - Chris Littlewood
- Primary Care Centre versus Arthritis, Research Institute for Primary Care and Health SciencesKeele University Staffordshire UK
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20
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Mann EG, VanDenKerkhof EG, Johnson A, Gilron I. Help-seeking behavior among community-dwelling adults with chronic pain. Can J Pain 2019; 3:8-19. [PMID: 35005390 PMCID: PMC8730570 DOI: 10.1080/24740527.2019.1570095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Background: Some individuals with chronic pain do not seek care. This decision may be due to characteristics of the individual, pain, and/or their health professional(s). Aims: This study aimed to identify and compare features of individuals with chronic pain, their pain and general health, and their health care professional between community-dwelling adults who did and did not seek care. Methods: Randomly selected adults were mailed a study questionnaire that screened for chronic pain (pain persisting ≥3 months) and asked about their general well-being (Short Form [SF]-36), pain location (body diagram), pain intensity and characteristics (Leeds Assessment of Neuropathic Symptoms and Signs), experiences with health care professionals (Chronic Illness Resources Survey), and visits made to health professionals over the past year. Respondents were categorized as help-seeking (≥1 visit in the past year) and non-help-seeking (zero visits in the past year). Results: Six percent of respondents (44/696) were non-help-seeking. These respondents differed in individual, pain, and health care professional characteristics when compared to those who did seek care. Specifically, when other variables were controlled, non-help-seeking individuals were less likely to be male (relative risk [RR] = 0.39, 95% confidence interval [CI], 0.18-0.86), report comorbid conditions (RR = 0.46, 95% CI, 0.22-0.98), report being treated as an equal partner in decision making (RR = 0.40, 95% CI, 0.18-0.93), and rate their health care professional as important to their pain management (RR = 0.39, 95% CI, 0.18-0.85). They were more likely to use over-the-counter medication to manage their pain (RR = 2.52, 95% CI, 1.14-5.58). Conclusions: Experiences with health professionals play a role in determining whether an individual manages his or her pain independently. Future research should explore the safety of those who do not seek care.
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Affiliation(s)
- Elizabeth G. Mann
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth G. VanDenKerkhof
- School of Nursing and Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Ana Johnson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Kingston General Hospital, Kingston, Ontario, Canada
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21
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Nawai A. Chronic Pain Management Among Older Adults: A Scoping Review. SAGE Open Nurs 2019; 5:2377960819874259. [PMID: 33415254 PMCID: PMC7774444 DOI: 10.1177/2377960819874259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 08/13/2019] [Indexed: 01/15/2023] Open
Abstract
Chronic pain is a significant problem for older adults. The effect of chronic pain on older people's quality of life needs to be described and identified. For a decade, the Roy Adaptation Model has been used extensively to explain nursing phenomena and guide nursing research in several settings with several populations. The objective of this study was to use the Roy Adaptation Model to describe chronic pain and present a systematic scoping review of the literature about the middle-range theory of chronic pain among older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses model guided a scoping review search method. A literature search was undertaken using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Ovid, and ProQuest. The search terms were "chronic pain," "pain management," "older adult," "Roy Adaptation Model," and "a scope review." The search included articles written in English published for the period of 2004-2017. All articles were synthesized using concepts of Roy's Adaptation Model. Twenty-two studies were considered for the present review. Twenty-one articles were reports of quantitative studies, and one was a report of a qualitative study. Two outcome measures were found in this systematic scoping review. The primary outcomes reported in all articles were the reduction of pain due to interventions and an increase in coping with chronic pain. The secondary outcome measures reported in all studies were the improvement of physical function, quality of life, sleep disturbance, spiritual well-being, and psychological health related to pain management interventions among older adults. Many interventions of all studies reported improvement in chronic pain management among older adults. However, to improve chronic pain management, nurses need to understand about nursing theories, the context which instruments work, and develop empirical instruments based on the conceptual model.
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Affiliation(s)
- Ampicha Nawai
- Boromarajonani College of Nursing, Chiang
Mai, Thailand
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22
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Clewley D, Rhon D, Flynn T, Koppenhaver S, Cook C. Health seeking behavior as a predictor of healthcare utilization in a population of patients with spinal pain. PLoS One 2018; 13:e0201348. [PMID: 30067844 PMCID: PMC6070259 DOI: 10.1371/journal.pone.0201348] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/13/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global burden of low back pain is growing rapidly, accompanied by increasing rates of associated healthcare utilization. Health seeking behavior (HSB) has been suggested as a mediator of healthcare utilization. The aims of this study were to: 1) develop a proxy HSB measure based on healthcare consumption patterns prior to initial consultation for spinal pain, and 2) examine associations between the proxy HSB measure and future healthcare utilization in a population of patients with spine disorders. METHODS A cohort of 1,691 patients seeking care for spinal pain at a single military hospital were included. Cluster analyses were performed for the identification of a proxy HSB measure. Logistic regression was used to identify the predictive capacity of HSB on eight different general and spine-related high healthcare utilization (upper 25%) outcomes variables. RESULTS The strongest proxy measure of HSB was prior primary care provider visits. In unadjusted models, HSB predicted healthcare utilization across all eight general and spine-related outcome variables. After adjusting for covariates, HSB still predicted general and spine-related healthcare utilization for most variables including total medical visits (OR = 2.48, 95%CI 1.09,3.11), total medical costs (OR = 2.72, 95%CI 2.16,3.41), and low back pain-specific costs (OR = 1.31, 95%CI 1.00,1.70). CONCLUSION Health seeking behavior prior to initial consultation for spine pain was related to healthcare utilization after consultation for spine pain. HSB may be an important variable to consider when developing an individualized care plan and considering the prognosis of a patient.
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Affiliation(s)
- Derek Clewley
- Rocky Mountain University of Health Professions, Provo, Utah, United States of America
- Duke University School of Medicine, Department of Orthopaedics, Division of Physical Therapy, Durham, North Carolina, United States of America
| | - Dan Rhon
- Center for the Intrepid, San Antonio, Texas, United States of America
- Baylor University, Doctor of Physical Therapy Program, Waco, Texas, United States of America
| | - Timothy Flynn
- South College, School of Physical Therapy, Knoxville, Tennessee, United States of America
| | - Shane Koppenhaver
- Baylor University, Doctor of Physical Therapy Program, Waco, Texas, United States of America
| | - Chad Cook
- Duke University School of Medicine, Department of Orthopaedics, Division of Physical Therapy, Durham, North Carolina, United States of America
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23
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Bellido-Vallejo JC, Pancorbo-Hidalgo PL. Cultural Adaptation and Psychometric Evaluation of the Spanish Version of the Nursing Outcome “Pain Control” in Primary Care Patients with Chronic Pain. Pain Manag Nurs 2017; 18:337-350. [DOI: 10.1016/j.pmn.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/21/2017] [Accepted: 04/02/2017] [Indexed: 01/11/2023]
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24
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Mah K, Tran KT, Gauthier LR, Rodin G, Zimmermann C, Warr D, Librach SL, Moore M, Shepherd FA, Gagliese L. Psychometric Evaluation of the Pain Attitudes Questionnaire-Revised for People With Advanced Cancer. THE JOURNAL OF PAIN 2017; 18:811-824. [DOI: 10.1016/j.jpain.2017.02.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/02/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
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25
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Guerriero F. Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World J Clin Cases 2017; 5:73-81. [PMID: 28352631 PMCID: PMC5352962 DOI: 10.12998/wjcc.v5.i3.73] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023] Open
Abstract
Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients.
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26
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Lee K, Cooke J, Cooper G, Shield A. Move it or Lose it. Is it Reasonable for Older Adults with Osteoarthritis to Continue to Use Paracetamol in Order to Maintain Physical Activity? Drugs Aging 2017; 34:417-423. [PMID: 28258536 DOI: 10.1007/s40266-017-0450-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Osteoarthritis is a common progressive disease in older adults, and those affected often have impaired physical function, co-existing disease states, and reduced quality of life. In patients with osteoarthritis, pain is reported as a primary cause of mobility limitation, and guidelines recommend a mix of pharmacologic and non-pharmacologic strategies for pain management. The benefits of exercise in the management of osteoarthritis are well established; however, pain appears to be the biggest barrier to patients engaging in, and adhering to, physical activity programs. Attitudes towards the use of pain medications differ widely, and lack of efficacy or fear of side effects may lead to sub-therapeutic dosing. Furthermore, a recent review suggesting that short-term paracetamol use is ineffective for osteoarthritis has added to the confusion. This narrative review investigates limitations of current medications, summarizes patient attitudes toward the use of analgesics for osteoarthritis pain (with a focus on paracetamol), and explores the uptake of physical activity for osteoarthritis management. Evidence suggests that, despite clear guidelines, symptoms of osteoarthritis generally remain poorly managed. More research is required to investigate clinical outcomes in patients with osteoarthritis through optimized medication plans to better understand whether longer-term analgesic use in conjunction with physical activity can assist patients to overcome mobility limitations.
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Affiliation(s)
- Kayla Lee
- Faculty of Health, University of Canberra, Locked Bag 1, Canberra, ACT 2601, Australia
| | - Julie Cooke
- Faculty of Health, University of Canberra, Locked Bag 1, Canberra, ACT 2601, Australia
| | - Gabrielle Cooper
- Faculty of Health, University of Canberra, Locked Bag 1, Canberra, ACT 2601, Australia
| | - Alison Shield
- Faculty of Health, University of Canberra, Locked Bag 1, Canberra, ACT 2601, Australia.
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27
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Mann EG, Johnson A, Gilron I, VanDenKerkhof EG. Pain Management Strategies and Health Care Use in Community-Dwelling Individuals Living with Chronic Pain. PAIN MEDICINE 2017; 18:2267-2279. [DOI: 10.1093/pm/pnw341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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28
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McClive-Reed KP, Gellis ZD. Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC). JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2016; 59:572-586. [PMID: 27585987 DOI: 10.1080/01634372.2016.1222474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.
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Affiliation(s)
- Kimberly P McClive-Reed
- a Center for Mental Health & Aging, School of Social Policy and Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Zvi D Gellis
- a Center for Mental Health & Aging, School of Social Policy and Practice , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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29
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Park HR, Park E, Park JW. Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives. Collegian 2016. [DOI: 10.1016/j.colegn.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Epidemiological data suggests that the prevalence of musculoskeletal and neuropathic pain increases with age until at least late mid-life, though the pattern is somewhat unclear beyond this point. And though the prevalence of some types of pain may peak in late midlife, pain is still a substantial and common complaint even in the oldest age groups. This article provides an overview of later-life pain and includes a brief review of its epidemiology, describes commonly encountered barriers to its management, and discusses guidelines and recommended approaches to its assessment and management.
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Affiliation(s)
- Steven M Savvas
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia.
| | - Stephen J Gibson
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia
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31
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Muntinga ME, Jansen APD, Schellevis FG, Nijpels G. Expanding access to pain care for frail, older people in primary care: a cross-sectional study. BMC Nurs 2016; 15:26. [PMID: 27110220 PMCID: PMC4842300 DOI: 10.1186/s12912-016-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/16/2016] [Indexed: 12/15/2022] Open
Abstract
Background Although untreated pain has a negative impact on quality of life and health outcomes, research has shown that older people do not always have access to adequate pain care. Practice nurse-led, comprehensive geriatric assessments (CGAs) may increase access to tailored pain care for frail, older people who live at home. To explore this, we investigated whether new pain cases were identified by practice nurses during CGAs administered as part of an intervention with the Geriatric Care Model, a comprehensive care model based on the Chronic Care Model, and whether the intervention led to tailored pain action plans in care plans of frail, older people. Methods We used cross-sectional data from the older Adults: Care in Transition (ACT) study, a 2-year clinical trial carried out in two regions of the Netherlands. Practice nurses proactively visited older people at home and administered an in-home CGA that included an assessment of pain. Pain care-related agreements and actions (pain action plans) based on CGA results were described in a tailored care plan. We analyzed care plans of 781 older people who received a first-time CGA by a practice nurse for the presence of pain, pain location and cause, new pain cases, and pain action plans. We used descriptive statistics to analyze our data. Results We found that 315 (40.3 %) older people experienced any type of pain. Practice nurses identified 20 (10.6 %) new pain cases, and 188 (59.7 %) older people with pain formulated at least one therapeutic or non-therapeutic pain action plan together with a practice nurse. More than half of the older people whose pain had already been identified by a primary care physician wanted a pain action plan. Most pain action plans consisted of actions or agreements related to continuity of care. Discussion and conclusion Practice nurses in primary care can contribute to expanding older people's access to tailored pain care. Future researchers should continue to direct their focus at ways to overcome the barriers that restrict older people’s access to pain care.
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Affiliation(s)
- M E Muntinga
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schellevis
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands ; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Dargan PJ, Simm R, Murray C. New approaches towards chronic pain: patient experiences of a solution-focused pain management programme. Br J Pain 2015; 8:34-42. [PMID: 26516532 DOI: 10.1177/2049463713516755] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Research has suggested that Solution-Focused Brief Therapy (SFBT) may be effective in facilitating meaningful change for those living with chronic pain. This study aimed to further this understanding through exploring the experiences of people living with chronic pain, who had attended an 8-week solution-focused pain management programme. The design of this study was conducted in consultation with a service-user advisory group, and employed a qualitative and interpretative design rooted in critical community psychology, participatory research frameworks and emancipatory disability research. Five participants opted-in to the study following an opportunity sampling method of persons who had attended a programme in the last 18 months. Interviews were transcribed verbatim and analysed using inductive thematic analysis. Five main themes were identified: 'Accessing the pain management programme', 'A solution-focused group', 'The solution-focused clinician', 'Solutions and changes' and 'Challenges and improvements'. Clinical and research implications of the findings are discussed. SUMMARY POINTS There has been an international proliferation of pain management programmes (PMPs) aimed at helping those with chronic pain to live well, despite an unremitting condition.Arguably, the most popular psychological approaches used within PMPs are informed by cognitive behavioural therapy (CBT).Despite a supportive evidence base for psychological approaches in pain management, there is a recognised need for further research into alternative approaches and their effectiveness.Emerging research and policy recommendations are beginning to value the expertise of those living with chronic conditions, particularly how these perspectives can be used to develop effective treatments and services.SFBT is an approach aimed at achieving a patient's goals or 'preferred future' through identifying and utilising their expertise. SFBT may have significant efficacy in helping those with chronic conditions to live improved, meaningful lives.
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Affiliation(s)
- Peter J Dargan
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
| | - Rebecca Simm
- Clinical Health Psychology Service and Community Pain Service, Southport & Ormskirk Hospital NHS Trust, Southport, UK
| | - Craig Murray
- Department of Clinical Psychology, Lancaster University, Lancaster, UK
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Ayorinde AA, Macfarlane GJ, Saraswat L, Bhattacharya S. Chronic pelvic pain in women: an epidemiological perspective. ACTA ACUST UNITED AC 2015; 11:851-64. [PMID: 26450216 DOI: 10.2217/whe.15.30] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.
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Affiliation(s)
- Abimbola A Ayorinde
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lucky Saraswat
- Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, Scotland, UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
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O'Donnell S, Rusu C, Hawker GA, Bernatsky S, McRae L, Canizares M, MacKay C, Badley EM. Arthritis has an impact on the daily lives of Canadians young and old: results from a population-based survey. BMC Musculoskelet Disord 2015; 16:230. [PMID: 26319735 PMCID: PMC4553213 DOI: 10.1186/s12891-015-0691-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 08/20/2015] [Indexed: 11/30/2022] Open
Abstract
Background There is a perception that the impacts of arthritis are greatest among older adults. However, the effect of age on health-related outcomes in individuals with arthritis has not been explicitly studied. This study examined whether the physical and mental health impacts of arthritis are greater in older (75+ years) versus younger (20–44, 45–64 and 65–74 years) Canadian adults. Methods Data were from the arthritis component of the 2009 Survey on Living with Chronic Diseases in Canada. The responses were weighted to be representative of Canadians (≥20 years) with arthritis. Associations between age and the prevalence of severe/frequent joint pain, severe/frequent fatigue, sleep limitations, instrumental activities of daily living (IADLs) limitations, high levels of stress, suboptimal general and suboptimal mental health, were examined descriptively prior to conducting multivariate log-binomial regression analyses. Results A total of 4565 respondents completed the survey (78 % response rate). Individuals with arthritis were mostly female (63 %), of working age (57 %) and overweight or obese (67 %). Upon adjusting for covariates, younger (20–44 years) and/or middle aged (45–64 years) adults were more likely than those older (75+ years) to report severe/frequent joint pain, sleep limitations, high levels of stress and suboptimal mental health. After adjusting for covariates, age was not associated with IADL limitations, severe/frequent fatigue or suboptimal general health. Conclusions Contrary to the belief that older adults with arthritis experience more severe physical and mental health outcomes, we found that older adults were less likely to report worse outcomes than younger adults. In light of these findings, public health messaging should stress that arthritis does not just affect the elderly and emphasize the importance of timely diagnosis and management at all ages in order to prevent or, minimize arthritis-related impairment.
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Affiliation(s)
- Siobhan O'Donnell
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Corneliu Rusu
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Gillian A Hawker
- Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada. .,Department of Medicine, Women's College Hospital, Toronto, ON, Canada.
| | - Sasha Bernatsky
- Division of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada. .,Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
| | - Louise McRae
- Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Mayilee Canizares
- Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, ON, Canada.
| | - Crystal MacKay
- Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, ON, Canada.
| | - Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Babadağ B, Alparslan GB, Güleç S. The Relationship Between Pain Beliefs and Coping with Pain of Algology Patients'. Pain Manag Nurs 2015; 16:910-9. [PMID: 26320677 DOI: 10.1016/j.pmn.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 07/05/2015] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Abstract
A patient's beliefs, expectations, and attitudes about coping with pain are effective on the patient's pain control. The aim of this investigation was to evaluate the correlation between pain beliefs and coping with pain in algology patients. This descriptive study was carried out with 201 patients at a University Hospital Algology Clinic between May and July 2014. The research instruments used included a Descriptive Characteristics Data Form, Pain Beliefs Questionnaire, and Pain Coping Questionnaire. Data were evaluated by descriptive statistical methods, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. According to the findings, the duration of pain in the patients ranged from 1 month to 40 years, with a mean duration of 68.37 ± 89.42 months. Patients' organic beliefs mean score was 3.97 ± 0.78 and the psychological beliefs mean score was 5.01 ± 1.01. There was a significant negative correlation between patients' organic beliefs score and the self-management (p < .001, r = -.388) and conscious cognitive interventions scores (p < .001, r = -.331); with the helplessness score (p < .001, r = .365) there was a positive correlation. There was also a positive correlation between patients' psychological beliefs score and self-management score (p < .05, r = .162). Moreover, there is significant difference between organic beliefs score and patients who use opioid analgesic. Patients who believe that their pain's origin is a organic cause, such as damage and harm in the body, cannot cope with pain and feel more helplessness. Appropriate nursing interventions for individuals' pain beliefs should be implemented to nursing care plans on pain management.
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Affiliation(s)
- Burcu Babadağ
- School of Health, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Güler Balcı Alparslan
- School of Health, Department of Nursing, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Sacit Güleç
- Department of Anesthesiology and Reanimation, Eskişehir Osmangazi University, Eskisehir, Turkey
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Abstract
This review summarizes existing evidence relevant to the epidemiology of chronic pain in older adults, age-related differences relevant to pain, pain assessment, and important considerations regarding pain management in later life. Features unique to pain assessment in older adults include the likelihood of multiple diagnoses contributing to chronic pain, the ability of older adults to self-report, including those with mild to moderate cognitive impairment, and recognition that some older adults with cognitive impairment may demonstrate various behaviors to communicate pain. Management is best accomplished through a multimodal approach, including pharmacologic and nonpharmacologic treatments, physical rehabilitation, and psychological therapies. Interventional pain therapies may be appropriate in select older adults, which may reduce the need for pharmacologic treatments.
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Affiliation(s)
- Mark C Bicket
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, 55 Fruit Street Gray-Bigelow 444, Boston, MA 02114, USA.
| | - Jianren Mao
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Wang Ambulatory Care Center, 55 Fruit Street Gray-Bigelow 444, Boston, MA 02114, USA
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Lalonde L, Choinière M, Martin E, Lévesque L, Hudon E, Bélanger D, Perreault S, Lacasse A, Laliberté MC. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program. J Pain Res 2015; 8:203-15. [PMID: 25995648 PMCID: PMC4425332 DOI: 10.2147/jpr.s78177] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. METHODS Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. RESULTS Challenges identified in focus group discussions were related to five dimensions: knowledge gap, "work in silos", lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. CONCLUSION Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients.
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Affiliation(s)
- Lyne Lalonde
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada
| | - Manon Choinière
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Anesthesiology Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Elisabeth Martin
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Lise Lévesque
- Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Eveline Hudon
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Danielle Bélanger
- Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Sylvie Perreault
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marie-Claude Laliberté
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; AbbVie Corporation, St-Laurent, QC, Canada
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Karttunen NM, Turunen J, Ahonen R, Hartikainen S. More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain. Age Ageing 2014; 43:845-50. [PMID: 24814961 DOI: 10.1093/ageing/afu052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND persistent pain is a major problem in older people, but little is known about older persons' opinion about the treatment of persistent pain. OBJECTIVE the objective of this study was to investigate the factors associated with older participants having chronic musculoskeletal pain and hoping persistently that physician would pay more attention to the pain management. METHODS this 3-year follow-up study was a part of large population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. The population sample (n = 1000) of the GeMS study was randomly selected from older inhabitants (≥75 years) of Kuopio city, Finland, and participants were interviewed annually in the municipal health centre or in the participant's current residence by three study nurses. The current substudy included participants with chronic musculoskeletal pain (n = 270). Participants were asked specifically whether they hoped that more attention would be paid to pain management by the physician. RESULTS at baseline, 41% of the community-dwelling older participants with chronic musculoskeletal pain hoped the physician would pay more attention to pain management. Of those participants, 49% were still continuing to hope after 1 year and 31% after 2 years. A persistent hope to receive more attention to pain management was associated with poor self-rated health (OR: 2.94; 95% CI: 1.04-8.30), moderate-to-severe pain (OR: 3.46; 95% CI: 1.42-8.44), and the daily use of analgesics (OR: 4.16; 95% CI: 1.08-16.09). CONCLUSION physicians need to take a more active role in the process of recognising, assessing and controlling persistent pain in older people.
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Affiliation(s)
- Niina Maria Karttunen
- School of Pharmacy, University of Eastern Finland, PO Box 1627, Kuopio 70211, Finland
| | | | - Riitta Ahonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Tang SK, Tse MYM. Aromatherapy: does it help to relieve pain, depression, anxiety, and stress in community-dwelling older persons? BIOMED RESEARCH INTERNATIONAL 2014; 2014:430195. [PMID: 25114901 PMCID: PMC4119713 DOI: 10.1155/2014/430195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/10/2014] [Indexed: 12/21/2022]
Abstract
To examine the effectiveness of an aromatherapy programme for older persons with chronic pain. The community-dwelling elderly people who participated in this study underwent a four-week aromatherapy programme or were assigned to the control group, which did not receive any interventions. Their levels of pain, depression, anxiety, and stress were collected at the baseline and at the postintervention assessment after the conclusion of the four-week programme. Eighty-two participants took part in the study. Forty-four participants (37 females, 7 males) were in the intervention group and 38 participants (30 females, 8 males) were in the control group. The pain scores were 4.75 (SD 2.32) on a 10-point scale for the intervention group and 5.24 (SD 2.14) for the control group before the programme. There was a slight reduction in the pain score of the intervention group. No significant differences were found in the same-group and between-group comparisons for the baseline and postintervention assessments. The depression, anxiety, and stress scores for the intervention group before the programme were 11.18 (SD 6.18), 9.64 (SD 7.05), and 12.91 (SD 7.70), respectively. A significant reduction in negative emotions was found in the intervention group (P<0.05). The aromatherapy programme can be an effective tool to reduce pain, depression, anxiety, and stress levels among community-dwelling older adults.
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Affiliation(s)
- Shuk Kwan Tang
- Department of Orthopaedics & Traumatology, United Christian Hospital, Kowloon, Hong Kong
| | - M. Y. Mimi Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Abstract
Too many older adults live with the negative consequences of chronic pain and its detrimental impact on quality of life. To explore this, an extended literature review was conducted to identify barriers the older person encountered in the self-reporting of their chronic pain. Four themes were found to mediate help-seeking behaviour. Attitudes such as stoicism, beliefs such as pain being a necessary part of ageing, and the external barriers generated by health professionals, all have a multidimensional relationship with the 'decision' to seek help for pain. Personality and the perceived importance of independence were found to influence these responses. The findings imply that communication between the health professional and patient needs to improve during the more comprehensive assessment of chronic pain. To achieve such improvements, it is first necessary to eradicate ageist attitudes held both by the elderly and within health care.
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Affiliation(s)
- Victoria Gammons
- Staff Nurse, Critical Care Department, Doncaster Royal Infirmary, Doncaster
| | - Glenys Caswell
- Research Fellow, School of Health Sciences, University of Nottingham
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Van Son CR, Gileff TY. Relying on what they know: older Slavic emigres managing chronic health conditions. QUALITATIVE HEALTH RESEARCH 2013; 23:1660-1671. [PMID: 24132306 DOI: 10.1177/1049732313508842] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As the U.S. population ages and becomes increasingly diverse, health care professionals need to recognize the role of culture and life course in managing chronic health conditions. Older émigrés, in particular, face daunting challenges learning to navigate a new language, country, and health care system. In this focused ethnography, data collection included 16 months of participant observation and interviews with 28 Slavic participants (older émigrés, family caregivers, and key informants). Participants shared beliefs about the causes of chronic conditions, described treatments used, identified barriers to care, and expressed their expectations of U.S. health care providers. The findings provide insight into older émigrés' explanatory models of health, which can be used by health care providers to improve health care delivery to this underserved population.
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Abstract
OBJECTIVES The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients' experiences of chronic low back pain. METHODS Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and 'synthesised' to create superordinate themes. RESULTS Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams - health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors' recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. DISCUSSION The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.
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Abstract
Purpose
To review the current literature on help seeking for hearing health care among older adults.
Method
The authors conducted a literature review regarding help seeking for hearing-related communication difficulties as well as for other chronic medical conditions.
Results
Untreated hearing loss can lead to numerous negative secondary consequences; uptake and use of hearing aids remain low, despite the fact that hearing aids provide an effective treatment option for older adults with hearing loss. The authors describe models relevant to understanding the help-seeking and decision-making behaviors of older adults with hearing loss and discuss recommendations for future research.
Conclusion
Because of the considerable overlap in factors associated with help-seeking behaviors across chronic medical conditions and because help-seeking behaviors are complex, help seeking should be examined within the framework of a multifactorial model, such as the health belief model or the transtheoretical stages of change model.
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Affiliation(s)
- Gabrielle H. Saunders
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
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