Pain Attitudes Research Articles

Pediatric residents’ perceived barriers to opioid use in sickle cell disease pain management

Current guidelines recommend high-priority treatment of severe sickle cell disease (SCD) pain with opioids; however, patients with SCD have historically been undertreated. We used mixed methods to assess pediatric residents' perceptions toward opioid use in SCD pain management. We distributed a survey to 88 residents at an urban pediatric medical center in a cross-sectional study. Participants responded to questions about perceived barriers to acute SCD pain management and attitudes toward patients with SCD. Responses were examined using bivariate analyses. Five pediatric residents were interviewed, to provide more in-depth understanding of barriers to SCD pain management. Fifty-three residents (60%) completed the survey. Participants were divided into "more experienced" (had seen ≥ 21 patients with SCD; 45.3%) or "less experienced." Both groups reported potential for tolerance and dependence as major barriers to opioid use in SCD. Less experienced residents reported a greater need for additional training in SCD pain management (P<0.05), more concern about addiction, and greater empathy for patients with SCD (P<0.05). Both groups agreed that patients with SCD were "frustrating to care for." Thematic analysis revealed that increased patient and provider barriers led to distrust, ultimately leading to undertreatment of pain and inadequate care. Although more experienced residents reported feeling more comfortable treating acute SCD pain and were less concerned with addiction compared with less experienced residents, certain negative views of patients with SCD were prevalent among all residents. Findings suggest that residency training must address provider attitudes as well as knowledge about SCD.

Changes in pain knowledge, attitudes and beliefs of osteopathy students after completing a clinically focused pain education module

BackgroundChronic pain is a substantial burden on the Australian healthcare system with an estimated 19.2% of Australians experiencing chronic pain. Knowledge of the neurophysiology and multidimensional aspects of pain is imperative to ensure health professionals apply a biopsychosocial approach to pain. Questionnaires may be used to assess learner changes in neurophysiology knowledge and beliefs and attitudes towards pain after education interventions.The aim of this study was to evaluate changes in pain neurophysiology knowledge, beliefs and attitudes following a 12 week clinically-focused pain module in year 3 osteopathy students as measured by the Neurophysiology of Pain (NPQ) Questionnaire and Health Care Providers Pain and Impairment Relationship scale (HC-PAIRS).MethodsA pre-post design was utilised. Learners completed a demographic information survey pre-module, and completed the NPQ & HC-PAIRS prior to undertaking, and after completing, a twelve week clinically-focused pain module.ResultsLearners (n = 55) completed the NPQ & HC-PAIRS at both time points. The median NPQ score was significantly increased with a large effect size (p < 0.001, z = − 5.71, r = 0.78) following the completion of the module. In contrast, the HC-PAIRS total score was significantly increased after the completion of the module (p < 0.01, z = − 6.95, r = 0.91) suggesting an increase in negative pain attitudes and beliefs. Results indicate that a clinically-focused pain module can increase pain neurophysiology knowledge. However the HC-PAIRS results suggest an increase in negative pain attitudes and beliefs. The HC-PAIRS questionnaire was developed for use with chronic low back pain attitudes & beliefs in practitioners, rather than pre-clinical students. Students were provided with general principles of pain management, rather than condition specific pain management. This study is the first comparing pain neurophysiology knowledge and changes in attitudes and beliefs towards pain pre-post a clinically-focused pain module using the NPQ & HC-PAIRS.ConclusionsThere was a significant improvement in NPQ score after the 12 week clinically-focused pain module. The HC-PAIRS result was paradoxical and may reflect issues with the module design or the measurement tool. The module duration is longer than that reported in the literature and demonstrates effectiveness in increasing pain neurophysiology knowledge.

CN59 - Cancer pain knowledge and attitudes of nursing and medical professionals in a Greek general hospital

CN59 - Cancer pain knowledge and attitudes of nursing and medical professionals in a Greek general hospital

Item response theory evaluation of the biomedical scale of the Pain Attitudes and Beliefs Scale.

ObjectivesThe assessment of health care professionals’ attitudes and beliefs towards musculoskeletal pain is essential because they are key determinants of their clinical practice behaviour. The Pain Attitudes and Beliefs Scale (PABS) biomedical scale evaluates the degree of health professionals’ biomedical orientation towards musculoskeletal pain and was never assessed using item response theory (IRT). This study aimed at assessing the psychometric performance of the 10-item biomedical scale of the PABS scale using IRT.MethodsTwo cross-sectional samples (BeBack, n = 1016; DABS; n = 958) of health care professionals working in the UK were analysed. Mokken scale analysis (nonparametric IRT) and common factor analysis were used to assess dimensionality of the instrument. Parametric IRT was used to assess model fit, item parameters, and local reliability (measurement precision).ResultsResults were largely similar in the two samples and the scale was found to be unidimensional. The graded response model showed adequate fit, covering a broad range of the measured construct in terms of item difficulty. Item 3 showed some misfit but only in the DABS sample. Some items (i.e. 7, 8 and 9) displayed remarkably higher discrimination parameters than others (4, 5 and 10). The scale showed satisfactory measurement precision (reliability > 0.70) between theta values -2 and +3.DiscussionThe 10-item biomedical scale of the PABS displayed adequate psychometric performance in two large samples of health care professionals, and it is suggested to assess group-level professionals degree of biomedical orientation towards musculoskeletal pain.

A theory-based hybrid II implementation intervention to improve pain management in Swiss nursing homes: A mixed-methods study protocol.

To present a protocol for evaluating an implementation intervention to improve pain management in nursing homes by addressing behaviour change of the care workers. Pain management in nursing homes often is inadequate despite the availability of evidence-based pain management guidelines. Barriers to pain management in nursing homes occur on several levels including lack of knowledge and negative beliefs towards pain of care workers. A comprehensive approach incorporating contextual and behavioural factors is needed to sustainably improve pain management practice. A hybrid type II effectiveness-implementation design comprising an incomplete non-randomized stepped-wedge design and concurrent focus groups is proposed. A convenience sample of six nursing homes will be included. Implementation of a facility pain management policy will be facilitated by introduction of a facility pain champion and training of all care workers in pain assessment and management. Quantitative outcomes assessed at baseline, after 3 and 6 months include self-efficacy in pain management and attitudes to pain of care workers and functional interference from pain and pain intensity in residents. Feasibility and acceptability of the intervention and implementation strategies and potential barriers to implementation will be explored in focus groups and interviews. (Protocol approved in October 2017). The proposed intervention implementation has been developed in a participatory approach involving relevant stakeholders. To further improve the contextual fit, development of implementation strategies was guided by the consolidated framework of implementation research. Findings of this research are expected to inform adaptions to the implementation of the intervention. ClinicalTrials.gov: NCT03471390.

The Impact of an In-service Educational Program on Nurses' Knowledge and Attitudes Regarding Pain Management in an Ethiopian University Hospital.

Background: Although pain control for hospitalized patients is a central issue for all health care providers, nurses' knowledge, and attitudes are the major barriers. Educational program is a strategy to improve nurses' knowledge and attitudes on pain management. However, there is paucity of information on how in-service education program influences nurses' knowledge and attitudes score for pain management in Ethiopia. The objective of this study was therefore, to investigate the influence of an in-service educational program on nurses' knowledge and attitudes regarding pain management in an Ethiopian university hospital.Methods: A quasi-experimental study was conducted between 1 October and 15 November 2016. Totally 111 nurses working at Jimma University Medical Center participated in the study. We provided 2 consecutive days of intensive pain management education with a follow-up training session after 1 month. Knowledge and Attitudes Survey Regarding Pain (KASRP) was used as a tool for measuring the impact of educational program. Data were analyzed using the Wilcoxon signed-rank test, and results were considered significant at p < 0.05.Result: Of the 111 nurses, who participated in the study, 39.5% were female, 46.8% had a baccalaureate degree, and 67.6% had worked in nursing for 6–10 years. The mean age of respondents was 26.9 (SD ± 5.6) years. On average, participants answered 41.4% of the survey items correctly before the intervention and 63.0% after the intervention. The mean rank score of nurses' knowledge and attitudes regarding pain significantly improved following participation in the educational program (Z = −9.08, p < 0.001).Conclusion: The educational program improved nurses' scores for pain management knowledge and attitudes. This may lead to more effective pain management by nurses.

Prevalence, localization, perception and management of pain in dance: an overview

Background and aims Pain is a highly complex bio-psychosocial phenomenon that may present a (potential) health risk and either occurs as a warning sign or a symptom of injury. It cannot be ruled out that these rising or changing requirements in dance of all styles, are reflected in health-related outcomes such as pain. The aim of this narrative review article is to outline an overview of prevalence and localization, concepts of performance pain and injury pain, pain perception and pain management in dance. At that consequences of pain and influencing factors focusing on different dance styles or forms of professionalism are discussed. Methods The databases CINAHL, Cochrane, Google Scholar, Medline, MeSH and Web of Science were screened for relevant articles. Results Pain prevalence in dance is very high. Pain localizations can be related to high dance-specific mechanical stress on the musculoskeletal system. Depending on the pain characteristics, dancers perceive pain as "positive" (performance pain) or "negative" (injury pain). Concerning pain attitudes and management, dancers show an increasing pain tolerance. Pain seems to be accepted as a necessity, often ignored and dancing is continued despite pain. Conclusions The findings of this article suggest that occurrence of pain, pain perception, coping with pain and pain history appear to be connected to dance-specific mechanical stress as well as to socialization in dance culture. In dance, effects of pain on health seem to be associated with characteristics of pain and pain behavior. Implications The results highlight the high relevance of pain in dance and the need to take into account preventive as well as rehabilitative measures.

Effects of pain management training on pain perception in nurses with entrance level

Objective To explore the effects of pain management training on the perception of pain among nurses with entrance level. Methods A total of 140 nurses with entrance level who met the criteria were selected for the study in Zhejiang Quhua Hospital from January 2015 to December 2016. All subjects were randomly divided into training group and control group according to the random number method with 70 in each group. The nurses in the control group only carried out clinical practice. The training group nurses received pain management training on the basis of clinical practice. The scores of pain knowledge and attitude questionnaire before and after the training of nurses, the application of evaluation tools of nurses and the satisfaction of patients' analgesic effect were compared. Results Before intervention, there was no significant difference in the score of each dimension of pain knowledge and attitude questionnaire and the total score between the training group and the control group (P>0.05) . After intervention, the score of each dimension of pain knowledge and attitude questionnaire and the total score of the training group were all higher than those of the control group, with statistical significance (P<0.001) . In addition, after intervention, the accuracy of the applying assessment tool and patients' analgesic satisfaction rate in the training group were both higher than those in the control group, and the differences were statistically significant (P<0.05) . Conclusions Pain management training can improve the pain perception of the nurses with entrance level, improve the correct application of pain assessment tools, and improve patient satisfaction with pain. Key words: Pain; Cognition; Training; Nurses with entrance level

Neurophysiological Pain Education for Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=-1.03 (95% confidence interval [CI], -0.55 to -1.52), and after 3 months, WMD=-1.09 (95% CI, -2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=-0.47 (95% CI, -0.80 to -0.13) and after 3 months SMD=-0.38 (95% CI, -0.74 to -0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=-5.73 (95% CI, -13.60 to 2.14) and after 3 months WMD=-0.94 (95% CI, -6.28 to 4.40). There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.

The role of pain in chronic pain patients' perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients.

Background and aims Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics. Methods Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects. Results There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables. Conclusions Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.

The attitudes and beliefs of UK osteopaths towards the management of low back pain: A cross-sectional study

ObjectivesTo assess the biomedical (BM) and biopsychosocial (BM) attitudes and beliefs of osteopaths towards the management of low back pain (LBP) and whether this is associated with certain demographic variables. MethodsA cross-sectional survey of UK osteopaths was undertaken utilising the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT), which assesses practitioners' treatment orientation (BPS or BM) in LBP management. A demographic questionnaire was used to assess the relationship with certain demographic variables. ResultsResponses were analysed from 107 osteopaths. The mean PABS.PT score for the BM scale was 32.41 (SD 6.32) and 31.99 (SD 4.09) for the BPS scale. There was a statistically significant, negative correlation between the scales. Most osteopaths recognised stress as a contributing factor to LBP and believed in the benefits of exercise for LBP but had diverse views regarding the relationships between pain and tissue damage. None of the demographic variables were associated with the PABS.PT scales. ConclusionOsteopaths' beliefs may indicate an acceptance of the BPS approach, but some still hold strong BM beliefs about pain, which may influence their clinical decision making. Future studies should investigate the impact of osteopaths’ beliefs on their clinical management of LBP.

Pain Knowledge and Attitudes Among Nurses in Cancer Care in Norway.

The purpose of this study was to survey knowledge on, and attitudes to, pain and pain management among a cohort of Norwegian Nurses in cancer care, and to explore whether there is any association between various demographic variables and knowledge level. This is a web-based survey and nurses were recruited from the Forum for Cancer Nursing. Nurses completed the questionnaire "Nurses' Knowledge and Attitudes Survey Regarding Pain (NKAS)". Univariate and multivariate linear regression analysis were used to evaluate the association between knowledge and attitudes and demographic variables. Nurses from all over Norway answered. The majority were women and most had education above bachelor level. Mean NKAS total score was 31 points (75%). Significant associations were found between NKAS total score and pain management course (p = 0.01) and workplace (p = 0.04). Nurses in cancer care in Norway have relatively good pain knowledge. The potential for improvement is the greatest with regard to pharmacology and nurses' attitudes to how patients express pain. Our findings suggest that an extensive pain management course with patient histories may result in more theoretical knowledge being applied to the patients. In a time with large migration among nurses, our findings indicate that pain management courses should be aware of cultural differences in the educational training.

Investigation of pain knowledge and attitude of clinical nurses

Objective To investigate and analyze the level and attitude of the pain knowledge of clinical nurses in a Third-level grade-A hospital and provide an objective basis for improving the comprehensive standardized pain nursing management system. Methods Pain Knowledge and Attitude Questionnaire translated by Tong Yingge were used to have investigation.The method of stratified random sampling was used to have questionnaire for 200 clinical nurses of a certain grade III class A hospital. Results The pain knowledge of clinical nurses was poor, and the score of pain knowledge was only 42.65%. Conclusion Clinical nurses pain related knowledge is quite scarce.We needs to strengthen clinical nurses pain knowledge training, standardize the pain nursing management, improve the level of clinical nurses pain knowledge, thereby improving the patient's satisfaction and quality of life. Key words: Pain; Nurses; Attitude

The Effect of Pain Neuroscience Education on Sports Therapy and Rehabilitation Students' Knowledge, Attitudes, and Clinical Recommendations Toward Athletes With Chronic Pain.

Context: Pain education is a fundamental part of a holistic approach to athlete injury management. Objective: To investigate the effect of pain neuroscience education (PNE) on sports therapy and rehabilitation students (1)knowledge of persistent pain, (2)attitudes toward athletes with persistent pain, and (3)clinical recommendations for athletes with persistent pain. Design: Parallel groups, single-blind randomized control trial. Setting: A university in the United Kingdom. Participants: Sixty-one undergraduate and postgraduate sports therapy and rehabilitation students. Interventions: The PNE session (intervention group) provided detailed information on the neuroscience of persistent pain, the modulating role of psychosocial factors on pain biology, and how this information could be used to inform clinical practice. The red flags (control group) session provided information on screening patients with persistent pain for serious/sinister pathologies. Each education session lasted 70 minutes. Outcome measures: (1)Knowledge-the Revised Pain Neurophysiology Questionnaire; (2)Attitudes-the Health Care Pain Attitudes and Impairment Relationship Scale; and (3)Clinical recommendations-an athlete case vignette. Results: Posteducation, the PNE group had a greater increase in pain neuroscience knowledge (mean difference 3.2; 95% confidence interval [95% CI], 2.1 to 4.3; P < .01) and improved attitudes (mean difference -10.1; 95% CI, -16.6 to -3.6; P < .01). In addition, students in the PNE group were more likely to make appropriate clinical recommendations (odds ratio [OR]; 95% CI) regarding return-to-work (OR = 6.1; 95% CI, 1.1 to 32.3; P = .03), exercise (OR = 10.7; 95% CI, 2.6 to 43.7; P ≤ 01), and bed rest (OR = 4.3; 95% CI, 1.5 to 12.8; P = 01). Conclusion: A brief PNE session can, in the immediate term, increase sports therapy and rehabilitation students' knowledge of pain neuroscience, improve attitudes toward athletes with pain, and shift their clinical recommendations in line with current guidelines. Such changes could lead to enhanced rehabilitation for athletes with persistent pain.

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'.

Background and aim: ‘Reasoning 4 Change’ (R4C) is a newly developed instrument, including four domains (D1–D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1–D4); inter-rater reliability (D2–D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67–0.91), satisfactory test-retest reliability (ICC range: 0.46–0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94–1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06–0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Beliefs and attitudes in patients with chronic low back pain

ABSTRACT BACKGROUND AND OBJECTIVES: Dysfunctional attitudes and beliefs in patients with low back pain may interfere with pain, disability, and mood. The objective of this study was to evaluate the behavior of beliefs and attitudes in chronic low back pain and to correlate them with the intensity of pain, disability, anxiety, and depression. METHODS: We evaluated 82 patients with chronic low back pain according to the Numerical Scale of Pain, Survey of Pain Attitudes, Hospital Scale of Anxiety and Depression, and Oswestry Disability Index. RESULTS: More than half of the patients were female (51.22%) with a mean age above 40 years. The pain was mild to moderate at 53.65%. Severe disability was observed in 64.63%, anxiety in 63.41% and depression in 41.46%. The solicitude and disability beliefs showed significant associations in all groups. For physical damage, there was an association with disability and anxiety. Medical cure correlated between the anxiety variable. CONCLUSION: Patients presented dysfunctional beliefs associated with the intensity of pain, anxiety, depression and mainly disability, with a probable influence on the treatment. This relationship shows how important it is to carry out new studies that evaluate therapeutic approaches, such as targeted interventions and educational programs, aimed at the patient’s beliefs with low back pain to determine their impact on pain control and treatment.

A Preliminary Study of Chiropractors’ Beliefs About Biomedical and Biopsychosocial Pain: A Survey of University of Western States Alumni

ObjectiveThe purpose of this preliminary study was to investigate differences between doctors of chiropractic with respect to their preference for the biomedical or biopsychosocial attitude and belief models. MethodsAlumni of the University of Western States doctor of chiropractic program were asked to complete an online survey that included the Pain Attitudes and Beliefs Scale for Physiotherapists. This scale yields a biomedical score (10-60 scale) and a biopsychosocial score (9-54 scale). These scores are reported for 5 participant characteristics: sex, country of residence (USA vs other), chiropractic program completed (University of Western States vs other), decade of graduation, and years in practice. Secondarily, multiple linear regression was performed to evaluate the independent effects of participant characteristics on the 2 Pain Attitudes and Beliefs Scale for Physiotherapists scales. ResultsOf 3877 surveys, 233 were included in the analysis (response rate = 4.7%-7.4%). The mean biomedical scale score was 33.9 (standard deviation = 6.5), and the mean biopsychosocial scale score was 32.4 (standard deviation = 4.1). There was little variation in scores across the 5 participant characteristics (P > .05). Cronbach’s α for the biomedical scale reached an acceptable level of internal consistency (0.74). In contrast, Cronbach’s α for the biopsychosocial scale was 0.40. ConclusionThis preliminary study found that in a sample of chiropractic program alumni of the University of Western States, there were no differences with respect to preference for the biomedical or biopsychosocial attitude and belief models. A better understanding requires a larger study comparing attitudes/beliefs with behavior in practice.

Improved health-related quality of life, participation, and autonomy in patients with treatment-resistant chronic pain after an intensive social cognitive intervention with the participation of support partners.

Despite the availability of various specific treatments, most patients with chronic pain (CP) consider their pain problem as undertreated. Recently, multiple sclerosis (MS) patients who were given an intensive 3-day social cognitive treatment with the participation of support partners experienced lasting improvements in health-related quality of life (HRQoL) and self-efficacy. In this study, a similar intervention was given to treatment-resistant CP patients with stressors, relational problems with support partner, and distress, anxiety or depression. Before and 1, 3, and 6 months after the intervention, patients completed the Euro-Qol 5 Dimensions 5 Levels (EQ-5D-5L) and Impact on Participation and Autonomy (IPA) questionnaires (primary outcomes), and the Survey Of Pain Attitudes (SOPA), the Four-Dimensional Symptom Questionnaire (4DSQ) (distress, depression, anxiety, and somatization), and Visual Analog Scale for pain intensity, whereas the support partners completed the Caregiver Strain Index (CSI) questionnaire. Differences between baseline and post-treatment were tested via paired t-tests (significance level 0.05). Of the 39 patients who were included, 34 (87.2%) completed the 3-day treatment. At 1, 3, and 6 months, improvements were seen in EQ-5D-5L-Index (+40.6%; +22.4%; +31.7%), Health Today (+61.8%; +36.3%; +46.8%), Control attitude (+45.8%; not significant [NS]; +55.0%) and decreases in IPA-Problems (−14.8%; NS; −20.4%), Harm attitude (−18.9%; −15.0%; −17.7%), Distress (−17.7%; −31.8%; −37.1%), and Depression (−37.4%; −31.4%; −35.7%) scores. The CSI score had decreased by −29.0%, −21.4%, and −25.9%, respectively. In conclusion, after an intensive 3-day social cognitive intervention, treatment-resistant CP patients experienced substantial and lasting improvements in HRQoL and in problematic limitations to participation and autonomy, in association with improvements in pain attitudes, depression, and distress. To assess whether this innovative approach may be an effective treatment for this subgroup of CP patients, future randomized controlled studies are needed.

Do Correlates of Pain-Related Stoicism and Cautiousness Differ in Younger and Older People With Advanced Cancer?

Age differences are not evident in pain-related stoicism and cautiousness in people with cancer pain. Little is known about the factors associated with these pain-related attitudes or age-related patterns in these associations. The present cross-sectional study investigated the biopsychosocial correlates of the attitudes in younger and older patients with advanced cancer. Pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60 years old) and 114 older (60 years old or older) patients with advanced cancer completed the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity, cognitive-affective pain-related responses, physical functioning, psychological distress and well-being, and psychosocial functioning. Backwards regression analyses identified correlates for each PAQ-R factor separately for younger and older patients. Activity engagement was a frequent correlate, but its relationship with concealment was the only association common to both age groups. Younger and older patients exhibited different avoidance-related constructs suggesting relational challenges in the former group (avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance). Medical correlates also showed age differences: younger patients showed symptom-focused correlates, whereas older patients showed aging-related correlates. Findings support a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental perspective. PerspectiveTo our knowledge, this article is the first to identify biopsychosocial correlates of stoic and cautious attitudes toward cancer pain in younger and older patients with advanced cancer. Findings highlight possible age-related motivations for greater pain-related stoicism or cautiousness and can potentially inform interventions addressing challenges in cancer-pain adaptation in advanced cancer.

Chronic Pain and Associated Factors in India and Nepal: A Pilot Study of the Vanderbilt Global Pain Survey.

Evaluation and treatment of chronic pain worldwide are limited by the lack of standardized assessment tools incorporating consistent definitions of pain chronicity and specific queries of known social and psychological risk factors for chronic pain. The Vanderbilt Global Pain Survey (VGPS) was developed as a tool to address these concerns, specifically in the low- and middle-income countries where global burden is highest. The VGPS was developed using standardized and cross-culturally validated metrics, including the Brief Pain Inventory and World Health Organization Disability Assessment Scale, as well as the Pain Catastrophizing Scale, the Fibromyalgia Survey Questionnaire along with queries about pain attitudes to assess the prevalence of chronic pain and disability along with its psychosocial and emotional associations. The VGPS was piloted in both Nepal and India over a 1-month period in 2014, allowing for evaluation of this tool in 2 distinctly diverse cultures. Prevalence of chronic pain in Nepal and India was consistent with published data. The Nepali cohort displayed a pain point prevalence of 48%-50% along with some form of disability present in approximately one third of the past 30 days. Additionally, 11% of Nepalis recorded pain in 2 somatic sites and 39% of those surveyed documented a history of a traumatic event. In the Indian cohort, pain point prevalence was approximately 24% to 41% based on the question phrasing, and any form of disability was present in 6 of the last 30 days. Of the Indians surveyed, 11% reported pain in 2 somatic sites, with only 4% reporting a previous traumatic event. Overall, Nepal had significantly higher chronic pain prevalence, symptom severity, widespread pain, and self-reported previous traumatic events, yet lower reported pain severity. Our findings confirm prevalent chronic pain, while revealing pertinent cultural differences and survey limitations that will inform future assessment strategies. Specific areas for improvement identified in this VGPS pilot study included survey translation methodology, redundancy of embedded metrics and cultural limitations in representative sampling and in detecting the prevalence of mental health illness, catastrophizing behavior, and previous traumatic events. International expert consensus is needed.