Chronic Pain Duration Research Articles

Assessing the Association of Pain Intensity Scales on Quality of Life in Elderly Patients with Chronic Pain: A Nursing Approach.

Chronic pain is prevalent among the elderly and significantly affects their quality of life (QoL). Pain intensity scales are crucial tools in evaluating the severity of pain and tailoring management strategies. This study investigates the relationship between various pain intensity scales and QoL among elderly patients with chronic pain, highlighting the implications for nursing practice. A cross-sectional study was conducted with 150 elderly patients (aged 65 and above) in Riyadh, Saudi Arabia. Participants were assessed using the Numeric Rating Scale (NRS), Visual Analog Scale (VAS), and McGill Pain Questionnaire (MPQ) alongside the 36-Item Short-Form Health Survey (SF-36) to evaluate QoL. Data analysis involved Pearson correlation and multiple regression to explore the association of pain intensity on QoL. All pain scales showed significant negative correlations with QoL. The MPQ exhibited a significant association, suggesting its comprehensive nature captures the multidimensional association of pain more effectively. Regression analysis identified pain intensity, age, and duration of chronic pain as significant predictors of reduced QoL. The findings emphasize the importance of selecting appropriate pain assessment tools that reflect the complex nature of pain in elderly patients. Implementing comprehensive pain assessments like the MPQ can enhance individualized care strategies and potentially improve the QoL in this population. This study underscores the role of nurses in optimizing pain management approaches tailored to the elderly.

Prevalence and epidemiological characteristics of chronic pain in the Spanish population. Results from the pain barometer.

Chronic pain (CP) is a public health problem worldwide. To update the prevalence of CP and compare the clinical and social characteristics of people with CP with those with non-chronic continuous pain and a group without pain. An observational cross-sectional study was carried out in a representative sample of 7058 adults from the Spanish population. Sociodemographic data, the presence of CP and non-chronic continuous pain, characteristics of pain, limitations on activities of daily living (ADL), the presence and level of anxiety and depression (HADS), quality of life (SF-12v2) and social support (DUKE) were collected. Descriptive and bivariate analyses were performed. The prevalence of CP was 25.9% (95% CI;24.8-26.9) and that of non-chronic continuous pain was 7.7% (95% CI;7.1-8.3). Women presented a higher prevalence of both CP (30.5% vs. 21.3%) and non-chronic continuous pain (8.8% vs. 6.6%). CP was more common in the group between 55 and 75 years old (30.6%, 95% CI = 28.6-32.6%), non-chronic continuous pain affected most the population between 18 and 34 years old (11.2%, 95% CI = 9.6-12.7%). The median duration of CP was 4 years. The lumbar was the most frequent pain site (58.1%), and 27.1% did not know the cause. A greater frequency of limitations on ADL, more anxiety and depression, and worse quality of life were shown among the subjects with CP. CP affects one in four Spanish people and impairs the mental, physical and social health. Differences exist by sex and age in its frequency. Identifying subjects with non-chronic continuous pain is fundamental to prevent their pain from becoming chronic. Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Due to its high prevalence and impact on quality of life, chronic pain has become one of the main health problems nowadays. Attention must be paid to it both from a clinical and social perspective, trying to raise awareness among the population of its possible causes and consequences. In routine clinical practice, greater consideration is given to groups of people with a higher prevalence of chronic pain, such as women and people with middle age, and with no chronic pain to prevent the appearance of chronic pain.

Relationship between perfectionism, overactivity, pain severity, and pain interference in individuals with chronic pain: A cross-lagged panel model analysis.

Overactivity is a characteristic of individuals with chronic pain. Previous cross-sectional studies demonstrated a relationship between perfectionism and overactivity. Therefore, the present study used a longitudinal design to determine whether pain severity and pain interference were exacerbated by overactivity and whether overactivity was exacerbated by perfectionism. Participants with chronic pain were recruited using crowdsourcing. The participants completed the questionnaires at three time points: T1, T2, and T3 (September, October, and November 2021, respectively). The questionnaire assessed overactivity, perfectionistic strivings, perfectionistic concerns, pain severity, and pain interference. We created cross-lagged panel models to examine the hypothesized relationships among pain, overactivity, and perfectionism. After excluding ineligible participants and invalid response sets, we analyzed the questionnaires completed by 666 participants at T1, 560 at T2, and 554 at T3. The average duration of chronic pain at T1 was 36.35 ± 53.53 months. Perfectionistic strivings were partially linked to overactivity, and pain interference was partially related to overactivity. Contrary to our expectations, overactivity did not predict pain severity or pain interference. The hypotheses that perfectionism exacerbates overactivity and that overactivity exacerbates pain severity and pain interference were not supported. These results may have been affected by the quality of the assessment of overactivity. Therefore, further research with a refined evaluation of overactivity is required.

Management of chronic pain in a rural Australian setting: Findings from the Crossroads-II mixed-methods study.

A cross-sectional survey (2016-18) involving quantitativeand text-based data was completed by adultsfrom randomly selected households in the Goulburn Valley, Victoria. Among the 2680 respondents, 594 (22%) reported chronic pain. Few (6%) respondents with chronic pain were accessing specialist pain clinics. Logistic regression analysis suggested that the strongest predictors of well‑managed chronic pain were older age, the absence of depression or disability and a longer duration of chronicpain. This study found a similar prevalence of chronic pain to other, predominantly metropolitan Australian studies, withlow participation in specialist pain clinics. The results suggest that improved access to multidisciplinary pain management approaches in rural areas is warranted.

The Duration of Chronic Pain Can Affect Brain Functional Changes of the Pain Matrix in Patients with Chronic Back Pain: A Resting-State fMRI Study.

This study was conducted to explore the differences in functional changes in the pain matrix in patients with chronic back pain (CBP) at different stages and identify whether these brain changes were related to the pain duration. In this study, 29 healthy individuals and 54 patients with CBP were recruited. According to the pain duration, 25 patients (3 to 12 months) were divided into the CBP-S group and 29 patients (≥ 24 months) were divided into the CBP-L group. All subjects completed clinical pain-related measurement and functional magnetic resonance imaging (fMRI) scans. Moreover, the amplitude of low-frequency fluctuation (ALFF), functional connectivity (FC), and correlation analysis were conducted in this study. Compared with healthy controls, patients in the CBP-L group showed significantly decreased ALFF in the left precuneus. In the FC analysis, patients in the CBP-S and CBP-L groups showed significantly decreased FC in several regions in the bilateral orbitofrontal cortices (OFC) and the left ventral posterior insula. Moreover, there were significant differences in the FC between the left hyper granular insula and the probabilistic area in OFC in pairwise group comparisons. The correlation analysis results demonstrated that pain duration was correlated with these functional brain changes, and the ANCOVA results revealed that pain intensity and pain interference scores did not affect the FC analysis results. There are different changes in the pain neural matrix in patients with chronic pain at different stages. Furthermore, the pain duration is related to brain functional changes.

The impact of fibromyalgia syndrome on obstructive sleep apnea syndrome in terms of pain threshold, daytime symptoms, anxiety, depression, disease severity, and sleep quality: a polysomnographic study.

Current studies have focused on the association of fibromyalgia syndrome (FMS) and obsctructive sleep apnea syndrome (OSAS). Results of these studies on the effect of this association have been inconsistent. The current study aimed to investigate the effect of FMS on OSAS regarding sleep quality, pressure pain threshold, fatigue, daytime symptoms, anxiety, and depression, and also to determine the relationship between OSAS severity and FMS. In a cross-sectional design, patients diagnosed with OSAS were evaluated in two groups comparing those with and those without FMS. Data on demographics, headache, morning fatigue, and chronic pain duration were collected. Questionnaires including the Fatigue Severity Scale (FSS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were completed. Pressure pain threshold, tender points, and polysomnographic data were recorded. Of 69 patients, 27 were diagnosed with FMS + OSAS and 42 were diagnosed as OSAS only. Statistically significant differences were found between the two groups in VAS, pain duration, morning fatigue, headache, BAI, tender point count, FIQ and FSS scores, and algometer measurements. All polysomnografic data were compared, and no statistically significant differences were found between the two groups. There were no statistically significant differences in the algometer, BDI, BAI, FIQ, and FSS scores when analyzed according to the severity of OSAS. The findings suggest that FMS has no effect on polysomnographic parameters of OSAS. Headache, daytime fatigue, anxiety, depression, pain duration, and pain intensity are higher while the pressure pain threshold is lower when FMS is present. No correlation was found between OSAS severity and FMS, fatigue, pressure pain threshold, depression, and anxiety. NCT05367167/date: April 8, 2022.

Deep Brain Stimulation for Chronic Facial Pain: An Individual Participant Data (IPD) Meta-Analysis

Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be considered as a potential effective treatment option. We performed an individual participant data (IPD) meta-analysis including searches on PubMed, Embase, and the Cochrane Library (2000-2022). The primary endpoint was the change in pain intensity (visual analogue scale; VAS) at a defined time-point of ≤3 months post-DBS. In addition, correlation and regression analyses were performed to identify predictive markers (age, duration of pain, frequency, amplitude, intensity, contact configuration, and the DBS target). A total of seven trials consisting of 54 screened patients met the inclusion criteria. DBS significantly reduced the pain levels after 3 months without being related to a specific DBS target, age, contact configuration, stimulation intensity, frequency, amplitude, or chronic pain duration. Adverse events were an infection or lead fracture (19%), stimulation-induced side effects (7%), and three deaths (unrelated to DBS-from cancer progression or a second stroke). Although comparable long-term data are lacking, the current published data indicate that DBS (thalamic and PVG/PAG) effectively suppresses facial pain in the short-term. However, the low-quality evidence, reporting bias, and placebo effects must be considered in future randomized-controlled DBS trials for facial pain.

Factors associated with general practitioner visits for pain in people experiencing chronic pain.

Introduction Patients with chronic pain (CP) are frequent users of general practitioners (GPs). Aim This study aimed to assess factors associated with the rate of GP visits related to pain in patients with CP. Methods This study used data collected by adult specialist pain management services (SPMS) that participated in the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia. Adult patients (18 years or older) with CP (duration greater than 3 months) who were referred to SPMS from the calendar year 2015-2021 were included (N = 84 829). Results Patients who reported severe anxiety, stress, pain, pain interference, pain catastrophising and severely impaired pain self-efficacy were more likely to seek help from a GP. Patients with longer pain duration had a lower rate of GP visits. The rate of GP visits was 1.22 (IRR = 1.22, 95% CI: 1.19, 1.26) times higher in patients with severe pain severity, compared to patients with mild pain severity. Patients who used opioids were more likely to visit a GP (IRR = 1.32, 95% CI: 1.30, 1.34) than those who were not using opioids. Discussions More than half of the adult CP patients had greater than three GP visits in the 3 months before referral. This study would indicate that some patients may attend their GP to seek an opioid prescription. Given the rising use of opioids nationally, future study is required on opioid users' GP visitation practices. Additionally, the inverse association between pain duration and the rate of GP visits warrants further exploration.

Reading Wharton with Pain: On Rest, Practices, and Care.

Critics have widely regarded Edith Wharton's Twilight Sleep (1927) as an ironic novel about pain: a satire of modern life's supposed promise that pain can be avoided. This essay argues that Wharton's novel is as much about managing pain as it is about avoiding it. I consider the novel in light of experiences of chronic pain and illness, both Wharton's and my own. My analysis finds that while the novel's satire targets the fleeing of pain, the text also engages aspects of life lived with pain. The characters demonstrate constant fatigue, a symptom of pain's presence; they undertake mental, physical, and care practices as modes of pain management; and the text's formal structures suggest chronic pain's duration. By focusing not on direct representations of pain but on how pain can condition a life (and a narrative), I elucidate the ongoing value of making a distinction between managing pain and avoiding it.

Occupational therapy lifestyle intervention added to multidisciplinary treatment for adults living with chronic pain: a feasibility study

ObjectivesTo evaluate the feasibility and outcomes of an occupational therapy lifestyle intervention for adults living with chronic pain.DesignThis one-group pre-post interventional study investigated the feasibility and outcomes of the Redesign...

Spinal cord stimulation for treatment of complex regional pain syndrome: a single-centre retrospective case series study.

Complex regional pain syndrome (CRPS) is a debilitating disease with limited available treatment options. Spinal cord stimulation (SCS) is a universal option that promises to improve quality of life by reducing intractable neuropathic pain. The aim of this study was to describe the effectiveness and safety of SCS as a treatment for CRPS patients. SCS as an invasive method has relatively recently been introduced to CRPS therapy. We hypothesised that by assessing the effectiveness and safety of SCS, we could justify its early use in the treatment of this debilitating condition. CRPS is a multifactorial and disabling disorder with complex aetiopathogenesis. The primary goals of CRPS treatment include pain relief, functional restoration, and psychological stabilisation. Early intervention is needed to achieve these objectives. In this study, we performed a retrospective evaluation of clinical outcomes in seven patients with severe, intractable CRPS treated by SCS. All patients underwent implantation of a non-rechargeable prime advanced MRI implantable pulse generator (IPG) (Medtronic, Minneapolis, MN, USA) between December 2017 and December 2020 using identical surgical and intraprocedural techniques. From a total of 21 patients treated with SCS over the three years in question, seven (33%) were diagnosed with severe CRPS. The duration of chronic pain ranged between two and 12 years. In six cases (86%), an electrode was implanted in the thoracic segment. Good (partial pain reduction) or very good (complete pain relief) treatment results were observed in five patients (72%). In two cases (28%), two revision surgeries were performed for wound debridement. These hardware-related complications were primarily related to erosions located over implanted IPG's. SCS is the best alternative for patients with CRPS. It should be used immediately after the failure of conservative treatment. Despite the relatively high complication rate in our series, it is the best choice for pain reduction management in this select group of patients.

A new therapeutic target for chronic pain: GPR171 agonism reduces chronic neuropathic and inflammatory pain

Chronic pain is a debilitating condition leading to impaired quality of life but has few efficacious therapeutic options. The use of opioids to treat chronic pain is associated with well‐known drawbacks including drug dependence and addiction. The development of opioid alternatives to treat chronic pain is an urgent, yet unmet, need. Here we show the therapeutic potential of GPR171, a G‐Protein Coupled Receptor that was recently identified to regulate morphine antinociception. Previously shown that systemic administration of the GPR171 agonist, MS15203, enhances morphine antinociception in acute pain tests in mice. Here, we show that once‐daily systemic administration of MS15203 (10 mg/kg, i.p.) over the course of 1 week improved chronic pain outcomes in two different mouse pain models. Chemotherapy‐induced peripheral neuropathy (CIPN) was induced by injecting Paclitaxel (16 mg/kg cumulative) and inflammatory pain was induced by injecting Complete Freund’s Adjuvant (CFA) under the epidermis into the plantar surface of both hind paws (20 µl/paw). MS15203 improved mechanical allodynia caused by CIPN and reduced thermal hypersensitivity caused by CFA‐induced inflammatory pain. The reduction of chronic pain duration was observed only in male mice, but not in female mice, indicating a sex‐dependent effect at this particular dose of GPR171 agonist. Analysis of GPR171 protein levels in the midbrain Periaqueductal Gray showed that neuropathic pain decreased GPR171 receptor levels in males, but treatment by MS15203 rescued this decrease. Taken together, our findings show that GPR171 activity exhibits sexual dimorphism and can regulate multiple modalities of chronic pain.

The duration of chronic low back pain is associated with acute postoperative pain intensity in lumbar fusion surgery: a prospective observational study

BackgroundPre-existing chronic pain has been associated with severe postoperative pain. In this study, we sought to prospectively analyse the association between the duration of chronic low back pain and the intensity of acute postoperative pain after lumbar fusion surgery.MethodsA total of 330 patients who underwent lumbar fusion surgery were divided into three groups (chronic low back pain less than 1 year, one to 5 years, and more than 5 years) based on the duration of chronic pain. On the first postoperative day, the maximum pain scores of each patient were recorded during the day and at night. Bivariate correlation and logistic regression were performed to identify relationships between acute postoperative pain and related variables (age, sex, smoking history, body mass index, operation history, duration of surgery, level of preoperative pain, aetiology of back pain, Self-rating Anxiety Scale, Self-rating Depression Scale, FRAIL scale, and duration of chronic low back pain). If the postoperative pain score was > 3 when the patient reported was at rest, the patients were treated with postoperative intravenous self-controlled analgesia or rescue analgesics if necessary.ResultsThere was an association between severe acute postoperative pain and the duration of chronic low back pain. In terms of VAS day, multivariable logistic regression showed the duration of chronic low back pain was not statistically significant (OR = 2.48, 95% CI: 0.900 to 6.828, p = 0.0789). The result is uncertain because the confidence interval included the null after controlling for SAS, SDS, BMI, and aetiology of back pain. In terms of VAS night, patients with a duration of chronic low back pain of more than 5 years were more likely having moderate to severe acute postoperative pain (VAS > 3) compared to patients with a duration of chronic low back pain less than 1 year (OR = 3.546, 95% CI: 1.405 to 8.95, p = 0.0074). Hospital stay, the pain score on the day of discharge and the pain score after 3 months displayed no significant difference among the three groups (P > 0.05). However, the need for postoperative rescue analgesics was different among the three groups (P < 0.05).ConclusionThe longer the duration of chronic pain was, the higher the incidence of moderate to severe acute postoperative pain was and the greater the amount of analgesics required after surgery.Trial registrationThis study was registered at the Chinese Clinical Trial Registration Center (http://www.chictr.org.cn/index.aspx, clinical trial number: ChiECRCT20200165, date of registration: July 6, 2020).

Chronic Lumbar Pain and Insomnia in College-Aged Students.

Insomnia in college students has a significant impact on academic performance and mental health (e.g., depression). Although the mechanisms underlying insomnia and chronic pain are becoming clearer, only a few studies on college students have examined these factors by their location in the body. The purpose of the present study was to identify the location of chronic pain in the body most associated with insomnia in college students. A web-based survey was used to collect information pertaining to nine questions from 494 university students: sex, age, presence of chronic pain, intensity of chronic pain, location of chronic pain, and duration of chronic pain, as well as scores from the Athens Insomnia Scale (AIS), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. To examine the association between insomnia and the site of chronic pain, stepwise logistic regression analysis was conducted with AIS as the target variable. The results showed a significant positive correlation between chronic pain in the lumbar region and AIS scores. Future longitudinal studies including multiple factors are necessary to clarify the causal relationship between insomnia and chronic lower back pain.

367 Development of Machine Learning Based Models to Predict Treatment Response to Spinal Cord Stimulation

INTRODUCTION: Despite spinal cord stimulation’s (SCS) proven efficacy, failure rates are high with no clear understanding of which patients benefit long-term. Currently, patient selection for SCS is based on the subjective experience of the implanting physician. METHODS: A combined unsupervised (clustering) and supervised (classification) ML techniques was applied on a prospectively collected cohort of 151 patients which included 31 features. Clusters identified using unsupervised K-means clustering were fitted with individualized predictive models of logistic regression, random forest and XGboost. RESULTS: Two distinct clusters were found and patients in the cohorts significantly differed in age, duration of chronic pain, pre-operative numeric rating scale (NRS) and pre-operative pain catastrophizing scale scores. Using the 10 most influential features, logistic regression predictive models with a nested cross-validation demonstrated the highest overall performance with area under the curve (AUC) of 0.757 and 0.708 for each respective cluster. CONCLUSION: This combined unsupervised-supervised learning approach yielded high predictive performance, suggesting advance ML-derived approaches have potential to be utilized as a functional clinical tool to improve long-term SCS outcomes.

Development of Machine Learning-Based Models to Predict Treatment Response to Spinal Cord Stimulation.

Despite spinal cord stimulation's (SCS) proven efficacy, failure rates are high with no clear understanding of which patients benefit long term. Currently, patient selection for SCS is based on the subjective experience of the implanting physician. To develop machine learning (ML)-based predictive models of long-term SCS response. A combined unsupervised (clustering) and supervised (classification) ML technique was applied on a prospectively collected cohort of 151 patients, which included 31 features. Clusters identified using unsupervised K-means clustering were fitted with individualized predictive models of logistic regression, random forest, and XGBoost. Two distinct clusters were found, and patients in the cohorts significantly differed in age, duration of chronic pain, preoperative numeric rating scale, and preoperative pain catastrophizing scale scores. Using the 10 most influential features, logistic regression predictive models with a nested cross-validation demonstrated the highest overall performance with the area under the curve of 0.757 and 0.708 for each respective cluster. This combined unsupervised-supervised learning approach yielded high predictive performance, suggesting that advanced ML-derived approaches have potential to be used as a functional clinical tool to improve long-term SCS outcomes. Further studies are needed for optimization and external validation of these models.

The The Role of Executive Functioning in Understanding Chronic Pain Experiences in Adolescence: A Pilot Multi-Method Study

Background: Optimal executive functioning is pivotal to successful self-management of chronic pain (e.g., by being able to adapt self-management behaviours to changing situations), thereby contributing to improved health-related quality of life. However, preliminary evidence points to impaired executive functioning in people with chronic pain. Despite adolescence being identified as a sensitive period for the development of appropriate self-management and executive functioning skills, little is known about the associations between chronic pain and executive functioning performance in adolescents. The aim of the study was to pilot a multi-method approach to compare executive functioning, chronic pain, and quality of life between adolescents with and without chronic pain. Methods: A sample of 22 adolescents with chronic pain (12-18 years, 82% female, mean chronic pain duration = 6.68 years) and 13 pain-free adolescents (age and sex matched) participated. All participants completed a battery of neuropsychological tasks to assess the three key executive functioning components (i.e., inhibition, working memory and cognitive flexibility) and provided self-report on their executive functioning, pain experiences and health-related quality of life. Results: In addition to confirming the feasibility of the methods, data revealed that 23-62% of adolescents with chronic pain showed problematic performance, using normative scoring, in all three executive functioning components and showed significantly lower performance on all three executive functioning components compared to pain-free adolescents. Self-reported, but not neuropsychologically assessed, working memory and emotional control difficulties were associated with more pain-related interference and lower health-related quality of life. Conclusion: These preliminary findings reveal the critical need to screen for and address any potential deficits in executive functioning in adolescents with chronic pain to optimise their self-management of pain and subsequent health-related quality of life. The findings also illustrate the feasibility of and need for future systematic, multi-method and prospective investigations in larger samples to further clarify the cyclical associations between chronic pain and executive functioning in adolescents.

Disruption to normal excitatory and inhibitory function within the medial prefrontal cortex in people with chronic pain.

Growing evidence indicates a link between changes in the medial prefrontal cortex and the pathophysiology of chronic pain. In particular, chronic pain is associated with altered medial prefrontal anatomy and biochemistry. Due to the comorbid affective disorders seen across all pain conditions, the medial prefrontal cortex is a region of significance as it is involved in emotional processing. We have recently reported that a decrease in medial prefrontal N-acetylaspartate and glutamate is associated with increased emotional dysregulation, indicating there are neurotransmitter imbalances in chronic pain. Therefore, we compared medial prefrontal neurochemistry in 24 people with chronic pain conditions to 24 age and sex-matched healthy controls with no history of chronic pain. GABA-edited MEGA-PRESS was used to measure GABA+ levels, and short TE PRESS was used to measure glutamate levels in the medial prefrontal cortex. Psychometric measures regarding pain intensity a week before scanning, during the scan and the total duration of chronic pain, were also recorded and compared to measured GABA+ and glutamate levels. This study reveals that the presence of chronic pain is associated with significant decreases in medial prefrontal GABA+ and glutamate. These findings support the hypothesis that chronic pain is associated with altered medial prefrontal biochemistry. The dysregulation of glutamatergic and GABAergic neurotransmitter systems supports a model of disinhibition of chronic pain, which may play a key role in both the experience of persistent pain and its associated affective disturbances. This study reveals a significant reduction in γ-aminobutyric acid (GABA+ ) and glutamate within the medial prefrontal cortex in chronic pain sufferers. While the current findings should be considered with reference to a small sample size, the disruption to normal excitatory and inhibitory medial prefrontal cortex function may be key in the development and maintenance of chronic pain and comorbid mental health disorders.

Moderate to Severe Chronic Pain in Later Life: Risk and Resilience Factors for Recovery

Despite extensive research on the development and risk factors of chronic pain, the process of recovery from chronic pain in later life has been rarely studied. We estimated the recovery rate of moderate to severe chronic pain (chronic pain of moderate or severe severity or interfering with usual activities) among older adults and investigated predictors of recovery. Leveraging the longitudinal Health and Retirement Study 2006–2016 data (6 waves), we estimated the biennial national attrition-adjusted recovery rate of moderate to severe chronic pain among 6,132 US adults aged 65–75 at baseline. Generalized estimating equation Poisson models examined pain-related, sociodemographic, psychosocial and health-related factors in relation to recovery within any 2-year interval using longitudinal lagged design. Between 2006–2016, the prevalence of moderate to severe chronic pain increased from 28% to 33% with the incidence increasing from 14% to 18% and the recovery rate approximately 30%. Previous chronic pain duration, age, chronic diseases and a personality trait (agreeableness) were associated with a lower probability of recovery. Greater financial wealth and physical activity, better sleep quality and self-reported health were associated with a greater probability of recovery. Interventions that improve physical activity and sleep quality may be important avenues for reducing chronic pain burden among older adults. PerspectiveOur longitudinal findings suggested that recovery from moderate to severe chronic pain is common in later life and we further identified several key factors associated with this recovery process. Future research should consider the potential of interventions that improve physical activity and sleep quality to enhance recovery among older adults.

The effect of gender, opioid use/risk, duration of chronic pain and associated factors on response to medical/procedural intervention in chronic pain patients

Although numerous studies have evaluated the correlation of various factors such as age/gender/opioid use on the presence of chronic pain, very few have evaluated whether such factors determine how well a patient will respond to a medical/procedural intervention. In this retrospective study, we evaluated various factors that affected response to intervention and whether the type of intervention (medical vs procedural) affected the degree of response. In a study approved by the University of Arizona IRB, Electronic Medical Records (EMRs) were obtained from the Banner University of Arizona pain clinic. From the 2,980 EMRs of adult patients a total of 371 EMRs with different chronic pain conditions were randomly selected and appropriate variables were extrapolated from the charts. Response to medical/procedural intervention was measured by patient reported outcomes for pain and quality of life measures. Data were analyzed by linear regression. The sampled population had 2:3 male/female ratio was and mean age of 54.5 years. We found that the higher initial pain score, and higher opioid risk score, were negatively associated with response to the intervention. Regardless of initial pain score, females and patients with more than one pain sites were likely to respond to the intervention. Interestingly, duration of pain or amount of the opioids had no effect on the degree of response patients had after the intervention. Finally, patients were likely to respond favorably to a procedural intervention compared to medication alone. Our study points towards numerous factors that may affect response to an intervention offered in a chronic pain clinic and procedural intervention is likely going to result in greater reduction in pain compared to medication alone. Future studies will need to evaluate whether the response varies by the type of pain and type of procedure. National Institute of Health (NIH K08 NS104272).