Co-occurrence Of Chronic Pain Research Articles

Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities.

Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.

The Role of Benefit Finding in the Relationship Between Pain and Posttraumatic Stress Symptoms in Youth With Chronic Pain: A Longitudinal Analysis.

Chronic pain and posttraumatic stress symptoms (PTSS) co-occur in youth at high rates. Current conceptual models of mutual maintenance do not identify specific youth resilience factors, such as benefit finding in this co-occurrence. Benefit finding is the process of perceiving positive benefits as the results of experiencing adversity. It has been viewed as a potential mitigator for illness symptoms; however, only minimal cross-sectional research has been conducted and none has longitudinally examined the possible buffering effect of benefit finding in the co-occurrence of chronic pain and PTSS in youth. This longitudinal investigation examined whether benefit finding changes over time, influences pain outcomes and moderates the relationship between PTSS and chronic pain in a clinical sample of youth with chronic pain. Youth ( N =105, Female = 78.1%) with chronic pain between the ages of 7-17 years ( M = 13.70; SD = 2.47) participated. Participants completed measures at baseline, 3 months, and 6 months to assess pain intensity and interference, PTSS, and benefit finding. Benefit finding did not significantly change over time. Cross-sectionally, benefit finding at 3 months significantly explained the variance in pain interference and intensity at 3 months. Benefit finding at 3 months did not significantly moderate the relationship between baseline PTSS and pain interference or intensity at 6 months. These findings replicate previous research that found positive cross-sectional associations between PTSS and chronic pain, and between benefit finding and worse pain intensity and interference. Further research on resilience in pediatric chronic pain is needed.

Development and validation of the sleep assessment instrument for older adults with pain.

The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness. Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults. Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items. We applied the "Sleep Assessment Instrument for Pain in older adults" (SAIOAP) in a sample of 100 older individuals. A Cronbach's alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults. The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

Misalignment of Stakeholder Incentives in the Opioid Crisis.

The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

Reduced sensitivity to ethanol and excessive drinking in a mouse model of neuropathic pain.

The co-occurrence of chronic pain and alcohol use disorders (AUDs) involves complex interactions between genetic and neurophysiological aspects, and the research has reported mixed findings when they both co-occur. There is also an indication of a gender-dependent effect; males are more likely to use alcohol to cope with chronic pain problems than females. Recently, a new conceptualization has emerged, proposing that the negative affective component of pain drives and maintains alcohol-related behaviors. We studied in a longitudinal fashion alterations in alcohol drinking patterns and pain thresholds in a mouse model of chronic neuropathic pain in a sex-dependent manner. Following partial denervation (spared nerve injury [SNI]), stimulus-evoked pain responses were measured before chronic alcohol consumption, during drinking, during a deprivation phase, and following an episode of excessive drinking. During the course of alcohol drinking, we observed pronounced sex differences in pain thresholds. Male mice showed a strong increase in pain thresholds, suggesting an analgesic effect induced by alcohol over time, an effect that was not observed in female mice. SNI mice did not differ from sham-operated controls in baseline alcohol consumption. However, following a deprivation phase and the reintroduction of ethanol, male SNI mice but not female mice showed more pronounced excessive drinking than controls. Finally, we observed decreased central ethanol sensitivity in male SNI mice but not in females. Together with our finding, that ethanol is able to decrease a pain-induced negative affective memory we come to following conclusion. We propose that a lower sensitivity to the intoxicating effects of alcohol together with the ability of alcohol to reduce the negative affective component of pain may explain the higher co-occurrence of AUD in male chronic pain patients.

The association between multimorbidity and health-related quality of life: a cross-sectional survey among community middle-aged and elderly residents in southern China

BackgroundMultimorbidity is common among the middle-aged and elderly residents. And it is associated to the reduction of health-related quality of life (HRQoL), including physical and psychological dimensions. However, there are few studies that have paid attention to the HRQoL of residents with multimorbidity in China. Therefore, this study aims to investigate the relationships between different multimorbidity patterns and HRQoL among middle-aged and elderly adults in China.MethodsBased on a cross-sectional survey, the information regarding 18,137 adults, who were at least 45 years of age, was collected through interviews. Self-perceived HRQoL was assessed with the EQ-5D-3 L instrument, and the EQ-5D-3 L index score was calculated using the Chinese EQ-5D-3 L value set. The Tobit regression was used to explore the impacts of multimorbidity groups on HRQoL.ResultsOf 18,137 respondents, more than a fifth (3773,20.8%) of people had multimorbidity. Mean (SD) of EQ-5D index and VAS values were 0.95(0.14) and 76.02(13.66), respectively. Significant correlations were found between a lower HRQoL and increasing numbers of chronic conditions (P < 0.001). Most of chronic diseases co-occurred frequently, and the association between hypertension and diabetes mellitus was the strongest (adjusted OR = 3.82). The most prevalent disease is hypertension (5052,27.9%), and the most prevalent chronic diseases pair is hypertension and diabetes mellitus (841,4.6%). Among those chronic diseases with high prevalence, the effects on HRQoL ranged from chronic pain to hypertension (adjust b = − 0.036 to − 0.008). In the common multimorbidity patterns, co-occurrence of chronic pain and bone disease (adjust b = − 0.039) had the greatest impact on HRQoL.ConclusionsThe HRQoL of middle-aged and elderly adults declines by multimorbidity. More attention should be paid to the HRQoL of residents with multimorbidity in China. The effect of different multimorbidity patterns on HRQoL is not simply added by two diseases, but changes by the different combination. Identifying different multimorbidity patterns of residents can provide more targeted measures to improve the HRQoL.

Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research.

The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology. Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms 'child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder'. Studies were retrieved and reviewed based on relevance to the topic. Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain. Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. WHAT DOES THIS REVIEW ADD?: This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations. We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.

The co-occurrence of chronic pain and psychological distress and its associations with salient socio-demographic characteristics among long-term social assistance recipients in Norway

BackgroundWhile lower socioeconomic status increases individual's risk for chronic conditions, little is known about how long-term social assistance recipients (LTRs) with multiple chronic health problems experience chronic pain and/or psychological distress. Social assistance is the last safety net in the Norwegian welfare system and individuals have a legal right to economic assistance if they are unable to support themselves or are entitled to other types of benefits. The purposes of this study were to determine the co-occurrence of both chronic pain and psychological distress and to evaluate for differences in demographic and social characteristics, as well as health-related quality of life, among LTRs. MethodsThis descriptive, cross-sectional study surveyed people receiving long-term social assistance in Norway about their health and social functioning from January-November 2005. The social welfare authority offices in each of 14 municipalities in Norway were responsible to locate the LTRs who met the study's inclusion criteria. The selected municipalities provided geographic variability including both rural and urban municipalities in different parts of the country. LTRs were included in this study if they: had received social assistance as their main source of income for at least 6 of the last 12 months; were between 18 and 60 years of age; and were able to complete the study questionnaire. In this study, 405 LTRs were divided into four groups based on the presence or absence of chronic pain and/or psychological distress. (1) Neither chronic pain nor psychological distress (32%, n=119), (2) only chronic pain (12%, n=44), (3) only psychological distress and (24%, n=87), (4) both chronic pain and psychological distress (32%, n=119). ResultsExcept for age and marital status, no differences were found between groups in demographic characteristics. Significant differences were found among the four groups on all of the items related to childhood difficulties before the age of 16, except the item on sexual abuse. LTRs with both chronic pain and psychological distress were more likely to have experienced economic problems in their childhood home; other types of abuse than sexual abuse; long-term bullying; and had more often dropped out of school than LTRs with neither chronic pain nor psychological distress. LTRs with both chronic pain and psychological distress, reported more alcohol and substance use/illicit drug use, more feelings of loneliness and a lower mental score on SF-12 than LTRs with only chronic pain. Conclusions and implicationsCo-occurrence of chronic pain and psychological distress is common in LTRs and problems in early life are associated with the co-occurrence of chronic pain and psychological distress in adult life. Although this study cannot assign a clear direction or causality to the association between social and demographic characteristics and chronic pain and psychological distress, the findings when examining LTRs’ problems in childhood before the age of 16, indicated that incidents in early life create a probability of chronic pain and psychological distress in the adult life of the individuals. Further studies should use life course studies and longitudinal data in to investigate these important questions in LTRs.

Chronic Pain and Traumatic Brain Injury in OEF/OIF Service Members and Veterans

The co-occurrence of chronic pain and traumatic brain injury (TBI) are 2 of the most common concerns among the Operations Enduring Freedom and Iraqi Freedom population and present unique challenges for evaluation and treatment. Previous research suggests that almost half the cohort report clinically significant pain, while up to 1 in 4 experiences some form of TBI. There is limited information regarding how TBI affects the presence and course of pain, and how pain impacts TBI and its symptoms. The present paper provides an overview of the range and degree of TBIs as well as a brief summary of current knowledge regarding the interaction between chronic pain and TBI, particularly in light of the numerous variables impacting it. Information on ways to best assess for and treat pain in the TBI population, including in those with multiple system injuries or associated affective symptoms, is provided. In addition, several innovative approaches for addressing the needs of this complex cohort of patients are described, which may stimulate further research and clinical innovation for this important subgroup.

Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy

To investigate the prevalence and co-occurrence of chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy (SBCP) and explore associations of chronic pain and fatigue with depressive symptoms and daily functioning. Fifty-six adults with SBCP without severe cognitive impairment participated (35 males, 21 females; mean age 36y 5mo, SD 5y 10mo; Gross Motor Function Classification System level I [13], II [28], III [11], IV [4]). Chronic pain (>3mo), severity and nature of fatigue (Fatigue Severity Scale; Multidimensional Fatigue Inventory), and depressive symptoms (Center for Epidemiological Studies Depression Scale) were assessed. Associations were explored using multivariable logistic regression analyses. The study sample had a higher prevalence of chronic pain (75% vs 39%; p<0.001), mean fatigue (Fatigue Severity Scale, 4.4 [SD 1.3] vs 2.9 [SD 1.1]; p<0.001), and prevalence of depressive symptoms (25% vs 12%; p=0.004) than Dutch healthy reference samples. Chronic pain and severe fatigue co-occurred in 34% and in combination with depressive symptoms in 16% of the participants. Severity of fatigue was associated with depressive symptoms (OR 3.38; p<0.01). Chronic pain and fatigue were not associated with limitations in daily functioning. These findings suggest that adults with SBCP are severely affected by chronic pain, fatigue, and depressive symptoms, in addition to their spastic paresis.

The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors

ObjectivesAlthough research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population. MethodsIn a population-based, cross-sectional telephone survey, 5001 adults aged ≥18years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions. ResultsThe overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9–6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms. ConclusionThis study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.

Understanding and Managing Clinically Significant Pain in Patients with an Anxiety Disorder

It is now well established that chronic pain and various anxiety disorders frequently co-occur. Co-occurrence of chronic pain is often unrecognized in anxiety disorder settings; yet, when unaddressed, it can complicate treatment, reduce treatment effectiveness, and exacerbate functional limitations and suffering for patients. The purpose of this clinical synthesis is to describe the core features of clinically significant pain experiences, summarize findings from epidemiological studies of co-occurrence, describe biopsychosocial models and associated mechanisms posited to account for co-occurrence, and provide anxiety disorder practitioners with time-efficient pain assessment strategies and promising options for treating clinically significant pain presentations in their patients. Future directions are also briefly highlighted.

The relationship among PTSD symptoms, chronic pain acceptance, and disability

The co-occurrence of chronic pain and Post Traumatic Stress Disorder (PTSD) has been estimated to be from 9% to 50%. Theoretical models have described how symptoms of PTSD and chronic pain may each negatively impact the course of the other disorder; yet, the mechanism for this relationship is not well understood. This study examined whether symptoms of PTSD, as well as pain intensity, vigilance, and pain awareness would be associated with chronic pain-related disability and acceptance. We hypothesized that first, the above variables would predict disability, and second, that they would predict chronic pain acceptance. The current sample consisted of 30 outpatients at a hospital-based pain management clinic. Data were collected as part of a larger study. Participants completed the Pain Disability Index (PDI), Chronic Pain Acceptance Questionnaire (CPAQ), Pain Vigilance and Awareness Questionnaire (PVAQ), and PTSD Checklist – Civilian (PCL-C). Self-reported pain intensity was measured on a scale from 0 (no pain) to 10 (worst pain). Linear multiple regression analyses were performed to test the above hypotheses. The overall model for the first hypothesis was significant (p = .008), where hyperarousal (B = 4.20, p = .029) was predictive of disability and highest reported pain intensity approached significance (B = .07, p = .069). The overall model for the second hypothesis was also significant (p = .02), where hyperarousal (B = -3.81, p = .035) and highest reported pain (B = -4.61, p = .023) significantly predicted chronic pain acceptance. The results indicated that hyperarousal significantly predicted increased pain related disability and decreased acceptance, and that in a larger sample, pain intensity might significantly predict disability. Hyperarousal is an important variable to explore when considering the link between chronic pain and PTSD. Better understanding of the above may be beneficial for treating individuals presenting with both disorders.