Higher Pain Interference Research Articles

The association of diabetes mellitus and routinely collected patient-reported outcomes in patients with cancer. A real-world cohort study.

Current studies have indicated that diabetes mellitus (DM) is highly prevalent in patients with cancer, but there is little research on consequences on the well-being of patients during cancer treatment. This analysis evaluates the relationship between DM and patient-reported outcomes (PRO) in patients with cancer, using a large and well-characterized cohort. This study utilized the Total Cancer Care protocol at the University of Utah Huntsman Cancer Institute. For this analysis, we integrated data from electronic health records, the Huntsman Cancer Registry, and routinely collected PRO questionnaires. We assessed the association between DM in patients with cancer and PRO scores for anxiety, depression, fatigue, pain interference, and physical function using multiple linear regression and t-tests. The final cohort comprised 3512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n = 1724) were female, with 82.0% (n = 2879) patients reporting PROs at least at one time point. Compared with patients who responded, nonresponders were more often female (p = 0.0035), less frequently non-Hispanic White (p = 0.0058), and had a higher BMI (p = 0.0759). Patients with cancer and diabetes had worse PRO scores for anxiety (p = 0.0003), depression (p < 0.0001), fatigue (p < 0.0001), pain interference (p < 0.0001), and physical function (p < 0.0001) compared to patients with cancer without diabetes. Significant associations between diabetes and PRO scores were observed for anxiety (β ± SE: 1.27 ± 0.48; p = 0.0076), depression (β ± SE: 1.46 ± 0.45; p = 0.0011), fatigue (β ± SE: 2.11 ± 0.52; p < 0.0001), pain interference (β ± SE: 1.42 ± 0.50; p = 0.0046), and physical function (β ± SE: -2.74 ± 0.48; p < 0.0001). The results of this study suggest that patients with cancer and diabetes may be at greater risk for anxiety, depression, fatigue, higher pain interference, and reduced physical function. Strengthening diabetes management is imperative to address the negative impact of diabetes on PROs. In particular, this may be true for patients with skin, breast, prostate, and kidney cancer.

Characterization of chronic pain, pain interference, and daily pain experiences in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

Although survivors of childhood cancer are at an increased risk, little is known about the prevalence of chronic pain, associated interference, and daily pain experiences. Survivors (N = 233; mean age = 40.8 years, range 22-64 years; mean time since diagnosis = 32.7 years) from the Childhood Cancer Survivor Study completed pain and psychosocial measures. Survivors with chronic pain completed 2-week, daily measures assessing pain and psychological symptoms using mHealth-based ecological momentary assessment. Multivariable-modified Poisson and linear regression models estimated prevalence ratio estimates (PR) and mean effects with 95% confidence intervals (CI) for associations of key risk factors with chronic pain and pain interference, respectively. Multilevel mixed models examined outcomes of daily pain and pain interference with prior day symptoms. Ninety-six survivors (41%) reported chronic pain, of whom 23 (24%) had severe interference. Chronic pain was associated with previous intravenous methotrexate treatment (PR = 1.6, 95% CI 1.1-2.3), respiratory (PR = 1.8, 95% CI 1.2-2.5), gastrointestinal (PR = 1.6, 95% CI 11.0-2.3), and neurological (PR = 1.5, 95% CI 1.0-2.1) chronic health conditions, unemployment (PR = 1.4, 95% CI 1.0-1.9) and clinically significant depression and anxiety (PR = 2.9, 95% CI 2.0-4.2), as well as a diagnosis of childhood Ewing sarcoma or osteosarcoma (PR = 1.9, 95% CI 1.0-3.5). Higher pain interference was associated with cardiovascular and neurological conditions, unemployment and clinical levels of depression and/or anxiety, and fear of cancer recurrence. For male, but not female survivors, low sleep quality, elevated anxiety, and elevated depression predicted high pain intensity and interference the next day. A substantial proportion of childhood cancer survivors experience chronic pain and significant associated interference. Chronic pain should be routinely evaluated, and interventions are needed.

Decreasing Hip Offset in Total Hip Arthroplasty Results in Decreased Physical Function Scores

BackgroundAcetabular and femoral offset play an important role in total hip arthroplasty (THA) for postoperative stability and biomechanical function. However, it is unknown whether offset impacts patient-reported outcomes (PROs). This study evaluated patients undergoing direct anterior (DA) THA with the hypothesis that patients who have a decrease in hip offset postoperatively would have lower physical function scores and higher pain interference. MethodsThere were 499 patients who underwent DA THA at a single tertiary academic institution who were retrospectively evaluated. Preoperative and postoperative hip offset was measured by 2 reviewers using the Sundsvall method on standing anteroposterior pelvis radiographs. Postoperative changes in hip offset were categorized as increased (> 5 mm), matched (within 5 mm of the preoperative offset measurement), or decreased ( >5 mm). Postoperative PROs with a minimum 1-year follow-up were recorded. A one-way analysis of variance was utilized to compare postoperative pain and PROs between groups. ResultsPatients who had decreased offset had the lowest mean postoperative physical function scores at 39.4 (8.0), followed by the increased offset group at 42.2 (10.4) and the matched offset group at 42.8 (9.8) (P < .01). There were significant differences in postoperative physical function scores between matched offset (42.8) and decreased offset (39.4) groups (P < .01), as well as between increased offset (42.2) and decreased offset (39.4) groups (P = .04). There was no difference between matched and increased offset cohorts. ConclusionsOur data suggests that reducing hip offset may result in worse physical function scores compared to those who have matched or increased hip offset. This should be considered intraoperatively, and efforts should be made to avoid reduced offset even in the presence of hip stability.

Associations Between Body Image, Kinesiophobia, and Pain in Women Post-Breast Cancer Treatment

Background: The purpose of this study was to evaluate factors associated with body image, kinesiophobia, pain severity, and pain interference in women following breast cancer (BrCA) treatment. Methods: A convenience sample of women (n = 160) post-BrCA treatment participated in this cross-sectional study. They completed demographic and clinical questionnaires and performed left/right judgment tasks (LRJTs). Regression analyses evaluated factors associated with the Body Image Scale, Tampa Kinesiophobia Scale, Brief Pain Inventory (BPI) pain severity subscale, and BPI pain interference subscale. Results: Higher quality of life (QoL) and older age were associated with better body image, while mastectomy and greater kinesiophobia were associated with worse body image. Higher QoL, better body image, more exercise time (minutes/week), and mastectomy were associated with less fear of movement. Slower chest LRJT response time, higher pain interference, and reconstructive surgery were associated with greater kinesiophobia. Higher QoL was associated with lower pain severity, while more exercise time was associated with higher pain severity. Higher QoL and slower chest LRJT response time were associated with lower pain interference. More exercise time and greater kinesiophobia were associated with greater pain interference. Conclusion: Poor body image and kinesiophobia are common in women after unilateral BrCA treatment. This study provides evidence on positive and negative associations between several factors associated with body image, fear of movement, pain severity, and pain interference in women following BrCA treatment. There is benefit to including assessment of these predictors and outcomes in research and clinical settings.

Pain Catastrophizing Moderates the Relationship Between Pain Sensitivity and Clinical Pain in Adolescents With Functional Abdominal Pain

Pain catastrophizing has been linked to amplified pain sensitivity assessed using quantitative sensory testing (QST) in adults; pediatric data are limited, particularly in youth with functional abdominal pain (FAP). With increasing use of QST to evaluate somatosensory function and predict pain outcomes, we examined the associations between QST and clinical pain in adolescents with FAP and tested the moderating effects of pain catastrophizing. Seventy-seven adolescents (mean age 16.6 years, 85.7% female, 72.7% White, 90.8% non-Hispanic) who fulfilled diagnostic criteria for FAP completed QST assessment (pressure pain threshold and tolerance, heat pain threshold, conditioned pain modulation) and measures of abdominal pain intensity, pain interference, and pain catastrophizing. Adjusting for age and sex, only higher heat pain threshold was associated with higher abdominal pain intensity (Beta per 1-standard deviation = .54, P = .026). Contrary to hypothesis, for youth with higher pain catastrophizing, higher pressure pain tolerance was associated with greater abdominal pain intensity, but associations were not significant for youth with lower catastrophizing (P = .049). Similarly, for those with higher pain catastrophizing (in contrast to lower pain catastrophizing), higher pressure pain thresholds and tolerance were associated with higher pain interference (P = .039, .004, respectively). Results highlight the need to investigate the influence of pain catastrophizing on QST. PerspectiveThis study demonstrated unexpected findings of pain catastrophizing moderating the relationships between pressure pain threshold and tolerance, and clinical pain in adolescents with FAP. This raised questions regarding our understanding of psychological contributions to QST findings in pediatric populations with chronic pain.

Efficiency of PROMIS MCAT Assessments for Orthopaedic Care

ABSTRACT Administration of patient-reported outcome measures (PROs), using multidimensional computer adaptive tests (MCATs) has the potential to reduce patient burden, but the efficiency of MCAT depends on the degree to which an individual’s responses fit the psychometric properties of the assessment. Assessing patients’ symptom burden through the administration of MCATs is gaining popularity in clinical settings, especially in orthopeadics where patients reporting low physical functioning and high pain interference may not always report high levels of depression. Are MCATs more efficient and precise than unidimensional CATs in a patient profile where the person-item fit varies between symptoms? Results depend on the item selection algorithm used in the assessments. Constraining item selection algorithm can substantially reduce test lengths where person-item fit is poor. This study demonstrates how MCAT can reduce patient burden in settings where collecting PROs is becoming part of routine care. Abbreviations: PRO: Patient-reported outcome; PROMIS®: Patient-Reported Outcomes Measurement Information System; CAT: Computer Adaptive Test; IRT: item response theory; EHR: electronic health record; UCAT: unidimensional computer adaptive tests; MCAT: multidimensional computer adaptive tests; HRQOL: health-related quality of life; MEPV: minimum expected posterior variance; SE: standard error; RMSE: root mean squared error; EAP: Expected a priori; MPEV-P: minimum expected posterior variance with domain preference; KL: Kullback-Leibler.

Mental Health Distress Is Associated With Higher Pain Interference in Patients With Opioid Use Disorder Stabilized on Buprenorphine or Methadone.

The relationships between opioid use disorder (OUD), chronic pain, and mental health distress are complex and multidirectional. The objective of this exploratory study was to examine the relationship between mental health conditions and Chronic pain severity and interference among patients stabilized on either buprenorphine or methadone. We report baseline data from a randomized trial of a mind-body intervention conducted at 5 outpatient clinics that provided either buprenorphine or methadone treatment. Validated scales were used to measure substance use, mental health distress, and pain severity and interference. Statistical analyses examined the relationship between mental health conditions and pain severity and interference. Of 303 participants, 57% (n = 172) reported Chronic pain. A total of 88% (n = 268) were prescribed buprenorphine. Mental health conditions were common, with one-quarter of the sample screening positive for all 3 mental health conditions (anxiety, depression, and posttraumatic stress disorder [PTSD]). Compared to participants without Chronic pain, participants with Chronic pain were more likely to screen positive for moderate-severe anxiety (47% vs 31%); moderate-severe depression (54% vs 41%); and the combination of anxiety, depression, and PTSD (31% vs 18%). Among participants with Chronic pain, mental health conditions were associated with higher pain interference. Pain severity was higher among participants with mental health conditions, but only reached statistical significance for depression. Pain interference scores increased with a higher number of co-occurring mental health conditions. Among individuals stabilized on either buprenorphine or methadone, highly symptomatic and comorbid mental health distress is common and is associated with increased pain interference. Adequate screening for, and treatment of, mental health conditions in patients with OUD and Chronic pain is needed.

Examination of Risk Factors Associated With Falls and Injurious Falls in People With Multiple Sclerosis: An Updated Nationwide Study

ObjectiveTo provide an update on risk factors associated with falls and injurious falls among people with multiple sclerosis (PwMS) in the United States. DesignNationwide cross-sectional web-based survey. SettingCommunity setting. ParticipantsAdult PwMS (n=965). InterventionsNot applicable. Main Outcome MeasuresParticipants completed self-report surveys of demographics, clinical data, concerns about falling, occurrence of falls, factors associated with falls, and injurious falls in the past 6 months. Participants also completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of depression, pain interference, and physical function, and the Fatigue Severity Scale. ResultsThe most common self-reported factors associated with falls included personal factors such as poor balance (75%), muscle weakness (54%), and/or fatigue (35%), environmental factors such as general surface conditions (37%) and/or distraction (15%), and activities-related factors such as urgency to complete a task (35%) and/or multitasking (27%). Logistic regression analyses indicated that higher fatigue severity (OR=1.19, P<.01) and higher pain interference (OR=1.02, P<.01) were associated with higher odds of experiencing at least 1 fall. Any level of concern, even minimal concern about falling was also significantly associated with a higher odd of experiencing at least 1 fall (ORs range 2.78 - 3.95, all P<.01). Fair to very high concerns about falling compared with no concern about falling (ORs range=5.17 – 10.26, all P<.05) was significantly associated with higher odds of sustaining an injurious fall. ConclusionsFindings suggest falls prevention approaches in PwMS should be multifactorial and include personal, environmental, and activities-related factors. Particular attention on fatigue, pain, and concern about falling may be needed to reduce incidence of falls and injurious falls in this population.

Effects of physical activity and sitting on health outcomes in adults with whiplash associated disorders

Background In spite of known detrimental effects of physical inactivity and sitting, little is known about levels of physical activity (PA) and sitting in adults with chronic whiplash associated disorders (WAD) and their effects on health outcomes. Methods This cross-sectional study compared PA and sitting levels between 258 adults with WAD and 30 healthy controls. Adults with WAD were divided into four categories based on achieving ‘low’ or moderate-to-vigorous PA (‘MVPA’) levels and sitting greater (‘high sit’)/less (‘low sit’) than 8 hours daily on the International Physical Activity Questionnaire. Kruskal-Wallis tests compared health outcomes across these categories, followed by Mann–Whitney tests for pairwise comparisons. Results Adults with WAD demonstrated lower levels of PA (2151 vs. 4097 MET minutes/week, p<.001), and higher levels of sitting (343 vs. 232 min per day, p<.001) than healthy controls. Significant differences were found between all four categories on all five health outcomes (pain intensity, pain interference, disability, physical health, mental health). Low PA/High Sit had higher disability and lower physical and mental health when compared to MVPA/High Sit and MVPA/Low Sit. Low PA/Low Sit demonstrated higher pain intensity than other groups; higher pain interference and disability and lower physical and mental health when compared to MVPA/High Sit or MVPA/Low Sit. Conclusions Adults with WAD demonstrated lower levels of PA and higher levels of sitting. Achieving recommended levels of MVPA appeared to be associated with better health outcomes, regardless of sitting times. Both levels of PA and sitting need to be considered in management of WAD.

Chronic Pain andChildhood Adversity Experiences Among U.S. Military Personnel.

Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted. The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses. Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03). Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.

Baseline Characteristics From a New Longitudinal Cohort of Patients With Noncancer Pain and Chronic Opioid Use in the United States

Retrospective cohort studies have consistently observed that long-term prescription opioid use is a risk factor for new major depressive episodes. However, prospective studies are needed to confirm these findings and establish evidence for causation. The Prescription Opioids and Depression Pathways cohort study is designed for this purpose. The present report describes the baseline sample and associations between participant characteristics and odds of daily versus nondaily opioid use. Second, we report associations between participant characteristics and odds of depression, dysthymia, anhedonia, and vital exhaustion. Patients with noncancer pain were eligible if they started a new period of prescription opioid use lasting 30 to 90 days. Participants were 54.8 (standard deviation ± 11.3) years of age, 57.3% female and 73% White race. Less than college education was more common among daily versus nondaily opioid users (32.4% vs 27.3%; P = .0008), as was back pain (64.2% vs 51.3%; P < .0001), any nonopioid substance use disorder (12.8% vs 4.8%; P < .0001), and current smoking (30.7% vs 18.4% P < .0001). High pain interference (50.9% vs 28.4%; P < .0001) was significantly associated with depression, as was having more pain sites (6.9 ± 3.6 vs 5.7 ± 3.6; P < .0001), and benzodiazepine comedication (38.2% vs 23.4%; P < .0001). High pain interference was significantly more common among those with anhedonia (46.8% vs 27.4%; P < .0001), and more pain sites (7.0 ± 3.7 vs 5.6 ± 3.6; P < .0001) were associated with anhedonia. Having more pain sites (7.9 ± 3.6 vs 5.5 ± 3.50; P < .0001) was associated with vital exhaustion, as was back pain (71.9% vs 56.8%; P = .0001) and benzodiazepine comedication (42.8% vs 22.8%; P < .0001). Patients using prescription opioids for noncancer pain have complex pain, psychiatric, and substance use disorder comorbidities. Longitudinal data will reveal whether long-term opioid therapy leads to depression or other mood disturbances such as anhedonia and vital exhaustion. PerspectiveThis study reports baseline characteristics of a new prospective, noncancer pain cohort study. Risk factors for adverse opioid outcomes were most common in those with depression and vital exhaustion and less common in dysthymia and anhedonia. Baseline data highlight the complexity of patients receiving long-term opioid therapy for noncancer pain.

Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features.

Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.

The Impact of Education Level, Access to Transportation, and the Home Environment on Patient-Reported Outcomes after Orthopaedic Trauma Surgery

Objectives It is known that Social Determinants of Health (SDOH) impact a variety of health outcomes. Of these determinants, it remains unclear how education level, access to transportation, and the home environment influence Patient-Reported Outcomes (PROs) following orthopaedic trauma surgery. Methods A cross-sectional survey was conducted at an urban level 1 trauma center to collect data on demographics, education level, access to transportation, and the home environment of 120 patients who underwent fracture fixation surgery. Patient data was correlated with PRO data as measured by Patient Reported Outcomes Measurement Information System (PROMIS) survey scores, including global mental health (GM), global physical health (GP), pain interference (PI), and physical function (PF). A multivariable mixed-effects regression analysis was performed to determine associations between SDOH and PROs. Results Multivariable regression analysis results demonstrated that patients with high school or lower education levels were associated with better PF (P=0.007). Patients with access to transportation were associated with higher GM (P = 0.016), while those who lived greater than 5 miles from the hospital were associated with higher GP (P = 0.0498). Those with difficulty accessing the bathroom were associated with lower GP (P = 0.007) and GM (P = 0.0008), increased PI (P = 0.0002), and lower PF (P = 0.004). People living in apartments had higher GM (P = 0.0008). Navigating stairs inside the home was associated with lower GP (P = 0.030) and higher PI (P = 0.0007), while those who navigated stairs outside of their home reported higher GP (P = 0.038). Conclusion This study found that in our population, education level, access to transportation, and the home environment appeared to be associated with PROs following orthopaedic trauma surgery.

Association of Patient-Reported Outcomes Measurement Information System Measures With Injection and Surgical Treatment Response in Patients With De Quervain Tenosynovitis

Treatment of de Quervain tenosynovitis is largely empiric. Patient-Reported Outcomes Management Information System (PROMIS) scores at the time of diagnosis might provide insights into the probability of success of nonsurgical management and predict the necessity for surgical treatment. We aimed to identify which, if any, of the PROMIS metrics may be used to identify patients who will opt for surgery or be managed with injection alone. Patients presenting to a tertiary academic medical center from 2014 to 2019, with a sole diagnosis of de Quervain tenosynovitis, were identified and separated by initial and most invasive treatment of either injection or surgery. These groups were then dichotomized using cut points of more than one SD from the mean on the PROMIS physical function and pain interference scales, and a logistic regression model was used to determine the odds ratio of surgical intervention. Patients who had low physical function or high pain interference had significantly increased odds of ultimately undergoing surgery. Age ranging from 40 to 60 years and female sex were also associated with increased odds of undergoing surgery. Patients who scored lower than 40 for physical function or higher than 60 for pain interference had significantly increased odds of eventually undergoing surgical release for de Quervain tenosynovitis. PROMIS scores may identify patients who are likely to fail steroid injections as a sole nonsurgical intervention and inform an individualized discussion about surgical management of this condition. Prognostic IV.

Resilience and well-being among persons with spinal cord injury/disorders.

We examined positive behavioral resources and characteristics that might distinguish resilient personality prototypes among persons with chronic spinal cord injury/disorder (SCID). Positive psychology variables with clear linkages to existing psychological interventions were examined as potential mediators of the resilience-well-being relationship. Research Method and Design: A cross-sectional, self-report study was conducted. Two hundred and ninety-eight consenting members of the Paralyzed Veterans of America (268 male; 236 self-identified as white) provided useable survey data for analysis (including 161 veterans with tetraplegia, 107 with paraplegia, 30 with cauda equina). Cluster analysis of Big Five personality traits identified resilient and nonresilient personality profiles. Tests of mean differences between resilient and nonresilient participants on behavioral resources and characteristics were performed. Path models predicting well-being and health-related quality of life (HRQL) were conducted. One hundred and sixty-three respondents had resilient personality profiles and 135 had nonresilient profiles. Resilient individuals reported significantly more optimal scores on every positive psychology variable, and greater well-being and HRQL than nonresilient respondents. Path models found the relationship of resilience to well-being was explained through its beneficial associations with psychological flexibility, use of personal strengths, meaning in life (MIL), and gratitude. Psychological flexibility also mediated the resilience-HRQL relationship. Cauda equina was significantly associated with higher pain interference and lower HRQL. Higher gratitude, MIL, use of personal strengths, and psychological flexibility appear to characterize resilience and well-being among persons with chronic SCID. Further studies are needed to understand the impact of pain interference on HRQL among individuals with cauda equina. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme?

Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory - pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation. A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted. Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement (p = < .0005). The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.

Bodily pain in physical function and the role of physical activity among community-dwelling adults aged 50-69 years in Ghana.

Older adults who experience pain are likely to report higher functional limitations (FL) and lower physical activity (PA) levels. However, the extent to which PA explains the association of pain with FL is largely unknown, particularly in low- and middle-income countries. This study estimates whether and how much pain in FL is mediated by PA engagement. We used cross-sectional data from 770 adults aged 50-69 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana. FL and pain characteristics were defined using the Medical Outcomes Study Short Form-36. PA was assessed by the International Physical Activity Questionnaire short form. Bootstrapped mediation analyses estimated the direct and indirect hypothesized associations. The control variables included age, sex, residential type, level of education, monthly income, social isolation, emotional distress, multimorbidity, and self-rated health. After adjusting for potential confounders, higher pain interference (β=0.091, p<0.05) and higher pain severity (β=0.075, p<0.05) were associated with greater FL. The bootstrapping analyses showed that PA mediated the pain interference-FL association, accounting for ~58% (β=0.124, Boots 95%CI=0.078-0.175) of the total effect (β=0.215, Boots 95%CI=0.095-0.335). Similarly, PA mediated the association of pain severity with FL, accounting for ~37% (β=0.044, Boots 95%CI=0.001-0.094) of the overall effect (β=0.119, Boots 95%CI=-0.011-0.249). Our data suggest that the higher pain severity and pain interference may lead to higher FL in middle and old age, and the associations are partially explained by PA. Effective and low-cost PA participation could be targeted in efforts to reduce the effect of pain on physical functioning among middle-aged and older adults.

Post-COVID Patients With New-Onset Chronic Pain 2 Years After Infection: Cross-Sectional Study

BackgroundAlthough pain is common in non-hospitalized post-COVID-19 syndrome, only a few studies have provided information on the pain experience of these patients. AimTo identify the clinical and psychosocial profile associated with pain in non-hospitalized patients with post-COVID-19 syndrome. MethodIn this study there were three groups: healthy control group, successfully recovered group, and post-COVID syndrome group. Pain-related clinical profile and pain-related psychosocial variables were collected. Pain-related clinical profile included: pain intensity and interference (Brief Pain Inventory), central sensitization (Central Sensitization Scale), insomnia severity (Insomnia Severity Index), and pain treatment. Pain-related psychosocial variables were: fear of movement and (re)injury (Tampa Scale for Kinesiophobia), catastrophizing (Pain Catastrophizing Scale), depression, anxiety and stress (Depression, Anxiety and Stress Scale), and fear-avoidance beliefs (Fear Avoidance Beliefs Questionnaire). ResultsIn all, 170 participants were included in the study (healthy control group n = 58, successfully recovered group n = 57, and post-COVID syndrome group n = 55). Post-COVID syndrome group obtained significantly worse punctuation in pain-related clinical profile and psychosocial variables than the other two groups (p < .05). ConclusionsIn conclusion, patients with post-COVID-19 syndrome have experienced high pain intensity and interference, central sensitization, increased insomnia severity, fear of movement, catastrophizing, fear-avoidance beliefs, depression, anxiety, and stress.

PD45-01 THE QUALITY OF LIFE IMPACT OF URETEROSCOPY FOR NEPHROLITHIASIS: RESULTS FROM THE ENDOUROLOGICAL SOCIETY TOWER RESEARCH COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023PD45-01 THE QUALITY OF LIFE IMPACT OF URETEROSCOPY FOR NEPHROLITHIASIS: RESULTS FROM THE ENDOUROLOGICAL SOCIETY TOWER RESEARCH COLLABORATIVE Amanda Jones, Roby Daniel, Zili Zong, Jing Huang, and Justin Ziemba Amanda JonesAmanda Jones More articles by this author , Roby DanielRoby Daniel More articles by this author , Zili ZongZili Zong More articles by this author , Jing HuangJing Huang More articles by this author , and Justin ZiembaJustin Ziemba More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urolithiasis is among the most common urological conditions, however, the quality-of-life impact of stone disease remains significantly understudied, particularly following surgical intervention. We prospectively captured patient-reported outcomes related to pain interference and social participation in the short term post-operative period to better understand the quality-of-life impact of ureteroscopy (URS). METHODS: Adults undergoing URS for renal/ureteral stones were eligible for inclusion (10/2020-09/2022). Two instruments were used to evaluate social participation and pain interference. Patients prospectively completed PROMIS Ability to participate in social roles and activities and Pain Interference instruments pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores with a change of 5 (0.5 SD) considered clinically significant. RESULTS: 178 patients completed enrollment at POD 0 (POD 1=87, POD 7=83, POD 14=70, POD30=67). There were statistically significant differences in pain interference and social participation scores between all-time point comparisons (Figure 1 and 2, all p<0.05). Higher BMI was associated with both lower baseline social participation (OR -0.46; CI: -0.71- -0.20, p<0.01) and greater baseline pain interference (OR 0.52; CI: 0.22-0.81, p<0.01). Pre-operative stent is associated with greater baseline pain interference (OR 7.1; CI: 2.3–12; p=0.004). Having a stent post-operatively is associated with higher pain interference (OR 24; CI: 0.66-48, p<0.04) and lower social participation (OR -38; CI: -64--11; p<0.01) on POD 7. CONCLUSIONS: Ability to participate in social roles and activities declines immediately post-operatively, while pain interference sharply increases. However, patients return to baseline social participation and see resolution of pain interference by POD 14. Findings suggest both pre-operative and post-operative stents may be impacting patients’ quality of life. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1162 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Jones More articles by this author Roby Daniel More articles by this author Zili Zong More articles by this author Jing Huang More articles by this author Justin Ziemba More articles by this author Expand All Advertisement PDF downloadLoading ...

Identification of age differences in cancer-related symptoms in women undergoing chemotherapy for breast cancer in China

BackgroundBoth contextual and cancer-related factors could be identified as causes of the interindividual variability observed for symptoms experienced during breast cancer treatment with chemotherapy. Understanding age differences and the predictors of latent class memberships for symptom heterogeneity could contribute to personalized interventions. This study aimed to identify the role of age differences on cancer-related symptoms in women undergoing chemotherapy for breast cancer in China.MethodsA cross‑sectional survey was conducted among patients with breast cancer in three tertiary hospitals in central China between August 2020 to December 2021. The outcomes of this study included sociodemographic and clinical characteristics, Patient-Reported Outcomes Measurement Information System (PROMIS)-57 and PROMIS-cognitive function short form scores.ResultsA total of 761 patients were included, with a mean age of 48.5 (SD = 11.8). Similar scores were observed across age groups for all symptoms except for fatigue and sleep disturbance domains. The most central symptoms varied among each group, and were fatigue, depression, and pain interference for the young-aged, middle-aged, and elderly-aged groups, respectively. In the young-aged group, patients without health insurance (OR = 0.30, P = 0.048) and in the fourth round of chemotherapy or above (OR = 0.33, P = 0.005) were more likely to belong to low symptom classes. In the middle-aged group, patients in menopause (OR = 3.58, P = 0.001) were more likely to belong to high symptom classes. In the elderly-aged group, patients with complications (OR = 7.40, P = 0.003) tended to belong to the high anxiety, depression, and pain interference classes.ConclusionsFindings from this study indicated that there is age-specific heterogeneity of symptoms present for Chinese women being treated for breast cancer with chemotherapy. Tailored intervention should consider the impact of age to reduce patients’ symptom burdens.