Higher Pain Interference Research Articles

P103. PROMIS physical health domain scores are related to cervical deformity severity

BACKGROUND CONTEXT Computer adaptive testing is becoming increasingly common in assessing patient outcomes. The Patient Reported Outcome Measurement Information System (PROMIS) instruments of Physical Function, Pain Intensity and Pain Interference have been shown to correlate with established patient outcome metrics. There is a lack of studies investigating the relationship between PROMIS physical health domain metrics and established Ames cervical deformity (CD) radiographic classification. PURPOSE To evaluate the association of available cervical alignment components via the Ames cervical deformity classification parameters with PROMIS physical domains. STUDY DESIGN/SETTING Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE A total of 208 CD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES PROMIS metrics [Pain Intensity (PI), Physical Function (PF), Pain Interference] and Ames CD modifiers [cSVA, TS-CL]. METHODS Surgical CD patients (C2-C7 Cobb angle >10° or C2-C7 sagittal vertical axis >4cm or TS-CL>15°) ≥18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the Spine Quality Database (Quality). Patients were classified according to Ames CD modifiers for cSVA and TS-CL (non-deformed [Non], moderate deformity [Mod], severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF, and Interference across CD deformity modifiers. Conditional Tree Analysis with logistic regression sampling were performed to determine a possible threshold of PROMIS scores for which the correlation with Ames radiographic cut-offs was most significant. Reported cut off values for Mod (cSVA: 4-8cm; TS-CL: 15-20°) and Sev (cSVA: >8cm; TS-CL: >20°) disability were used. RESULTS A total of 208 pts (58.8yrs, 51%F, 29.6kg/m2, mean Charlson Comorbidity score: 1.19) met inclusion criteria. By surgical approach: 79.3% posterior, 5.7% anterior, 14.9% combined; mean levels fused: 3.7±4.2. Baseline cervical cSVA modifier by severity: 83.2% Non, 16.8% Mod. No patients met criteria for severe cSVA modifier. Baseline TS-CL modifier by severity: 18.8% Non, 22.1% Mod, 59.1% Sev. Mean PI score: 89.6±15.4, mean PF score: 11.9±13.1, mean Int score: 56.9±6.8. PI did not differ between cSVA or TS-CL modifier severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups both trended towards lower PF scores and higher pain interference scores though this was not significant (P>0.05). Conditional tree analysis determined thresholds for PROMIS scores that were independent predictors of modifier severity. A PI score>96(OR: 0.658[0.303-1.430]), a PF score 57.4 (OR: 1.712[0.811-3.616]) were predictors of Mod cSVA. A PI score of >87(OR: 1.428[0.767-2.659]), a PF score 56.3 (OR:1.656[0.946-2.897]) were predictors of Sev TS-CL. CONCLUSIONS PROMIS physical health domain metrics of Pain Intensity, Physical Function, and Pain Interference were related to cervical malalignment parameters of the Ames cervical deformity classifications system. Certain baseline PROMIS thresholds can be connected to severity of cervical deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Deficient Inhibitory Endogenous Pain Modulation Correlates With Periaqueductal Gray Matter Metabolites During Chronic Whiplash Injury.

This study examined predictive correlations between periaqueductal gray (PAG) and anterior cingulate cortex (ACC) metabolite levels with deficient inhibitory endogenous pain modulation (EPM), including sensory and affective measures of pain during chronic whiplash injury (WHI). Healthy patients, and participants with chronic WHI, without (WHI-noP) or with pain (WHI-P), were screened with the Douleur Neuropathique 4 tool (DN4). EPM was assessed with C6 tonic heat pain stimuli with a Conditioned Pain Modulation (CPM) protocol. Magnetic resonance spectroscopy quantified ACC and PAG metabolite levels. WHI-P participants were characterized with high pain intensity and interference, and lower quality of life scores, compared with WHI-noP. Inhibitory CPM at 30 seconds was identified in the healthy noninjured (-45±16%; P<0.001) and WHI-noP groups (-36±8%; P<0.001). However, inhibitory EPM was not detected in the WHI-P group (-25±15%; P=0.06). Best fit and stepwise multiple regression revealed that the PAG glutamate/myoinositol metabolite ratio (P=0.01) and total creatine levels (P=0.02) predicted loss of EPM in the WHI-P group (r=0.71, α=0.97). Although myoinositol predicted loss of EPM in the ACC (P=0.04), this was below statistical power (r=0.31; α=0.56). The ACC N-acetyl-aspartate/myoinositol ratio (P=0.006) predicted chronic pain (DN4, r=0.53; α=0.87). The results of this study demonstrate deficient EPM at 30 seconds during tonic heat pain stimulation in WHI-P participants, compared with noninjured healthy volunteers or individuals with WHI-noP. In addition, quantification of PAG and ACC metabolites related to glutamate and glia predicted central chronic pain mechanisms related to loss of inhibitory EPM, while ACC metabolites characterized chronic pain described by descriptors and sensory changes.

Creating value in spine surgery: using patient reported outcomes to compare the short-term impact of different orthopedic surgical procedures

BACKGROUND CONTEXTSociety increasingly asks Medicine to create “value” for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative “value” of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate. METHODSThe Patient Reported Outcome Measurement Information System (PROMIS) assessments for Physical Function, Pain Interference, and Depression are routinely collected in our orthopedic clinics. Patients who underwent lumbar discectomy (DSC) or arthroscopic anterior cruciate ligament reconstruction (ACLR) were retrospectively identified. Data relating to PROMIS domains, patient demographics, and other relevant encounter details were extracted. The primary outcomes were (1) preoperative PROMIS domain scores, (2) scores at a minimum of 40 days postoperatively for DSC patients and 133 days postoperatively for ACLR patients, and (3) the change in scores with surgery. Propensity score matching identified age-, sex-, race-, and comorbidity-matched groups from each cohort. Chi-square tests and nonparametric Kruskal-Wallis tests compared the distribution of outcomes and characteristics. Multivariate linear regression models with interactions between the matched cohort and operative phase estimated the change in the outcomes scores between the two cohorts and controlled for the baseline differences between them. RESULTSBefore surgery, the DSC cohort had lower physical function, higher pain interference and higher depression scores as compared with the ACLR cohort. This pattern remained postoperatively, indicating less desirable outcomes for DSC patients. However, after controlling for their baseline scores, DSC patients experienced significantly greater improvements after surgery of 3.84 (95% CI 1.08–6.60; p=.01), −4.87 (95% CI −7.52 to −2.23; p<.001), and −2.95 (95% CI −5.70 to −0.21; p=.04) points in their physical function, pain interference, and depression scores, respectively, as compared with ACLR patients. CONCLUSIONSBased upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.

The Association Between Sleep Quality On Quality Of Life Among Healthy High School Athletes

PURPOSE: The objective of our study was to investigate the association between self-reported sleep quality (SQ) and quality of life (QOL) measures in healthy high school athletes. METHODS: We assessed the SQ and QOL of high school athletes (age range = 13-18 years) during their pre-participation physical examination (PPE). Participants completed the Pittsburgh Sleep Quality Index (PSQI), and the PROMIS Pediatric Profile 37 QOL questionnaire. Standard PPE forms which included demographics, sports participation, and injury history were also completed by the participants. Based upon the self-reported sleep habits assessed during the PSQI, we grouped participants into poor (PSQI score ≥ 5) or good (PSQI score < 5) SQ. We compared QOL between groups using independent sample t-tests and Fisher’s exact tests. A series of multivariable linear regression models were then constructed to evaluate the independent association between PSQI and QOL ratings after adjusting for age and sex. RESULTS: A total of 99 participants completed both the PSQI and PROMIS 37 questionnaires; 33 were classified as having poor SQ [mean PSQI: 6.8±2.0; mean age:15.1±1.0; 56% female] and 66 were classified as having good SQ [mean PSQI: 2.2±1.3; mean age: 15.2±1; 59% female]. There were no significant demographic differences (age, sex, level of play, hours per week in sports, injury history) between the groups. While the two groups reported similar bed times, the poor SQ group reported taking significantly longer to fall asleep than the good SQ group (mean=25.7±18.6 vs. 11.2±5.5 minutes; p<0.001), and woke up one hour earlier than the good SQ group (mean=6:10AM vs. 6:28AM; p<0.001). Multivariable regression analysis indicated that worse SQ was significantly associated with higher pain interference (β=0.42; 95% CI=0.14-0.70; p=0.004), anxiety (β=0.48; 95% CI=0.16-0.80; p=0.004), depressive symptoms (β=0.49; 95% CI=0.19-0.80; p=0.002), and fatigue (β=0.60; 95% CI=0.14-0.70; p=0.004) ratings. CONCLUSION: Poor self-reported SQ among healthy adolescent athletes is associated with more anxiety and depressive symptoms, fatigue, and pain interference ratings. When treating youth athletes, clinicians should consider assessing sleep hygiene and patterns in order to provide guidance on issues pertaining to reduced QOL.

Association of disease prognostic model (PM) with baseline quality of life (QOL) in metastatic castration resistant prostate cancer (mCRPC).

e16579 Background: PM’s in mCRPC accurately predict survival, but little is known about their association with QOL. We hypothesize that pre-treatment QOL is inversely correlated with PM derived scores. Our study explored associations between baseline Halabi PM derived risk score (including metastatic site, opioid use, ECOG performance status (ECOG PS), Alk phos, albumin, hemoglobin, LDH, and PSA) and multiple QOL domains at treatment initiation with docetaxel and prednisone (DP). Methods: The DP arm of MAINSAIL, a multicenter, randomized Phase 3 study of DP +/- lenalidomide in mCRPC, was analyzed via ProjectDataSphere. Halabi PM score was computed as continuous with higher score reflecting worse survival and classified as low- ( &lt; 140 points), intermediate- (140-194.96) or high-risk groups ( &gt; 194.96 points). QOL tests included FACT-P (higher score = better QOL), BPI-SF Severity score (BPI-SFSS; higher score = higher pain severity); and BPI-SF Interference score (BPI-SFIS, higher score = worse pain). General linear regression model was used to calculate beta estimates and 95% confidence intervals. Results: The sample included 526 mCPRC pts (median 68 years, White: 91.9%, Black: 5.3%, median PSA 75.95 ng/ml). Median [range] for FACT-P, BPI-SFSS and BPI-SFIS were 111 [0-152], 1.8 [0-9.3], and 1.4 [0-10], respectively. PM score was correlated with BPI-SFIS and BPI-SFSS and inversely correlated with FACT-P with correlation of 0.36, 0.31 and -0.33, respectively (all p &lt; 0.0001). For each unit increase in the PM score, BPI-SFIS increased by 2.1 points), BPI-SFSS increased by 1.5 points, and FACT-P decreased by 16.4 points. Using the three-risk groups, pts in the intermediate and high-risk groups had worse FACT-P QOL and higher BPI-SFIS and BPI-SFSS than pts in the low-risk group. In multivariate analysis, factors negatively impacting FACT-P QOL, BPI-SFSS and BPI-SFIS were higher ECOG PS, visceral metastases and opioid use. Declining hemoglobin levels were associated with increased BPI-SFSS and BPS-SFIS. Conclusions: Higher PM scores are associated with a lower baseline QOL overall, higher pain and higher pain interference. These results should be validated prospectively.

Self-Reported Pain Interference and Analgesic Characteristics in Rural Older Adults

BackgroundPain impacts the lives of millions of community-dwelling older adults. An important characteristic of pain is “pain interference” which describes the influence of pain on function. A description of pain interference is limited in rural settings where the number of older adults is expected to increase, and health disparities exist. AimsThe purpose of this study was to describe pain interference and analgesic medication use, highlighting those that may be potentially inappropriate in a sample of rural community-dwelling older adults. DesignThis secondary analysis was from a cross sectional study. Sample and SettingsData were analyzed from a sample of 138 rural community-dwelling older adults. MethodsStatistical analyses were performed on demographics, health characteristics, pain interference, and potentially inappropriate analgesic medication data. ResultsPain interference with work activity was reported by 76% of older adults overall, with 23% reporting moderate and 4% extreme interference, and 41% reported sleep difficulty due to pain. Higher pain interference was significantly associated with higher body mass index, more health providers, and the daily use of non-steroidal anti-inflammatory drugs (NSAIDs). Older women experienced more sleep difficulties due to pain. Over-the-counter analgesics were used most frequently by rural older adults to manage pain. Of most risk was the daily use of NSAIDs, in which only 30% used medications to protect the gastrointestinal system. ConclusionsOlder adults in rural settings experience pain interference and participate in independent-medicating behaviors that may impact safety.

Health professionals' referral practice and related healthcare utilization for people with low back pain in Singapore: A retrospective study.

Background:Low back pain is a common musculoskeletal disorder that can incur high financial burden. A significant proportion of this burden may be incurred from referrals to health services and subsequent healthcare usages. Patients’ overall experience of pain and its related life interferences may also have some relevance to this usage.Objective:This study aimed to examine the referral practices and subsequent health service utilization of patients with LBP within a tertiary specialist clinic setting. A secondary objective was to explore potential associations between primary independent variables of pain and life interferences with health service utilization.Methods:Participants were patients with low back pain, who completed a set of self-reported low back pain measures. These included measures for pain intensity, pain interference, disability and quality of life. The participants’ back pain-related referral and health service utilization in the subsequent 12 months were recorded.Results:A total of 282 patients completed the full measures. Of these, 59.9% were referred for physiotherapy, 26.3% for diagnostic imaging and 9.2% for interventional procedures. Compared to patients who were referred from tertiary care, those from primary care had lower pain intensity (), pain interference (), disability (), but better physical and mental quality of life (, ). High pain interference was a common factor among patients who were referred on to other services after first consultation. Levels of medical utilization and physiotherapy utilization were both associated with pain intensity (, vs , ), pain interference (, vs , 0.01) and disability (, vs , ). Regression analysis showed that the source of referral contributed to 6% of the variance in medical utilization and 3% of the variance in physiotherapy utilization. After controlling the demographic variables and referral sources, none of the independent variables added any significant variance to medical utilization. Only pain intensity contributed an additional 2% variance to physiotherapy utilization.Conclusion:Referral patterns and practices appear similar to those reported in other studies. Higher levels of pain intensity, interference, disability and quality of life appear to influence the referral to different health services and subsequent treatment utilization.

(307) The Role of Fluctuations in Pain Acceptance, Coping, and Catastrophizing in the Daily Lives of People with Chronic Pain and Spinal Cord Injury

The experience of chronic pain can be influenced by choice of coping skills, the presence of catastrophizing, and the degree of acceptance of chronic pain. Neither the independent contributions of coping, catastrophizing, and acceptance of the pain experience nor the relative variability of these factors on a day-to-day basis are well understood. Thus, this study aimed to examine the role of daily changes in pain acceptance, coping, and catastrophizing in the daily lives of people with chronic pain and spinal cord injury (SCI). We collected seven days of end-of-day diary assessments of pain acceptance, pain coping, and pain catastrophizing, and five additional criterion variables of interest – pain interference, social participation, depressive symptoms, and positive affect and well-being in 124 individuals. In multilevel random effects modeling (controlling for age, gender, mobility, and pain intensity), pain acceptance, coping, and catastrophizing were each independently associated with some, but not all, of the daily criterion variables. Both acceptance and catastrophizing demonstrated similarly robust and consistent associations with outcomes, whereas pain coping demonstrated weaker and less consistent relationships with outcomes. Days of higher than usual catastrophizing were related to same-day lower positive affect and well-being and higher pain interference and depressed mood. Days of high pain acceptance were associated with higher same-day social participation and lower pain interference and depressed mood. Interestingly, when people reported higher than usual pain coping, they also reported higher same-day depressed mood. The findings suggest that psychosocial interventions targeting both pain catastrophizing and pain acceptance may be beneficial in terms of pain, mood, and social outcomes for those with chronic pain. Individuals may engage in more behavioral coping strategies to manage pain when experiencing negative mood. Further research examining the complex dynamics of adaptive and maladaptive responses to pain in daily life is warranted.

(187) Associations between Pain Interference and Brain Volume in Community-Dwelling Older Adults

Pain is common in older individuals often interfering with daily function, and pain interference is a common proxy for measuring physical functioning in this population. Although both pain and aging are associated with changes to brain volume, relatively few studies have examined the association between pain interference and brain volume among older individuals. As part of the Neuromodulatory Examination of Pain Across the Lifespan (NEPAL) study at the University of Florida, older individuals 60 to 93 years old (n=49, 69% female) filled out demographic and pain questionnaires followed by a structural 3-Tesla MRI scan. FreeSurfer 6.0.0 was used for preprocessing, quality control, and for volumetric parcellation generation. FreeSurfer Query, Design, Estimate, Contrast (QDEC) processing stream was used for statistical analysis controlling for multiple comparisons with gender as a nuisance covariate. Higher pain interference was associated with smaller volume in the lateral orbitofrontal cortex, rostral middle frontal cortex, post-central cortex, superior temporal cortex, and precuneus but larger volume in the superior frontal and parstriangularis cortices (False Discovery Rate p's

GENDER DISPARITIES IN PATIENT-REPORTED OUTCOMES OF SPORTS-RELATED CONCUSSION PATIENTS

Background Patient-Reported Outcomes Measurement Information System (PROMIS) scales have been utilized to assess symptoms in a variety of medical conditions but have not been previously examined in patients with sports-related concussions. Our objective was to analyze PROMIS scores of University of Rochester Medical Center’s concussion patients to assess for demographic differences in symptoms and recovery. Methods: ICD9/10 codes retrospectively identified 214 concussion patients (51% female) less than 30 years old (mean age 15.1 +/- 2.3 years) with PROMIS metrics for physical function, pain and depression. Minimal clinically important difference for these domains is considered 4 points. Two-way ANOVA assessed the influence of gender on PROMIS domains with age as a covariate. T-tests measured the association of gender with the number of previous concussions and clinic visits. Multiple linear regression was utilized to assess the influence of the listed variables on the number of clinic visits. Results: Females initially present with 4.0 points lower physical function (95% Confidence interval (CI) 1.5-6.6), 5.8 points (95% CI 3.3-8.3) higher pain interference and 5.4 points (95% CI 2.7-8.2) higher depression compared to males (p &lt;0.01). The history of previous concussions did not differ by gender (1.2 ± 0.1 for females vs. 1.2 ± 0.1 for males), however, the number of visits per episode of care was greater for females (females=8.7±0.4 vs. males=5.3±0.6, p &lt;0.01). Multiple linear regression showed that gender, pain rating, and physical function were significant predictors of the number of clinic visits (r-value = 0.35, p &lt;0.01). Conclusions: In our clinic, females and males report concussion at the same prevalence, but post-concussive females experienced statistically significant greater pain and depression and lower physical function compared to their male counterparts. Gender was not associated with the number of previous concussions, but did influence the number of visits. The combination of gender, physical function, and pain were significantly correlated with number of visits, and these variables may be considered in future efforts to determine prognosis of recovery at intake post-concussion.

Mental and Physical Health Correlates of Pain Treatment Utilization Among Veterans With Chronic Pain: A Cross-sectional Study.

The annual cost of treatment and lost productivity due to chronic pain is estimated to be $635 billion within the USA. Self-management treatments for chronic pain result in lower health care costs and lower utilization of provider-management treatments, such as hospitalization and medication use. The current study sought to identify and characterize patient factors and health conditions associated with chronic pain treatment utilization to inform ways to improve engagement in self-management pain treatment (e.g., applying heat or ice, exercising, or practicing relaxation). This study predicted (1) greater pain intensity and pain interference would be associated with greater utilization of self-management treatments and (2) this association would be moderated by patient factors (gender and age) and health comorbidities (anxiety, trauma, depression, and sleep disturbance). Baseline data from a three-arm clinical trial were collected for 127 Veterans seeking treatment for chronic pain. Veterans were recruited via clinician referral and medical record review at the Veterans Affairs Puget Sound Health Care System, Washington, USA. Self-management treatments were more utilized than provider-management treatments. Pain intensity and pain interference were not uniquely associated with provider-management or self-management treatment utilization after controlling for demographics and mental health status. Sleep disturbance moderated the relationship between pain interference and provider-management treatment utilization. Depression moderated the relationship between pain intensity and provider-management treatment utilization. While study conclusions may not generalize to all Veteran populations, findings suggest that Veterans with chronic pain were more likely to seek provider-management treatments when experiencing high-pain interference and high-sleep disturbance. In addition, Veterans were more likely to seek provider-management treatments when experiencing low-pain intensity and high-depression symptoms.

Pain in Patients with Multiple Sclerosis.

Multiple sclerosis is a chronic inflammatory disease which affects the central nervous system. Many patients with multiple sclerosis suffer from persistent pain during the disease course. In Iranian cases, pain has not been regarded as it should be. The goal of this study was to determine the prevalence and types of pain in Iranian multiple sclerosis patients. This cross sectional study was conducted in the multiple sclerosis clinic of Sina Hospital between October 2014 and August 2015. Eighty eight multiple sclerosis patients were enrolled. Participants were asked to fill a valid and reliable Persian version of the Brief Pain Inventory. Demographic data (sex, age), disease duration and disease course were extracted from patients' medical files. All patients were examined by an expert neurologist to obtain Kurtzke Expanded Disability Status Scale (EDSS). The mean age and mean duration of disease were 30.4±7.6 years and 5.9±4 years, respectively. Median EDSS was 1. All patients reported pain. The most common sites of pain were upper extremities (52.3%). Higher the EDSS score, higher pain interference with the evaluated items. By using the worst pain intensity as a dependent variable, and age, sex, EDSS, disease duration and type of disease as independent variables, regression analysis showed that the EDSS score was an independent predictor for the intensity of pain in this group of patients. Pain is a common symptom found in patients diagnosed with multiple sclerosis. Thus, an accurate and thorough assessment of pain should be integrated in the routine evaluation of patients diagnosed with multiple sclerosis.

Stigma and Pain in Adolescents Hospitalized for Sickle Cell Vasoocclusive Pain Episodes.

Sickle cell disease (SCD) pain and hospitalizations increase during adolescence and adolescents with SCD may be at-risk for experiencing health-related stigma, which may result in poor health outcomes. This study examined relations among health-related stigma, pain interference, social support, quality of life (QOL), and hospital outcomes (ie, loneliness, pain reduction, and length of stay [LOS]) in adolescents hospitalized with SCD pain. Twelve- to 18-year-old adolescents (N=92) hospitalized with SCD pain completed measures of stigma, pain interference, social support, QOL, and state loneliness. Reduction of pain intensity during hospitalization and LOS were collected from medical chart review. Higher stigma was associated with higher pain interference, lower QOL, more loneliness, and less pain reduction in the hospital. Pain interference was positively associated with LOS. These preliminary findings highlight the importance of assessing and addressing SCD-related stigma and pain interference in adolescents hospitalized for SCD pain as these factors may influence treatment outcomes.

Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy

The pain experience may vary greatly among individuals reporting equally high levels of pain. We sought to examine the demographic and clinical characteristics associated with pain interference in patients with high pain intensity. Among patients with chronic musculoskeletal pain who were prescribed long-term opioid therapy and who were recruited from 2 health care systems, we identified a subset who reported high pain intensity (n = 189). All individuals completed self-report assessments of clinical and demographic factors. Analyses examined characteristics associated with pain interference. Within this group of patients with high reported pain intensity, 16.4% (n = 31) had low pain interference, 39.2% (n = 74) had moderate pain interference, and 44.4% (n = 84) had high pain interference. In bivariate analyses, patients with lower pain interference had fewer symptoms of depression and anxiety, less pain catastrophizing, a better quality of life, and greater self-efficacy for managing pain. In multivariate analyses, variables most strongly associated with low pain interference, relative to high interference, were depression severity (odds ratio 0.90; 95% confidence interval 0.82-0.99) and pain self-efficacy (odds ratio 1.07; 95% confidence interval 1.02-1.12). Study results suggest that chronic pain treatments that address symptoms of depression and enhance pain self-efficacy may be prioritized, particularly among patients who are prescribed long-term opioid therapy.Perspective: This article describes the prevalence and correlates of pain interference categories (low, medium, and high) among patients with high pain intensity who are prescribed long-term opioid therapy. Findings reveal that 16.4% of participants with high pain intensity had low impairment. Multivariate analyses indicate that variables significantly associated with low pain interference were lower depression scores and greater pain self-efficacy.

Pain interference and alcohol, nicotine, and cannabis use disorder in a national sample of substance users

BackgroundPain interference is associated with substance use, but has yet to be considered as a potential indicator of SUDs among substance users. We sought to examine whether moderate and high pain interference would confer risk for SUDs in ever and weekly users. MethodsUsing data from the National Epidemiologic Survey on Alcohol and Related Conditions, logistic regression analyses were conducted to examine the association between pain interference and concurrent and prospective alcohol and nicotine dependence, as well as concurrent cannabis use disorder. Those with no/low pain were used as the reference group. Gender was examined as a moderator. ResultsControlling for relevant covariates, moderate pain interference was associated with past year alcohol (odds ratio [OR] = 1.33, 95% CI, 1.16–1.52, p < .001) and nicotine (OR = 1.41, 95% CI 1.27–1.56, p < .001) dependence among ever users. In prospective analyses, moderate pain interference predicted the development of alcohol (Moderate: OR = 1.56, 95% CI, 1.39–1.75, p < .001) and nicotine (OR = 1.37, 95% CI, 1.14–1.65, p < .001) dependence. Similar results were found with high pain and for weekly users. Both moderate and high pain interference were associated with past-year occurrence of cannabis use disorder for women but not men. High pain predicted the development of nicotine dependence exclusively among males. ConclusionPain interference may confer risk for the occurrence of cannabis use disorder among female cannabis users and the occurrence and development of alcohol and nicotine dependence among users of both genders. Pain interference may be an important factor to monitor in these populations.

Telephone-based management of chronic pain in older adults in an integrated care program.

Few studies have explored behavioral strategies for managing chronic pain in older adults. Pain Care Management (PCM) is a telephone-based behavioral intervention for chronic pain. The present study examined chronic pain characteristics among older adults and tested the delivery of PCM as an adjunct to depression and anxiety care management. Participants were drawn from a state-sponsored program offering care management services to community members aged 65 and older who were prescribed a psychotropic medication by a primary care provider. Chronic pain information was collected for all participants in the state program (N=250) and treatment outcome data were collected for a subset with significant chronic pain. Eighty participants with high chronic pain interference were offered PCM and compared to 80 participants with chronic pain who received monitoring only on depression, anxiety, and pain interference outcomes. Chronic pain was identified in 14% of older adults newly prescribed a psychotropic medication. Compared to monitoring only, PCM participants had higher odds of seeing a reduction of 2 or more points in pain interference at 6months. Pain care management participants' anxiety scores significantly decreased over the study period. Older adults treated with psychotropic medications often also experience chronic pain that interferes with daily activities. A telephone-based care management intervention is acceptable and feasible with an older community-based population and can lead to improvements in anxiety symptoms and interference from chronic pain. Further research will help to refine interventions that may help improve symptoms and increase functioning with this population.

The Relationship Between Pain Interference and Psychosocial Well-Being Among Veterans With Spinal Cord Injuries/Disorders.

The study objectives were to compare psychosocial well-being in individuals with spinal cord injuries/disorders (SCI/D) and above-mean ("high") versus below-mean ("low") pain interference, and to determine whether psychosocial well-being was negatively associated with pain interference. Data were collected via a cross-sectional survey mailed in late 2014 to early 2015 to a national sample of veterans with SCI/D who received prior-year Veterans Affairs healthcare and assessed demographics, injury-related factors, select health conditions, pain interference, and psychosocial well-being. Bivariate comparisons and multivariate linear regressions identified factors related to higher pain interference. Approximately 79% of the sample (n = 813) reported high pain interference. Veterans with high (vs. low) pain interference reported worse perceptions of all included psychosocial well-being measures. Regression results indicated that higher pain interference was associated with higher grief/loss (β = 0.38, P < .0001) and negative psychosocial illness impact (β = 0.39, P < .0001), and lower positive affect (β = -0.39, P < .0001), resilience (β = -0.31, P < .0001), and life satisfaction (β = -0.39, P < .0001). The pain experience is independently associated with poor psychosocial well-being among individuals with SCI/D. Efforts to decrease perceptions of pain interference and improve factors associated with psychosocial well-being may symbiotically improve outcomes in SCI/D cohorts. Such efforts may focus on effective pain management programs aligned with patients' treatment preferences.

Perceived Interrelations of Pain and Cigarette Smoking in a Sample of Adult Smokers Living With HIV/AIDS.

Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigarette smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. This study examined the factor structure, reliability, and validity of a measure of perceived interrelations of pain and smoking in a sample of PLWH. Participants in this study were 108 current cigarette smoking PLWH (64.8% reporting current pain) in the Bronx, NY. Participants completed assessments of demographics, smoking behaviors, and pain. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI). The dimensionality of the PSI was evaluated using Horn's Parallel Analysis and exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha, and validity analyses evaluated the relationship between the PSI and demographics, HIV clinical characteristics, smoking, and pain in the total sample. A single-factor structure was the best fit for the PSI. The internal consistency of the PSI total score was excellent in the total sample (α = 0.94) and among participants with pain (α = 0.93). The PSI total score was significantly higher for PLWH who smoke and had current pain versus no current pain. Among smokers with HIV and pain, higher PSI scores were associated with higher pain interference, pain severity, and certain neuropathic pain symptoms (ie, numbness and pain to touch). Among a sample of PLWH, the PSI appeared to be a reliable and valid instrument as a one-factor measure to assess perceived interrelations among pain and cigarette smoking. Even though PLWH have very high prevalences of both pain and cigarette smoking, little is known about the relationship between pain and smoking for PLWH. This study is the first to examine a measure of the perceived interrelations of pain and smoking in a sample of PLWH. The measure was reliable and valid, and higher scores, reflecting that higher perceived interrelations of pain and smoking, were associated with more intense pain and pain interference. Learning more about pain and smoking among PLWH will help to better target smoking interventions to this key subgroup of smokers.

Associations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study

ObjectivesCompensable injury increases the likelihood of having persistent pain after injury. Three-quarters of patients report chronic pain after traumatic injury, which is disabling for about one-third of patients. It is...

The Characteristics of Pain in Patients Diagnosed with Depression and Heart Failure

Heart failure (HF) is a costly and growing health problem that is routinely complicated by chronic pain and depression. The purpose of this paper is to describe the characteristics of pain and pain management in depressed HF patients. In this descriptive cross-sectional study, we analyzed data from 62 participants with depression and class II-IV HF. Study variables of interest were collected from the Brief Pain Inventory, Beck Depression Inventory, and Rand-36. Almost all participants (98%) had some pain in the past month and most had pain in the last 24 hours (66%). The median pain score was 4 (0-10 scale) with the majority reporting moderate to severe pain. The median pain interference score was 4.42 (0-10 scale) with the majority reporting moderate to extreme interference. Medication to treat pain was used by all participants who reported pain, with only 5% also using nonpharmacologic treatment. The majority of participants reported moderate or severe pain while also having moderate to extreme pain interference. Nonpharmacologic pain treatments were severely underused. Women were more likely to have higher levels of pain intensity and more pain interference than men, suggesting that additional screening for the impact of pain is especially important in women. The wide variety of body areas affected, along with moderate to high intensity pain and considerable interference scores reported, indicate that pain was ineffectively treated. Nonpharmacologic treatments should be considered to decrease the impact of pain.