Medication Disability Research Articles

Chronic daily headache: Transformational migraine, chronic migraine, and related disorders

Chronic daily headache is an important category of headache illness that affects 4% of the general population. Within this classification are four chronic headache entities: chronic migraine/transformational migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Chronic migraine/transformational migraine is the most common of these entities and is frequently accompanied by medication overuse, neurobehavioral comorbidity, and disability. The terminology and classification of this entity continue to be confounding. Current research is directed at identifying factors that might promote the progression of this disorder from episodic migraine to daily or almost daily headache, and at identifying the best approaches to treatment, which include both pharmacotherapeutic and non-medicinal interventions. Patients with intractable cases are often hospitalized as a consequence of the convergence of several factors that make outpatient management unlikely to succeed.

Concerns About Medication and Medication Use in Chronic Pain

This report describes a study of how patients view their pain medications. Two hundred and twenty patients with chronic pain completed a set of 78 items regarding beliefs and concerns about pain medication, a brief measure of medication use, and measures of depression and disability. Item and scale analyses resulted in a 47-item measure, the Pain Medication Attitude Questionnaire (PMAQ), that assesses 7 areas of patient concern: addiction, perceived need, unfavorable scrutiny by others, adverse side effects, tolerance, mistrust in the prescribing doctor, and withdrawal. These seven scales had excellent internal consistency and predictable relations with the measures of medication use, depression, and disability supporting their validity. Correlation analyses highlighted relatively strong associations between concerns about medication and measures of emotional distress and disability, suggesting that these concerns may add significantly to the burden of chronic pain. We suggest that concerns about medication use warrant further study and may deserve clinical attention. Perspective All medication use by chronic pain sufferers is essentially a pattern of patient behavior over time. As such, it appears to be multiply-determined, by beliefs, emotions, bodily sensations, and the social, cultural, and personal learning history that give these experiences their meaning and functions.

Pain Medication Beliefs and Medication Misuse in Chronic Pain

This study assessed the influence of medication beliefs, symptom severity, disability, mood, and psychiatric history on opiate medication misuse behaviors in 288 chronic pain patients. Data were gathered by questionnaires and systematic reviews of electronic medical records. The results demonstrate that patients with a history of substance abuse, compared to those without, showed greater medication misuse despite similar dosages and self-rated opiate effectiveness. Misusers believed more strongly in the potential for opiate addiction and that they required higher doses than others, but also had greater belief in opiate effectiveness and the importance of free access. Although both anxiety and substance abuse history are related to medication misuse, a multivariate analysis indicated that these factors can be seen as mediated by medication beliefs. These data suggest important roles for historical, affective, and cognitive variables in understanding medication misuse. Patients with a history of substance abuse report stronger beliefs in opiate effectiveness while simultaneously showing awareness of their addiction potential. Providers may help patients by addressing these issues prior to prescribing opiates. Perspective History of substance abuse is associated with increased opiate medication misuse independent of differences in reported opiate effectiveness. Self-attributions regarding opiate treatment related to need for higher doses, dose control, and addiction potential, may be important mediators of this relationship and interact with anxiety to produce heightened risk of opiate misuse.

Pain catastrophizing is associated with health indices in musculoskeletal pain: a cross-sectional study in the Dutch community.

Cross-sectional associations were examined between pain catastrophizing and several health indices in 1,164 people with musculoskeletal pain from a Dutch community sample. Health indices included in the present study were specialist consultation, use of medication, and absenteeism or work disability. The results demonstrate that for people with a current episode of musculoskeletal pain, pain catastrophizing, pain intensity, and the presence of multiple pain locations were significantly associated with specialist consultation, use of pain medication, and absenteeism or work disability. The authors conclude that the role of pain itself has perhaps been underestimated in recent models of chronic pain-related disability. Some clinical implications and suggestions for further research are given.

A community-dwelling sample of people with Parkinson's disease: characteristics of fallers and non-fallers.

people with Parkinson's disease often fall. to report the frequency of falls and characteristics of fallers and non-fallers in a community-based sample of people with Parkinson's disease. we administered a battery of standardized tests in the home and the laboratory. we recruited 63 people with Parkinson's disease through general practices. Forty (64%, 95% confidence interval 51-74%) had fallen in the previous 12 months. Many factors associated with falling in the general population were associated with Parkinson's disease fallers (e.g. use of multiple medication and greater physical disability). Fallers were more likely to be depressed and anxious than non-fallers. Condition-specific factors associated with falling included greater disease severity (although there were exceptions) and more marked response to levodopa treatment, including more dyskinesia and on-off phenomena. Fallers took more steps to complete a test of mobility. They also had a shorter functional reach and greater postural sway whilst completing a dual task than non-fallers. this community-based study confirms the high risk of falling in Parkinson's disease. Our results suggest that disease-specific factors contribute to the increased risk and that there is scope for specific therapeutic interventions.

Chronic Daily Headache: Theory to Therapy.

Headaches are among the most frequent symptoms for which Americans seek physician advice and treatment. Although headache may herald a serious underlying organic or psychological illness, it more commonly represents a primary disorder of brain stem nociceptive processing and modulation. Chronic daily headache characteristically develops gradually from episodic tension or migraine-type headaches into a refractory syndrome often associated with medication overuse and disability. Better understanding of the pathophysiology and evolutionary mechanisms involved in the development of chronic headache has led to recommended changes in nosology originally proposed by the International Headache Society (IHS). Recent scientific and clinical observations prompting revised classification have also led to the integration of pathoanatomic models, which explain persistent headache. Strategies for the management of chronic craniofacial pain should emphasize key behavioral and attitudinal changes and avoidance of medication overusage.

Medication use and disability among migraineurs: a national probability sample survey.

To measure the use of prescription medication in treating migraine headache and the associations between medication use and sociodemographic factors, and headache characteristics. National sample survey using a mailed questionnaire to determine symptoms accompanying or preceding severe headaches; frequency, duration, and disability from severe attacks: use of medications to control pain; and medical-care use for severe headaches. A stratified sample of United States households. A sample of 20,468 respondents, aged 12 to 80 years, who responded to a survey on "severe" headaches during the prior year. Overall, 20.2% of respondents reported severe headaches. Migraine was found in 17.6% of females and 5.7% of males. Of the migraineurs, 40.1% of female and 28.3% of male migraineurs reported using prescription drugs to control pain. Blacks were less likely than whites to report prescription use. Insignificant differences were seen in rates of prescription use among various income levels and regions of the country. Use of prescription medication varied considerably by symptoms and characteristics of migraine attacks. Vomiting and sensory aura were most frequently associated with medication use, as were severity and duration of attacks. Use of urgent-care services for severe headache attacks was associated with frequent use of prescription medications. Patients who reported a physician diagnosis of migraine were more likely to use prescription medication than other migraineurs. Most migraineurs in the United States are not being treated with prescription medications. Many active migraine patients would benefit from appropriate treatment if care was sought and diagnosis made.

Medication Use and Disability from Severe Headache: A National Probability Sample Survey

Medication Use and Disability from Severe Headache: A National Probability Sample Survey