People In Chronic Pain Research Articles

Pain Rehabilitation's Effect on People in Chronic Pain: A Prospective Cohort Study.

Multidisciplinary long-term pain rehabilitation programs with a team of healthcare professionals are an integrated approach to treat patients with chronic non-malignant pain. In this longitudinal prospective cohort study, we investigated the long-term effects of multidisciplinary pain rehabilitation on the self-reported causes of pain, pain self-management strategies, sleep, pain severity, and pain’s interference with life, pre- and post-treatment. Eighty-one patients, aged 20–69 years, with chronic pain responded. The two most frequently reported perceived causes of pain were fibromyalgia and accidents. The difference in average self-reported pain severity decreased significantly at one-year follow-up (p < 0.001), as did pain’s interference with general activities, mood, walking ability, sleep, and enjoyment of life. At one-year follow-up, participants (21%) rated their health as good/very good and were more likely to state that it was better than a year before (20%). No change was found in the use of pain self-management strategies such as physical training at one-year follow-up. The intervention was effective for the participants, as reflected in the decreased pain severity and pain interference with life.

Breaking the vicious circle: Experiences of people in chronic pain on the pain rehabilitation journey.

AimTo explore the lived experience of individuals' in chronic pain of participating in a pain rehabilitation programme in Iceland.DesignPhenomenological research.MethodThe Vancouver School of Doing Phenomenology. Eleven participants were interviewed.ResultsThe overarching theme was as follows: “the journey of breaking the vicious circle of chronic pain.” Before the programme, the participants felt they were in survival mode, trying to survive each day; they were stuck in a vicious circle of chronic pain, simultaneously trying to ease and conceal the pain. Reaching out for professional help was a turning point. While attending the programme, participants began deconstructing their old ways of dealing with chronic pain. After completing the programme, they were still reconstructing their daily lives. In conclusion, pain rehabilitation programmes can be the first step towards breaking the vicious circle of chronic pain.

Yoga improves occupational performance, depression, and daily activities for people with chronic pain.

Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.

Abstract PR341

Background & Objectives: Long-term care (LTC) is an important issue in an aged society, because of not only maintaining subjective well-being among older adults, but also spending large amount of social security cost. In addition to that, chronic pain (CP) has a possibility to disturb independence of older adults. A few studies have reported that prevalence of CP increases with age1)2) and that CP impairs basic activities of daily living (ADL) and instrumental activities of daily living (IADL) in Japan3). However, little is known about prevalence rate of CP in the old-old adults and relationship between CP and LTC. Therefore we investigated about CP in the elderly who are 74 years old and older. Materials & Methods: This work used data from the Keio-Kawasaki Aging Study, in which stratified random sampling was performed on the basic residential register in Kawasaki city, Kanagawa prefecture, Japan. The participants ware allocated to the following 3 groups, 74 to 76 years old (75 y/o group), 79 to 81 years old (80 y/o group), and 84 to 86 years old (85 y/o group). Interviewers visited participants’ home and asked them questions. CP was defined as pain lasting for 3 months and more. LTC and requiring help (RH), which is a middle state between LTC state and independence, are certified according to individual disability. We performed chai-square test, multiple logistic regression analysis, and so on, as statistical analyses. The present study obtained approval of an ethical committee in Keio University. Results: Response rate was 38.0% (873 / 2297 persons). Mean prevalence rate of CP was 31.8% and the rate was significantly increased with age (p<0.001). ADL and IADL were significantly impaired in people with CP (p<0.001, p<0.05). Life satisfaction was also significantly low in the people (p<0.001). The rates of LTC and RH state were significantly higher in the 85 y/o group and in the CP people respectively (p<0.001). Age- and sex-adjusted odds ratios (ORs) of LTC and RH according to CP were significantly high (OR=2.85 and 2.20, p<0.01) and the significant differences were remained after additional adjustment of both ADL and IADL (OR=2.74 and 1.88, p<0.05). Conclusion: The old-old adults had the high prevalence rate of chronic pain. Chronic pain was an independent variable to disturb an independent life for them, though it also impaired ADL, IADL, and well-being.

Thinking Through the Pain.

For many decades, the care of people in chronic pain has vexed caregivers, challenged policymakers, and bedeviled the lives of people seeking relief from low back pain, migraines, arthritis, and other ailments. In two books-Pain: A Political History (2014) and Dying in the City of the Blues (2001)-I have argued that controversy over pain care persists because pain is at once a clinical, a cultural, and a political problem. The questions surrounding people in pain are fraught. Are complainants truly in the pain they claim to endure, and how do we know? And if so, what type of relief do they need or deserve? Is painkiller drug relief counterproductive, leading to addiction? Are disability benefits warranted? To say that pain is political is merely to recognize the deep connection between these questions of clinical judgment and swirling dilemmas surrounding social welfare in America.

A Message from AAPM's President

It gives me great pleasure to invite you to the AAPM's 31st Annual Meeting to be held March 19–22, 2015, in National Harbor, Maryland. Chronic pain is an astounding societal problem. Tackling this issue is a moral imperative, one that directs the cultural transformation in how we care for people in chronic pain, educate our providers, as well as in how we prevent and research pain. To that end, there are several major initiatives that we have undertaken. One includes our …

Qualitative evaluation of the SMART2 self-management system for people in chronic pain

Purpose: Technology could support the self-management of long-term health conditions such as chronic pain. This article describes an evaluation of SMART2, a personalised self-management system incorporating activity planning and review, feedback on behaviour- and acceptance-based therapeutic exercises. Method: The SMART2 system was evaluated over a four-week trial in the homes of people in chronic pain. At conclusion, participants were interviewed to understand the experience of using and living with the SMART2 system as a therapeutic tool. Results: Qualitative analysis of the interviews found that participants liked the system and reported making associated changes to their behaviour. Goal setting and feedback were the most useful elements of the system. A third key and unexpected element was that by simulating some of the functions of a therapist, SMART2 also simulated some of the process of interacting with a therapist. Conclusions: People in chronic pain may experience positive outcomes when using a self-management system designed for behaviour change. Furthermore, some of the supportive aspects of the therapeutic context can be elicited by self-management technologies.Implications of RehabilitationSelf-management technology has the potential to assist rehabilitation by supporting goal setting and providing feedback.By simulating some of the functions of a therapist, technology can simulate some of the process of therapy during rehabilitation.People in chronic pain liked using the technology in their own home and thought it could augment services delivered by clinical practitioners.Complex programmes of therapeutic exercises delivered by technology had limited success in engaging people in chronic pain.

Pain Intensity and Suicidal Ideation of People in Chronic Pain: Mediating Effects of Depression

We investigated a potential mediating role of depression between level of pain intensity and suicidal ideation of people who are in chronic pain from nonmalignant illnesses. Participants in this study were 248 patients seeking treatment for chronic pain at the pain center of a university hospital in Korea. Structural equation analyses showed that only the original full mediation model had adequate goodness-of-fit indices for suicidal ideation. Bootstrapping procedures we performed on the original full mediation model yielded a significant mediation effect of depression on suicidal ideation. The findings suggested that intense pain may lead to elevated rates of depression, thereby contributing to an increase in suicidal ideation, rather than playing a role as a direct contributing factor for greater suicidal ideation among people in chronic pain.

The Costs and Consequences of Adequately Managed Chronic Non‐Cancer Pain and Chronic Neuropathic Pain

Chronic pain is distressing for patients and a burden on healthcare systems and society. Recent research demonstrates different aspects of the negative impact of chronic pain and the positive impact of successful treatment, making an overview of the costs and consequences of chronic pain appropriate. To examine recent literature on chronic noncancer and neuropathic pain prevalence, impact on quality and quantity of life, societal and healthcare costs, and impact of successful therapy. Systematic reviews (1999 to February 2012) following PRISMA guidelines were conducted to identify studies reporting appropriate outcomes. Chronic pain has a weighted average prevalence in adults of 20%; 7% have neuropathic pain, and 7% have severe pain. Chronic pain impeded activities of daily living, work and work efficiency, and reduced quality and quantity of life. Effective pain therapy (pain intensity reduction of at least 50%) resulted in consistent improvements in fatigue, sleep, depression, quality of life, and work. Strenuous efforts should be put into obtaining good levels of pain relief for people in chronic pain, including the opportunity for multiple drug switching, using reliable, validated, and relatively easily applied patient-centered outcomes. Detailed, thoughtful and informed decision analytic policy modeling would help understand the key elements in organizational change or service reengineering to plan the optimum pain management strategy to maximize pain relief and its stream of benefits against budgetary and other constraints. This paper contains the information on which such models can be based.

The quality of life of people in chronic pain: Developing a pain and discomfort module for use with the WHOQOL

This article reports the development of a pain and discomfort module (PDM) designed to assess the full impact of quality of life (QoL) relating to chronic pain, which could be used with the generic World Health Organisation Quality of Life Assessment (WHOQOL). First, cognitive interviewing was completed with nine participants with chronic pain, for 108 items representing 10 pain-specific facets of QoL. Sixty-eight QoL items and 16 importance questions on pain were relevant, comprehensive, comprehensible and acceptable to users, and were confirmed to assess their purported concepts. Secondly, these items were pilot tested using a cross-sectional survey of 216 people with chronic pain, to investigate the preliminary psychometric properties of the PDM, and reduce its items statistically. All new facets were important to those with chronic pain. Sixteen items within four facets of pain relief, anger and frustration, vulnerability/fear/worry, and uncertainty were retained, and demonstrated acceptable to good internal consistency reliability (α = 0.77–0.85). The PDM is a self-administered, multidimensional subjective assessment of pain-related QoL, with potential to evaluate pain-relieving interventions, identify sufferer's needs, and for survey use.

Response to Gregory C. Murphy: Criterion Problems in Rehabilitation Outcome Research

I agree with Murphy that the title of our article is ambitious and we have not covered many aspects of recovery. The losses attributed to repetitive strain injury (RSI) are numerous and variable and are experienced not just by the person in pain but by friends, family, work colleagues and insurance companies to name a few. Measuring recovery from these losses is very complex. In our study we have chosen to focus on only two areas of recovery — decrease in pain and increase in function. In doing so, we have not defined recovery specifically in the title and we have implied, although not explicitly stated, our definition throughout the text. We are glad of the opportunity to clarify this here.Our definition of recovery depends on context and client. If we work in educating counsellors we may believe that observable behaviours are important indicators of recovery. I work with people in chronic pain and for most of them decrease in pain and increase in function are the most important indicators of recovery. As these changes take place, other changes follow. For example, their mood improves and they can assume normal role responsibilities (or redefined role responsibilities). If, however, they assume normal role responsibilities without increase in function and decrease in pain, the behaviour is often not sustainable long term and more losses are incurred. If we choose to measure recovery from the perspective of the person in pain it seems reasonable to use a questionnaire that measures improvements from that perspective. We cannot assume that the observations of counsellors are more objective, comprehensive, reliable or valid than the person with RSI, particularly in view of the fact that the person with RSI lives with the condition 24 hours a day, seven days a week.

Pain management among older people in need of help with activities of daily living

The aim of this study was to investigate the use of various pain relief methods among older people in chronic pain and in need of help to manage activities of daily living. People who reported pain and were in need of help to manage activities of daily living were included in the study. The Multidimensional Pain Inventory—Swedish version and a modified version of the Pain Management Inventory were used to study pain and methods of pain relief. The respondents used a variety of methods (median = 3) to relieve their pain; pharmacologic methods, rest, and distraction were the predominant strategies employed. A cluster analysis identified 2 main groups of people: people who used a few well-known methods and were significantly older and people who used a larger repertoire of methods to relieve their pain and reported higher pain severity and interference with daily life. About a third of older people reported inadequate pain relief. These findings stress the need for nurses to inform older people about available methods for pain relief and to do systematic pain assessments to evaluate the effectiveness of various pain relief methods.

Break the pain barrier

Rosemary Showell set up a pain management service for people in chronic pain, writes Steven Black