Exploring the Experiences of Co-morbid Pain and Depression in Older African American Women and Their Preferred Management Strategies

Drazich, Brittany; Jenkins, Emerald; Nkimbeng, Manka; Abshire, Martha; Szanton, Sarah L.; Wright, Rebecca; Beach, Mary Catherine; Taylor, Jan

doi:10.3389/fpain.2022.845513

Cited by 2 publications

(5 citation statements)

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“…Within these focus groups, we explained GBGB and asked participants questions about their experiences with various pain management strategies, their perceptions of the GBGB intervention and their thoughts about adaptations (eg, number of visits, interventionists, etc.) ( 10 ). Themes from the focus groups were used to guide us in adapting the GBGB intervention.…”

Section: Methodsmentioning

confidence: 99%

“…Few studies have explored this phenomenon in older African American women, highlighting a lack of research on this unique perspective ( 7 ). Drazich and colleagues found that older African American women experiencing comorbid pain and depressive symptoms described a link between their pain and depressive symptoms, and how it interfered with their daily lives and their interactions with healthcare providers ( 10 ). Various factors contribute to the inequities in pain and mental health outcomes in middle-aged and older African American women that present complexity in treating both conditions.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Despite the comorbid nature of the conditions, African American women are less likely to receive adequate treatment for these conditions than non-Hispanic Whites and men, respectively ( 16 , 21 ). In addition, in 1 study, African American women with pain and depression reported that their health care providers lacked an understanding of the gravity and impact of their comorbid symptoms ( 10 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Testing GBGB has shown a reduction in depression scores, anxiety, functional disability, and improved behavioral activation levels. We adapted GBGB with input and guidance from older African American women with pain and depression and individuals from the original research team of GBGB ( 10 , 27 ). The adaptations to GBGB included (a) training a nurse as the interventionist, (b) focusing on pain and depressive symptoms, and (c) working with older African American women on self-directed goals surrounding pain and depression through behavioral activation.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Self-regulation theory involves 2 tenets: (a) participants manage their response to situations based on their experiences (experiences with pain and depression) and knowledge of an event and (b) participants’ goals are to maintain comfort and decrease the negative effects of an illness (pain and/or depression) on their lives ( 25 , 26 ). African American women have had experiences within health care, experiences in society, and specific experiences with access and use of pain management strategies that have shaped their responses to their pain and their mental health ( 10 , 29–31 ). In this study, we are testing the feasibility of the DAPPER intervention and working with participants who will set their goals based on their experiences and existing knowledge about pain and depressive symptoms, and their experiences and preferences surrounding treatment.…”

Section: Background and Objectivesmentioning

confidence: 99%

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Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women

Taylor,

Clair,

Gitlin

et al. 2023

Innovation in Aging

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Background and Objectives The intersection of race, gender and age puts older African American women at high risk of experiencing comorbid pain and depressive symptoms. The purpose of this study was to assess feasibility and acceptability of a 12-week behavioral activation intervention to target self-selected goals related to pain and depressive symptoms in middle aged and older African American women. Research Design and Methods This randomized waitlist control study included 34 self-identified African American women, 50 years of age or older, with moderate to severe chronic pain and depressive symptoms. The intervention consisted of eight in person or virtual 1-hour visits with a nurse. Follow-up acceptability assessments were conducted with 10 participants. Results The average age of the participants was 64.8 (SD: 10.5). They reported an average pain intensity score of 7.0 (SD:1.9) out of 10 and an average PHQ-9 depressive symptoms score of 11.9 (SD:4.0) at baseline. Of the 34 participants who consented, 28 (82.4%) women started the intervention, and 23 (82.1%) completed the intervention. Participants described the study as useful and beneficial. Participants recommended including a group component in future iterations. Effect sizes at 12 weeks were -0.95 for depressive symptoms indicating a substantial decrease in experienced depressive symptoms, but pain intensity was virtually unchanged (+ 0.09). Discussion and Implications The findings of this study demonstrate that the intervention is acceptable among middle-aged and older African American women and their personal goals were met. Including a group component and identifying effective ways to decrease attrition rates will be key in the next steps of development for this intervention. It is crucial to provide tailored, non-pharmacological approaches to pain, and depression symptom management in older adult populations who experience inequities in pain and mental health outcomes. This study emphasizes the importance of participant-driven goal-setting interventions.

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Section: Methodsmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

See 3 more Smart Citations

Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women

Taylor,

Clair,

Gitlin

et al. 2023

Innovation in Aging

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Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System

Herrera,

Carreño,

Wondwossen

et al. 2024

Military Medicine

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Introduction Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non-pharmacological (e.g., exercise and sleep hygiene) interventions to reduce symptoms and improve quality of life in people living with fibromyalgia. However, some of these therapies may lack robust evidence as to their efficacy, have side effects that may outweigh benefits, or carry risks. Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members. Therefore, the primary goal of this retrospective study is to examine co-occurring conditions and pain-management care receipt in the 3 months before and 3 months after fibromyalgia diagnosis in active duty service members from 2015 to 2022. Materials and Methods Medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the U.S. Military Health System was included in the analyses. Bivariate analyses evaluated inequities in co-occurring diagnoses (abdominal and pelvic pain, insomnia, psychiatric conditions, and migraines), health care (acupuncture and dry needling, biofeedback and other muscle relaxation, chiropractic and osteopathic treatments, exercise classes and activities, massage therapy, behavioral health care, other physical interventions, physical therapy, self-care management, and transcutaneous electrical nerve stimulation), and prescription receipt (anxiolytics, gabapentinoids, muscle relaxants, non-opioid pain medication, opioids, selective serotonin and norepinephrine inhibitors, and tramadol) across race and ethnicity and assigned sex. Pairwise comparisons were made using a false discovery rate adjusted P value. Results Overall, 13,663 service members received a fibromyalgia diagnosis during the study period. Approximately 52% received a follow-up visit within 3 months of index diagnosis. Most service members received a co-occurring psychiatric diagnosis (35%), followed by insomnia (24%), migraines (20%), and abdominal and pelvic pain diagnoses (19%) fibromyalgia diagnosis. At least half received exercise classes and activities (52%), behavioral health care (52%), or physical therapy (50%). Less commonly received therapies included other physical interventions (41%), chiropractic/osteopathic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%). The most common prescriptions received were non-opioid pain medications (72%), followed by muscle relaxers (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepinephrine reuptake inhibitor (21%), selective serotonin reuptake inhibitors (20%), and tramadol (15%). There were many inequities identified across outcomes. Conclusion Overall, service members diagnosed with fibromyalgia received variable guideline-congruent health care within the 3 months before and after fibromyalgia diagnosis. Almost 1 in 3 service members received an opioid prescription, which has been explicitly recommended against use in guidelines. Pairwise comparisons indicated unwarranted variation across assigned sex and race and ethnicity in both co-occurring health conditions and care receipt. Underlying reasons for health and health care inequities can be multisourced and modifiable. It is unclear whether the U.S. Military Health System has consolidated patient resources to support patients living with fibromyalgia and if so, the extent to which such resources are accessible and known to patients and their clinicians.

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Exploring the Experiences of Co-morbid Pain and Depression in Older African American Women and Their Preferred Management Strategies

Cited by 2 publications

References 50 publications

Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women

Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women

Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System

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