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

Adams, Melissa H.; Dobscha, Steven K.; Smith, Ning; Yarborough, Bobbi Jo H.; Deyo, Richard A.; Morasco, Benjamin J.

doi:10.1016/j.jpain.2018.04.005

Cited by 13 publications

(10 citation statements)

References 59 publications

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“…This study employs a cross-sectional design. Patients seeking care for a persistent pain problem completed the Brief Pain Inventory and were then classified according to their scores on both activity and affective pain interference to either a “low” (under 7.00) or “high” level (equal or above 7.00) [18,21,22]. This produced four distinct groups: A (low activity interference/high affective interference), B (high activity interference/high affective interference), C (low activity interference/low affective interference), and D (high activity interference/low affective interference).…”

Section: Methodsmentioning

confidence: 99%

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Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Miettinen¹,

Kautiainen²,

Mäntyselkä³

et al. 2019

PLoS ONE

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Chronic pain patients enter treatment with different problem profiles making careful assessment a necessity for more individualized treatment plans. In this cross-sectional study we assigned 320 patients entering tertiary multidisciplinary pain treatment into four categories based on whether they scored low or high on the activity and the affective pain interference dimensions of the Brief Pain Inventory (BPI). To determine whether this categorization system delineates issues that should be assessed further, the categories were compared with ANOVA and MANOVA analyses on three domains: variables affecting physical well-being (body mass index, exercise, substance use), psychological resources (mood), and pain-specific psychological factors (pain anxiety, pain acceptance). The results indicated that subjects who scored low on both interference dimensions compared similarly in weight: mean Body Mass Index (BMI) 27.0 (SD 6.0) kg/m 2 , and exercise: mean of 2.4 (SD 1.7) exercising sessions over 20 minutes per week, to the general population, had no depressive symptoms on average: mean Beck Depression Index II (BDI-II) score 11.7 (SD 7.5), and had the most favorable psychological reactions to pain relative to the other categories: mean total Pain Anxiety Symptoms Scale-20 (PASS-20) score 36.4 (SD 17.9). In contrast, when interference was high on activity, more physical well-being problems were evident e.g. weight: mean BMI 31.0 (SD 7.3) kg/m 2 , diminished exercise: mean of 1.5 (SD 1.6) exercising sessions per week, and avoidance behavior: mean PASS-20 Escape/Avoidance subscale 3.7 (95% CI: 1.7 to 5.8) scores higher in comparison to activity interference remaining low. With high affective interference, more depressive symptoms: mean BDI-II score 17.7 (SD 7.3), and more cognitive pain anxiety: mean PASS-20 Cognitive Anxiety subscale 2.8 (95% CI 0.7 to 4.8) scores higher in comparison to affective interference remaining low, emerged. Having high interference on both dimensions indicated accumulated risks for reduced physical well-being: mean BMI 29.9 (SD 6.1) kg/m 2 , mean of 1.2 (SD 1.7) exercising sessions per week, mood problems: mean BDI-II 20.3 (SD 10.6), and negative psychological reactions to pain: mean total PASS-20 score 53.2 (18.4). The results suggest that low interference on both dimensions may allow assessment with only physician consultations, while high interference on either dimension may call attention to distinct issues to be addressed with the help of a physiotherapist or a psychologist, whereas high interference on both dimensions highlights the need for a full multidisciplinary assessment.

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Section: Methodsmentioning

confidence: 99%

“…Patients with less pain catastrophizing and more self-efficacy [18] or better pain acceptance [19,20] have reported less pain interference. Thus, helping the patient to reduce pain-related anxiety or to adopt a more accepting attitude towards pain might help in reducing the impact of pain.…”

Section: Introductionmentioning

confidence: 99%

Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Miettinen¹,

Kautiainen²,

Mäntyselkä³

et al. 2019

PLoS ONE

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“…In light of the complexity of chronic pain situations, decreasing interference from pain might require a more comprehensive approach. Previous research showed that the experience of functional impairment due to pain is strongly associated with perceived self‐efficacy; depression, in contrast, is known to rather increase interference from pain …”

Section: Discussionmentioning

confidence: 99%

“…Previous research showed that the experience of functional impairment due to pain is strongly associated with perceived self-efficacy; depression, in contrast, is known to rather increase interference from pain. 42,43 Testing complex interventions in a real-world setting is challenging due to the potential of influencing factors to disrupt internal validity. In this regard, it is crucial to distinguish between an intervention's effectiveness and the success of the implementation efforts.…”

Section: Discussionmentioning

confidence: 99%

Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study

Brunkert

Simon

Ruppen

et al. 2019

J American Geriatrics Society

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OBJECTIVES To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions. DESIGN An implementation science pilot study using a quasi‐experimental effectiveness‐implementation (hybrid II) design. SETTING Four NHs in Switzerland. PARTICIPANTS All consenting long‐term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61). INTERVENTION Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions. MEASUREMENTS Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption. RESULTS Pain‐related outcomes improved for self‐reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%). CONCLUSION Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574–2580, 2019

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“…An association has been found between a number of psychological variables and chronic opioid prescription. For example, Adams et al [ 32 ] noted that depressive symptoms are common among patients who have been initiated [ 33 ] and maintained on long-term opioid treatment [ 28 , 34 , 35 ]. Other studies have found that higher levels of depression have been reported among patients who were prescribed opioids compared to those who have not been prescribed opioids [ 22 , 36 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age

Ramírez‐Maestre

Reyes-Pérez

Esteve

et al. 2020

IJERPH

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Background: Psychological factors of patients may influence physicians’ decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic back pain from those who had not been prescribed opioids and (2) to determine which factors make significant and independent contributions to the prediction of opioid prescribing. Methods: A total of 675 patients from four primary care centers were included in the sample. Variables included sex, age, pain intensity, depressive symptoms, pain catastrophizing, and pain acceptance. Results: Although no differences were found between men and women, participants with chronic noncancer pain who were prescribed opioids were older, reported higher levels of pain intensity and depressive symptoms, and reported lower levels of pain-acceptance. An independent association was found between pain intensity and depressive symptoms and opioid prescribing. Conclusions: The findings suggest that patient factors influence physicians’ decisions on prescribing opioids. It may be useful for primary care physicians to be aware of the potential of these factors to bias their treatment decisions.

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

Cited by 13 publications

References 59 publications

Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Pain interference type and level guide the assessment process in chronic pain: Categorizing pain patients entering tertiary pain treatment with the Brief Pain Inventory

Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study

Opioid Pain Medication Prescription for Chronic Pain in Primary Care Centers: The Roles of Pain Acceptance, Pain Intensity, Depressive Symptoms, Pain Catastrophizing, Sex, and Age

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