This study uses 12 years of longitudinal data from the Health and Retirement Study to examine sociodemographic disparities in chronic pain among older American adults. It finds high and increasing prevalence of chronic pain over time. Multivariate analysis reveals large disparities in reported pain levels by sex, education, and wealth. There is no disadvantage in pain for racial/ethnic minorities after accounting for socioeconomic factors. Pain levels are predictive of mortality even a decade later. Measurement biases like reporting heterogeneity and mortality selection may impact estimates of social disparities in pain.
1) The study examined the association between spousal or significant other solicitous responses and opioid dose in 466 patients with chronic pain. 2) It found that higher scores on a scale measuring solicitous responses, such as asking about pain symptoms, were associated with higher daily morphine equivalent doses. 3) This association remained even after adjusting for other factors like age, sex, depression and pain severity. The findings suggest solicitous responses may influence opioid dose among chronic pain patients.
Sample 3 bipolar on female adult populationNicole Valerio
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Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Pain is very common in advanced cancer patients, with 70% experiencing moderate to severe pain. The most common types of pain are from bone metastases and neuropathic pain. Failure to properly manage pain is due to several factors including limited resources in developing countries, legal restrictions, lack of physician education, and patients fearing addiction. Despite adequate resources, pain remains undertreated even in developed countries due to a focus on disease rather than symptom management.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Roger Chou, MD, Associate Professor of Medicine for Oregon Health & Science University
and Director of Pacific Northwest Evidence-based Practice Center.
This document discusses PTSD in Peru and compares it to the Western conceptualization of PTSD. It notes that the prolonged political violence from 1980-2000 in Peru put the indigenous Quechuan population at high risk for developing PTSD. Ancient Quechuan concepts like "Yaguas" and "La Enfermedad de Susto" influenced the subjective experience of PTSD among this group. The document compares the DSM criteria for PTSD between the US and Peru and notes that while the diagnosis is similar, the prevalence differs due to disparate social, economic and political contexts between the two countries. It argues that cross-cultural studies of PTSD are complicated by its origins in Western understandings of trauma.
Introduction: The severity and duration of primary dysmenorrhea vary; most of the previous studies were depending on the individual interpretation, which is most likely changing from one individual to another and from one country to another. Objectives and Aim: The main aim of this study was to establish a formula to fi nd out “pain sensation scale” for primary dysmenorrhea. Secondary aims were to fi nd out the prevalence of dysmenorrhea in fi ve various regions in the KSA, and the correlation of infl uence factors for dysmenorrhea such as age, oral contraceptives, and menstruation regularity.
1) The study examined the association between spousal or significant other solicitous responses and opioid dose in 466 patients with chronic pain. 2) It found that higher scores on a scale measuring solicitous responses, such as asking about pain symptoms, were associated with higher daily morphine equivalent doses. 3) This association remained even after adjusting for other factors like age, sex, depression and pain severity. The findings suggest solicitous responses may influence opioid dose among chronic pain patients.
Sample 3 bipolar on female adult populationNicole Valerio
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
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Families, Family Interaction and Health 2009 NIMH PresentionJames Coyne
The document summarizes critiques of past studies that claimed to find direct physiological links between family interactions and health outcomes like diabetes control or mortality. Some key criticisms included small sample sizes, overanalyzed data, ignoring obvious behavioral explanations like medication adherence, and findings that did not replicate or pass common sense tests. Later work found marital quality predicted survival through more plausible mechanisms like supporting complex medical regimens rather than direct physiological pathways. The takeaway is to be cautious of strong claims from weak evidence and avoid distractions from testable hypotheses about behavioral pathways.
Pain is very common in advanced cancer patients, with 70% experiencing moderate to severe pain. The most common types of pain are from bone metastases and neuropathic pain. Failure to properly manage pain is due to several factors including limited resources in developing countries, legal restrictions, lack of physician education, and patients fearing addiction. Despite adequate resources, pain remains undertreated even in developed countries due to a focus on disease rather than symptom management.
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Roger Chou, MD, Associate Professor of Medicine for Oregon Health & Science University
and Director of Pacific Northwest Evidence-based Practice Center.
This document discusses PTSD in Peru and compares it to the Western conceptualization of PTSD. It notes that the prolonged political violence from 1980-2000 in Peru put the indigenous Quechuan population at high risk for developing PTSD. Ancient Quechuan concepts like "Yaguas" and "La Enfermedad de Susto" influenced the subjective experience of PTSD among this group. The document compares the DSM criteria for PTSD between the US and Peru and notes that while the diagnosis is similar, the prevalence differs due to disparate social, economic and political contexts between the two countries. It argues that cross-cultural studies of PTSD are complicated by its origins in Western understandings of trauma.
Introduction: The severity and duration of primary dysmenorrhea vary; most of the previous studies were depending on the individual interpretation, which is most likely changing from one individual to another and from one country to another. Objectives and Aim: The main aim of this study was to establish a formula to fi nd out “pain sensation scale” for primary dysmenorrhea. Secondary aims were to fi nd out the prevalence of dysmenorrhea in fi ve various regions in the KSA, and the correlation of infl uence factors for dysmenorrhea such as age, oral contraceptives, and menstruation regularity.
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
This research study examined psychology doctoral students' ability to correctly diagnose obsessive-compulsive disorder (OCD) based on case presentations. The study found that prior to a video intervention, students were less aware of and more likely to misdiagnose OCD presentations that did not involve contamination or symmetry obsessions. After viewing an educational video about OCD, students' rates of misdiagnosing OCD decreased significantly. The results suggest that graduate training in mental health could benefit from targeted education to improve identification of diverse OCD symptoms beyond just contamination and symmetry.
Battered women syndrome;Intimate Partner ViolenceBenson Babu
This document contains summaries of 4 qualitative research studies on intimate partner violence:
1. The first study interviewed abused women in Sweden about their experience leaving violent relationships. It identified fear, confusion from the partner's behavior changes, and worry for safety as driving forces to leave. External support also played a key role.
2. The second study interviewed battered women in Finland about coping with violence. It found they struggled to survive and escape total control by partners using threats and violence. Support from others was important in leaving.
3. The third study in the UK used interviews to understand how domestic abuse affected women's identity, sense of self, and resilience. It found culture and society influenced how abuse was perceived and
Immanent Justice Reasonsing and Consistency (Keith Dowd)abramrickards
The document summarizes two studies on how external factors can influence adults' reliance on immanent justice reasoning when making causal attributions.
In Study 1, participants were more likely to attribute a negative health outcome to a person's diet when the person was described as good versus bad. In Study 2, participants were more likely to use immanent justice reasoning when the person experiencing the negative outcome was described as bad versus good.
Both studies found that supplementary information about a person's diet or character can influence whether participants rely more on immanent justice reasoning or external factors like diet in their causal reasoning. The level of influence depended on whether the outcome was consistent or inconsistent with the person's described moral character.
Higher prescribed opioid doses are associated with elevated suicide risk among veterans with chronic pain. The study analyzed medical records of over 123,000 veterans with chronic pain receiving opioids from 2004 to 2005. It found that compared to those receiving less than 20 mg/day of opioids, the hazard ratio for suicide was 1.48 for 20 to less than 50 mg/day, 1.69 for 50 to less than 100 mg/day, and 2.15 for 100 mg/day or more, after controlling for other factors. Similarly, rates of suicide by intentional overdose increased from 8.2 per 100,000 person-years at less than 20 mg/day to 27.8 per 100,000 person-years at 100 mg
Providing Hope in Terminal Cancer: When is it Appropriate and When is it Not?Teresa Muñoz Migueláñez
1. The document discusses providing hope in terminal cancer and when it is appropriate versus not. It focuses on the importance of realistic yet empathetic communication between doctors and patients about diagnosis, prognosis, and treatment options.
2. Unrealistic or false hope can be created by misinformation from external parties or an obsession with extending survival time without regard for quality of life. Hope requires a balance of realism with psychosocial and spiritual support.
3. The case study examines communicating prognosis and treatment options to a patient with advanced pancreatic cancer. It emphasizes conveying both risks and benefits of various options factually yet hopefully to help the patient make informed decisions.
Caregivers’ perspective on non-fatal deliberate self harmiosrjce
This document summarizes a study examining caregivers' perspectives on non-fatal deliberate self-harm. Fifty patients who engaged in deliberate self-harm and were admitted to a hospital were evaluated. Caregivers of these patients were interviewed using a 15-item questionnaire to assess their attitudes. Common characteristics of the self-harm incidents were that they occurred when someone else was present and no suicide notes were left. The most common psychiatric diagnosis among patients was major depressive disorder. Most caregivers reported feeling shock, anger, and a need to overprotect the individual after the self-harm incident. A significant association was found between caregivers perceiving an unsympathetic family attitude and repetition of deliberate self-harm.
The document summarizes a study that examined perceptions of veterans with PTSD based on whether they had a formal diagnosis or not. The study found that most people held similar views of veterans displaying PTSD symptoms, regardless of a diagnosis. However, females preferred to spend time with and introduce a formally diagnosed veteran to their family more than a non-diagnosed veteran displaying the same symptoms. The study had small effect sizes, suggesting the manipulation did not account for large differences in perceptions. It provides recommendations for future research focusing more on issues of personal safety with veterans.
This clinical report explores whether a specific phobia of vomiting (SPOV), also known as emetophobia, should be classified as an obsessive compulsive and related disorder (OCRD). The report reviewed 83 cases that met diagnostic criteria for SPOV. It found that 62% reported being markedly or very severely preoccupied by fears of vomiting. A majority reported repetitive behaviors like compulsive checking, reassurance seeking, and washing to prevent vomiting. The highest rate of comorbidity was with obsessive compulsive disorder. The results suggest SPOV shares similarities with OCRDs in terms of phenomenology and validators, and implicate it as worthy of further study within this classification.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
1) The study examined the effects of short-term and long-term exposure to sexist humor on perceptions of women. Immediate exposure to sexist clips did not significantly impact sexist views, but long-term preference for sexist media was linked to higher sexism.
2) Correlation analyses found relationships between sexist media viewing habits and various measures of sexism. Regression analyses found some media habits predicted certain types of sexism.
3) Future research should further examine the differences between short and long-term exposure to sexist humor, using a more diverse sample and updated measures of sexism.
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
Current methods of fraud detection used by insurance companies are not cost effective. This presentation describes the inaccuracy of the MMPI, and presents a new test, which can predict who will had medical test abnormalites with 95% accuracy, and who wil not have medical test abnormalities with 85% accuracy (the fakers). Available in English and Spanish at www.MarylandClinicalDiagnostics.com
This document discusses posttraumatic stress disorder (PTSD) and proposes a research study comparing different treatments for PTSD. It provides background on PTSD, including common symptoms, prevalence among different populations, comorbidities, and societal impacts. The document discusses current recommended treatment of cognitive behavioral therapy (CBT) and its limitations. It also reviews research on intranasal oxytocin (OT) and its potential anxiolytic effects for PTSD patients. The proposed longitudinal study aims to compare the short-term and long-term effectiveness of medication-enhanced psychotherapy (MEP), CBT, and OT, and examine how treatment responses may differ based on patients' sex, stress history, and coping style.
Current methods of fraud detection used by insurance companies are not cost effective. This presentation describes the inaccuracy of the MMPI, and presents a new test, which can predict who will had medical test abnormalites with 95% accuracy, and who wil not have medical test abnormalities with 85% accuracy (the fakers). Available in English and Spanish at www.MarylandClinicalDiagnostics.com
This study analyzed a cohort of 1,182 people in New Zealand who were identified as having inadequate housing based on hospital admission records from 2002-2014. 10.7% of the cohort died during a median follow-up of 5.7 years. The median survival of the cohort was 63.5 years, about 20 years less than the general population. Within the cohort, Māori individuals and those diagnosed with substance use disorders or diabetes were at significantly higher risk of premature death.
A review of sexual dysfunction in psoriasis with a focus on genital involvement. Genital psoriasis: Prevalence, Impact , Treatment
Increased recognition?
Fibromyalgia patients and their unaffected sisters completed a personality inventory. The study found statistically significant differences in personality between the two groups. Fibromyalgia patients scored higher in Neuroticism, with higher levels of Anxiety, Hostility, Depression, and Vulnerability. They also scored higher in Agreeableness. At the facet level, fibromyalgia patients had higher scores on Anxiety, Hostility, Depression, Vulnerability, and Modesty, as well as lower scores on Assertiveness. The results suggest personality may be related to fibromyalgia and its clinical characteristics.
Overgeneral memory (OGM) refers to the tendency to recall categories of events from memory, rather than specific memories, even when it is explicitly instructed to recall specific events. Unlike depressed and traumatized patients, patients diagnosed with borderline personality disorder (BPD) inconsistently show OGM. Non-suicidal self-injury (NSSI) on the other hand, is very common in patients with BPD. Like OGM, NSSI is considered to be an affect-regulation mechanism. This study investigated how these strategies relate to each other. Based on earlier findings (Startup et al., 2001), we hypothesized that NSSI and OGM would be inversely associated. Fifty three BPD patients completed the Structured Clinical Interview for DSM-IV Disorders (Axis II as well as Axis I-mood modules), the Autobiographical Memory Test to assess OGM, and the Self-Injury Questionnaire - Treatment Related (SIQ-TR) to assess NNSI. We found that patients who engage in NSSI do not differ from patients who do not with respect to OGM. However, we found that participants who use more different NSSI methods showed less OGM, but this association disappeared when we controlled for age. We propose a balance-model of affect-regulation as one possible explanation for the relationship between these two affect-regulation behaviours, and discuss the clinical relevance of our findings.
Persistent Pain and Well-beingA World Health Organization St.docxdanhaley45372
Persistent Pain and Well-being
A World Health Organization Study in Primary Care
Oye Gureje, MBBS, PhD, FWACP; Michael Von Korff, ScD;
Gregory E. Simon, MD, MPH; Richard Gater, MRCPsych
Context.— There is little information on the extent of persistent pain across cul-
tures. Even though pain is a common reason for seeking health care, information
on the frequency and impacts of persistent pain among primary care patients is in-
adequate.
Objective.— To assess the prevalence and impact of persistent pain among pri-
mary care patients.
Design and Setting.— Survey data were collected from representative samples
of primary care patients as part of the World Health Organization Collaborative
Study of Psychological Problems in General Health Care, conducted in 15 centers
in Asia, Africa, Europe, and the Americas.
Participants.— Consecutive primary care attendees between the age of major-
ity (typically 18 years) and 65 years were screened (n = 25 916) and stratified ran-
dom samples interviewed (n = 5438).
Main Outcome Measures.— Persistent pain, defined as pain present most of the
time for a period of 6 months or more during the prior year, and psychological ill-
ness were assessed by the Composite International Diagnostic Interview. Disabil-
ity was assessed by the Groningen Social Disability Schedule and by activity-
limitation days in the prior month.
Results.— Across all 15 centers, 22% of primary care patients reported persis-
tent pain, but there was wide variation in prevalence rates across centers (range,
5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more
likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4.14; 95%
confidence interval [CI], 3.52-4.86), to experience significant activity limitations
(adjusted OR, 1.63; 95% CI, 1.41-1.89), and to have unfavorable health perceptions
(adjusted OR, 1.26; 95% CI, 1.07-1.49). The relationship between psychological
disorder and persistent pain was observed in every center, while the relationship
between disability and persistent pain was inconsistent across centers.
Conclusions.— Persistent pain was a commonly reported health problem
among primary care patients and was consistently associated with psychological
illness across centers. Large variation in frequency and the inconsistent relation-
ship between persistent pain and disability across centers suggests caution in
drawing conclusions about the role of culture in shaping responses to persistent
pain when comparisons are based on patient samples drawn from a limited num-
ber of health care settings in each culture.
JAMA. 1998;280:147-151
PAIN is one of the most common1 and
among the most personally compelling
reasons for seeking medical attention.
People seek health care for pain not only
for diagnostic evaluation and symptom
relief, but also because pain interferes
with daily activities, causes worry and
emotional distress, and undermines con-
fidence in one’s health. When .
Journal of Traumatic StressApril 2013, 26, 266–273Public.docxtawnyataylor528
Journal of Traumatic Stress
April 2013, 26, 266–273
Public Mental Health Clients with Severe Mental Illness and
Probable Posttraumatic Stress Disorder: Trauma Exposure and
Correlates of Symptom Severity
Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4
Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5
Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5
1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,
Scotch Plains, New Jersey, USA
2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA
3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, Piscataway, New Jersey, USA
4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA
5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic
stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public
mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual
abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically
experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic
ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred
on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged
after-effects.
Over the past two decades, a growing body of research has
shown that individuals with severe mental illness (SMI) are
at greatly increased risk for trauma exposure (see Grubaugh,
Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although
national surveys indicate that more than half of people in the
general population report exposure to at least one event that
according to the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., DSM-IV; American Psychiatric Associa-
tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet,
Hughes, & Nelson, 1995), studies of people with a SMI (such as
This research was supported by National Institute of Mental Health grant R01
MH064662. We wish to thank the following individuals for their assistance
with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose-
marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott,
Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Sh ...
This document summarizes the results of moderator analyses from a large randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) for chronic pain from osteoarthritis. The trial compared 10 sessions of Pain Coping Skills Training (PCST), a form of CBT, delivered by nurse practitioners to a usual care control group. Several demographic and clinical variables were examined as potential moderators of treatment response. The analyses found that patients' pain coping style, expectations for treatment, disease severity, age, and education level significantly moderated outcomes, with some subgroups showing stronger responses to PCST. Sex, race, BMI, and depression did not impact treatment response. Specifically, patients with interpersonal pain coping problems did not benefit much from
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
This research study examined psychology doctoral students' ability to correctly diagnose obsessive-compulsive disorder (OCD) based on case presentations. The study found that prior to a video intervention, students were less aware of and more likely to misdiagnose OCD presentations that did not involve contamination or symmetry obsessions. After viewing an educational video about OCD, students' rates of misdiagnosing OCD decreased significantly. The results suggest that graduate training in mental health could benefit from targeted education to improve identification of diverse OCD symptoms beyond just contamination and symmetry.
Battered women syndrome;Intimate Partner ViolenceBenson Babu
This document contains summaries of 4 qualitative research studies on intimate partner violence:
1. The first study interviewed abused women in Sweden about their experience leaving violent relationships. It identified fear, confusion from the partner's behavior changes, and worry for safety as driving forces to leave. External support also played a key role.
2. The second study interviewed battered women in Finland about coping with violence. It found they struggled to survive and escape total control by partners using threats and violence. Support from others was important in leaving.
3. The third study in the UK used interviews to understand how domestic abuse affected women's identity, sense of self, and resilience. It found culture and society influenced how abuse was perceived and
Immanent Justice Reasonsing and Consistency (Keith Dowd)abramrickards
The document summarizes two studies on how external factors can influence adults' reliance on immanent justice reasoning when making causal attributions.
In Study 1, participants were more likely to attribute a negative health outcome to a person's diet when the person was described as good versus bad. In Study 2, participants were more likely to use immanent justice reasoning when the person experiencing the negative outcome was described as bad versus good.
Both studies found that supplementary information about a person's diet or character can influence whether participants rely more on immanent justice reasoning or external factors like diet in their causal reasoning. The level of influence depended on whether the outcome was consistent or inconsistent with the person's described moral character.
Higher prescribed opioid doses are associated with elevated suicide risk among veterans with chronic pain. The study analyzed medical records of over 123,000 veterans with chronic pain receiving opioids from 2004 to 2005. It found that compared to those receiving less than 20 mg/day of opioids, the hazard ratio for suicide was 1.48 for 20 to less than 50 mg/day, 1.69 for 50 to less than 100 mg/day, and 2.15 for 100 mg/day or more, after controlling for other factors. Similarly, rates of suicide by intentional overdose increased from 8.2 per 100,000 person-years at less than 20 mg/day to 27.8 per 100,000 person-years at 100 mg
Providing Hope in Terminal Cancer: When is it Appropriate and When is it Not?Teresa Muñoz Migueláñez
1. The document discusses providing hope in terminal cancer and when it is appropriate versus not. It focuses on the importance of realistic yet empathetic communication between doctors and patients about diagnosis, prognosis, and treatment options.
2. Unrealistic or false hope can be created by misinformation from external parties or an obsession with extending survival time without regard for quality of life. Hope requires a balance of realism with psychosocial and spiritual support.
3. The case study examines communicating prognosis and treatment options to a patient with advanced pancreatic cancer. It emphasizes conveying both risks and benefits of various options factually yet hopefully to help the patient make informed decisions.
Caregivers’ perspective on non-fatal deliberate self harmiosrjce
This document summarizes a study examining caregivers' perspectives on non-fatal deliberate self-harm. Fifty patients who engaged in deliberate self-harm and were admitted to a hospital were evaluated. Caregivers of these patients were interviewed using a 15-item questionnaire to assess their attitudes. Common characteristics of the self-harm incidents were that they occurred when someone else was present and no suicide notes were left. The most common psychiatric diagnosis among patients was major depressive disorder. Most caregivers reported feeling shock, anger, and a need to overprotect the individual after the self-harm incident. A significant association was found between caregivers perceiving an unsympathetic family attitude and repetition of deliberate self-harm.
The document summarizes a study that examined perceptions of veterans with PTSD based on whether they had a formal diagnosis or not. The study found that most people held similar views of veterans displaying PTSD symptoms, regardless of a diagnosis. However, females preferred to spend time with and introduce a formally diagnosed veteran to their family more than a non-diagnosed veteran displaying the same symptoms. The study had small effect sizes, suggesting the manipulation did not account for large differences in perceptions. It provides recommendations for future research focusing more on issues of personal safety with veterans.
This clinical report explores whether a specific phobia of vomiting (SPOV), also known as emetophobia, should be classified as an obsessive compulsive and related disorder (OCRD). The report reviewed 83 cases that met diagnostic criteria for SPOV. It found that 62% reported being markedly or very severely preoccupied by fears of vomiting. A majority reported repetitive behaviors like compulsive checking, reassurance seeking, and washing to prevent vomiting. The highest rate of comorbidity was with obsessive compulsive disorder. The results suggest SPOV shares similarities with OCRDs in terms of phenomenology and validators, and implicate it as worthy of further study within this classification.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
1) The study examined the effects of short-term and long-term exposure to sexist humor on perceptions of women. Immediate exposure to sexist clips did not significantly impact sexist views, but long-term preference for sexist media was linked to higher sexism.
2) Correlation analyses found relationships between sexist media viewing habits and various measures of sexism. Regression analyses found some media habits predicted certain types of sexism.
3) Future research should further examine the differences between short and long-term exposure to sexist humor, using a more diverse sample and updated measures of sexism.
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
Current methods of fraud detection used by insurance companies are not cost effective. This presentation describes the inaccuracy of the MMPI, and presents a new test, which can predict who will had medical test abnormalites with 95% accuracy, and who wil not have medical test abnormalities with 85% accuracy (the fakers). Available in English and Spanish at www.MarylandClinicalDiagnostics.com
This document discusses posttraumatic stress disorder (PTSD) and proposes a research study comparing different treatments for PTSD. It provides background on PTSD, including common symptoms, prevalence among different populations, comorbidities, and societal impacts. The document discusses current recommended treatment of cognitive behavioral therapy (CBT) and its limitations. It also reviews research on intranasal oxytocin (OT) and its potential anxiolytic effects for PTSD patients. The proposed longitudinal study aims to compare the short-term and long-term effectiveness of medication-enhanced psychotherapy (MEP), CBT, and OT, and examine how treatment responses may differ based on patients' sex, stress history, and coping style.
Current methods of fraud detection used by insurance companies are not cost effective. This presentation describes the inaccuracy of the MMPI, and presents a new test, which can predict who will had medical test abnormalites with 95% accuracy, and who wil not have medical test abnormalities with 85% accuracy (the fakers). Available in English and Spanish at www.MarylandClinicalDiagnostics.com
This study analyzed a cohort of 1,182 people in New Zealand who were identified as having inadequate housing based on hospital admission records from 2002-2014. 10.7% of the cohort died during a median follow-up of 5.7 years. The median survival of the cohort was 63.5 years, about 20 years less than the general population. Within the cohort, Māori individuals and those diagnosed with substance use disorders or diabetes were at significantly higher risk of premature death.
A review of sexual dysfunction in psoriasis with a focus on genital involvement. Genital psoriasis: Prevalence, Impact , Treatment
Increased recognition?
Fibromyalgia patients and their unaffected sisters completed a personality inventory. The study found statistically significant differences in personality between the two groups. Fibromyalgia patients scored higher in Neuroticism, with higher levels of Anxiety, Hostility, Depression, and Vulnerability. They also scored higher in Agreeableness. At the facet level, fibromyalgia patients had higher scores on Anxiety, Hostility, Depression, Vulnerability, and Modesty, as well as lower scores on Assertiveness. The results suggest personality may be related to fibromyalgia and its clinical characteristics.
Overgeneral memory (OGM) refers to the tendency to recall categories of events from memory, rather than specific memories, even when it is explicitly instructed to recall specific events. Unlike depressed and traumatized patients, patients diagnosed with borderline personality disorder (BPD) inconsistently show OGM. Non-suicidal self-injury (NSSI) on the other hand, is very common in patients with BPD. Like OGM, NSSI is considered to be an affect-regulation mechanism. This study investigated how these strategies relate to each other. Based on earlier findings (Startup et al., 2001), we hypothesized that NSSI and OGM would be inversely associated. Fifty three BPD patients completed the Structured Clinical Interview for DSM-IV Disorders (Axis II as well as Axis I-mood modules), the Autobiographical Memory Test to assess OGM, and the Self-Injury Questionnaire - Treatment Related (SIQ-TR) to assess NNSI. We found that patients who engage in NSSI do not differ from patients who do not with respect to OGM. However, we found that participants who use more different NSSI methods showed less OGM, but this association disappeared when we controlled for age. We propose a balance-model of affect-regulation as one possible explanation for the relationship between these two affect-regulation behaviours, and discuss the clinical relevance of our findings.
Persistent Pain and Well-beingA World Health Organization St.docxdanhaley45372
Persistent Pain and Well-being
A World Health Organization Study in Primary Care
Oye Gureje, MBBS, PhD, FWACP; Michael Von Korff, ScD;
Gregory E. Simon, MD, MPH; Richard Gater, MRCPsych
Context.— There is little information on the extent of persistent pain across cul-
tures. Even though pain is a common reason for seeking health care, information
on the frequency and impacts of persistent pain among primary care patients is in-
adequate.
Objective.— To assess the prevalence and impact of persistent pain among pri-
mary care patients.
Design and Setting.— Survey data were collected from representative samples
of primary care patients as part of the World Health Organization Collaborative
Study of Psychological Problems in General Health Care, conducted in 15 centers
in Asia, Africa, Europe, and the Americas.
Participants.— Consecutive primary care attendees between the age of major-
ity (typically 18 years) and 65 years were screened (n = 25 916) and stratified ran-
dom samples interviewed (n = 5438).
Main Outcome Measures.— Persistent pain, defined as pain present most of the
time for a period of 6 months or more during the prior year, and psychological ill-
ness were assessed by the Composite International Diagnostic Interview. Disabil-
ity was assessed by the Groningen Social Disability Schedule and by activity-
limitation days in the prior month.
Results.— Across all 15 centers, 22% of primary care patients reported persis-
tent pain, but there was wide variation in prevalence rates across centers (range,
5.5%-33.0%). Relative to patients without persistent pain, pain sufferers were more
likely to have an anxiety or depressive disorder (adjusted odds ratio [OR], 4.14; 95%
confidence interval [CI], 3.52-4.86), to experience significant activity limitations
(adjusted OR, 1.63; 95% CI, 1.41-1.89), and to have unfavorable health perceptions
(adjusted OR, 1.26; 95% CI, 1.07-1.49). The relationship between psychological
disorder and persistent pain was observed in every center, while the relationship
between disability and persistent pain was inconsistent across centers.
Conclusions.— Persistent pain was a commonly reported health problem
among primary care patients and was consistently associated with psychological
illness across centers. Large variation in frequency and the inconsistent relation-
ship between persistent pain and disability across centers suggests caution in
drawing conclusions about the role of culture in shaping responses to persistent
pain when comparisons are based on patient samples drawn from a limited num-
ber of health care settings in each culture.
JAMA. 1998;280:147-151
PAIN is one of the most common1 and
among the most personally compelling
reasons for seeking medical attention.
People seek health care for pain not only
for diagnostic evaluation and symptom
relief, but also because pain interferes
with daily activities, causes worry and
emotional distress, and undermines con-
fidence in one’s health. When .
Journal of Traumatic StressApril 2013, 26, 266–273Public.docxtawnyataylor528
Journal of Traumatic Stress
April 2013, 26, 266–273
Public Mental Health Clients with Severe Mental Illness and
Probable Posttraumatic Stress Disorder: Trauma Exposure and
Correlates of Symptom Severity
Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4
Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5
Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5
1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,
Scotch Plains, New Jersey, USA
2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA
3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, Piscataway, New Jersey, USA
4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA
5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic
stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public
mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual
abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically
experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic
ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred
on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged
after-effects.
Over the past two decades, a growing body of research has
shown that individuals with severe mental illness (SMI) are
at greatly increased risk for trauma exposure (see Grubaugh,
Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although
national surveys indicate that more than half of people in the
general population report exposure to at least one event that
according to the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., DSM-IV; American Psychiatric Associa-
tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet,
Hughes, & Nelson, 1995), studies of people with a SMI (such as
This research was supported by National Institute of Mental Health grant R01
MH064662. We wish to thank the following individuals for their assistance
with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose-
marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott,
Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Sh ...
This document summarizes the results of moderator analyses from a large randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) for chronic pain from osteoarthritis. The trial compared 10 sessions of Pain Coping Skills Training (PCST), a form of CBT, delivered by nurse practitioners to a usual care control group. Several demographic and clinical variables were examined as potential moderators of treatment response. The analyses found that patients' pain coping style, expectations for treatment, disease severity, age, and education level significantly moderated outcomes, with some subgroups showing stronger responses to PCST. Sex, race, BMI, and depression did not impact treatment response. Specifically, patients with interpersonal pain coping problems did not benefit much from
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
The association between a history of lifetime traumatic events and pain sever...Paul Coelho, MD
This study examined the associations between a history of lifetime abuse and affective distress, fibromyalgia symptoms, pain severity, interference, and physical functioning in 3,081 chronic pain patients. The study found that those with a history of abuse had greater depression, anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the 2011 Fibromyalgia Survey criteria. Mediation models showed that fibromyalgia survey scores and affective distress independently mediated the relationship between abuse history and pain severity and physical functioning. The findings support a biopsychosocial model where affective distress and fibromyalgia symptoms interact to play roles in how abuse relates to increased pain morbidity.
This study compared chronic pain patients whose symptoms were considered medically unexplained (cases) to those whose symptoms had clear medical explanations (controls). The key findings were:
1. Medically unexplained symptoms were associated with higher rates of psychiatric morbidity, including a 3.4 times higher odds of any psychiatric diagnosis.
2. Cases reported more potential iatrogenic factors like over-investigation and over-treatment from healthcare providers compared to controls.
3. There were no significant differences between cases and controls in rates of medication abuse or dependence.
Ressler, Bradshaw, Gualtieri and Chui: Communicating The Experience Of Chro...pkressler
This document summarizes a study that examined the perceived psychosocial and health benefits of blogging about chronic pain or illness. The study involved an online questionnaire completed by 230 respondents. Key findings included:
1) Respondents reported that blogging decreased feelings of isolation and provided an opportunity to share their illness story and find connections with others.
2) Blogging also promoted accountability, helped respondents make meaning and gain insights from their illness experience, and nurtured a sense of purpose.
3) Results suggest blogging may decrease isolation and increase a sense of purpose, but more research is needed involving larger and more diverse samples.
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
This document discusses overlapping chronic pain conditions (COPCs), where many common pain conditions frequently co-occur. It notes the high degree of overlap is often not accounted for in clinical trials. The failure to consider the heterogeneous and overlapping nature of chronic pain may result in treatments with only small effects. It presents the concept of COPCs and reviews their epidemiology, finding significant overlap between conditions like headaches, neck pain, and jaw pain in the general US population based on a national health survey. It concludes more research is needed that considers the overlapping nature of chronic pain conditions.
This document discusses overlapping chronic pain conditions (COPCs), where many common pain conditions frequently co-occur and overlap. It notes that COPCs are more prevalent in women than men. The failure to account for the heterogeneous and overlapping nature of most chronic pain conditions may result in small treatment effects when administered to general chronic pain populations. It recommends advancing the understanding of COPCs by considering their overlapping nature in clinical trials and pain condition classifications.
This study examined the heritability of pain catastrophizing using a twin study design. 400 twins completed measures of pain catastrophizing and underwent a cold pressor task experiment. Results showed pain catastrophizing was 37% heritable, with the remaining 63% due to unique environmental factors. The association between catastrophizing and increased pain response during the cold pressor task was not attributable to shared genetics or environment, suggesting a direct relationship between catastrophizing and experimental pain outcomes. This was the first study to examine the genetic contributions to catastrophizing and its relationship to experimental pain responses.
This study compared cognitive rigidity and differentiation in patients with depression alone and patients with comorbid depression and fibromyalgia. Thirty-one patients with both depression and fibromyalgia were matched with 31 patients who had depression alone based on age, sex, and number of depressive episodes. Patients completed measures of depressive symptoms and cognitive structure using repertory grid technique. Results showed that depressed patients with fibromyalgia had higher levels of depressive symptoms, greater cognitive rigidity, and lower cognitive differentiation compared to depressed patients without fibromyalgia. This suggests more extreme and polarized thinking patterns in patients with comorbid depression and chronic pain. The findings could help inform future treatment approaches for this patient group.
This document summarizes a literature review on the management of chronic pain in adolescents. It finds that chronic pain is common in adolescents and is best treated through a multidisciplinary approach using psychological therapies and functional restoration, along with medical care and pharmaceutical interventions as needed. While multidisciplinary care has shown benefits, there is limited high-quality research on pharmacological treatments for chronic pain in adolescents. More research is needed to guide safe and effective use of medications for managing chronic pain in this population.
Chronic Emotional Detachment, Disorders, and Treatment-Team BSarah M
This document discusses chronic emotional detachment and how it may lead to increased rates of mental health disorders like anxiety, depression, and PTSD. It hypothesizes that suppressing natural emotions to conform to societal pressures causes stress and depersonalization over time. When a distressing trigger occurs, this imbalance can lead to mental disorders. The document reviews literature linking emotional suppression to increased disorders in populations like veterans and refugees. It proposes studying the relationship between evolutionary survival mechanisms and societal norms. The methodology section describes a mixed-methods study using surveys, interviews, and archival data from a random sample to understand subjective emotional experiences and medication effectiveness.
This study investigated the relationship between pain catastrophizing and outcomes in 253 chronic pain patients prescribed opioids in primary care settings. Patients completed measures of pain catastrophizing, intensity, disability, side effects, and opioid misuse at baseline and 6-month follow up. The results showed that patients with high catastrophizing reported greater pain, disability, negative affect, side effects, and opioid misuse compared to low catastrophizing patients, both at baseline and over 6 months. Higher catastrophizing was associated with worse pain outcomes and increased risk of opioid misuse among chronic pain patients prescribed opioids in primary care.
Meta-Analysis of population studies on the prevalence of chronic pain in UK –...Pubrica
Chronic pain, which includes illnesses like low back pain and osteoarthritis, was recently highlighted as one of the most common causes of disability worldwide by the Global Burden of disease studies in a meta-analysis study.
Reference : https://bit.ly/3Ki4o96
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This summary provides an overview of a document that discusses racial disparities in acute outcomes of life-threatening injury.
The document includes an integrative review of 7 studies that examined the relationship between race/ethnicity and acute outcomes for those with severe injuries requiring intensive care. The findings from the 7 studies were mixed, with 4 studies finding significant relationships between race/ethnicity and worse acute outcomes, while 3 studies found no significant relationships. The review concludes that the inconclusive results indicate a need for more research on racial/ethnic disparities in acute outcomes following life-threatening injuries.
Dr. Tamara Baker presented at the 21st IAGG World Congress of Gerontology and Geriatrics on understanding pain disparities. Her presentation covered:
1) Identifying patient, provider, healthcare system, and regulatory barriers to effective pain management.
2) Exploring determinants of health and intersectionality models to address disparities in pain management and research.
3) Discussing implementation strategies to acknowledge pain disparities.
She emphasized the need to move beyond singular categories and recognize that multiple intersecting factors shape experiences of pain and health outcomes. Understanding and addressing pain disparities requires considering social determinants of health and the complex ways identities intersect.
This study examined the impact of racism experienced by physicians of color through a mixed-methods survey. 71 physicians of color completed surveys measuring experiences of microaggressions, professional quality of life, and open-ended responses describing instances of racism. Quantitative results found microaggressions were correlated with secondary traumatic stress. Qualitative analysis identified domains of racism experienced from patients, colleagues, and institutions including assumptions of abilities, microaggressions, and exclusion from opportunities. Participants recommended institutions provide spaces to discuss diversity, implement inclusive policies, and promote a diverse workforce. The study suggests physicians of color regularly experience racism which can negatively impact their well-being and career advancement.
Meta-Analysis of population studies on the prevalence of chronic pain in UK –...Pubrica
Chronic pain, which includes illnesses like low back pain and osteoarthritis, was recently highlighted as one of the most common causes of disability worldwide by the Global Burden of disease studies in a meta-analysis study.
Reference : https://bit.ly/3Ki4o96
Our services : https://pubrica.com/services/research-services/meta-analysis/
Why Pubrica:
When you order our services, We promise you the following – Plagiarism free | always on Time | 24*7 customer support | Written to international Standard | Unlimited Revisions support | Medical writing Expert | Publication Support | Biostatistical experts | High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
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Similar to Sociodemographic disparities in chronic pain... (20)
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
The conundrum of opioid tapering in long term opioid therapy for chronic pain...Paul Coelho, MD
The document discusses the challenges clinicians face when tapering patients off long-term opioid therapy for chronic pain. It explains that opioid dependence can cause worsening pain, psychiatric symptoms, and functioning during tapering due to neuroplastic changes. While tapering seems logical to address risks of high-dose opioids, it may paradoxically make a patient's issues worse due to protracted abstinence syndrome. The document provides guidance for managing these complex patients focused on both pain and opioid dependence.
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CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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According to the TechSci Research report titled "India Home Healthcare Market - By Region, Competition, Forecast and Opportunities, 2029," the India home healthcare market is anticipated to grow at an impressive rate during the forecast period. This growth can be attributed to several factors, including the rising demand for managing health issues such as chronic diseases, post-operative care, elderly care, palliative care, and mental health. The growing preference for personalized healthcare among people is also a significant driver. Additionally, rapid advancements in science and technology, increasing healthcare costs, changes in food laws affecting label and product claims, a burgeoning aging population, and a rising interest in attaining wellness through diet are expected to escalate the growth of the India home healthcare market in the coming years.
Browse over XX market data Figures spread through 70 Pages and an in-depth TOC on "India Home Healthcare Market”
https://www.techsciresearch.com/report/india-home-healthcare-market/15508.html
nursing management of patient with Empyema pptblessyjannu21
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
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India Medical Devices Market: Size, Share, and In-Depth Competitive Analysis ...Kumar Satyam
According to TechSci Research report, “India Medical Devices Market Industry Size, Share, Trends, Competition, Opportunity and Forecast, 2019-2029,” the India Medical Devices Market was valued at USD 15.35 billion in 2023 and is anticipated to witness impressive growth in the forecast period, with a Compound Annual Growth Rate (CAGR) of 5.35% through 2029. This growth is driven by various factors, including strategic collaborations and partnerships among leading companies, a growing population, and the increasing demand for advanced healthcare solutions.
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Strategic Collaborations and Partnerships
One of the most significant trends driving the India Medical Devices Market is the increasing number of collaborations and partnerships among leading companies. These alliances aim to merge the expertise of individual companies to strengthen their market position and enhance their product offerings. For instance, partnerships between local manufacturers and international companies bring advanced technologies and manufacturing techniques to the Indian market, fostering innovation and improving product quality.
Browse over XX market data Figures and spread through XX Pages and an in-depth TOC on " India Medical Devices Market.” - https://www.techsciresearch.com/report/india-medical-devices-market/8161.html
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The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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2. longitudinally? (2) Second, this study investigates 4 possible
sources of measurement bias: pain severity, reporting heteroge-
neity, survey nonresponse, and mortality selection. Do these
factors bias estimates of social disparities in pain, and if so, how?
In particular, could the apparent minority advantage in pain be
a consequence of reporting heterogeneity? Could the plateauing
of pain after age 60 reflect mortality selection and/or nonresponse
bias?
Overall, this study provides a fuller view of the national
distribution of chronic pain, and identifies key sources of
measurement bias relevant to pain disparities research.
2. Methods
2.1. Data
This study is based on secondary analysis of 7 consecutive
biennial waves of the Health and Retirement Study (HRS; http://
hrsonline.isr.umich.edu/index.php), a study sponsored by the
National Institute of Aging (grant number NIA U01AG009740) and
conducted by the University of Michigan. The HRS began in
1992, and by 1998 was expanded to be nationally representative
of the noninstitutionalized above-50 population of the United
States. The 1998 response rate was 83.75%.58
Respondents
were noninstitutionalized at baseline, but were followed if they
moved to institutions in subsequent waves.30
Surveys have been
repeated every 2 years, with respondents interviewed by
telephone or in person depending on health and preferences.
Follow-up response rates for the nondeceased have been high
(85%-93%),31
including among racial/ethnic minorities, a fact
attributed to high-quality training of interviewers and targeted
follow-up strategies.50
The present analyses start with the 1998 over-50 sample, and
follow this group over 7 waves. This closed cohort design was
selected so that 12 years’ worth of data would be available for all
respondents except in cases of nonresponse or death. Of
baseline respondents (n 5 20,007), 331 were excluded for
missing all information about education or pain status, yielding an
analytic sample of 19,776. The HRS oversamples African-
Americans, Hispanics, and Floridians and uses a different
sampling frame for “oldest old” respondents30
; sampling weights
must thus be used to generate estimates representative of the
population. Based on HRS-provided sampling weights, the
analytic sample represents 67,338,111 Americans.
2.2. Measures
2.2.1. Pain
Since 1998, HRS biennial waves have used identical wording for
pain-related questions. The initial question reads, “Are you often
troubled with pain?” Respondents answering “yes” are here
considered to be experiencing chronic pain. This wording has the
advantage of not priming respondents to privilege continuous
over episodic pain, or requiring respondents to be experiencing
pain at the moment of the interview. Previous research finds that
respondents are less than half as likely to report being “often
troubled by pain” as to report experiencing “any pain in the last 30
days,”5
which indicates that the HRS question is unlikely to
capture fleeting or trivial experiences of pain.
Respondents answering “Yes” to the opening question are
then asked, “How bad is the pain most of the time: mild,
moderate, or severe?”. Responses to this question were
combined with the previous one to create a 4-category “pain
status” variable for each survey wave: no pain (0), mild pain (1),
moderate pain (2), and severe pain (3). Pain status was treated as
a ratio variable in some analyses, as in previous studies.23
Because this study focuses on chronic noncancer pain, pain
status was set to missing when pain was likely due to cancer or
cancer treatment, ie, when respondents had received a new
cancer diagnosis, received treatment for cancer, or reported that
their cancer had become worse since the last study wave. This
cancer exclusion affected between 0.67% and 3.38% of the
sample depending on the wave.
The final question in the series, “Does the pain make it difficult
for you to do your usual activities such as household chores or
work?,” serves as a measure of pain-related disability in the tests
of reporting heterogeneity described below. Its mention of both
household and out-of-house work makes it appropriate for
a population of mixed employment and retirement statuses.
Item nonresponse for pain questions was very low, never
exceeding 1.8%. Wave nonresponse (conditional on survivorship)
ranged from 5.76% in 2000 to 14.37% in 2010.
2.2.2. Covariates
Demographic variables used in analyses include sex, age in 1998
(categorized as 51-59, 60-69, 70-79, and 80 or above), race/
ethnicity (non-Hispanic white, non-Hispanic black or African-
American, and Hispanic—henceforth “white,” “black,” and
“Hispanic” for brevity; the category “non-Hispanic other” was
too small to be analyzed), highest level of education (less than
high school, high school diploma, 4-year college degree, and
graduate degree), 1998 household wealth quartiles (with mean
values, in US dollars, of $6,286, $75,032, $200,899, and
$937,662), and a “survival status” variable indicating whether
the respondent died before the end of the study period. Wealth
was included rather than income based on evidence of nonlinear
Table 1
Sociodemographic characteristics of the analytic sample (n 5
19,776; from the Health and Retirement Study, 1998).
Proportion or mean SD N
Sex
Female 0.57 11,233
Male 0.43 8543
Age in 1998 66.98 10.17
Age categories
51-59 in 1998 0.28 5513
60-69 in 1998 0.34 6801
70-79 in 1998 0.24 4809
80 or above in 1998 0.13 2653
Race/ethnicity
White (non-Hispanic) 0.77 15,132
Black (non-Hispanic) 0.14 2749
Hispanic 0.08 1591
Other (non-Hispanic) 0.02 304
Education
Less than high school 0.29 5644
High school degree 0.54 10,765
4-y college degree 0.10 1952
Graduate degree 0.07 1415
Household income in 1998 $48,902 $97,678
Wealth in 1998 $309,736 $1,092,179
Survival Status (1998-2010)
Alive throughout study period 0.64 12,671
Died during study period 0.36 7105
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3. relationships between income and overall socioeconomic stand-
ing when looking at populations of mixed retirement statuses.27
Socioeconomic characteristics of the analytic sample are
summarized in Table 1.
2.3. Analytic strategy
To summarize the prevalence and distribution of chronic pain,
time series graphs of pain status were constructed for the full
population and for specific sociodemographic groups. To assess
multivariate associations, a probit-based latent growth curve
model was run using the 7 waves of pain data and all key
covariates. Latent growth curve models depict the underlying
latent trajectory of change in terms of an intercept and a slope,
with variation by time-invariant covariates treated as deviations
from this general intercept and slope.7
The model was estimated
under missing data theory using all available data45
; findings
using list-wise deletion of respondents with missing pain status
were extremely similar.
The likely direction of bias due to reporting heterogeneity was
estimated by comparing the association between reported levels
of pain and of pain-related disability across groups. If one group is
more stoical in pain reporting than another (eg, if its members call
“moderate” what others would call “severe”), we would expect
the stoical group to experience more disability for a given level of
pain (ie, we would expect their “moderate” pain to cause greater
functional disruption than the other group’s “moderate” pain).
Estimating such differences in reporting style could clarify
whether studies likely underestimate or overestimate group
differences in pain. Concretely, reporting heterogeneity was
assessed through logistic regression of pain-related disability
(yes/no) on the core sociodemographic variables plus self-
reported pain severity. Because findings were similar across
survey waves, results from a model pooling all 7 waves of data are
presented.
To clarify whether focusing on prevalence rather than severity
might bias estimates of pain disparities, the distribution of any,
mild, moderate, and severe pain by sociodemographic group
was calculated, also using pooled data from all 7 waves. To
assess pain-related survey nonresponse (in the form of attrition
bias), I conducted a logistic regression of wave nonresponse on
categorical pain status at the previous survey wave, conditional
on survivorship.
Mortality selection occurs if individuals with high pain are more
likely to die and hence exit the population than individuals with low
pain (regardless of whether this association is causal57
). This
leads to a reduced slope in the graph of pain by age, which
reflects population compositional changes; ie, it can occur even if
mean pain increases steadily with age among survivors.63
To test
whether mortality selection contributes to the apparent plateau-
ing of pain after age 60, I conducted a logistic regression of death
by a given survey wave on categorical pain status at the prior
wave. Mortality selection was also assessed by comparing mean
pain across time for decedents, survivors, and the full sample, to
examine whether decedents have higher average pain scores
than survivors, and whether the full-sample slope is flatter than
that for either survivors or decedents separately.
All presented graphs and analyses are sample weight-
adjusted, except those aiming to identify quasicausal relation-
ships rather than to describe population parameters66
(ie, the
tests of attrition bias, mortality selection, and reporting
heterogeneity).
Stata MP/13.1 (StataCorp LP, College Station, TX) was used
for all analyses except the latent growth curve model, which was
implemented with Mplus version 7.31 (Muth ´en & Muth ´en, Los
Angeles, CA). Code is available upon request.
3. Results
3.1. Longitudinal disparities in pain: bivariate results
Figure 1 shows the proportion of respondents in each pain status
category (no, mild, moderate, or severe pain) by survey wave. In
1998, 27.3% of respondents reported that they were often
troubled with pain; by 2010, this had increased to 36.6%. The
ratio of mild to moderate to severe pain remained fairly constant
across the 7 waves, at approximately 3:6:2.
Figure 2 shows graphs of mean pain status over time by sex,
education, wealth, race/ethnicity, age group, and survival status.
All groups show an upward slope in mean pain, with slopes
generally roughly parallel across groups. Intercepts, however,
often differ dramatically across groups. As shown in Figure 2A,
women consistently report higher pain than men—on average,
38% higher. Figures 2B and C show large gradients by
socioeconomic status (SES), with pain scores monotonically
lower with each categorical increase in education or wealth. On
average, respondents with no high school degree have pain
scores over twice as high as respondents with graduate degrees.
Similarly, the least wealthy respondents have scores on average
78% higher than the wealthiest. Mean pain scores by race/
ethnicity (Fig. 2D) are relatively closely clustered together.
Although some racial/ethnic differences are significant in bivariate
models, these patterns change in models with socioeconomic
controls, as discussed below.
Mean pain scores for respondents in each baseline age group
are shown in Figure 2E. Mean pain rises with time in each age
group, undermining the claim that pain plateaus or declines after
age 60. At the same time, mean pain scores for most age groups
are virtually indistinguishable throughout the 12-year period, with
only respondents 80 years or older showing noticeably higher
pain scores in most waves. If a researcher were to use data only
from a single wave, then mean pain scores would indeed seem to
plateau with age, except for a possible rise after age 80.
This graph also indicates that pain is worsening by period,
above and beyond worsening with age. For example, in 1998,
respondents in their 60s had a mean pain score of 0.50. In 2008,
respondents in their 60s (ie, who had been in their 50s at baseline)
had a significantly higher mean pain score of 0.66—a 32%
increase. Findings are similar for respondents in their 70s, whose
pain scores were 28% higher in 2008 than in 1998. Respondents
in their 80s had similar levels of pain in 1998 and 2008, however.
Figure 1. Chronic pain status by wave (n 5 19,776; from the Health and
Retirement Study, 1998-2010). Sample weight-adjusted.
February 2017
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4. Figure 2F compares mean pain scores for respondents who
died during the 12-year study period and those who survived
throughout. The difference between both groups is large and
consistently significant, with decedents having, on average, 31%
higher pain scores than survivors.
3.2. Longitudinal disparities in pain: multivariate results
Results from a multivariate latent growth curve model of
disparities in chronic pain over time are presented in Table 2.
Goodness-of-fit measures suggest “extremely good” fit,40
with
the root mean square error of approximation below 0.01 and the
comparative fit index and Tucker-Lewis index very near one. The
patterns observed in Figure 2 for sex, education, wealth, and
survival status persist in multivariate context. As shown by
substantively and statistically significant coefficients for the
intercept (left half of Table 2), women have higher levels of pain
than do men (b 5 0.199; P , 0.001), and both education and
wealth are negatively associated with pain levels, with each
increase in education or wealth associated with a lower intercept.
Differences in intercept between those in the lowest and highest
educational category (b 5 0.415) or wealth category (b 5 0.321)
are quite large—larger than the difference between men and
women. Respondents who died during the study also had
a significantly higher intercept than did those who survived (b 5
0.283; P , 0.001), though also a less steep slope (reflecting exit
of high-pain individuals due to death).
Not all patterns observed in Figure 2 persist in the multivariate
model. Once education and wealth are controlled for, the
previously observed pain disadvantage of Hispanics relative to
whites disappears, as shown by the lack of significant differences
in intercept or slope. Moreover, inclusion of socioeconomic
controls shows African-Americans to have a significantly lower
intercept than whites (b 5 20.112; P , 0.001). In other words,
the minority disadvantage in pain scores observed earlier is
attributable to lower socioeconomic standing; once this is
controlled for, the disadvantage disappears (for Hispanics) or
reverses (for blacks).
Figure 2. Mean pain status over time by sociodemographic characteristics (n 5 19,776; from the Health and Retirement Study, 1998-2010). Means calculated by
assigning scores: no pain 5 0; mild pain 5 1; moderate pain 5 2; severe pain 5 3. Sample weight-adjusted. All differences by sex, education, wealth, and survival
status (A, B, C, and F) are significant (P , 0.05, 2-tailed) except between college and graduate degree, and, in 1998, between wealth quartiles 3 and 4. The only
significant differences by race/ethnicity (D) are between Hispanics and whites, 1998 to 2006; and by baseline age (E) are between 801 and younger groups, 1998
and 2000.
316 H. Grol-Prokopczyk
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5. Across successively older baseline age groups, the intercept for
the latent curve decreases monotonically, ie, net of other covariates,
older cohorts have lower pain levels. This supports the earlier
observation that pain levels seem to be increasing over time,
disadvantaging younger birth cohorts. Nonetheless, the slope for all
age groups is positive (since both the slope constant and the age-
specific slope coefficients are positive), showing that within age
categories, pain increases with age and accelerates at older ages.
With the noted exceptions, differences across groups in terms
of slope were generally small and not statistically significant
(Table 2, right half). In contrast, all intercept coefficients except
one (for Hispanics) were statistically and substantively significant.
Consistent with Figure 2, then, pain disparities across socio-
economic groups manifest primarily as differences in intercepts.
3.3. Disparities in any pain vs in pain severity
Table 3 shows the percentage of respondents in each group who
reported any pain and, conditional on reporting pain, who
reported mild, moderate, and severe pain. (Data are pooled from
all 7 survey waves; individual waves show very similar percen-
tages.) The table reveals that disparities in chronic pain by sex,
education, wealth, and survival status are likely underestimated in
studies relying on binary pain measures: not only are disadvan-
taged groups in these categories more likely to report any pain,
but the pain is more likely to be severe. Thus, women are not only
28% more likely than men to report chronic pain (34.62% vs
27.09%), but also 37% more likely to report that their pain is
severe (19.77% vs 14.43%). Differences in pain severity are even
more pronounced by education and wealth: eg, 25.57% of pain
sufferers without a high school degree term their pain “severe,”
whereas only 9.79% of those with graduate degrees do so. The
difference across wealth quartiles is similar. Higher pain scores
among respondents who died during the study period also reflect
a combination of prevalence and severity: decedents were 18%
more likely to report any pain, and, conditional on reporting pain,
were 48% more likely to deem the pain severe (All differences
noted are statistically significant).
Across racial/ethnic groups, the pattern in Table 3 is
somewhat more complex, with Hispanics the most likely to
report any pain, but blacks the most likely to report that their pain
is severe. Indeed, combining information about pain prevalence
and severity reveals that 8.8% of all blacks report severe pain,
compared with 8.3% of all Hispanics. How one ranks blacks vs
Hispanics in terms of pain burden thus depends on whether one
prioritizes prevalence or severity. Whites have both the lowest
prevalence and lowest level of severe pain among the 3 groups,
with only 4.96% of whites experiencing severe pain. Differences
across age categories were relatively small and usually not
statistically significant.
Table 2
Multivariate latent growth curve model for pain status over the 12-year period (n 5 19,776; from the Health and Retirement Study,
1998-2010).
Intercept Slope
b SE b SE
Sex (reference: male)
Female 0.199*** 0.016 0.001 0.004
Education (reference: no degree)
High school degree 20.168*** 0.024 0.016** 0.006
4-year college degree 20.309*** 0.042 0.009 0.009
Graduate degree 20.415*** 0.042 0.012 0.011
Wealth (reference: quartile 1)
Quartile 2 20.218*** 0.026 0.013* 0.006
Quartile 3 20.298*** 0.024 0.013 0.007
Quartile 4 (wealthiest) 20.321*** 0.025 0.003 0.007
Race/ethnicity (reference: white non-Hispanic)
Black (non-Hispanic) 20.112*** 0.029 20.002 0.007
Hispanic 0.002 0.033 20.015 0.008
Age categories (reference: 51-59 in 1998)
61-69 in 1998 20.112*** 0.023 0.016*** 0.004
71-79 in 1998 20.203*** 0.024 0.022*** 0.005
80 or above in 1998 20.246*** 0.037 0.029** 0.009
Survival status (reference: survived)
Died during the study period 0.283*** 0.023 20.017* 0.007
Constant 0.000*** 0.033*** 0.008
Covariance of slope with intercept 20.033*** 0.002
Sample size 19,776
Chi-square value (df 5 94) 199.56***
RMSEA (and 90% CI) 0.008 (0.006-0.009)
CFI 0.997
TLI 0.997
*P , 0.05; **P , 0.01; ***P , 0.001; 2-tailed.
Estimation conducting using sample weights. Results are from a multivariate model simultaneously including all independent variables. Intercepts for wealth quartile 3 and 4 are not significantly different from each other.
CI, confidence interval; RMSEA, root mean square error of approximation; CFI, comparative fit index; TLI, Tucker-Lewis index.
February 2017
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6. 3.4. Reporting heterogeneity
Results of the logistic regression of pain-related disability on
sociodemographic covariates (controlling for pain severity) are
shown in Table 4. Odds ratios above 1 reflect relative stoicism in
reporting pain, as they indicate that for a given level of reported pain,
members of the group are more likely to experience pain-related
disability (suggesting that the pain level itself may be understated).
Odds ratios below 1 reflect greater expressivenessin reporting pain.
By this interpretation, many socioeconomic disparities in pain
reported earlier appear to be underestimates. Groups already
reporting the most pain—women, the less educated, and the less
wealthy—also seem to be the most stoical in reporting pain. If this
were accounted for, disparities across groups would seem even
larger.
Across racial/ethnic categories, no significant differences in
reporting styles were found between blacks and whites,
suggesting that the black advantage found in the multivariate
model (Table 2) is genuine, ie, not an artefact of reporting
heterogeneity. However, Hispanics do seem to be significantly
more expressive than whites, complicating interpretation of
relative pain burden: Hispanics may, like blacks, have lower
average pain scores than whites after all.
The foregoing interpretations assume that self-reported pain-
related disability is free from, or at least less prone to, reporting
heterogeneity than self-reported pain. If, however, both questions
are subject to similar tendencies toward stoicism or expressive-
ness, then the present findings may be less illuminating than
tautological. These findings are thus presented as tentative, not
definitive, assessments of reporting heterogeneity.
3.5. Nonresponse bias and mortality selection
Results of tests of attrition bias can be briefly summarized: little to
no evidence that pain predicts survey attrition was found. Odds of
wave nonresponse were not significantly higher for those
reporting pain (regardless of severity) in the previous wave than
for those without pain, with the lone exception of higher
nonresponse in 2000 among 1998 respondents with severe pain
(OR 5 1.29; P , 0.05).
Results of tests of mortality selection were also very consistent,
but in the opposite direction: pain, specifically moderate and
severe pain, strongly and consistently predicted death by the next
wave (P , 0.01 in all cases). Compared with pain-free
respondents and controlling for age in years, those with moderate
pain had on average 0.72 the odds of surviving until the next
survey wave (range across waves: 0.64-77), and those with
severe pain had 0.50 the odds (range: 0.42-55). Those with mild
pain had 0.87 the odds (range: 0.78-1.01), but this was not
statistically significant.
Figure 3 presents mean pain scores over time for decedents
by period of death, for survivors, and for the full sample. As noted,
decedents experience higher pain than survivors in the years
before death. In addition, Figure 3 shows that the earlier in the
study period respondents die, the higher their mean pain tends to
be, both at baseline and in subsequent waves. (Similar patterns
are observed when restricting the sample to specific age
categories.) Higher pain among decedents cannot merely reflect
acute pain in the final months of life, as higher pain at baseline
predicts death even 10 to 12 years later. Pain seems to serve as
a marker of long-term mortality risk.
Table 3
Percent reporting any pain, mild pain, moderate pain, and severe pain, based on pooled data from all waves (n 5 102,275; from
the Health and Retirement Study, 1998-2010).
% reporting any pain (SE) Of those reporting pain, % reporting mild, moderate, or severe pain
Mild pain (SE) Moderate pain (SE) Severe pain (SE)
Sex
Female 34.62 (0.50) 24.03 (0.45) 56.20 (0.50) 19.77 (0.50)
Male 27.09 (0.50) 33.16 (0.63) 52.41 (0.66) 14.43 (0.51)
Education
Less than high school 37.79 (0.77) 24.37 (0.64) 50.06 (0.83) 25.57 (0.70)
High school degree 31.89 (0.47) 26.29 (0.46) 57.59 (0.59) 16.12 (0.45)
4-y college degree 24.29 (0.89) 33.80 (1.86) 55.66 (1.66) 10.54 (0.69)
Graduate degree 21.08 (0.77) 43.10 (1.64) 47.11 (1.41) 9.79 (1.23)
Wealth
Quartile 1 (least wealthy) 40.36 (0.86) 23.19 (0.64) 50.88 (0.73) 25.93 (0.77)
Quartile 2 32.95 (0.59) 26.26 (0.66) 55.59 (0.91) 18.15 (0.74)
Quartile 3 28.81 (0.62) 29.34 (0.75) 56.56 (0.88) 14.09 (0.63)
Quartile 4 (wealthiest) 25.53 (0.56) 31.92 (1.01) 56.65 (0.80) 11.43 (0.57)
Race/ethnicity
White (non-Hispanic) 30.98 (0.39) 27.65 (0.47) 56.34 (0.48) 16.01 (0.38)
Black (non-Hispanic) 31.78 (0.94) 27.48 (0.85) 44.75 (1.18) 27.77 (1.58)
Hispanic 35.74 (1.10) 25.15 (0.99) 51.59 (1.66) 23.26 (1.66)
Age categories
51-59 in 1998 32.62 (0.70) 30.28 (0.69) 52.82 (0.85) 16.90 (0.57)
61-69 in 1998 30.33 (0.50) 25.80 (0.65) 56.92 (0.63) 17.27 (0.59)
71-79 in 1998 29.73 (0.66) 25.76 (0.64) 55.05 (0.61) 19.19 (0.63)
80 or above in 1998 33.06 (0.82) 22.86 (0.84) 56.69 (1.03) 20.44 (0.92)
Survival status (1998-2010)
Alive throughout study 30.27 (0.41) 28.96 (0.47) 55.14 (0.54) 15.90 (0.45)
Died during the study period 35.77 (0.63) 22.64 (0.60) 53.86 (0.51) 23.50 (0.74)
Sample weight-adjusted; bivariate statistics.
318 H. Grol-Prokopczyk
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7. Figure 3 also shows that the slope for the full sample is less
steep than the slope for survivors or for any group of decedents.
This is a clear example of mortality selection: within all population
subgroups, pain increases fairly steadily with time, but individuals
with higher pain are more likely to die and thus to exit the
population. Such compositional changes lead the full population
slope to appear shallower than the slope for any individual
subgroup.
4. Discussion
To heed recent calls to take chronic pain seriously as a public
health problem,10,19,34
as well as to better understand and
address US health disparities,8,11,13
accurate estimation of pain’s
prevalence, long-term patterns, and sociodemographic distribu-
tion is needed. This study uses 12-year longitudinal data to
describe the national distribution of chronic noncancer pain
among older (age 511) American adults, and to investigate
whether and how pain severity, reporting heterogeneity, survey
nonresponse, and mortality selection might bias estimates of
social disparities in pain. Like previous studies using national
samples, this one finds chronic pain prevalence to be high: 27.3%
in 1998, rising to 36.6% 12 years later. Several additional key
points may be highlighted from the present findings.
First, disparities in chronic pain by sex and, especially, SES are
extremelylarge,inbothbivariateandmultivariatecontexts.Incontrast,
although racial/ethnic minorities have slightly higher pain scores (and
experience more severe pain) than whites in bivariate analyses, this
disadvantage inpainscoresdisappearswhencontrollingforSES,and
indeed a black advantage vis-`a-vis whites emerges.
Next, studies that do not account for group differences in pain
severity and/or in styles of rating pain (which includes most existing
studies) are likely to underestimate pain disparities by sex and SES.
Women, the less educated, and the less wealthy experience not
only more pain, but also more severe pain, as well as greater
disability for a given reported level of pain. Tests of reporting
heterogeneity show no difference between white and black pain
rating styles, however, indicating that the aforementioned black
advantage is likely genuine. Hispanics show a more expressive
rating style than other groups, consistent with previous stud-
ies22,56
; were this accounted for, Hispanics might also show
a lower pain burden than whites in multivariate models.
Next, chronic noncancer pain (in particular moderate or severe
pain) strongly predicts death. Mortality selection thus leads to
underestimation of the rise in pain with age when using cross-
sectional data. The cross-sectional finding that pain plateaus or
declines after age 609,29,47,59
is not replicated longitudinally.
Instead, all age cohorts—including those above age 60—show
steady increases in mean pain scores over time. Cross-sectional
findings are biased by the higher death rates of individuals with
high pain, leading to an apparent flattening of the pain curve.
Finally, the burden of pain seems to be increasing not only with
age, but also by period, ie, younger birth cohorts face higher pain
levels than older ones (controlling for age). This phenomenon
further contributes to the appearance of plateauing pain levels
when using cross-sectional data. This finding corroborates
recent research based on National Health Interview Survey data,
which finds rising rates of chronic pain in the United States
between 1997-1999 and 2011-201314
(very close to the present
study’s range of 1998 to 2010).
Comparing current findings with those of previous research
more broadly, we may note that the main claims of cross-sectional
pain disparities studies (summarized in the introduction) are
supported here, except for the plateauing of pain with age.
However, effect sizes from previous studies must be interpreted
cautiously, because most studies do not incorporate information
on pain severity or reporting heterogeneity, and thus likely
underestimate disparities by sex and SES. Previous longitudinal
research on chronic conditions such as hypertension and diabetes
suggests that cumulative disadvantage (health differentials widen-
ing with age) is likely to be observed when mortality selection is
accounted for.24
In the present study, however, differences in pain
by sex, education, and wealth remain roughly parallel over time,
even when controlling for mortality—a pattern consistent neither
Table 4
Multivariate logistic regression of pain-related disability on
socioeconomic covariates controlling for pain severity, based
on pooled data from all waves (n 5 32,048; from the Health and
Retirement Study, 1998-2010).
Odds ratio SE
Sex (reference: male)
Female 1.32*** 0.03
Education (reference: no degree)
High school degree 0.82*** 0.03
4-y college degree 0.72*** 0.04
Graduate degree 0.61*** 0.04
Wealth (reference: quartile 1)
Quartile 2 0.87*** 0.03
Quartile 3 0.78*** 0.03
Quartile 4 (wealthiest) 0.73*** 0.03
Race/ethnicity (ref.: white non-Hispanic)
Black (non-Hispanic) 1.01 0.04
Hispanic 0.75*** 0.03
Age categories (ref.: 51-59 in 1998)
61-69 in 1998 0.93* 0.03
71-79 in 1998 0.94 0.03
80 or above in 1998 0.99 0.05
Pain severity (reference: mild pain)
Moderate pain 2.79*** 0.08
Severe pain 8.55*** 0.38
* 5 P , 0.05; ** 5 P , 0.01; *** 5 P , 0.001; 2-tailed.
Results are from a multivariate model simultaneously including all independent variables.
Figure 3. Mean pain status over time by survival status (n 5 19,776; from the
Health and Retirement Study, 1998-2010). Means calculated by assigning
scores: no pain 5 0; mild pain 5 1; moderate pain 5 2; severe pain 5 3.
Sample weight-adjusted. Because “Died 1998 to 2000” yielded only a single
pain score (and thus was not easily observable on the graph), this category was
merged with the subsequent one, yielding “Died 1998 to 2002.” Mean pain for
those who died in 1998 to 2000 was 0.73. All groups of decedents are
statistically significantly different from survivors, in all waves (P , 0.02).
February 2017
·Volume 158
·Number 2 www.painjournalonline.com 319
Copyright Ó 2017 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
8. with the cumulative disadvantage hypothesis nor the age-as-
leveler hypothesis. Chronic pain may follow a different long-term
pattern than other common chronic conditions.
For health disparities researchers and pain epidemiologists,
a key methodological implication of these findings is to attend to
pain severity, reporting heterogeneity, and mortality selection as
sources of measurement bias. (Techniques for overcoming
reporting heterogeneity remain challenging to develop, how-
ever.28
) Nonresponse bias may be worth attending to as well,
despite a lack of evidence for it in this study. Not only did the
present data permit testing only for attrition bias rather than
general nonresponse bias, but even the findings regarding
attrition could reflect a unique feature of the HRS: that
respondents who become institutionalized continue to be
interviewed. Many surveys exclude institutionalized respondents
and thus may lose individuals with high pain who move to nursing
homes.
This study also underscores the importance of further research
on mechanisms underlying socioeconomic disparities in pain.
Although sex differences in pain experiences have been “a topic
of tremendous scientific interest” for the past 2 decades—
yielding a broad set of biological and psychosocial explanations
for such differences (25:447)—comprehensive explorations of
mechanisms linking SES to chronic pain at the population level
have been much rarer.6
This may be changing, however, with
recent studies (especially European ones) exploring specific
diseases,21
job characteristics,39
neighborhood effects,6
and
mental health41
as mediating factors. A US-based article notes
that low SES individuals are more likely to be perceived by health
care providers as exaggerating pain and to have bureaucratic
difficulties contending with health insurance, if they have in-
surance at all.33
(Clinicians may wish to take note of such findings,
to ensure that their own clinical practices do not contribute to
poor treatment of the socially disadvantaged.) Research clarifying
the relative importance of these and additional factors, and
testing for generalizability across countries, would help answer
why large socioeconomic disparities in pain are observed, and
how they might be effectively addressed.
Recent years have also seen growing scholarly interest in the
association between chronic pain and death. Studies have tested
whether or not specific pain conditions predict mortality3,4
and
whether the association between chronic pain and death is
causal or spurious2,43,60,67
—a question still without definitive
answer.57
Further research would ideally clarify why chronic pain
predicts death, and what can be done about it.
This study has several key limitations beyond those already
discussed. First, the HRS’s measure of pain (“Are you often troubled
by pain?”) does not match common definitions of chronic pain as
pain lasting at least 3 months35
or 6 months.62
Nonetheless,
estimates presented in this study align with those of several previous
studies.29,36,37,53
For example, a study using 2010 NHIS data finds
27.6% of Americans 50 or older to experience “persistent pain”37
—
an estimate extremely close to the current baseline estimate of
27.3%. Moreover, the present pain measure has advantages over
those of some other studies. Unlike in the National Center for Health
Statistic’s 2006 report, there is no requirement that pain “persist for
more than 24 hours”47
—a criterion that could exclude people who
experience pain regularly, even daily, but only in briefer bursts, eg,
while walking.Unlike in the study byTsang et al.,61
painis not defined
by specific conditions such as arthritis and headaches—which, if
mild or well-managed, might not be considered chronic pain by the
respondent.37
Such differences in pain definition and measurement
likely explain why this article’s prevalence estimates fall in the mid
range of recent estimates.
Additional limitations result from sample characteristics.
Because the sample is restricted to Americans above age 50,
generalization to the full US population is not possible. Moreover,
findings from the United States may not be generalizable to other
countries, due to differences in health care systems, treatment
regimens, etc. (One may note, for example, that Americans
constitute only 4.6% of the world’s population, but consume
“80% of the global opioid supply,” and even higher percentages
of specific opioids.42
Could such heavy use of opioid analgesics
directly or indirectly contribute to the association between pain
and death, as has been suggested?14
)
A key message from this study for both researchers and policy
makers is that addressing health and mortality disparities in the
United States will have to involve addressing pain disparities. As
shown, chronic pain is not only extremely common but also
strongly patterned by socioeconomic class. It is also highly
disabling,18
has been proposed as a cause of recent mortality
increases among middle-aged Americans,14
and may well
contribute to the United States’ poor standing among peer
countries in rankings of life expectancy.48
Especially when paired with evidence of rising pain prevalence,
these are strong arguments for prioritizing chronic pain research
and treatment. If pain is merely a marker of mortality risk, research
should clarify and address the root causes of the association. If
pain itself raises mortality risk, then pain is doubly injurious,
depriving its sufferers not only of quality of life but of life itself. In
either case, continued efforts to better understand pain at the
population level—and especially to explain and address its high
prevalence and dramatically unequal distribution—are needed.
Conflict of interest statement
The author has no conflicts of interest to declare.
This article uses data from the Health and Retirement Study
(HRS), which is sponsored by the NIA (grant number NIA
U01AG009740) and is conducted by the University of Michigan.
Early stages of this research were supported by core grants to the
Center for Demography of Health and Aging (NIA P30 AG017266)
and the Center for Demography and Ecology and (NICHD R24
HD047873) at the University of Wisconsin–Madison.
Acknowledgements
The author thanks Joan Fujimura, Robert M. Hauser, Pamela
Herd, and Cameron Macdonald for helpful comments on an early
version of this manuscript.
Article history:
Received 15 February 2016
Received in revised form 26 October 2016
Accepted 7 November 2016
Available online 15 November 2016
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