Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain

Family function and health self-management ability among older adults from mountainous areas in China: moderated mediation model in a cross-sectional study

BACKGROUND

Improving the health self-management ability (HSMA) of older adults is a feasible strategy for addressing population ageing and the high incidence of non-communicable diseases. Identifying psychosocial factors that facilitate better self-management of health is key to developing effective interventions. This study explored whether self-efficacy mediates the relationship between family function and HSMA and whether this mediation is moderated by personal income.

METHODS

A multicentre cross-sectional survey was conducted with 596 participants (response rate of 97.2%) in the mountainous Lishui region of China by using a multi-stage, stratified, cluster-sampling procedure. The survey included questions on sociodemographic characteristics, the Adult Health Self-Management Skills (Ability) Rating scale, family APGAR scale and General Self-Efficacy (GSE) scale. Data were analysed using descriptive statistics, Spearman's correlation, and multiple regression analysis with mediation and moderated mediation models.

RESULTS

The average score for HSMA, family function, and GSE were 149.6 ± 18.1 (out of 190), 8.2 ± 2.2 (out of 10), and 24.0 ± 6.0 (out of 40), respectively, which indicate moderate HSMA and family function levels and low GSE among older adults in Lishui. Significant correlations were observed between family function and GSE (rs = 0.150, P < 0.001), GSE and HSMA (rs = 0.336, P < 0.001), and family function and HSMA (rs = 0.297, P < 0.001). The mediation model explained 21.5% of the variance in HSMA, with significant total (c: B = 0.343, P < 0.001) and indirect effects (ab: B = 0.0505, 95% CI = [0.0227, 0.0830]). The indirect effects (family function → GSE → HSMA) decreased with decreasing income (high income, B = 0.0497; middle income, B = 0.0353; low income, B = 0.0233), while the direct effect (family function → HSMA) increased with decreasing income (high income, B = 0.189; middle income, B = 0.270; low income, B = 0.350).

CONCLUSION

HSMA, APGAR score and GSE score were positively related among older adults in the Lishui region, highlighting potential areas for improvement. The results clarify the mediating effect of GSE on the relationship between family function and HSMA along with the moderating role of personal income. Strengthening family function may enhance HSMA, especially in low income older adults, while boosting GSE may benefit those with higher incomes. Future longitudinal studies should confirm these relationships and their causal direction.

Factors Influencing the Self-Management Stages of Older Patients With Chronic Pain: A Cross-Sectional Study

PURPOSE

To investigate the current status and related influencing factors of self-management stages in older patients with chronic pain.

DESIGN

A cross-sectional study.

METHODS

A total of 326 older patients with chronic pain were selected as the study subjects in five city districts from December 2022 to June 2023. We used a general information survey form, a numerical rating scale, a pain stages of change questionnaire, a health literacy assessment instrument for patients with chronic pain, and a psychological inflexibility in pain scale to collect relevant information from participants. Univariate analysis and multiple ordinal logistic regression analysis were conducted to identify the relevant influencing factors of the self-management stages.

RESULTS

The self-management stages of older patients with chronic pain were as follows: precontemplation stage (n = 52; 16.0%), contemplation stage (n = 103; 31.6%), action stage (n = 62; 19.0%), and maintenance stage (n = 109; 33.4%). Regression results showed that average monthly household income, smoking history, pain duration, health literacy, and psychological inflexibility were the influencing factors for the self-management stages of older patients with chronic pain.

CONCLUSIONS

In this study, the self-management stages of older patients with chronic pain still needed to be improved. Suitable personalized pain self-management strategies should be developed based on identified factors affecting patients to improve their self-management stages.

CLINICAL IMPLICATIONS

Nursing professionals can use research survey findings to identify patients at low levels of self-management stage and develop personalized intervention strategies based on various influencing factors. For example, nurses can provide practical smoking cessation guidance to assist older chronic pain patients in improving their lifestyle. Nurses can also seek support from family members to collectively offer better medical care and nursing services for the patient if financially feasible. Secondly, as our study has demonstrated, patients' health literacy and psychological flexibility were poor. Nurses can utilize available clinical resources to offer educational materials, such as portable handbooks and online videos, covering pain-related knowledge, managing pain medication, and coping strategies like massage and exercise. Combining this approach with mental health education, such as relaxation therapy, can help patients better understand their pain and actively participate in their self-management. In addition, nursing staff should pay more attention to the self-management stages of older chronic pain patients, and the assessment of self-management stages can be included in clinical pain management for patients. Regular assessment will help track more patients needing attention and make timely adjustments to their pain management plans.

Prescriptions of opioid-containing drugs in patients with chronic cough

BACKGROUND

Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.

OBJECTIVES

To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.

DESIGN

Retrospective cohort study.

METHODS

Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's t-test, Pearson's chi-square, and zero-inflated Poisson models were used.

RESULTS

About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.

CONCLUSION

Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.

Social determinants of health and physical activity are related to pain intensity and mental health in patients with carpal tunnel syndrome

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper limb and a frequent cause of disability.

OBJECTIVE

To analyze the association between social determinants of health (SDH) and physical activity with pain intensity and mental health in patients with CTS.

DESIGN

A cross-sectional study was conducted in patients with CTS awaiting surgery in two public hospitals in Chile.

METHODS

The SDH collected included: employment status, educational level and monetary income. The level of physical activity was defined according to compliance with WHO recommendations. Outcome measures included: Pain intensity (Visual Analog Scale), Symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), and catastrophic thinking (Pain Catastrophizing Scale). The adjusted regression coefficient (β) for the association between SDH and physical activity with each outcome was obtained using multivariable linear regression models controlling for age, sex, body mass index and symptom duration.

RESULTS

Eighty-six participants were included (mean age 50.9 ± 10 years, 94% women). A high level of physical activity was associated with a 12.41 mm decrease in pain intensity (β = -12.41, 95%CI: -23.87 to -0.95) and a 3.29 point decrease in depressive symptoms (β = -3.29, 95%CI: -5.52 to -1.06). In addition, being employed was associated with a 2.30 point decrease in anxiety symptoms (β = -2.30; 95%CI: -4.41 to -0.19) and a high educational level was associated with a 7.71 point decrease in catastrophizing (β = -7.71; 95%CI: -14.06 to -1.36).

CONCLUSION

Multidisciplinary care teams should be aware of the association between SDH and physical activity with physical and mental health.

The relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine patients: the mediating role of pain self-efficacy

BACKGROUND

Migraine is a neurological disease that has several physical and psychological complications, which is characterized by disability and impaired quality of life.

AIMS

The aim of this study was to explore the mediating role of pain self-efficacy in the relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine sufferers. The relationship between these factors with quality of life (QOL) was not fully explored in migraine patients.

METHOD

This study was a correlational study of structural equations. Therefore, 300 patients with migraine who referred to one of the specialized neurological treatment centers in Zanjan in 2021 were recruited based on the inclusion criteria. Patients also completed the World Health Organization Quality of Life Scale (WHOQOL-BREF), Meaning in Life Questionnaire, Multidimensional Scale of Perceived Social Support, Spiritual Well-Being Scale, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire. Finally, the hypotheses were then analyzed with correlation coefficient and path analysis method by using SPSS-26 and LISREL-10.2 programs.

RESULTS

The results of the present study showed that pain self-efficacy has a mediating role in the relationship between meaning of life and quality of life (B = 0.015), perceived social support with quality of life (B = 0.022), spiritual well-being with quality of life (B = 0.021), as well as pain catastrophizing with quality of life (B = - 0.015).

CONCLUSION

According to the results of this study, by considering the role of self-efficacy of pain, it is possible to develop the programs to strengthen and improve the meaning of life, perceived social support, spiritual well-being and also reduce pain catastrophizing, in order to improve the quality of life of patients with migraine.