The development of the Pain Management Inventory for patients with arthritis

Utilization of Methods for Pain Treatment and Management Among Older Adults with Chronic Pain

BACKGROUND

Older adults have a high prevalence of chronic pain, which can have a substantial effect on their health and quality of life. Patients' use of effective pain relief methods is a central part of the treatment and management of chronic pain. The utilization of pain relief methods and their perceived effectiveness are important knowledge for treating and managing chronic pain for clinicians and older adults. However, this has been poorly investigated.

AIM

We aimed to survey the methods used by older people to treat and manage chronic pain as well as their perceived effectiveness.

METHODS

A total of 2,000 questionnaires were sent to a random sample of people aged 65 years of age or older living in Sweden and 1,141 questionnaires were returned in usable condition. A total of 433 participants reported having chronic pain and completed the Pain Management Inventory to map the use and perceived effectiveness of used treatment and management methods.

RESULTS

The prevalence of chronic pain was 38% and the most used pain treatment methods were passive approaches, i.e., rest (60%), distractions (53%), non-prescribed medicine (49%), and prescribed medicine (44%). A total of 72% of respondents used either prescribed or non-prescribed medicine. The most used active treatment was physical activity (52%). The perceived effectiveness varied to a large extent for each method, and, on average, no treatment method seemed to be more effective than any other.

CONCLUSIONS

Knowledge about the actual use of pain treatment methods and the varied perceived effectiveness can guide clinicians in recommending new approaches or alternatives to manage chronic pain in older adults. How used methods are aligned with current clinical recommendations could be further explored in the future.

Differences in Structural Brain Characteristics Between Individuals with Chronic Nonspecific Neck Pain and Asymptomatic Controls: A Case–Control Study

Background

Neck pain is a prevalent and costly problem, but its underlying mechanisms are poorly understood. Neuroimaging studies show alterations in brain morphometry in chronic musculoskeletal pain, but reports on neck pain are scarce.

Objective

This study investigates (1) differences in brain morphometry between individuals with chronic nonspecific neck pain and asymptomatic individuals and (2) associations between brain morphometry and patient-reported outcomes.

Methods

Sixty-three participants (33 pain, 11 female, mean [SD] age 35 [10] years; 30 control, 12 female, age 35 [11] years) underwent magnetic resonance imaging. Brain regions of interest (ROIs) were determined a priori, outcomes included cortical thickness and volume. Between-group differences were determined using cluster-wise correction for multiple comparisons and analyses of pain-related ROIs.

Results

Between-group differences in volume were identified in the precentral, frontal, occipital, parietal, temporal, and paracentral cortices. ROI analyses showed that parahippocampal cortical thickness was larger in the neck pain group (p=0.015, 95% CI: −0.27 to −0.03). Moderate to strong associations between volume and thickness of the cingulate cortex, prefrontal cortex, and temporal lobe and neck pain duration, pain intensity, and neck disability were identified (p-values 0.006 to 0.048).

Conclusion

Alterations in brain morphology that are associated with clinical characteristics inform the mechanisms underlying chronic nonspecific neck pain and may guide the development of more effective treatment approaches.

Pain and Self-Management Status Among Chinese Patients With Cancer During the COVID-19 Pandemic

BACKGROUND

To investigate the pain and self-management status of patients with cancer and the influencing factors of pain and self-management status during the COVID-19 pandemic.

METHODS

A cross-sectional design was used. Eighty-one Chinese patients with cancer were recruited in December 2020. The Brief Pain Inventory, the Pain Management Inventory, and the Pain Self-efficacy Questionnaire were used to evaluate patients' pain and self-management status. Descriptive statistical analysis and multiple linear regression models were conducted for the research aims.

RESULTS

Two thirds of the participants experienced moderate to severe pain. Cancer pain had moderate to severe interference on 90.12% of patients' lives. Self-management of pain in these participants was low. The most commonly used methods of pain management included adjusting activity intensity to avoid fatigue, using distraction techniques, and massaging the sore area. The most effective methods to manage pain included taking analgesics prescribed by doctor, taking over-the-counter analgesics, and massaging the sore area. Fifteen patients (18.5%) believed that the COVID-19 pandemic had an impact on pain management and 26 patients (32.1%) needed support. Pain education, pain interference on sleep, chemotherapy, and payment status were significantly associated with cancer patients 'pain self-management.

CONCLUSIONS

During the COVID-19 pandemic, patients with cancer had moderate to severe pain intensity with low levels of self-management and self-efficacy towards that pain.

Patterns and Perceptions of Self-Management for Osteoarthritis Pain in African American Older Adults

OBJECTIVE

To explore and describe older African Americans' patterns and perceptions of managing chronic osteoarthritis pain.

METHODS

A convergent parallel mixed-methods design incorporating cross-sectional surveys and individual, semistructured interviews.

SETTING

One hundred ten African Americans (≥50 years of age) with clinical osteoarthritis (OA) or provider-diagnosed OA from communities in northern Louisiana were enrolled.

RESULTS

Although frequency varied depending on the severity of pain, older African Americans actively used an average of seven to eight self-management strategies over the course of a month to control pain. The average number of self-management strategies between high and low education and literacy groups was not statistically different, but higher-educated adults used approximately one additional strategy than those with high school or less. To achieve pain relief, African Americans relied on 10 self-management strategies that were inexpensive, easy to use and access, and generally perceived as helpful: over-the-counter (OTC) topicals, thermal modalities, land-based exercise, spiritual activities, OTC and prescribed analgesics, orthotic and assistive devices, joint injections, rest, and massage and vitamins.

CONCLUSIONS

This is one of the first studies to quantitatively and qualitatively investigate the self-management of chronic OA pain in an older African American population that happened to be a predominantly higher-educated and health-literate sample. Findings indicate that Southern-dwelling African Americans are highly engaged in a range of different self-management strategies, many of which are self-initiated. Although still an important component of chronic pain self-management, spirituality was used by less than half of African Americans, but use of oral nonsteroidal anti-inflammatory drugs and opioids was relatively high.

Pain experiences and self-management strategies among middle-aged and older adults with arthritis

AIMS AND OBJECTIVES

The purposes were (1) to explore pain experiences and the use and perceived effectiveness of pain self-management methods among middle-aged and older adults with osteoarthritis or rheumatoid arthritis in mainland China and (2) to compare those with diagnoses of osteoarthritis and rheumatoid arthritis.

BACKGROUND

Prior research has suggested that pain is a major concern for people with arthritis. However, studies systematically investigating pain experiences and self-management status of arthritis patients are scarce in mainland China.

DESIGN

Descriptive survey.

METHODS

Participants (n = 197) aged 45 and over, diagnosed with either osteoarthritis or rheumatoid arthritis, and experiencing persistent pain were administered three self-report questionnaires: the Demographic Data Questionnaire, the Brief Pain Inventory and the Pain Management Inventory.

RESULTS

The mean of the overall pain intensity was 5.6 (SD = 1.3). The median of number of pain sites was 7.0 (QR = 7.0) and the overall pain interference was 6.0 (QR = 2.6). Most participants experienced moderate to severe pain and interference. The current methods used for managing pain were perceived as only moderately effective. The sample used a median of 4.0 (QR = 3.0) self-management methods. Most often used were prescribed medicine, massage, heat and activity pacing. Methods perceived as most helpful included prescribed medicine, over-the-counter medicine, hot baths and heat. Persons with rheumatoid arthritis had significantly more pain sites, higher pain intensity and greater number of pain management methods used compared to those with osteoarthritis.

CONCLUSIONS

Pain management is a significant problem in this population. The findings highlight the importance of helping the individual to identify and appropriately use a variety of self-management methods, selecting the appropriate method(s) at any one time.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers are urged to develop appropriate interventions on pain management tailored to arthritis patients in mainland China.

Management of persistent pain in older adults: the MOBILIZE Boston Study

OBJECTIVES

To describe the prevalence of pharmacological (PS) and nonpharmacological (NPS) pain management approaches used by older adults with persistent pain and to identify characteristics associated with use of these approaches.

DESIGN

Population-based cohort.

SETTING

Urban and suburban communities in the Boston, Massachusetts, area.

PARTICIPANTS

Seven hundred sixty-five adults aged 64 and older underwent a home interview and clinic examination. Those reporting any persistent pain were included in this analysis (N = 599).

MEASUREMENTS

All prescription and nonprescription medications were recorded during the home interview. NPS modalities for pain management were assessed using a modification of the Pain Management Inventory. The baseline assessment included extensive measures of pain, health, and functioning.

RESULTS

More than one-third (37.5%) of participants reported using both PS and NPS modalities. Thirty-one percent reported use of NPS modalities alone, and 11.5% used PS modalities alone. NPS modalities (68.4%) were reported more frequently than PS modalities (49%). Women (odds ratio (OR)= 2.2, 95% confidence interval (CI) = 1.26-3.82), individuals with knee osteoarthritis (OR = 3.07, 95% CI = 1.6-5.9), and individuals with moderate to severe pain (OR = 5.02, 95% CI = 2.23-11.28) were more likely to report combined use of PS and NPS modalities. Characteristics associated with individual NPS modalities varied greatly.

CONCLUSION

Only one-third of older adults with persistent pain reported pain management strategies consistent with current guidelines. Further research is required to understand reasons behind choices, barriers to adherence, and the benefits of multiple modalities that older adults with persistent pain use.

Pain management in elderly persons who require assistance with activities of daily living: a comparison of those living at home with those in special accommodations

OBJECTIVES

To describe and compare the methods of pain management used by elderly individuals with chronic pain and requiring assistance with activities of daily living, depending on whether they live alone, with someone, at home or in special accommodations.

METHODS

This study comprised 294 people aged 76-100 years, identified as having chronic pain and requiring assistance with activities of daily living. Pain and pain management methods were compared using the Multidimensional Pain Inventory, Swedish version, and the Pain Management Inventory.

RESULTS

Those living in special accommodations reported more pain than those living at home. Those living with someone reported more pain and interference in daily life than those living alone, despite using more pain-relief methods and having greater social support. The median number of pain-relieving methods used was 3.0 (75th-25th percentile: 5-2). Some (3.8%) did not use any method to relieve their pain. The most frequently used methods were prescribed medicine (20%), rest (20%) and distraction (15%). The methods rated most effective were using cold, exercise, hot bath/shower and consuming alcohol.

CONCLUSION

Participants had only a small repertoire of pain management methods and these were mostly conventional in nature. Few non-pharmacological methods were used. The findings suggest the importance of thorough assessment, and the need to fully discuss pain management options with the elderly.

The epidemiology of chronic pain in a general population: results of a survey in southern Sweden

OBJECTIVES

The aim was to investigate the prevalence of chronic pain in different age groups and pain locations, as well as to identify variables associated with chronic pain.

METHODS

This cross-sectional survey had a randomized age-stratified sample comprising 826 respondents aged 18–102 years. Comparisons were made across age groups and pain locations. Multiple logistic regression analysis was used to identify variables associated with chronic pain.

RESULTS

The overall pain prevalence rate was 46%, with a variance of 27–55% across age groups. The prevalence increased up to the 60–74-year age group, after which it remained more or less constant. The pain sites differed across age groups. Forty-six per cent of the respondents had not received any diagnosis or did not know the reason for their pain, while 21% had no pain management. Several complaints (e.g. appetite loss, constipation, fatigue, depressed mood) were both more prevalent and more severe among those in pain than those with no pain. The regression analysis showed that body mass index (BMI), fatigue, sleep, and mobility problems were significantly associated with chronic pain.

CONCLUSIONS

Chronic pain is common and constitutes a major public health problem. Interventions should not only be focused on the pain per se but should also include coexisting factors.

The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis

AIMS AND OBJECTIVES

The aim in this study was to evaluate the effect of local heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis.

BACKGROUND

Local heat application is used as a non-pharmacological practice for the treatment of knee osteoarthritis. On the other hand, literature reveals limited information on the effects of heat application.

DESIGN

The study was a comparative study.

METHODS

The patients with knee osteoarthritis were divided into two groups (23 patients in each) as intervention and control groups, and patients in the control group were applied with the routine medication of the physician. The intervention group received 20-minute heat application every other day for four weeks in addition to the routine medication. The data were collected using data collection form, Western Ontario and McMaster Universities Index and SF-36.

RESULTS

The Western Ontario and McMaster Universities pain and Western Ontario and McMaster Universities disability scores of the patients with knee osteoarthritis in control and intervention groups before and after the intervention were compared, and the differences for both scores in the change were found to be statistically significant (p < 0.05). Moreover, statistically significant differences were found between the control and intervention group patients in terms of changes in the scores for physical function, pain and general health perception (p < 0.05).

CONCLUSIONS

It was found that heat application every other day decreased pain and disability of the patients with knee osteoarthritis. Also, heat application was found to improve the subdimensions of quality of life scores of physical function, pain and general health perception of patients.

RELEVANCE TO CLINICAL PRACTICE

The data obtained in this study on the efficiency of heat application on pain, stiffness, physical function and general health perception of patients with knee osteoarthritis may offer an insight into decision-making process for appropriate intervention.

Sex differences in muscle pain: self-care behaviors and effects on daily activities

Women have a higher prevalence of fibromyalgia and myofascial pain than men, but sex differences in muscle pain are inconsistently detected. We examined sex differences in ratings and effects of recalled and experimentally-induced muscle pain. In study 1 (n = 188), participants completed a questionnaire about recalled muscle pain. In study 2 (n = 55), participants described muscle pain from an exercise stimulus across 3 days by telephone. Muscle pain ratings, self-care behaviors for muscle pain, and effects of muscle pain on activities were measured. No significant sex differences were found except that women tended to view exercise as more effective for decreasing muscle pain than men (F (1, 187) = 5.43, P = .02, eta(2) = .03), fewer women performed exercise for induced muscle pain than men, and women's activity interference was significantly higher than men's at the third day after exercise (F (2, 42) = 6.54, P = .01, eta(2) = .14). These findings support the absence of meaningful sex differences in muscle pain ratings. However, additional investigations are needed that consider the daily activities completed by people and the prevalence and incidence of performing a wide range of self-care behaviors for pain.

PERSPECTIVE

These studies support that sex differences are not present in recalled and experimentally-induced muscle pain ratings. Therefore, we must be cautious about generalizing the musculoskeletal pain literature to muscle pain. Additional research is needed to interpret potential sex differences in self-care behaviors for muscle pain and activity interference from muscle pain.

The Patient Satisfaction Scale--an empirical investigation into the Finnish adaptation

RATIONALE AND AIMS

The aim of this paper is to empirically investigate the performance characteristics of the Finnish adaptation PSS-Fin of the Patient Satisfaction Scale (PSS) intended to measure patient satisfaction with nursing care. The PSS-Fin includes three sub-scales: technical-scientific, informational and interaction/support care-needs.

METHODS

The PSS-Fin was used in a cross-sectional survey measuring the satisfaction of Finnish surgical patients (n=454) with the nursing care they received. The feasibility, internal consistency, stability, equivalence and construct validity of the measure were investigated. Evaluation was based on statistical methods.

RESULTS

The PSS is brief and easy to use, and it produced low missing data. Cronbach's alpha coefficient ranged from 0.79 to 0.89 for the sub-scales. The items correlated strongly with the sub-scales and the sub-scales with the total PSS as well. Test-retest reliability of 0.7 showed reasonable stability over time. Three factor analytic procedures supported for the three-factor solution with a technical-scientific, informational and interaction/support factors, explaining approximately 77% of the variance. The PSS had some equivalence with another satisfaction instrument, but also exhibited the ability to discriminate between each other. In multiple regression analysis the informational care-needs sub-scale was the most significant factor explaining patient satisfaction.

CONCLUSION

The PSS-Fin demonstrated good psychometric properties and conceptual rigour and is thus reliable tool for examining patient satisfaction with nursing care.

Concept analysis of coping with arthritic pain by South Korean older adults: Development of a hybrid model

This study was conducted to clarify and conceptualize the phenomenon of coping with arthritic pain by older adults. The Hybrid Model of concept development was applied to develop a conceptual structure of coping with arthritic pain by older adults. A refined definition of coping with arthritic pain by older adults emerged that identified the attributes and structure of the concept. This study reveals the characteristics of the ways that older adults cope with arthritic pain, such as how they experience themselves, how pain affects their daily life, and how they perceive the meaning of coping with arthritic pain. These characteristics indicate the complexity of the concept regarding the coping of older adults with arthritic pain. This area needs to be clarified when nursing staff assess coping with pain and plan pain management for older adults.

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

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

Improved sleep may reduce arthritis pain

Studies indicate that pain interferes with sleep and, in turn, sleep disturbances increase pain. Statistics show that up to 60% of those with arthritis experience pain during the night. But despite these findings, sleep is not generally addressed as a major treatment concern among this population. This article reviews the relationship between pain and sleep; sleep issues as they relate to 3 common types of arthritis--osteoarthritis, rheumatoid arthritis, and fibromyalgia; and holistic approaches that may be used by the patient in the self-management of pain and sleep.

Reconstructing a meaning of pain: older Korean American women's experiences with the pain of osteoarthritis

The purpose of this grounded theory study was to gain a deeper understanding of older Korean American women's experiences of chronic osteoarthritic pain. The data included a set of 3 interviews with 7 women over age 60, field notes, observations, memos, and the literature about the chronic pain of osteoarthritis. Through constant comparative analysis and coding typical of grounded theory, a five-stage process emerged inductively from the data. The core variable, Reconstructing a Meaning of Pain, included the concepts of the process in the grounded theory through which the women learned to manage and tolerate the pain. During this process, the women came to perceive their pain as a component of aging rather than as a symptom of disease.

Living with persistent pain: experiences of older people receiving home care

BACKGROUND

Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge.

AIM

To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain.

METHODS

Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis.

FINDINGS

Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living.

CONCLUSION

This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.

Managing pain in older persons who receive home-help for their daily living. Perceptions by older persons and care providers

Pain is a common problem for older persons who need professional help for their daily living. In this study 94 older persons (75+) in persistent pain were compared with 52 care providers concerning the pain management methods they had used/administered during the previous week and how helpful they perceived these methods to be. Interviews were based on 16 items from the original version of the pain management inventory (PMI). Both groups perceived prescribed medication, rest and distraction as the most frequently utilized methods. Specific methods such as transcutaneous electrical nerve stimulation (TENS) or bracing/splinting or bandaging the affected body part were seldom employed, although most users perceived these methods as helpful. Care providers perceived most methods for managing pain as more effective than older persons did. The results imply that care providers need skills in a variety of pharmacological and nonpharmacological methods to manage pain and a need to evaluate effectiveness of the methods in a systematic way.

Assessment of pain perception in clinical practice

With pain a frequent precipitant in individuals seeking manual therapy, it is important for therapists to adequately assess pain. At one level, pain forms an important part of the diagnostic assessment. It is suggested that a simple, reliable and quantitative pain measure be used in patients who present with routine problems. At another level, when the therapist is presented with clients in whom pain does not make sense in terms of its pattern, distribution, history or features, it is advisable to go beyond a simple pain intensity measure.

Evaluating the use of a pain assessment tool and care plan: a pilot study

Pain control in hospital has long been documented as ineffective and problematic. A multi-professional group of clinicians formed to consider how they might continue to improve pain management at a district general hospital. Following a pain audit, in general wards, it became apparent that pain assessment tools were not being used. The group devised a draft pilot assessment tool and care plan which was piloted over a 2-week period on a rehabilitation ward for elderly people. A review of these documents revealed that pain assessment using the body map ascertained considerable detail about the pain location, and the pain ruler elicited pain intensity and associated descriptors. None of the documented goals for pain were measurable, and interventions focused on analgesia and actions to relieve the physical cause of the pain. No psychosocial interventions were mentioned. All care plans were evaluated at least once but 44% of evaluations did not refer to the pain. On this ward, these outcomes suggest the pain assessment tool has the potential to improve communication of pain between the patient and the nurse but there is an urgent need for education to enable this information to be used effectively and develop pain management strategies which reflect the multidimensional nature of pain.