Talking about chronic pain in family settings: a glimpse of older persons’ everyday realities

The impact of chronic pain on functional capacity in middle-aged and older adults: The mediating role of family relationships

OBJECTIVES

Investigating the impact of pain on overall functional capacity and the role of family relationships between them.

METHODS

Data was drawn from the China Health and Retirement Longitudinal Study (CHARLS) 2018. Propensity score matching was used to reduce confounding factors, and a mediation model was employed to examine the mediating role of family relationships between pain and functional capacity.

RESULTS

Pain was negatively associated with overall functional capacity (P < 0.001). Within the five domains of functional capacity, the pain group and the non-pain group in meeting basic needs, mobility, and contributing to society domains were different. Family relationships partially mediated the relationship between pain and functional capacity (95 % CI: -0.011 to -0.002).

CONCLUSION

Pain's impact on functional capacity is mediated by family relationships. Interventions for healthy aging should manage pain and enhance family relationships in health practice to promote functional capacity.

It's Not Written All Over My Face: Constructing Chronic Pain as Invisible in Pain Clinic Consultations and Interviews

OBJECTIVES

Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible.

MATERIALS AND METHODS

The qualitative approach of interactional sociolinguistic analysis is used to analyze 37 consultations and 11 semistructured interviews with patients with chronic pain, collected at a Belgian pain clinic. This fine-grained approach to studying communication provides an in-depth empirical understanding of the phenomenon under scrutiny.

RESULTS

The data show that pain is constructed as invisible on several levels: (1) on the biomechanical and clinical level, in terms of its lack of visible or traceable tissue injury, (2) on the level of interaction, as pain needs to be made apparent to other people through pain displays, and (3) on the social level, as chronic pain often is not visible or apparent in society more broadly.

CONCLUSION

The discussion explores how on these 3 levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e., not a neutral or desirable state of being), whereas, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also relates to how patients and health care providers often orient to the stigma around chronic pain.

Pain intensity and self-perceived burden mediate the relationship between family functioning and pain catastrophizing in patients with neuropathic pain

This cross-sectional study aimed to investigate the relationship between family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Moreover, we also wanted to explore the multiple mediating roles of pain intensity and self-perceived burden. From October 2022 to March 2023, 252 Chinese people with neuropathic pain completed face-to-face questionnaires to assess family functioning, pain intensity, self-perceived burden, and pain catastrophizing. Data analysis was done using descriptive statistics and a structural equation model. The results showed better family functioning was significantly associated with more intense pain, less self-perceived burden, and less pain catastrophizing. Mediation analysis showed that family functioning could indirectly affect pain catastrophizing through pain intensity and self-perceived burden in addition to a direct effect on pain catastrophizing. Moreover, the mediating variable of pain intensity played a masking role. These findings suggest that good family functioning can effectively reduce the self-perceived burden and pain catastrophizing in patients with neuropathic pain. However, family functioning cannot show its maximum effectiveness, and it may be necessary to construct a model of family functioning suitable for patients with neuropathic pain in the future.

Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study

BACKGROUND

Pain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain. However, there is limited research in South Asian communities in the UK on their experiences of pain. The aim of this study is to explore the experiences and attitudes of patients and family carers from South Asian communities about pain and its management within advanced disease or serious illness.

METHODS

Qualitative thematic analysis based on descriptive phenomenology (Sundler et al. 2019). Qualitative semi-structured interviews with patients or family carers from South Asian communities (N = 15). Interviews were recorded, transcribed and analysed using an inductive approach. Public and Patient Involvement representatives from British South Asian communities were consulted for guidance.

RESULTS

There were five key themes from the interviews: The importance of communication about pain with healthcare professionals; Concerns about taking pain medication; Personal resilience, privacy and self-management; Gender, culture and pain; Home pain management as struggle and frustration.

CONCLUSION

To improve pain management for people from South Asian communities with advanced disease or a serious illness, there are a number of important issues for healthcare professionals from palliative and primary care services to address. These include: greater awareness around people's fears and concerns about pain medication; their potential use of alternative pain management strategies; and cultural issues such as resilience, privacy, dignity and gender roles. Effective communication between doctors, patients and family members could be improved by using a 'cultural humility' model; providing clear and accessible pain medication information; understanding and taking account of people with both low, and medium levels, of English language proficiency; and improving patient trust. Additionally, improvements to out of hours services could improve pain management for all patients managing their pain at home.