Endometriosis and Disability: Analysis of Federal Court Appeals of Social Security Disability Insurance and Supplemental Security Income Claims by Individuals Suffering From Endometriosis

BACKGROUND

Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal.

METHODS

We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal.

RESULTS

Eighty-seven appeals addressed an endometriosis-related issue. Three themes-evidence, treatment, and time-were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences.

CONCLUSIONS

Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis.

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia

Introduction

Vestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD.

Methods

Twenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18-51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic.

Results

One hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups.

Discussion

Mucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD.

The Effects of Co-Occurring Interpersonal Trauma and Gender on Opioid Use and Misuse

The association between interpersonal trauma (IPT) and opioid misuse is well established. There are important gaps, however, in our understanding of this relationship. Studies often do not account for the co-occurrence of IPT across time (i.e., multiple experiences of the same type of IPT) and contexts (i.e., experiences of different types of IPT). In addition, few studies have examined the relationship between IPT and prescription opioid use or gender differences. To address these gaps, this study examines the impact of IPT co-occurrence and gender on prescription opioid use and opioid misuse. Data were collected through a cross-sectional online survey of 235 adults with a self-reported history of IPT (i.e., intimate partner violence, sexual assault, adverse childhood experiences). IPT co-occurrence and interactions between IPT, as continuous scales, were assessed as correlates of opioid use and misuse using multinomial regression models. IPT was associated with opioid misuse, but not use, adjusting for gender. The relationship between sexual assault and opioid misuse was confounded by exposure to other types of IPT. Intimate partner violence was associated with opioid misuse among men. Adverse childhood experiences were associated with misuse among women. The interaction between intimate partner violence and sexual assault increased odds of opioid use among women. This study highlights the importance of accounting for IPT co-occurrence and examining gender differences in clinical practice and research related to opioid use/misuse. These approaches are important for understanding the relationship between IPT and opioid use/misuse by more accurately representing the complexity of the lives of survivors.

Personal resource profiles of individuals with a history of interpersonal trauma and their impact on opioid misuse

OBJECTIVE

Individuals who experience interpersonal trauma (e.g., intimate partner violence, sexual assault, and adverse childhood experiences) are disproportionately affected by the opioid epidemic; however, not all will engage in opioid misuse behaviors. Personal resources, such as coping, social support, and self-efficacy, may attenuate the negative effects of trauma and foster resiliency. This study examines how personal resources affect opioid misuse among individuals with a history of interpersonal trauma.

METHOD

Data were collected from a convenience sample (N = 236) through a cross-sectional, self-report survey. Latent profile analysis identified subgroups with different personal resource profiles based on coping behaviors, social support, and health-related self-efficacy. Logistic regression examined subgroup differences in sociodemographics and opioid misuse behaviors.

RESULTS

Results supported a 3-class (low, moderate, and high personal resource groups) and 4-class model (low, internal, external, and high resource groups). Males, African Americans, and Hispanics were more likely to have low resource profiles. Low resource groups had the highest probability of reporting opioid misuse; however, there were no significant between-class differences after adjusting for depressive symptoms, pain intensity, sex, race/ethnicity, and age. Pain intensity and depressive symptoms largely accounted for subgroup differences in opioid misuse.

CONCLUSIONS

Findings suggest that sex and race/ethnicity play an important role in the personal resource profiles of individuals with a history of interpersonal trauma. Interventions to promote resiliency and mitigate the effects of trauma on opioid misuse should consider personal resource profiles, mental health, and effective pain management. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Timing, delays and pathways to diagnosis of endometriosis: a scoping review protocol

INTRODUCTION

Pathways to diagnosis for women with endometriosis are frequently characterised with delays. Internationally, women face significant barriers and times to diagnosis. The prolonged time without a diagnosis may result in treatment delay, with clinical implications of chronic pain and an unknown effect on fertility outcomes. As delays in diagnosis extend, those suffering from endometriosis incur more cost and frequently experience a reduction in quality of life. The scoping review described in this protocol will (1) map current international scientific peer-reviewed and grey literature investigating pathways, timing, and delay of diagnosis of endometriosis, (2) define common concepts used in the literature, and (3) identify gaps for future examination and intervention development.

METHODS AND ANALYSIS

This protocol outlines a scoping review to investigate the current research focused on pathways, timing, and delays in endometriosis diagnosis. The scoping review uses the Joanna Briggs Institute Methodology. The researchers applied the Population, Concept, Context approach to form the research questions. A search string of key terms and Medical Subject Headings will be used to systematically search the PubMed, CINAHL, EMBASE, Web of Science, and Cochrane databases. We will also search ClinicalTrials.gov and grey literature sources. The original search was performed in July 2020, and it will be rerun prior to the manuscript submission. Finally, the reference lists of included works will be reviewed for additional studies. The search results will be screened and reviewed according to predetermined inclusion and exclusion criteria. Data will be extracted from the studies identified for final inclusion using a predetermined tool. The resulting data will be analysed to report the state of the science.

ETHICS AND DISSEMINATION

The proposed scoping review does not require review or approval by an ethical board. The researchers will disseminate the study results via conference presentations and publication in a peer-reviewed journal.

Exploring stress, cognitive, and affective mechanisms of the relationship between interpersonal trauma and opioid misuse

BACKGROUND

People with a history of interpersonal trauma, including intimate partner violence, sexual assault, and adverse childhood experiences, are disproportionately affected by the current opioid epidemic. Interpersonal trauma has been shown to increase risk for chronic pain conditions, prescription opioid use, and opioid misuse. Stress, cognition, and affective function have been examined as potential mechanisms that may influence opioid misuse among individuals with a history of interpersonal trauma. However, no studies have examined these factors simultaneously, despite their interrelatedness.

OBJECTIVE

The purpose of this study was to 1) examine perceived stress, perceived cognitive function, depressive symptoms, and PTSD symptoms as potential mechanisms of opioid misuse among individuals with a history of interpersonal trauma, 2) examine the types of interpersonal trauma that are associated with opioid misuse, and 3) assess the mediating role of pain and opioid prescription.

METHODS

A cross-sectional, observational study design was conducted. Data were collected through a confidential self-report online survey using validated instruments (n = 230). A series of regression analyses were conducted to identify mechanistic factors and interpersonal trauma types associated with opioid misuse, opioid prescription, and pain intensity. Structural equation modeling was used to examine mediating effects of pain intensity and opioid prescription.

RESULTS

Opioid prescription, depressive symptoms, and intimate partner violence increased the odds of reporting opioid misuse. Pain intensity and adverse childhood experiences increased the odds of opioid prescription. Higher levels of perceived stress and depressive symptoms were associated with increased pain intensity. Pain intensity emerged as a mediator of the relationship between depressive symptoms and opioid misuse.

CONCLUSIONS

Our work shows that there are likely several pathways through which interpersonal trauma can lead to opioid misuse. Interventions aimed at improving depressive symptoms and coping with traumatizing events should be included as part of comprehensive trauma-informed pain management practices.