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(386) Assessing willingness to try pharmacological versus nonpharmacological treatments for pain in patients with temporomandibular disorders
P72
Other (384) Virtual human technology as a novel approach to investigating pain-related clinical decision making A Hirsh, S Manamalkav, M Robinson; University of Florida, Gainesville, FL The decision making process regarding the clinical assessment and treatment of pain is an important topic of inquiry. Unfortunately, the empirical investigation of this topic poses numerous methodological challenges. The two principal approaches to studying pain assessment and treatment are the retrospective and vignette designs. Although each possesses unique strengths, these approaches are also characterized by notable limitations that place constraints on the interpretation of obtained data. A particularly salient limitation of the retrospective approach is the lack of experimental control over the independent variables of interest. Although vignette designs permit greater control, they suffer from low external validity and high task transparency. Further, neither approach readily permits a detailed analysis of the decision making process itself; rather, both are primarily intended as methods of examining the decision product. With these limitations in mind, we describe the development of a creative and perhaps more methodologically sound design for the investigation of pain-related clinical decision making. The use of virtual human technology and lens model methodology is outlined. Healthcare providers’ (N⫽54) opinions were elicited regarding the applicability and representativeness of this methodological approach. Results were encouraging. Over 70% of providers indicated that the virtual humans’ facial expressions were realistic depictions of pain. Over 90% regarded the clinical vignette as reflective of a real post-operative scenario. The patient information provided in the vignette was judged to be similar to that of an actual clinical setting by over 80% of respondents. Finally, over 70% of providers indicated that they made pain-related clinical decisions in a manner that is similar to how they would approach a real patient. These initial results suggest that this technology and methodology hold promise for the continued investigation of pain-related clinical decision making. Future empirical and technological directions are discussed.
Abstracts (386) Assessing willingness to try pharmacological versus nonpharmacological treatments for pain in patients with temporomandibular disorders S Hofkamp, L Buenaver, M Smith, R Edwards, E Sarlani, E Grace, J Haythornthwaite; Johns Hopkins University, Baltimore, MD The undertreatment of pain remains a large problem in our society and has multiple determinants including physicians’ fears of addiction and side effects when prescribing opioid therapy. Patient factors also influence pain management practice patterns. Willingness to use a specific pain treatment is the construct we conceptualize as a potential factor mediating the behavior of using that specific treatment. The present study examined the psychometric properties of a pain treatment willingness questionnaire, originally studied in spinal cord injury (SCI; N⫽115) patients. We examined its concurrent validity related to participants’ evaluation of a psychosocial intervention in 140 temporomandibular disorder (TMD) patients. Participants were randomized to receive either cognitive-behavior therapy (CBT) or standard education (EDU) for pain management in addition to medications. No significant group differences were observed on baseline pain ratings (t(124)⫽0.50, p⫽0.62). Factor analysis revealed two factors: willingness to use medications and willingness to use nonpharmacological treatments. The questionnaire was administered prior to randomization and items were rated on a 1 (not willing) to 6 (extremely willing) scale. Individuals rated their willingness to use nonpharmacological treatments (M⫽5.5, SD⫽0.7) higher than willingness to use medications (M⫽2.8, SD⫽1.5) for treatment of pain. A “willingness to use opioids” scale was also created for comparisons to the SCI sample. No differences were found between TMD and SCI groups regarding opioid therapy willingness (t(250)⫽0.51 p⫽0.61); however, TMD patients were significantly more willing to use nonpharmacological treatments (t(250)⫽6.26 p⬍0.0001). Furthermore, a questionnaire evaluating the credibility of the treatment in the trial was significantly correlated with both willingness scales in the EDU group (nonpharmacological, r⫽ 0.36, p⫽0.01; medication, r⫽ 0.30, p⫽0.04) but only with nonpharmacological treatment willingness in the CBT group (r⫽ 0.29, p⫽0.03). Assessment of patient attitudes toward different pain treatments may facilitate optimization of adherence to nonpharmacological or pharmacological treatments.
(385) Anxiety sensitivity, catastrophizing, and the experience of pain in children
(387) Barriers to pain management among adolescents with cancer
J Tsao, Q Lu, S Evans, S Kim, C Myers, L Zeltzer; University of California, Los Angeles, Los Angeles, CA The considerable overlap between chronic pain and clinical anxiety syndromes suggests that these conditions may share common predisposing factors. Catastrophizing about the consequences of pain has been found to contribute to enhanced pain experiences. Anxiety sensitivity (AS), the belief that anxiety sensations lead to dangerous consequences, has also been associated with increased laboratory and clinical pain. This study examined the relationships among AS, catastrophization and pain in 241 healthy children (122 girls; mean age ⫽ 12.7 years, range ⫽ 8-18). Children completed a questionnaire about current pain problems and standardized measures of AS and catastrophizing prior undergoing laboratory pain tasks. Over one third (n ⫽ 81; 33.6%) reported current pain problems vs. 160 (66.4%) who reported no pain problems. AS and catastrophization were strongly correlated (r ⫽ .57, p ⬍ .001). ANCOVAs controlling for child age, sex, and socioeconomic status (SES), revealed that relative to children without pain, children with pain reported greater AS (F(4, 219) ⫽ 15.26, p ⬍ .001) and catastrophization (F(4, 219) ⫽ 9.66, p ⬍ .01). Sequential logistic regression analysis indicated that after controlling for demographics, AS but not catastrophization significantly predicted group membership (Pain vs. No pain). A 1 unit increase in AS increased the likelihood of being in the Pain group by 1.09 units (95% Confidence Interval (CI) ⫽ 1.02 – 1.17). Additional analyses of the AS subscales (i.e., physical, social and mental concerns) indicated that a 1 unit increase in AS mental concerns increased the likelihood of membership in the Pain group by 1.33 units (95% CI ⫽ 1.02 – 1.72). These results support a robust link between catastrophizing about pain and about anxiety symptoms. Although both cognitive styles were associated with pain experience, fear of anxiety sensations was more strongly related to current pain problems in this sample of healthy children.
S Ameringer, S Ward, S Hughes; University of Wisconsin-Madison, Madison, WI Patient-related barriers to pain management are one of the determinants of poor pain management in adults. Adolescents with cancer have reported similar barriers as adults (e.g., fear of addiction), but have also reported unique barriers, such as the concern about being involved in treatment decisions. However, barriers in adolescents with cancer have not been systematically investigated. Guided by Ward and colleague’s barriers model, which suggests that barriers influence coping, which in turn, influences outcomes, the aims were to describe barriers among adolescents with cancer, and examine the relationships between barriers, coping (hesitancy to report pain and use analgesics; and adequacy of analgesic use) and outcomes (pain severity, physical and psychosocial function). Adolescents with cancer (N⫽60) participated and data from 22 participants with pain were used in this analysis. Participants completed the Adolescent Barriers Questionnaire, Hesitancy, Pain Management Index, 4 pain severity items, Functional Disability Index, and PedsQL. Mean age was 14.95 years (SD 1.94; range 12-17); the majority was Caucasian (81.8%) and female (54.5%). The mean (SD) Barriers score was 1.81 (0.77) on a scale from 0-5, with higher scores indicating greater barriers. The ABQ subscales with the highest means were the concern that social activities will be restricted if pain is reported, worry about becoming tolerant to analgesics, and fear of becoming addicted to analgesics. Because none of the females was categorized as adequately medicated for pain, adequacy of analgesic use was excluded from the analysis. Tests of mediation showed that barriers were significantly associated with coping (reporting pain and use analgesics), t(19)⫽2.15, p⫽.046, but coping did not mediate the relationship between barriers and the outcomes. Results suggest that adolescents with cancer have barriers to pain management that are associated with reporting pain and using analgesics. Supported by NINR R01 NR03126, 5F31NR009324, and Beta-Eta-at-Large Sigma Theta Tau International Chapter.
Other (384) Virtual human technology as a novel approach to investigating pain-related clinical decision making A Hirsh, S Manamalkav, M Robinson; University of Florida, Gainesville, FL The decision making process regarding the clinical assessment and treatment of pain is an important topic of inquiry. Unfortunately, the empirical investigation of this topic poses numerous methodological challenges. The two principal approaches to studying pain assessment and treatment are the retrospective and vignette designs. Although each possesses unique strengths, these approaches are also characterized by notable limitations that place constraints on the interpretation of obtained data. A particularly salient limitation of the retrospective approach is the lack of experimental control over the independent variables of interest. Although vignette designs permit greater control, they suffer from low external validity and high task transparency. Further, neither approach readily permits a detailed analysis of the decision making process itself; rather, both are primarily intended as methods of examining the decision product. With these limitations in mind, we describe the development of a creative and perhaps more methodologically sound design for the investigation of pain-related clinical decision making. The use of virtual human technology and lens model methodology is outlined. Healthcare providers’ (N⫽54) opinions were elicited regarding the applicability and representativeness of this methodological approach. Results were encouraging. Over 70% of providers indicated that the virtual humans’ facial expressions were realistic depictions of pain. Over 90% regarded the clinical vignette as reflective of a real post-operative scenario. The patient information provided in the vignette was judged to be similar to that of an actual clinical setting by over 80% of respondents. Finally, over 70% of providers indicated that they made pain-related clinical decisions in a manner that is similar to how they would approach a real patient. These initial results suggest that this technology and methodology hold promise for the continued investigation of pain-related clinical decision making. Future empirical and technological directions are discussed.
Abstracts (386) Assessing willingness to try pharmacological versus nonpharmacological treatments for pain in patients with temporomandibular disorders S Hofkamp, L Buenaver, M Smith, R Edwards, E Sarlani, E Grace, J Haythornthwaite; Johns Hopkins University, Baltimore, MD The undertreatment of pain remains a large problem in our society and has multiple determinants including physicians’ fears of addiction and side effects when prescribing opioid therapy. Patient factors also influence pain management practice patterns. Willingness to use a specific pain treatment is the construct we conceptualize as a potential factor mediating the behavior of using that specific treatment. The present study examined the psychometric properties of a pain treatment willingness questionnaire, originally studied in spinal cord injury (SCI; N⫽115) patients. We examined its concurrent validity related to participants’ evaluation of a psychosocial intervention in 140 temporomandibular disorder (TMD) patients. Participants were randomized to receive either cognitive-behavior therapy (CBT) or standard education (EDU) for pain management in addition to medications. No significant group differences were observed on baseline pain ratings (t(124)⫽0.50, p⫽0.62). Factor analysis revealed two factors: willingness to use medications and willingness to use nonpharmacological treatments. The questionnaire was administered prior to randomization and items were rated on a 1 (not willing) to 6 (extremely willing) scale. Individuals rated their willingness to use nonpharmacological treatments (M⫽5.5, SD⫽0.7) higher than willingness to use medications (M⫽2.8, SD⫽1.5) for treatment of pain. A “willingness to use opioids” scale was also created for comparisons to the SCI sample. No differences were found between TMD and SCI groups regarding opioid therapy willingness (t(250)⫽0.51 p⫽0.61); however, TMD patients were significantly more willing to use nonpharmacological treatments (t(250)⫽6.26 p⬍0.0001). Furthermore, a questionnaire evaluating the credibility of the treatment in the trial was significantly correlated with both willingness scales in the EDU group (nonpharmacological, r⫽ 0.36, p⫽0.01; medication, r⫽ 0.30, p⫽0.04) but only with nonpharmacological treatment willingness in the CBT group (r⫽ 0.29, p⫽0.03). Assessment of patient attitudes toward different pain treatments may facilitate optimization of adherence to nonpharmacological or pharmacological treatments.
(385) Anxiety sensitivity, catastrophizing, and the experience of pain in children
(387) Barriers to pain management among adolescents with cancer
J Tsao, Q Lu, S Evans, S Kim, C Myers, L Zeltzer; University of California, Los Angeles, Los Angeles, CA The considerable overlap between chronic pain and clinical anxiety syndromes suggests that these conditions may share common predisposing factors. Catastrophizing about the consequences of pain has been found to contribute to enhanced pain experiences. Anxiety sensitivity (AS), the belief that anxiety sensations lead to dangerous consequences, has also been associated with increased laboratory and clinical pain. This study examined the relationships among AS, catastrophization and pain in 241 healthy children (122 girls; mean age ⫽ 12.7 years, range ⫽ 8-18). Children completed a questionnaire about current pain problems and standardized measures of AS and catastrophizing prior undergoing laboratory pain tasks. Over one third (n ⫽ 81; 33.6%) reported current pain problems vs. 160 (66.4%) who reported no pain problems. AS and catastrophization were strongly correlated (r ⫽ .57, p ⬍ .001). ANCOVAs controlling for child age, sex, and socioeconomic status (SES), revealed that relative to children without pain, children with pain reported greater AS (F(4, 219) ⫽ 15.26, p ⬍ .001) and catastrophization (F(4, 219) ⫽ 9.66, p ⬍ .01). Sequential logistic regression analysis indicated that after controlling for demographics, AS but not catastrophization significantly predicted group membership (Pain vs. No pain). A 1 unit increase in AS increased the likelihood of being in the Pain group by 1.09 units (95% Confidence Interval (CI) ⫽ 1.02 – 1.17). Additional analyses of the AS subscales (i.e., physical, social and mental concerns) indicated that a 1 unit increase in AS mental concerns increased the likelihood of membership in the Pain group by 1.33 units (95% CI ⫽ 1.02 – 1.72). These results support a robust link between catastrophizing about pain and about anxiety symptoms. Although both cognitive styles were associated with pain experience, fear of anxiety sensations was more strongly related to current pain problems in this sample of healthy children.
S Ameringer, S Ward, S Hughes; University of Wisconsin-Madison, Madison, WI Patient-related barriers to pain management are one of the determinants of poor pain management in adults. Adolescents with cancer have reported similar barriers as adults (e.g., fear of addiction), but have also reported unique barriers, such as the concern about being involved in treatment decisions. However, barriers in adolescents with cancer have not been systematically investigated. Guided by Ward and colleague’s barriers model, which suggests that barriers influence coping, which in turn, influences outcomes, the aims were to describe barriers among adolescents with cancer, and examine the relationships between barriers, coping (hesitancy to report pain and use analgesics; and adequacy of analgesic use) and outcomes (pain severity, physical and psychosocial function). Adolescents with cancer (N⫽60) participated and data from 22 participants with pain were used in this analysis. Participants completed the Adolescent Barriers Questionnaire, Hesitancy, Pain Management Index, 4 pain severity items, Functional Disability Index, and PedsQL. Mean age was 14.95 years (SD 1.94; range 12-17); the majority was Caucasian (81.8%) and female (54.5%). The mean (SD) Barriers score was 1.81 (0.77) on a scale from 0-5, with higher scores indicating greater barriers. The ABQ subscales with the highest means were the concern that social activities will be restricted if pain is reported, worry about becoming tolerant to analgesics, and fear of becoming addicted to analgesics. Because none of the females was categorized as adequately medicated for pain, adequacy of analgesic use was excluded from the analysis. Tests of mediation showed that barriers were significantly associated with coping (reporting pain and use analgesics), t(19)⫽2.15, p⫽.046, but coping did not mediate the relationship between barriers and the outcomes. Results suggest that adolescents with cancer have barriers to pain management that are associated with reporting pain and using analgesics. Supported by NINR R01 NR03126, 5F31NR009324, and Beta-Eta-at-Large Sigma Theta Tau International Chapter.