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(225) Pain influences ADLs in for-profit nursing homes
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Abstracts
The Journal of Pain
(224) Pain predicts depression in for-profit nursing home residents S Swank, R Harden, R Bakshi, and E Maletta; University of Michigan, Ann Arbor, MI
B17 Pain in Minority Populations (226) Ethnic differences in Interleukin 6 and Neuropeptide Y response to capsaicin in healthy participants
Pain is widespread among nursing home residents and is a common comorbidity of depression. Depression increases nursing home costs. These costs may undermine efforts by for-profit nursing homes to maximize revenues. Though pain may indirectly increase for-profit nursing home costs by exacerbating depression, no studies have yet investigated this relationship. Pain was hypothesized to predict depression in for-profit nursing home residents. Data from 301 for-profit nursing homes with 8880 residents were included in a large-scale analysis. Percentages of residents reporting moderate to severe pain were compared to percentages of residents reporting depressive symptoms using simple linear regression. Mean percent of residents reporting moderate to severe pain was 10.1% (SD = 6.08, 95% CI 8.04 – 12.2). Mean percent of residents reporting depressive symptoms was 4.03% (SD = 5.01, 95% CI 3.47 – 4.61). Linear regression showed that pain was predictive of depressive symptoms (F (1, 299) = 8.66, p < .05, R=0.17). This data suggests that higher levels of pain are predictive of increased depression in nursing home residents. Pain not only directly increases costs in long-term care via medication costs and potential side effects, but may indirectly increase healthcare costs by exacerbating depression. Improving pain management is an important aspect of care. The relationship between pain and depression in for-profit nursing homes suggests that improved pain management may hold financial benefits.
C Campbell, D Tompkins, V Mathur, L McCauley, L Swedberg, O Schoeck, R Edwards, M Smith, J Haythornthwaite, and G Page; Johns Hopkins University, Baltimore, MD
(225) Pain influences ADLs in for-profit nursing homes
(227) Differences in phenotype between Hispanic and non-Hispanic White women with chronic vulvar pain
S Swank, A Chiodo, and A Haig; University of Michigan, Ann Arbor, MI Disabled nursing home residents incur higher costs to nursing homes. Pain is widespread among this population and subjectively reduces function. Higher nursing home expenditures on disabled residents may undermine efforts by for-profit nursing homes to maximize revenues. Though pain may increase for-profit nursing home costs by exacerbating disability, no studies have investigated this relationship. Pain was hypothesized to have a significant relationship with disability in for-profit nursing home residents. In a large-scale analysis, data was included from 301 Michigan for-profit nursing homes with 8880 residents. Percentages of residents reporting moderate to severe pain and percentages of residents requiring increased need for ADL assistance were obtained from the Centers for Medicare and Medicaid website. The relationship between pain and need for ADL assistance was analyzed using simple linear regression. Mean percent of residents reporting moderate to severe pain was 10.1% (SD = 6.08, 95% CI 8.04 – 12.2). Mean percent of residents who had increased need for assistance with ADLs was 14.0% (SD = 6.89, 95% CI 13.2 – 14.8). Moderate to severe pain in residents significantly predicted increased need for assistance with ADLs (F (1, 299) = 26.3, p < .001). This data suggests that pain is significantly related to ADLs in for-profit nursing home residents. Pain may indirectly increase care costs by influencing function. Improving pain management is an important aspect of care. The relationship between pain and function in for-profit nursing homes suggests that improved pain management may hold financial benefits.
Substantial evidence has documented ethnic differences in clinical and laboratory pain reports. African Americans consistently report greater pain in a variety of chronic pain conditions and are generally more sensitive to quantitative sensory testing. Inflammatory cytokines and neuropeptides significantly impact the physiology of nociception and the pathophysiology of pain. A dearth of information exists regarding disparities in these chemical messengers and how they relate to pain response. In the current study, we examined ethnic differences in Interleuelkin 6 (IL-6) and Neuropeptide Y (NPY) in response to capsaicin pain. Twenty-five healthy individuals (16 African American, 9 non-Hispanic White) participated. Blood was drawn before application of 10% topical capsaicin to the dorsum of the nondominant hand. A thermode was strapped to the area and maintained a constant temperature of 40 degrees Celsius for 90 minutes. Blood was drawn again following the procedure. Pain ratings were obtained every five minutes throughout testing. Repeated Measures Analyses of CoVariance (ANCOVA) were conducted to examine the relationship between ethnicity, pain and IL-6/NPY controlling for body mass index. African Americans reported greater pain in response to the capsaicin task when compared to non-Hispanic Whites. A time x sex and time x sex x ethnicity interaction (ps < 0.05) emerged with African American women displaying enhanced IL-6 in response to the pain stimulus compared to men and non-Hispanic White women. Main effects of sex and ethnicity were observed for NPY, with non-Hispanic Whites and men having higher overall levels. These findings hint at a role for chemical messengers as an underlying mechanism potentially contributing to disparities in pain. These findings warrant additional study and the implications for these results will be discussed. This work was supported by the American Pain Society.
R Nguyen and B Harlow; University of Minnesota, Minneapolis, MN Hispanic women have significantly higher prevalence of chronic vulvar pain compared to non-Hispanic Whites, a finding consistently shown across population-based studies. However, chronic vulvar pain is known to have heterogeneous phenotypes, and it is not known whether Hispanic women more often present with phenotypes different from that of non-Hispanic Whites. Improved understanding of phenotypes may elucidate underlying biopsychosocial mechanisms, and allow for targeted therapies. Therefore, we examined symptoms consistent with particular phenotypes to determine whether they differed among Hispanic versus non-Hispanic White women. Data were from a population-based cross-sectional study of 29,582 women in Minneapolis/St. Paul between 2010 - 2013 who returned a mailed screener inquiring about the presence and description of vulvar pain. Surveys were available in Spanish and English. Overall in this population, 8% of respondents exhibited chronic vulvar pain consistent with a vulvodynia diagnosis, and Hispanics are 40% more likely to have chronic vulvar pain than non-Hispanic Whites. In this analysis we found that Hispanics were more likely (adj. risk ratio=1.40, p<0.01) to report primary vulvodynia, defined as pain with first intercourse or tampon use, after accounting for age at menarche, vulvar pain duration, and the number of chronic overlapping pain conditions (COPC). However, Hispanics were 16% more likely to report that their pain can be alleviated with some type of behavior or remedy (p=0.04); among the subgroup with vulvar pain who used yeast cream, Hispanics more often reported benefit of some degree (adj. risk ratio=1.49, p<0.01). No differences between the two ethnicities were found for provoked versus unprovoked, generalized versus localized, or intermittent versus continuous vulvar pain phenotypes. Hispanics were 52% more likely (p=0.02) than non-Hispanic Whites to describe a burning pain. Our findings suggest that the difference in the rates of primary vulvodynia may, in part, explain the differences in prevalence between Hispanic and non-Hispanic women.
Abstracts
The Journal of Pain
(224) Pain predicts depression in for-profit nursing home residents S Swank, R Harden, R Bakshi, and E Maletta; University of Michigan, Ann Arbor, MI
B17 Pain in Minority Populations (226) Ethnic differences in Interleukin 6 and Neuropeptide Y response to capsaicin in healthy participants
Pain is widespread among nursing home residents and is a common comorbidity of depression. Depression increases nursing home costs. These costs may undermine efforts by for-profit nursing homes to maximize revenues. Though pain may indirectly increase for-profit nursing home costs by exacerbating depression, no studies have yet investigated this relationship. Pain was hypothesized to predict depression in for-profit nursing home residents. Data from 301 for-profit nursing homes with 8880 residents were included in a large-scale analysis. Percentages of residents reporting moderate to severe pain were compared to percentages of residents reporting depressive symptoms using simple linear regression. Mean percent of residents reporting moderate to severe pain was 10.1% (SD = 6.08, 95% CI 8.04 – 12.2). Mean percent of residents reporting depressive symptoms was 4.03% (SD = 5.01, 95% CI 3.47 – 4.61). Linear regression showed that pain was predictive of depressive symptoms (F (1, 299) = 8.66, p < .05, R=0.17). This data suggests that higher levels of pain are predictive of increased depression in nursing home residents. Pain not only directly increases costs in long-term care via medication costs and potential side effects, but may indirectly increase healthcare costs by exacerbating depression. Improving pain management is an important aspect of care. The relationship between pain and depression in for-profit nursing homes suggests that improved pain management may hold financial benefits.
C Campbell, D Tompkins, V Mathur, L McCauley, L Swedberg, O Schoeck, R Edwards, M Smith, J Haythornthwaite, and G Page; Johns Hopkins University, Baltimore, MD
(225) Pain influences ADLs in for-profit nursing homes
(227) Differences in phenotype between Hispanic and non-Hispanic White women with chronic vulvar pain
S Swank, A Chiodo, and A Haig; University of Michigan, Ann Arbor, MI Disabled nursing home residents incur higher costs to nursing homes. Pain is widespread among this population and subjectively reduces function. Higher nursing home expenditures on disabled residents may undermine efforts by for-profit nursing homes to maximize revenues. Though pain may increase for-profit nursing home costs by exacerbating disability, no studies have investigated this relationship. Pain was hypothesized to have a significant relationship with disability in for-profit nursing home residents. In a large-scale analysis, data was included from 301 Michigan for-profit nursing homes with 8880 residents. Percentages of residents reporting moderate to severe pain and percentages of residents requiring increased need for ADL assistance were obtained from the Centers for Medicare and Medicaid website. The relationship between pain and need for ADL assistance was analyzed using simple linear regression. Mean percent of residents reporting moderate to severe pain was 10.1% (SD = 6.08, 95% CI 8.04 – 12.2). Mean percent of residents who had increased need for assistance with ADLs was 14.0% (SD = 6.89, 95% CI 13.2 – 14.8). Moderate to severe pain in residents significantly predicted increased need for assistance with ADLs (F (1, 299) = 26.3, p < .001). This data suggests that pain is significantly related to ADLs in for-profit nursing home residents. Pain may indirectly increase care costs by influencing function. Improving pain management is an important aspect of care. The relationship between pain and function in for-profit nursing homes suggests that improved pain management may hold financial benefits.
Substantial evidence has documented ethnic differences in clinical and laboratory pain reports. African Americans consistently report greater pain in a variety of chronic pain conditions and are generally more sensitive to quantitative sensory testing. Inflammatory cytokines and neuropeptides significantly impact the physiology of nociception and the pathophysiology of pain. A dearth of information exists regarding disparities in these chemical messengers and how they relate to pain response. In the current study, we examined ethnic differences in Interleuelkin 6 (IL-6) and Neuropeptide Y (NPY) in response to capsaicin pain. Twenty-five healthy individuals (16 African American, 9 non-Hispanic White) participated. Blood was drawn before application of 10% topical capsaicin to the dorsum of the nondominant hand. A thermode was strapped to the area and maintained a constant temperature of 40 degrees Celsius for 90 minutes. Blood was drawn again following the procedure. Pain ratings were obtained every five minutes throughout testing. Repeated Measures Analyses of CoVariance (ANCOVA) were conducted to examine the relationship between ethnicity, pain and IL-6/NPY controlling for body mass index. African Americans reported greater pain in response to the capsaicin task when compared to non-Hispanic Whites. A time x sex and time x sex x ethnicity interaction (ps < 0.05) emerged with African American women displaying enhanced IL-6 in response to the pain stimulus compared to men and non-Hispanic White women. Main effects of sex and ethnicity were observed for NPY, with non-Hispanic Whites and men having higher overall levels. These findings hint at a role for chemical messengers as an underlying mechanism potentially contributing to disparities in pain. These findings warrant additional study and the implications for these results will be discussed. This work was supported by the American Pain Society.
R Nguyen and B Harlow; University of Minnesota, Minneapolis, MN Hispanic women have significantly higher prevalence of chronic vulvar pain compared to non-Hispanic Whites, a finding consistently shown across population-based studies. However, chronic vulvar pain is known to have heterogeneous phenotypes, and it is not known whether Hispanic women more often present with phenotypes different from that of non-Hispanic Whites. Improved understanding of phenotypes may elucidate underlying biopsychosocial mechanisms, and allow for targeted therapies. Therefore, we examined symptoms consistent with particular phenotypes to determine whether they differed among Hispanic versus non-Hispanic White women. Data were from a population-based cross-sectional study of 29,582 women in Minneapolis/St. Paul between 2010 - 2013 who returned a mailed screener inquiring about the presence and description of vulvar pain. Surveys were available in Spanish and English. Overall in this population, 8% of respondents exhibited chronic vulvar pain consistent with a vulvodynia diagnosis, and Hispanics are 40% more likely to have chronic vulvar pain than non-Hispanic Whites. In this analysis we found that Hispanics were more likely (adj. risk ratio=1.40, p<0.01) to report primary vulvodynia, defined as pain with first intercourse or tampon use, after accounting for age at menarche, vulvar pain duration, and the number of chronic overlapping pain conditions (COPC). However, Hispanics were 16% more likely to report that their pain can be alleviated with some type of behavior or remedy (p=0.04); among the subgroup with vulvar pain who used yeast cream, Hispanics more often reported benefit of some degree (adj. risk ratio=1.49, p<0.01). No differences between the two ethnicities were found for provoked versus unprovoked, generalized versus localized, or intermittent versus continuous vulvar pain phenotypes. Hispanics were 52% more likely (p=0.02) than non-Hispanic Whites to describe a burning pain. Our findings suggest that the difference in the rates of primary vulvodynia may, in part, explain the differences in prevalence between Hispanic and non-Hispanic women.