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(351) Who completes an interdisciplinary pain program? Identifying potential barriers to completion of treatment
Abstracts (348) Confirmatory factor analysis of the Pain Catastrophizing Scale in African Americans with pain in a primary care setting A Vallerand, B Pieper, E DiNardo, C Nordstrom; Wayne State University, Detroit, MI Pain catastrophizing is frequently cited in studies of patients with pain as a contributing factor to poor coping, disability, distress, and increased pain levels. The Pain Catastrophizing Scale is the most commonly used instrument to measure this construct. The factor structure of the Pain Catastrophizing Scale has been identified in primarily Caucasian samples as having 3 factors: Rumination, Magnification, and Helplessness. Recently, it has been suggested that there may be only 2 factors (Rumination and “Powerlessness”) in an African American Workman’s Compensation sample. 1 The factor structure has not been examined in an African American sample in the primary care setting. This study used confirmatory factor analysis to explore the factor structure in African Americans (n⫽278) with pain in an urban primary care setting for indigent adults. Patients were 53% male, 56% had a high school education or better, 54% were single, and 73% were not working, primarily due to pain. Results supported the original 3-factor model of Rumination, Magnification, and Helplessness with RMSEA and CFI indices of 0.62 and .957, respectively. Correlations among the three latent factors were high ranging from .80 to .89. Internal consistencies (Cronbach’s alpha) within each factor were also high at .85 for Helplessness, .73 for Magnification, and .75 for Rumination. Standard path coefficients for individualized items ranged from .60-.81 for Helplessness, from .64 to .75 for Magnification, and from .32 to .84 for Rumination. As frequency of using the Pain Catastrophizing Scale to determine patients’ responses to pain increases, it is important to determine differences in specific populations. Testing of this instrument on various ethnic groups, genders, and pain types will increase the understanding of the results and improve the usefulness of the instrument. Supported by a grant from the Detroit Medical Center/Wayne State University College of Nursing Scholars Award. (1. Chibnall, Pain, 2005.)
(349) Sex and race differences in rating others’ pain, painrelated negative mood, pain coping, and need for medical treatment M Robinson, A Alqudah, A Hirsh, L Stutts; University of Florida, Gainesville, FL Sex and race are understood to influence pain ratings but likely also affect other pain-related sequelae. This study examined the influences of sex and race on ratings of pain intensity, pain unpleasantness, painrelated negative mood, pain coping, and need for medical treatment. Seventy-five undergraduates viewed virtual humans expressing pain, and provided computerized ratings with Visual Analogue Scales. Mixed ANOVAs showed that male and female participants rated female virtual humans higher than male virtual humans on pain intensity, [F (1, 73) ⫽ 4.92, p ⬍ 0.05], pain unpleasantness, [F (1, 73) ⫽ 7.61, p ⬍ 0.01], painrelated negative mood, [F (1, 73) ⫽ 6.76, p ⬍ 0.05], poor pain coping, [F (1, 73) ⫽ 6.37, p ⬍ 0.05], and need for medical treatment, [F (1, 73) ⫽ 5.98, p ⬍ 0.05]. Male participants also rated African American and Caucasian virtual humans’ need for medical treatment higher than females’ ratings, (F (1, 73) ⫽ 4.02, p ⬍ 0.05). Caucasian and African American participants’ ratings for female videos were higher than male videos only on pain intensity, [F (1, 73) ⫽ 6.93, p ⬍ 0.05] and pain unpleasantness, [F (1, 73) ⫽ 4.17, p ⬍ 0.05]. Caucasian virtual humans were viewed as having higher pain-related negative mood [F (1, 73) ⫽ 3.99, p ⫽ 0.05] and poorer pain coping [F (1, 73) ⫽ 6.86, p ⬍ 0.05] than African American virtual humans. African American virtual humans’ pain intensity was rated higher only by African American participants [F (1, 73) ⫽ 4.73, p ⬍ 0.05]. Females’ higher negative mood and poorer coping might be explained by the relationship between pain, mood, and coping. Males’ tendency to seek more pain medications may explain their high levels of recommending virtual humans to seek treatment. Results also show that races may differ in sensitivity to pain expressions.
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Other (350) Incorporating the facial pain patient’s perspective into treatment: Comparisons across three pain groups L Stutts, E Banou, R McCulloch, J Craggs, L Waxenberg, H Gremillion, M Robinson; University of Florida, Gainesville, FL Due to the multidimensionality of chronic pain, patient-centered models of healthcare may be particularly useful. Recent studies highlight the importance of examining patients’ criteria versus standard statistical criteria for success. These studies indicate that patients require greater symptom change than typically demonstrated by statistical significance. However, little is known about the consistency across pain groups. This study examined patient-centered success criteria across three chronic pain groups. Participants included 53 facial pain (46 women, 7 men), 52 fibromyalgia (49 women, 3 men), and 52 back pain patients (30 women, 22 men) who completed the Patient Centered Outcomes (PCO) Questionnaire, which assesses four domains relevant to chronic pain populations: pain, fatigue, distress, and interference in daily activities. Repeated Measures Analyses of Variance were performed using patients’ PCO ratings for their usual levels, expected levels, successful improvement levels, importance levels, and change (usual minus success) needed for each of the four domains during treatment. There was a significant difference between the pain groups and usual level of pain [F(2, 154) ⫽ 9.58, p ⬍ .01], fatigue [F(2, 154) ⫽ 14.09, p ⬍ .01], distress [F(2, 154) ⫽ 6.84, p ⬍ .01], and interference [F(2, 154) ⫽ 17.42, p ⬍ .01]. Facial pain and back pain patients had lower usual pain ratings, fatigue, distress, and interference compared to fibromyalgia patients. For all pain groups, success was defined by significant decreases in their usual pain ratings, fatigue, distress, and interference. Facial pain patients and back pain patients required significantly less improvement in fatigue and distress compared to fibromyalgia patients. Facial pain patients also required significantly less improvement in interference compared to fibromyalgia patients and back pain patients. These results demonstrate the similarities and differences in patient-centered outcomes across chronic pain groups. It also highlights the need to further investigate the nature of these differences.
(351) Who completes an interdisciplinary pain program? Identifying potential barriers to completion of treatment S Oslund, R Robinson, T Clark, C Noe, J Garofalo; Baylor University Medical Center, Dallas, TX Interdisciplinary treatment programs for chronic pain patients have been found effective. However, limited research has occurred investigating factors related to failure to complete such programs. The interdisciplinary treatment program at Baylor University Medical Center is a comprehensive, outpatient, four-week program that includes individual counseling, group education, and occupational and physical therapy. Since 2001, 638 patients have entered our program, with 496 patients (77.7%) graduating. Independent samples t-tests comparing graduates to non-graduates were performed on several biopsychosocial variables (including the Multidimensional Pain Inventory, Beck Depression Inventory-2 and Beck Anxiety Inventory). Graduates were significantly older (M⫽ 49.41) than non-graduates (M⫽ 46.48; p⫽.008), had fewer emergency room visits (M⫽ 1.14, M⫽ 2.39 respectively; p⫽ .007), and had fewer previous mental health visits (M⫽ 3.52, M⫽5.69 respectively, p⫽ .020). Furthermore, graduates reported lower levels of distress than non-graduates (M⫽ 7.72, M⫽ 8.31 respectively; p⫽.044), and lower levels of depression (M⫽ 22.84, M⫽26.29 respectively; p⫽.004) and anxiety (M⫽ 17.82, M⫽22.88 respectively; p⬍.001). In addition, graduates reported a greater sense of mental health (M⫽ 31.98) than non-graduates (M⫽ 30.29; p⫽0.19), walked further (M⫽15.30, M⫽14.10 respectively; p⫽.015), and had a greater sense of life control (M⫽ 46.04, M⫽43.26 respectively; p⫽.036). A forward binary logistic regression was performed utilizing the above variable. The number of emergency room visits over the last year correctly classified 83% of patients. With each number of emergency room visits in the last year, individuals were found to have a 28% greater risk of not graduating from the program (OR⫽0.780, 95% CI: 0.680 – 0.896, p⬍ .001). Although the results are preliminary, these findings identify potential risk factors for further investigation, which could lead to interventions to increase successful completion of an interdisciplinary pain program.
(349) Sex and race differences in rating others’ pain, painrelated negative mood, pain coping, and need for medical treatment M Robinson, A Alqudah, A Hirsh, L Stutts; University of Florida, Gainesville, FL Sex and race are understood to influence pain ratings but likely also affect other pain-related sequelae. This study examined the influences of sex and race on ratings of pain intensity, pain unpleasantness, painrelated negative mood, pain coping, and need for medical treatment. Seventy-five undergraduates viewed virtual humans expressing pain, and provided computerized ratings with Visual Analogue Scales. Mixed ANOVAs showed that male and female participants rated female virtual humans higher than male virtual humans on pain intensity, [F (1, 73) ⫽ 4.92, p ⬍ 0.05], pain unpleasantness, [F (1, 73) ⫽ 7.61, p ⬍ 0.01], painrelated negative mood, [F (1, 73) ⫽ 6.76, p ⬍ 0.05], poor pain coping, [F (1, 73) ⫽ 6.37, p ⬍ 0.05], and need for medical treatment, [F (1, 73) ⫽ 5.98, p ⬍ 0.05]. Male participants also rated African American and Caucasian virtual humans’ need for medical treatment higher than females’ ratings, (F (1, 73) ⫽ 4.02, p ⬍ 0.05). Caucasian and African American participants’ ratings for female videos were higher than male videos only on pain intensity, [F (1, 73) ⫽ 6.93, p ⬍ 0.05] and pain unpleasantness, [F (1, 73) ⫽ 4.17, p ⬍ 0.05]. Caucasian virtual humans were viewed as having higher pain-related negative mood [F (1, 73) ⫽ 3.99, p ⫽ 0.05] and poorer pain coping [F (1, 73) ⫽ 6.86, p ⬍ 0.05] than African American virtual humans. African American virtual humans’ pain intensity was rated higher only by African American participants [F (1, 73) ⫽ 4.73, p ⬍ 0.05]. Females’ higher negative mood and poorer coping might be explained by the relationship between pain, mood, and coping. Males’ tendency to seek more pain medications may explain their high levels of recommending virtual humans to seek treatment. Results also show that races may differ in sensitivity to pain expressions.
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Other (350) Incorporating the facial pain patient’s perspective into treatment: Comparisons across three pain groups L Stutts, E Banou, R McCulloch, J Craggs, L Waxenberg, H Gremillion, M Robinson; University of Florida, Gainesville, FL Due to the multidimensionality of chronic pain, patient-centered models of healthcare may be particularly useful. Recent studies highlight the importance of examining patients’ criteria versus standard statistical criteria for success. These studies indicate that patients require greater symptom change than typically demonstrated by statistical significance. However, little is known about the consistency across pain groups. This study examined patient-centered success criteria across three chronic pain groups. Participants included 53 facial pain (46 women, 7 men), 52 fibromyalgia (49 women, 3 men), and 52 back pain patients (30 women, 22 men) who completed the Patient Centered Outcomes (PCO) Questionnaire, which assesses four domains relevant to chronic pain populations: pain, fatigue, distress, and interference in daily activities. Repeated Measures Analyses of Variance were performed using patients’ PCO ratings for their usual levels, expected levels, successful improvement levels, importance levels, and change (usual minus success) needed for each of the four domains during treatment. There was a significant difference between the pain groups and usual level of pain [F(2, 154) ⫽ 9.58, p ⬍ .01], fatigue [F(2, 154) ⫽ 14.09, p ⬍ .01], distress [F(2, 154) ⫽ 6.84, p ⬍ .01], and interference [F(2, 154) ⫽ 17.42, p ⬍ .01]. Facial pain and back pain patients had lower usual pain ratings, fatigue, distress, and interference compared to fibromyalgia patients. For all pain groups, success was defined by significant decreases in their usual pain ratings, fatigue, distress, and interference. Facial pain patients and back pain patients required significantly less improvement in fatigue and distress compared to fibromyalgia patients. Facial pain patients also required significantly less improvement in interference compared to fibromyalgia patients and back pain patients. These results demonstrate the similarities and differences in patient-centered outcomes across chronic pain groups. It also highlights the need to further investigate the nature of these differences.
(351) Who completes an interdisciplinary pain program? Identifying potential barriers to completion of treatment S Oslund, R Robinson, T Clark, C Noe, J Garofalo; Baylor University Medical Center, Dallas, TX Interdisciplinary treatment programs for chronic pain patients have been found effective. However, limited research has occurred investigating factors related to failure to complete such programs. The interdisciplinary treatment program at Baylor University Medical Center is a comprehensive, outpatient, four-week program that includes individual counseling, group education, and occupational and physical therapy. Since 2001, 638 patients have entered our program, with 496 patients (77.7%) graduating. Independent samples t-tests comparing graduates to non-graduates were performed on several biopsychosocial variables (including the Multidimensional Pain Inventory, Beck Depression Inventory-2 and Beck Anxiety Inventory). Graduates were significantly older (M⫽ 49.41) than non-graduates (M⫽ 46.48; p⫽.008), had fewer emergency room visits (M⫽ 1.14, M⫽ 2.39 respectively; p⫽ .007), and had fewer previous mental health visits (M⫽ 3.52, M⫽5.69 respectively, p⫽ .020). Furthermore, graduates reported lower levels of distress than non-graduates (M⫽ 7.72, M⫽ 8.31 respectively; p⫽.044), and lower levels of depression (M⫽ 22.84, M⫽26.29 respectively; p⫽.004) and anxiety (M⫽ 17.82, M⫽22.88 respectively; p⬍.001). In addition, graduates reported a greater sense of mental health (M⫽ 31.98) than non-graduates (M⫽ 30.29; p⫽0.19), walked further (M⫽15.30, M⫽14.10 respectively; p⫽.015), and had a greater sense of life control (M⫽ 46.04, M⫽43.26 respectively; p⫽.036). A forward binary logistic regression was performed utilizing the above variable. The number of emergency room visits over the last year correctly classified 83% of patients. With each number of emergency room visits in the last year, individuals were found to have a 28% greater risk of not graduating from the program (OR⫽0.780, 95% CI: 0.680 – 0.896, p⬍ .001). Although the results are preliminary, these findings identify potential risk factors for further investigation, which could lead to interventions to increase successful completion of an interdisciplinary pain program.