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S84 (932) Ethnic differences in pain, acculturation, and pain coping in young adults L Campbell, B Flores, F Keefe; Duke University, Durham, NC Ethnic differences in the use of pain coping strategies have been reported in previous research with both young adults and adults, indicating that African-Americans report using praying/hoping strategies more frequently than Caucasians. However, cultural explanations for these ethnic differences have not been put forth. The purpose of this study was to explore the association between pain coping strategies and acculturation, a cultural variable that may contribute to ethnic differences in pain coping. Acculturation is defined as a shift in cultural values, behaviors, or attitudes resulting from contact between two distinct cultures. The association between acculturation and pain coping was explored in 100 college students. African American (n ⫽ 34), Latino (n ⫽ 33), and Caucasian (n ⫽ 33) students were represented in approximately equal numbers. Participants completed questionnaires assessing their current pain; least, worst, and average pain in the last month; pain coping strategies used; and acculturation. It was hypothesized that ethnic groups would differ in their 1) pain report, 2) their use of pain coping strategies, controlling for pain and 3) and acculturation levels. It was also hypothesized that acculturation would be correlated with coping strategies use. Results revealed significant ethnic differences in pain with African-American students reporting significantly higher levels of current pain than Latinos and more average pain in the previous month as compared to Caucasians. However, ANCOVA analyses controlling for pain, revealed no significant differences in pain coping strategies use across the 3 ethnic groups. With regard to acculturation, Latinos had lower acculturation scores than both African Americans and Caucasians. In Latinos, but not in the other 2 groups, lower acculturation scores were significantly correlated with more frequent use of diverting attention and praying/hoping coping strategies. These findings suggest that acculturation may be more relevant for understanding pain coping in Latinos than for other groups.
Abstracts
H. Ethical, Legal, Financial & Education H02 - Education: Professional and Lay (934) Underestimation of pain by medical students is associated with negative emotional reactions to pain B Murinson, A Agarwal, B Klick, J Haythornthwaite; Johns Hopkins School of Medicine, Baltimore, MD The underestimation of pain by health professionals is a prevalent and persistent cause of pain under-treatment, the origins of which are poorly understood. Previous studies have identified patient-associated factors that influence pain estimation including race, socioeconomic status, presence of an obvious pain-associated condition and others. The provider-associated factors pain that lead to pain underestimation have been less well studied but may include complex gender and practice effects. The aim of this study was to assess the reactions of medical students to pain in a patient, focusing on 1) students’ rating of pain based on a standardized vignette, 2) the impact of pain knowledge and emotional response on this rating, 3) the valence and extent of emotional response, and 4) the extent of educational reflection in these students regarding pain. We also measured demographic variables and gauged the extent of personal experience with pain. The data were analyzed using the difference between student-estimated pain score and the patient-reported pain score as the primary outcome measure. When ideal pain accuracy was graded as 100%, the average student response was 72%. Pain underestimation by medical students was associated with negative emotions in relation to the pain vignette but was not associated with pain knowledge, measures of reflection, year of study or pain history. There was a minor association of gender and pain estimation. We conclude that underestimation of pain is present early in medical training and the reasons for medical student underestimation of pain may include negative emotional reactions associated with pain.
(933) Buttock pain: An unusual presentation of disk herniation
(935) Missouri pain initiative’s SURE project: A survey of pain education availability and needs statewide
C Cooper, H Wu; Medical College of Wisconsin, Milwaukee, WI A forty-seven year old female, with a past medical history significant for fibromyalgia, was referred to the pain clinic for chronic, bilateral buttock pain of 6 months duration. The patient’s symptoms were originally attributed to fibromyalgia and piriformis syndrome, for which she received trigger point injections, botox injections, and pharmacologic management with no improvement. Upon presenting to the pain clinic, she reported the pain as a constant, dull, aching, 8/10 on VAS, nonradiating, exacerbated by sitting. The patient denied any weakness, sensory disturbance, or radicular symptoms. She also reported a remote history of the pain starting after coughing while washing dishes 6 months earlier. Physical examination was unremarkable except for tenderness to palpation in the bilateral buttock region. Subsequently, an MRI of the lumbosacral spine was ordered, showing a broad based disk herniation at L5-S1, contacting the bilateral S1 nerve roots. The patient underwent a L5-S1 lumbar epidural steroid injection under fluoroscopic guidance, with complete resolution of her symptoms at 2 months, and 8 months of greater than 50% pain relief. Once her pain recurred, she received another epidural steroid injection with similar results. This case is interesting because this patient presented only with buttock pain, no radicular symptoms, negative SLR’s, and no neurogenic claudication, but was found to have a disk herniation contacting the bilateral S1 nerve roots. Though buttock pain is often associated with a herniated disk, it is usually a part of a constellation of symptoms, rarely presenting as the only symptom. Clinicians should be aware of this unusual presentation.
T Geller, C Herndon, J Chibnall, E Bettonville, R Tait; St Louis University, St Louis, MO The Missouri Pain Initiative randomly surveyed 2000 physicians, pharmacists, nurses, physical and occupational therapists and psychologists/social workers regarding practice location, practice type, and patient mix. Pain experience, recent continuing educational pain programs, and preferred venues for education were assessed. Providers’ comfort level in managing chronic pain patients, and their perception of patient satisfaction with their management were assessed. Of 361 respondents(18.1% response rate), 50.1% were physicians, 29.4% nurses, 4.2% pharmacists and 11.9%therapists. The majority of providers had 5 to 20 plus years experience in managing pain patients. However,56.8% had not participated in a pain educational program in the prior year; almost half of respondents indicated it was unlikely they would engage in pain management education in the following year. Three quarters of respondents were from rural and non-metropolitan regions within Missouri. Current sources of pain education were professional journals and professional conferences (31% each), or local lectures or grand rounds (25% each). The most frequently suggested educational topics included management of chronic low back pain, neuropathic and post-operative pain. Additional suggested topics were drug abuse and diversion in the pain population. Among respondents, 49.5% disagreed or strongly disagreed with mandatory pain-related continuing medical education requirements, a controversial proposal in numerous states. Preferred venues for pain education were local lectures or grand rounds, followed by webbased or electronically based sources. The majority (81.4%) of providers felt able to manage pain adequately to extremely well; yet 58% of providers recognized that patient satisfaction with their care was probably adequate to poor. Delivering quality pain care requires an ongoing commitment to continued education. These data demonstrate a continuous need for pain management educational programming or electronic materials across a wide range of health care professions.
Abstracts
H. Ethical, Legal, Financial & Education H02 - Education: Professional and Lay (934) Underestimation of pain by medical students is associated with negative emotional reactions to pain B Murinson, A Agarwal, B Klick, J Haythornthwaite; Johns Hopkins School of Medicine, Baltimore, MD The underestimation of pain by health professionals is a prevalent and persistent cause of pain under-treatment, the origins of which are poorly understood. Previous studies have identified patient-associated factors that influence pain estimation including race, socioeconomic status, presence of an obvious pain-associated condition and others. The provider-associated factors pain that lead to pain underestimation have been less well studied but may include complex gender and practice effects. The aim of this study was to assess the reactions of medical students to pain in a patient, focusing on 1) students’ rating of pain based on a standardized vignette, 2) the impact of pain knowledge and emotional response on this rating, 3) the valence and extent of emotional response, and 4) the extent of educational reflection in these students regarding pain. We also measured demographic variables and gauged the extent of personal experience with pain. The data were analyzed using the difference between student-estimated pain score and the patient-reported pain score as the primary outcome measure. When ideal pain accuracy was graded as 100%, the average student response was 72%. Pain underestimation by medical students was associated with negative emotions in relation to the pain vignette but was not associated with pain knowledge, measures of reflection, year of study or pain history. There was a minor association of gender and pain estimation. We conclude that underestimation of pain is present early in medical training and the reasons for medical student underestimation of pain may include negative emotional reactions associated with pain.
(933) Buttock pain: An unusual presentation of disk herniation
(935) Missouri pain initiative’s SURE project: A survey of pain education availability and needs statewide
C Cooper, H Wu; Medical College of Wisconsin, Milwaukee, WI A forty-seven year old female, with a past medical history significant for fibromyalgia, was referred to the pain clinic for chronic, bilateral buttock pain of 6 months duration. The patient’s symptoms were originally attributed to fibromyalgia and piriformis syndrome, for which she received trigger point injections, botox injections, and pharmacologic management with no improvement. Upon presenting to the pain clinic, she reported the pain as a constant, dull, aching, 8/10 on VAS, nonradiating, exacerbated by sitting. The patient denied any weakness, sensory disturbance, or radicular symptoms. She also reported a remote history of the pain starting after coughing while washing dishes 6 months earlier. Physical examination was unremarkable except for tenderness to palpation in the bilateral buttock region. Subsequently, an MRI of the lumbosacral spine was ordered, showing a broad based disk herniation at L5-S1, contacting the bilateral S1 nerve roots. The patient underwent a L5-S1 lumbar epidural steroid injection under fluoroscopic guidance, with complete resolution of her symptoms at 2 months, and 8 months of greater than 50% pain relief. Once her pain recurred, she received another epidural steroid injection with similar results. This case is interesting because this patient presented only with buttock pain, no radicular symptoms, negative SLR’s, and no neurogenic claudication, but was found to have a disk herniation contacting the bilateral S1 nerve roots. Though buttock pain is often associated with a herniated disk, it is usually a part of a constellation of symptoms, rarely presenting as the only symptom. Clinicians should be aware of this unusual presentation.
T Geller, C Herndon, J Chibnall, E Bettonville, R Tait; St Louis University, St Louis, MO The Missouri Pain Initiative randomly surveyed 2000 physicians, pharmacists, nurses, physical and occupational therapists and psychologists/social workers regarding practice location, practice type, and patient mix. Pain experience, recent continuing educational pain programs, and preferred venues for education were assessed. Providers’ comfort level in managing chronic pain patients, and their perception of patient satisfaction with their management were assessed. Of 361 respondents(18.1% response rate), 50.1% were physicians, 29.4% nurses, 4.2% pharmacists and 11.9%therapists. The majority of providers had 5 to 20 plus years experience in managing pain patients. However,56.8% had not participated in a pain educational program in the prior year; almost half of respondents indicated it was unlikely they would engage in pain management education in the following year. Three quarters of respondents were from rural and non-metropolitan regions within Missouri. Current sources of pain education were professional journals and professional conferences (31% each), or local lectures or grand rounds (25% each). The most frequently suggested educational topics included management of chronic low back pain, neuropathic and post-operative pain. Additional suggested topics were drug abuse and diversion in the pain population. Among respondents, 49.5% disagreed or strongly disagreed with mandatory pain-related continuing medical education requirements, a controversial proposal in numerous states. Preferred venues for pain education were local lectures or grand rounds, followed by webbased or electronically based sources. The majority (81.4%) of providers felt able to manage pain adequately to extremely well; yet 58% of providers recognized that patient satisfaction with their care was probably adequate to poor. Delivering quality pain care requires an ongoing commitment to continued education. These data demonstrate a continuous need for pain management educational programming or electronic materials across a wide range of health care professions.