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Chronic pain among veterans of Operations Enduring Freedom and Iraqi Freedom
S78
Abstracts
(879) Chronic pain among veterans of Operations Enduring Freedom and Iraqi Freedom
(881) Children’s strategies for coping with pain: Impact of age, sex, and pain experience
R. Gironda, M. Clark, R. Walker; James A. Haley Veterans’ Hospital, Tampa, FL Epidemiological studies have revealed that chronic pain is one of the most frequently-reported complaints among veterans of the Persian Gulf War. Although good prevalence estimates are not available, rates of musculoskeletal pain and headache have been found to be higher among these veterans than in both the general population and in groups of Gulf War-era veterans who were not deployed to the Persian Gulf Theater. Because the scope of Operations Enduring Freedom and Iraqi Freedom (OIF/OEF) is far greater than that of the Persian Gulf War in terms of duration of hostilities, number of casualties, and U.S. troops deployed, it is not unreasonable to expect that a significant number of veterans will soon be entering the VA and other healthcare systems with existing chronic pain conditions. To the extent that these new demands on the healthcare system can be anticipated, effective strategic planning, resource allocation, and personnel training can be implemented to ensure the early identification and treatment of chronic pain among veterans returning from Iraq and Afghanistan. The primary objective of this study was to determine the prevalence and nature of chronic pain among OIF/OEF veterans seeking care at a large veterans’ medical center. Preliminary data analyses suggest that approximately 43% of the more than 800 veterans already enrolled at this facility report some level of current pain. Demographic and epidemiologic data will be presented. Implications for pain service strategic planning will be discussed.
K. Krmpotic, A. Koster-Baier, P. McGrath, K. Speechley; The Hospital for Sick Children, Toronto, ON As part of a broader study evaluating whether children’s knowledge about pain differed by age, sex, and pain experience, 187 children and adolescents varying in age (5 to 16 years; M⫽9.9; SD⫽3.0), sex (98 females; 89 males), and pain experience (103 children with pain problems and 84 pain-free children) were interviewed about pain etiology and interventions. Two independent raters coded the content of children’s responses (i.e., physical and psychological causes, and physical/behavioral, pharmacological, psychological interventions). In response to ’What causes pain?’ almost all children (99.5%) cited physical causes and 58.1% of children also cited emotional causes. Children responded that many drug and non-drug interventions would lessen pain: the most commonly cited interventions were physical or behavioral (80.7%), followed by pharmacological (43.9%), psychological (34.8%), and general help-seeking strategies (21.4%). Logistic regression analyses were used to compare children’s responses by age, sex, and pain experience. Children’s knowledge of pain etiology did not differ by sex or pain experience. However, children who cited psychological causes were older (M⫽11.1, SD⫽2.5) than children who cited only physical causes (M⫽8.2, SD⫽2.8), p⫽.000. Children’s knowledge of interventions differed by age: children who reported psychological strategies were older (M⫽10.9, SD⫽2.9) than children who did not (M⫽9.4, SD⫽2.9), p⫽.002; children who described pharmacological treatments were older (M⫽10.5, SD⫽3.0) than children who did not (M⫽9.4, SD⫽2.9), p⫽.006. Age correlated positively with the number of interventions children described, r⫽.302, p⫽.001. While children’s knowledge of physical and help-seeking interventions did not differ by age, sex, or pain experience, chi-square analyses revealed significant sex-related differences in children’s knowledge of psychological interventions: more females (43.9%) than males (24.7%) cited psychological interventions (OR 8.9, p⫽.015). These results indicate that children’s age, more than sex or pain experience, is associated with their knowledge of pain etiology and interventions to lessen pain.
(880) Pain and posttraumatic stress in adults treated for cancer
(882) Pain in persons who call the Cancer Information Service
J. Gold, M. Douglas, M. Thomas, J. Elliott, S. Rao, C. Miaskowski; VA Palo Alto Health Care System, Palo Alto, CA The association of pain symptoms to cancer treatment and the development of Posttraumatic Stress Disorder (PTSD) have yet to be investigated. While PTSD has been modified to include life-threatening illnesses, investigators have neglected to examine the potential impact of pain as a trigger or symptom of PTSD. The current investigation examines the relationship between pain and PTSD in a general adult population of patients diagnosed and treated for cancer. As part of a multi site investigation of cancer and pain management, 289 participants (254 males, 35 females) with a mean age of 61.31 (range 21-88) were recruited from outpatient oncology clinics. PTSD was measured using the PTSD Checklist-Civilian Version (PCL-C), a 17-item questionnaire that corresponds to the DSM-IV symptoms of PTSD, yielding a total and subscale scores (reexperiencing, avoidance/numbing, and hyperarousal) symptoms. Pain was measured using the Brief Pain Inventory (BPI), which consists of 19 sections assessing pain intensity and interference of pain in the patient’s life. Seventy-eight (27%) of participants diagnosed and treated for cancer met criteria consistent with a PTSD diagnosis. Analyses were conducted comparing all subscales of PTSD with pain intensity (worst, least, average pain in the past 7 days and pain now), by (PTSD⫹) and (PTSD-) groupings. PTSD⫹ participants demonstrated associations between total PTSD score and worst (r⫽.34**) and average pain (r⫽.27**). Reexperiencing (r⫽.32**) and hyperarousal (r⫽.34**) were also associated with worst pain. In addition, hyperarousal correlated with least (r⫽.29**) and average pain (r⫽.37**). PTSD- participants had significant correlations with hyperarousal and worst (r⫽.14*) and average pain (r⫽.21**). Participants who receive cancer treatment are at risk of developing PTSD. Ongoing pain symptoms are associated with and may exacerbate PTSD symptoms. Given the literature on the negative impact of PTSD on psychoneuroimmunology, early identification and treatment aimed at symptom reduction is essential in facilitating the recovery process.
K. Wang, S. Ward, R. Serlin, S. Peterson; University of Wisconsin, Madison, WI A randomized trial of an intervention to overcome attitudinal barriers to pain management is being conducted with patients who call the Cancer Information Service (CIS). The CIS provides cancer-related information to callers through a toll-free telephone number (800-4-CANCER). The RCT is in progress, but in this poster we present descriptive data collected at baseline regarding the incidence, severity, and impact of pain. Note that subjects who called the CIS specifically to ask about pain were considered ineligible for the RCT. As a consequence, the following data reflect the presence pain as an “occult” problem in these subjects. Most of the 199 subjects were female (73.4%) and Caucasian (82%) and their mean (SD) age was 54.7 (12.58). Subjects were asked, “How frequently in the past week have you had moderate or severe pain?” They responded “sometimes” 90 (45%), “often” 45 (23%), “almost always” 34 (17%), or “always” 30 (15%). Subjects randomized to one of the study arms were not asked any further descriptive information, but the 123 subjects in the other two arms were asked to respond to items from the Brief Pain Inventory (BPI) that address pain severity and pain interference with life activities (on 0 to 10 scales). For these subjects, mean (SD) pain worst was 5.51 (2.86), pain least was 2.04 (1.99) and pain now was 2.74 (2.57). Mean (SD) pain interference scores were: general activity 5.08 (3.23); mood 5.21 (3.33); walking 4.39 (3.51); working 5.53 (3.45), relationships 4.21 (3.27), sleep 5.32 (3.34), and enjoyment of life 5.28 (3.37). The data reveal that many CIS callers have significant levels of pain that interfere with life activities. The CIS is therefore an excellent site for recruiting subjects to trials of interventions designed to improve pain management and improve quality of life for persons with cancer.
Abstracts
(879) Chronic pain among veterans of Operations Enduring Freedom and Iraqi Freedom
(881) Children’s strategies for coping with pain: Impact of age, sex, and pain experience
R. Gironda, M. Clark, R. Walker; James A. Haley Veterans’ Hospital, Tampa, FL Epidemiological studies have revealed that chronic pain is one of the most frequently-reported complaints among veterans of the Persian Gulf War. Although good prevalence estimates are not available, rates of musculoskeletal pain and headache have been found to be higher among these veterans than in both the general population and in groups of Gulf War-era veterans who were not deployed to the Persian Gulf Theater. Because the scope of Operations Enduring Freedom and Iraqi Freedom (OIF/OEF) is far greater than that of the Persian Gulf War in terms of duration of hostilities, number of casualties, and U.S. troops deployed, it is not unreasonable to expect that a significant number of veterans will soon be entering the VA and other healthcare systems with existing chronic pain conditions. To the extent that these new demands on the healthcare system can be anticipated, effective strategic planning, resource allocation, and personnel training can be implemented to ensure the early identification and treatment of chronic pain among veterans returning from Iraq and Afghanistan. The primary objective of this study was to determine the prevalence and nature of chronic pain among OIF/OEF veterans seeking care at a large veterans’ medical center. Preliminary data analyses suggest that approximately 43% of the more than 800 veterans already enrolled at this facility report some level of current pain. Demographic and epidemiologic data will be presented. Implications for pain service strategic planning will be discussed.
K. Krmpotic, A. Koster-Baier, P. McGrath, K. Speechley; The Hospital for Sick Children, Toronto, ON As part of a broader study evaluating whether children’s knowledge about pain differed by age, sex, and pain experience, 187 children and adolescents varying in age (5 to 16 years; M⫽9.9; SD⫽3.0), sex (98 females; 89 males), and pain experience (103 children with pain problems and 84 pain-free children) were interviewed about pain etiology and interventions. Two independent raters coded the content of children’s responses (i.e., physical and psychological causes, and physical/behavioral, pharmacological, psychological interventions). In response to ’What causes pain?’ almost all children (99.5%) cited physical causes and 58.1% of children also cited emotional causes. Children responded that many drug and non-drug interventions would lessen pain: the most commonly cited interventions were physical or behavioral (80.7%), followed by pharmacological (43.9%), psychological (34.8%), and general help-seeking strategies (21.4%). Logistic regression analyses were used to compare children’s responses by age, sex, and pain experience. Children’s knowledge of pain etiology did not differ by sex or pain experience. However, children who cited psychological causes were older (M⫽11.1, SD⫽2.5) than children who cited only physical causes (M⫽8.2, SD⫽2.8), p⫽.000. Children’s knowledge of interventions differed by age: children who reported psychological strategies were older (M⫽10.9, SD⫽2.9) than children who did not (M⫽9.4, SD⫽2.9), p⫽.002; children who described pharmacological treatments were older (M⫽10.5, SD⫽3.0) than children who did not (M⫽9.4, SD⫽2.9), p⫽.006. Age correlated positively with the number of interventions children described, r⫽.302, p⫽.001. While children’s knowledge of physical and help-seeking interventions did not differ by age, sex, or pain experience, chi-square analyses revealed significant sex-related differences in children’s knowledge of psychological interventions: more females (43.9%) than males (24.7%) cited psychological interventions (OR 8.9, p⫽.015). These results indicate that children’s age, more than sex or pain experience, is associated with their knowledge of pain etiology and interventions to lessen pain.
(880) Pain and posttraumatic stress in adults treated for cancer
(882) Pain in persons who call the Cancer Information Service
J. Gold, M. Douglas, M. Thomas, J. Elliott, S. Rao, C. Miaskowski; VA Palo Alto Health Care System, Palo Alto, CA The association of pain symptoms to cancer treatment and the development of Posttraumatic Stress Disorder (PTSD) have yet to be investigated. While PTSD has been modified to include life-threatening illnesses, investigators have neglected to examine the potential impact of pain as a trigger or symptom of PTSD. The current investigation examines the relationship between pain and PTSD in a general adult population of patients diagnosed and treated for cancer. As part of a multi site investigation of cancer and pain management, 289 participants (254 males, 35 females) with a mean age of 61.31 (range 21-88) were recruited from outpatient oncology clinics. PTSD was measured using the PTSD Checklist-Civilian Version (PCL-C), a 17-item questionnaire that corresponds to the DSM-IV symptoms of PTSD, yielding a total and subscale scores (reexperiencing, avoidance/numbing, and hyperarousal) symptoms. Pain was measured using the Brief Pain Inventory (BPI), which consists of 19 sections assessing pain intensity and interference of pain in the patient’s life. Seventy-eight (27%) of participants diagnosed and treated for cancer met criteria consistent with a PTSD diagnosis. Analyses were conducted comparing all subscales of PTSD with pain intensity (worst, least, average pain in the past 7 days and pain now), by (PTSD⫹) and (PTSD-) groupings. PTSD⫹ participants demonstrated associations between total PTSD score and worst (r⫽.34**) and average pain (r⫽.27**). Reexperiencing (r⫽.32**) and hyperarousal (r⫽.34**) were also associated with worst pain. In addition, hyperarousal correlated with least (r⫽.29**) and average pain (r⫽.37**). PTSD- participants had significant correlations with hyperarousal and worst (r⫽.14*) and average pain (r⫽.21**). Participants who receive cancer treatment are at risk of developing PTSD. Ongoing pain symptoms are associated with and may exacerbate PTSD symptoms. Given the literature on the negative impact of PTSD on psychoneuroimmunology, early identification and treatment aimed at symptom reduction is essential in facilitating the recovery process.
K. Wang, S. Ward, R. Serlin, S. Peterson; University of Wisconsin, Madison, WI A randomized trial of an intervention to overcome attitudinal barriers to pain management is being conducted with patients who call the Cancer Information Service (CIS). The CIS provides cancer-related information to callers through a toll-free telephone number (800-4-CANCER). The RCT is in progress, but in this poster we present descriptive data collected at baseline regarding the incidence, severity, and impact of pain. Note that subjects who called the CIS specifically to ask about pain were considered ineligible for the RCT. As a consequence, the following data reflect the presence pain as an “occult” problem in these subjects. Most of the 199 subjects were female (73.4%) and Caucasian (82%) and their mean (SD) age was 54.7 (12.58). Subjects were asked, “How frequently in the past week have you had moderate or severe pain?” They responded “sometimes” 90 (45%), “often” 45 (23%), “almost always” 34 (17%), or “always” 30 (15%). Subjects randomized to one of the study arms were not asked any further descriptive information, but the 123 subjects in the other two arms were asked to respond to items from the Brief Pain Inventory (BPI) that address pain severity and pain interference with life activities (on 0 to 10 scales). For these subjects, mean (SD) pain worst was 5.51 (2.86), pain least was 2.04 (1.99) and pain now was 2.74 (2.57). Mean (SD) pain interference scores were: general activity 5.08 (3.23); mood 5.21 (3.33); walking 4.39 (3.51); working 5.53 (3.45), relationships 4.21 (3.27), sleep 5.32 (3.34), and enjoyment of life 5.28 (3.37). The data reveal that many CIS callers have significant levels of pain that interfere with life activities. The CIS is therefore an excellent site for recruiting subjects to trials of interventions designed to improve pain management and improve quality of life for persons with cancer.