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Correlates of absenteeism and presenteeism in temporomandibular joint disorder
S8 (129) Chronic headache after traumatic brain injury D Nampiaparampil; Muscle and Nerve Pain Specialists, LTD, Chicago, IL The Centers for Disease Control estimates that 1.4 million individuals in the United States suffer from traumatic brain injuries (TBI) each year. The association of TBI with chronic pain was first described in 1915 in troops returning from World War I with ‘‘shell shock.’’ One study of veterans returning from Iraq and Afghanistan experiencing post-concussive syndrome found that post-traumatic stress disorder accounted for all symptoms except for pain. The objective of this study is to determine the prevalence of headache as an often overlooked consequence of traumatic brain injury (TBI). The Ovid/Medline database was searched for articles published between 1951 and February 2008 using any combination of the terms brain injury, pain, headache, blast injury, and combat. The PubMed, MD Consult, Cochrane Collaboration, National Institutes of Health Clinical Trials Database, Meta-Register of Current Controlled Trials, and CRISP databases were searched using the keyword brain injury. 1110 articles were identified for evaluation. 258 articles were reviewed and 15 met the inclusion criteria for calculating the prevalence of headache after TBI. Fifteen studies assessed headache (HA) pain in 1932 patients. Of these, 1081 complained of chronic HA, yielding a prevalence of 56.0% (95%CI, 53.9%-58.2%). We found evidence to suggest that there is an association between TBI and the development of chronic HA pain. Chronic pain from headache is a common complication of TBI and is common even with apparently minor injuries to the brain. The evidence suggests that this condition is independent of psychiatric disorders such as post-traumatic stress disorder and depression.
Abstracts
G09 Predication of Outcome (131) How do changes in average pain severity levels correspond with changes in health? A Sadosky, D Hoffman, E Dukes, J Alvir; Pfizer Global Outcomes Research, New York, NY Data (N = 327-342) from a randomized placebo-controlled trial of in painful diabetic peripheral neuropathy (DPN) were analyzed to derive pain severity cutpoints on a 0-10 pain numerical rating scale (NRS), and to compare the magnitude of within-patient change in pain severity with corresponding changes in function and health status. The cutpoint analysis indicated that pain severity ratings of 1-3, 4-6 and 7-10 corresponded to mild, moderate and severe pain, respectively. Patients were stratified according to the magnitude of change in the NRS from baseline to 12weeks, classified by percent reduction in NRS (levels ranging from # 10% to $ 50%) and pain severity cutpoint categories. For each change category, mean (6 SD) score changes were examined for the mBPI-sf and the EQ-5D. On the mBPI-sf Pain Interference Index (PII; 0-10 NRS), mean changes of -5.5 (6 2.1) corresponded with a shift from severe pain to no/mild pain; -3.3 (6 2.1), severe to moderate; -3.2 (6 2.1), moderate to no/mild; -0.9 (6 2.0), no change; and 0.4 (6 2.6), worsening (P < .0001). Mean changes in the PII ranged from -4.5 (6 2.2) for patients with a $ 50% NRS reduction and -0.2 (6 2.0) for patients with a < 10% NRS reduction (P < .0001). Similar differences were observed for the EQ-5D. Results quantify associations between within-patient changes in pain severity and changes in function and health status, and help to identify different magnitudes of change in outcome instruments that are clinically important for patients with painful DPN. (Supported by Pfizer Inc.)
(130) Factors associated with moderate and severe postoperative pain
(132) Correlates of absenteeism and presenteeism in temporomandibular joint disorder
J Kless; Case Western Reserve University, Cleveland, OH Postoperative pain continues to be a serious consequence of surgical intervention. Understanding the predictive factors of postoperative pain would allow health care providers to identify those at increased risk, and better direct resources to ameliorate significantly high levels of postoperative pain. The purpose of this study is to identify the factors correlated with moderate and severe postoperative pain. Using a predictive correlational design, this study is a secondary analysis of a random controlled trial of nonpharmacological interventions in the treatment of postoperative pain. Logistic regression is used to examine the relationship of gender, age, chronic preoperative pain, acute preoperative pain, physical status, surgical procedure, length of surgery, and length of incision, on the levels of moderate and severe postoperative pain. The amount of variance explained and the most significant factors will be examined. Logistic regression will identify a predictive model for comparison to existing literature and future testing.1 (1. Good, Pain, 1999).
N Quinn, L Buenaver, M Smith, R Edwards, E Grace, J Haythornthwaite; University of Maryland Baltimore County, Baltimore, MD Chronic health conditions have been shown to be important determinants of reported levels of absenteeism and work impairment. Severe pain and maladaptive pain coping have also been demonstrated to negatively impact daily functioning. However, the role of these factors in determining lost work productivity in temporomandibular joint disorder (TMD) has received little attention. The current study investigates the effects of pain severity and catastrophizing on absenteeism (physical absence from work) and presenteeism (on-the-job lost work productivity) in a full-time, working for pay TMD sample (N = 93; 71% female). Percentage impairment scores were obtained from the Work Productivity and Activity Impairment Scale. The prevalence of presenteeism was higher than absenteeism, with percentage impairment scores of 23.4% and 1.3% respectively. Multiple regressions were used to examine whether pain severity and catastrophizing predicted greater work-related impairment, controlling for depressive symptoms. Other covariates included gender for absenteeism and race for presenteeism. Results demonstrated that pain severity significantly predicts both absenteeism and presenteeism in TMD patients (p < .05). Catastrophizing did not significantly predict absenteeism, but did significantly predict presenteeism (b = .377, p < .001; total model R2 = .538, p < .001). None of the covariates remained significant after including the predictors in the model. A closer examination of catastrophizing (rumination, magnification, helplessness) was conducted to determine which aspect of catastrophizing accounts for presenteeism. Helplessness was the only catastrophizing subscale to predict presenteeism, controlling for depression (b = .435, p < .001; total model R2 = .576, p < .001). These results suggest that helplessness can impact work-related disability above and beyond the effects of depressive symptoms. Given the higher prevalence of presenteeism, interventions targeted at pain severity and reported helplessness may reduce the occupational and economic impact of lost work productivity due to pain.
Abstracts
G09 Predication of Outcome (131) How do changes in average pain severity levels correspond with changes in health? A Sadosky, D Hoffman, E Dukes, J Alvir; Pfizer Global Outcomes Research, New York, NY Data (N = 327-342) from a randomized placebo-controlled trial of in painful diabetic peripheral neuropathy (DPN) were analyzed to derive pain severity cutpoints on a 0-10 pain numerical rating scale (NRS), and to compare the magnitude of within-patient change in pain severity with corresponding changes in function and health status. The cutpoint analysis indicated that pain severity ratings of 1-3, 4-6 and 7-10 corresponded to mild, moderate and severe pain, respectively. Patients were stratified according to the magnitude of change in the NRS from baseline to 12weeks, classified by percent reduction in NRS (levels ranging from # 10% to $ 50%) and pain severity cutpoint categories. For each change category, mean (6 SD) score changes were examined for the mBPI-sf and the EQ-5D. On the mBPI-sf Pain Interference Index (PII; 0-10 NRS), mean changes of -5.5 (6 2.1) corresponded with a shift from severe pain to no/mild pain; -3.3 (6 2.1), severe to moderate; -3.2 (6 2.1), moderate to no/mild; -0.9 (6 2.0), no change; and 0.4 (6 2.6), worsening (P < .0001). Mean changes in the PII ranged from -4.5 (6 2.2) for patients with a $ 50% NRS reduction and -0.2 (6 2.0) for patients with a < 10% NRS reduction (P < .0001). Similar differences were observed for the EQ-5D. Results quantify associations between within-patient changes in pain severity and changes in function and health status, and help to identify different magnitudes of change in outcome instruments that are clinically important for patients with painful DPN. (Supported by Pfizer Inc.)
(130) Factors associated with moderate and severe postoperative pain
(132) Correlates of absenteeism and presenteeism in temporomandibular joint disorder
J Kless; Case Western Reserve University, Cleveland, OH Postoperative pain continues to be a serious consequence of surgical intervention. Understanding the predictive factors of postoperative pain would allow health care providers to identify those at increased risk, and better direct resources to ameliorate significantly high levels of postoperative pain. The purpose of this study is to identify the factors correlated with moderate and severe postoperative pain. Using a predictive correlational design, this study is a secondary analysis of a random controlled trial of nonpharmacological interventions in the treatment of postoperative pain. Logistic regression is used to examine the relationship of gender, age, chronic preoperative pain, acute preoperative pain, physical status, surgical procedure, length of surgery, and length of incision, on the levels of moderate and severe postoperative pain. The amount of variance explained and the most significant factors will be examined. Logistic regression will identify a predictive model for comparison to existing literature and future testing.1 (1. Good, Pain, 1999).
N Quinn, L Buenaver, M Smith, R Edwards, E Grace, J Haythornthwaite; University of Maryland Baltimore County, Baltimore, MD Chronic health conditions have been shown to be important determinants of reported levels of absenteeism and work impairment. Severe pain and maladaptive pain coping have also been demonstrated to negatively impact daily functioning. However, the role of these factors in determining lost work productivity in temporomandibular joint disorder (TMD) has received little attention. The current study investigates the effects of pain severity and catastrophizing on absenteeism (physical absence from work) and presenteeism (on-the-job lost work productivity) in a full-time, working for pay TMD sample (N = 93; 71% female). Percentage impairment scores were obtained from the Work Productivity and Activity Impairment Scale. The prevalence of presenteeism was higher than absenteeism, with percentage impairment scores of 23.4% and 1.3% respectively. Multiple regressions were used to examine whether pain severity and catastrophizing predicted greater work-related impairment, controlling for depressive symptoms. Other covariates included gender for absenteeism and race for presenteeism. Results demonstrated that pain severity significantly predicts both absenteeism and presenteeism in TMD patients (p < .05). Catastrophizing did not significantly predict absenteeism, but did significantly predict presenteeism (b = .377, p < .001; total model R2 = .538, p < .001). None of the covariates remained significant after including the predictors in the model. A closer examination of catastrophizing (rumination, magnification, helplessness) was conducted to determine which aspect of catastrophizing accounts for presenteeism. Helplessness was the only catastrophizing subscale to predict presenteeism, controlling for depression (b = .435, p < .001; total model R2 = .576, p < .001). These results suggest that helplessness can impact work-related disability above and beyond the effects of depressive symptoms. Given the higher prevalence of presenteeism, interventions targeted at pain severity and reported helplessness may reduce the occupational and economic impact of lost work productivity due to pain.