Prevalence of prehospital pain and pain assessment difference between patients and paramedics: a prospective cross-sectional observational study.

Adequate analgesia is one of the most important interventions in emergency medicine. However, studies suggest that many patients are undertreated for pain. There can be many reasons why patients assess their pain differently to the paramedics. This study aimed to assess the differences in pain ratings between patients and paramedics and factors influencing them in prehospital emergencies. This prospective cross-sectional observational study included patients treated and transported by paramedics or paramedics and emergency physicians of the German Red Cross in Reutlingen, Germany. This study included 6,365 patients. The prevalence of pain was 49.7%. Among patients with a self-reported numerical rating scale (NRS) > 0, the mean patient pain rating was NRS 4.2 ± 2.7, while the mean paramedic pain rating was NRS 3.6 ± 2.4 (p < 0.001). Approximately 11.8% (n = 751) of patients reported subjectively unbearable pain. Patients reported a mean NRS of 7.7 ± 1.8 for unbearable pain, but a mean NRS of 3.3 ± 2.0 for bearable pain (p < 0.001). The difference in pain ratings between patients and paramedics increased with pain severity. Univariate analysis showed that there were no gender differences, but the difference in pain rating was influenced by patient age (p < 0.001) and paramedic age (p = 0.042). The differences in pain ratings were particularly pronounced for abdominal diseases (p < 0.001) and trauma (p < 0.001). There is a difference in pain ratings between patients and paramedics, which increases with pain severity and appears to be associated with the patient's age and the paramedic's age. To determine the desire and need for analgesics, the question about unbearable pain is a good addition to the NRS.

Trends in low-value GP care during the COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: Several studies showed that during the pandemic patients have refrained from visiting their general practitioner (GP). This resulted in medical care being delayed, postponed or completely forgone. The provision of low-value care, i.e. care which offers no net benefit for the patient, also could have been affected. We therefore assessed the impact of the COVID-19 restrictions on three types of low-value GP care: 1) imaging for back or knee problems, 2) antibiotics for otitis media acuta (OMA), and 3) repeated opioid prescriptions, without a prior GP visit. METHODS: We performed a retrospective cohort study using registration data from GPs part of an academic GP network over the period 2017-2022. The COVID-19 period was defined as the period between April 2020 to December 2021. The periods before (January 2017 to April 2020) and after the COVID-19 period (January 2022 to December 2022) are the pre- and post-restrictions periods. The three clinical practices examined were selected by two practicing GPs from a top 30 of recommendations originating from the Dutch GP guidelines, based on their perceived prevalence and relevance in practice (van Dulmen et al., BMC Primary Care 23:141, 2022). Multilevel Poisson regression models were built to examine changes in the incidence rates (IR) of both registered episodes and episodes receiving low-value treatment. RESULTS: During the COVID-19 restrictions period, the IRs of episodes of all three types of GP care decreased significantly. The IR of episodes of back or knee pain decreased by 12%, OMA episodes by 54% and opioid prescription rate by 13%. Only the IR of OMA episodes remained significantly lower (22%) during the post-restrictions period. The provision of low-value care also changed. The IR of imaging for back or knee pain and low-value prescription of antibiotics for OMA both decreased significantly during the COVID-restrictions period (by 21% and 78%), but only the low-value prescription rate of antibiotics for OMA remained significantly lower (by 63%) during the post-restrictions period. The IR of inappropriately repeated opioid prescriptions remained unchanged over all three periods. CONCLUSIONS: This study shows that both the rate of episodes as well as the rate at which low-value care was provided have generally been affected by the COVID-19 restrictions. Furthermore, it shows that the magnitude of the impact of the restrictions varies depending on the type of low-value care. This indicates that deimplementation of low-value care requires tailored (multiple) interventions and may not be achieved through a single disruption or intervention alone.

Sociodemographic disparities and potential biases in persistent pain estimates: Findings from 5 waves of the Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: Pain is a prevalent, debilitating condition among older adults. Much evidence on this topic comes from cohort studies, which may be affected by attrition and measurement bias. Little is known about the impact of these biases on pain estimates for European older adults. Additionally, there is a lack of longitudinal research on pain and sociodemographic disparities in Irish older adults. METHODS: We analysed data from 8171 participants (aged ≥50 at baseline) across five waves of the Irish Longitudinal Study on Ageing. Longitudinal pain severity and sociodemographic disparities in pain were explored visually and using a latent growth curve model. Using multivariate logistic regression, we examined bias due to attrition at later waves associated with reported pain at Wave 1. Measurement biases due to reporting heterogeneity were assessed by investigating associations between sociodemographic factors and pain-related disability for given pain levels. RESULTS: Wave 1 severe pain was associated with increased odds of attrition due to death by Wave 5 (AOR: 1.63, 95% CI: 1.20, 2.19). Not having private health insurance was associated with increased odds of pain-related disability at Wave 1, controlling for pain severity (AOR: 1.37, 95% CI: 1.15, 1.64). These results suggested mortality bias and reporting heterogeneity measurement bias, respectively. Sex, education level, and private health insurance status disparities in pain were observed longitudinally. CONCLUSIONS: Mortality bias and reporting heterogeneity measurement bias must be accounted for to improve older adult pain estimates. There is a need for policymakers to address sociodemographic disparities in older adult pain levels. SIGNIFICANCE: This study highlights a need to address bias in the estimation of pain in observational studies of older adults. Understanding the sources and extent of these biases is important so that health practices and policies to address pain disparities can be guided by accurate estimates. Women, those with lower educational attainment, and those without private health insurance were found to have the highest pain burden longitudinally, suggesting a need for targeted interventions for these groups in Ireland and internationally.

Associations Between Psychological Stress and Hand Pain Among Rural and Urban Adults: Findings From the KoGES Community Cohort Study.

Despite known health disparities in chronic pain conditions between rural and urban adults, few studies have examined whether longitudinal associations between psychological stress and hand pain differ. Utilizing community-based cohort data, this study examined whether rural and urban adults differed in the extent to which psychological distress was associated with hand osteoarthritis (OA) symptoms and later functional limitations related to hand pain. Community-dwelling adults (mean age = 51.97, 52.3% women) in a rural (n = 2,971) and urban area (n = 2,782) provided demographic data at baseline and, at a 4-year follow-up, responded to questionnaires about psychological distress and clinical symptoms of hand OA. Levels of functional limitations in hands were assessed at an 8-year follow-up. Ordinal logistic and linear regression were conducted to examine the effects of psychological distress on hand OA symptoms and functional limitations, and whether associations between psychological distress and these pain outcomes were moderated by residential area. The results showed that psychological distress was associated with a higher risk for hand OA symptoms and functional limitations, even after adjusting for demographic and health covariates. There was significant moderation by residential area, such that the association between psychological distress and hand OA was significant only among rural adults and the association with functional limitations was stronger in rural adults than urban adults. Findings suggest greater vulnerability to hand arthritis and hand-related functional limitations among rural adults and the potential for tailored intervention programs to help resolve health disparities among rural communities. PERSPECTIVE: This study compares the association between psychological distress and hand pain outcomes between rural and urban adults using community-based cohort data and suggests that rural adults are more vulnerable to experiencing negative effects of psychological distress on concurrent hand OA symptoms and longitudinal functional limitations in hands.

Social determinants of health in patients with arthritis: a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System.

CONTEXT: Social determinants of health (SDOH) are economic, social, and political conditions that affect a person's overall health or the health of a group of people. Researchers have investigated the effects of SDOH on various diseases, such as asthma, obesity, and chronic stress, but few publications have been made regarding its effects on arthritis. OBJECTIVES: Our primary objective was to analyze the implications of SDOH on disease severity relating to pain levels and limitations experienced among people with diagnosed arthritis. METHODS: We performed a cross-sectional analysis of the 2017 Behavioral Risk Factor Surveillance System (BRFSS). We included individuals who reported having arthritis, were over the age of 45, and who also completed the SDOH module. Pain scores from the four-question Arthritis Burden Module were correlated to question responses pertaining to SDOH to determine their associations. RESULTS: For the analysis, our sample size was 25,682, with response rates varying slightly among the SDOH questions. Individuals diagnosed with arthritis were more likely to report functional limitations if they experienced food insecurity (χ2=234.0, p<0.001), financial instability (χ2=149.7, p<0.001), or frequent stress (χ2=297.6, p<0.001). Further, we found that individuals with arthritis experiencing any domain of SDOH reported higher mean pain scores than those not experiencing that domain, with the highest pain score difference among those reporting frequent stress (Coefficient: 1.93, CI=1.74-2.13, t=19.43, p<0.001). CONCLUSIONS: Our results show that SDOH profoundly impact pain levels and limitations experienced by patients with arthritis. Although work has already begun to help alleviate burdens associated with SDOH, more research and actions are required to create equitable health throughout the population.

Association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States: Cross-sectional study using 2020 medical expenditure panel survey.

This study aimed to assess the association between pain burden and presence of any limitation among older adults (≥50 years of age) with pain who used opioids in the United States. This cross-sectional study used 2020 Medical Expenditure Panel Survey data and included all adults aged 50 or older, who were alive for the 2020 calendar year, used an opioid at least once in the calendar year, and reported having pain in the past 4 weeks. Unadjusted and adjusted logistic regression models were developed to assess the association between any limitation (AL) (yes or no), pain burden (extremely, quite a bit, moderately, or little bit) and the control variables among a nationally representative sample of United States adults. A total of 844 of the 27,805 participants included in the dataset were eligible for the study. Of these, 71.2% (95% confidence interval (CI) = 67.2, 75.1%) reported the presence of AL. The adjusted logistic regression analysis showed that having extreme, quite a bit, or moderate pain (vs little pain) was associated with 10.30 (95% CI = 3.87, 27.40), 5.07 (95% CI = 2.77, 9.30), and 2.49 (95% CI = 1.40, 4.45), respectively, times greater odds of having AL. Furthermore, being unemployed (vs employed; adjusted odds ratio (aOR) = 5.26, 95% CI = 2.94, 9.09%), unmarried (vs married; aOR = 1.92, 95% CI = 1.12, 3.33%), having poor overall health (vs good overall health; aOR = 2.08, 95% CI = 1.08, 4.17), and residing in the Midwest (vs West; aOR = 2.04, 95% CI = 1.10, 3.80) were associated with greater odds of having AL. Extreme, quite a bit, and moderate pain burden were significantly associated with greater odds of reporting AL compared to little pain burden. Developing effective pain management strategies that address not only pain relief but also functional improvement among this population is of importance. Future research could then be conducted to determine the most effective pain management strategies that will provide pain relief and improve their functional abilities.

Educational disparities in joint pain within and across US states: do macro sociopolitical contexts matter?

ABSTRACT: Despite growing recognition of the importance of social, economic, and political contexts for population health and health inequalities, research on pain disparities relies heavily on individual-level data, while neglecting overarching macrolevel factors such as state-level policies and characteristics. Focusing on moderate or severe arthritis-attributable joint pain-a common form of pain that considerably harms individuals' quality of life-we (1) compared joint pain prevalence across US states; (2) estimated educational disparities in joint pain across states; and (3) assessed whether state sociopolitical contexts help explain these 2 forms of cross-state variation. We linked individual-level data on 407,938 adults (ages 25-80 years) from the 2017 Behavioral Risk Factor Surveillance System with state-level data on 6 measures (eg, the Supplemental Nutrition Assistance Program [SNAP], Earned Income Tax Credit, Gini index, and social cohesion index). We conducted multilevel logistic regressions to identify predictors of joint pain and inequalities therein. Prevalence of joint pain varies strikingly across US states: the age-adjusted prevalence ranges from 6.9% in Minnesota to 23.1% in West Virginia. Educational gradients in joint pain exist in all states but vary substantially in magnitude, primarily due to variation in pain prevalence among the least educated. At all education levels, residents of states with greater educational disparities in pain are at a substantially higher risk of pain than peers in states with lower educational disparities. More generous SNAP programs (odds ratio [OR] = 0.925; 95% confidence interval [CI]: 0.963-0.957) and higher social cohesion (OR = 0.819; 95% CI: 0.748-0.896) predict lower overall pain prevalence, and state-level Gini predicts higher pain disparities by education.

Pain is associated with exclusive use and co-use of tobacco and cannabis: Findings from Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study.

INTRODUCTION: Rates of tobacco and cannabis use are disproportionately high among individuals with pain, and evidence suggests that pain may engender greater likelihood of substance co-use, yielding additive risk. This study examined national associations of pain with past-month tobacco use, cannabis use, and co-use of tobacco and cannabis. METHODS: Data came from a nationally representative US sample of adults in Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health study (N = 32,014). The sample included civilian, non-institutionalized people who use tobacco and people who do not use tobacco. Past-week pain intensity (0-10) was dichotomized (0-4 no/low pain; 5-10 moderate/severe pain). Multinomial models adjusted for demographics examined substance use category membership (no tobacco or cannabis use, exclusive cannabis use, exclusive tobacco use, co-use) as a function of pain status. RESULTS: Moderate/severe pain was associated with increased relative risk of exclusive tobacco use (RRR [CI] 2.26 [2.05, 2.49], p <.001), exclusive cannabis use (1.49 [1.22, 1.82], p <.001), and co-use of tobacco and cannabis (2.79 [2.51, 3.10], p <.001), in comparison to no tobacco or cannabis use. Additionally, moderate/severe pain was associated with increased risk of co-use compared to exclusive tobacco use (1.23 [1.11, 1.37], p <.001) and exclusive cannabis use (1.88 [1.54, 2.29], p <.001). DISCUSSION: Findings suggest that not only is pain independently associated with greater risk of exclusively using tobacco or cannabis, but pain is also associated with heightened risk of co-using both products. Future work should examine the dynamic and potentially bidirectional relationships between pain and use of cannabis and tobacco.

Effect of foot health-related quality of life in rural population: A case-control study.

BACKGROUND: Foot health problems can affect quality of life and general health producing a source of discomfort and pain. Low levels of foot health-related quality of life (HRQoL) are present in patients with foot disabilities, such as hallux valgus, plantar fasciitis, or minor toe deformities. OBJECTIVE: The objective was to analyze the foot health status in patients with and without foot problems in a rural population and its relationship with quality of life. MATERIAL AND METHODS: A prospective case-control study was developed with a sample of 152 patients, 76 subjects with podiatric pathologies and 76 without, in a rural population. HRQoL was measured through the SF-36 Health Questionnaire in the Spanish version. RESULTS: The case group had a mean age of 49.18 ± 14.96 and the control group 44.16 ± 11.79. Regarding the score of the lowest levels of quality of life related to foot problems, the case group compared to the controls showed: for physical function (79.86 ± 26.38 vs. 92.63 ± 11 0.17, p < 0.001); for the physical role (73.68 ± 41.00 vs. 88.48 ± 27.51, p < 0.0022); for body pain (45.81 ± 27.18 vs. 73.68 ± 41.00, p < 0.035); and for general health (60.36 ± 30.58 vs. 68.71 ± 18.52, p < 0.047). The differences between groups were analyzed using the Mann-Whitney U test, which showed statistical significance (P < 0.05). CONCLUSIONS: In the rural population, people with foot pathologies present a worse quality of life compared to those who do not present foot pathology, especially for the health domains: physical function, physical role, body pain and health general.

Tobacco use and cancer-related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study.

BACKGROUND: Understanding the relationship between tobacco use and symptom burden may inform tobacco treatment interventions tailored to the needs of individuals with cancer. METHODS: The study included 1409 adult cancer survivors from Wave 5 of the US Food and Drug Administration Population Assessment of Tobacco and Health (PATH) Study. A multivariate analysis of variance controlling for age, sex, and race/ethnicity assessed the association of cigarette smoking and vaping on cancer-related symptom burden (fatigue, pain, emotional problems) and quality of life (QoL). Generalized linear mixed models controlling for the same factors were used to assess associations among symptom burden, QoL, and quit-smoking intentions, quit-smoking likelihood, and past 12-month smoking quit attempts. RESULTS: Weighted rates of current cigarette smoking and vaping were 14.21% and 2.88%, respectively. Current smoking was associated with greater fatigue (p < .0001; partial η 2  = .02), pain (p < .0001; partial η 2  = .08), emotional problems (p < .0001; partial η 2  = .02), and worse QoL (p < .0001; partial η 2  = .08). Current vaping was associated with greater fatigue (p = .001; partial η 2  = .008), pain (p = .009; partial η 2  = .005), and emotional problems (p = .04; partial η 2  = .003), but not worse QoL (p = .17). Higher cancer symptom burden was not associated with reduced interest in quitting, likelihood of quitting, or odds of past year quit attempts (p > .05 for each). CONCLUSIONS: Among adults with cancer, current smoking and vaping were associated with greater symptom burden. Survivors' interest in and intentions to quit smoking were not related to symptom burden. Future research should examine the role of tobacco cessation in improving symptom burden and QoL.

Three-year hospital-wide pain management system implementation at a tertiary medical center: Pain prevalence analysis.

We developed a pain management system over a 3-year period. In this project, "Towards a pain-free hospital", we combined evidence-based medicine and medical expertise to develop a series of policies. The intervention mainly included the development of standard procedures for inpatient pain management, the implementation of hospital-wide pain medicine education and training, the establishment of a dashboard system to track pain status, and regular audits and feedback. This study aimed to gain an understanding of the changes in the prevalence of pain in inpatients under the care of the pain management system. The subjects of the survey are inpatients over 20 years old, and who had been hospitalized in the general ward for at least 3 days. The patients would be excluded if they were unable to respond to the questions. We randomly selected eligible patients in the general ward. Our trained interviewers visited inpatients to complete the questionnaires designed by our pain care specialists. A total of 3,094 inpatients completed the survey from 2018 to 2020. During the three-year period, the prevalence of pain was 69.5% (2018) (reference), 63.3% (2019) (OR:0.768, p<0.01), and 60.1% (2020) (OR:0.662, p <0.001). The prevalence rates of pain in patients undergoing surgery during the 3-year period were 81.4% (2018), 74.3% (2019), and 68.8% (2020), respectively. As for care-related causes of pain, injection, change in position/chest percussion, and rehabilitation showed a decreasing trend over the 3-year period of study. Our pain management system provided immediate professional pain management, and achieved a good result in the management of acute moderate to severe pain, especially perioperative pain. Studies on pain prevalence and Pain-Free Hospitals are scarce in Asia. With the aid of the policies based on evidence-based medicine and the dashboard information system, from 2018 to 2020, the prevalence of pain has decreased year by year.

Assessment of pain and ease of intrauterine device placement according to type of device, parity, and mode of delivery.

OBJECTIVE: We compared pain and the ease of insertion of two different types of intrauterine devices (IUDs; the levonorgestrel intrauterine systems 52 mg (LNG-IUS 52 mg) and the copper-bearing IUD [TCu380A]) among nulligravidas and parous women with and without caesarean delivery. METHODS: A cross-sectional study assessed pain referred by women and ease of insertion of the two IUDs models. We applied a visual analogue scale (VAS) to assess pain, while the ease of insertion was defined by healthcare professionals. RESULTS: We assessed 1076 women, including 334 nulligravidas and 566 parous women who had had at least one caesarean delivery and 176 women with history of only vaginal delivery. Regarding pain at IUD placement, 26 (2.5%) women reported no pain, 167 (16.4%) light pain, 319 (31.3%) moderate and 506 (49.7%) intense pain. The highest scores for pain were reported by nulligravidas (67.2%, p = 0.001), while the mean pain score was higher in the LNG-IUS 52 mg group. Difficulties reported by healthcare providers were more frequent in the nulligravidas (21.2%) and women with previous caesarean delivery (16.9%). CONCLUSIONS: Our findings suggested differences between the two IUDs tested, with higher pain associated with the LNG-IUS 52 mg, and highlights the need for pain management, mainly among nulligravida and women with history of caesarean delivery.SHORT CONDENSATIONIntense pain at insertion was more related to nulligravida than parous women and more pain with placement of LNG-IUS 52 mg IUDs than TCu380A IUDs. Nevertheless, our results confirmed that ease of IUD placement was between 80% to 90% of all insertions, being more common in parous women without previous caesarean delivery.

Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study.

BACKGROUND: In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. METHODS: The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. RESULTS: Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was - 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). CONCLUSION: Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1 .

Maternal psychosocial factors associated with postpartum pain.

BACKGROUND: The experience of pain is shaped by a host of psychological, cultural, and social factors. Although pain is the most common postpartum complaint, data on its relationship with psychosocial factors and postpartum pain are limited. OBJECTIVE: This study aimed to examine the relationship between self-reported postpartum pain scores and patient-level psychosocial factors, including relationship status, pregnancy intendedness, employment, education, and psychiatric diagnosis. STUDY DESIGN: This was a secondary analysis of data from a prospective observational study of postpartum patients at 1 institution (May 2017 to July 2019) who used an oral opioid at least once during their postpartum hospitalization. Enrolled participants completed a survey, which included questions regarding their social situation (including relationship status), psychiatric diagnoses, and perceptions of their pain control during their postpartum hospitalization. The primary outcome was self-reported overall pain during the postpartum hospitalization (score of 0-100). Multivariable analyses accounted for age, body mass index, nulliparity, and mode of delivery. RESULTS: In this cohort of 494 postpartum patients, most patients (84.0%) underwent cesarean delivery, and 41.3% of patients were nulliparous. In a pain score of 0 to 100, participants reported a median pain score of 47. On bivariable analyses, there was no significant difference in pain score between patients with and without an unplanned pregnancy or a psychiatric diagnosis. Patients who were unpartnered, those without a college education, and those who were unemployed reported significantly higher pain scores (57.5 vs 44.8 [P<.01], 52.6 vs 44.6 [P<.01], and 53.6 vs 44.6 [P<.01], respectively). In multivariable analyses, patients who were unpartnered and unemployed reported significantly higher adjusted pain scores than patients who were partnered and employed (adjusted beta coefficients: 7.93 [95% confidence interval, 2.29-13.57] vs 6.67 [95% confidence interval, 2.28-11.05]). CONCLUSION: Psychosocial factors, such as relationship and employment statuses, which are indicators of social support, are associated with the experience of pain postpartum. These findings suggest that addressing social support, such as via enhanced support from the health care team, warrants exploration as a nonpharmacologic means of improving the postpartum pain experience.

The burden of pre-admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients.

INTRODUCTION: Increasing numbers of individuals admitted to hospitals for trauma are older adults, many of whom also have underlying serious illnesses. Older adults with serious illness benefit from palliative care, but the palliative care needs of seriously ill older adults with trauma have not been elucidated. We hypothesize that older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours before trauma admission. METHODS: Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients 66 years or older who met an established definition of serious illness in surgery and were admitted with trauma. Descriptive analyses were performed for baseline patient characteristics, pre-admission pain (dichotomized as none/mild vs. moderate/severe), depression (dichotomized as no, Center for Epidemiologic Studies Depression scale [CES-D] < 3 vs. yes, CES-D ≥ 3), and unpaid caregiving hours (dichotomized as low (<30 h/month), high (≥30 h/month)). RESULTS: We identified 1741 patients, 67.4% were female and 86.8% White. Mean age was 83 (SD 7.5), and 60.3% had ≥4 comorbidities. The majority (62.9%) were admitted due to falls, 33.5% had isolated hip fracture. The prevalence of baseline moderate/severe pain and depression were 38.1% and 42.6%, respectively. Among the cohort, 42.2% had unpaid caregiving, of those 27.7% had ≥30 h/week of unpaid caregiving hours. CONCLUSIONS: Prior to trauma admission, older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours. These findings may inform targeted palliative care interventions to reduce symptom burden and post-discharge healthcare utilization.

Pain and Disability Transitions Among Older Americans: The Role of Education.

Previous literature has rarely examined the role of pain in the process of disablement. We investigate how pain associates with disability transitions among older adults, using educational attainment as a moderator. Data are from the National Health and Aging Trends Study, N = 6,357; 33,201 1 year transitions between 2010 to 2020. We estimate multinomial logistic models predicting incidence or onset of and recovery from functional limitation and disability. Results show pain significantly predicts functional limitation and disability onset 1 year after a baseline observation, and decreases odds of recovery from functional limitation or disability. Contrary to expectations, higher education does not buffer the association of pain in onset of disability, but supporting expectations, it facilitates recovery from functional limitation or disability among those with pain. The analysis implicates pain as having a key role in the disablement process and suggests that education may moderate this with respect to coping with and subsequently recovering from disability. PERSPECTIVE: This article is among the first examining how pain is placed in the disablement process by affecting onset of and recovery from disability. Both paths are affected by pain, but education moderates the association only with respect to the recovery process.

Educational Differences in Life Expectancies With and Without Pain.

OBJECTIVES: This study computes years and proportion of life that older adults living in the United States can expect to live pain-free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations. METHODS: Data are from National Health and Aging Trends Study, 2011-2020. The sample contains 10,180 respondents who are age 65 and older. Pain expectancy estimates are computed using the Interpolated Markov Chain software that applies probability transitions to multistate life tables. RESULTS: Those with higher educational levels expect not only a longer life but also a higher proportion of life without pain. For example, a 65-year-old female with less than high school education expects 18.1 years in total and 5.8 years, or 32% of life, without pain compared with 23.7 years in total with 10.7 years, or 45% of life without pain if she completed college. The education gradient in pain expectancies is more salient for females than males and narrows at the oldest ages. There is no educational disparity in the percent of life with nonlimiting pain. DISCUSSION: Education promotes longer life and more pain-free years, but the specific degree of improvement by education varies across demographic groups. More research is needed to explain associations between education and more and less severe and limiting aspects of pain.

Prevalence of unmet pain and symptom management needs in adults with cystic fibrosis.

BACKGROUND: Although people living with CF (PLwCF) commonly report pain and other symptoms, little is known regarding their experiences of living with and accessing treatment for burdensome symptoms. METHODS: PLwCF completed online questionnaires assessing symptom prevalence and distress and were also asked about experiences accessing pain and symptom treatment, using both closed-ended and free-text entries. RESULTS: Pain was the most prevalent symptom experienced among the 55 participants (76%) and the symptom that most commonly caused distress (64%). PLwCF not on CFTR modulator therapy were likelier to endorse pain as distressing (p = 0.007). Respondents expressed that their pain was commonly underrecognized and undermanaged, they desired a multi-modal approach to treatment, and noted concerns about disease progression affecting their symptom management options. CONCLUSIONS: Our study suggests that PLwCF often have unmet symptom management needs that may impair quality of life.

Physical and financial impacts caused by the COVID-19 pandemic exacerbate knee pain: A longitudinal study of a large-scale general population.

OBJECTIVES: This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain. METHODS: We analysed the pre- and post-COVID-19 longitudinal data set of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 data set was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analysed for correlation analyses with changes in KSS. RESULTS: Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = .008), low educational level (p < .001), and undesirable financial impact (p = .030) were independently associated with knee pain exacerbation. CONCLUSION: The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.

Longitudinal Associations Between Pain and Use of Cigarettes and E-cigarettes in the Population Assessment of Tobacco and Health (PATH) Study.

INTRODUCTION: Pain has been implicated in the onset and maintenance of nicotine addiction, and there is initial cross-sectional evidence of covariation between pain and the use of cigarettes and e-cigarettes. The goals of the current study were to: (1)test pain severity as a predictor of initiating co-use of cigarettes and e-cigarettes, (2)examine longitudinal associations between pain and use/co-use of cigarettes and e-cigarettes, (3)generate the first prevalence rate data regarding cigarette and e-cigarette use as a function of pain, and (4)examine gender as a moderator of these associations. AIMS AND METHODS: Data were drawn from Waves 1-4 of the Population Assessment of Tobacco and Health Study (2013-2018). RESULTS: Among exclusive cigarette smokers at Wave 1 (n = 7719), pain severity was associated with a greater likelihood of and faster trajectory to initiating co-use of cigarettes and e-cigarettes (ps < .05). A significant pain × gender interaction (p < .05) revealed this prospective relationship was stronger among women. Among adult respondents who provided at least three waves of data (n = 24 255), greater Wave 1 pain severity was positively associated with e-cigarette use, cigarette smoking, and co-use of cigarettes and e-cigarettes at Waves 2, 3, and 4 (ps < .001). At Wave 4 (n = 33 822), adults with moderate or severe pain endorsed rates of e-cigarette and cigarette use almost two times greater versus no or low pain (ps < .001). CONCLUSIONS: Collectively, these findings provide evidence that pain likely serves as an important candidate risk factor for the initiation and maintenance of cigarette and e-cigarette use. IMPLICATIONS: This is the first prospective study to show that pain serves as an important risk factor for initiation and maintenance of cigarette and e-cigarette use over time. Weighted prevalence estimates further demonstrated that individuals with moderate or severe pain endorsed rates of cigarette and e-cigarette use and co-use approximately two times greater compared to those with no or low pain. These findings highlight a subpopulation of nicotine users more susceptible to greater healthcare burden, nicotine dependence, and physical impairment. Nicotine users with comorbid pain may benefit from integrated interventions that address pain in the context of cessation.