The Impact of the Quantity and Quality of Social Support on Patients with Chronic Pain.

PURPOSE OF REVIEW: Social support is an important yet often overlooked aspect of chronic pain management. Understanding the impact of social support on patients with chronic pain and determining if a relationship exists between a patient's perceived social support and their perceived quality of life is a crucial component to completely treating a pain patient. We sought to develop an intervention for patients with chronic pain that addresses the different types of social support, barriers to using social support, and ways to improve the quality of their social support. RECENT FINDINGS: A retrospective review of a prospectively collected database was utilized in an Outpatient Chronic Pain Rehabilitation Program with 23 patients with a chronic pain diagnosis who participated in a 3-week comprehensive pain rehabilitation program. Evaluation, intervention, and discharge were evaluated utilizing The American Chronic Pain Association's Quality of Life Scale and The Canadian Occupational Performance Measure (COPM). The intervention phase comprised a 45-min group session. At discharge, the occupational therapist followed up with the patient regarding the results of their social survey. Overall, the results indicated an underutilization of social support among patients with chronic pain. Out of the four questions asked on the social support survey, patients scored their use of tangible support (Q2) as the lowest. No significant positive correlation (0.27) was found between social support and quality of life which can be attributed to the wide variety of patients seen at the PRC. Social support is an essential part of chronic pain treatment and should be addressed throughout all stages of pain management.

A qualitative study of traditional healing practices among American Indians with chronic pain.

OBJECTIVE: Although chronic pain is prevalent among American Indian (AI) populations, the use of traditional healing practices has not been widely investigated. The aim of this qualitative study was to solicit information from adult AIs with chronic pain regarding use of traditional health practices (THPs) for chronic pain and pain reduction. DESIGN: Prospective qualitative design. SETTING: The Min No Aya Win Human Services Center, Fond du Lac Band Reservation in Cloquet, MN, and the Center for American Indian Resources, Duluth, MN. PATIENTS: The cohort included 21 (10 women and 11 men) AI patients with chronic pain. INTERVENTION: A semi-structured interview guide was developed, and audiotaped interviews were conducted with all patients. OUTCOME MEASURE: Audiotaped interviews were transcribed, and thematic analysis strategies were used to identify core concepts and categories for coding interview data. A qualitative software analysis program was used to facilitate data coding. RESULTS: A range of THP were described including smudging (burning sage), sweat lodge (ceremonial sauna), sema (ceremonial tobacco), feasting (strengthening process), pipes (ceremonial herb and tobacco), storytelling (nonhierarchical environment for verbal communication), and contact with a traditional healer (elder spiritual leader). The majority of individuals from the Reservation described prior exposure to THP; however, the majority of urban individuals reported limited exposure. Although the majority of individuals endorsed inclusion of THP in ambulatory-based pain treatment programs, recommendations for inclusion of specific practices were not systematically identified. CONCLUSIONS: The findings of this qualitative study suggest AIs from this tribal community utilize THP, but which specific THPs should be included in an ambulatory-based pain treatment program will require further research.

Cognitive behavioral therapy, self-efficacy, and depression in persons with chronic pain.

Chronic pain is a complex and often disabling condition compounded by depression and poor self-efficacy. The purpose of this evidence-based project was to explore the relationship of cognitive behavioral therapy (CBT)-focused groups with self-efficacy and depression in persons with chronic pain at an intensive interdisciplinary 3-week pain rehabilitation center (PRC). The project sample consisted of 138 persons admitted to a PRC and scoring ≥27 on the Center for Epidemiological Study Depression Scale (CES-D) and then completing the Pain Self-Efficacy Questionnaire (PSEQ). After completing the PRC program, including CBT-focused groups, discharge CES-D and PSEQ scores were analyzed. A comparison group of CES-D scores from 134 persons admitted to the PRC from a 9-month time period preceding the addition of the CBT-focused groups was also examined. There was a significant increase in self-efficacy after participation in the intensive pain rehabilitation program including CBT-focused groups. Patient groups both before and after introduction of CBT-focused groups showed the same rate of improvement on the depression scores, suggesting that persons who participated in CBT-focused groups improved equally compared with persons who did not participate in these groups. Ninety-three percent of the participants expressed satisfaction with the CBT groups. This evidence-based practice is well supported in the literature and can be implemented with knowledgeable staff and engaged stakeholders.

Clinical outcomes of multidisciplinary pain rehabilitation among african american compared with caucasian patients with chronic pain.

OBJECTIVES: The primary aim of this study was to determine if the immediate outcomes of multidisciplinary pain rehabilitation were different for African Americans compared with Caucasians. DESIGN: A retrospective repeated measures design was used, and all analyses were adjusted for marital and employment status, years of education, and pain duration. SETTING: Multidisciplinary pain rehabilitation center. SUBJECTS: Each African American (N = 40) consecutively admitted to a multidisciplinary pain rehabilitation program was matched with three Caucasians (N = 120) on age, sex, and treatment dates. INTERVENTION: A 3-week outpatient multidisciplinary pain rehabilitation program. OUTCOME MEASURES: The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, and Pain Catastrophizing Scale were administered at admission and dismissal. RESULTS: At baseline, African Americans had greater pain severity (P < 0.001) and poorer physical function compared with Caucasians (P < 0.001). At program completion, African Americans had greater pain severity (P < 0.001) and poorer measures of life interference (P = 0.004), perceived control (P = 0.013), affective distress (P < 0.001), role physical (P = 0.001) and role emotional function (P = 0.001), physical (P < 0.001) and social function (P = 0.002), general health (P = 0.005), depression (P < 0.001), and pain catastrophizing (P < 0.001). A repeated measures analysis demonstrated a time by race interaction effect for pain interference (P = 0.038), affective distress (P = 0.019), role physical function (P = 0.007), social function (P = 0.029), and depression (P = 0.004), indicating African Americans experienced less improvement compared with Caucasians. CONCLUSIONS: The results of this study highlight an under-recognized health disparity which provides the basis for developing targeted interventions aimed at improving the clinical outcomes of African Americans with chronic pain.

Associations between spousal or significant other solicitous responses and opioid dose in patients with chronic pain.

OBJECTIVE: The primary aim of this study was to determine the effects of spouse or significant other solicitous responses on morphine equivalent dose among adults with chronic pain. DESIGN: Retrospective design. SETTING: Multidisciplinary pain rehabilitation center. PATIENTS: The cohort included 466 consecutively admitted patients who had a spouse or significant other and were using daily opioids. Intervention. Three-week outpatient pain rehabilitation program. OUTCOME MEASURES: Solicitous subscale of the Multidimensional Pain Inventory and morphine equivalent dose upon admission. RESULTS: The mean solicitous subscale score and morphine equivalent dose were 49.8 (standard deviation [SD] = 8.7) and 118mg/day (SD =149), respectively. Univariate linear regression analysis showed that greater subscale scores were associated with greater doses of opioids (P = 0.007). In a multivariate model adjusted for age, sex, ethnicity, years of education, employment status, pain duration, depression, and pain severity, the association retained significance (P = 0.007). CONCLUSIONS: These findings suggest solicitous responses from a spouse or significant other may have an important influence on opioid dose among adults with chronic pain.

Dietary soy supplement on fibromyalgia symptoms: a randomized, double-blind, placebo-controlled, early phase trial.

Most patients with fibromyalgia use complementary and alternative medicine (CAM). Properly designed controlled trials are necessary to assess the effectiveness of these practices. This study was a randomized, double-blind, placebo-controlled, early phase trial. Fifty patients seen at a fibromyalgia outpatient treatment program were randomly assigned to a daily soy or placebo (casein) shake. Outcome measures were scores of the Fibromyalgia Impact Questionnaire (FIQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and after 6 weeks of intervention. Analysis was with standard statistics based on the null hypothesis, and separation test for early phase CAM comparative trials. Twenty-eight patients completed the study. Use of standard statistics with intent-to-treat analysis showed that total FIQ scores decreased by 14% in the soy group (P = .02) and by 18% in the placebo group (P < .001). The difference in change in scores between the groups was not significant (P = .16). With the same analysis, CES-D scores decreased in the soy group by 16% (P = .004) and in the placebo group by 15% (P = .05). The change in scores was similar in the groups (P = .83). Results of statistical analysis using the separation test and intent-to-treat analysis revealed no benefit of soy compared with placebo. Shakes that contain soy and shakes that contain casein, when combined with a multidisciplinary fibromyalgia treatment program, provide a decrease in fibromyalgia symptoms. Separation between the effects of soy and casein (control) shakes did not favor the intervention. Therefore, large-sample studies using soy for patients with fibromyalgia are probably not indicated.

Smoking cessation and chronic pain: patient and pain medicine physician attitudes.

Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment-related stressors. Several pain-related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.

Associations between heat pain perception and pain severity among patients with chronic pain.

OBJECTIVE: The primary aim of this study was to investigate the associations between standardized values of thermal sensory perception and standardized scores of clinical pain among a heterogeneous cohort of adults with chronic pain that included individuals receiving chronic opioid therapy. DESIGN: The study used a prospective design. SETTING: The study was set in a multidisciplinary pain rehabilitation center at a tertiary medical center. PATIENTS: The cohort included 163 patients (female 58%) who met inclusion criteria, and were admitted from March 2007 to June 2008. INTERVENTION: Using a validated quantitative sensory test method of levels, standardized values of heat pain (HP) perception and cooling detection threshold were obtained 1day following admission. OUTCOME MEASURES: Standardized scores of clinical pain were obtained at admission using the pain severity subscale of the Multidimensional Pain Inventory. RESULTS: At admission, 109 (67%) patients were using opioids, and the mean morphine equivalent dose was 192mg/day. The mean pain duration was 10.5years, and the two most frequent diagnoses were low back pain (29%) and headache (12%). A significant negative correlation was found between pain severity and HP threshold (r=-0.170, P=0.030), where lower values of HP threshold correlated with greater scores of pain severity. Post hoc linear regression analysis showed the association between HP threshold and pain severity retained statistical significance (P=0.039) after adjusting for opioid dose, pain duration and pain diagnosis. CONCLUSION: The use of standardized values of HP perception and clinical pain may be key methodological approaches for investigating the clinical correlates of HP perception among heterogeneous populations of adults with chronic pain.

Associations between heat pain perception and opioid dose among patients with chronic pain undergoing opioid tapering.

OBJECTIVE: The purpose of this study was to investigate the associations between morphine equivalent dose and heat pain (HP) perception in patients with chronic pain undergoing opioid tapering in the context of a multidisciplinary rehabilitation program. DESIGN: Prospective design. SETTING: Multidisciplinary pain rehabilitation center. PATIENTS: The cohort included 109 patients using opioids (female 52%) who met inclusion criteria, and were consecutively admitted from March 2007 to June 2008. INTERVENTION: Three-week outpatient multidisciplinary rehabilitation program that incorporates opioid tapering. OUTCOME MEASURES: Using a standardized quantitative sensory test (QST) method of levels, standardized values of HP perception were obtained one day following program admission and following completion of the opioid taper at program dismissal. RESULTS: At admission, the mean morphine equivalent dose was 192 mg/day. Univariate linear regression analysis showed that greater baseline morphine equivalent dose was associated (P = 0.040) with lower, or more hyperalgesic, values of HP 5-0.5, which is a standardized measure of HP perception. The dose dependent association retained significance (P = 0.029) after adjusting for pain severity, pain duration and pain diagnosis. Tapering of greater morphine equivalent dosages was associated (P = 0.001) with lower values of HP 5-0.5. The association retained significance (P = 0.001) after adjusting for pain severity, pain duration, pain diagnosis, opioid withdrawal symptoms, and time between completion of the taper and performance of the dismissal QST. CONCLUSION: The use of a validated QST method of levels and standardized values of HP 5-0.5 may expand the methodological approaches available for investigating the clinical effects of opioids on HP perception.

Longitudinal treatment outcomes for geriatric patients with chronic non-cancer pain at an interdisciplinary pain rehabilitation program.

OBJECTIVE: This study examined depression, pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary pain rehabilitation center compared with middle and younger age groups. DESIGN: Quasi-experimental time series. SETTING: Interdisciplinary pain rehabilitation center at a tertiary referral medical center. PATIENTS: In total, 411 patients with chronic non-cancer pain completed the pain rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40-59; n = 230) and younger (ages 18-39; n = 141). INTERVENTION: A 3-week outpatient interdisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. OUTCOME MEASURES: The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. RESULTS: Older patients reported reduced depression, catastrophizing, pain severity, and pain interference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up (P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. CONCLUSION: Interdisciplinary pain rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic pain patients.

The effects of smoking status on opioid tapering among patients with chronic pain.

OBJECTIVE: The primary aim of this study was to determine if smoking status affected the ability of patients with chronic pain to reduce opioid consumption during a 3-wk pain rehabilitation program. Secondary aims included determining the associations between smoking status, admission opioid use, and pain severity. METHODS: We used a retrospective, repeated measures design to assess pre- and post-treatment outcomes in a consecutive series of patients admitted to a 3-wk, outpatient pain treatment program from September 2003 through February 2007. Outcome measures included the frequency of successful opioid tapering, pain severity subscale of the Multidisciplinary Pain Inventory, and program completion status. RESULTS: The study cohort included 1241 patients (women 928); 313 (25%) smokers, 294 (24%) former smokers, and 634 (51%) never smokers. There were more smokers using opioids at admission (P < 0.001) compared to former and never smokers. Likewise, the mean morphine equivalent dose (P = 0.013) and pain severity scores (P < 0.001) of smokers were higher compared to former and never smokers. The success of opioid tapering did not depend on smoking status, and all groups experienced significant reductions in pain severity at program completion (P < 0.001). However, a higher proportion of smokers did not complete treatment (P < 0.001). CONCLUSIONS: For patients completing a pain rehabilitation program, most were able to eliminate opioid use, regardless of smoking status. However, significantly more smokers did not complete treatment. The most frequent reasons for program noncompletion included discrepant expectations of treatment, acute illness, and psychosocial stressors.

Reduction in medication costs for patients with chronic nonmalignant pain completing a pain rehabilitation program: a prospective analysis of admission, discharge, and 6-month follow-up medication costs.

OBJECTIVE: Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. DESIGN: This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. RESULTS: Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). CONCLUSION: Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs.

Sex differences in characteristics of smokers with chronic pain undergoing multidisciplinary pain rehabilitation.

OBJECTIVE: The primary aim of this study was to determine the influence of sex and the interactions between sex and smoking status on the immediate treatment outcomes of patients undergoing multidisciplinary pain treatment. DESIGN: A retrospective, repeated measures design. Setting. Multidisciplinary pain rehabilitation center at a tertiary referral medical center. PATIENTS: The cohort (N = 1,241) included 928 women and 313 men of whom 313 were current smokers, 294 were former smokers and 634 were never smokers consecutively admitted from September 2003 through February 2007. Interventions. A 3-week outpatient multidisciplinary pain rehabilitation program. OUTCOME MEASURES: The Multidimensional Pain Inventory, Short Form-36 Health Status Questionnaire, Center for Epidemiologic Studies-Depression scale, Pain Anxiety Symptom Scale, and Pain Catastrophizing Scale were administered at admission and dismissal. RESULTS: Women experienced significantly greater improvement in depressive symptoms compared with men (P = 0.023). Smokers experienced significantly greater improvements in depression (P = 0.039), pain catastrophizing (P = 0.010), and anxiety (P = 0.037) compared with former and never smokers. No significant interaction effects between treatment by sex by smoking status were observed. A significant sex by smoking status interaction was observed for daily morphine equivalent dose (mg/d) where male smokers consumed greater quantities of opioids compared with female smokers at program admission (P < 0.001). CONCLUSIONS: The effects of smoking status on the immediate treatment outcomes of multidisciplinary pain treatment are not modified by sex. However, women experienced significantly greater improvement in depression than men and male smokers consumed significantly greater quantities of opioids compared with female smokers at admission.

Effects of smoking status on immediate treatment outcomes of multidisciplinary pain rehabilitation.

OBJECTIVE: The primary aim of this study was to determine the effects of smoking on treatment outcomes following multidisciplinary pain rehabilitation. A secondary aim was to assess the tobacco use characteristics of smokers with chronic pain. DESIGN: A prospective, nonrandomized, repeated measures design. SETTING: Multidisciplinary pain rehabilitation center at a tertiary referral medical center. PATIENTS: All patients (N = 193) consecutively admitted from August 2005 through February 2006. INTERVENTIONS: A 3-week outpatient multidisciplinary pain rehabilitation program. OUTCOME MEASURES: The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Center for Epidemiologic Studies-Depression scale (CES-D), Pain Anxiety Symptom Scale (PASS-20) and Pain Catastrophizing Scale (PCS) were administered at admission and dismissal. RESULTS: The study involved 49 (83% women) smokers and 144 (83% women) nonsmokers. The mean number of cigarettes smoked daily was 17.5 (SD 11.1) and the mean duration of smoking was 21.5 years (SD 12.1). After adjusting for demographic differences, repeated measures of analysis of covariance showed a main effect of smoking status for MPI affective distress (P = 0.008), CES-D (P = 0.001) and PCS (P = 0.011). An interaction of smoking status and time was found for the PASS-20 (P = 0.028), MPI affective distress (P = 0.033), MPI life control (P = 0.003) and SF-36 role-emotional (P = 0.004) subscale. While the majority of smokers were ready to consider smoking abstinence, 43% declined a brief smoking cessation intervention. CONCLUSIONS: In this series of patients undergoing multidisciplinary treatment for chronic pain, immediate treatment effects for a variety of outcome measures were similar or significantly better in smokers compared with nonsmokers.

Chronic pain rehabilitation in chronic headache disorders.

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation, reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.

Exposure to violence, support needs, adjustment, and motivators among Guatemalan humanitarian aid workers.

Indigenous aid workers carry out the majority of humanitarian aid work, yet there is little empirical information available on their support needs in different contexts. Focus groups (N = 26: Study 1) and a survey (N = 137; Study 2) were conducted with Guatemalan aid workers to explore their exposure to violence, posttraumatic stress symptoms, burnout, support needs, and motivators. Participants reported experiencing an average of 13 events of community violence and 17% reported symptoms consistent with posttraumatic stress disorder (PTSD). Direct community violence exposure and levels of emotional exhaustion were positively related to PTSD symptoms, while levels of personal accomplishment were inversely related to PTSD symptoms. Expressed support needs, motivators and rewards for aid work in the face of adversity are also reported as potential protective factors for further exploration. Implications for training and support of aid workers in similar contexts are also suggested.

Chronic pain rehabilitation in chronic headache disorders.

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation, reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.

Prevalence and clinical correlates of vitamin D inadequacy among patients with chronic pain.

OBJECTIVE: Vitamin D inadequacy is associated with medication refractory musculoskeletal pain and neuromuscular dysfunction. This vitamin deficiency could subsist as an unrecognized comorbid condition among patients with chronic pain. The primary objective of this study was to determine the prevalence and clinical correlates of vitamin D inadequacy in patients seeking treatment for chronic pain. DESIGN: Retrospective case series. SETTING: Multidisciplinary pain rehabilitation center at a tertiary referral medical center. PATIENTS: The study involved 267 chronic pain patients admitted from February to December 2006. INTERVENTION: Serum 25-hydroxyvitamin D (25[OH]D) was drawn at admission. OUTCOME MEASURES: Patients with serum 25[OH]D levels < or=20 ng/mL were considered to have inadequate levels and those with levels >20 ng/mL were considered to have adequate levels. Upon admission, opioid intake was documented and patients completed the Short Form-36 Health Status Questionnaire. RESULTS: The prevalence of vitamin D inadequacy was 26% (95% confidence interval, 20.6-31.1%). Among patients using opioids, the mean morphine equivalent dose for the inadequate vitamin D group was 133.5 mg/day compared with 70.0 mg/day for the adequate group (P = 0.001). The mean duration of opioid use for the inadequate and adequate groups were 71.1 months and 43.8 months, respectively (P = 0.023). Opioid users with inadequate levels reported worse physical functioning (P = 0.041) and health perception (P = 0.003) than opioid users with adequate levels. CONCLUSION: The prevalence and clinical correlates identified in this pilot study provide the basis for the assertion that vitamin D inadequacy may represent an under-recognized source of nociception and impaired neuromuscular functioning among patients with chronic pain.

The triallelic serotonin transporter gene polymorphism is associated with depressive symptoms in adults with chronic pain.

BACKGROUND: The serotonin (5-HT) transporter-linked polymorphic region (5-HTTLPR) moderates the relationship between stressful life events and depression. Given the high prevalence of depression in chronic pain, the primary aim of this preliminary study was to investigate the associations between the 5-HTTLPR and the severity of depressive symptoms in a cohort of adults with chronic pain. METHODS: Adults with chronic pain who were consecutively admitted to an outpatient pain rehabilitation program and met inclusion criteria were recruited for study participation (n=277). Individuals were genotyped for the 5-HTTLPR (including rs25531) and categorized as high, intermediate, or low expressors of the 5-HT transporter. The severity of depressive symptoms at admission was measured by using the Center for Epidemiologic Depression scale (CES-D). RESULTS: The distribution of the high-, intermediate-, and low-expressing genotypes was 61 (22%), 149 (54%), and 67 (24%), respectively. The Hardy-Weinberg P-value was 0.204, which indicated no departure from equilibrium. A main effect of 5-HTTLPR was observed for depressive symptoms (P=0.040) where Center for Epidemiologic Depression scale (CES-D) scores were significantly greater in the low-expressing group compared to the high- (P=0.019) and intermediate (P=0.029)-expressing groups. In multivariate multinomial logistic regression analysis adjusted for age, sex, pain severity, pain catastrophizing, and pain anxiety, greater CES-D scores were significantly associated with the 5-HTTLPR low-expressing group compared to the high-expressing group (P=0.023), but not for the low-expressing group compared to the intermediate-expressing group (P=0.056). CONCLUSION: These preliminary findings suggest that the triallelic 5-HTTLPR could influence the severity of depressive symptoms in adults with chronic pain. Individuals with chronic pain may be particularly vulnerable to the moderating effects of 5-HTTLPR due to high levels of pain-related stress that are inherently present in this population.

Physical and emotional functioning of adult patients with chronic abdominal pain: comparison with patients with chronic back pain.

UNLABELLED: Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE: As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.