Chronic pain: good management of practical pain control strategies is associated with being older, more health activated and having better mental health.

INTRODUCTION Chronic pain affects a large proportion of the adult population and people in pain need to learn how to manage it in order to maintain quality of life. AIM This study aimed to examine how well people with long-term conditions make use of self-management strategies to control their pain, and to identify personal attributes associated with a higher degree of success. METHODS People with chronic pain who participated in the first phase of a longitudinal long-term conditions study in the MidCentral region made up the study sample (N=326, response rate 21%). They completed a questionnaire by mail or online, which included items on pain management, general health, patient activation, experiences with general practice and demographics. RESULTS Pain control strategies were managed fairly well overall. Taking pain medication and avoiding caffeine, alcohol, heavy meals and exercise before bed were managed best, whereas sleep, relaxation breathing and remaining socially active were managed least well. A multiple regression analysis found higher scores on patient activation, self-rated overall pain management at home, mental health and older age (≥75 years) to be associated with better management. DISCUSSION This study identified pain control strategies that are managed well, and less well, outside of a specific intervention. Results highlight topics for discussion in consultations and identify areas where general practice could provide better self-management support, such as sleep and exercise. Better overall pain control strategy management was most strongly associated with patient activation; that is, a combination of knowledge, skills and confidence to manage health and health care that is amenable to intervention. Improving the level of activation in people with long-term conditions may enhance their use of pain control strategies.

The role and measurement of patient activation in the management of long-term conditions in New Zealand.

AIM: Patient activation represents people's knowledge, skills and confidence to manage their own health. We provide information regarding the nature of patient activation and use New Zealand data to consider its utility in New Zealand. METHODS: Self-report data using the patient activation measure (PAM) and seven health and general practice experience measures were collected from 544 general practice patients in the MidCentral region. PAM scores were used to categorise respondents into four levels of activation. Mean scores were calculated by activation level, separately for Maori (14.9%) and non Maori (85.1%). RESULTS: Patterns of activation similar to those reported in earlier research were found. More positive health and general practice experience scores were found for those at higher levels of activation for both ethnicities. The magnitudes of the differences by activation level were similar for both groups and overall differences were significant for all variables for non Maori and for three for Maori. CONCLUSIONS: The PAM behaved as it has done in previous overseas studies with respect to score distribution, reliability and validity. We recommend its use for research and clinical practice in New Zealand to assist with designing appropriate levels of LTC education and self-management support aimed at increasing health engagement.

Challenges of measuring the mental health of Indigenous Australians: honouring ethical expectations and driving greater accuracy.

OBJECTIVE: While Indigenous Australians are exposed to more risk factors and experience a greater burden and complexity of mental disorder, there is as yet limited capacity to assess this at individual, community or societal levels. This paper explores factors associated with and consequences of inadequate mental health assessment processes. METHOD AND FINDINGS: The excess burden of Indigenous mental disorders is now demonstrated but is still clearly an underestimate. This motivated a project based in northern Australia to develop effective mental health assessment tools. The initial stages of this project brought together academics and practitioners with Indigenous workers and researchers from Australia and New Zealand. This provided significant and shared insights in relation to the collection and use of Indigenous mental health data. CONCLUSIONS: Critical themes to guide researchers, services and practitioners were defined and presented in this paper along with a range of individual, social, service and economic consequences associated with systematic non-recognition and under-rating of mental disorders outlined.