Confirmatory Factor Analysis of the Analgesic Adverse Drug Event Measure.

Background and Purpose: The Analgesic Adverse Drug Event Measure (AADEM) measures how people respond when they experience analgesic adverse drug events (ADEs). The purpose of this study was to confirm the underlying constructs of the AADEM: attributed ADE, consulted provider, sought care, and continued/discontinued analgesic. Methods: A cross-sectional instrumentation design was used. Three hundred and thirty-two adults who self-reported an analgesic ADE responded to the online AADEM. Confirmatory factor analysis and reliability testing were conducted. Results: Model fit was adequate across all indexes. Internal consistency for the full AADEM was low, while subscale internal consistency was generally acceptable probably due to three significant negative correlations and two positive correlations between the latent factors. Conclusions: The results supported the construct validity of the AADEM. Advanced practice nurses and other primary care providers can use the AADEM to investigate analgesic ADEs. Greater insight into how people respond to an analgesic ADE via the use of the AADEM may help prevent future analgesic ADEs.

Barriers and Facilitators of Pain Self-Management Among Patients with Cancer: An Integrative Review.

BACKGROUND: Defining the main barriers and facilitators of cancer pain self-management are essential to improve patients' overall quality of life. AIM: The main purpose of this review was to identify the main barriers and facilitators for cancer pain self-management. METHOD: An integrative review guided by the five-stages framework that was identified by Souza et al. (2010) was used: (1) preparing the guiding question; (2) searching or sampling the literature; (3) data collection; (4) critical analysis of the studies; and (5) discussion of results. A comprehensive literature review was conducted using the electronic databases of PubMed/MEDLINE, CINAHL, Scopus, and Psych INFO. RESULTS: Twenty-two studies were identified. The main facilitators that foster the process of cancer pain self-management were supportive ambiances including family caregivers as well as health care providers, active participation of patients with cancer in health care including self-discovery and self-awareness, acquiring pain knowledge, and using a pain diary. The main barriers include concerns regarding the use of pain medications, knowledge deficit, negative beliefs and attitudes, unsupportive ambiance, and psychological distress. Some patients' characteristics could be related to these barriers such as age, sex, race, marital status, educational level, level of pain, and presence of comorbidity. CONCLUSIONS: Patients with cancer pain experience multiple barriers and facilitators when attempting to take on an active role in managing their pain.

Predictors of older adults' chronic pain in the context of opioid adverse drug events.

BACKGROUND: Factors predictive of chronic pain in older adults could help focus prevention and treatment efforts for those most at risk of chronic pain. PURPOSE: The objective of the study was to describe demographic and pain self-management factors predictive of chronic pain in the context of opioid adverse drug events (ADEs) reported for a cohort of older adults within the same year. METHOD: The design was a post hoc analysis of 9,095 cases aged 65 years and older from the 2019 National Health Interview Survey that reported chronic pain and 380 cases aged 65 years and older with opioid adverse events reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) during the second quarter of 2019. Logistic regression predicted chronic pain. RESULTS: Less than a baccalaureate education increased the odds of chronic pain by 28.0% while lower income minimally increased the odds. Male gender increased the odds of chronic pain by 12.0%. Increased age minimally increased the odds for chronic pain. Use of opioids, other pain treatments, complementary treatments, and antidepressants were all associated with increased odds of chronic pain. FAERS opioid ADEs ranged from pruritus to death, with death identified in 16 (4.2%) cases. Misuse, abuse, or dependence was documented in 1.8% of cases. CONCLUSIONS AND IMPLICATIONS: Less-educated older adults may be particularly at risk of chronic pain and should be routinely assessed and prescribed safe and efficacious pain self-management as needed. Some men may need additional support to use pain treatments.

Philosophical Assumptions Used in Research on Barriers for Effective Cancer Pain Management: A Scoping Review.

Cancer pain is one of the most common symptoms in cancer patients and often has a negative impact on patients' functional status and quality of life. Despite the available guidelines for effective pain management, factors such as barriers to cancer pain management still exist. The lens or philosophical assumptions used to guide cancer pain management research is a crucial but often overlooked component of high-quality research. Therefore, the purpose of this scoping review was to classify and map the available evidence and identify the knowledge gap regarding using a philosophical assumption to address the barriers of pain management among patients with cancer. Absence of clear philosophical assumptions in the qualitative research and generally a theoretical quantitative research may contribute to the slow progress in identifying and addressing barriers to cancer pain management. Therefore, the hermeneutic circle was suggested to address the main barriers of cancer pain management, focusing on the dialectic approach between the participants including researchers, cancer patients, and their family caregivers, health care providers, and policymakers. Understanding and possible solutions of the problem could be obtained through fusion of the horizons; in which the participants past and present horizons emerge. Then the collaborative efforts between the participants may yield effective strategies to overcome cancer pain barriers to improve the quality of cancer pain management.

Predictors of serious adverse drug events from opioids: Results from the Food and Drug Administration Adverse Events Reporting System.

BACKGROUND: Opioids pose significant increased risk for serious adverse drug events (ADEs). PURPOSE: The purpose was to identify significant predictors and their associated magnitude of risk for serious life-threatening opioid ADEs. METHODS: A post hoc design was used to examine predictors of opioid analgesics ADEs with Food and Drug Administration Adverse Events Reporting System (FAERS) data. The sample consisted of all eligible cases from the second quarter of the 2019 FAERS where an opioid analgesic was identified as the primary suspect for an ADE. Logistic regression was used to predict serious life-threatening ADEs. Final predictors included age, gender, misuse/substance use disorder, number of concurrent opioids; use of benzodiazepines, other sedatives, and antidepressants; and use of morphine, fentanyl, and oxycodone. RESULTS: Life-threatening ADEs, excluding suicide and suicide attempts, comprised 19.9% of the cases. Protective factors that reduced risk included female gender, use of antidepressants, and use of morphine. Harmful factors that increased risk of a serious ADE included misuse/substance use disorder, use of benzodiazepines, and use of other sedatives. Persons taking an opioid with both a benzodiazepine and another sedative increased risk of a serious ADE by 18.78 times. IMPLICATIONS FOR PRACTICE: Results provide risk data helpful to share with people who use prescribed opioids for self-management of pain. Combination of opioids and clinically indicated antidepressants that do not both promote serotonin uptake inhibition may reduce risk for serious opioid ADEs. Practitioners should continue to avoid prescribing benzodiazepines and other sedatives when opioids are used.

Predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs: Results from the Food and Drug Administration Adverse Event Reporting System.

BACKGROUND: Hemorrhagic strokes have not declined in the United States despite a decline worldwide. PURPOSE: To identify hemorrhagic stroke risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs), other medications associated with increased risk for hemorrhagic stroke, and diabetes, cardiovascular disease, gender, and age. METHODS: A post hoc design was used to examine predictors of hemorrhagic stroke for adults of age 65 years and older from the Food and Drug Administration Adverse Events Reporting System database. The initial sample consisted of all cases reported during the third quarter of 2016 and the second quarter of 2018 with an NSAID as the primary suspect for the adverse drug event (ADE). An additional 397 cases with warfarin as the primary suspect were included in the final sample (N = 3,784) to test for bias from including only NSAID as the primary ADE suspect cases. Extracted data included the primary ADE (hemorrhagic stroke or other ADE), age, gender, primary suspect drug (NSAID or warfarin), and presence of a second NSAID, rivaroxaban, warfarin, clopidogrel, antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants), inhaled corticosteroids, diabetes, or cardiovascular medications. Logistic regression was used to predict hemorrhagic stroke. RESULTS: Aspirin and warfarin increased the risk for hemorrhagic stroke by 3.458 and 3.059, respectively. Presence of an additional NSAIDs reduced the risk by 48%. IMPLICATIONS FOR PRACTICE: Hemorrhagic stroke risk specific to older adults may provide helpful estimates for practitioners as they weigh the risk benefit of prescribing aspirin as an antiplatelet therapy for older adults.

African American Young Adults' Pain and Pain Reduction Strategies.

BACKGROUND: Effective acute pain management strategies are important for young adults in order to reduce risk for transition to chronic pain. AIM: To describe pain and pain self-management strategies used by African American young adults. DESIGN & SETTING: A national online cross-sectional survey design was used. PARTICIPANT/SUBJECTS: Ninety-four African Americans Qualtrics panelists ages 18-25 who reported previous experience with acute pain responded. Methods: Respondents completed the Brief Pain Inventory Short Form to describe their pain intensity, pain interference with function, pain self-management, and percent of relief obtained from their self-management. RESULTS: African American young adults reported pain primarily in the back (n = 22, 23.4%) and head (n = 19, 20.2%), with moderate pain intensity M = 4.5 (standard deviation [SD] = 1.79) and pain interference with function M = 4.6 (SD = 2.36). African American young adults described their worst pain in the last 24 hours as M = 5.7 (SD = 2.01), least pain as M = 3.4 (SD = 2.41), and average pain as M = 5.1 (SD = 2.09). They reported 61.3% pain relief from self-treatment. A total of 45 (47.9%) reported no pain self-management strategies. CONCLUSIONS: African American young adults report moderate levels of pain intensity and pain interference with function. A significant number report no pain self-management strategies. Focused pain assessment and education about efficacious pain self-management strategies, both pharmacological and complementary, could assist young African Americans to reduce their pain and risk of chronic pain in the future.

A mixed methods evaluation of got care!

This study aimed to assess the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach and Training with Care! (GOT Care!), and the observed 26% reduction in Emergency Department (ED) visits for the 51 older adult participants. A convergent parallel mixed-methods design was utilized. Demographic data and ED visit data were collected and analyzed using paired-samples t-tests, poisson regression and generalized poisson regression. Stakeholder perspectives were assessed via emailed open-ended surveys and analyzed using content analysis. The quantitative results were transformed into trends that were compared and contrasted with the qualitative themes. The results were consistent with the current literature that IPCP models may have a greater impact on older adults with certain demographic characteristics such as polypharmacy, diabetes and prior ED use, while nursing was identified as an ideal leader for IPCP teams.

Development of the Adverse Analgesic Drug Event Measure.

BACKGROUND: Little is known about how people respond to an analgesic adverse drug event despite the significant incidence of deaths and hospitalizations associated with analgesic adverse drug events. OBJECTIVE: The purpose of this two-phase instrument development study was to test the validity and reliability of the Analgesic Adverse Drug Event Measure (AADEM). METHODS: Content validity was established during Phase I. Six experts rated the 58-item measure developed from a pilot survey of adults who had experienced an analgesic adverse drug event. Experts' ratings supported a 17-item AADEM with a scale content validity index of .86. Phase II consisted of online administration of the AADEM to a national Qualtrics panel who reported an adverse drug event from a self-administered analgesic. Exploratory factor analysis was conducted using principal axis factoring and oblique rotation including Direct Oblimin and Promax rotations with Kaiser normalization. RESULTS: Four factors emerged from the analysis: sought care, consulted provider, discontinued or continued analgesic, and attributed adverse drug event with a total explained variance of 55.4%. Scale content validity index for the 13-item AADEM was .88. Internal consistency for the four subscales was acceptable, but low for the full 13-item AADEM. DISCUSSION: Results establish preliminary evidence for the validity and reliability of the 13-item AADEM to measure response to an analgesic adverse drug event. Next steps involve confirmatory factor analysis in a different sample to examine the underlying construct of the AADEM. The AADEM might help identify people at risk for serious analgesic adverse drug events.

The Electronic Pain Management Life History Calendar: Development and Usability.

BACKGROUND: Changes over time to self-managed chronic pain treatments are not a routine part of pain management discussions and might provide insight into adjustments that improve pain outcomes. AIMS: The purpose of this study was to develop and test an electronic pain management life history calendar (ePMLHC) for use with older adults with chronic pain. DESIGN: An instrument development design was used to develop and test the ePMLHC. METHODS: Twenty-four community-dwelling older adults with osteoarthritis pain completed the ePMLHC describing their pain treatment regimens and treatment response history. Accuracy of the ePMLHC data was examined through post-ePMLHC audiorecorded interviews, with the older adults describing their pain treatment history. Feedback on use of the ePMLHC was also measured. An iterative process was used to refine and retest the ePMLHC. The final ePMLHC version was examined with the remaining 12 older adults. RESULTS: Significant differences between data reported via the ePMLHC and interviews did not support feasibility of independently reported data via the ePMLHC. Older adults reported that completing the ePMLHC helped them more fully self-reflect on their pain self-management. CONCLUSIONS: The ePMLHC has the potential to enhance communication about past pain management treatments and promote more personalized pain treatment regimens, but further development is required.

Reminiscence About Physical Activity: A Pilot Study to Reduce Pain in Older Adults.

The aim of the current randomized attention control pilot study was to conduct a preliminary test of a facilitated reminiscence intervention about past physical activity for the effect on increased physical activity and reduced pain in older adults with osteoarthritis. Thirteen older adults were randomized to the facilitated reminiscence or health education group and participated in six individual sessions over 6 weeks. Reminiscence functions, self-reported physical activity, pain intensity, and pain interference with function were measured at baseline and 1 and 3 months postintervention. Facilitated reminiscence did not result in increased physical activity, but instead resulted in increased pain intensity. Content analysis of reminiscence session transcripts indicated most reminiscence was conversational. Benefits from reminiscence included reconnecting with estranged family and distraction from pain. Past physical activities might be helpful to include as part of a program of facilitated integrated reminiscence for individuals with sufficient history of past physical activity. [Res Gerontol Nurs. 2019; 12(4):193-202.].

Predictors of gastrointestinal bleeding in older persons taking nonsteroidal anti-inflammatory drugs: Results from the FDA adverse events reporting system.

BACKGROUND AND PURPOSE: Older adults continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) to manage chronic pain. The study's purpose was to identify predictors of gastrointestinal (GI) bleeding in older adults taking NSAIDs. METHODS: A secondary analysis of the 2016 Food and Drug Administration's Adverse Events Reporting System data was conducted with 1,347 cases aged 65 years and older with an NSAID as the primary suspect for an adverse drug event (ADE). Data included age, sex, NSAID, multiple NSAID use, rivaroxaban, warfarin, clopidogrel, cardiovascular drug (proxy for cardiovascular disease), diabetes drug (proxy for diabetes mellitus), and primary adverse drug response. CONCLUSIONS: Aspirin was the primary suspect NSAID in 72.5% of cases. Rivaroxaban was taken in 67.9% of cases. Logistic regression was conducted to predict GI bleed versus other NSAID-related ADEs with age, sex, cardiovascular medication, diabetes medication, warfarin, clopidogrel, concurrent NSAID use, aspirin, and rivaroxaban as predictors. Aspirin, rivaroxaban, and concurrent NSAID were significant predictors of GI bleed. Gastrointestinal bleed risk versus other ADE risk increased by 39.77 times when taking aspirin, rivaroxaban, and another NSAIDs concurrently. IMPLICATIONS FOR PRACTICE: Results support reduced NSAID use by older adults, especially aspirin, and avoidance of rivaroxaban in older persons taking NSAIDs.

Older Adults' Response to Analgesic Adverse Drug Reactions: A Pilot Study.

BACKGROUND: Older adults who take analgesics for chronic pain are at increased risk for adverse drug events (ADEs). Aims/Design: The purpose of this descriptive pilot survey was to examine how older adults self-identify analgesic ADEs, and actions they take in response to analgesic ADEs. Setting/Participants/Methods: Twenty-two community dwelling older adults with chronic pain who reported an analgesic ADE associated with their chronic pain management were interviewed and asked to describe their analgesic related ADE. Written responses were content analyzed. RESULTS: Nineteen opioids were reported by 15, 11 NSAIDs were reported by 8, and acetaminophen was reported by 2 older adults as associated with an ADE. Gastrointestinal ADEs were most common with upset stomach (31.8%) most frequent. Neurological ADEs were also common but more varied with dizziness (27.3%) and headache (13.6%) reported most frequently. A total of 54.5% responded to their ADE by contacting their physician. Three (13.6%) went to the emergency department. A total of 36.4% stopped taking their ADE associated analgesic, 22.7% started taking a different analgesic, and 22.7% started prophylaxis. Three (13.6%) continued their ADE related analgesic. A total of 54.5% reported their symptoms subsided, but 13.6% reported their symptoms remained. CONCLUSIONS: A significant number of older adults with chronic pain self-manage their analgesic related ADE without contacting their primary care provider. Analgesic related ADE prevention and management should be discussed during primary care visits to reduce ADEs and enhance pain management outcomes for older adults with chronic pain.

The Relationship Between Reminiscence Functions, Optimism, Depressive Symptoms, Physical Activity, and Pain in Older Adults.

The study purpose was to examine the association between reminiscence functions, optimism, depressive symptoms, physical activity, and pain in older adults with chronic lower extremity osteoarthritis pain. One hundred ninety-five community-dwelling adults were interviewed using the Modified Reminiscence Functions Scale, Brief Pain Inventory, Life Orientation Test-Revised, Center for Epidemiologic Studies Short Depression Scale, and Physical Activity Scale for the Elderly in random counterbalanced order. Structural equation modeling supported chronic pain as positively associated with depressive symptoms and comorbidities and unrelated to physical activity. Depressive symptoms were positively associated with self-negative reminiscence and negatively associated with optimism. Spontaneous reminiscence was not associated with increased physical activity or reduced pain. Individuals may require facilitated integrative reminiscence to assist them in reinterpreting negative memories in a more positive way. Facilitated integrative reminiscence about enjoyed past physical activity is a potential way to increase physical activity, but must be tested in future research. [Res Gerontol Nurs. 2016; 9(5):223-231.].

The Pain Management Life History Calendar: A Pilot Study.

Pain management trajectory data that includes previous pain treatments, timing, changes, and outcomes provide crucial data for patients with chronic pain and their practitioners to use when discussing ways to optimize pain management regimens. The aim of this study was to test the use of the life history calendar method to identify pain treatments, treatment regimens, timing, and outcomes of the pain management trajectory of individuals with chronic pain, and to examine feasibility. A pilot, descriptive, methodological design was used. Settings included community-based sites such as congregate housing. Nineteen community-dwelling older adults with osteoarthritis (OA) pain of at least 1 year's duration participated. Participants were interviewed and asked to chronicle from the beginning of the OA pain to the present all of their pain treatments and treatment effects (pain outcomes and adverse events). Raters independently content analyzed the transcribed interviews to identify pain treatments, treatment groupings (regimens), and treatment effects on pain. Feasibility of patients reporting their pain management trajectories was content analyzed by identifying participant difficulty identifying pain treatments, treatment effects, treatment sequence; and difficulty discriminating between treatments, and between OA pain and other pain sources. Individual pain management trajectories were constructed that depicted chronological order of pain treatment regimens and treatment effects. Participants identified pain treatments, discriminate between treatments and between OA and other conditions, and identified treatment effects. Treatment sequence was identified, but more precise timing was generally not reported. Pain management trajectories could provide a helpful way for practitioners to discuss safe, efficacious pain management options with patients.

A closer look: Alternative pain management practices by heart failure patients with chronic pain.

OBJECTIVE: To describe alternative non-pharmaceutical non-nutraceutical pain self-management strategies used by people with heart failure (HF) in order to reduce chronic non-cardiac pain. BACKGROUND: Little is known about alternative pain self-treatments used by HF patients with chronic pain. METHODS: A cross-sectional descriptive design was used with 25 hospitalized HF patients who had chronic pain and used at least one alternative pain treatment. Pain intensity, pain interference with function, and current pain treatments were measured with the Brief Pain Inventory. RESULTS: Alternative treatments included walking, stretching, use of heat and cold. Five patients used evidence-based pain treatments for their chronic pain conditions. Patients reported moderate pain intensity and pain interference with activity. CONCLUSIONS: Patients with HF and chronic pain use few alternative pain treatments. Screening for chronic pain and referral to Integrative Medicine and/or Palliative care for a pain management consult might reduce the added burden of pain in people with HF.

Hispanic Inpatient Pain Intensity.

Hispanic adults experience significant pain, but little is known about their pain during hospitalization. The purpose of this research was to describe Hispanic inpatients' pain intensity and compare their pain intensity with that of non-Hispanic patients. A post hoc descriptive design was used to examine 1,466 Hispanic inpatients' medical records (63.2% English speakers) and 12,977 non-Hispanic inpatients' medical records from one hospital for 2012. Mean documented pain intensity was mild for both Hispanic and non-Hispanic inpatients. Pain intensity was greater for English-speaking Hispanic patients than Spanish speakers. The odds of being documented with moderate or greater pain intensity decreased 30% for Spanish-speaking patients. Greater pain intensity documented for English-speaking Hispanic inpatients suggests underreporting of pain intensity by Spanish-speaking patients. Practitioners should use interpreter services when assessing and treating pain with patients who speak languages different from the practitioners' language(s).

Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

Trialing to pain control: a grounded theory.

The aim of this study was to examine the basic social psychological process of managing inadequately relieved pain in adults. Transcribed data from 23 ambulatory medical visits of adults with pain and interviews with four practitioners and four patients with pain were analyzed using constant comparative analysis. The basic problem was perception of running out of treatment options. Trialing was the process used to resolve the problem and consisted of four phases: finding the right practitioner, initiating the trial, adjusting treatments, and continuing to monitor with the patient taking control over the pain. Failure to achieve control over pain occurred when providers were unclear or failed to listen or when patients disagreed about treatment. Improving patient-provider communication may enhance trialing.

Older black adult osteoarthritis pain communication.

A quantitative descriptive secondary data analysis design was used to describe older black adult communication of osteoarthritis pain and the communication strategies used to convey the pain information. Pain content from 74 older black adults with persistent osteoarthritis pain was analyzed using criteria from the American Pain Society arthritis pain management guidelines that included type of pain (nociceptive/neuropathic), quality of pain, source, location, intensity, duration/time course, pain affect, effect on personal lifestyle, functional status, current pain treatments, use of recommended glucosamine sulfate, effectiveness of prescribed treatments, prescription analgesic side effects, weight management to ideal body weight, exercise regimen or physical therapy and/or occupational therapy, and indications for surgery. Communication strategies were analyzed with criteria derived from Communication Accommodation Theory that included being clear, using medical syntax, using ethnic specific syntax, being explicit, and staying on topic when discussing pain. The majority of communicated pain content included pain location, intensity, and timing. Regarding communication strategies, most of the older black adults used specific descriptions of pain and remained on topic. Fewer used explicit descriptions of pain that produced a vivid mental image, and few used medical terminology. Use of medical syntax and more explicit descriptions might improve communication about pain between health care practitioners and patients. Practitioners might assist older black adults with persistent osteoarthritis pain to communicate important clinical pain information by helping them to use relevant medical terminology and more explicit pain descriptions when discussing pain management.