Exploring effect of pain education on chronic pain patients' expectation of recovery and pain intensity.

BACKGROUND AND AIMS: Chronic pain affects an estimated 1 in 10 adults globally regardless of age, gender, ethnicity, income or geography. Chronic pain, a multifactorial problem requires multiple interventions. One intervention which demonstrates promising results to patient reported outcomes is pain education. However, patient perspective on pain education and its impact remains fairly unknown. A cross-sectional study involving individuals with chronic pain examined their perspectives on pain education; did it change their understanding about their pain and self-management and did it have any impact on their perceived pain intensity and recovery. METHODS: The study complied with CHERRIES guidelines and the protocol was locked prior to data collection. Primary outcomes were pain intensity and participants' expectation of recovery. Univariate and multiple logistic regressions were used to analyze the data. RESULTS: Five hundred and seventy three people participated; full data sets were available for 465. Participants who observed changes in their pain cognition and self-management following pain education reported lower pain intensity and greater expectation of recovery than participants who did not observe changes to cognition and management. CONCLUSIONS: The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. IMPLICATIONS: Pain intensity and expectations about recovery are primary considerations for people in pain. What influences these factors is not fully understood, but education about pain is potentially important. The results suggest that individuals who observed changes to pain cognition and self-management on receiving pain education reported lower pain intensity and higher expectations of recovery than their counterparts who did not perceive any changes to pain cognition and self-management. The results from this study highlight the importance of effective pain education focused on reconceptualization of pain and its management.

Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset.

BACKGROUND: Previous estimates for the prevalence of musculoskeletal conditions (MSK) and chronic pain in Australia have been based on self-report. We aimed to determine the prevalence and distribution of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis and current consultations for chronic pain among adults attending Australian general practice, and describe their distribution according to sociodemographic characteristics and presence of co-morbidities. METHODS: We investigated 1,501,267 active adult patients (57.6% females; 22.5% ≥65y) evaluated between 2013 and 2016 and included in the MedicineInsight database (a National Prescribing Service MedicineWise program), a large general practice data program that extracts longitudinal de-identified electronic medical record data from 'active' patients in over 550 practices. Three main groups of outcomes were investigated: 1) "prevalence" of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies, and/or rheumatoid arthritis between 2000 and 2016; 2) "current" diagnosis/encounter for the same conditions occurring between 2013 and 2016, and; 3) "current" consultations for chronic pain of any type occurring between 2013 and 2016. RESULTS: The combined "prevalence" of the investigated MSK (diagnosis between 2000 and 2016) among adults attending Australian general practice was 16.8% (95%CI 15.9;17.7) with 21.3% (95%CI 20.2;22.4) of the sample consulting for chronic pain between 2013 and 2016. The investigated MSK with the highest "prevalence" were arthritis (9.5%) and chronic back pain (6.7%). Patients with some of these MSK attended general practices more frequently than those without these conditions (median 2.0 and 1.0 contacts/year, respectively). The "prevalence" of the investigated MSK and "current" consultations for chronic pain increased with age, especially in women, but chronic pain remained stable at 22% for males aged > 40 years. The investigated MSK and chronic pain were more frequent among those in lower socioeconomic groups, veterans, Aboriginal and Torrent Strait Islanders, current and ex-smokers, and patients with chronic obstructive pulmonary disease or heart failure. CONCLUSIONS: The investigated MSK are more frequent among lower socioeconomic groups and the elderly. Based on information collected from adults attending Australian general practices, MedicineInsight provided similar estimates to those obtained from population-based studies, with the advantage of being based on medical diagnosis and including a national sample.

Factors Associated with Vitamin D Testing, Deficiency, Intake, and Supplementation in Patients with Chronic Pain.

Vitamin D deficiency is a public health issue, with reports of six- to twenty-five-fold rise in vitamin D testing. Vitamin D deficiency has been linked to many chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and chronic pain. Identifying factors associated with risk of deficiency in individuals with chronic pain will help minimize time and cost. This study aims to examine the factors associated with vitamin D testing, intake, and physician-advised supplementation in individuals with chronic pain. Using a cross-sectional design, data were collected from 465 individuals with chronic pain. These data were analyzed using penalized logistic regression with the LASSO technique. Fifty-seven percent reported being tested for vitamin D, about 40% reported being diagnosed with vitamin D deficiency, and of those who had been tested, 60% reported taking vitamin D supplementation. The findings suggest older age (OR 3.12, CI [1.02, 9.50]) and higher mean pain intensity score (OR 2.02, CI [1.13, 3.59]) increased an individual's chance of being vitamin D deficient. Unemployment or on leave due to pain (OR 1.79, [CI 1.03, 3.11]), part-time employment (OR 1.86, CI [1.02, 3.39]), and being a resident of Australia (OR 2.32, CI [1.13, 4.72]) increased chances of being tested for vitamin D. Being diagnosed with vitamin D deficiency (OR 6.67, CI [2.75, 16.19]), unemployed or on leave due to pain (OR 3.71, CI [1.25, 11.00]), and in part-time employment (OR 2.69, CI [0.86, 8.38]) were associated with physician-advised vitamin D supplementation. Our results may have practical implications, as identifying pretest risk factors may assist in identifying who is at risk of vitamin D deficiency, whom to test, and when to treat.

Understanding patient perspectives on management of their chronic pain - online survey protocol.

BACKGROUND: It is widely recognized that both doctors and patients report discontent regarding pain management provided and received. The impact of chronic pain on an individual's life resonates beyond physical and mental suffering; equal or at times even greater impact is observed on an individual's personal relationships, ability to work, and social interactions. The degree of these effects in each individual varies, mainly because of differences in biological factors, social environment, past experiences, support, and belief systems. Therefore, it is equally possible that these individual patient characteristics could influence their treatment outcome. Research shows that meeting patient expectations is a major challenge for health care systems attempting to provide optimal treatment strategies. However, patient perspectives and expectations in chronic pain management have not been studied extensively. The aim of this study is to investigate the views, perceptions, beliefs, and expectations of individuals who experience chronic pain on a daily basis, and the strategies used by them in managing chronic pain. This paper describes the study protocol to be used in a cross sectional survey of chronic pain patients. METHODS AND ANALYSIS: The study population will comprise of individuals aged ≥18 years, who have experienced pain for ≥3 months with no restrictions of sex, ethnicity, or region of residence. Ethics approval for our study was obtained from Humans research ethics committees, University of Adelaide and University of South Australia. Multinomial logistic regression will be used to estimate the effect of duration and character of pain, on patient's perception of time to recovery and supplement intake. Logistic regression will also be used for estimating the effect of patient-provider relationship and pain education on patient-reported recovery and pain intensity. DISCUSSION: Knowledge about the perceptions and beliefs of patients with chronic pain could inform future policies, research, health care professional education, and development of individualized treatment strategies.

Why older women do or do not seek help from the GP after a fall: a qualitative study.

BACKGROUND: It is recommended that older people report their falls to their general practitioner (GP), to identify falls risk factors. However, many older people do not report falling to their GP. Little is known about the reasons why older people do and do not seek help about falling. OBJECTIVE: To explore why older women do or do not seek GP help after a fall. METHODS: A qualitative study, using semi-structured interviews with 11 community-dwelling women aged ≥ 65 years, living in Adelaide, Australia, who had fallen in the last 12 months. Interviews focused on women's experience of falling and seeking GP help. Interviews were analysed using constant comparison. RESULTS: Four women sought GP help when they believed their fall-related injury was serious enough. Family and a bystander persuaded three women to attend for a fall-related injury. The four women who did not seek help believed their fall or fall-related injury was not serious enough to seek help and justified this by using internal rationales (they monitored and managed the outcome of falling, they wanted to be associated with a positive image and attitude, and they recognized and interpreted the cause and control of falling) and external rationales (they did not want to waste GPs' time for trivial reasons and they believed they did not have timely access to their GP). CONCLUSIONS: Given the reasons why some older women do not seek help for falling, GPs should routinely ask older women for their 12-month fall history.

Does vitamin D sufficiency equate to a single serum 25-hydroxyvitamin D level or are different levels required for non-skeletal diseases?

OBJECTIVE: Clarify the concept of vitamin D sufficiency, the relationship between efficacy and vitamin D status and the role of Vitamin D supplementation in the management of non-skeletal diseases. We outline reasons for anticipating different serum vitamin D levels are required for different diseases. METHOD: Review the literature for evidence of efficacy of supplementation and minimum effective 25-hydroxyvitamin D (25-OHD) levels in non-skeletal disease. RESULTS: Evidence of efficacy of vitamin supplementation is graded according to levels of evidence. Minimum effective serum 25-OHD levels are lower for skeletal disease, e.g., rickets (25 nmol/L), osteoporosis and fractures (50 nmol/L), than for premature mortality (75 nmol/L) or non-skeletal diseases, e.g., depression (75 nmol/L), diabetes and cardiovascular disease (80 nmol/L), falls and respiratory infections (95 nmol/L) and cancer (100 nmol/L). CONCLUSIONS: Evidence for the efficacy of vitamin D supplementation at serum 25-OHD levels ranging from 25 to 100 nmol/L has been obtained from trials with vitamin D interventions that change vitamin D status by increasing serum 25-OHD to a level consistent with sufficiency for that disease. This evidence supports the hypothesis that just as vitamin D metabolism is tissue dependent, so the serum levels of 25-OHD signifying deficiency or sufficiency are disease dependent.

Vitamin D and obesity.

Obesity is a significant health problem world-wide, particularly in developed nations. Vitamin D deficiency is pandemic, and has been implicated in a wide variety of disease states. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined, and recommendations for future research are made. There is a clear need for adequately-powered, prospective interventions which include baseline measurement of 25D concentrations and involve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention remains uncertain.

Efficacy and tolerability of calcium, vitamin D and a plant-based omega-3 oil for osteopenia: a pilot RCT.

OBJECTIVES: Our pilot study tested the efficacy, acceptability and tolerability of DHA supplementation in addition to calcium and vitamin D in individuals with osteopenia. STUDY DESIGN: 40 participants were randomised to either algal oil containing 400mg docosahexanoic acid (DHA) daily or placebo. All participants received 1200 mg calcium carbonate with vitamin D(3) 1000 IU daily. MAIN OUTCOME MEASURES: Bone mineral density (BMD) was measured at baseline and 12 months. Bone turnover was assessed with serum c-terminal telopeptides (CTx) at baseline and 12 months. Tolerability and acceptability were assessed using a validated questionnaire. RESULTS: Mean CTx was suppressed after 12 months for all participants (p=0.04) with no difference in effect size between DHA and control groups (p=0.53). Changes in CTx at 12 months were significantly correlated with changes in BMD at the lumbar spine (p=0.01) and total proximal femur (TPF) (p=0.03). There was a non-significant trend towards rising BMD at 12 months. Participants rated the supplements as tolerable and acceptable, with few adverse events. CONCLUSIONS: The combination of oral calcium, vitamin D(3) and DHA was safe, tolerable and acceptable when used for 12 months by osteopenic individuals in this pilot study. The combination had a positive effect on bone health as indicated by serum CTx, with no effect demonstrated from the addition of DHA 400mg. Changes in BMD at the lumbar spine and TPF were significantly correlated with changes in CTx, which may be useful in monitoring bone health and response to treatment.

Cholesterol lowering medication - patients' knowledge, attitudes and experiences.

BACKGROUND: Despite evidence of the efficacy of cholesterol lowering medication, it is known there is suboptimal patient adherence to this medication. The aim of this study is to investigate patient knowledge, attitudes and experiences of their cholesterol lowering medication, and explore patient views regarding programs to support self management. METHODS: A semiqualitative exploratory study using semistructured telephone interviews of adult patients with poorly controlled hyperlipidaemia. RESULTS: Twenty-six patients were interviewed. Most patients could name at least one risk factor for their hyperlipidaemia. Approximately one-third of patients reported they did not understand the reasons they were taking their cholesterol medication and over two-thirds did not understand how their medication worked. Most reported that their general practitioner was their main source of information about cholesterol. Many expressed a desire to be better informed about cholesterol, its risk factors and medication and that an information session at their local general practice clinic would be useful. DISCUSSION: This study provides preliminary evidence that patients on long term statin therapy may have gaps in their knowledge about their condition and treatment options and a desire to be better informed.

Vitamin D insufficiency in Aboriginal Australians.

OBJECTIVE: To investigate the adequacy of vitamin D status in a South Australian Aboriginal population, and to examine the relationship between serum 25-hydroxyvitamin D (25-OHD) levels and biochemical variables of calcium and bone mineral homeostasis, as well as other factors which may influence vitamin D synthesis, storage and metabolism. DESIGN, SETTING AND PARTICIPANTS: A single-visit, observational study of 58 adults from two Aboriginal community-controlled health services in Adelaide and Yalata, South Australia. Participants were recruited between May 2008 and December 2009. MAIN OUTCOME MEASURES: Serum levels of 25-OHD, parathyroid hormone (PTH), fasting glucose and fasting C-terminal telopeptides of type I collagen (ß-CTx). RESULTS: Serum 25-OHD levels showed clear seasonal variation, being higher in summer (P < 0.001). The overall mean level was 56.8 nmol/L (SD, 22.1), which is below the recommended target level of 60 nmol/L. Serum 25-OHD levels correlated significantly with ß-CTx (P = 0.03), but not with age, body mass index (BMI), PTH levels or levels of fasting glucose. A significant association was found between BMI and PTH levels (P = 0.001). A significant inverse association between serum 25-OHD levels and BMI, observed in other studies, was not found in our study. CONCLUSIONS: Vitamin D insufficiency is highly prevalent in this population of adult Aboriginal Australians, with low mean values found in all seasons other than summer.

Vitamin D and people with intellectual disability.

BACKGROUND: Vitamin D is essential for the normal functioning of a diverse range of metabolic processes, especially bone health. It is widely appreciated that the elderly are at increased risk of vitamin D insufficiency, but it is less well known that people with intellectual disability are also at increased risk. OBJECTIVE: This article summarises the issues regarding vitamin D in people with intellectual disability, making recommendations about screening, management and follow up. DISCUSSION: The prevalence of intellectual disability in the Australian population has been estimated at just over 1%, implying that most general practitioners will care for several people with intellectual disability. Relatively simple steps are likely to have a significant impact on the health of this vulnerable group of people.