Epidemiologic perspective on chronic pain treatment.

Objective: To review the epidemiologic literature concerning psychosocial mediators of outcome in chronic pain. These factors deserve attention in the assessment and treatment of chronic pain by mental health professionals.

Method: We reviewed literature dealing with epidemiologic perspectives on abuse, depression, addiction, employment, coping skills, and psychosocial problems.

Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis.

Objective: To review the relation between chronic pain and psychological comorbidities, and the influence on course and prognosis, based on epidemiologic and population studies.

Method: We present a narrative overview of studies dealing with the epidemiology of chronic pain associated with mental health and psychiatric factors. Studies were selected that were of good quality, preferably large studies, and those that dealt with prevalences, course and prognosis of chronic pain, risk factors predicting new pain and comorbid disorders, and factors that affect health outcomes.

Experiences and benefits of volunteering in a community AIDS organization.

This qualitative study examines the AIDS service organization-volunteer relationship from the volunteer's point of view. Factors that led to a relationship with an AIDS service organization included personal values and individual characteristics and needs. Volunteers reported many rewards from the work itself and the responses of others.

Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS.

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health.

Longitudinal study of inpatients admitted to a general activation service: variables that predict discharge to a patient's discharge goal location.

Objective: To determine which sociodemographic and clinical characteristics of patients admitted to a general activation service (GAS) are predictive of discharge to patients' discharge goal locations (DGLs).

Design: Prospective cohort study.

Setting: Rehabilitation and complex continuing care hospital in southern Ontario, Canada.

An exploration of seniors' ability to report pain.

The purpose of this study was to evaluate the ability of a group of elderly residents to use self-report methods to measure their pain in an accurate fashion. Using a comparative descriptive design, completion rates of three pain assessment tools and the self-report skills of a sample of 130 long-term care residents with varying levels of cognitive impairment were evaluated. The majority of residents with mild to moderate cognitive impairment were able to complete at least one of the verbal pain assessment tools, with the Present Pain Intensity and Numerical Rating Scales being the preferred choices for use in clinical settings.

A comparison of pain-assessment tools for use with elderly long-term-care residents.

The purpose of this study was to examine the psychometric properties (test-retest and interrater reliability, criterion concurrent validity) of 3 verbal pain-assessment tools (Faces Pain Scale, Numerical Rating Scale, Present Pain Intensity Scale) and a behavioural pain-assessment scale for use with an elderly population. The study used a repeated-measures design to examine the reliability and validity of the tools across 4 groups of participants with varying levels of cognitive impairment using a non-random stratified sample of 130 elderly long-term-care residents. The findings support the test-retest and interrater reliability of the behavioural pain-assessment tool across all levels of cognitive impairment, whereas the same measures of reliability for the verbal-report tools decreased with increasing cognitive impairment; however, the majority of elderly with mild to moderate cognitive impairment were able to complete at least 1 of these tools.

Biopsychosocial multivariate predictive model of occupational low back disability.

Study Design: To establish outcome, 253 workers with subacute and chronic low back conditions were assessed with a comprehensive multimethod biopsychosocial protocol at baseline, 3 days after the initial examination, and 3 months later.

Objective: To validate empirically a biopsychosocial model for prediction of occupational low back disability.

Summary Of Background Data: Costs of low back occupational disability continue to spiral despite stabilization of low back injury rates.

Are components of a comprehensive medical assessment predictive of work disability after an episode of occupational low back trouble?

Study Design: One hundred fifty-nine subacute low back work-injured patients completed a full medical assessment at baseline. A full repeat examination was performed 3 months later, when return-to-work status was determined.

Objective: To determine the prognostic value of a comprehensive medical assessment for the prediction of return-to-work status.

Determinants of occupational disability following a low back injury: a critical review of the literature.

The aim of this research was to determine prognostic indicators of work disability in occupational back pain as reported in the literature, by systematically searching the research literature, assessing the methodological quality of the research, and synthesizing the findings into a concise summary. An article was considered eligible for review if research participants had an injury of the back, the article was based on original research, published in English, and involved a cohort with back pain less than 6 months post injury with at least one follow up assessment. Each article was independently reviewed by two "blinded" reviewers using 19 appraisal criteria for methodological quality of prognostic studies.

An epidemiological follow-up survey of persistent pain sufferers in a group family practice and specialty pain clinic.

The course and prognosis of persistent pain are largely unknown. In addition, follow-up studies of chronic pain sufferers have come from specialized pain clinics and have ignored the question of how representative this special group is to the general population who suffer persistent pain. Because health care planners are assumed to require these data for projection of health care needs, it is important to determine the course of persistent pain in those persistent pain sufferers in the general population as well as those referred to a specialty clinic.

Coping with persistent pain: a comparison of persistent pain sufferers in a specialty pain clinic and in a family practice clinic.

Coping has been defined as an effort to manage external and internal demands and conflicts that tax or exceed a person's resources. This paper examines the types of coping strategies used by two groups of persistent pain sufferers: one from a family practice clinic and the other from a specialty pain clinic. The relationship between the use of different types of coping strategies and adjustment was determined.

Tender points in fibromyalgia.

To establish inter-rater and test-retest reliability of use of a pressure algometer, 5 males and 5 females suffering from chronic fibromyalgia ('fibrositis'), and a normal group of 5 males and 5 females, were examined 2 times by each of 2 independent examiners, using 1 kg/sec rate of application, over 10 paired and typical 'tender points,' localized by skin marker. Tenderness thresholds of tender points were coded and analyzed using repeated measures ANOVA, for factors sex, normal/fibromyalgia, and side, rater, and time 1/time 2. There was significantly lower tenderness thresholds of tender points in fibromyalgia compared to normal subjects.

The prevalence of pain complaints in a general population.

The authors argue that the study of the complaint of pain falls within the purview of epidemiological study. An analytic survey of 500 randomly selected households on the roster of a group family practice clinic was undertaken. The purpose was to determine the self-reported prevalence rates of any pain complaint and to determine the distribution of pain rates according to selected demographic and socioeconomic variables.