Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic (original) (raw)
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Rheumatology, 2008
Objective. Chronic musculoskeletal pain is a very common and costly health problem. Patients presenting to rheumatology clinics with chronic pain can be difficult to manage. We studied 354 patients referred to a rheumatology chronic pain clinic over 5 yrs to identify factors affecting their self-efficacy and intensity of pain. Methods. We collected data for each patient, covering demographic and psychosocial factors, characteristics of their pain and previous treatment. We measured self-efficacy using a validated questionnaire, and pain intensity (PI) on an NRS. We performed multiple regression analysis to determine as to which factors were independently associated with these outcomes. Results. Despite extensive previous investigations and treatment, these patients had low self-efficacy [median ¼ 26.5, interquartile range (IQR) 15-38, best possible ¼ 60] and high PI scores (median ¼ 7, worst possible ¼ 10, IQR 5-9). Low self-efficacy was most clearly associated with depressive symptoms and not being employed. PI was most clearly associated with depressive symptoms, extensive pain and lower level of education. Conclusion. Community-based studies suggest psychosocial factors are very important in determining outcomes in patients with chronic pain. This study suggests that the same is true in patients referred to rheumatologists due to chronic musculoskeletal pain and that these factors-particularly depressive symptoms and not being employed-are more important than site or duration of pain in those patients. by guest on December 2, 2015 http://rheumatology.oxfordjournals.org/ Downloaded from Disclosure statement: The authors have declared no conflicts of interest.
Journal of Clinical Medicine
This study aims to shed light on the frequency and associated factors of self-reported adherence to analgesic treatment among chronic pain (CP) patients in the Spanish population. A nationwide cross-sectional study was performed of 1066 Spanish adults, of whom 251 suffered from CP and 168 had been prescribed analgesic treatment. Adherence was assessed using a self-reported direct questionnaire and related factors were collected. Descriptive and bivariate analyses were conducted. Among the 23.5% (95% CI: 21.0–26.2%) of the sample with CP, 66.9% (95% CI: 60.7–72.7%) were taking analgesic treatment prescribed by a doctor, and 81.0% (95% CI: 74.2–86.6%) said they took the treatment as the doctor indicated. However, 17.6% forgot to take the medication, 11% overused them when in great pain, 46.3% stopped the treatment when feeling better and 33.3% when feeling worse, and 7.3% stopped taking them for financial reasons. Higher intensity of pain, polymedication, administration route (injecti...
Predictors of Frequent Oral Analgesic Use in Rheumatoid Arthritis
Pakistan Journal of Medical Sciences, 1969
The main objective of this study was to determine the predictors of frequent oral analgesic use among Rheumatoid Arthritis (RA) patients who were prescribed with the above medication on an 'asneeded' basis. Methods: Patients with RA were recruited consecutively from the Rheumatology outpatient clinics in this cross-sectional study. The sociodemographic data, frequency of oral analgesic intake, Patient Global Assessment (PGA) scores and HAQ (Health Assessment Questionnaire) scores were determined by interviewing the subjects. Subjects were divided into 2 groups; frequent users (3 days and above in a week) and less frequent users (less than 3 days in a week). Results: In a total of 112 subjects, 39 (34.8%) were frequent analgesic users. Both the HAQ and PGA scores were significantly higher among the frequent users (p < 0.05). Using multivariate analysis, the HAQ scores (p=0.015, odds ratio 3.161 [95% confidence interval of 1.246-8.015]) and PGA scores (p=0.039 odds ratio 1.291 [95% confidence interval of 1.012-1.646]) were found to be independent predictors of frequent analgesic use. Conclusions: Our study confirms that the frequency of analgesic intake in Rheumatoid Arthritis has a significant relationship with patient-reported functional capacity and well being.
Patient Perceptions concerning Pain Management in the Treatment of Rheumatoid Arthritis
Journal of International Medical Research, 2010
Previous qualitative studies have revealed discrepancies between patients' and physicians' perceptions of rheumatoid arthritis (RA) and its treatment. Questionnaires were administered to 2795 patients with RA (756 from Europe; 2039 from the USA) to measure patients' perceptions regarding pain management in RA. Although the majority of patients reported their RA as somewhat-to-completely controlled, 75% of European and 82% of US patients reported their pain as moderate-to-severe in the previous 2 months. The majority of European (60%) and US (65%) patients reported dissatisfaction with their arthritis pain. Patients' pain levels corresponded with their disease severity. A higher percentage of patients who reported severe pain were being treated for depression than those who had moderate or mild pain. Patients in the USA rated pain relief as the top required benefit from their RA medication. A comprehensive examination of patients' perspectives regarding pain could...
European Journal of Pain, 2012
Background: It is not known whether general practitioners (GPs) prescribe analgesic medication according to intensity of pain or a hierarchical prescribing regimen. Aims: The aim of this study was to assess the association of strength of pain-relief medication prescribed by the GP with the strength of previous prescription and pain level. Methods: The PROG-RES study collected data on pain intensity in 428 patients aged Ն50 years with non-inflammatory musculoskeletal pain during a consultation with their GP. Prescriptions for analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were identified on the day of the consultation and in the previous year and were classified as basic, moderate or strong analgesic or NSAID. Regression models were used to assess the association of strength of analgesia and prescription of a NSAID with the strength of previous prescription and the level of pain. Results: The majority of patients were not prescribed medication for their pain at the index consultation, but had such a prescription the previous year. There was an association between strength of analgesic and intensity of pain: more intense pain resulted in a stronger drug. This association was attenuated by adjustment for prescribed analgesia in the previous year. There was no association between intensity of pain and NSAID prescription, but previous NSAID prescription predicted another such prescription. Conclusion: GPs do not always issue prescriptions for musculoskeletal pain. In cases where a prescription is issued, this is more strongly influenced by previous prescriptions than the patient's pain level. GPs adopt an individualized approach to the treatment of musculoskeletal pain in older adults.
Pain self-efficacy beliefs and pain behaviour. A prospective study
Pain, 2001
This study examined the relationship between pain self-efficacy beliefs and a range of pain behaviours, as measured by the pain behaviour questionnaire (PBQ), using a prospective design. A heterogeneous sample of 145 chronic pain patients completed sets of questionnaires on four occasions over a nine-month period. Multiple hierarchical regression analyses revealed that the subjects' confidence in their ability to perform a range of tasks despite pain (assessed at baseline), was predictive of total pain behaviour and avoidance behaviour over the ninemonth study period. This finding was particularly significant because the analyses controlled for the possible effects of pain severity (at each measurement occasion), pain chronicity, age, gender, physical disability, depression, neuroticism and catastrophising. These findings suggest that pain self-efficacy beliefs are an important determinant of pain behaviours and disability associated with pain, over and above the effects of pain, distress and personality variables. In particular, higher pain self-efficacy beliefs are predictive of reduced avoidance behaviours over an extended period.
Development and validation of a short-form Pain Medication Attitudes Questionnaire (PMAQ-14)
PAIN, 2016
Attitudes to pain medication are important aspects of adjustment to chronic pain. They are measured by the 47-item Pain Medication Attitudes Questionnaire (PMAQ). To measure those attitudes more quickly and easily, we developed and evaluated a 14-item PMAQ using data from three separate surveys of people with pain in the general population. In survey 1, participants (n=295) completed the 47-item PMAQ and measures of pain, analgesic use, analgesic dependence and attitudes to self-medication. For each of the seven PMAQ scales, the two items that best preserved the content of the parent scales were identified using correlation and regression. The 2item and parent scales had very similar relationships with other measures, indicating validity had been maintained. The resulting 14-item PMAQ was then completed by participants in survey 2 (n=241) and survey 3 (n=147), along with the same other measures as in survey 1. Confirmatory factor analysis showed that the 14-item PMAQ retained the 7-factor structure of the 47-item version, and correlations with other measures showed it retained the validity of the 47-item version. The PMAQ scale Need was the most significant independent predictor of analgesic dependence in each of four separate multiple regression analyses. This short form of the PMAQ allows attitudes to pain medications to be measured in a valid and more efficient way.
Pain self-efficacy questionnaire and its use in samples with different pain duration time
Revista Dor, 2018
BACKGROUND AND OBJECTIVES: The pain self-efficacy questionnaire has been frequently used in several languages, but its use is limited to chronic pain. This study aimed to i) evaluate the properties of the pain self-efficacy questionnaire among Brazilians with different durations of pain occurrence; ii) present a new proposal for estimation of the overall self-efficacy belief score; and iii) compare such score among different pain duration time. METHODS: A total of 1,155 adults (79.0% women; 38.6±10.8 years) participated, 337 had no pain, 386 reported pain for less than 3 months, 253 reported pain for more than 3 months with a recurrent pattern, and 179 reported continuous pain for more than 3 months. The confirmatory factor analysis was performed to check the pain self-efficacy questionnaire unifactorial model good-fit. The pain self-efficacy questionnaire invariance was tested in independent samples using multigroup analysis. We proposed the calculation of the self-efficacy belief score from the factor score obtained in the confirmatory factor analysis. The score was compared among groups (ANOVA, alpha=5%). RESULTS: After inserting four correlations between errors of items, the pain self-efficacy questionnaire model shows to be fit to the sample (X2/df=7.059; CFI=0.978; GFI=0.964; RM-SEA=0.072). The model was invariant between independent samples. Lower self-efficacy belief was found among participants with pain for less than three months (p<0.05). Pain self-efficacy questionnaire and its use in samples with different pain duration time Questionário de autoeficácia relacionado à dor e seu uso em amostra com diferentes durações de ocorrência de dor
PLOS ONE, 2019
This study aimed to investigate whether changes in psychosocial factors and pain severity were associated with reduction in disability due to pain among patients with chronic pain. We hypothesized that increased self-efficacy would reduce disability. Patients and methods This longitudinal observational study included 72 patients. Patients' psychological and physical variables were assessed before and after 3 months of treatment. Demographic and clinical information were collected, including the Pain Disability Assessment Scale (PDAS), the Pain Self-Efficacy Questionnaire (PSEQ), the Hospital Depression and Anxiety Scale, and the Numeric Rating Scale (NRS) to assess pain intensity. First, univariate regression analyses were conducted to clarify associations between change in PDAS and sex, age, pain duration, changes in psychosocial factors (self-efficacy, anxiety, and depression) and change in pain intensity. Second, multivariate regression was conducted using the variables identified in the univariate analyses (PSEQ and NRS) to detect the most relevant factor for reducing disability. Results Univariate regression analyses clarified that changes in PSEQ (β = −0.31; 95% CI: −0.54-−0.08, p = 0.008) and NRS (β = 0.24; 95% confidence interval [CI]: 0.01-0.47, p = 0.04) were associated with reduction in PDAS. Multivariate regression analysis demonstrated that change in PSEQ (β = 0.26; 95% CI: −0.50-−0.02; p = 0.01) was associated with a reduction in disability, independent of change in NRS.