(227) Comparative Study of Intra-Articular Morphine, Fentanyl or Bupivacaine for Knee Surgery

Abstract

Chronic pain is increasingly prevalent, with associated disability carrying a high economic cost and related depression having a negative effect on the quality of life for patients and their families. A growing base of research supports that self-efficacy beliefs significantly contribute to the extent that a person is disabled by their chronic pain. To help explain the circumstances under which disability develops and why so many chronic pain patients become depressed a path analytic model was tested in 3 samples conceptualizing self-efficacy as a mediator of the disability and depression that results from chronic pain. One sample included patients evaluated at a major referral center and a second sample was derived from patients at a community-based primary care and specialty clinic in a non-urban center. A third sample was obtained from both of those settings, however patients in this sample were screened in a manner that excluded patients who had a history of depression prior to the onset of their pain. All patients completed questionnaires prior to an initial consultative visit with a pain specialist at one of the two outpatient pain clinics in New England. A total of 476 participants provided complete data on all model variables, met the eligibility criteria and consented to be included in the study (Tertiary Center, n ϭ 225; Community-based Clinic n ϭ 136; and combined setting with No Prior Depression, n ϭ 115). Self-efficacy was supported as a mediator and in conjunction with pain intensity contributes to over a third of the explained variance in disability and depression. Slight differences were noted in patients based on the setting, and their history of depression prior to the onset of chronic pain. These findings add to the support that the person's belief in their own abilities is a contributor to the depression and disability, that afflicts many chronic pain patients. (201) The Effect of an IntegratedCognitive-behavioral treatment programs have demonstrated the ability to reduce pain, emotional distress and disability for individuals with chronic pain. Investigators suspect a change in self-efficacy beliefs may be the mechanism by which these positive outcomes occur. This investigation examined pre-and post-program data from participants of an integrated cognitive-behavioral program, to identify patterns of change in the areas of pain intensity (visual analogue scale), self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), pain-related disability (Pain Disability Index) and depression (CES-D) in 170 chronic pain patients. At the end of the 10-session treatment program, the greatest area of change was an increase in self-efficacy levels by 38% from baseline. This increase was significantly (p Ͻ 0/00.1) associated with a 24% reduction in pain intensity, while disability and depression scores declined by 17% and 28% respectively. Patients responding to a follow-up survey one year after completion (n ϭ 41) reported continued improvements. Pain, disability and depression scores declined to 27%, 25%, an...