Multiple Levels of Suffering

Mathur, Vani A.; Kiley, Kasey B.; Haywood, Carlton; Bediako, Shawn M.; Lanzkron, Sophie; Carroll, C. Patrick; Buenaver, Luis F.; Pejsa, M.; Edwards, Robert R.; Haythornthwaite, Jennifer A.; Campbell, Claudia M.

doi:10.1097/ajp.0000000000000361

Cited by 60 publications

(15 citation statements)

References 64 publications

(81 reference statements)

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“…This mixed methods analysis used data from the DISC Study to identify aspects of patient experiences associated with perceived racial/ethnic discrimination in healthcare among a large, diverse sample of patients being treated for pain. It is important to understand experiences of perceived discrimination in healthcare settings for patients with pain, specifically, as experiences of discrimination have been linked to increased pain sensitivity, pain severity, disability, and development of chronic pain [8,9,[28][29][30][31]. In addition, there are well-documented racial/ethnic disparities in both the clinical impact and treatment of pain, for which discrimination may be a contributing factor [14,17,32].…”

Section: Discussionmentioning

confidence: 99%

“…Feeling as though one has been treated unfairly because of one's membership in a stigmatized group, referred to as perceived discrimination, is associated with less favorable health-related behaviors, mental health, and physical health [1][2][3]. Perceiving discrimination specifically in healthcare settings has been found to be associated with less positive communication with providers, less satisfaction with care, and greater pain severity, among other unfavorable outcomes [4][5][6][7][8][9]. Given the sequelae of perceived discrimination, it is important to identify factors that contribute to perceived discrimination in healthcare.…”

Section: Introductionmentioning

confidence: 99%

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Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

et al. 2020

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Background Healthcare experiences associated with perceived racial/ethnic discrimination among patients are poorly understood. Objective Identify domains of patient dissatisfaction associated with perceived racial/ethnic discrimination among patients with pain. Design Semi-structured telephone surveys completed in 2013-2015. Participants White, African American, and Latino participants who reported receiving pain management from 25 Veterans Affairs (VA) Medical Centers. Main measures Surveys included open-ended questions about healthcare satisfaction/dissatisfaction and a measure of perceived racial/ethnic-based discrimination while seeking VA healthcare. Binary indicators for ten qualitative domains of dissatisfaction were derived from openended questions. We used multilevel models to identify dissatisfaction domains associated with perceived discrimination, adjusting for patient characteristics and site. Within domains associated with discrimination, we identified the most frequent codes and examined whether patients primarily referenced clinical or non-clinical staff in their experiences.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

et al. 2020

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“…Further, stigma, negative provider attitudes, and perceived racial bias are associated with SCD pain, 379,380 which may compromise care, thus leading to increased suffering from pain and pain care delivery. [381][382][383][384][385] • RECOMMENDATION 3A: Develop comprehensive care delivery models for SCD pain management, including collaborative partnerships among pain medicine, SCD specialists and advocates, and multidisciplinary teams.…”

Section: Gapmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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“…Racial discrimination is related to lower heat pain tolerance in African Americans with OA (Goodin et al, 2013) and increased low back pain in African Americans (Edwards, 2008). Racial discrimination is also related to a greater burden of pain and more pain sensitivity in those with sickle cell disease (Haywood et al, 2014; Mathur et al, 2016).…”

mentioning

confidence: 99%

Pain, Racial Discrimination, and Depressive Symptoms among African American Women

Taylor

Campbell

Thorpe

et al. 2018

Pain Management Nursing

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African American women with osteoarthritis (OA) are at high risk of experiencing pain. They report more pain than non-Hispanic White women and men of other racial/ethnic groups. This pain can limit independence and diminish their quality of life. Despite the detrimental effects that pain can have on older African American women with OA, there is a dearth of literature examining factors beyond the OA pathology that are associated with pain outcomes within this population. The purpose of this study was to examine the relationships between racial discrimination and depressive symptoms with pain intensity in African American women with OA. The sample comprised of 120 African American women, aged 50-80 years, with OA, from Texas and New Mexico. The women completed survey booklets to answer study questionnaires. We used multiple linear regression to test associations between racial discrimination, depressive symptoms, and pain intensity. We tested whether depressive symptoms mediated the relationship between racial discrimination and pain intensity by using bootstrapping. Results indicated that racial discrimination was significantly associated with pain intensity and that this relationship was mediated by depressive symptoms, even after controlling for body mass index, years of education, and length of time with OA. Both depressive symptoms and racial discrimination may be modifiable. If these modifiable factors are addressed in this population, there may be decreased pain in middle-aged and older African American women.

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Multiple Levels of Suffering

Cited by 60 publications

References 64 publications

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Pain, Racial Discrimination, and Depressive Symptoms among African American Women

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