The relationship of demographic and psychosocial variables to pain-related outcomes in a rural chronic pain population

Abstract

Rural residency and low socioeconomic status (SES) are associated with increased likelihood of chronic pain. Other demographics are also differentially associated with the experience of pain. This study examines the relations between demographic and pain-related variables in a virtually unstudied population of rural Alabama chronic pain patients. One-hundred-and-fifteen patients completed validated measures of pain catastrophizing, depression, pain intensity, pain interference, perceived disability, and life satisfaction. Average age of study participants was 52-years, 79% were female, 74% were African-American, 72% reported annual income between 00,000-12,999, and 61% were unemployed. Although average years of reported education was 12.26, reading level percentile (primary literacy indicant) was 17.33. Cross-sectional multivariate and univariate analyses were conducted to examine associations among demographic and psychosocial variables in relation to various pre-treatment pain-related variables. The mediating role of pain catastrophizing and depression was investigated. Results indicate that race was significantly associated with pain intensity and pain interference, such that African-Americans reported higher scores than White-Americans. Pain catastrophizing was uniquely associated with pain intensity, pain interference, and perceived disability; depression was uniquely associated with pain interference, and life satisfaction. Pain catastrophizing mediated the relation between primary literacy and pain intensity; age effects were differentially mediated by either pain catastrophizing or depression. These analyses provide insight into the specific demographic and psychosocial factors associated with chronic pain in a low-literacy, low-SES rural population.

Source of prescription drugs used nonmedically in rural and urban populations

“…Differences in physician prescribing practices and use of prescription monitoring programs between geographic areas may contribute to the community supply of certain drugs (30,48,49). One study suggested that methadone is more commonly prescribed in rural areas for chronic pain than in urban areas (50).…”

Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain?

“…The recently reported RCT examined the feasibility and efficacy of a literacyadapted, culturally sensitive group CBT program in comparison to a similarly adapted Pain Education intervention [35]. Participants were rural, predominantly African-American people with chronic pain, and characterized by low socioeconomic status (SES) and low literacy [36]. Typically found to be largely inert, systematic reviews have reported no clinically significant effect of group education-based programs, such as "back schools [37][38][39]."…”

Prevalence of chronic pain in patients attending primary healthcare facilities in south-west Tshwane

“…11 The BPI was designed to assess the impact of pain and has been found to be reliable and valid, with an internal consistency (Chronbach's alpha = 0.85) in different cultural and socioeconomic settings. 12 The BPI was translated into four local South African languages. These translations were used as a reference by the research assistants.…”