Longitudinal epidemiology of pain severity and interference among women with metastatic breast cancer

Knowledge is limited about risk factors for cancer pain experienced over the course of disease in specific tumor types. In this study, we assessed pain hazards using data originally collected over 51 weeks in a clinical trial among 1,124 women with metastatic breast cancer; pain was measured by the Brief Pain Inventory (BPI) severity and interference with daily living 0-10 subscales. Under a continuous time assumption, we conducted univariate (per-cutpoint) and multivariate (cutpoints 3, 4, 5, 6, and 7 on the BPI) proportional hazards analyses to estimate effects of baseline characteristics on pain hazards. For the severity scale, compared with Caucasian race, non-Caucasian race was associated with 2.29 times the hazard of reaching severity cutpoint 7 versus 1.38 for cutpoint 3, all other covariates held constant. For the interference scale, compared with active baseline Eastern Cooperative Oncology Group (ECOG) status, restricted baseline ECOG status was associated with 2.97 times the hazard of reaching interference cutpoint 7 versus 2.00 for cutpoint 3. Under a categorical (interval-censored) time assumption, we used piecewise exponential models to estimate associations of baseline and time-dependent characteristics with "survival" rates for not yet reaching a score of 7 or above on each subscale, per 80-day interval. Estimated survival rates at the first interval were 0.92 for Caucasian women versus 0.80 for non-Caucasian women; for the interference scale, these rates were 0.80 versus 0.70, respectively. In subsequent intervals, rates declined similarly for Caucasian and non-Caucasian women, but for both pain outcomes, the cumulative survival rate for Caucasians in the last interval was still higher than that of non-Caucasians in the first interval. In confirming associations of ECOG performance status (both as a baseline and timedependent covariate) and race with pain hazards over time in metastatic breast cancer, our findings inform individualized prognoses for pain outcomes according to baseline patient attributes. Early intervention and more aggressive pain management strategies can be tailored to these personalized prognoses over the course of treatment, to delay first occurrence of higher pain scores among those at greatest risk. Future research should specifically target potential sources of racial disparities in cancer pain

Spine and Pain Clinics Serving North Carolina Patients With Back and Neck Pain: What Do They Do, and Are They Multidisciplinary?

Cross-sectional survey

Exercise prescription for chronic back or neck pain: Who prescribes it? who gets it? What is prescribed?

While current practice guidelines promote exercise for chronic back and neck pain, little is known about exercise prescription in routine care. The objective of this study was to describe exercise prescription in routine clinical practice for individuals with chronic back or neck pain

The Rising Prevalence of Chronic Low Back Pain

National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP, and the demographic, health-related, and care-seeking characteristics of individuals with the condition have changed over the past 14 years

Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care.

BackgroundThe Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States.MethodsWe collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses.ResultsWhen measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state.ConclusionsReducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources