Cancer and Breakthrough Pain's Impact on a Diverse Population

Background.  Although breakthrough pain (BTP; pain flares interrupting well-controlled baseline pain) is common among patients with cancer, its prevalence, characteristics, and impact on health-related quality of life (HRQOL) are poorly understood in ethnic minorities. Methods.  This comparative study examines ethnic and gender differences in BTP characteristics and impact on HRQOL. Patients with stage III or IV cancer of the breast, prostate, colorectal, or lung, or stage II–IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 months, and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Results.  Respondents (N = 96) were 75% white, 66% female with a mean age of 56 ± 10 years. All subjects experienced significant psychological distress, but there were no racial differences in depression prevalence. Minorities reported significantly greater severity for consistent pain at its worst ( P  = 0.009), least ( P  ≤ 0.001), on average ( P  = 0.004), and upon initial assessment ( P  = 0.04) as well as greater severity for BTP at its worst ( P  = 0.03), least ( P  = 0.02), and at initial assessment ( P  = 0.008). Although minorities reported more flare types (3.0 vs 1.8, P  = 0.001), there were no significant ethnic differences in the duration, quality, or location of pain flares. Minorities consistently reported poorer outcomes on each HRQOL subscale (physical, role, emotional, cognitive, and social functioning) measured, although not statistically significant, as well as poorer QOL symptom control ( P  = 0.08) including lower dyspnea control ( P  = 0.002). Conclusions.  Overall, minorities experienced greater consistent and breakthrough pain as well as poorer HRQOL. These data suggest further health care disparities in the cancer and pain experience for minorities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72924/1/j.1526-4637.2009.00564.x.pd

Predictors of Complementary and Alternative Medicine Use in Chronic Pain Patients

We used Andersen's behavioral model of healthcare utilization to assess the relationship between sociodemographic, physical and psychosocial factors, and Complementary and Alternative Medicine (CAM) use among chronic pain patients. Three practitioner-based alternative therapies were considered: acupuncture, biofeedback/relaxation training, and manipulation services.A retrospective analysis of self-reported clinical data with 5,750 black and white adults presenting for initial assessment between 1994 and 2000 at the University of Michigan Multidisciplinary Pain Center was performed.CAM therapies were used in high frequencies, with 34.7% users. Specifically 8.3% used acupuncture, 13.0% used biofeedback/relaxation, and 24.9% used manipulation techniques. Race and age were predisposing factors associated with CAM use. Blacks used less biofeedback/relaxation and manipulation services than whites. Aging was related to more acupuncture, but less biofeedback/relaxation use. Women marginally used more biofeedback/relaxation services than men, and education was positively associated with all three CAM use. Perceived pain control was a consistent enabling factor positively correlated with the use of all three CAM services. Among need factors, pain characteristics and physical health were positively associated with at least one of the modalities. Depressive symptoms were not related to CAM services use.This study identifies variable patterns of CAM usage based on sociodemographic and health factors in chronic pain patients. Overall, who uses CAM depends on the modality; however, education, pain severity, and pain duration are persistent correlates of CAM usage regardless of the therapy considered. We found that mental health, as measured by depressive symptoms, had no noticeable impact on CAM usage among chronic pain patients. The clinical, policy, and research implications of CAM use are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78625/1/j.1526-4637.2009.00767.x.pd

Attitudes towards complementary and alternative medicine in chronic pain syndromes: a questionnaire-based comparison between primary headache and low back pain

<p>Abstract</p> <p>Background</p> <p>Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM.</p> <p>Methods</p> <p>Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients.</p> <p>Results</p> <p>In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p = 0.006), "take action against the disease" (56.8% vs. 43.2%; p = 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience.</p> <p>Conclusion</p> <p>Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdens for daily life.</p

Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African Countries

In the first of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues find low levels of surgical care provision suggesting unmet need for surgical services

Parents' decision making and access to preventive healthcare for young children: Applying Andersen's Model

Background and objective: Implementing preventive health care for young children provides the best chance of improving health and changing a child's life course. In Australia, despite government support for preventive health care, uptake of preventive services for young children is low. Using Andersen's behavioural model of health-care utilization, we aimed to understand how parents conceptualized their children's preventive health care and how this impacted on access to preventive health-care services. Design: Semi-structured telephone interviews conducted between May and July 2011. Setting and participants: Twenty-eight parents of children aged 3-5 years from three diverse socio-economic areas of Melbourne, Australia. Results: Thematic analysis showed parents' access to child preventive health care was determined by birth order of their child, cultural health beliefs, personal health practices, relationship with the health provider and the costs associated with health services. Parents with more than one child placed their own experience ahead of professional expertise, and their younger children were less likely to complete routine preventive health checks. Concerns around developmental delays required validation through family, friends and childcare organizations before presentation to health services.Conclusions: To improve child preventive health requires increased flexibility of services, strengthening of inter-professional relationships and enhancement of parents' knowledge about the importance of preventive health in early childhood. Policies that encourage continuity of care and remove point of service costs will further reduce barriers to preventive care for young children. Recent reforms in Australia's primary health care and the expansion of child preventive health checks into general practice present a timely opportunity for this to occur

Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

In the second of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues describe the range of providers of surgical care and anesthesia and estimate the related costs

Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification

The current study focuses exclusively on middle-aged and old-aged adults with incident diabetes, and describes the course of diabetes in late adulthood in terms of physical, mental, and cognitive health change. To do this, it utilizes time-varying diabetes duration as the measure of time to define health trajectories after diabetes diagnosis. The study consists of three empirical analyses of the Health and Retirement Study, an ongoing representative biennial panel survey of Americans age 50 and older. Each study covers a different domain of health, and together they provide a comprehensive and dynamic view of people’s experiences with diabetes. Hierarchical linear models of health change with longer diabetes duration (used as the measure of time), reveals that the course of diabetes is characterized by a quadratic acceleration in physical disability and a linear decline in mental and cognitive health. People who are older at the time of diagnosis, younger cohorts, women (due to lower socioeconomic status), blacks and Hispanics (partly due to socioeconomic disadvantage and health disparities before diagnosis) are generally at increased risk of a poor course of diabetes, when compared to their counterparts. Cumulative or persistent socioeconomic disadvantages were found for all outcomes, with worse health trajectories among older adults whose socioeconomic status was lower, with the exception of those in the top two income quartiles, who experienced a faster decline in mental health despite better scores at diagnosis. The study results confirm that diabetes cannot be viewed as a time-constant individual characteristic. Rather, the clinical course of diabetes in terms of physical, mental, and cognitive health changes with longer diabetes duration. Social variations in these changes need to be better understood so that effective healthcare and policy interventions can be devised to ensure successful and equitable aging with late-onset diabetes.PhDHealth Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113478/1/kndaobr_1.pd