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Social Contact Frequency and Pain among Older Adults with HIV: An Ecological Momentary Assessment Study
Abstract
Background
Social relationships are important for pain management among individuals with HIV, but the impact of daily social contact on pain responses in real-time, real-world settings has never been specifically examined.
Purpose
The purpose of the present study was to examine the relationship between social contact frequency and pain, and the role of negative and positive affect in this relationship among older adults with HIV using ecological momentary assessment (EMA).
Methods
A total of 66 (Mage = 59.3, SD = 6.3, range: 50–74) older adults with HIV completed EMA surveys that included social contact frequency, pain level, and negative and positive affect four times per day for 2 weeks. Mixed-effects regression models were used to examine concurrent and lagged associations between social contact frequency, pain, and negative and positive affect.
Results
Greater recent social contact frequency was associated with less severe current pain (unstandardized B = −0.04, 95% CI: −0.08, −0.01, p = .014), while greater current pain was associated with lower subsequent social contact frequency (unstandardized B = −0.07, 95% CI: −0.11, −0.03, p < .001). Further, higher current negative affect was related to greater current pain, and this relationship was dampened by increased recent social contact frequency (unstandardized B = −0.17, 95% CI: −0.26, −0.08, p < .001). Neither negative nor positive affect was significantly associated with the relationship between current pain and subsequent social contact frequency.
Conclusions
Social contact frequency and pain are bidirectionally and inversely associated among older adults with HIV. Further, recent social contact influences current pain by attenuating negative affect. Together, these results highlight the need to address social engagement in interventions for pain among older adults with HIV.
... Only intensive and ecologically valid measurement tools can adequately capture this diversity. Although the influence of social contact on pain has been acknowledged in the literature [1,21], very few studies have investigated this interplay in daily life settings [22,64,65]. ...
... In a larger sample of older adults with HIV (n=66) and smartphone surveys (4/day for 2 weeks), Herbert et al [64] sought to replicate the results reported by Paolillo et al [65], showing an association between recent social contact and lower current pain. In contrast, Herbert et al [64] found that higher current pain was temporally associated with less subsequent social contact. ...
... In a larger sample of older adults with HIV (n=66) and smartphone surveys (4/day for 2 weeks), Herbert et al [64] sought to replicate the results reported by Paolillo et al [65], showing an association between recent social contact and lower current pain. In contrast, Herbert et al [64] found that higher current pain was temporally associated with less subsequent social contact. Interestingly, recent social contact buffered the relation between negative affect and current pain, as only those with low contact frequency exhibited an increase in pain with higher negative affect. ...
Pain is a biopsychosocial phenomenon, resulting from the interplay between physiological and psychological processes and social factors. Given that humans constantly interact with others, the effect of social factors is particularly relevant. Documenting the significance of the social modulation of pain, an increasing number of studies have investigated the effect of social contact on subjective pain intensity and pain-related physiological changes. While evidence suggests that social contact can alleviate pain, contradictory findings indicate an increase in pain intensity and a deterioration of pain coping strategies. This evidence primarily stems from studies examining the effect of social contact on pain within highly controlled laboratory conditions. Moreover, pain assessments often rely on one-time subjective reports of average pain intensity across a predefined period. Ecological momentary assessments (EMAs) can circumvent these problems, as they can capture diverse aspects of behavior and experiences multiple times a day, in real time, with high resolution, and within naturalistic and ecologically valid settings. These multiple measures allow for the examination of fluctuations of pain symptoms throughout the day in relation to affective, cognitive, behavioral, and social factors. In this opinion paper, we review the current state and future relevance of EMA-based social pain research in daily life. Specifically, we examine whether everyday-life social support reduces or enhances pain. The first part of the paper provides a comprehensive overview of the use of EMA in pain research and summarizes the main findings. The review of the relatively limited number of existing EMA studies shows that the association between pain and social contact in everyday life depends on numerous factors, including pain syndromes, temporal dynamics, the nature of social interactions, and characteristics of the interaction partners. In line with laboratory research, there is evidence that everyday-life social contact can alleviate, but also intensify pain, depending on the type of social support. Everyday-life emotional support seems to reduce pain, while extensive solicitous support was found to have opposite effects. Moreover, positive short-term effects of social support can be overshadowed by other symptoms such as fatigue. Overall, gathering and integrating experiences from a patient’s social environment can offer valuable insights. These insights can help interpret dynamics in pain intensity and accompanying symptoms such as depression or fatigue. We conclude that factors determining the reducing versus enhancing effects of social contact on pain need to be investigated more thoroughly. We advocate EMA as the assessment method of the future and highlight open questions that should be addressed in future EMA studies on pain and the potential of ecological momentary interventions for pain treatment.
... Most studies were cross-sectional (n = 32) ; 5 were longitudinal [67][68][69][70][71], and 4 used other study designs (e.g., Ecological Momentary Assessment studies or interrupted time series) [72][73][74][75]. Included studies were published between 2010 and 2023; earlier studies from the late 1980s to early 2000s understandably included mostly younger adults (given that the HIV epidemic began in the late 1970s and individuals are now aging with HIV in the era of antiretroviral therapy). ...
... Greater levels of social support were associated with reduced odds of falling and loneliness and living alone were associated with increased odds of falls [42,47] and fractures [42]. Loneliness was also associated with the presence of chronic pain [56] and more frequent social contact was associated with lower pain [72]. Associations between loneliness and self-rated health Content courtesy of Springer Nature, terms of use apply. ...
Self-management of HIV is crucial to reduce disease-related negative health outcomes. Loneliness and social isolation are associated with poor disease self-management (e.g., medication non-adherence and care disengagement) in younger people with HIV and negative health outcomes in the general older adult population. Older adults with HIV (OWH) are at increased risk for loneliness and social isolation, but the associated health outcomes remain unclear. A comprehensive review of Pubmed, Embase, PsycINFO, and Web of Science databases was conducted. Criteria for inclusion were original quantitative research, published in the English language, included adults with a mean age ≥ 50 years, and included a measure for loneliness or social isolation, and a health outcome measure. A total of 41 studies were analyzed and 19,282 participants contributed to this review. The main findings were that loneliness and social isolation were associated with negative health behavior, disease self-management, physiological, and psychological outcomes. Pooled prevalence of loneliness was 33.9% across 8 studies. Loneliness and social isolation are highly prevalent in OWH and are associated with negative outcomes in OWH, similarly to older adults in the general population. Older adults with HIV, however, are challenged by unique psychosocial circumstances that place them at greater risk for loneliness and social isolation and associated negative health outcomes. These findings should be verified in larger, diverse, and longitudinal samples to better understand interrelationships of psychosocial factors and clinical outcomes in OWH.
... Furthermore, adverse health-related factors (i.e., poorer self-rated health and more depressive symptoms) were associated with a stronger preference for solitude. Individuals reporting poor health may suffer pain and discomfort [35], hindering social interactions [36]. Moreover, individuals with perceived poor health may prefer being alone as they may struggle to participate in social activities. ...
Aim
Our first aim was to present norm values for the Preference for Solitude Scale by sex, age, and other sociodemographic groups. Our second aim was to evaluate the correlates of preference for solitude.
Methods
Data were collected in August/September 2023 from a sample of individuals (N = 5000) living in Germany aged 18 to 74 years (ensuring representativeness in terms of sex, age group and federal state for the German general adult population). The established and valid Preference for Solitude Scale (range 0 to 12, with higher values reflecting a stronger preference for solitude) was used to quantify the preference for solitude. Norm values were provided by sex and age groups. Multiple linear regressions were used to examine the correlates of preference for solitude.
Results
Average preference for solitude score was 7.6 (SD = 3.0; 0 to 12). The average score was 7.3 (SD = 3.0) among males and 7.9 (SD = 2.9) among females. Regressions showed that a stronger preference for solitude was associated with being female (β = .51, p < .001), being older (e.g., being 40 to 49 years compared to 18 to 29 years, β = .85, p < .001), being single (e.g., divorced compared to being single, β = -.78, p < .01), higher level of education (secondary education compared to primary education, β = .43, p < .01), never been a smoker (e.g., daily smoker compared to never smokers, β = -.61, p < .001), absence of alcohol consumption (e.g., drinking once a week compared to never drinking, β = -1.09, p < .001), no sports activity (e.g., 2–4 hours per week compared to no sports activity, β = -.60, p < .001), poorer self-rated health (β = .28, p < .001) and more depressive symptoms (β = .05, p < .001). Sex-stratified regressions yielded similar results.
Conclusion
Norm values provided in this study can be used as a benchmark for comparison with other countries and can guide further research dealing with preferences for solitude. We demonstrated the importance of several sociodemographic factors (e.g., marital status), lifestyle-related factors (e.g., sports activity), and health-related factors (e.g., depressive symptoms) for the preference for solitude. Such knowledge about the correlates of preference for solitude may help to characterize them. This is essential to ensure a good balance between social interaction and being alone. This is important because preference for solitude is associated with poor self-rated health and depression, but also with healthy behaviors such as abstaining from smoking and drinking
A comprehensive understanding of the patterns of psychosocial characteristics in older adults with pain is needed. Our objectives were to (1) identify psychosocial phenotypes (comprising depression, anxiety, affect, self-realization, resilience, and social participation) among older adults with pain and (2) compare pain characteristics, physical health, and cognition among the identified phenotypes. Using cross-sectional 2021 data from the National Health and Aging Trends Study, we performed latent class analysis to identify four psychosocial phenotypes of older adults with pain ( N = 1903): Favorable (best psychosocial characteristics, 67.7%), Adverse (worst psychosocial characteristics, 4.9%), Intermediate (moderate scores on psychosocial variables, 12.6%), and Compensated (moderate scores with relatively high self-realization and resilience, 14.9%). Phenotypes with less psychosocial adversity had generally better clinical outcomes. Future research should explore precision pain management interventions in older adults based on their psychosocial phenotypes, longitudinal trajectories of phenotypes, and technology-based, point-of-care clinical insights for pain management.
Objectives: People living with HIV (PWH) have seen reduction in HIV-associated morbidity and increase in near-normal life expectancy, yet unhealthy alcohol use poses substantial risks to older as well as younger adults. Further research regarding age-associated physical and mental health concerns among PWH who drink alcohol is needed to inform services, given the expanding age range of patients in care.
Methods: We compared age group differences (18–34, 35–44, 45–54, ≥55 years old) in two-year patient-reported outcomes and HIV viral control among PWH enrolled in a primary care-based behavioral alcohol intervention trial; with 90% follow up from baseline.
Results: Of 553 PWH, 50 (9%) were 18–34, 85 (15%) were 35–44, 197 (36%) were 45–54, and 221 (40%) were ≥55 years old. Most were men (97%) and White (64%). At two years, PWH ≥55 reported less substance use in the prior 30 days, fewer social contacts, and more pain; younger PWH had lower antiretroviral therapy (ART) adherence. In adjusted analyses, PWH ages 18–34 had higher odds of unhealthy alcohol use, tobacco, cannabis, or other substances compared to those ≥55; with higher odds of anxiety among PWH 35–44 compared with those ≥55; and physical quality of life was worse among those ≥55 compared with younger groups.
Conclusions: While older PWH report less substance use than younger PWH and have better ART adherence post-treatment, they are more likely to experience limited social support and worse physical quality of life. Findings can inform interventions to address varying needs of PWH across the lifespan.
Objective:
Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone.
Methods:
Adolescent and Young Adult (AYA) survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol.
Results:
Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety.
Conclusions:
Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety. This article is protected by copyright. All rights reserved.
Objectives
Suicide in the elderly is a complex and significant public health problem. The purpose of our study was to examine the role of loneliness and social integration as potential mediators in the relationship between physical pain and suicidal ideation in the elderly.
Design
Descriptive, bivariate correlations, and moderated mediation analyses were performed.
Setting
Personal meetings were held with participants in their homes.
Participants
A total of 198 elderly men aged 65 and over.
Measurements
Self-report measures: Beck Scale for Suicidal Ideation, Physical pain subscale, Multidimensional Social Integration in Later Life Scale, and University of California, Los Angeles (UCLA) Loneliness Scale (Version 3).
Results
Our findings showed that the association between physical pain and suicidal ideation was mediated by loneliness and social integration. Further analyses revealed that this mediation model was significant among single, but not married, men.
Conclusions
Physical pain and social factors are both important in understanding suicidality in late life. Elderly single men who experience physical pain may be lonelier and less socially integrated, and these factors may contribute to higher risk of suicidal ideation.
Abstract Effect size reporting is crucial for interpretation of applied research results and for conducting meta-analysis. However, clear guidelines for reporting effect size in multilevel models have not been provided. This report suggests and demonstrates appropriate effect size measures including the ICC for random effects and standardized regression coefficients or f 2 for fixed effects. Following this, complexities associated with reporting R 2 as an effect size measure are explored, as well as appropriate effect size measures for more complex models including the three-level model and the random slopes model. An example using TIMSS data is provided.
Background:
Social isolation is associated with an increased risk for mental and physical health problems, especially among older persons living with HIV (PLWH). Thus, there is a need to better understand real-time temporal associations between social activity and mood- and health-related factors in this population to inform possible future interventions.
Objective:
This study aims to examine real-time relationships between social activity and mood, fatigue, and pain in a sample of older PLWH.
Methods:
A total of 20 older PLWH, recruited from the University of California, San Diego HIV Neurobehavioral Research Program in 2016, completed smartphone-based ecological momentary assessment (EMA) surveys 5 times per day for 1 week. Participants reported their current social activity (alone vs not alone and number of social interactions) and levels of mood (sadness, happiness, and stress), fatigue, and pain. Mixed-effects regression models were used to analyze concurrent and lagged associations among social activity, mood, fatigue, and pain.
Results:
Participants (mean age 58.8, SD 4.3 years) reported being alone 63% of the time, on average, (SD 31.5%) during waking hours. Being alone was related to lower concurrent happiness (beta=-.300; 95% CI -.525 to -.079; P=.008). In lagged analyses, social activity predicted higher levels of fatigue later in the day (beta=-1.089; 95% CI -1.780 to -0.396; P=.002), and higher pain levels predicted being alone in the morning with a reduced likelihood of being alone as the day progressed (odds ratio 0.945, 95% CI 0.901-0.992; P=.02).
Conclusions:
The use of EMA elucidated a high rate of time spent alone among older PLWH. Promoting social activity despite the presence of pain or fatigue may improve happiness and psychological well-being in this population.
Purpose of Review
This review summarizes how aging contributes to pain chronification and how recent developments in neuroscience can inform management of chronic pain in the elderly.
Recent Findings
Normal aging can boost pain chronification through neurodegeneration, alterations in circadian rhythms, inflammaging, as well as musculoskeletal deterioration and metabolic dysregulation. These processes are interconnected and bidirectional. There is accumulating evidence for the central role of inflammaging in chronic pain, and novel therapies are in development to address inflammaging. Social support and relapse prevention are particularly important aspects of interventions in the elderly.
Summary
The confluence of multiple neurobiological mechanisms in the course of aging and pain chronification calls for an integrative health approach to management. In addition to pharmacotherapy, a comprehensive approach should include nutritional, psychological, and physical interventions.
Background and aims
Pain is not merely an isolated experience occurring within the person. It takes place in a wider social context, including the immediate social relationships that the person is a part of. The aim of this paper is to provide an overview of how intercouple interactions might influence pain coping in couples coping with chronic pain.
Methods
Four different approaches to understanding the influence of intercouple interactions have been proposed in the literature. In this review, we present and discuss the empirical support for each of these models. A literature search on all studies published up until May 2017 (PubMed and PsycINFO) was performed. The search string consisted of 3 steps: Chronic pain AND couple interaction*/partner validation/marital interaction/chronic pain couple*/spouse response* AND coping/adjustment/disability/function/work participation/sick leave/sickness absence/work disability.
Results
The operant model views partner responses from the perspective of conditioned learning and focuses on how such responses might increase or decrease the occurrence of pain behaviour. The notion that partner responses can reinforce pain behaviour generally finds support in the literature. However, when it comes to negative partner responses results are mixed, and the model paints a limited picture of the range of interactions that takes place in a couple. The communal coping model focuses on one specific type of coping (i.e. catastrophizing), and emphasizes the interpersonal aspect of pain coping. There is some evidence that a tendency to catastrophize is related both to couple interactions and pain coping, but it has proved difficult to test this model empirically. The interpersonal process model of intimacy is concerned with patient disclosures of distress and subsequent validating and invalidating partner responses. There is some preliminary support that such mechanisms of validation and invalidation can be linked to pain coping. A dyadic approach focuses on processes where the couple negotiates a shared meaning of events and participates in mutual coping of a shared stressor. This approach has not been investigated explicitly, but preliminary support can be derived from studies conducted within other frameworks.
Conclusions
Each of the four approaches find some support in the research literature, yet none of them can explain the full range of couple interactions. We argue that the different approaches are complementary and that several of the approaches can be integrated in a dyadic understanding of pain coping.
Implications
All the models indicate that couple interactions can affect pain coping and that this should be taken into account when developing treatment programmes for chronic pain patients.
On the relationship between positive and negative affect: Their correlation and their co-occurrence. Emotion. Abstract Understanding the nature of emotional experience requires understanding the relationship between positive and negative affect. Two particularly important aspects of that relationship are the extent to which positive and negative affect are correlated with one another and the extent to which they co-occur. Some researchers have assumed that weak negative correlations imply greater co-occurrence (i.e., more mixed emotions) than do strong negative correlations, but others have noted that correlations may imply very little about co-occurrence. We investigated the relationship between the correlation between positive and negative affect and co-occurrence. Participants in each of two samples provided moment-to-moment happiness and sadness ratings as they watched an evocative film and listened to music. Results indicated (a) that four measures of the correlation between positive and negative affect were quite highly related to one another, (b) that the strength of the correlation between measures of mixed emotions varied considerably, (c) that correlational measures were generally (but not always) weakly correlated with mixed emotion measures, and (d) that bittersweet stimuli consistently led to elevations in mixed emotion measures but did not consistently weaken the correlation between positive and negative affect. Results highlight that the correlation between positive and negative affect and their co-occurrence are distinct aspects of the relationship between positive and negative affect. Such insight helps clarify the implications of existing work on age-related and cultural differences in emotional experience and sets the stage for greater understanding of the experience of mixed emotions.
Methods:
The Women's Interagency HIV Study (WIHS) is a multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced.
Results:
The association between internalized stigma and self-reported sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, p = .009, CI [0.52,0.91]), but not for non-Hispanic whites (AOR = 2.15, p = .19, CI [0.69,6.73]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted sub-optimal medication adherence.
Conclusions:
Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.
Researchers and policy makers have become increasingly interested in using happiness or subjective wellbeing (SWB) as an index of quality of life. We examine the utility of using SWB as a social indicator, arguing that SWB is intrinsically valuable as a measure of the end goal of all human activities and extrinsically valuable as a predictor of a wide range of positive outcomes and an indicator of the effects of changing societal conditions. Using the examples of wealth and unemployment, we show that changes in objective societal conditions influence individual and national SWB. Because SWB is sensitive to changes in societal conditions, it can be fruitfully used to measure societal progress. Encouraged by strong evidence that societal conditions influence SWB, researchers and policy makers should focus future efforts on identifying and implementing those societal changes that have the greatest potential to enhance happiness.
Objective
Chronic pain in individuals with HIV is a common, impairing condition. Behavioral interventions for chronic pain specifically tailored to this population have yet to be developed. We assert that understanding self-management strategies already used by persons living with these conditions is an essential first step, and is the objective of this investigation.DesignWe conducted a thematic analysis of qualitative data from 25 in-depth interviews with individuals with HIV and chronic pain.ResultsThe primary pain self-management strategies articulated by participants were: physical activity; cognitive and spiritual strategies; spending time with family and friends and social support; avoidance of physical/social activity; medication-centric pain management; and substance use.Conclusions
Some of these strategies may be viewed as beneficial and overlap with known HIV self-management strategies (cognitive strategies), whereas others may have negative health consequences (substance use). Interventions that incorporate healthy self-management strategies may be particularly effective in improving both HIV and pain outcomes.
Introduction
Pain is one of the most commonly reported symptoms in people living with HIV/AIDS (PLWHA). However, wide ranges of pain prevalence have been reported, making it difficult to determine the relative impact of pain in PLWHA. A systematic review of the literature was conducted to establish the prevalence and characteristics of pain and to explore pain management in PLWHA.
Methods
Studies that included cross-sectional data were included in the search, which was conducted in April 2012. Databases searched using a time limit of March 1982 to March 2012 included PubMed, Scopus, Africa-wide: NIPAD, CINAHL, PsychARTICLES, PSYCINFO, PSYCHIATRYONLINE, ScienceDirect and Web of Science. Search terms selected were “pain” and “HIV” or “acquired immune deficiency syndrome.” Two reviewers independently screened all citation abstracts for inclusion. Methodological quality was evaluated using a standardized 11-item critical appraisal tool.
Results
After full text review, 61 studies fulfilled the inclusion criteria. Prevalence of pain ranged from a point prevalence of 54% (95%CI 51.14–56.09) to 83% (95%CI 76–88) using a three-month recall period. The reported pain was of moderate-to-severe intensity, and pain was reported in one to two and a half different anatomical sites. Moderate levels of pain interference with function were reported. All nine studies reporting on the adequacy of pain management recorded marked under-treatment of pain.
Discussion
The studies reviewed reported that pain commonly presents at multiple pain sites with a range of severity suggesting that there are several differing pathological processes contributing to pain at one time. The interplay of variables associated with pain suggests that the biopsychosocial model of pain is an appropriate paradigm from which to view pain in PLWHA and from which to approach the problem, explore causes and establish effective treatment.
Conclusions
The results highlight that pain is common in PLWHA at all stages of the disease. The prevalence rates for pain in PLWHA do not appear to have diminished over the 30 years spanning the studies reviewed. The body of work available in the literature thus far, while emphasizing the problem of pain, has not had an impact on its management.
Abstract Pain represents a significant source of morbidity, function loss, and decreased quality of life among people living with HIV. The present study examined the associations among pain, pain treatment, and ARV adherence among indigent, HIV-positive substance abusers. Participants were recruited via targeted sampling strategies, and completed a one-time computer-assisted personal interview. ANOVA and chi square tests were used to analyze differences in demographics, health and psychological status, health behaviors, by pain and pain treatment status; a multivariate logistic regression model was constructed to examine the contribution of pain/treatment status to recent ARV adherence. Results indicated that those with untreated pain had lower odds of achieving gold-standard 95% ARV adherence as compared to the pain-free and treated pain groups; higher substance dependence symptoms were also associated with significantly lower odds of 95% ARV adherence. Findings suggest that pain management is critical to the health of people living with HIV, specifically those with high levels of co-morbid health and psychological problems. The prevalence of untreated pain was elevated among this group, and contributed to reduced ARV adherence. Providers of clinical care to disadvantaged HIV-positive patients should emphasize routine assessment and appropriate treatment of pain in order to provide comprehensive HIV care.
Maximum likelihood or restricted maximum likelihood (REML) estimates of the
parameters in linear mixed-effects models can be determined using the lmer
function in the lme4 package for R. As for most model-fitting functions in R,
the model is described in an lmer call by a formula, in this case including
both fixed- and random-effects terms. The formula and data together determine a
numerical representation of the model from which the profiled deviance or the
profiled REML criterion can be evaluated as a function of some of the model
parameters. The appropriate criterion is optimized, using one of the
constrained optimization functions in R, to provide the parameter estimates. We
describe the structure of the model, the steps in evaluating the profiled
deviance or REML criterion, and the structure of classes or types that
represents such a model. Sufficient detail is included to allow specialization
of these structures by users who wish to write functions to fit specialized
linear mixed models, such as models incorporating pedigrees or smoothing
splines, that are not easily expressible in the formula language used by lmer.
Epidemiologic studies in the United States have estimated that 1.1%-4.3% of the general population attempt suicide at some time in their lives, but limited information is available on suicidal attempts within the HIV-positive population after the introduction of effective antiretroviral therapy. In this study, we evaluate the profile and trends of attempted suicide in a sample of HIV patients in Bayamón, Puerto Rico.
A retrospective cohort study design was employed to analyze data from the HIV/AIDS longitudinal data bank generated in the Retrovirus Research Center at the Universidad Central del Caribe, Puerto Rico, from 2000 through 2004. We analyzed cumulative self-reported suicide attempts from 714 individuals. Annual percentage changes were assessed by using general linear model with Poisson distribution. Adjusted odds ratios were estimated by using logistic regression.
The prevalence of suicide attempts increased in the five-year period examined, from 9.0% to 22.0%. In our study, men were more likely to attempt suicide than were women. In addition, the risk factors most strongly related to suicide attempts after adjusting for age, sex, HIV/AIDS status at study entry, and injection drug use were stress factors related to filial relationships, use of psychoactive substance, and isolation. Changes in conducts related to depression, confusion and anxiety were positively associated with suicide attempts.
Prevention and intervention programs should embrace a more comprehensive approach to care for HIV/AIDS. This approach should recognize the psychological needs and provide the support these patients desperately need.
Research on emotion and pain has burgeoned. We review the last decade's literature, focusing on links between emotional processes and persistent pain.
Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection.
Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.
Advances in the treatment of HIV have resulted in a large growing population of older adults with HIV. These aging adults face added social, psychological, and physical challenges associated with the aging process. Correlations between depression, loneliness, health, and HIV/AIDS-related stigma have been studied, but there is little evaluation of these associations among HIV-positive adults over the age of 50. Data for these analyses were taken from the Research on Older Adults with HIV study of 914 New York City-based HIV-positive men and women over the age of 50. In total, 39.1% of participants exhibited symptoms of major depression (CES-D > 23). Multivariate modeling successfully explained 42% of the variance in depression which was significantly related to increased HIV-associated stigma, increased loneliness, decreased cognitive functioning, reduced levels of energy, and being younger. These data underscore the need for service providers and researchers to assert more aggressive and innovative efforts to resolve both psychosocial and physical health issues that characterize the graying of the AIDS epidemic in the USA. Data suggest that focusing efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health.
Social support becomes an increasingly critical resource for people as they age. In New York City, 25% of all people living with HIV/AIDS are over age 50, and 64% are over age 40. This study sample (n=160) reflects current HIV/AIDS epidemiology, with 34% females and 89% people of color. This study provides a detailed profile of this growing, aging cohort and their social networks. Our study finds this growing group of aging adults is isolated from informal networks due to the stigma of HIV/AIDS and ageism. Typically, partners and family members are key sources of informal support, but only 1/3 of respondents had a partner and 71% lived alone. This group relies heavily on friends, many of whom are also HIV-positive. Participants were in primary care and many (86%) utilized Medicaid. The fragile networks of these older adults will be challenged by age-related comorbidities. Without traditional caregivers, these aging adults with HIV/AIDS will have an immense impact on healthcare delivery and community-based programs.
This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.
Social support has been reliably related to lower rates of morbidity and mortality. An important issue concerns the physiological mechanisms by which support influences such health endpoints. In this review, I examine evidence linking social support to changes in cardiovascular, neuroendocrine, and immune function. Consistent with epidemiological evidence, social support appears to be related to more positive "biological profiles" across these disease-relevant systems. Recent research on immune-mediated inflammatory processes is also starting to provide data on more integrative physiological mechanisms potentially linking social support to health. The implications of these links, along with future research directions are discussed.
Ecological Momentary Assessment data present some new modeling opportunities. Typically, there are sufficient data to explicitly model the within‐subject (WS) variance, and in many applications, it is of interest to allow the WS variance to depend on covariates as well as random subject effects. We describe a model that allows multiple random effects per subject in the mean model (eg, random location intercept and slopes), as well as random scale in the error variance model. We present an example of the use of this model on a real dataset and a simulation study that shows the benefit of this model, relative to simpler approaches.
Research suggests that people living with HIV (PLHIV) experience levels of pain disproportionate to the general population. Pain is a stressor that can negatively impact health-related quality of life. As the number of people aging with HIV increases, we must understand the dynamics of pain experiences among PLHIV and how to effectively harness evidence-based treatments and supportive resources to enhance adaptive coping. We used experience sampling method (ESM; also called ecological momentary assessment) to assess moment-to-moment experiences of pain and social support three times a day for seven days in a sample of 109 men living with HIV. Participants also responded to questionnaires assessing attachment-related insecurity and social support. In hierarchical linear modeling analyses controlling for age, race, sexual orientation, and socioeconomic status, we found that experiences of social support were associated with lower subsequent pain within-persons. On the other hand, experiences of pain were not associated with later experiences of social support. Men with higher levels of attachment-related avoidance reported more pain on average. Attachment-related avoidance also moderated the association between moment-to-moment experiences of felt social support on pain. Results suggest that within-persons, experiences of daily social support reduce experiences of pain. Between-persons, attachment style may influence how individuals make use of social support in coping with experiences of pain. These findings imply a need to assess social well-being at the clinic level and also support tailored biopsychosocial approaches to pain management in HIV care settings.
Objective:
This review aimed to explore the processes that underlie the main and the buffering effect of social support on decreased pain experience.
Methods:
The systematic review was conducted according to the PRISMA guidelines. Online databases of PubMed and PsycINFO were searched for peer-reviewed articles using keywords (("social support", OR "interpersonal", OR "social presence", OR "spouse", OR "couple", OR "marriage") AND "pain"). Articles were included if they examined the cognitive or behavioural processes linking social support to any aspects of reduced pain experience.
Results:
The database search identified 38 studies, of which 33 were cognitive-behavioural studies and 5 were neurobiological. Cognitive-behavioural studies generated a total of 57 findings of the analgesic influence of social support. This effect was further categorized as social support decreasing the adverse influence of pain-related stress (28/44 findings), reappraising pain-related stress (7/9 findings), and facilitating coping attempts (2/4 findings). Of the 5 neurobiological studies, the influence of social support on pain reduction was associated with reduced neural and physiological stress systems in response to painful stimuli.
Discussion:
This review presents evidence that the stress-buffering effect is more often able to account for the relationship between social support and pain experience. Moreover, findings suggest the critical significance of stress appraisal and attenuated stress systems in linking social support to aspects of reduced pain experience. Findings implicate the role of integrating perceived support and intimacy in support-oriented interventional trials for chronic pain.
Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms.
Design: 181 PLWH from across the United States completed an online survey.
Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index.
Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms.
Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.
Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed in order to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (e.g. degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use co-morbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Co-located interventions for chronic pain in this setting should focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore since chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.
As the advent of highly active antiretroviral therapy, HIV has become a chronic disease for most individuals in developed countries. Chronic pain is a common occurrence for HIV-infected patients and has an impact on quality of life and antiretroviral adherence. The objective of this study was to examine relationships between chronic pain and depression, substance use, mental health treatment, and pain treatment in HIV-infected patients.
Cross-sectional study.
Three primary care sites where HIV+ patients receive treatment.
Two hundred and thirty eight HIV-infected primary care patients.
We collected self-report and chart-review information on demographics, HIV clinical status, chronic pain, depression, substance use, mental health treatment, and pain treatment. We collected data between October 2012 and November 2013.
Of the patients enrolled in this study, 107 reported no chronic pain, 24 reported mild chronic pain, and 107 reported moderate-severe chronic pain. Participants in the moderate-severe pain group were more likely to have high levels of depressive symptoms than those in the no chronic pain group. Similarly, there was a significant relationship between chronic pain status and interference with life activities due to pain. Participants with moderate-severe chronic pain were more likely to be taking an antidepressant medication than those with mild chronic pain, and more likely to be taking a prescription opioid than the other two groups. We did not find a significant relationship between problematic substance use and chronic pain status.
Despite pharmacologic treatment, moderate-severe chronic pain and elevated depression symptoms are common among HIV-infected patients and frequently co-occur.
Wiley Periodicals, Inc.
Social integration is increasingly recognized as key to successful aging; however, definitions and assessments vary greatly across gerontological studies. This study describes the development of and provides preliminary evidence for the multidimensional Social Integration in Later Life Scale (SILLS). A review of previous measures led to the development of a 30-item questionnaire, which was given to a community-based sample of 399 older adults (ages 60-100). Factor analysis was used to determine a four-factor structure that included dimensions of frequency-social ties, frequency-social activities, satisfaction-social ties, and satisfaction-social activities. The overall scale Cronbach's α was .86 (subscales ranged from .72 to .84), demonstrating good internal consistency. Preliminary results suggest that the SILLS has adequate concurrent and convergent validity. By assessing enacted and perceived integration across social ties and activities, this comprehensive measure is a useful tool for understanding social integration in later life.
© The Author(s) 2015.
Social contact frequency is a well-defined and relatively objective measure of social relationships, which according to many studies is closely associated with health and longevity. However, no previous meta-analysis has isolated this measure; existing reviews instead aggregate social contact with other diverse measures of social support, leaving unexplored the unique contribution of social contact to mortality. Furthermore, no study has sufficiently explored the factors that may moderate the relationship between contact frequency and mortality. We conducted meta-analyses and meta-regressions to examine 187 all-cause mortality risk estimates from 91 publications, providing data on about 400,000 persons. The mean hazard ratio (HR) for mortality among those with lower levels of social contact frequency was 1.13 (p < 0.05) among multivariate-adjusted HRs. However, sub-group meta-analyses show that there is no significant relationship between contact and mortality for male individuals and that contact with family members does not have a significant effect. The moderate effect sizes and the lack of association for some subgroups suggest that mere social contact frequency may not be as beneficial to one's health as previously thought.
Objectives:
To study the relationship between expected pain and future outcomes along with the moderating effects of expected pain in neuropathic pain patients.
Methods:
Study participants were recruited for the Canadian Neuropathic Pain Database. To examine the relationship between expected pain and 6-month pain intensity, pain-related disability, and catastrophizing, multiple regressions were performed. These relationships were adjusted for potential confounding (age, sex, baseline pain intensity, and psychological distress). To evaluate the moderating effect of expected pain on the relationship between baseline pain intensity and 6-month outcomes, pain intensity×expected pain interaction terms were created.
Results:
Complete data for analysis was available for 560 patients (71%). Expected pain was positively correlated with pain intensity and pain-related disability scores at 6 months. The relationship between baseline pain intensity and 6-month catastrophizing scores was moderated by expected pain (however, despite a similar trend, expected pain did not statistically moderate the relationship between baseline pain intensity and 6-month pain intensity or disability). At higher levels of pain, predicted catastrophizing scores were higher for those with low levels of expected pain than those with high levels of expected pain. An opposite relationship was observed for patients with the lower levels of pain.
Discussion:
In neuropathic pain patients whose pain does not respond to therapy, high levels of expected pain may relate to relatively lower catastrophizing scores by shifting focus away from futile attempts at "curing" pain toward focusing on achievement of more realistic personal goals.
Objective:
This narrative review summarizes and integrates the available literature on positive affect (PA) and pain to: (1) provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and pain; (2) provide a theoretical foundation from which to understand how PA operates in the context of chronic pain (CP); and (3) highlight how the prevailing psychosocial treatments for CP address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with CP.
Results:
In experimental studies, the evidence suggests PA is analgesic. In clinical studies, the association of PA and pain is dynamic, time variant, and may be best considered in context of its interacting role with negative affect.
Discussion:
We offer an "upward spiral" model of PA, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance CP self-management.
Human immunodeficiency virus (HIV)-infected patients in the current treatment era can achieve normal life expectancies but experience a high degree of medical and psychiatric comorbidity. Impaired physical function and pain, often in the context of mood disorders and substance abuse, are common in HIV-infected patients. The objective of this study was to investigate the relationship of pain, a modifiable condition, to functional impairment in HIV-infected patients, independent of mood disorders and substance abuse.
Participants in a prospective cohort of HIV-infected patients at the University of Alabama at Birmingham were included. Patient-reported outcome measures were used to cross-sectionally assess pain and physical function (EuroQOL), mood disorders (PHQ), and substance abuse (ASSIST). Univariate and multivariable models were built with pain as the principal independent variable of interest and three domains of physical function (mobility, self-care, and usual activities) as outcomes. Covariates included mood, substance abuse, age, race, sex, insurance status, HIV transmission risk factor, and CD4+ T-cell count.
Among 1,903 participants, 693 (37%) reported pain; 509 (27%) had a mood disorder; and 157 (8.4%) reported current substance abuse. In multivariable models, pain was independently associated with increased odds of impairment in all three domains of physical function investigated-mobility (aOR 10.5, 95% CI 7.6-14.6), self-care (aOR 4.1, 95% CI 2.2-7.4), and usual activities (aOR 5.4, 95% CI 4.0-7.4).
Pain was associated with substantially increased odds of impairment in physical function. Pain should be an important consideration in HIV primary care. Interventions to address pain and impaired physical function should be investigated.
HIV risk behaviors, susceptibility to HIV acquisition, progression of disease after infection, and response to antiretroviral therapy all vary by age. In those living with HIV, current effective treatment has increased the median life expectancy to >70 years of age. Biologic, medical, individual, social, and societal issues change as one ages with HIV infection, but there has been only a small amount of research in this field. Therefore, the Office of AIDS Research of the National Institutes of Health commissioned a working group to develop an outline of the current state of knowledge and areas of critical need for research in HIV and Aging; the working groups' findings and recommendations are summarized in this report. Key overarching themes identified by the group included the following: multimorbidity, polypharmacy, and the need to emphasize maintenance of function; the complexity of assessing HIV versus treatment effects versus aging versus concurrent disease; the inter-related mechanisms of immune senescence, inflammation, and hypercoagulability; the utility of multivariable indices for predicting outcomes; a need to emphasize human studies to account for complexity; and a required focus on issues of community support, caregivers, and systems infrastructure. Critical resources are needed to enact this research agenda and include expanded review panel expertise in aging, functional measures, and multimorbidity, and facilitated use and continued funding to allow long-term follow-up of cohorts aging with HIV.
HIV disease is often perceived as a condition affecting young adults. However, approximately 11% of new infections occur in adults aged 50 years or older. Among persons living with HIV disease, it is estimated that more than half will be aged 50 years or older in the near future. In this review, we highlight issues related to HIV prevention and treatment for HIV-uninfected and HIV-infected older Americans, and outline unique considerations and emerging challenges for public health and patient management in these 2 populations.
To systematically review the research findings regarding the associations between psychosocial factors and adjustment to chronic pain in persons with physical disabilities.
A key word literature search was conducted using articles listed in PubMed, PsychInfo, and CINAHL up to March 2010, and manual searches were made of all retrieved articles to identify published articles that met the review inclusion criteria.
To be included in the review, articles needed to (1) be written in English, (2) include adults with a physical disability who report having pain, (3) include at least 1 measure of a psychosocial predictor domain, (4) include at least 1 criterion measure of pain or patient functioning, and (5) report the results of associations between the psychosocial factors and criterion measures used in the study. Twenty-nine studies met the inclusion criteria.
Three reviewers tabulated study details and findings.
The disability groups studied included spinal cord injury (SCI), acquired amputation, cerebral palsy (CP), multiple sclerosis (MS), and muscular dystrophy (MD). Psychosocial factors were shown to be significantly associated with pain and dysfunction in all disability groups. The psychosocial factors most closely associated with pain and dysfunction across the samples included (1) catastrophizing cognitions; (2) task persistence, guarding, and resting coping responses; and (3) perceived social support and solicitous responding social factors. Pain-related beliefs were more strongly associated with pain and dysfunction in the SCI, CP, MS, and MD groups than in the acquired amputation group.
The findings support the importance of psychosocial factors as significant predictors of pain and functioning in persons with physical disabilities. Clinical trials to test the efficacy of psychosocial treatments for pain and dysfunction are warranted, as are studies to determine whether psychosocial factors have a causal influence on pain and adjustment in these populations.
To date, pain research has focused almost exclusively on operant models to interpret the function and predict the consequences of pain-related interaction in chronic pain couples. However, evidence suggests that intimacy models of interaction may provide additional and alternative explanations for pain interaction. Specifically, intimacy models conceptualize verbal complaints about pain-related distress as emotional disclosure, which the partner may validate or invalidate. This review compares and contrasts models of pain-related interaction in chronic pain couples, describes limitations of the existing research, and offers directions for future research drawing upon a social support framework.
Utilizing a heterogenous sample of adults diagnosed with HIV infection, the current study sought to explore associations among age, various dimensions of social support, and psychological and functional well-being.
Cross-sectional data capturing subjective and instrumental support, social interaction, behavioral health service utilization, and psychological well-being (ie, positive affect and depressive symptomatology), and physical functioning, were collected from 109 men and women living with HIV. To explore age group differences, participants were stratified by age (<54 vs. 55+ years).
Despite endorsing greater medical comorbidity, older adults reported significantly lower depressive symptomatology and greater positive affect and were less likely to report seeing a behavioral health specialist than their younger counterparts. No age group differences emerged for instrumental support or amount of social interaction. However, older adults reported higher subjective support, which in turn was associated with lower depressive symptomatology, greater positive affect, and nonutilization of behavioral health services.
More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.
This paper is a report of a study exploring the impact of neuropathic pain on family, social and working relationships among patients at a pain clinic serving a large urban area.
Neuropathic pain is a particularly distressing type of chronic pain which is extremely difficult to manage successfully. It produces a range of unpleasant symptoms and adversely affects patients' quality of life, but little is known about its personal impact.
A descriptive and exploratory approach was used and 10 participants participated in three focus groups in 2005. Because of the low response rate of 20% from the initial sample, a second sample of 16 patients was invited to participate. However, only one person responded and therefore it was not possible to convene an additional group.
The unpleasant and bizarre nature of neuropathic pain underpinned much of its impact in terms of respondents' difficulties in maintaining a range of relationships. For closer relationships, key difficulties centred on the reduction in quality and/or number of personal relationships. For more distant relationships and those with professionals, frustration at the invisibility of their pain and their own failure to communicate symptoms and its consequences were central.
More extensive work is needed to improve our understanding of how neuropathic pain is experienced, how it affects close and more distant kinds of relationships, and how healthcare professionals might best support people with persistent neuropathic pain to maintain personal and social relationships, and to communicate their pain effectively.
The present study investigated whether pain expectancies cause pain in chronic low back patients. Back patients (N = 29) were requested to perform four exercise bouts (two with each leg), each consisting of flexing and extending the knee three times at maximal force (Cybex 350 System). During each exercise bout the baseline pain, the expected pain and experienced pain were recorded. Patients also reported their experienced fear of further injury to the back. Furthermore, the peak force of both knee flexors and extensors was assessed. Although patients did expect a back pain increase during the first exercise bout with each leg, no evidence was found for the thesis that pain expectancies generate increases in subjective pain experiences. Instead, the reported pain expectancy was readily corrected during the next exercise bout, whereas the experienced pain remained unchanged. Furthermore, a high pain expectancy co-occurred with (1) a marginally significant fear of (re)injury, and (2) a significant lower peak torque of the knee flexors. These results are consistent with conditioning models which state that pain expectations are associated with a fear response and an urge to avoid the pain.
Studies with (sub) acute back pain patients show that negative expectancies predict pain and disability at a one-year follow up. Yet, it is not clear how expectations relate to other factors in the development of chronic disability such as pain and fear. This study investigates the relationship between expectations, pain-related fear and pain and studies how these variables are related to the development of chronic pain and disability. Subjects (N = 141) with back and/or neck pain (duration <1 year) were recruited via primary care. They completed measures on pain, expectancy, pain-related fear (pain-related negative affect and fear avoidance beliefs) and function. A one-year follow up was conducted with regard to pain and function. It was found that pain, expectancy, pain-related fear and function were strongly interrelated. In the cross-sectional analyses negative expectancies were best explained by frequent pain and a belief in an underlying and serious medical problem. Prospectively, negative expectancy, negative affect and a belief that activity may result in (re) injury or increased pain, explained unique variance in both pain and function at one-year follow up. In conclusion, expectancy, negative affect and fear avoidance beliefs are interrelated constructs that have predictive value for future pain and disability. Clinically, it can be helpful to inquire about beliefs, expectancy and distress as an indication of risk as well as to guide intervention. However, the strong interrelations between the variables call for precaution in treating them as if they were separate entities existing in reality.
Unlabelled:
Researchers have become increasingly interested in the social context of chronic pain conditions. The purpose of this article is to provide an integrated review of the evidence linking marital functioning with chronic pain outcomes including pain severity, physical disability, pain behaviors, and psychological distress. We first present an overview of existing models that identify an association between marital functioning and pain variables. We then review the empirical evidence for a relationship between pain variables and several marital functioning variables including marital satisfaction, spousal support, spouse responses to pain, and marital interaction. On the basis of the evidence, we present a working model of marital and pain variables, identify gaps in the literature, and offer recommendations for research and clinical work.
Perspective:
The authors provide a comprehensive review of the relationships between marital functioning and chronic pain variables to advance future research and help treatment providers understand marital processes in chronic pain.
There is a critical need for practical measures for screening and documenting decisional capacity in people participating in different types of clinical research. However, there are few reliable and validated brief tools that could be used routinely to evaluate individuals' capacity to consent to a research protocol.
To describe the development, testing, and proposed use of a new practical instrument to assess decision-making capacity: the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). The UBACC is intended to help investigators identify research participants who warrant more thorough decisional capacity assessment and/or remediation efforts prior to enrollment.
We developed the UBACC as a 10-item scale that included questions focusing on understanding and appreciation of the information concerning a research protocol. It was developed and tested among middle-aged and older outpatients with schizophrenia and healthy comparison subjects participating in research on informed consent. In an investigation of reliability and validity, we studied 127 outpatients with schizophrenia or schizoaffective disorder and 30 healthy comparison subjects who received information about a simulated clinical drug trial. Internal consistency, interrater reliability, and concurrent (criterion) validity (including correlations with an established instrument as well as sensitivity and specificity relative to 2 potential "gold standard" criteria) were measured.
Reliability and validity of the UBACC.
The UBACC was found to have good internal consistency, interrater reliability, concurrent validity, high sensitivity, and acceptable specificity. It typically took less than 5 minutes to administer, was easy to use and reliably score, and could be used to identify subjects with questionable capacity to consent to the specific research project.
The UBACC is a potentially useful instrument for screening large numbers of subjects to identify those needing more comprehensive decisional capacity assessment and/or remediation efforts.
Pain treatment and antiretroviral medication adherence among vulnerable HIV-positive patients
- H L Surratt
- S P Kurtz
- M A Levi-Minzi
- T J Cicero
- K Tsuyuki
- O' Grady
Surratt HL, Kurtz SP, Levi-Minzi MA, Cicero TJ, Tsuyuki K,
O'Grady CL. Pain treatment and antiretroviral medication adherence among vulnerable HIV-positive patients. AIDS Patient
Care STDS. 2015;29:186-192.
- K P High
- M Brennan-Ing
- D B Clifford
High KP, Brennan-Ing M, Clifford DB, et al. HIV and aging.
JAIDS J Acquir Immune Defic Syndr. 2012; 60:S1-S18.
Pain and emotion: A biopsychosocial review of recent research
- MA Lumley
- JL Cohen
- GS Borszcz