Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Intimate partner aggression perpetration in primary care chronic pain patients

This study examined the prevalence and correlates of partner aggression perpetration in 597 primary care chronic pain patients. Approximately 30% of participants reported perpetrating low-level aggression, 12% reported injuring their partner, and 5% reported engaging in sexual coercion. Women reported more low-level aggression perpetration than men, and men reported more engagement in sexual coercion than women. Substance use disorders (SUD) were associated with all outcomes, and both aggression victimization and lifetime ratings of posttraumatic stress disorder (PTSD) were associated with low-level aggression and injuries. In multivariate analyses, gender, aggression victimization, PTSD, and SUD evidenced associations with one or more outcomes. Findings indicate a need for aggression screening in this population and highlight avenues for intervention.     

A criterion-referenced multidimensional job-related model prediction capability to perform occupations among persons with chronic pain

OBJECTIVE: The purpose of this prospective study was an exploration of the construct of the criterion-referenced multidimensional job-related model (CMVA) aimed for predicting patients' with chronic pain capability to perform occupations. METHODS: The study samples were 1) participants (n=84) who at present were not performing employed work (median sick-listing period 12 months) because of chronic pain and 2) participants (n = 104) who at present were performing employed work at least 20 hours of a workweek. The participants had experiences of 40 different occupations classified into five of the occupational categories of Jist's Enhanced Dictionary of Occupational Titles. Data were collected through ten assessment instruments and a structured interview, comprising 54 variables and 465 items. Data were analyzed using multiple regression with forward entering of variables. RESULTS: The CMVA model (Adjusted R^2 0.777, F (4, 183) = 164.067; p<0.001) was able to explain 78% of the variance. CMVA contained the aspects; "the work demands-variable, the person-variable of work life values, the environment-variable of social support and the two occupational performances-variables; self-perceived capability to perform work tasks/the simulated work tasks". CONCLUSIONS: The construct of CMVA was robust suggesting that among persons with chronic pain, the predictors focusing on their capability to perform occupations are of great importance.     

Alcohol education provided to opioid treatment program patients: results of a nationwide survey

Alcohol-related problems are especially common among opioid treatment program (OTP) patients, suggesting that educating OTP patients about alcohol and its harmful effects needs to be a priority in OTPs. Using data collected in interviews with a nationwide U.S. sample of OTP directors (N = 200) in 25 states, we identified factors that differentiate OTPs that provided this education to all OTP patients from those that did not. Findings indicate that these factors include (1) providing this education in a greater variety of ways, (2) having a larger percent of staff knowledgeable about alcohol-related issues, (3) having a director who views alcohol issues as a high priority, and (4) having a written OTP policy.     

The effects of a topical analgesic and placebo in treatment of chronic knee pain

Chronic knee pain is a prevalent health problem of old and middle age. The authors' objective was to determine whether a topical analgesic would reduce knee pain and improve the function of a group of 40- to 65-year-old people with chronic knee pain. The experimental design was a double-blind, randomized, placebo-controlled clinical trial. The dependent variables were knee pain, active range of motion, and isometric strength. Forty-six men and women volunteered, of whom 3 dropped out, leaving 23 in the treatment group and 20 in the placebo group. Knee pain was assessed with a visual analogue scale and the knee-pain scale for frequency and severity. Testing took place before treatment and after 21 and 35 days of treatment. The results indicated that although both groups experienced improved pain scores, there were no differences between groups over the treatment period for any of the dependent variables.     

Socialization to dying: social determinants of death acknowledgement and treatment among terminally ill geriatric patients.

Although the vast majority of deaths occur among terminally ill geriatric patients, little is known about the etiology of these patients' death acknowledgement and ultimate type of treatment. Based on interviews with 76 triads composed of physicians, terminally ill patients, and primary caregivers, this study uses the socialization perspective to identify the actors and actions that most strongly affect the patient's death acknowledgment and receipt of exclusively palliative care (i.e., socialization to the dying role). Whereas patient preferences and sociodemographic characteristics do not influence significantly the patient's odds of death acknowledgment, these odds are increased if their primary caregivers accept death, their physicians are not affiliated with a teaching hospital, and the terminal prognosis is disclosed to them and disclosed "matter-of-factly." Patients who acknowledge death, whose agents value pain alleviation over life-prolongation, and whose physicians are not affiliated with a teaching hospital, are substantially more likely to receive exclusively palliative rather than curative terminal treatment.     

Relationship among differentiation of self, relationship satisfaction, partner support, and depression in patients with chronic lung disease and their partners

The purpose of the present study is to test the relationships among differentiation of self, relationship satisfaction, perceived partner support, and depression in a sample of patients with chronic lung disease (CLD) and their partners. The sample consisted of 52 patients with CLD and their partners. Hierarchical multiple regression was used for data analysis. The results indicate that (a) patients' differentiation of self is significantly lower than partners' differentiation of self, (b) patients' relationship satisfaction is positively correlated with partners' relationship satisfaction, (c) patients' relationship satisfaction predicts perceived partner supportive behavior, (d) perceived partner unsupportive behavior predicts patients' depression, (e) partners' differentiation of self predicts partners' relationship satisfaction, (f) partners' relationship satisfaction predicts partner supportive behavior, and (g) partners' differentiation of self and relationship satisfaction predicts partners' depression. The study serves to highlight the fact that the patient is part of a system, and that taking the system into account is relevant to the well-being of both the patient and the partner, in particular for patients with CLD, a heretofore unstudied population. The results of such studies have significant implications for couple and family therapists.