APS Press Room
News Highlights from The Journal of Pain • December 2006
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
DISABILITY DETERMINATION: VALIDITY WITH OCCUPATIONAL LOW BACK PAIN
Raymond C. Tait, John C. Chibnall, Elena M. Anderson and Nortin M. Hadler
St. Louis University School of Medicine
This study investigated 580 African American and 892 white workers' compensation claimants for occupational low back pain. They were surveyed 21 months after claim settlement. Disability determination for low-back pain has been problematic due to the need to accommodate a wide variety of cognitive-related or coping modifiers. Also, there is significant variability among health care providers in their approaches to the assessment and management of low-back pain and dysfunction.
The authors determined there were weak associations between claimant disability ratings and the post-settlement clinical and occupational status. African Americans were negatively associated with disability ratings and also with diagnosis, surgery and medical costs. The disability ratings, however, correlated weakly with post-settlement status at 21-month follow-up. The association between race and disability ratings suggests that inequities occur in disability determination. The authors commented this finding raises serious issues regarding the validity of current disability determination methods. Further, the evidence is clear that claimants with higher disability ratings fared better than claimants with lower ratings. This raises questions about the utility of such ratings for assessing claimants with low-back pain.
The authors believe their results show the inequitable allocation of disability ratings reflects disparities in the management of these work-related injuries. The results also raise concerns about social justice in the management of occupational back pain, as well as the validity of associated determination processes.
BURDEN OF ILLNESS IN PAINFUL DIABETIC PERIPHERAL NEUROPATHY: THE PATIENTS' PERSPECTIVE
Mugdha Gore, Nancy A. Brandedberg, Deborah L. Hoffman, Kei-Sing Tai
and Brett Stacy
Avalon Health Solutions, Philadelphia
Diabetic peripheral neuropathy (DPN) affects up to 50 percent of all patients with diabetes. Alleviating neuropathic pain is difficult because of the lack of medications targeted to relieve this pain. As a result, inadequately treated neuropathic pain often results in anxiety, depression and sleep disturbance. Understanding the multidimensional human burden of DPN, therefore, is essential for the development of satisfactory treatment approaches. In this article, the authors attempted to evaluate the psycho-social burden, current treatment patterns, healthcare utilization and medication usage among a geographically and ethnically diverse sample of 265 DPN patients.
The authors reported the patients with DPN they evaluated were older and suffered from other chronic pain syndromes. A majority also had other chronic conditions, such as anxiety, depression and nephropathy. Although they could not examine causal relations in this cross-sectional study, pain levels in the DPN patients were high and some 25 percent had doctor-diagnosed anxiety, depression and sleep disturbance.
Further, half of the subjects reported using NSAIDS, which are not effective against neuropathic pain, and fewer reported using medications specifically recommended for it. Pain levels among these patients were high and most said they were not satisfied with their pain management.
SEX DIFFERENCES IN FACIAL ENCODING OF PAIN
Miriam Kunz, Andreas Gruber and Stephan Lautenbacher
Philipps University, Marburg, Germany
The objective of this study was to investigate whether men and women differ in their facial expressiveness of pain, and if sex modulates the relationship between self-report and facial pain responses when tonic experimental pain is applied.
In previous studies, men and women have appeared to differ substantially in their emotional expressiveness, with women being more facially expressive. But in this research, the authors found that 20 male and 20 female subjects did not differ in their subjective responses to pain or their facial expressiveness. However, sex had a noticeable influence on the relationship between self-report and facial expression of pain, with women showing the stronger correlation. This suggests that facial responses to pain can be used to estimate the intensity of subjective pain in women better than in men. The authors concluded that in future studies sex should be considered an important modulating factor governing the relationship between self-report and nonverbal pain behaviors.