Chronic Pain and Sleep Disorders in Primary Care

Background. Chronic pain (CP) and sleep disorders (SD) are highly prevalent in the general population. However, comprehensive data regarding the prevalence and characteristics of pain and SD in primary care are rare. Methods. From N=578 patients N=570 were included within 8 weeks (mean age: 50.8±18.7 years, females: 289). Sociodemographic data, Insomnia Severity Index (ISI), and parts of a self-report questionnaire for pain (Multidimensional German Pain Questionnaire) were recorded and additional medical information (pain medication, sleep medication) was gathered from the patient charts. Results. Of the total sample, 33.2% (n=189) suffer from CP (pain ≥ 6 months) and 29.1% (n=166) from SD. 45.5% of the CP patients suffer from SD and 26.5% from clinical insomnia (ISI ≥ 15). SD (β = 0.872, SE = 0.191, t = 4,572, p<0.001, CI [0.497; 1.246]) and older age (β = 0.025, SE = 0.005, t = 5.135, p<0.001, CI [0.015; 0.035]) were significantly associated with pain experience. Conclusion. About a quarter of CP patients suffer from clinical insomnia. The suggested bidirectional relation should be considered during comprehensive assessment and treatment of patients.

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The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.06.001 ◽

2015 ◽

Vol 9 (1) ◽

pp. 22-27 ◽

Cited By ~ 12

Author(s):

Elena Dragioti ◽

Tobias Wiklund ◽

Peter Alföldi ◽

Björn Gerdle

Keyword(s):

Chronic Pain ◽

Factor Analysis ◽

Factor Structure ◽

Depression Scale ◽

Severity Index ◽

Invariance Property ◽

Insomnia Severity Index ◽

Chronic Pain Patients ◽

Pain Patients ◽

Insomnia Severity

AbstractObjectiveInsomnia is the most commonly diagnosed comorbidity disorder among patients with chronic pain. This circumstance requests brief and valid instruments for screening insomnia in epidemiological studies. The main object of this study was to assess the psychometric properties and factor structure of the Swedish version of the Insomnia Severity Index (ISI). The ISI is a short instrument designed to measure clinical insomnia and one of the most common used scales both in clinical and research practice. However there is no study in Sweden that guarantees neither its factor structure nor its feasibility in chronic pain patients. We further examined the measurement invariance property of the ISI across the two sexes.MethodsThe ISI was administered to 836 (269 men and 567 women) chronic pain patients from the Swedish Quality Registry for Pain Rehabilitation. This study used demographic data, the Hospital Anxiety and Depression Scale (HADS), the Mental Summary Component (MSC) of the Health Survey (SF-36) and the item 7 from Multidimensional Pain Inventory (MPI). The sample was divided into two random halves: exploratory factor analysis (EFA) was performed in the first sample (N1 = 334, 40%) and confirmatory factor analysis (CFA) in the second half of the sample (N2 = 502, 60%). The measurement and structural invariance of the proposed structure (4-item version) between the two sexes as well as reliability and validity indexes were further assessed.ResultsExploratory factor analysis using the principal axis factoring method generated one global factor structure for the ISI, explaining 63.1% of the total variance. The one factor solution was stable between the two sexes. Principal component analysis was also applied and indicated almost identical results. The structure was further assessed by CFA, resulting in an adequate fit only after omitting three items. The difference on structural and measurement invariance in the loadings by participants’ sex was not significant (Δχ2 = 10.6; df = 3; p = .69 and Δχ2 = 2.86; df = 3; p = 41 respectively). The shorter version four-item Insomnia Severity Index (ISI-4) was analysed further. The Chronbach’s alpha for the global ISI-4 score was 0.88. The construct validity of the ISI-4 was also supported by the, Hospital Anxiety and Depression Scale, the Mental Summary Component of quality of life and quality of sleep data. Pain intensity was significantly associated with the ISI-4 score (beta = .29, p < 001) whereas no significant correlation between four-item Insomnia Severity Index score and age was observed (p > 05).Conclusions and implicationsAlthough short, the four-item Insomnia Severity Index (ISI-4) version seemed to effectively assess insomnia in chronic pain patients. An important clinical implication is that the four-item Swedish Insomnia Severity Index can be used in chronic pain cohorts when screening for insomnia problems. Its measurement and structural invariance property across the two sexes shows that the ISI-4 is a valid measure of the insomnia across groups of chronic patients. Our results also suggest its utility both in pain clinical practice and research purposes.

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(554) Primary care based integrated assessment and treatment for patients with complex chronic pain conditions: foundation and development

Journal of Pain ◽

10.1016/j.jpain.2014.01.466 ◽

2014 ◽

Vol 15 (4) ◽

pp. S114

Author(s):

L. Kindler ◽

L. DeBar ◽

C. Elder

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Integrated Assessment ◽

Assessment And Treatment ◽

Chronic Pain Conditions

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Smartphone Use and Professional Communication Among Medical Residents in Primary Care

PRiMER ◽

10.22454/primer.2018.766371 ◽

2018 ◽

Vol 2 ◽

Author(s):

Danielle L. Terry ◽

Christopher P. Terry

Keyword(s):

Primary Care ◽

Medical Information ◽

Data Access ◽

Self Report ◽

Medical Residents ◽

Future Research ◽

History Of ◽

Smartphone Use ◽

History Of Culture ◽

Primary Care Practices

Introduction: The rapid integration and evolution of technology has impacted remote data access, dissemination of medical information, and use of applications (apps) for patient care and treatment. The aims of this study were to (1) describe patterns of smartphone use by residents in a rural clinical setting (both clinical and communicative patterns), (2) examine residents’ perceptions of benefits of smartphone use, and (3) determine whether there is an association between smartphone use and organizational attributes. Methods: Self-report surveys were administered to family medicine and internal medicine residents (N=39). Results: Descriptive analyses indicated that primary care residents used their pagers more often for communication, but also believed smartphones were more efficient, and increased accessibility and timeliness of attending physicians. Additional analyses suggested that smartphone use was not associated with chaos, and was negatively correlated with history of culture change within the organization. Conclusion: Overall, use of smartphones among medical residents is relatively common, and residents believe there are numerous benefits of use. Future research might consider causal reasons why there is reduced communication among primary care practices with a history of change.

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A New Measure for Assessing Substance-Related and Addictive Disorders: The Addictive Behavior Questionnaire (ABQ)

Journal of Clinical Medicine ◽

10.3390/jcm7080194 ◽

2018 ◽

Vol 7 (8) ◽

pp. 194 ◽

Cited By ~ 7

Author(s):

Vincenzo Caretti ◽

Alessio Gori ◽

Giuseppe Craparo ◽

Marco Giannini ◽

Giuseppe Iraci-Sareri ◽

...

Keyword(s):

Psychometric Properties ◽

Clinical Sample ◽

Control Sample ◽

Severity Index ◽

Total Sample ◽

Addictive Behavior ◽

Self Report ◽

Addictive Behaviors ◽

Internal Reliability ◽

Addictive Disorders

This article evaluates the psychometric properties of a new measure for assessing Substance-Related and Addictive Disorders: the Addictive Behavior Questionnaire (ABQ). The ABQ is a self-report measure composed of two sections: the Severity Index (SI) and the Seven Domains Addiction Scale (7DAS). Materials and methods. A total sample of 698 subjects divided into two groups (515 subjects in the clinical sample and 183 subjects in the control sample), participated in this study. We applied Exploratory Factor Analysis (EFA) to examine features of ABQ construct validity, we used Cronbach’s alpha coefficient to assess its internal reliability, and explored some aspects of its concurrent validity by examining its associations with other measures assessing addictive behaviors and psychopathology. Results and conclusions: results of EFA indicated that all the scales of the ABQ are unidimensional and showed good internal consistency. The correlations between the sections of the ABQ and the other measures used in the current study were significant and in the expected directions. These results suggest that the ABQ has good psychometric properties and allows researchers and clinicians to gather relevant information regarding behaviors, psychopathology and severity of symptoms, for the best clinical reasoning and for planning tailored treatment for each patient.

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There Are Not Enough Sheep

Psychological and Psychiatric Issues in Patients with Chronic Pain ◽

10.1093/med/9780197544631.003.0014 ◽

2021 ◽

pp. 117-126

Author(s):

Daniel M. Doleys ◽

Nicholas D. Doleys

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Sleep Apnea ◽

Sleep Disturbance ◽

Pain Intensity ◽

Sleep Disorders ◽

Physical Factor ◽

Pain Clinic ◽

Poor Sleep ◽

Potential Impact

It is difficult to overemphasize the potential impact of sleep and sleep disorders on chronic pain. Indeed, there are data indicating that sleep disturbance mat be a significant causal factor in the development and maintenance of chronic pain. One would think that daytime pain would predict degree of sleep. But, in fact, it is the opposite; sleep is better predictor of daytime pain intensity. The factor associated with poor sleep are many and varied. Ruling out sleep apnea should be a priority. The availability of in-home studies simplifies the assessment/screening, and may engender greater cooperation. Sleep apnea contributes to hypogonadism, which, in turn, impact a number of physical factor that influence mood, function, and pain. There is a number of approaches that can be implemented in the primary care and pain clinic setting to address the problem of sleep disorders in the patient with chronic pain.

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Diagnosis, assessment, and treatment of childhood eczema in primary care: cross-sectional study

BJGP Open ◽

10.3399/bjgpopen17x100821 ◽

2017 ◽

Vol 1 (2) ◽

pp. bjgpopen17X100821 ◽

Cited By ~ 2

Author(s):

Laureen Jacquet ◽

Daisy M Gaunt ◽

Kirsty Garfield ◽

Matthew J Ridd

Keyword(s):

Primary Care ◽

Diagnostic Criteria ◽

Feasibility Study ◽

Severity Index ◽

Cross Sectional Study ◽

Severity Assessment ◽

Sectional Study ◽

Cross Sectional ◽

Assessment And Treatment ◽

The Uk

BackgroundThe majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.AimTo compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines.Design & settingCross-sectional study using data from a randomised controlled feasibility study. General practices, UK.MethodBaseline data from children aged 1 month to 5 years recruited ‘in-consultation’ for the Choice of Moisturiser in Eczema Treatment (COMET) feasibility study was used. These included clinician diagnosis and global severity assessment; the parent-completed Patient Orientated Eczema Measure (POEM); a questionnaire about eczema treatments, including use of topical corticosteroid (TCS); and, the Eczema Area Severity Index (EASI) carried out by trained researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with the National Institute for Health and Care Excellent (NICE) guidance.ResultsData were available for 90 participants. Only 46% of participants labelled as having eczema met the UK diagnostic criteria. Agreement between the global severity assessment by a healthcare practitioner with the EASI and POEM measures of eczema severity were 44% and 48% respectively. Emollients and TCSs were underused with 44% of participants not using any emollient and 46% using one or more TCSs. The ‘match’ between eczema severity and TCSs potency was poor.ConclusionDiscrepancies were found between the diagnosis, assessment, and treatment of children with eczema in primary care, and UK diagnostic criteria and guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.

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