Caulfield Pain Management and Research Center

Caulfield, Australia

Caulfield Pain Management and Research Center

Caulfield, Australia

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Holmes A.,University of Melbourne | Williamson O.,Monash University | Williamson O.,Alfred Hospital | Hogg M.,Royal Melbourne Hospital | And 2 more authors.
Pain Medicine (United States) | Year: 2013

Objective: Patients with pain 3 years after injury are at risk of lifetime pain. It is not known if the predictors of chronic pain at 3 years are the same as those for earlier time points or whether other factors become important. Clarifying these factors will aid our understanding of the development of long-term pain and further inform the development of models for screening and early intervention for pain in the aftermath of injury. Design: Patients admitted to two trauma centers underwent a comprehensive physical and psychological assessment of known and potential risk factors for chronic pain during their index admission. Three years after injury, these patients were assessed for the presence of chronic pain (score was ≥5 on an 11-point numerical rating scale during the last episode of pain, and present in the last month and at least two times in the past week) and pain-related disability. Logistic regression was used to identify independent risk factors for the presence of chronic pain and disability. Results: Two hundred and twenty patients (75.9% of the original cohort) were assessed at 3 years. Of these, 146 (66.7%) reported some pain and 52 (23.7%) reported chronic pain. Factors (present at the time of injury) that predicted chronic pain were lower socioeconomic status, pain severity, and injury severity. The predictive power of these combined factors was modest. Conclusions: Three years after serious injury, almost a quarter of patients report chronic pain, and more than a third report at least moderate pain-related disability. The predicative power of measures taken in the acute setting is not enough to support discharge screening alone as a method of triaging high-risk patients to early intervention. © 2013 American Academy of Pain Medicine.


Holmes A.,University of Melbourne | Williamson O.,Monash University | Hogg M.,Royal Melbourne Hospital | Arnold C.,Caulfield Pain Management and Research Center | And 4 more authors.
Pain Medicine | Year: 2010

Objective. The majority of patients will report pain 12 months after a serious injury. Determining the independent risk factors for pain after serious injury will establish the degree to which high-risk patients can be detected in the acute setting and the viability of early triage to specialist pain services.Design. A prospective cohort study of patients following serious injury was conducted. The initial assessment comprised a comprehensive battery of known and possible risk factors for persistent pain. Patients were assessed at 12 months for pain severity and for the presence of chronic pain.Results. Two hundred ninety patients underwent an initial assessment of whom 238 (82%) were followed up at 12 months. At 12 months, 171 (72%) patients reported some pain over the past 24 hours. Thirty-five patients (14.7%) reported chronic pain. Five factors independently predicted the 24-hour pain severity: preinjury physical role function, preinjury employment status, initial 24 hours pain score, higher beliefs in the need for medication, and compensable injury (R2=0.21, P<0.0001). Four factors predicted the presence of chronic pain at 12 months: not working prior to injury, total Abbreviated Injury Scale, initial pain severity, and initial pain control attitudes (pseudo R2=0.24, P=0.0001).Conclusions. Factors present at the time of injury can allocate patients into high- or low-risk groups. The majority of cases of chronic pain emerging from the high-risk group warrant more intense clinical attention. We recommend recording these factors in discharge documentation as indicators of persistent pain. © 2010 Wiley Periodicals, Inc.


Holmes A.,University of Melbourne | Christelis N.,Alfred Hospital | Arnold C.,Caulfield Pain Management and Research Center
Medical Journal of Australia | Year: 2012

Chronic pain and major depression commonly occur together.Major depression in patients with chronic pain is associated with decreased function, poorer treatment response and increased health care costs.The experience and expression of chronic pain vary between individuals, reflecting complex and changing interactions between physical, psychological and social processes.The diagnosis of major depression in patients with chronic pain requires differentiation between the symptoms of pain and symptoms of physical illness.Antidepressants and psychological therapies can be effective and should be delivered as part of a coordinated, cohesive, multidisciplinary pain management plan. © 2012, Australasian Medical Publishing Co. Ltd. All rights reserved.


PubMed | Caulfield Pain Management and Research Center, University of Melbourne and Alfred Hospital
Type: Journal Article | Journal: The Medical journal of Australia | Year: 2014

Chronic pain and major depression commonly occur together. Major depression in patients with chronic pain is associated with decreased function, poorer treatment response and increased health care costs. The experience and expression of chronic pain vary between individuals, reflecting complex and changing interactions between physical, psychological and social processes. The diagnosis of major depression in patients with chronic pain requires differentiation between the symptoms of pain and symptoms of physical illness. Antidepressants and psychological therapies can be effective and should be delivered as part of a coordinated, cohesive, multidisciplinary pain management plan.


Lukas A.,National Ageing Research Institute | Lukas A.,University of Ulm | Barber J.B.,National Ageing Research Institute | Johnson P.,National Ageing Research Institute | And 3 more authors.
European Journal of Pain (United Kingdom) | Year: 2013

Background: Observer-rated pain assessment instruments for people with dementia have proliferated in recent years and are mainly effective in identifying the presence of pain. The objective of this study was to determine whether these tools can also be used to evaluate intensity of pain. Method: Quasi-experimental design. Cognitively intact [Mini Mental State Examination (MMSE) ≥ 24, n = 60] and impaired people (MMSE < 20, n = 65) in nursing home facilities took part in the study. Participants were observed at rest and during a movement protocol. Directly afterwards, the observer, blinded to cognitive status, completed three behavioural pain assessment instruments (Abbey Pain Scale, Pain Assessment in Advanced Dementia Scale (PAINAD), Non-communicative Patient's Pain Assessment Instrument (NOPPAIN) ], before interviewing the resident about pain self-report. Results: Significant correlations were found between observer-rated and self-rated measures of pain and were stronger in persons with dementia than in cognitively intact adults. Discriminant function analysis (DFA) revealed: (1) that the use of observer-rated instruments improved recognition of the presence or absence of pain by up to 25.4% (in dementia) and 28.3% (in cognitively intact adults) above chance; and (2) the same instruments improved the classification of residents into the correct self-reported level of pain intensity by up to 42.5% (in dementia) and 34.1% (in cognitively intact adults) above chance. However, DFA also reveals a considerable rate of 'false alarms' for pain in cognitively intact and 'misses' in cognitively impaired people. Conclusions: The use of the Abbey Pain Scale, PAINAD or NOPPAIN improves both the recognition of pain presence/absence as well as rating pain severity in older people with impaired cognition. © 2013 European Federation of International Association for the Study of Pain Chapters.


Wood B.M.,University of Sydney | Wood B.M.,Royal North Shore Hospital | Nicholas M.K.,University of Sydney | Blyth F.,University of Sydney | And 4 more authors.
Journal of Pain | Year: 2013

This study examined the role of catastrophizing in mediating the relationship between pain intensity and depressed mood in older adults with persistent pain using reliable and valid measures for this population. A convenience sample of 669 patients 61 years and over attending a tertiary-level referral pain center completed questionnaires measuring pain intensity, depressed mood, and catastrophizing as part of a clinical assessment process. The catastrophizing subscale of the Pain-Related Self-Statements scale (PRSS-Catastrophizing) was examined for internal consistency and factor structure. Mediation was tested for each factor from the optimal model of the PRSS-Catastrophizing scale using regression analyses, which included measures of pain intensity and depressed mood. The PRSS-Catastrophizing scale was found to be a reliable measure of pain-related catastrophizing. A 2-factor solution (magnification, helplessness) was identified. Both factors partially and significantly mediated the relationship between pain intensity and depressed mood. This study highlights the importance of cognitive factors - in this case catastrophizing - in the persistent pain experience of older adults. It also demonstrates that pain-related catastrophizing can be reliably measured in this population. These findings have important clinical implications. They emphasize the importance of using interventions to reduce catastrophizing to modify the pain experience of older adults with persistent pain. Perspective: This study confirms the mediating role of catastrophizing in the relationship between pain intensity and depressed mood in older adults with persistent pain using psychometrically sound measures. These findings indicate that clinicians should address catastrophizing to improve treatment outcomes with this population. © 2013 by the American Pain Society.


Wood B.M.,University of Sydney | Nicholas M.K.,University of Sydney | Blyth F.,University of Sydney | Asghari A.,University of Sydney | And 3 more authors.
Pain Medicine | Year: 2010

Objective. This study examined the assessment of the negative emotional constructs of depression, anxiety and stress with the short version (21 items) of the Depression Anxiety Stress Scales (DASS-21) in elderly patients (age > 60 years) with persistent pain. Design. A convenience sample of 2,045 patients attending a tertiary referral pain centre were categorized by age and included a group aged 60 years and under (n = 1,245) for assessment of age differences. Elderly patients (n = 800) were divided into 3 groups: 61-70 years (n = 366), 71-80 years (n = 308) and 81 years and over (n = 126). Patients completed the DASS-21 as part of an initial clinical assessment process. Results. The failure rate for scale completion increased across age groups and was significantly higher in the oldest group compared to the youngest group. All scales demonstrated reasonable convergent and divergent validity. Confirmatory factor analysis confirmed a three-factor structure and is consistent with previous studies. Age differences in depression, anxiety and stress scores were also assessed. Interestingly, patients aged 60 years and under had significantly higher Depression and Stress scores compared to all other age groups. This group also had significantly higher Anxiety scores compared to patients aged 61-70 years. Conclusions. Overall, the DASS-21 is a reliable and valid measure of depression, anxiety and stress in elderly patients with persistent pain. There are some age differences in the normative values for the reporting of mood symptoms and these need to be taken into account when assessing pain-related mood disturbance in older populations. © 2010 Wiley Periodicals, Inc.


Wood B.M.,University of Sydney | Wood B.M.,Royal North Shore Hospital | Nicholas M.K.,University of Sydney | Blyth F.,University of Sydney | And 4 more authors.
Journal of Pain | Year: 2010

This study examined the assessment of pain intensity and pain distress with the Numerical Rating Scale (NRS) in elderly patients (age >60 years) with persistent pain. A consecutive sample of 800 elderly patients were categorized by age into 3 groups: 61 to 70 years (n = 366), 71 to 80 years (n = 308), and 81 years and over (n = 126). Participants completed 3 Numerical Rating Scales assessing current pain intensity, and both the usual level of pain and average pain distress in the preceding week. The failure rate for scale completion was low for all scales for all age groups, but was significantly higher in the oldest group compared to the youngest group for the scales assessing current pain intensity and average pain distress in the preceding week. The NRS was shown to be a reliable and valid measure of pain intensity and pain distress in all these age groups. Distress related to pain appeared to be specific to the pain experience and was only weakly related to more generalized affective distress. These findings confirm that measures of pain intensity and pain distress, like the NRS, capture only part of the pain experience in older patients and should be supplemented by other measures in the assessment process. Perspective: This article confirms the utility of the Numerical Rating Scale (NRS) as a measure of pain intensity and pain distress in elderly patients with persistent pain. The use of a large sample increases confidence in the psychometric soundness of the NRS with this population. © 2010 by the American Pain Society.


Cole L.J.,University of Melbourne | Cole L.J.,National Ageing Research Institute | Farrell M.J.,University of Melbourne | Farrell M.J.,National Ageing Research Institute | And 4 more authors.
Neurobiology of Aging | Year: 2010

Compared with young adults, older people report more chronic pain complaints, and show reduced tolerance to experimental pain. Atrophy of brain parenchyma in normal ageing is well documented, with grey matter reduction occurring across many regions known to be involved in pain processing. However, the functional consequences of these changes, in particular their contribution toward age-related differences in pain perception and report, are yet to be elucidated. The present study investigated the effects of ageing on supraspinal pain processing by comparing regional brain responses to noxious pressure stimulation in 15 young (aged 26 ± 3 years) and 15 older (aged 79 ± 4 years) adults. Both groups showed significant pain-related activity in a common network of areas including the insula, cingulate, posterior parietal and somatosensory cortices. However, compared with older adults, young subjects showed significantly greater activity in the contralateral putamen and caudate, which could not be accounted for by increased age-associated shrinkage in these regions. The age-related difference in pain-evoked activity seen in the present study may reflect reduced functioning of striatal pain modulatory mechanisms with advancing age. © 2008 Elsevier Inc. All rights reserved.


Gersh E.,Caulfield Pain Management and Research Center | Arnold C.,Caulfield Pain Management and Research Center | Gibson S.J.,Caulfield Pain Management and Research Center | Gibson S.J.,National Ageing Research Institute
Pain Medicine | Year: 2011

Objective. The pain stages of change questionnaire (PSOCQ) has been designed to assess the willingness of chronic pain patients to engage in self-management approaches. This study sought to examine the utility of the PSOCQ as a predictor of treatment completion and the relationship with treatment outcome.Design. A convenience sample, uncontrolled, pre- and post-intervention cohort design.Setting. Multidisciplinary pain management center.Patients. Two hundred and sixty-one participants with chronic nonmalignant pain.Interventions. Eight-week program of either cognitive behavioral therapy group or a functional restoration group.Outcome Measures. Brief Pain Inventory average pain rating. The Short Form Health Survey (SF-36 version 2) mental health and physical functioning subscales as well as the PSOCQ.Results. Results suggest that those higher on precontemplation and lower on the other scales are less likely to complete treatment. A two-way multiple analysis of variance also found that when comparing those who progress through stages with those who stagnate or regress, "progressors" show significantly more improvement in measures of mood and functionality but not pain. The treatment groups did not appear to have significantly different outcomes in terms of stage of change.Conclusions. These findings suggest that the PSOCQ may be useful in making treatment more efficient, both by predicting who is less likely complete treatment and by providing targeted treatments according to patients' readiness to engage in self-management. Wiley Periodicals, Inc.

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