• A brief haemophilia pain coping questionnaire

      Elander, James; Robinson, Georgina; University of Derby (2008)
      Pain coping strategies are important influences on outcomes among people with painful chronic conditions. The pain coping strategies questionnaire (CSQ) was reviously adapted for sickle cell disease and haemophilia, but those versions have 80 items, and a briefer version with similar psychometric properties would facilitate research on pain coping. The full-length haemophilia-adapted CSQ, plus measures of pain frequency and intensity, pain acceptance, pain readiness to change, and health-related quality of life were completed by 190 men with haemophilia. Items were selected for a 27-item short form, which was completed 6 months later by 129 (68%) participants. Factor structure, reliability and concurrent validity were the same in the long and short forms. For the short form, internal reliabilities of the three composite scales were 0.86 for negative thoughts, 0.80 for active coping and 0.76 for passive adherence. Test–retest reliabilities were 0.73 for negative thoughts, 0.70 for active coping and 0.64 for passive adherence. Negative thoughts were associated with less readiness to change, less acceptance of pain and more impaired health-related quality of life, whereas active coping was associated with greater readiness to change and more acceptance of pain. The short form is a convenient brief measure of pain coping with good psychometric properties, and could be used to extend research on pain coping in haemophilia.
    • Development and validation of the satisfaction with treatment for pain questionnaire (STPQ) among patients with sickle cell disease

      Bij, Deepali; Kapadi, Romaana; Schofield, Malcolm B.; Osias, Arlene; Khalid, Nosheen; Kaya, Banu; Telfer, Paul; Elander, James; University of Derby (Wiley, 2019-06-23)
      A brief measure of patient satisfaction with treatment for pain is needed to help improve the treatment of painful episodes caused by sickle cell disease (SCD), especially during and after the transition from paediatric to adult care. Focus groups of 28 adolescent and adult patients were consulted about the content, clarity and relevance of 30 potential items, resulting in an 18-item version. This was validated by analysing questionnaire responses from 120 patients aged 12-53 years. Confirmatory factor analysis and item analysis indicated five subscales with high internal reliability: ‘Communication and Involvement’ (6 items, α=0.87); ‘Respect and Dignity’ (3 items, α=0.82); ‘Pain Control’ (3 items, α=0.91); ‘Staff Attitudes and Behaviour’ (4 items, α=0.88); and ‘Overall Satisfaction’ (2 items, α=0.85); plus a Total Satisfaction score (18 items, α=0.96). High negative correlations with the Picker Patient Experience Questionnaire, a measure of problem experiences, indicated good convergent validity. Lower satisfaction scores among patients aged over 18 years, those admitted via the emergency department, those treated by non-specialist hospital staff, and those reporting more breakthrough pain indicated good concurrent validity. The questionnaire provides a convenient brief measure that can be used to inform and evaluate improvements in healthcare for adolescent and adult patients with SCD, and could potentially be adapted for other painful conditions.
    • Factors affecting hospital staff judgments about sickle cell disease pain

      Elander, James; Marczewska, Malgorzata; Amos, Roger; Thomas, Aldine; Tangayi, Sekayi; University of Derby (2006)
      Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction. We used a vignette study to examine hospital staff judgments about patients with genuine symptoms of analgesic addiction and those with pain behaviors that merely resemble those symptoms. Nurses and doctors at hospitals in London, UK, judged the level of pain, the likelihood of addiction, and the analgesic needs of fictitious sickle cell disease patients. The patient descriptions included systematic variations to test the effects of genuine addiction, pain behaviors resembling addiction, and disputes with staff, which all significantly increased estimates of addiction likelihood and significantly decreased estimates of analgesic needs. Participants differentiated genuine addiction from pain behaviors resembling addiction when making judgments about addiction likelihood but not when making judgments about analgesic needs. The treatment by staff of certain pain behaviors as symptoms of analgesic addiction is therefore a likely contributory cause of inadequate or problematic hospital pain management. The findings also show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain. There are implications for staff training, patient education, and further research.
    • A longitudinal exploration of pain tolerance and participation in contact sports

      Thornton, Claire; Sheffield, David; Baird, Andrew; Northumbria University; University of Derby (Elsevier, 2017-03-22)
      Background/aims Athletes who choose to engage in contact sports do so with the knowledge that participation will bring pain in the form of contact with others, injury, and from exertion. Whilst athletes who play contact sports have been shown to have higher pain tolerance than those who do not, it is unclear whether this is a result of habituation over time, or as a result of individual differences at the outset. The aim was to compare pain responses over an athletic season in athletes who participated in contact sport and those who disengaged from it. Methods One hundred and two new contact athletes completed measures of cold and ischaemic pain tolerance, perceived pain intensity, pain bothersomeness, pain coping styles and attendance at the start, middle (4 months) and end (8 months) of their season. The athletes were drawn from martial arts, rugby and American football. Cluster analysis placed 47 athletes into a participating category and 55 into a non-participating cluster. Results Participating athletes had higher ischaemic pain tolerance at the start (r = 0.27, p = 0.05), middle (r = 0.41, p < 0.0001) and end of the season (r = 0.57, p < 0.0001) compared to non-participating athletes. In addition participating athletes were more tolerant to cold pain at the end of the season (r = 0.39, p < 0.0001), compared to non-participating athletes. Participating athletes also exhibited higher direct coping, catastrophized less about injury pain and also found contact pain to be less bothersome physically and psychologically compared to non-participating athletes. Participating athletes were more tolerant of ischaemic pain at the end of the season compared to the start (r = 0.28, p = 0.04). Conversely non-participating athletes became significantly less tolerant to both pain stimuli by the end of the season (cold pressor; r = 0.54, p < 0.0001; ischaemia; r = 0.43, p = 0.006). Pain intensity as measured by a visual analogue scale did not change over the season for both groups. Conclusions Those who cease participation in contact sports become less pain tolerant of experimental pain, possibly a result of catastrophizing. The results suggest that athletes who commit to contact sports find pain less bothersome over time, possibly as a result of experience and learning to cope with pain. Athletes who continue to participate in contact sports have a higher pain tolerance, report less bothersomeness and have higher direct coping than those who drop out. In addition, tolerance to ischaemic pain increased over the season for participating athletes. Implications Having a low pain tolerance should not prevent athletes from taking part in contact sports, as pain becomes less bothersome in athletes who adhere to such activities. Participating in contact sports may result in maintained cold pain tolerance, increased ischaemic pain tolerance, reduced catastrophizing and better coping skills. Coaches can therefore work with athletes to develop pain coping strategies to aid adherence to contact sports.
    • Pain and athletes: Contact sport participation and performance in pain

      Sheffield, David; Thornton, C; Jones, M.V.; University of Derby; Northumbria University; Manchester Metropolitan University (Elsevier BV, 2020-03-29)
      This study examined the effect of cold pressor pain on performance in high-contact athletes, low-contact athletes and non-athletes. A three-group between-subjects experimental design was used. Seventy-one participants completed a motor task and a cognitive task of different complexity (easy or hard) both in pain and not in pain. The motor task involved participants throwing a tennis ball at numbered targets in the correct order. In the cognitive task, participants were required to check off the numbers one to twenty-five in the correct order from a grid of randomly ordered numbers. Task difficulty was increased by adding dummy targets (motor task) or extra numbers (cognitive task). Cold pressor pain was rated as less intense by high-contact athletes during both tasks compared to low-contact athletes and non-athletes. High-contact athletes’ performance was not hampered by pain on the motor task, whereas it was in low-contact athletes and non-athletes. However, pain did not hamper performance for any group during the cognitive task. Low-contact and non-athletes did not differ from each other in their pain reports or the degree to which their performance was hampered by pain in either task. This study provides evidence that adaptation to pain through participation in high-contact sports can enhance both pain tolerance generally and motor performance specifically under increases in pain. The mechanisms behind these differences warrant further exploration.
    • Understanding the causes of problematic pain management in sickle cell disease: evidence that pseudoaddiction plays a more important role than genuine analgesic dependence

      Elander, James; Lusher, Joanne; Bevan, David; Telfer, Paul; Burton, Bernice; University of Derby (2004)
      Treatment of painful episodes in sickle cell disease (SCD) is sometimes complicated by disputes between patients and staff and patient behaviors that raise concerns about analgesic misuse. Those concern-raising behaviors could indicate either drug seeking caused by analgesic dependence or pseudoaddiction caused by undertreatment of pain. To make a systematic assessment of concern-raising behaviors and examine their associations with other factors, including DSM-IV symptoms of substance dependence, individual, in-depth interviews with SCD patients were conducted to apply pre-established criteria for concernraising behaviors. These included disputes with staff, tampering with analgesic delivery systems, passing prescribed analgesics from one person to another, being suspected or accused of analgesic misuse, self-discharging from hospital, obtaining analgesic prescriptions from multiple sources, using illicit drugs, and injecting analgesics. Assessments were also made of pain-related symptoms of substance dependence (where behaviors resemble substance dependence but reflect attempts to manage pain, increasing the risk of pseudoaddiction), non-pain-related symptoms of substance dependence (where substance dependence reflects analgesic use beyond pain management), and pain coping strategies (using the Pain Coping Strategies Questionnaire). Inter-rater reliability for the assessment of concern-raising behaviors was high, with Kappa coefficients of 0.63 to 1.0. The most frequent concern-raising behaviors were disputes with staff about pain or analgesics. The least frequent were tampering with analgesic delivery systems and passing analgesics between patients in hospital. The odds of concern-raising behaviors in hospital were raised eightfold by less use of ignoring pain as a coping strategy, and more than doubled by each additional pain-related symptom of substance dependence. Non-painrelated symptoms of substance dependence had no independent effect on concern-raising behaviors. Concern-raising behaviors were more closely associated with pain behaviors that make patients vulnerable to misperceptions of substance dependence than they were with genuine substance dependence. The results show how pseudoaddiction can adversely influence hospital pain management, and suggest that more emphasis should be placed on patients’ pain and analgesic needs when responding to concern-raising behaviors in hospital.