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In this chapter, I explore connections between institutional and personal narratives of treating chronic pain with prescription opioids.

I explore how stories told in a Food and Drug Administration public hearing construct moral boundaries around different kinds of pain patients and justify a label change intended to reduce prescribing of opioids to people with chronic pain. I then examine how personal narratives, acquired through interviews with chronic pain patients who rely on opioids, both conform to and challenge the institutional narratives told in the hearing and work as subversive stories. Additionally, I consider how institutional and personal narratives of chronic pain shed light on intersections and conflicts between the medical and social models of disability.

The “invisible disability” experience of chronic pain highlights the complex entanglement between the struggles associated with impairment emphasized by the medical model, and those stemming from cultural and structural barriers emphasized by the social model.

I conclude with a discussion of the methodological value of examining narratives such as those of chronic pain and disability at multiple levels of social life. This study contributes to efforts to broaden disability discourse to include experiences such as chronic pain that are poorly represented in disability scholarship.

Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.

To determine healthcare utilization issues for low-income Hispanic immigrants who have both excess weight and chronic pain.

Community health workers conducted at-home interviews with 101 middle-aged and older Mexican Americans (aged 40-79 years, M=52.1±8.8) associated with a community agency in southern California to evaluate healthcare underutilization and reported reasons for not using medical or pharmaceutical care.

Almost all participants (91 percent) reported having received at least some medical care in the year preceding the study interview. However, at some point during the prior year, 62 percent had not seen a doctor when it was needed and 45 percent had not taken a prescribed medication. While the primary reason for underutilization was financial, communication, and trust reasons were also reported.

Although cross-sectional and geographically restricted, this study lays the foundation for additional research on reasons for underutilization of recommended healthcare and lack of pain management in low-income Hispanic immigrants who are overweight and have chronic pain.

Policy implications include the urgent need for health insurance.

Implications for providers include the need for accurate pain assessment and better communication about medication to prevent non-adherence in this population.

The current study highlights the existence of healthcare underutilization among overweight and obese Mexican Americans with chronic pain and identifies specific barriers to care, care seeking, and pain management.

Job‐limiting pain (JLP) is an increasingly relevant topic in organizations. However, research to date has failed to examine the stress‐inducing properties of pain and its effects on job satisfaction and organizational citizenship behavior (OCB). To address this gap, the purpose of this paper is to examine the interactive relationship between JLP and political skill (PS) on job satisfaction (Studies 1 and 2) and OCB (Study 2).

In the first study, data are gathered from 143 employees of a product distribution company in the Southeastern USA. In Study 2, the independent and dependent variables are collected two months apart (and matched) from 237 members of a state agency located in the Southeastern USA, who are participating in developmental exercises.

PS is supported as a neutralizer of stress brought on by JLP. Job satisfaction and organizational citizenship scores decline as pain increases for those with low levels of PS. Increased JLP has little effect on satisfaction and citizenship for those with high levels of PS.

The data are collected exclusively via a survey; however, tests indicate that multicollinearity does not inflate results.

The research has implications for individuals and managers. Managers can understand and account for the widespread effects of JLP. Individuals can activate PS to neutralize stress.

This is the first study to examine the interaction between JLP and PS in the work environment. Gaps in several bodies of literature, including stress, organizational behavior, psychology, and the biopsychosocial approach, are addressed.

Clinicians in chronic pain services are facing the need to develop meaningful and methodologically adequate measures, not only to evaluate the effectiveness of interventions and to assure quality, but also to support the continued funding and future development of such services. Explores the problems inherent in assessing outcomes in chronic pain. These include the complexity of the chronic pain syndrome itself, the multidimensional nature of interventions and the challenges of defining outcomes in the chronic illness syndrome. The complexity and challenges of assessing outcomes may lead to some reticence in facing the challenges but it is the responsibility of the clinicians to continue developing measures and to communicate to purchasers and other stakeholders the complexity of assessing outcomes in chronic pain.

The process of chronic pain (CP) and strategies is to improve the patient’s health and well-being. CP is a frequent medical problem that presents a major challenge to healthcare providers because of its complex natural history, imprecise aetiology, and inadequate response to pharmacological treatment. Although different definitions exist it is widely accepted that CP is an ongoing pain that lasts more than 3 months or that persists longer than the reasonably expected healing time for the involved tissues. Also, it is acknowledged that its treatment is much different than the treatment for acute pain. When addressing a person with CP, one should always keep in mind that pain is much more about the individual than the underlying medical condition. Every person is different, and healthcare providers should take a tailor-made approach to managing their pain. This is the only way to ensure good results in pain treatment. Treatment goals should be discussed and adapted to the patient profile. It is fundamental to have clear goals from the beginning and to ensure these are realistic, individualized, and measurable. Effective treatment for CP is only achieved through a holistic framework in which the patient’s well-being is the first concern and an interdisciplinary and societal approach is implemented from the first day.

Chronic pain has important socio‐economic consequences. The reasons for the evolution of a distinct specialty to treat patients with intractable pain are discussed. The users of a pain relief service are defined and their needs explained. A multidisciplinary approach to pain management has many advantages and key personnel are identified. Facilities and funding must be adequate for effective functioning of the service. An important role is education of medical and non‐medical personnel. Careful long‐term planning, both at local and regional level, is needed to ensure that the specialty of pain relief meets current patient needs and can also accommodate new advances in therapy.

There is an ever-increasing number of patients suffering from various forms of acute and chronic pain and getting treatment for such ailments is a basic human right. Opioid analgesics remain one way of managing and attending to such patients. However, due to the prevalence of opiophobia, many doctors avoid prescribing opioid-based medicines, even at the cost of patients suffering leading to a hindrance in providing optimal health care. Up till now, there has been no reliable and valid instrument to measure the severity of opiophobia in doctors. For this reason, the purpose of this study is to represent the construction of a precise and reliable instrument for measuring opiophobia along with its validation for doctors in Pakistan.

Interviews and theoretical knowledge relating to opiophobia were used as the basis for the purpose of generating an item pool. The generated item pool was evaluated by subject matter experts for content validity and inter-rater reliability, followed by Velicer’s minimum average partial method and maximum likelihood factor analysis for establishing the factorial structure of the scale. As opiophobia in doctors prevails the most and causes a lower ratio of prescription of opioid analgesics. The present sample selected for the study was that of n = 100 doctors (men = 50; women = 50) from various hospitals, treating patients with chronic pain, in Rawalpindi and Islamabad.

A two-factor structure was suggested by Velicer’s minimum average partial method and maximum likelihood factor analysis, which were labeled as fear of opioid analgesics and justified acceptance of opioids. The developed opiophobia questionnaire along with its subscales displayed appropriate levels of reliability α = 0.733, α = 0.760 and α = 0.725, respectively, suggesting the scale to be reliable.

Like any other study, this study also tried to address every essential aspect, but still lacked at some places which should be considered and catered for in future studies. In the first place the sample size was very limited which was due to the fact, the study was conducted during a pandemic and physically going for data collection was unavailable, thus leading to consequent sample size. It is recommended a correspondent study can be conducted with larger sample size, so they can get more reliable results with greater precision and power. Then, they will have the advantage of a small margin of error. The second limitation was the study involved only doctors as that was the main focus of the present study. However, other hospital staff such as nurses should also be incorporated to assess their level of opiophobia. The current scale suggests the severity of opiophobia with higher scores though no cutoff point has been suggested. Future studies should try and incorporate a cutoff point to assess the difference between doctors who have conventional levels of reservations against opioids and those suffering from opiophobia. Another limitation was that the present scale did not establish additional validities such as convergent and divergent validity. Future studies should collect data from a larger sample to establish these validities to further refine the scale.

This instrument can be immensely effective in identifying doctors who have concerns and fears about prescribing opioids to patients with chronic pain. The findings acquired on such a scale can help in developing appropriate academic and psychological interventions which can help such doctors to overcome their opiophobia. This can enable more doctors to prescribe appropriate medicine to their patients instead of letting them suffer from pain. Additionally, researchers can equally benefit from the instrument as it can enable them to investigate opiophobia with other possible variables.

Developing such a scale about the fear faced by doctors while treating patients would be very useful as it is not possible to take such fear when it comes to a patient’s life. This fear is also common among patients where they have a fear about the undesirable effects, addiction of drugs and fear of dying. Better awareness should be given to them which will be helpful for successful and less painful treatment in hospitals.

This scale is an original work with the aim of accessing opiophobia among doctors toward (chronic) patients with severe pain. There was a lot of research work that has been done on opiophobia in developed countries and few Pakistani researchers have also worked on opiophobia and its impact on pain management but still, no scale has been developed to measure the extent or tendency of opiophobia among doctors or patients. This scale can be used globally on both men and women doctors to access the tendency of opiophobia among them.