Browsing by Author "Kapoor, Shweta"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Healthcare Use and Prescription of Opioids in Rural Residents with Pain
    (2014) Kapoor, Shweta; Thorn, Beverly; University of Alabama Tuscaloosa
    Chronic pain is a major public health problem. Increased healthcare utilization by individuals with pain puts enormous burden on financial and health resources. There is extremely limited understanding of psychosocial factors that affect healthcare use and prescription of opioids in individuals who experience heightened healthcare disparities associated with being African-American, having low income, and with rural residency. Health disparities research indicates that rural residency and low socioeconomic status are associated with greater self-reported pain levels. It is logical to expect then that this would be associated with increased needs for health services. However, at the same time, these very variables function as barriers in accessing health care. This disparity between greater need and limited access in turn creates greater distress. Further complicating the picture is the rapidly emerging concern about the misuse of prescription opioids in rural areas. As a result, empirical inquiry has started focusing on the variables influencing the likelihood of receiving opioid prescriptions in rural areas. The understanding of psychosocial factors affecting healthcare use and prescription of opioids in individuals who experience heightened healthcare disparities associated with being African-American, low-income, and living in rural areas remains extremely limited. The primary aim of this study was to examine the demographic and psychosocial variables that affect health services use in a rural, low-income population with chronic pain. Secondarily, the influence of these same variables on receiving prescription for opioids was examined. Methods: Healthcare use during a 3 month period, prescription analgesics, as well as medical comorbidities were obtained from the medical records of 64 patients with chronic pain. The participants were enrolling in an upcoming psychosocial intervention offered at two rural federally qualified health centers in a south-eastern state in the USA. For the present study, these participants consented to have their medical records reviewed for the 3 months prior to beginning the intervention protocol. Additionally, the pre-treatment (baseline) assessments were used in the present analyses. Demographic information, including age, sex, and education level, as well as measures of pain intensity, depressive symptoms, pain-related disability, and pain catastrophizing were collected.
  • Thumbnail Image
    Item
    Perceived stigma, illness invalidation, sleep difficulties, and psychological distress in emerging adults in college with persistent pain
    (University of Alabama Libraries, 2015) Kapoor, Shweta; Thorn, Beverly E.; University of Alabama Tuscaloosa
    Persistent pain is traditionally associated with middle-aged to older adults and most of the pain literature is focused on this age group. However, recent research indicates a high prevalence of pain in children and adolescents as well. These studies have indicated significant differences in the variables affecting pain experience of children and adolescents as compared to older adults. One of the least studied groups of individuals with pain is emerging adults, individuals between the ages of 18-29 years. The limited number of epidemiological surveys focused on this age group has suggested a surprisingly high prevalence of pain in this age group. A lack of understanding and acknowledgement of pain experience in emerging adults may lead to problems of inadequate pain relief and delay in treatment, potentially worsening long-term health outcomes. Preliminary analyses of a qualitative study of college students with chronic or recurrent pain (Kapoor, Thorn, & Eyer, forthcoming) suggest a perception of stigmatization because of their pain as well as perceived invalidation of their pain experience. These factors seemed to be additionally influenced by college students' perception of experiencing persistent pain as an off-time life event. The current study aimed to examine pain experience of college students with chronic or recurrent pain and compare them to peers who do not experience pain on a regular basis. It was hypothesized that participants with pain, apart from endorsing higher depressive symptomatology, would report lower satisfaction with life as well as lower physical quality of health. In addition, the association of sociocultural contextual factors such as perceived pain-related stigma and illness invalidation with pain-related variables and psychological variables was analyzed. The results revealed that greater perceived invalidation of pain was associated with a higher perceived pain-related stigma, lower satisfaction with life, heightened pain perception and catastrophizing, impaired quality of life, as well as greater self-reported depression. Finally, sleep difficulties of the participants with pain as compared to their same age peers were investigated. The results indicated that those with pain reported poorer quality as well as quantity of sleep. Furthermore, for participants with pain, higher self-reported depression was associated with a lower quality of sleep. Clinical implications are discussed.
  • Thumbnail Image
    Item
    Psychosocial predictors of health care utilization with chronic pain in rural alabama
    (University of Alabama Libraries, 2012) Kapoor, Shweta; Thorn, Beverly E.; University of Alabama Tuscaloosa
    This study examines psychosocial factors affecting health care utilization (HCU) in patients residing in rural AL who participated in psychosocial treatment for chronic pain. Based on previous literature, it was hypothesized that depression, disability, education, and quality of life would predict health care utilization both pre- and post-treatment. Additional exploratory aims included investigating whether completion status predicted health care utilization post-treatment and if the self-reported psychosocial measures predicted completion status. HCU data were gathered from medical records at two AL rural health centers and included number of visits, interval between visits, prescription analgesics, and comorbidities. Participants also completed the Pain Catastrophizing Scale, Roland Morris Disability Scale, Quality of Life Scale and Center for Epidemiologic Studies Depression Scale before as well as after treatment. Medical records for 64 participants were available for review. The participants were predominantly African-American (67.2%) females (73.4%) with an average age of 49.34 years and mean duration of pain of 18.5 years. Multiple regression analyses revealed that depression and pain catastrophizing predicted number of visits pre-treatment with depression accounting for most of the variance while catastrophizing and quality of life contributed to the model predicting the average interval between visits pre-treatment. Perceived disability and catastrophizing contributed to the regression model for HCU post-treatment. In regard to treatment completion, the latter was uniquely and significantly predicted by education, depression, quality of life, and catastrophizing. Thus, although rural patients in this study shared several common predictors of HCU with urban patients, catastrophizing emerged as an important predictor of both health care services use and treatment completion in this study, seldom reported in previous studies.
  • Thumbnail Image
    Item
    A Qualitative Analysis of a Randomized Controlled Trial Comparing a Cognitive-Behavioral Treatment With Education
    (Churchill Livingstone, 2011) Day, Melissa A.; Thorn, Beverly E.; Kapoor, Shweta; University of Alabama Tuscaloosa
    Cognitive behavioral therapy (CBT) is a widely accepted psychosocial treatment for chronic pain. However, the efficacy of CBT has not been investigated within a rural setting. Furthermore, few studies have utilized first-person accounts to qualitatively investigate the key treatment elements and processes of change underlying the well-documented quantitative improvements associated with CBT. To address these gaps, we conducted a randomized controlled trial (RCT) investigating the efficacy of group CBT compared to an active education condition (EDU) within a rural, low-literacy population. Posttreatment semistructured interviews of 28 CBT and 24 EDU treatment completers were qualitatively analyzed. Emerging themes were collated to depict a set of finalized thematic maps to visually represent the patterns inherent in the data. Patterns were separated into procedural elements and presumed change processes of treatment. Key themes, subthemes, and example extracts for CBT and EDU are presented; unique and shared aspects pertaining to the thematic maps are discussed. Results indicate that while both groups benefited from the program, the CBT group described more breadth and depth of change as compared to the EDU group. Importantly, this study identified key treatment elements and explored possible processes of change from the patients' perspective. Perspective: This qualitative article describes patient-identified key procedural elements and change process factors associated with psychosocial approaches for chronic pain management. Results may guide further adaptations to existing treatment protocols for use within unique, under-served chronic pain populations. Continued development of patient-centered approaches may help reduce health, treatment, and ethnicity disparities. (C) 2011 by the American Pain Society