Alan J. M. Brnabic

Chronic pain in Australia : a prevalence study

&NA; This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer‐Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two‐stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response rate=70.8%). Chronic pain was reported by 17.1% of males and 20.0% of females. For males, prevalence peaked at 27.0% in the 65–69 year age group and for females, prevalence peaked at 31.0% in the oldest age group (80–84 years). Having chronic pain was significantly associated with older age, female gender, lower levels of completed education, and not having private health insurance; it was also strongly associated with receiving a disability benefit (adjusted OR=3.89, P<0.001) or unemployment benefit (adjusted OR=1.99, P<0.001); being unemployed for health reasons (adjusted OR=6.41, P<0.001); having poor self‐rated health (adjusted OR=7.24, P<0.001); and high levels of psychological distress (adjusted OR=3.16, P<0.001). Eleven per cent of males and 13.5% of females in the survey reported some degree of interference with daily activities caused by their pain. Prevalence of interference was highest in the 55–59 year age group in both males (17.2%) and females (19.7%). Younger respondents with chronic pain were proportionately most likely to report interference due to pain, affecting 84.3% of females and 75.9% of males aged 20–24 years with chronic pain. Within the subgroup of respondents reporting chronic pain, the presence of interference with daily activities caused by pain was significantly associated with younger age; female gender; and not having private health insurance. There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, P<0.001) or being unemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage.

Chronic pain and frequent use of health care.

&NA; Little is known about the relationship between chronic pain status and overall use of healthcare. We examined whether disabling chronic pain was associated with more frequent use of healthcare in three settings: primary care, emergency departments, and hospital admissions. We used data from Computer‐Assisted Telephone Interviews (CATI) of 17,543 residents in New South Wales, Australia aged 16 and over who were randomly sampled using a population‐based two‐stage stratified sample and random digit dialling methods. The overall response rate was 70.8%. Compared to chronic pain respondents with no or limited pain‐related disability, those with most pain‐related disability reported more: primary care visits in the last 2 weeks and last 12 months (adjusted mean number of visits 0.59 vs 0.40 and 10.72 vs 4.81, both P<0.005); hospital admissions (0.46 vs 0.18, P<0.005); and emergency department visits (0.85 vs 0.17, P>0.005). In modelling, having chronic pain per se, or having chronic pain with any level of activity interference predicted health care use after adjusting for age, gender, self‐rated health, psychological distress, comorbidity and access to care. Higher levels of pain‐related disability predicted health care use more than other pain status variables. There was a strong association between pain‐related disability and greater use of services. Further work is needed to understand the nature of this association. Given the fluctuating course of chronic pain over time, there is a significant segment of the population that may be at risk of developing higher levels of disability associated with increased use of services.

Differing risk factors for falls in nursing home and intermediate-care residents who can and cannot stand unaided

Objectives: To determine fall risk factors in nursing home and intermediate‐care residents who can and cannot stand unaided.

Antibiotic prophylaxis in hip fracture surgery: a metaanalysis.

A metaanalysis was done to identify the most effective prophylactic antibiotic regimen in hip fracture surgery. Specific comparisons addressed were antibiotics at any dose versus placebo, multiple doses (>24 hours coverage) versus one dose of antibiotics, and multiple doses versus 24 hours antibiotic coverage. Outcomes measured included overall wound infections, deep wound infection, superficial wound infection, urinary tract infection, and mortality. A computer search of the Medline and EMBASE databases (English language literature from 1966 to 2000 and 1988 to 2000, respectively) retrieved 15 randomized controlled trials which addressed the specific aims. Most studies evaluated antibiotics from the cephalosporin group. Antibiotic prophylaxis significantly reduced overall wound infections when compared with placebo and was equally effective for deep and superficial infections. One dose of intravenous antibiotics seemed no different than multiple doses. Antibiotic use also was associated with a significant reduction in the incidence of urinary tract infection but had no significant effect on mortality.

Self-management intervention for chronic pain in older adults: a randomised controlled trial.

&NA; In the short term, combined CBT‐based pain self‐management and exercises are more effective than exercises and usual care in older adults with chronic pain. &NA; This study compared an outpatient pain self‐management (PSM) program, using cognitive‐behavioural therapy and exercises, with 2 control conditions in 141 chronic pain patients aged > 65 years. Results immediately posttreatment indicated that relative to the Exercise‐Attention Control (EAC) group, the PSM group was significantly improved on measures of pain distress, disability, mood, unhelpful pain beliefs, and functional reach. The mean effect size for these gains was 0.52 (range: 0.44–0.68). By 1‐month follow‐up, relative to the EAC group, the PSM group remained better on most measures. At the 1‐month follow‐up, relative to a Waiting List (usual care) (WL) group, the PSM group was significantly improved on measures of pain distress, disability, and unhelpful pain beliefs. The mean effect size for these variables was 0.69 (range: 0.56–0.83). Relative to the WL group, the EAC group made no significant gains on any of the measured variables. At 1‐month follow‐up, the mean proportion of reliably improved cases (across outcome variables) was 41% (range: 16–60%) for the PSM group, twice that of those who met this criterion in the 2 control conditions (and this difference was statistically significant). Similarly, significantly more (44%) of the PSM group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive‐behavioural therapy‐based PSM was more effective than exercises and usual care.

Cognitive exposure versus avoidance in patients with chronic pain: Adherence matters

Behavioural exposure methods can reduce pain‐avoidance behaviours, but outcomes vary. One possible explanation is that patients employ cognitive (experiential) avoidance during behavioural exposure. If so, reducing cognitive avoidance during behavioural exposure should help. One option is interoceptive exposure (IE), which involves sustained exposure (via attention) to pain sensations. In order to test if IE could improve outcomes from behavioural exposure, this study with mixed chronic pain patients compared outcomes from a cognitive behavioural therapy (CBT) pain management programme incorporating either IE or distraction from pain.

Can non‐prosecutory enforcement of public health legislation reduce smoking amonq hiqh school students?

Background: Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents? access.

Long-term outcomes from training in self-management of chronic pain in an elderly population: A randomised controlled trial

Abstract This study compares the outcomes, from pretreatment to 1-year follow-up, of an outpatient, CBT-based pain self-management program (PSM) that included exercises, pain education, and pain coping strategies, with a control condition (exercise-attention control, EAC) that included exercises and a control for the attention of the treatment team. We previously reported short-term results (to 1-month follow-up) from the same study. This new paper considers the important issue of maintenance of treatment-related gains. The participants (n = 141) were a heterogeneous sample of ambulant, community-dwelling older adult patients with chronic pain (mean age: 73.90 [6.5] years [range: 65-87 years]). The long-term results indicate the pain self-management program group achieved and maintained significantly better results than the exercise-attention control group on the primary outcome, pain-related disability, as well as on usual pain, pain distress, depression, and fear-avoidance beliefs. The mean effect size for these gains by the pain self-management program group over the exercise-attention control group was 0.37 (range: 0.29-0.45), which is in the small effect size range. While statistically and clinically meaningful, these findings do indicate some weakening in effects over time but not to a significant degree. The study has implications for the provision of pain management interventions for community-dwelling older adults with chronic pain.

Public health surveillance of hepatitis C: can it identify incident cases?

Objectives : To evaluate a follow‐up system to identify incident cases among individuals notified with the hepatitis C virus (HCV).