By Lindy McCollum-Brounley
GAINESVILLE, Fla. - "Honey, let me help you with that" is music to the ears of most spouses, especially when it comes to unpleasant tasks, such as washing dishes or taking out the trash. But for the 86 million Americans living with chronic pain -caused by maladies such as back injury, migraines and arthritis - theattention of overly solicitous spouses actually may be more harmful thanhelpful, University of Florida dental researchers report in the current issue of the Clinical Journal of Pain.
"We were interested in understanding the relationship between spousal responses and pain and disability, and whether those relationships might be different for men and women," said Roger Fillingim, Ph.D., an associate professor of public health services and research at UF's College of Dentistry.
Although previous studies have demonstrated higher levels of pain and disabilities among patients who report more solicitous oroverly supportive spousal responses, what has not been examined until now is whether men and women differ in how they respond to spousal solicitousness, pain and disability and other pain-related variables, hesaid.
To answer that question, UF researchers evaluated the responses of 203 men and 114 women with chronic-pain on several surveys, pain-tolerance assessments and measures of physical function. In one questionnaire, patients were asked to rate the responsiveness of their spouses, who were then grouped into two categories - those who exhibited high solicitousness and those who displayed low solicitousness.
Other questionnaires asked patients to rate the severity oftheir pain, disability and depression. Scientists rated the severity of each patient's disability after they completed tests of physical function gauging how fast they could walk around a 100-yard track, and assessed their ability to lift and carry weighted boxes, push and pull against a device that measures strength and withstand pain induced by temporarily cutting off blood flow to the arm.
"Overall, what we see is that for self-reported pain and disability, spousal responses were related to those two factors in malepatients but not female patients," Fillingim said. Men with highly solicitous spouses were more likely to rate theseverity of their pain and disability higher than men with spouses whowere less solicitous. But despite their differing perceptions, men in both groups performed the same on the functional tasks - indicating little to no difference in physical performance.
Women who reported having highly solicitous spouses had lower pain tolerance and poorer performance on functional tasks than women whosaid their spouses were not solicitous. They also were twice as likely to use narcotic pain medications. "What it looks like is that the spousal responses are related to how men say they're doing, while with the women patients, spousal responses seem to be related to how they actually are doing," Fillingim said.
According to Fillingim, patients may be predisposed to a certain physiological response to pain depending on the type of attention theirspouses give them. "The idea is if you are a chronic-pain patient and your spouse babies you, essentially you are being rewarded for being in pain. And
the more reinforcement you get for engaging in pain behaviors, the more pain behaviors you will show," Fillingim said. "Many physiological responses can be behaviorally conditioned, and I believe that pain is noexception to that rule," he said.
This idea is consistent with research conducted by Herta Flor, Ph.D., at the Central Institute of Mental Health in Mannheim, Germany. Flor's study also categorized chronic pain patients on the basis of spousal solicitousness during administration of harmless but unpleasant shocks, both in the presence of their spouses and without them. When patients with highly solicitous spouses were shocked in the presence of their spouses, they rated the pain as being more severe, and EKGs of brain activity showed a larger response to the painful stimulus than when their spouses were not present. For those patients whose spouses were not described as solicitous, the presence of their spouses did not affect their brain responses or their perception of the pain.
"So this suggests that a social variable, the presence of a solicitous spouse, may actually alter how our brain responds to pain andhow we perceive pain," Fillingim said. "It may not just be behaviors we're conditioning here, it may be physiological responses that can either help us or hurt us, depending on how the conditioning occurs."
Pain patients have a chronic condition they have to learn to manage, very much like diabetes, Fillingim said. Incorporating patientand spousal training as part of their treatment plans may help couples manage chronic pain conditions more effectively. Spouses can be taught to give other supportive responses that are not solicitous, such as distraction techniques, for example, or encouraging their spouses to useproven relaxation and strategies to soothe themselves.
"The whole goal here is to increase the patient's control, function and independence, rather than making the patient less functional and dependent on the spouse," he said. "Our study addresses a very complicated issue, the variables of which need further study to explain," he said. "But it does suggest that the interaction between clinical pain and interpersonal relationships may very well be different for men and women, and we should probably try to take that into account as we're evaluating patients, designing treatments and training spouses on how to be most appropriately supportive of their spouses who are in pain."
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University of Florida Drug Information Center,
this is Angela. May I help you?"
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GAINESVILLE, Fla. - "This has been a welcome greeting to professionals statewide, like Ray Moreno in Miami, who has logged in calls to his alma mater over many years.
Like other health-care professionals throughout Florida, Moreno has called on the UF Drug Information and Pharmacy Resource Center for hard-to-find drug information for his customers. Moreno, who comes from a family of pharmacists, moved to Gainesville to study pharmacy in the 1980s. After earning his bachelor's degree, he returned to South Florida to become a registered pharmacist and start a career in the family-owned Universal Arts Pharmacy in Hialeah. Miami has a rich blend of people from Cuba, Brazil, Argentina, Columbia and many other countries, said Moreno, who frequently calls the UF Drug Information Center to find a U.S. equivalent to a foreign drug prescription for a customer. He said the center is an immense resource that over time has helped him develop his own knowledge base. "My customers think I am really smart because I can find answers quickly, but I learned a long time ago from my professor, Paul Doering, that you don't have to know everything," Moreno said. "You just have to know your resources."
A free service for health-care professionals statewide, the UF Drug Information and Pharmacy Resource Center originated as a thesis project in 1972. The idea was to provide pharmacy students training through which they could learn to perform drug research and provide
pharmaceutical service.
Today, the center is funded through Shands HealthCare and co-directed by Randy Hatton, Pharm.D., from Shands at UF medical center, and Professor Paul Doering, M.S., from the College of Pharmacy.
The drug information center is staffed by Doctor of Pharmacy students in their last year of training, who complete a drug information rotation as part of their required curriculum. Several months of the year, these students are assisted by pharmacy residents - registered pharmacists who have earned their Doctor of Pharmacy degrees and are receiving additional training. Before answers are given, they are reviewed by Doering and other faculty.
"We take calls from Key West to Jacksonville and all pointsbetween," Doering said. "And we don't get easy questions - we get the hard stuff." One of the most unusual calls Doering remembers came from a veterinarian at the Jacksonville Zoo, who sought help in figuring out how to dose a human antibiotic for an African elephant. Doering has the satisfaction of not only teaching valuable skills to his students, but also educating practicing pharmacists. He has witnessed a trend over the years in which health professionals call on the center more frequently when starting their careers. As they gain experience and learn of new resources through calling UF's center, they become more proficient in their own research.
Whose voice is heard responding to the eight to 10 new callers each day? Recently it was that of UF pharmacy senior Angela Quickenton, who just completed a one-month rotation as a part of her training in researching drug information and providing pharmacy service. "Working at the center has been a great experience that I know I can take with me in my career," Quickenton said. Open Monday through Friday, 9 a.m. to 5 p.m., the center does not provide emergency services or address legal issues. The service only is available to health-care and law enforcement professionals, but any person in Florida needing research information can request it from their local pharmacist. The center receives more than 2,000 calls a year - a much lower number than in past years when a toll-free number was offered. This change was necessary due to budget cuts.
The center now provides a free Internet service that Florida professionals can use after registering on the Shands HealthCare Web site at
http://shands.org/professional/drugs. Out-of-state health-care providers can pay a fee to subscribe to the Web service.
By Linda Homewood
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A University of Florida nursing researcher is examining whether stress and pain management techniques can prevent work-related injuries and improve the overall health
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GAINESVILLE, Fla. - A University of Florida nursing researcher is examining whether stress and pain management techniques can prevent work-related injuries and improve the overall health of nursing professionals, potentially avoiding a worsening of the nation's nursing shortage.
Nancy Menzel, Ph.D., R.N., an assistant professor at the UF College of Nursing, will study two groups of 32 nursing staff members who have reported working with back pain in the past year. One group will attend six weeks of classes on stress and pain management before receiving state-of-the-art patient handling and movement technology equipment, such as motorized lifts and friction-reducing devices, for use on the job. The other group only will receive the ergonomic equipment, which is designed to reduce the risk of back injuries associated with patient handling and is being loaned for the study by commercial vendors.
The stress and pain management classes are designed to reduce stress, back pain and disability in nursing staff members. UF investigators will examine whether such classes can enhance the benefits of using patient handling equipment.
The study is among four pilot studies of the UF Biobehavioral Research Center launched this year and will be conducted at Brooks Rehabilitation Hospital in Jacksonville. Menzel will evaluate study results to determine whether standardized measurements of stress, pain, disability, emotional burnoutand job satisfaction can predict the incidence and length of unscheduled absences from work due to back pain.
Federal regulators and researchers have focused almost exclusively on reducing the physical risk factors associated with back injuries in nursing work environments, so Menzel says the project is needed to investigate psychosocial factors.
"In many instances pain and stress are intertwined," Menzel said. "We want to be able to set up an effective and convenient training schedule that may assist these nurses and nursing assistants with coping with both the pain and stress of their everyday jobs."
Psychosocial stress has been shown to increase spinal compression and thereby increase the risk of lower back disorder in some people. Previous research has shown that high job demand, low job satisfaction and low social support have been identified as risk factors for work-related musculoskeletal disorders.
Study participants will be Brooks Rehabilitation Hospital full-or-part-time nursing staff, including registered nurses, licensed practical nurses and nursing assistants of any age or gender who spend at least 80 percent of their time providing direct patient care and who report that they have had work-related back pain lasting a week or longer in the past 30 days.
The educational sessions have been adapted from successful stress and pain management programs administered to chronic pain patients at the UF Spine Center and Psychology Clinic. Sessions include instruction on relaxation techniques; time management; distraction techniques; on-the-job stress and conflict management; assertiveness training; communication skills and problem solving; and personal and health education in sleep, hygiene, nutrition and exercise.
In measuring stress, pain, disability, emotional burnout and job satisfaction, Menzel will use various standardized research questionnaires and inventories, including the Beck Depression Inventory, the Maslach Burnout Inventory and the Minnesota Satisfaction Questionnaire. Unscheduled absences will be measured by participants' reports of sick leave and lost days.
To assess the levels of physical stress from the use of patient handling devices, the study will compare salivary cortisol levels of participants only receiving the technological interventions both before and after introduction of the equipment.
Menzel will work with co-investigator Michael E. Robinson, Ph.D., a professor at the UF College of Health Professions and director of the Center for Pain Research and Behavioral Health at UF, which is dedicated to investigating and understanding the experience of pain in humans. Results from the pilot study will be used to form the basis for a larger, randomized study.
"The ultimate goal, if stress management is found to be effective, is to promote the widespread adoption by health-care facilities of such training for nursing staff, in lieu of body mechanics classes, which have been of limited usefulness in preventing back injuries," Menzel said.
By Tracy Brown
