Depression, Depressive Somatic or Nonsomatic Symptoms, and Function in a Primarily Hispanic Chronic Pain Population.

Chronic pain and depression are two major causes of disability. Comorbidity decreases psychosocial and physical functioning while increasing economic burden. The prevailing belief that Hispanics somaticize depression may hinder the diagnostic process and, thus, may impact outcomes. The purpose of this study was to explore the relationships among depression and depressive symptoms (somatic or nonsomatic) and function in chronic pain sufferers residing along the USA-Mexico border. Like other studies, as level of depression increased, level of pain increased and level of functioning decreased. So much so that almost a quarter of the participants reported moderate-to-severe depression, and another quarter of the participants reported suicidal ideation independent of depression or treatment. Unlike other published reports, we used a sample of chronic pain patients who received individualized, multimodal pain treatment. Compared to our previous work in a similar population, pain intensity and suicidal ideation were lower in this study. A plausible explanation is the use of antidepressants as adjuvant treatment for pain. Regardless of gender or ethnicity, persons with chronic pain will disclose symptoms of depression when appropriate tools are used to collect the data. Implications for future research and clinical practice are discussed.

Acculturation, depression, and function in individuals seeking pain management in a predominantly Hispanic southwestern border community.

Acculturation does not inform practice in the acute or primary care setting; nor does it explain ethnic disparities in the recognition and treatment of chronic diseases, particularly chronic pain. As clinicians, it is imperative that we recognize contributing factors, comorbid conditions, and the impact of chronic pain on individuals and families. The purposes of this article are to present evidence that exemplifies the nonsignificant role acculturation plays in expression of pain and function of a predominantly Hispanic population on the United States border; and to identify more meaningful perspectives of culture that may lessen health disparities and improve pain management.

Malingering? No evidence in a predominantly Hispanic workers' compensation population with chronic pain.

Providers suspect malingering when patients seek compensation for injury or when pain is unconfirmed via objective evidence, judged disproportionate to the cause, or recalcitrant to treatment. Suspicions or claims of malingering may prejudice treatment or reimbursement decisions. The purpose of this archival study was to identify malingering in a predominantly Hispanic workers' compensation population seeking treatment for pain. We used a correlational archival research design to collect data from the medical records of 91 patients treated over a 10-year period in a specialty clinic. Inclusion criteria included individuals with psychologic evaluation for persistent pain that affected function. Using a priori power analysis for a medium effect size, power of .80, and alpha of .05, data from 85 medical records were necessary to meet correlational significance. The study sample reflects the ethnicity, educational level, and socioeconomic status of the larger U.S.-Mexico border community. The majority (93%) had workers' compensation and about one-third had active litigation. No one was diagnosed with malingering or pain disorder with primarily psychologic origins. Depression coexisted with chronic pain, and patients reported serious impairment in physical, occupational, and social function an average of 5 years after the onset of chronic pain. However, the vast majority of patients returned to work. In our experience, there is no place for the labeling and resultant stigma of malingering in chronic pain sufferers.

The effectiveness of a peer-mentored older adult fitness program on perceived physical, mental, and social function.

PURPOSE: The purpose of this research was to compare changes in perceived physical, mental, and social function measured by the Short Form-36 (SF36vr2) in a group of older adults who were trained by peer mentors (PMs) versus a similar group trained by qualified kinesiology student mentors (SMs). DATA SOURCES: We conducted a two-arm repeated measures longitudinal intervention and collected data for 87 PM and 44 SM participants. Pre- and post-training subscale scores were computed for all eight subscales and the two summary physical and mental component scores. The percentage differences in the 10 scores were used as the response variables. CONCLUSIONS: After a 14-week physical fitness intervention, perceived physical, mental, and social functioning improved significantly (p < .05) for the PM group, but not for the SM group (p > .06). Thus, older adults who participated in a physical fitness program with peer support perceived (a) overall improvement in physical and mental well-being; (b) better social functioning, (c) enhanced ability to carry out physical and emotional roles, (d) improved general health, and (e) increased level of vitality. Thus, we conclude that peer-mentored exercise programs for older adults are superior to programs mentored by young professionals and may lead to increased adherence. IMPLICATIONS FOR PRACTICE: Nurse practitioners routinely prescribe exercise while educating older adults about the benefits of an active lifestyle; however, older adults often remain sedentary and exhibit poor adherence to exercise. One potential solution is to use peer support. Two factors that can improve adherence are availability of structured exercise programs for the older adult and peer mentoring.