Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain.

Although chronic pain is a frequent cause of suffering and disability and is costly to society, there continues to be limited access to specialty pain clinic services. Hence, there is a need for cost-effective, accessible interventions that will help people find ways to better manage this difficult problem. This randomized controlled trial examined the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP). It has a standard protocol that was modified from the successful Arthritis Self-Management Program (ASMP). One hundred and ten individuals with mixed idiopathic chronic pain conditions were enrolled in the study (75% female; mean age 40 years; mean chronicity 6 years) and were randomly assigned to one of two conditions: the 12-h (CPSMP) intervention group, or the 3-month wait-list control group. Self-report measures of pain-related and other quality of life variables as well as two hypothesized mediating variables were collected pre-treatment and 3 months later by assessors blind to group allocation. One hundred and two subjects completed the study. Results of intention-to-treat analysis indicated that the treatment group made significant short-term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction and in self-efficacy and resourcefulness as compared to the wait-list control group. Because it has a standard protocol, this intervention has the potential to be reliably delivered at low cost in varied urban and rural community settings and hence be more widely accessible to a greater number of people suffering from chronic pain than is currently the case with more specialized pain clinic services. Based on the results of this study, further research evaluating the long-term impact and potential cost savings to the individual and to the health care system is warranted.

Parental relationships, coping strategies, received support, and well-being in adolescents of separated or divorced and married parents.

The purpose of this cross-sectional study was to examine the impact of the perceived quality of the parental relationship and family status on coping strategies, received support, and well-being in adolescents from separated or divorced and married parents. Two hundred forty-four matched adolescents from separated/divorced and married households were drawn from an initial sample of 1,044 students who were tested at five colleges and three high schools of a large metropolitan and rural area. Regression analyses supported the hypothesis that a perceived poor parental relationship, and not family status, was associated with low life satisfaction and sense of future, and high anxiety in adolescents of divorced and married households. Hierarchical regression techniques revealed that coping strategies and received support did not mediate the association between a perceived poor parental relationship and low levels of well-being in adolescents from divorced and married households. The findings underscore the importance of intervening with adolescents within the context of their family relationships.

Living with chronic pain: the spouse's perspective.

This report is part of a larger study mounted for purposes of investigating the effects on a family of chronic pain in one of its adult members. Data concerning the spouses' understanding of their mate's pain along with the spouses' perception of the impact of this problem on their own health are presented. The factors of uncertainty and helplessness were found to be central to the distress experienced by the spouses in this study. The finding that the experience of living with chronic pain extends beyond the individual sufferer to encompass the family as a whole would suggest that health professionals must incorporate the family into the process of learning the meaning and management of chronic pain.