Amy Wachholtz

Pain is a multidimensional, complex experience. There are many challenges in identifying and meeting the needs of patients experiencing pain. Evaluation of pain from a bio-psycho-social-spiritual framework is particularly germane for patients approaching the end of life. This review explores the relation between the psychospiritual dimensions of suffering and the experience of physical pain, and...

232 Background: The beneficial effects of life story review and legacy activities on the mood and quality of life for adults with advanced illness is well described, including the creation of legacy videos for family gifting. It is unknown whether creating legacy videos with the intent of teaching future healthcare professionals about the “cancer patient” experience is acceptable, beneficial, or meaningful to patients. The study aim is to describe the acceptability and success of recruiting patients with advanced cancer to create teaching videos for healthcare professionals. Methods: Patients aged 18 and older were recruited from the outpatient oncology clinic, palliative medicine clinic, and inpatient service of an academic medical center in the Northeast. Eligibility included having a diagnosis of an unresectable advanced cancer, an ECOG score of 0-3, being English speaking, and not having active psychosis. Patients underwent in-person, digital video recorded interviews that followed a semi-structured interview guide. Interview questions addressed the lived experience of being a “cancer patient,” coping, and how the patient thought clinicians could provide better care to future patients. For each patient, we measured the Functional Assessment of Cancer Therapy - General (FACT-G), Hospital Anxiety and Depression Scale (HADS), Patient Dignity Inventory (PDI), Distress Thermometer, and study acceptability. Results: Recruitment is ongoing. To date, of 12 patients referred, 4 completed the video, and 3 completed the follow-up visit. On average, it takes six contact attempts (phone calls or text message threads) to schedule an appointment that resulted in a completed video. Each interview lasted about a 1-1.5 hours. Patients reported that they “really enjoyed the experience,” and “it had helped them process” their cancer experience. A common theme was the patient’s strong desire to help others by sharing their story. Conclusions: Patients with advanced cancer find recruitment and participation in an educationally-oriented legacy video project acceptable and potentially personally helpful.

This study sought to characterize the experience of stress, treatment patterns, and medical and disability profile in the migraineur population to better understand how the experience of migraines impacts the social and psychological functioning of this group. A 30-minute self-report survey was presented via a migraine-specific website with data collection occurring between May 15 and June 15, 2012. Recruitment for the study was done through online advertisements. In total, 2,907 individuals began the survey and 2,735 met the inclusion criteria for the study. The sample was predominantly female (92.8%). Migraine-associated stress was correlated with length of time since first onset of symptoms (PPPP<0.01), were also positively correlated with the measured stress resulting from migraines. Migraine-associated stress must be understood as a multidimensional experience with broader impacts of stress on an individual correlating much more highly with negative mental and physical health profiles. Stress resulting from frequent migraine headaches may contribute to the development of medical and psychological comorbidities and may be a part of a cyclical relationship wherein stress is both a cause and effect of the social and medical impairments brought about by migraine.

Data from emerging adults (ages 18–29, N = 900) in the National Comorbidity Survey Replication Study was used to examine the influence of childhood and emerging adult religiosity and religious-based decision-making, and childhood adversity, on alcohol use. Childhood religiosity was protective against early alcohol use and progression to later abuse or dependence, but did not significantly offset the influence of childhood adversity on early patterns of heavy drinking in adjusted logistic regression models. Religiosity in emerging adulthood was negatively associated with alcohol use disorders. Protective associations for religiosity varied by gender, ethnicity and childhood adversity histories. Higher religiosity may be protective against early onset alcohol use and later development of alcohol problems, thus, should be considered in prevention programming for youth, particularly in faith-based settings. Mental health providers should allow for integration of clients’ religiosity and spirituality beliefs and practices in treatment settings if clients indicate such interest.

Chronic migraine is a costly and highly disabling condition that impacts millions of people in the United States. While chronic migraine is hypothesized to result from more infrequent forms of migraine, the precise mechanism by which this develops is still being researched. This study sought to better characterize the treatment patterns, disorder characteristics, and medical and disability profile of the chronic migraine population using the largest dataset of chronic migraineurs ever collected. The survey was started by 8,359 individuals and 4,787 met the inclusion criteria for diagnosed chronic migraine The number of stressful life events participants experienced due to their migraines related to number of therapies tried (p2=0.215), depression (p2=0.178), number of comorbidities (p2=0.172), anxiety (p2=0.162), number of physician visits in the past year (p2=0.103), and chronic pain levels (p2=0.077).. The results of this survey suggest that chronic migraineurs may misattribute aspects of psychiatric or medical comorbidities to their chronic migraines. Further, the sample underutilized mental health services and were unsatisfied with their migraine treatments. Providers to chronic migraineurs should ensure that patients are receiving appropriate mental health care in order to alleviate psychological distress as well as to potentially lessen negative life events previously associated with migraine symptoms.

We explored the relationship between meaning in life and adjustment to chronic pain in a three-wave, 2 year, longitudinal study of 273 Belgian chronic pain patients. We examined the directionality of the relationships among the meaning in life dimensions (Presence of Meaning and Search for Meaning) and indicators of adjustment (depressive symptoms, life satisfaction, pain intensity, and pain medication use). We found that Presence of Meaning was an important predictor of well-being. Secondly, we used a typological methodology to distinguish meaning in life profiles, and the relationship of individual meaning in life profiles with indicators of adjustment. Five meaning in life profiles emerged: High Presence High Search, High Presence Low Search, Moderate Presence Moderate Search, Low Presence Low Search, and Low Presence High Search. Each meaning in life profile was associated with a unique adjustment outcome. Profiles that scored high on Presence of Meaning showed more optimal adjustment. The profiles showed little change over time and did not moderate the development of adjustment indicators, except for life satisfaction. Practical implications and suggestions for future research are discussed.