Moderate Chronic Pain, Weight and Dietary Intake: METHODS AND PROCEDURES
Study Design/Subjects
The current study used a survey design and medical records review to evaluate the effects of weight and BMI on pain and pain on dietary intake in patients with SCD. The study represents a cross-sectional analysis of first-year data collected as part of a larger, five-year, longitudinal survey and medical records evaluation of the relationship of medical and psychosocial factors to pain in patients with SCD. We sought to document patterns of weight as a function of height [body mass index (BMI)], the association of BMI to pain and pain-related indices, and an evaluation of changes in patterns of eating as a function of the presence of pain.
One-hundred-seventy-five consecutive patients receiving routine follow-up care were approached from the Duke Comprehensive Sickle Cell Center. Of the 175 patients approached, 140 patients provided consent for participation in the current study. Of patients who gave consent, 62 completed testing, 40 partially completed testing, 37 had not begun testing by the time of analysis, and one patient completed testing but had significant and relevant portions of the questionnaire unanswered. Twenty-nine male and 33 female subjects completed the consent and assessment process during the first 12 months of enrollment. Individuals who declined participation generally indicated: 1) time constraints, 2) already participating in another research study, or 3) not interested in participating in scientific research. Only completed datasets were used in the current analysis. All subjects signed informed consents and the study was approved by the Duke institutional review board. Patients were not provided monetary compensation for their participation in the study. cheap rimonabant
Subjects were excluded from participation if they were actively in an acute episode of pain or other urgent medical crisis at the time of clinic visit, had a diagnosed eating disorder, or if they were unable to read and comprehend the written instructions for testing. Patients were also excluded if they had a known physical diagnosis other than SCD (pulmonary hypertension, etc.).
Pain
The Multidimensional Pain Inventory (MPI-2) is a short form of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). The MPI-2 assesses self-reported levels of pain and the extent to which pain interferes with normal daily activities. It also assesses support and engagement in daily activities. The MPI has demonstrated adequate psychometric properties. Specifically, internal reliability coefficients range from 0.70-0.90 and test-retest reliabilities over a two-week period range from 0.62 to 0.91.
Diet/Nutritional Intake
Participants responded to several questions developed for the purpose of this investigation that were designed to assess eating and nutritional patterns in the context of pain in general, and during painful episodes in particular. General dietary/nutritional questions assessed whether participants believe that their pain affects their weight (i.e., “Does your pain affect your weight?”) and whether their weight affects their pain (i.e., “Does your weight affect your pain?”). They were also asked whether they follow a special diet. With regard to dietary patterns associated with painful episodes, the level of pain required to influence or change participants’ eating habits was assessed as well as the direction of change (i.e., eat more, eat less or eating habits not affected by pain levels). Participants were asked specifically whether they eat more, less or experience no change in their consumption of several macronutrients (i.e., fats, sugar, protein, salt). To our knowledge, the diet/nutrition questions posed in this study have not been used in previous studies; thus, specific psychometric proper-tie of these questions have not been assessed.
Longitudinal Exploration of Medical and Psychosocial Factors in Sickle Cell Disease
The Longitudinal Exploration of Medical and Psychosocial Factors in Sickle Cell Disease (LEMPFSCD), designed specifically for examining this population, was administered to each participant during routine clinic visits. The LEMPFSCD is a 700-question tool consisting of pain, demographic, and eight validated, content-driven instruments for the assessment of psychiatric, behavioral and social functioning. For the purpose of the current study, the following measures and question sets were examined: demographics (including BMI), pain, dietary intake and psychological distress. Participants completed the LEMPFSCD while waiting for and then after their normally scheduled appointments. Average completion time was approximately three hours. orlistat 60 mg
STATISTICAL ANALYSIS
Descriptive statistics were used to describe the sample characteristics. Pearson r correlation coefficients were used to evaluate the relationship of BMI to pain severity and interference from pain. Chi-square was used to evaluate reported changes in dietary intake of macronutrients like proteins, fats and sugars. Lastly, Analysis of Variance (ANOVA) was used to evaluate the differential effects of weight status (overweight and obese versus normal weight) on pain and changes in dietary intake in patients with SCD. P values <0.05 were used to establish statistical significance for analyses which included Pearson correlations, Chi-square and ANOVA.
