- Browse by Author
Browsing by Author "Anastas, Tracy"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Item Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference(Wolters Kluwer, 2018-11-22) Anastas, Tracy; Colpitts, Kelsey; Ziadni, Maisa; Darnall, Beth D.; Wilson, Anna C.; Psychology, School of ScienceIntroduction: Chronic pain in late adolescence and young adults is understudied and poorly characterized. Objectives: We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity. Methods: Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference. Results: Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference. Conclusion: Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.Item Examining the Effects of Contextually-Imposed Cognitive Load on Providers' Chronic Pain Treatment Decisions for Racially and Socioeconomically Diverse Patients(2022-08) Anastas, Tracy; Hirsh, Adam; Salyers, Michelle; Stewart, Jesse; Kroenke, KurtCompared to people who are White and have high socioeconomic status (SES), those who are Black and have low SES are more likely to receive suboptimal pain care. One potential contributor to these disparities is biased provider decision-making—there is compelling evidence that providers are influenced by patient race and SES when making pain treatment decisions. According to the dual process model, people are more likely to be influenced by demographic stereotypes, including implicit beliefs, when they are under high cognitive load (i.e., mental workload). One stereotype belief relevant to pain care is that Black and low SES people are more pain tolerant. Aligned with the dual process model, providers who are under high cognitive load and have strong implicit beliefs that Black and low SES people are more pain tolerant may be particularly likely to recommend fewer pain treatments to them. To test this hypothesis, I recruited physician residents and fellows (n=120) to make pain treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the providers were randomized to the high cognitive load group in which they were interrupted during the decision task to make conversions involving hypertension medications for another patient. Remaining providers completed the task without being interrupted. Providers’ implicit beliefs about race and SES differences in pain tolerance were measured with two separate Implicit Association Tests (IATs). Multilevel modeling indicated that providers recommended stronger medications to low than high SES patients (OR=.68, p=.03). There was also a significant interaction between patient SES and cognitive load (OR=-.56, p=.05) and a trending interaction between patient race and cognitive load (OR=1.7, p=.07). Under low cognitive load, providers recommended more pain treatments to high SES (vs. low SES) and Black (vs. White) patients, but under high cognitive load, providers recommended more pain treatments to low SES (vs. high SES) patients and equivalent treatment to Black and White patients. There were no three-way interactions between patient demographics (race or SES), cognitive load, and providers’ implicit beliefs (race-pain or SES-pain IAT scores). However, there was a trending interaction between patient race and race-pain IAT scores (OR=2.56, p=.09). Providers with stronger implicit beliefs that White people are pain sensitive and Black people are pain tolerant recommended more pain treatments to White patients and fewer pain treatments to Black patients. Lastly, there was a trending effect that providers with stronger implicit beliefs that high SES people are pain sensitive and low SES people are pain tolerant recommended stronger medications in general (OR=13.03, p=.07). Results support that provider cognitive load is clinically relevant and impacts clinical decision-making for chronic pain for racially and socioeconomically diverse patients. Future studies are needed to further understand the impact of cognitive load on providers’ pain care decisions, which may inform evidence-based interventions to improve pain care and reduce disparities.Item The Influence of Patient Race and Socioeconomic Status on Providers' Assessment and Treatment Recommendations for Chronic Pain(2019-05) Anastas, Tracy; Adam, Hirsh; Stewart, Jesse; Rand, KevinCompared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.Item A randomized controlled trial testing a virtual perspective-taking intervention to reduce race and socioeconomic status disparities in pain care(Wolters Kluwer, 2019-10-01) Hirsh, Adam T.; Miller, Megan M.; Hollingshead, Nicole A.; Anastas, Tracy; Carnell, Stephanie T.; Lok, Benjamin C.; Chu, Chenghao; Zhang, Ying; Robinson, Michael E.; Kroenke, Kurt; Ashburn-Nardo, Leslie; Psychology, School of ScienceWe conducted a randomized controlled trial of an individually-tailored, virtual perspective-taking intervention to reduce race and socioeconomic (SES) disparities in providers’ pain treatment decisions. Physician residents and fellows (n=436) were recruited from across the United States for this two-part online study. Providers first completed a bias assessment task in which they made treatment decisions for virtual patients with chronic pain who varied by race (Black/White) and SES (low/high). Providers who demonstrated a treatment bias were randomized to the intervention or control group. The intervention consisted of personalized feedback about their bias, real-time dynamic interactions with virtual patients, and videos depicting how pain impacts the patients’ lives. Treatment bias was re-assessed one week later. Compared to the control group, providers who received the tailored intervention had 85% lower odds of demonstrating a treatment bias against Black patients and 76% lower odds of demonstrating a treatment bias against low SES patients at follow-up. Providers who received the intervention for racial bias also showed increased compassion for patients compared to providers in the control condition. Group differences did not emerge for provider comfort in treating patients. Results suggest an online intervention that is tailored to providers according to their individual treatment biases, delivers feedback about these biases, and provides opportunities for increased contact with Black and low SES patients, can produce substantial changes in providers’ treatment decisions, resulting in more equitable pain care. Future studies should examine how these effects translate to real-world patient care, and the optimal timing/dose of the intervention.