Publications by authors named "Staja Q Booker"

31 Publications

A mediation appraisal of catastrophizing, pain-related outcomes, and race in adults with knee osteoarthritis.

J Pain 2021 May 22. Epub 2021 May 22.

University of Florida, College of Nursing; University of Florida, Community Dentistry and Behavioral Science. Electronic address:

The current cross-sectional study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis. Furthermore, this study examined mediation at 2-year follow-up. Participants included 187 community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee osteoarthritis. Participants completed several self-reported pain-related measures and pain catastrophizing subscale at baseline and 2-year follow-up. Non-Hispanic Black (NHB) adults reported greater pain, disability, and poorer functional performance compared to their non-Hispanic White (NHW) counterparts (ps<.05). NHB adults also reported greater catastrophizing compared to NHW adults. Mediation analyses revealed that catastrophizing mediated the relationship between ethnicity/race and pain outcome measures. Specifically, NHB individuals reported significantly greater pain and disability, and exhibited lower levels of physical function, compared to NHW individuals, and these differences were mediated by higher levels of catastrophizing among NHB persons. Catastrophizing was a significant predictor of pain and disability 2-years later in both ethnic/race groups. These results suggest that pain catastrophizing is an important variable to consider in efforts to reduce ethnic/race group disparities in chronic pain. The findings are discussed in light of structural/systemic factors that may contribute to greater self-reports of pain catastrophizing among NHB individuals. PERSPECTIVE: The current study examines whether pain catastrophizing mediates the relationship between ethnicity/race and OA-related pain, disability, and functional impairment at baseline and during a 2-year follow-up period in non-Hispanic Black and non-Hispanic White adults with knee pain. These results point to the need for interventions that target pain catastrophizing.
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http://dx.doi.org/10.1016/j.jpain.2021.04.018DOI Listing
May 2021

Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults.

Pain Manag Nurs 2021 May 7. Epub 2021 May 7.

Pain Research and Intervention Center of Excellence, College of Dentistry, University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida.

Chronic pain, and the ethical management thereof, is the single most imperative health issue of this decade. Although a growing majority of individuals with chronic pain are middle-aged, the largest proportion of sufferers are older adults. Shifting tides in practice and research have led to population-focused approaches to pain management; however, the practice of many healthcare providers remains reactive and individualistic, limiting the discovery and implementation of long-term solutions for pain management in older adults. Yet, nurses and other health professionals have an opportune position to provide expert pain care by proactively providing evidence-based care for patients systematically. The purpose of this article is to stimulate discussion on three paradigms important to population-focused pain management: (1) prevention; (2) restoration and rehabilitation; and (3) palliation, which are in line with current national policy initiatives for improving patients' care experience, improving overall health and quality of life, and reducing associated health care costs.
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http://dx.doi.org/10.1016/j.pmn.2021.03.011DOI Listing
May 2021

Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis.

BMC Musculoskelet Disord 2021 May 5;22(1):415. Epub 2021 May 5.

Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, USA.

Background: Pain is the hallmark symptom of knee osteoarthritis (OA), and varies widely across individuals. Previous research has demonstrated both fluctuating and stable pain trajectories in knee OA using various time periods. Changes in pain assessed quarterly (i.e. 3-month intervals) in knee OA are relatively unknown. The current study aimed to investigate temporal variations in pain over a one and a half year period (18 months) based on quarterly characteristic pain assessments, and to examine differences in pain patterns by sociodemographic and baseline pain characteristics.

Methods: The sample included a prospective cohort of 188 participants (mean age 58 years; 63% female; 52% non-Hispanic Black) with or at risk for knee OA from an ongoing multisite investigation of ethnic/race group differences. Knee pain intensity was self-reported at baseline and quarterly over an18-month period. Baseline pain assessment also included frequency, duration, and total number of pain sites. Group-based trajectory modeling was used to identify distinct pain trajectories. Multinomial logistic regression was used to examine associations between sociodemographic characteristics, risk factors, and pain trajectory groups.

Results: Pain trajectories were relatively stable among a sample of adults with knee pain. Four distinct pain trajectories emerged in the overall sample, with the largest proportion of participants (35.1%) classified in the moderate-high pain group. There were significant relationships between age, education, income, ethnicity/race and trajectory group; with younger, less educated, lower income, and non-Hispanic Black participants had a greater representation in the highest pain trajectory group.

Conclusions: Pain remained stable across a one and a half-year period in adults with or at risk for knee osteoarthritis, based on quarterly assessments. Certain sociodemographic variables (e.g. ethnicity/race, education, income, age) may contribute to an increased risk of experiencing greater pain.
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http://dx.doi.org/10.1186/s12891-021-04284-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101224PMC
May 2021

Study Protocol Modeling Evoked Pain in Older African Americans with Knee Osteoarthritis.

Nurs Res 2021 May 5. Epub 2021 May 5.

University of Florida College of Nursing, Gainesville, FL University of Connecticut School of Nursing, Storrs, CT University of Florida College of Medicine, Gainesville, FL University of Florida College of Dentistry, Gainesville, FL.

Background: African American (AA) older adults with knee osteoarthritis experience more severe chronic pain and advanced physical disability. One of the most prominent stimuli that provoke knee pain is movement. Research suggests that compared to White Americans, AAs report significantly higher movement-evoked pain (MEP) in the knee. However, little is known about the biopsychosocial-behavioral mechanisms underlying MEP.

Objectives: To present a study protocol to (a) characterize the biopsychosocial-behavioral mechanisms that predict MEP in AAs with knee osteoarthritis, and (b) develop a targeted, mechanism-based, self-management intervention to reduce MEP and maximize movement.

Methods: An observational, mixed-methods cohort study will enroll 90 AA/Black adults (ages 55-90) to understand intra-individual and interindividual effects on MEP. Participants will complete assessments of MEP, function and gait, biopsychosocial-behavioral questionnaires, quantitative sensory testing, and 7-day ecological momentary assessments of pain and related symptoms. For the qualitative phase, focus groups will be conducted to co-construct a mechanism-based, pain self-management intervention.

Results: We will develop phenotypes of MEP based on biopsychosocial-behavioral predictors and correlate measures of MEP with function. Our central hypothesis is that higher levels of MEP will predict lower self-reported function and poorer performance on functional tasks and multiple biopsychosocial and behavioral factors will be associated with MEP and function. Predictors may serve as risk or protective factors for MEP and physical function. In targeting the biopsychosocial-behavioral mechanisms of MEP, we anticipate that older AAs may request that intervention components include culturally tailored self-management education, movement/physical activity training, treatment decision-making skills, coaching, spirituality, and social/kinship support.

Conclusion: Osteoarthritis is now the single most common cause of disability, mobility limitations, and persistent pain in older adults-especially AA older adults. To our knowledge, this will be the first study to systematically phenotype MEP in an older racial minority population with knee osteoarthritis and will be relevant for reducing knee pain and improving function.
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http://dx.doi.org/10.1097/NNR.0000000000000520DOI Listing
May 2021

Managing osteoarthritis pain with smart technology: a narrative review.

Rheumatol Adv Pract 2021 16;5(1):rkab021. Epub 2021 Mar 16.

Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Science, College of Dentistry.

Osteoarthritis (OA) is a highly prevalent musculoskeletal condition worldwide. More than 300 million individuals are affected by OA, and pain is the most common and challenging symptom to manage. Although many new advances have led to improved OA-related pain management, smart technology offers additional opportunities to enhance symptom management. This narrative review identifies and describes the current literature focused on smart technology for pain management in individuals with OA. In collaboration with a health sciences librarian, an interdisciplinary team of clinician-scientists searched multiple databases (e.g. PubMed, CINAHL and Embase), which generated 394 citations for review. After inclusion criteria were met, data were extracted from eight studies reporting on varied smart technologies, including mobile health, wearables and eHealth tools to measure or manage pain. Our review highlights the dearth of research in this crucial area, the implications for clinical practice and technology development, and future research needs.
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http://dx.doi.org/10.1093/rap/rkab021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068316PMC
March 2021

A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse.

Pain Manag Nurs 2021 02 5;22(1):58-68. Epub 2021 Jan 5.

University of Nevada, Las Vegas, School of Nursing, Las Vegas, Nevada.

Background: Nursing brings a unique lens to care of patients with pain and opioid misuse.

Aims: This scoping review describes nursing's contribution to the literature on the management of patients with pain and opioid misuse, generating evidence to guide clinical care.

Design: The scoping review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline.

Data Sources: Using combined key terms ("opioid misuse," "pain," "nursing") in systematic searches in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases, snowball technique, and personal knowledge resulted in 108 relevant articles, reports, and websites.

Analysis Method: Summative approach to content analysis was used to quantify and describe nursing's contribution to the literature.

Results: Contributions of nurses emerged in the areas of research, clinical practice, policy, and education. The highest number of publications addressed research (50%, 54 of 108), whereas the fewest number of publications involved education (7%, 8 of 108).

Conclusion: Results provide a picture of the breadth of expertise and crucial leadership that nurses contribute to influence management of patients with pain and opioid misuse.

Implications For Nursing: This scoping review indicates the importance of continued support from key stakeholders, including training and interprofessional collaboration opportunities supported by the National Institutes of Health, to sustain nursing's contribution to quality care of patients with pain and opioid misuse. Ultimately, all health care professionals must collaborate to conduct rigorous research and construct evidence-based guidelines to inform policy initiatives and education strategies to solve the complex co-occurring epidemics of pain and opioid misuse.
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http://dx.doi.org/10.1016/j.pmn.2020.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887047PMC
February 2021

Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review.

Clin J Pain 2021 01;37(1):61-78

Department of Biobehavioral Nursing Science, College of Nursing, The University of Florida, Gainesville, FL.

Objective: Individuals with chronic pain conditions often report movement as exacerbating pain. An increasing number of researchers and clinicians have recognized the importance of measuring and distinguishing between movement-evoked pain (MEP) and pain at rest as an outcome. This scoping review maps the literature and describes MEP measurement techniques.

Materials And Methods: The scoping review utilized 6 databases to identify original studies that targeted pain or movement-related outcomes. Our search returned 7322 articles that were screened by title and abstract by 2 reviewers. The inclusion criteria focused on the measurement of MEP before, during, and after movement tasks in adults with chronic pain. Studies of children below 18 years of age or with nonhuman animals, case studies, qualitative studies, book chapters, cancer-related pain, non-English language, and abstracts with no full publish text were excluded from the study.

Results: Results from 38 studies revealed great variation in the measurement of MEP, while almost all of the studies did not provide an explicit conceptual or operational definition for MEP. In addition, studies collectively illuminated differences in MEP compared with rest pain, movement provocation methods, and pain intensity as the primary outcome.

Discussion: These results have clinically significant and research implications. To advance the study of MEP, we offer that consistent terminology, standardized measurement (appropriate for pain type/population), and clear methodological processes be provided in research publications. On the basis of the findings, we have put forth a preliminary definition of MEP that may benefit from the continued scholarly dialog.
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http://dx.doi.org/10.1097/AJP.0000000000000891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708514PMC
January 2021

The effect of music on pain sensitivity in healthy adults.

Arts Health 2020 Sep 30:1-19. Epub 2020 Sep 30.

College of Nursing, The University of Florida, Gainesville, FL, USA.

Background: Previous work suggests mediating effects of music on acute pain processing. This quasi-experimental pilot study examined the effects of music on experimental pain sensitivity.

Methods: Healthy adults ( = 40) completed quantitative sensory tests during three music conditions (silence, listening, and singing). Repeated Measures ANOVA , Friedman's Test, and post hoc comparisons determined differences in pain intensity and time to cold pain threshold and tolerance between conditions.. Pearson partial correlations evaluated the association of musical factorswith pain sensitivity.

Results: Participants demonstrated longer time intervals until perceiving pain and tolerated pain for longer durations when singing compared to listening. Greater self-reported singing proficiency was associated with higher tolerance. Several musical factors were significantly correlated with time from pain threshold to reaching tolerance.

Conclusion: Singing during an acute painful stimulus may increase tolerance. Various musical characteristics impact volunteers' central pain responses and singing may be an important adjunct pain management strategy.
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http://dx.doi.org/10.1080/17533015.2020.1827278DOI Listing
September 2020

A Paradigm Shift for Movement-based Pain Assessment in Older Adults: Practice, Policy and Regulatory Drivers.

Pain Manag Nurs 2021 02 15;22(1):21-27. Epub 2020 Sep 15.

College of Nursing, University of Florida, Gainesville, Florida.

Background: The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest.

Objective: The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.
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http://dx.doi.org/10.1016/j.pmn.2020.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886935PMC
February 2021

Patterns and correlates of self-management strategies for osteoarthritis related pain among older non-Hispanic Black and non-Hispanic White adults.

Arthritis Care Res (Hoboken) 2020 Aug 2. Epub 2020 Aug 2.

Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States.

Objective: Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black (NHB) and non-Hispanic White (NHW) older adults with or at risk for knee OA.

Methods: A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD-2) multisite observational study, which included NHB (n = 104) and NHW (n =98) community dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain.

Results: Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed clinical and experimental pain indices, as well as coping, number of pain sites, age and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race*type of pain management interaction effects for pain measures.

Conclusion: SM is common among older adults with or at risk for knee OA pain and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.
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http://dx.doi.org/10.1002/acr.24396DOI Listing
August 2020

"Bearing the Pain": The Experience of Aging African Americans With Osteoarthritis Pain.

Glob Qual Nurs Res 2020 Jan-Dec;7:2333393620925793. Epub 2020 Jun 3.

The University of Iowa, Iowa City, Iowa, USA.

Studies document that osteoarthritis-related joint pain is more severe in African American older adults, but research on the personal experience of osteoarthritis pain self-management in this population is limited. Using a qualitative descriptive design, our objective was to extend our understanding of the experience of life with osteoarthritis pain. Eighteen African Americans (50 years and older) were recruited from Louisiana to participate in a single semi-structured, in-depth interview. A conventional content analysis revealed that "Bearing the pain" characterized how older African Americans dealt with osteoarthritis. Bearing the pain comprised three actions: adjusting to pain, sharing pain with others, and trusting God as healer. We discovered that a metapersonal experience subsumes the complex biopsychosocial-cultural patterns and the intricate interaction of self, others, and God in living with and managing osteoarthritis pain. Study findings have implications for application of more inclusive self-management frameworks and interventions.
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http://dx.doi.org/10.1177/2333393620925793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271276PMC
June 2020

Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing.

J Pain Res 2020 1;13:883-895. Epub 2020 May 1.

Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States.

Purpose: Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.

Patients And Methods: Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).

Results: As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination ((1, 175)=26.660, <0.001), greater levels of pain catastrophizing ((1, 180)=12.919, <0.001), higher levels of clinical pain and disability, and lower levels of physical function (s<0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: =0.40, <0.01; NHW males: =0.37, <0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).

Conclusion: These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.
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http://dx.doi.org/10.2147/JPR.S235632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200232PMC
May 2020

Psychological Predictors of Perceived Age and Chronic Pain Impact in Individuals With and Without Knee Osteoarthritis.

Clin J Pain 2020 08;36(8):569-577

College of Nursing.

Objective: Chronological age is a risk factor in chronic pain; however, aging research supports the premise that physical and psychological health may better predict perceived age. Given the lack of evidence on perceived age in the context of chronic pain, the current study presents novel findings about the relationship between perceived age, chronic pain impact, and psychological function in adults with and without knee osteoarthritis.

Methods: This secondary analysis was part of an ongoing multisite observational cohort study to understand the progression of knee pain and disability. Community-dwelling adults (N=227) ages 45+ completed measures of trait resilience, trait positive and negative affect, pain catastrophizing, subjective perceptions of age, and the Graded Chronic Pain Scale.

Results: On average, participants reported feeling 10 years younger than their chronological age; however, this effect was attenuated in individuals reporting high-impact pain. Lower perceived age was associated with lower pain impact (low pain/low disability), while higher perceived age correlated with higher pain impact (high pain/high disability) and more adverse psychological effects. Using hierarchical linear regression, high-impact pain and positive affect emerged as statistically significant predictors of perceived age, whereas no differences were observed among trait resilience, negative affect, or pain catastrophizing.

Discussion: These findings highlight the importance of a biopsychosocial approach in understanding the intersection between psychological and physical factors associated with chronic pain. Addressing negative self-perceptions of aging, while simultaneously augmenting positive affect, through psychological therapies may mitigate pain and disability.
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http://dx.doi.org/10.1097/AJP.0000000000000842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335325PMC
August 2020

Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis.

J Clin Nurs 2020 Jul 5;29(13-14):2675-2690. Epub 2020 May 5.

Pain Research and Intervention Center of Excellence (PRICE), The University of Florida, Gainesville, FL, USA.

Aim And Objectives: To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high-risk analgesic use.

Background: African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed.

Design: A descriptive, secondary mixed-methods analysis.

Methods: A convenience sample of 110 African American adults (50-94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi-square or Fisher's exact test, t test, Mann-Whitney U and a qualitative content analysis.

Results: Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular-related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti-inflammatory drugs despite having hypertension.

Conclusions: There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present.

Relevance To Clinical Practice: Chronic pain and cardiovascular-related diseases are common and often co-occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.
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http://dx.doi.org/10.1111/jocn.15292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158848PMC
July 2020

Racial Differences in Pain Management for Patients Receiving Hospice Care.

Oncol Nurs Forum 2020 03;47(2):228-240

University of Florida.

Objectives: To investigate racial differences in implementation of 11 evidence-based cancer pain management strategies in a matched sample of patients in hospice.

Sample & Setting: 32 African American and 32 Caucasian American older adults (aged 65 years or older) with cancer pain receiving hospice care in the midwestern United States.

Methods & Variables: Matched cohort secondary data analysis of postintervention data in a cluster randomized controlled trial was used. Main outcomes are the summative and individual Cancer Pain Practice Index scores.

Results: There were few statistically significant or clinically meaningful differences in implementation of individual best practices for pain management by race. Assessment of primary pain characteristics and management of opioid-induced constipation with a bowel regimen was significantly lower in African Americans than in Caucasian Americans.

Implications For Nursing: African American older adults receiving hospice care at the end of life received pain management that was, overall, comparable to matched Caucasian American older adults. Hospice and oncology nurses play a critical role in effective pain management and should continue to implement evidence-based guidelines for pain management into daily practice. Diffusing the hospice model and principles of pain and symptom management into other settings and specialty care areas may reduce widespread pain disparities.
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http://dx.doi.org/10.1188/20.ONF.228-240DOI Listing
March 2020

The Reciprocal Relationship of Pain and Movement in African American Older Adults With Multi-Joint Osteoarthritis.

Res Gerontol Nurs 2019 Dec 12:1-11. Epub 2019 Dec 12.

Pain with movement is a common issue for older adults with osteoarthritis; however, there has been insufficient attention within populations at increased risk for disabling pain, such as African American older adults. Accordingly, using a mixed methods approach, the purpose of the current study is to describe the nature of chronic joint pain and movement and its impact on physical function in African American older adults with symptomatic osteoarthritis. The authors accrued a sample of 110 African American older adults who completed cross-sectional surveys; from this sample, the authors interviewed 18 participants. Findings suggest that patterns of movement are uniquely influenced by pain. Specifically, three dynamic themes emerged: The Impact of Pain on Movement; The Importance and Impact of Movement on Pain; and The Adaptation of Personal Behaviors to Minimize Pain With Movement. Function-focused nursing care rests on addressing challenges and opportunities that African American older adults face in maintaining healthy movement when managing osteoarthritis pain. [Research in Gerontological Nursing, xx(x), xx-xx.].
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http://dx.doi.org/10.3928/19404921-20191202-01DOI Listing
December 2019

Race/Ethnicity Moderates the Association Between Psychosocial Resilience and Movement-Evoked Pain in Knee Osteoarthritis.

ACR Open Rheumatol 2019 Mar 15;1(1):16-25. Epub 2019 Mar 15.

University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida.

Objective: Racial/ethnic disparities in pain are well-recognized, with non-Hispanic blacks (NHBs) experiencing greater pain severity and pain-related disability than non-Hispanic whites (NHWs). Although numerous risk factors are posited as contributors to these disparities, there is limited research addressing how resilience differentially influences pain and functioning across race/ethnicity. Therefore, this study examined associations between measures of psychosocial resilience, clinical pain, and functional performance among adults with knee osteoarthritis (OA), and assessed the moderating role of race/ethnicity on these relationships.

Methods: In a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD-2) study, 201 individuals with knee OA (NHB = 105, NHW = 96) completed measures of resilience (ie, trait resilience, optimism, positive well-being, social support, positive affect) and clinical pain, as well as a performance-based measure assessing lower-extremity function and movement-evoked pain.

Results: Bivariate analyses showed that higher levels of psychosocial resilience were associated with lower clinical pain and disability and more optimal physical functioning. NHBs reported greater pain and disability, poorer lower-extremity function, and higher movement-evoked pain compared with NHWs; however, measures of psychosocial resilience were similar across race/ethnicity. In moderation analyses, higher optimism and positive well-being were protective against movement-evoked pain in NHBs, whereas higher levels of positive affect were associated with greater movement-evoked pain in NHWs.

Conclusion: Our findings underscore the importance of psychosocial resilience on OA-related pain and function and highlight the influence of race/ethnicity on the resilience-pain relationship. Treatments aimed at targeting resilience may help mitigate racial/ethnic disparities in pain.
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http://dx.doi.org/10.1002/acr2.1002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858004PMC
March 2019

"Puttin' on": Expectations Versus Family Responses, the Lived Experience of Older African Americans With Chronic Pain.

J Fam Nurs 2019 11 13;25(4):533-556. Epub 2019 Nov 13.

University of South Florida, Tampa, Florida, USA.

The lack of family research documenting the changes that occur and the capacity of families to support individuals with chronic pain effectively is a major limitation in the application of the biopsychosocial model of pain. This study investigated the lived experience of older African Americans ( = 18) with chronic pain and explored their expectations and perceptions of familial support. A descriptive phenomenology framework revealed an existential theme: "puttin' on," a phenomenon that potentiates the power of pain to disrupt roles and relationships and discourages the family from meeting the expected needs of older African Americans. We uncovered new information into the actual support mechanisms that are missing or, when present, are not as positive and strong as would be expected in the African American culture, at least in the context of chronic pain management. Interventions should target family-based education, chronic pain destigmatization, and intergenerational empathy in the African American community.
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http://dx.doi.org/10.1177/1074840719884560DOI Listing
November 2019

Neuropathic-Like Pain Symptoms in a Community-Dwelling Sample with or at Risk for Knee Osteoarthritis.

Pain Med 2020 01;21(1):125-137

Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida.

Objective: To characterize neuropathic-like pain among individuals with or at risk for knee osteoarthritis.

Subjects: One hundred eighty-four individuals who self-identified as non-Hispanic black or non-Hispanic white and presented with unilateral or bilateral knee pain.

Design: Neuropathic-like pain was assessed using the painDETECT, and those with high vs low neuropathic-like pain were compared on clinical pain, psychological symptoms, physical function, and quantitative sensory testing. Analyses were unadjusted, partially and fully adjusted for relevant covariates.

Results: Thirty-two (17.4%) participants reported experiencing neuropathic-like pain features above the painDETECT clinical cut-score. The neuropathic-like pain group reported significantly greater pain severity on all measures of clinical pain and higher levels of psychological symptoms when fully adjusted for covariates, but no differences emerged for disability and lower extremity function. The neuropathic-like pain group also reported greater overall heat pain ratings during the heat pain threshold and increased temporal summation of heat pain in the fully adjusted model. Additionally, those with neuropathic-like pain symptoms reported greater painful after-sensations following heat pain temporal summation in all analyses. No significant group differences in pressure pain threshold emerged at any of the testing sites. In contrast, temporal summation of mechanical pain was significantly greater at both the index knee and the ipsilateral hand for the neuropathic-like pain group in all analyses.

Conclusions: Participants with or at risk for knee osteoarthritis who reported high neuropathic-like pain experienced significantly greater clinical pain and increased heat and mechanical temporal summation at the index knee and other body sites tested, suggesting central sensitization.
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http://dx.doi.org/10.1093/pm/pnz112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953341PMC
January 2020

Culturally Responsive Pain Management for Black Older Adults.

J Gerontol Nurs 2017 Mar 2:1-8. Epub 2017 Mar 2.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS XX contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "XXXX XXXX XXXXXX XXXXXXX XXXX XXXX XXX XXX XXXX XX" found on pages XX-XX, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until MONTH XX, 20XX. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. XXX 2. XXX DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The management of pain for Black older adults has received inadequate attention by health care professionals despite evidence of greater pain intensity, depressive symptoms, and functional disability compared with White American older adults. Pain management for this population may be significantly improved with more careful attention to the provision of culturally responsive care. As professionals concerned with the optimization of health and reduction of suffering throughout the lifespan, nurses have an ethical, moral, and professional responsibility to provide culturally responsive care to the populations they serve-particularly when clear disparities in health exist. By considering how culture affects important health beliefs, values, preferences, and customs, and integrating this understanding into practice, quality of life is likely to be improved. [Journal of Gerontological Nursing, xx(x), xx-xx.].
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http://dx.doi.org/10.3928/00989134-20170224-03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581727PMC
March 2017

Assessment and Measurement of Pain in Adults in Later Life.

Clin Geriatr Med 2016 11 11;32(4):677-692. Epub 2016 Aug 11.

The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, USA. Electronic address:

Pain in aging adults is a global health problem requiring a proactive and consistent assessment approach. Pain assessment is critical to detecting pain and developing a collaborative and adaptive pain management plan. Getting health providers to assess and measure pain even in older adults who are communicative and can self-report remains a challenge. Self-report is the best method for identifying pain. Using a validated pain assessment scale is key to evaluate pain intensity. This article discusses techniques to obtain self-report and describe appropriate self-report pain tools for a focused pain assessment and reassessment in adults in later life.
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http://dx.doi.org/10.1016/j.cger.2016.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444331PMC
November 2016

Chronic Pain in Older African American Grandparent Caregivers.

Authors:
Staja Q Booker

Home Healthc Now 2016 Jun;34(6):316-24

Staja Q. Booker, MS, PhD(c), RN, is a PhD Candidate, College of Nursing, The University of Iowa, Iowa City, Iowa.

African American grandparent caregiving is increasing, and evidence shows that grandparent caregiving influences health and its management. As older adults age, their potential of experiencing chronic pain increases, and this is profound given that physiological research shows that African Americans, aside from aging, may have a predisposition for developing chronic pain. Research shows older African Americans experience significant chronic pain, but few have discussed the implications of managing chronic pain in older African Americans who have added parental responsibility. Many older African Americans receive home healthcare services and there is a unique role for home healthcare clinicians in caring for this vulnerable population. This article discusses the impact of pain on caregiving, challenges in pain management, and practice and policy implications to assist home healthcare clinicians maintain the safety and protection of both the older grandparent and grandchildren.
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http://dx.doi.org/10.1097/NHH.0000000000000402DOI Listing
June 2016

Evaluating pain management in older adults.

Nursing 2016 Jun;46(6):66-9

Staja Booker is a National Hartford Center for Gerontological Nursing Excellence Patricia G. Archbold and MayDay Scholar (2013-2015) whose research and clinical focus is pain management in ethnically diverse older adults. Ms. Booker is also a PhD candidate. Christine Haedtke is a postdoctoral student at the University of Kentucky, in Lexington, Ky.

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http://dx.doi.org/10.1097/01.NURSE.0000482868.40461.06DOI Listing
June 2016

Culturally Conscientious Pain Measurement in Older African Americans.

West J Nurs Res 2016 10 11;38(10):1354-73. Epub 2016 May 11.

The University of Iowa, Iowa City, USA.

Despite considerable pain disparities across the care continuum, pain is an understudied health problem in older ethnic minority groups, such as African Americans. Quality pain measurement is a core task in pain management and a mechanism by which pain disparities may be reduced. Pain measurement includes the methods (e.g., assessment approaches, tools) and metrics that researchers and clinicians use to understand the characteristics of pain. However, there are significant issues and gaps that negatively affect pain measurement in older African Americans. Of concern is insufficient representation in pain research, which impedes the testing and refinement of many standardized self-report, behavioral and surrogate report, physiological, and composite measures of pain. The purposes for this article are to discuss the status of pain measurement and factors that affect our knowledge on pain measurement in older African Americans, and to provide guidance for culturally conscientious pain measurement using the available literature.
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http://dx.doi.org/10.1177/0193945916648952DOI Listing
October 2016

Assessing pain in nonverbal older adults.

Nursing 2016 May;46(5):66-9

Staja Booker is a National Hartford Center for Gerontological Nursing Excellence Patricia G. Archbold and MayDay Scholar (2013-2015) whose research and clinical focus is pain management in ethnically diverse older adults. Ms. Booker is also a PhD candidate. Christine Haedtke recently defended her dissertation at the University of Iowa, in Iowa City, Iowa, and is a postdoctoral student at the University of Kentucky.

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http://dx.doi.org/10.1097/01.NURSE.0000480619.08039.50DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991889PMC
May 2016

Assessing pain in verbal older adults.

Nursing 2016 Feb;46(2):65-8

Staja Booker is a National Hartford Center for Gerontological Nursing Excellence Patricia G. Archbold and MayDay Scholar whose research and clinical focus is pain management in ethnically diverse older adults. Ms. Booker is a PhD candidate and Christine Haedtke recently defended her dissertation at the University of Iowa in Iowa City, Iowa.

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http://dx.doi.org/10.1097/01.NURSE.0000473408.89671.52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959832PMC
February 2016

Lessons learned about ageing and gerontological nursing in South Africa.

Authors:
Staja Q Booker

Curationis 2015 Jul 30;38(1). Epub 2015 Jul 30.

The University of Iowa, College of Nursing.

Background: The unprecedented global growth in older adults merits high-quality gerontological nursing care. As gerontological nursing grows in visibility in developed and developing countries, nurses must possess a broader worldview of ageing with knowledge of physiological, psychosocial, and cultural issues.

Purpose: The purpose of this article is to: (1) highlight lessons learned on differences and similarities in ageing and care of older adults in the United States of America (USA) and South Africa (SA); and (2) provide recommendations on how to advance gerontological nursing education in SA.

Methods: A two-week international service-learning project was undertaken by visiting SA and learning about their nursing system and care of older adults. Service-learning is an innovative teaching-learning-service method that provided reflective and hands-on experience of gerontological nursing. This article provides a personal reflection of lessons learned about ageing and gerontological nursing during the service-learning project.

Findings: Care of older adults in SA is in many ways different from and similar to that in the USA. Consequently global nurses should recognise those differences and provide culturally appropriate care. This service-learning experience also demonstrated the need for gerontological nursing education in SA. Based on this, recommendations on how to infuse and advance gerontological nursing education in SA are provided.

Conclusion: Caring for older adults in a global context requires knowledge and understanding of cultures and their values and practices. With a growing population of diverse older adults, there is a need for incorporation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091647PMC
http://dx.doi.org/10.4102/curationis.v38i1.1216DOI Listing
July 2015

Older African Americans' Beliefs about Pain, Biomedicine, and Spiritual Medicine.

Authors:
Staja Q Booker

J Christ Nurs 2015 Jul-Sep;32(3):148-55

Persistent (chronic) pain prompts older African Americans (AAs) to utilize a combination of biomedicine (BM) and spiritual medicine (SM)for pain management. Because less is known about how older AAs use these pain management interventions, healthcare providers are unable to provide holistic care and optimal pain management. Using a Christian and Afrocentric perspective, this article reviews older AAs use of BM and SM, offering reconmendations on how to integrate BM and SM for pain management.
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http://dx.doi.org/10.1097/cnj.0000000000000152DOI Listing
August 2015

Are nurses prepared to care for Black American patients in pain?

Authors:
Staja Q Booker

Nursing 2015 Jan;45(1):66-9

Staja Q. Booker is a doctoral student at the University of Iowa College of Nursing. As a National Hartford Center of Gerontological Nursing Excellence Patricia G. Archbold and MayDay Scholar, Ms. Booker focuses her research and clinical interests on pain management in community-dwelling older African Americans.

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http://dx.doi.org/10.1097/01.NURSE.0000458944.81243.ebDOI Listing
January 2015