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The Prevalence and Treatment of Pain Among Rural Medicaid Beneficiaries with Disabilities<\/span><\/strong><\/p>\n <\/strong> February 2004<\/span><\/p>\n Pain has an enormous impact on the lives of many people with disabilities. <\/span>Recent research suggests that nearly 80% of people whose primary disability is not a pain disorder are still limited by pain as a secondary condition. As many as half of those people report that their pain is ongoing, intractable and limiting (Ehde, Jensen, Engel, Turner, Hoffman & Cardenas, 2003). Our research suggests strong associations between an individual’s pain and his or her quality of life, depression and the number of hours worked.<\/span><\/p>\n Background:<\/strong><\/span> Our research on the difficulties of recruiting people with disabilities into both health education seminars and physical activity programs identified pain as their greatest barrier to participation. Our latest longitudinal study examined the experience of people with disabilities who have pain and their perceptions of 14 different pain treatments.<\/p>\n Methods:<\/strong> <\/span>Working with Montana and Maine state Medicaid departments, we identified all Medicaid beneficiaries in one rural county of each state (N=6852). We sent a letter to each beneficiary describing our study’s eligibility criteria (18-65 years old, with a permanent mobility impairment) and enclosed a postage-paid return postcard with census-type disability questions. From these responses we identified 469 individuals who agreed to complete a survey in exchange for a $10 stipend. We received 268 usable surveys (60.9% response rate). Two years later, we collected a second questionnaire from 144 members of this cohort (30.1%); 114 respondents completed both surveys.<\/p>\n We collected basic demographic information, plus responses on several instruments.\u00a0 On the “Pain Disability Index” (Tait, Chibnall, Krause, 1990) respondents rate the degree to which pain limits them in each of seven life areas. Our respondents had a range of 0 to 70, with a mean of 36.5 (SD =14.86). On Radloff’s “Centers for Epidemiological Studies of Depression Scale” (CES-D, 1977), our respondents ranged from 0 to 60, with a mean of 20.69 (SD = 12.48). The “Health Related Quality of Life Scale” (Hadorn & Ubersax, 1995) has two items (suffering and activity limitation); our respondents ranged from 1.7 to 9.5, with a mean of 5.34 (SD = 1.99). Finally, on the “Pain Treatment Index” respondents indicate whether they have used a pain treatment and if so, they rate its effects (0=no relief; 10=complete relief).<\/p>\n Results:<\/strong><\/span> On Survey One, 208 (75.1%) individuals reported having ongoing pain (tingling, burning, aching). On Survey Two, 108 (79.6%) individuals reported having pain. Table 1 shows the change in pain status from the first to the second surveys. Chi Square analysis indicates a statistically significant change in pain status between surveys (Chi Square = 32.17, p < .000). Of the 79 people reporting pain in Survey One who also responded to Survey Two, 8.9 % no longer reported pain. Forty percent of those who did not report pain in Survey 1 did report having pain in Survey 2. Overall, these results suggest a 6.3% increase in the proportion of the sample reporting pain as a secondary condition over a two-year period.<\/p>\n <\/a>Table 1: Change in chronic pain status over 2 years.<\/strong>\u00a0 <\/span>Description of Table 1.<\/a><\/p>\n