Katrina Evacuation Caused Rise in Chronic Pain

THURSDAY, Feb. 23 (HealthDay News) -- Some of the thousands affected by Hurricane Katrina who suffered from chronic pain before the storm hit experienced more pain in the disaster's aftermath, while others saw their pain scores subside, two new studies suggest.

Researchers say the key factor in keeping pain levels down was the conditions under which victims found themselves in the days and weeks after the storm.

Pain scores rose especially for evacuees left stranded in terrible conditions, said the lead author of one study, Dr. Donna Bloodworth, an associate professor at the Baylor College of Medicine in Houston.

"Part of it could have been they simply didn't have their medication [for pain]," Bloodworth said. Conditions were extremely trying during the hurricane and then evacuees found themselves penned into the city's Astrodome, she said. "We took care of people who had been crouched 20 deep under an overpass, laying on their sides, trying to get out of the flood and the rain. These folks honestly suffered."

Bloodworth was scheduled to present her team's findings Thursday at the annual meeting of the American Academy of Pain Medicine in San Diego, Calif.

In another study, Dr. Yen Chou Joe Chen, a physician at pain management centers in Ocean Spring and Biloxi, Miss., evaluated the pain scores of 400 patients treated in his clinic. "These were my patients whom I saw before the storm," he said. Although many of these patients' homes were severely damaged by the storm, none were forced to evacuate the city.

When the patients returned for their first post-storm appointment, Chen asked each of them to rate their pain on a scale of 1 to 10.

He expected the scores to rise, just as they had in Bloodworth's study, but they didn't. "A score of 6.9 was the average before," he said. "And it was 6.3 within the first 30 days [after the hurricane]. That is a statistically significant drop."

As to why the pain scores dropped in his group, Chen speculated that "my patients were busy just surviving. They were probably less focused on their pain and more focused on survival."

Before, they might have focused on their pain, he added, but after the hurricane hit on August 29, striking the Gulf Coast of Louisiana, Mississippi and Alabama and killing about 1,400 people, "all of a sudden you are back to basics." He said he often heard from his patients: "Thank God we are alive."

"When people are busy trying to live their lives instead of focusing only on their pain, they were doing better," Chen said. "They are helping each other, trying to help the elderly people, trying to help families."

But Bloodworth's group found that pain scores rose in the hurricane victims they studied. However, the findings may not be as contradictory as they appear.

Bloodworth's colleagues surveyed 52 patients with pain evacuated to the Astrodome and four clinics in Houston, asking them to rate their pain three different times.

The result: "Their pain scores on average were 4.9 before Katrina, 5.9 the first few days after and 6.5 roughly two weeks after," Bloodworth said.

Why the difference between the two studies? "You are really looking at two very different groups of people," Bloodworth said. In her team's study, "you are looking at a group of people trapped in horrendous conditions who couldn't have helped themselves," she said. And in Chen's group, you're "looking at a group of people trying to shore up what they own and survive," she said.

"These are very important studies," said Dr. Scott Fishman, president of the American Academy of Pain Medicine and chief of the division of pain medicine at the University of California, Davis. Despite the differences in pain scores, he said, the studies show that "even in difficult times, patients in pain are fairly resilient."

"The people at the Astrodome in some ways had more distress," he said, noting they were uprooted from their homes and relocated. The medication shortage probably played a role in their increasing pain scores, too, he added.

Pain patterns are not always predictable, Fishman said. For instance, research shows that when soldiers are wounded, they report less pain right after a severe injury than after they are transported to a hospital, he said. "When soldiers get to the hospital, their pain rises," Fishman said, citing several studies. Why? "The stressor that had eclipsed the pain [in this case the shooting] was gone."

That could be reflected in new data from Chen's study. He said some of his pain patients are again reporting higher scores. "Now their pain is escalating again, as people fight with the insurance companies and some have post-traumatic stress disorder because they swam through the storm," he said.