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La Frenais FL, Bedder R, Vickerstaff V, Stone P, Sampson EL. Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing. J Am Geriatr Soc 2018; 66:376-382. [PMID: 29274247 PMCID: PMC5838548 DOI: 10.1111/jgs.15238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. DESIGN Systematic review. SETTING We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). PARTICIPANTS LTC residents. MEASUREMENTS We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. RESULTS Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. CONCLUSION Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively.
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Affiliation(s)
- Francesca L. La Frenais
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Rachel Bedder
- Division of PsychiatryUniversity College LondonLondonUnited Kingdom
- Institute of Cognitive NeuroscienceUniversity College LondonLondonUnited Kingdom
| | - Victoria Vickerstaff
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Patrick Stone
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
| | - Elizabeth L. Sampson
- Division of PsychiatryMarie Curie Palliative Care Research DepartmentUniversity College LondonLondonUnited Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison TeamNorth Middlesex University HospitalLondonUnited Kingdom
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202
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Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis 2018; 9:143-150. [PMID: 29392089 PMCID: PMC5772852 DOI: 10.14336/ad.2017.0306] [Citation(s) in RCA: 434] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/06/2017] [Indexed: 01/06/2023] Open
Abstract
NSAIDs, non-steroidal anti-inflammatory drugs, are one of the most commonly prescribed pain medications. It is a highly effective drug class for pain and inflammation; however, NSAIDs are known for multiple adverse effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID induced nephrotoxicity. As our society ages, it is crucial to have comprehensive knowledge of this class of medication in the elderly population. Therefore, we reviewed the pharmacodynamics and pharmacokinetics, current guidelines for NSAIDs use, adverse effect profile, and drug interaction of NSAIDs and commonly used medications in the elderly.
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Affiliation(s)
| | | | - Katie Melhado
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, PA 19141, USA.
| | - Janani Rangaswami
- Division of Nephrology, Department of Medicine, Einstein Medical Center, Philadelphia, PA 19144, USA
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203
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Abstract
Pain is a significant problem in older adults with cancer as older adults often receive suboptimal pain management. While overmedication can lead to adverse effects, under management of pain can lead to physiological and psychological problems such as functional decline and depression. This manuscript will discuss the assessment and management of pain in older adults, in consideration of the pharmacodynamic changes related to aging and other individual considerations. Current evidence from filtered and unfiltered sources, PubMed, current guidelines. Unrelieved pain can have a detrimental impact on older adults. A team approach is essential to assess patients at each encounter, consider the social environment in which the patient resides, and employ pharmacologic and nonpharmacologic strategies that are evidence-based and are tailored to the specific cancer pain syndrome.
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204
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Galor A, Moein HR, Lee C, Rodriguez A, Felix ER, Sarantopoulos KD, Levitt RC. Neuropathic pain and dry eye. Ocul Surf 2018; 16:31-44. [PMID: 29031645 PMCID: PMC5756672 DOI: 10.1016/j.jtos.2017.10.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/05/2017] [Accepted: 10/07/2017] [Indexed: 02/06/2023]
Abstract
Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.
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Affiliation(s)
- Anat Galor
- Miami Veterans Administration Medical Center, USA; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
| | - Hamid-Reza Moein
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Charity Lee
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Adriana Rodriguez
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, USA; Physical Medicine and Rehabilitation, University of Miami, USA
| | - Konstantinos D Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roy C Levitt
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
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205
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Petyaeva A, Kajander M, Lawrence V, Clifton L, Thomas AJ, Ballard C, Leroi I, Briggs M, Closs J, Dening T, Nunez KM, Testad I, Romeo R, Johar I, Corbett A. Feasibility of a staff training and support programme to improve pain assessment and management in people with dementia living in care homes. Int J Geriatr Psychiatry 2018; 33:221-231. [PMID: 28474837 DOI: 10.1002/gps.4727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/30/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem). METHODS PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches. Focus group discussions with staff explored the use of the PAIN-Dem intervention, and interviews were held with six residents and family carers. Pain was assessed in all residents at baseline, 3 and 4 weeks, and goal attainment scaling was assessed at 4 weeks. RESULTS Delivery of training was a key driver for success and feasibility of the PAIN-Dem intervention. Improvements in pain management behaviour and staff confidence were seen in homes where training was delivered in a care home setting across the care team with good manager buy-in. Family involvement in pain management was highlighted as an area for improvement. Goal attainment in residents was significantly improved across the cohort, although no significant change in pain was seen. CONCLUSIONS This study shows good initial feasibility of the PAIN-Dem intervention and provides valuable insight into training and support paradigms that deliver successful learning and behaviour change. There is a need for a larger trial of PAIN-Dem to establish its impact on resident pain and quantifiable staff behaviour measures. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anya Petyaeva
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Martine Kajander
- Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lei Clifton
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Alan J Thomas
- Institute for Neuroscience, Newcastle University, Newcastle, UK
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Exeter University Medical School, University of Exeter, Exeter, UK
| | - Iracema Leroi
- Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Michelle Briggs
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Jose Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Renee Romeo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iskandar Johar
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.,Exeter University Medical School, University of Exeter, Exeter, UK
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206
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207
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Prevalence of pain and pharmacological pain treatment among old people in nursing homes in 2007 and 2013. Eur J Clin Pharmacol 2017; 74:483-488. [PMID: 29260276 PMCID: PMC5849654 DOI: 10.1007/s00228-017-2384-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/26/2017] [Indexed: 10/30/2022]
Abstract
PURPOSE Many elderly people living in nursing homes experience pain and take analgesic medication. The aim of this study was to analyze the prevalence of pain and pharmacological pain treatment among people living in nursing homes in Sweden, in two large, comparable, samples from 2007 to 2013. METHODS Cross-sectional surveys were performed in 2007 and 2013, including all residents in nursing homes in the county of Västerbotten, Sweden. A total of 4933 residents (2814 and 2119 respectively) with a mean age of 84.6 and 85.0 years participated. Of these, 71.1 and 72.4% respectively were cognitively impaired. The survey was completed by the staff members who knew the residents best. RESULTS The prescription of opioids became significantly more common while the use of tramadol decreased significantly. The staff reported that 63.4% in 2007 and 62.3% in 2013 had experienced pain. Of those in pain, 20.2% in 2007 and 16.8% in 2013 received no treatment and 73.4 and 75.0% respectively of those with pain, but no pharmacological treatment, were incorrectly described by the staff as being treated for pain. CONCLUSIONS There has been a change in the pharmacological analgesic treatment between 2007 and 2013 with less prescribing of tramadol and a greater proportion taking opioids. Nevertheless, undertreatment of pain still occurs and in many cases, staff members believed that the residents were prescribed analgesic treatment when this was not the case.
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208
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Hirase T, Kataoka H, Nakano J, Inokuchi S, Sakamoto J, Okita M. Effects of a psychosocial intervention programme combined with exercise in community-dwelling older adults with chronic pain: A randomized controlled trial. Eur J Pain 2017; 22:592-600. [DOI: 10.1002/ejp.1149] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/11/2022]
Affiliation(s)
- T. Hirase
- Department of Physical Therapy Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - H. Kataoka
- Department of Rehabilitation; Nagasaki Memorial Hospital; Japan
| | - J. Nakano
- Department of Physical Therapy Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - S. Inokuchi
- Department of Physical Therapy Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - J. Sakamoto
- Department of Physical Therapy Sciences; Nagasaki University Graduate School of Biomedical Sciences; Japan
| | - M. Okita
- Department of Locomotive Rehabilitation Science; Nagasaki University Graduate School of Biomedical Sciences; Japan
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209
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Do Correlates of Pain-Related Stoicism and Cautiousness Differ in Younger and Older People With Advanced Cancer? THE JOURNAL OF PAIN 2017; 19:301-316. [PMID: 29155166 DOI: 10.1016/j.jpain.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 11/20/2022]
Abstract
Age differences are not evident in pain-related stoicism and cautiousness in people with cancer pain. Little is known about the factors associated with these pain-related attitudes or age-related patterns in these associations. The present cross-sectional study investigated the biopsychosocial correlates of the attitudes in younger and older patients with advanced cancer. Pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60 years old) and 114 older (60 years old or older) patients with advanced cancer completed the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity, cognitive-affective pain-related responses, physical functioning, psychological distress and well-being, and psychosocial functioning. Backwards regression analyses identified correlates for each PAQ-R factor separately for younger and older patients. Activity engagement was a frequent correlate, but its relationship with concealment was the only association common to both age groups. Younger and older patients exhibited different avoidance-related constructs suggesting relational challenges in the former group (avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance). Medical correlates also showed age differences: younger patients showed symptom-focused correlates, whereas older patients showed aging-related correlates. Findings support a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental perspective. PERSPECTIVE To our knowledge, this article is the first to identify biopsychosocial correlates of stoic and cautious attitudes toward cancer pain in younger and older patients with advanced cancer. Findings highlight possible age-related motivations for greater pain-related stoicism or cautiousness and can potentially inform interventions addressing challenges in cancer-pain adaptation in advanced cancer.
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210
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Cheng ST, Chan KL, Lam RWL, Mok MHT, Chen PP, Chow YF, Chung JWY, Law ACB, Lee JSW, Leung EMF, Tam CWC. A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial. Trials 2017; 18:528. [PMID: 29121961 PMCID: PMC5680817 DOI: 10.1186/s13063-017-2270-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i.e., pain education) in older adults with chronic musculoskeletal pain in Hong Kong. METHODS/DESIGN We are conducting a double-blind, cluster-randomized controlled trial. A sample of 160 participants aged ≥ 60 years will be recruited from social centers or outpatient clinics and will be randomized on the basis of center/clinic to either the multicomponent intervention or the pain education program. Both interventions consist of ten weekly sessions of 90 minutes each. The primary outcome is pain intensity, and the secondary outcomes include pain interference, pain persistence, pain self-efficacy, pain coping, pain catastrophizing cognitions, health-related quality of life, depressive symptoms, and hip and knee muscle strength. All outcome measures will be collected at baseline, postintervention, and at 3 and 6 months follow-up. Intention-to-treat analysis will be performed using mixed-effects regression to see whether the multicomponent intervention alleviates pain intensity and associated outcomes over and above the effects of pain education (i.e., a treatment × time intervention effect). DISCUSSION Because the activities included in the multicomponent intervention were carefully selected for ready implementation by allied health professionals in general, the results of this study, if positive, will make available an efficacious, nonpharmacological pain management program that can be widely adopted in clinical and social service settings and will hence improve older people's access to pain management services. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IIR-16008387. Registered on 28 April 2016.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK.
| | - Ka Long Chan
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Rosanna W L Lam
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong.,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norfolk, NR4 7TJ, UK
| | - Monique H T Mok
- Department of Rehabilitation and Extended Care, Kowloon Hospital, 147A Argyle Street, Kowloon, Hong Kong
| | - Phoon Ping Chen
- Department of Anesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Yu Fat Chow
- Department of Anesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong
| | - Alexander C B Law
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Jenny S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Edward M F Leung
- Department of Medicine and Geriatrics, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Kowloon, Hong Kong
| | - Cindy W C Tam
- Department of Psychiatry, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
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211
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Long-term use of opioids for nonmalignant pain among community-dwelling persons with and without Alzheimer disease in Finland: a nationwide register-based study. Pain 2017; 158:252-260. [PMID: 28092324 DOI: 10.1097/j.pain.0000000000000752] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Persons with Alzheimer disease (AD) commonly present with chronic nonmalignant pain, but long-term use of opioids among this population has not been studied previously. Our aim was to investigate the prevalence of long-term (≥180 days) use of opioids for nonmalignant pain and associated factors among community-dwelling persons with AD and to compare the prevalence with a matched cohort without AD. The Medication use and Alzheimer's disease (MEDALZ) cohort was used for this study, comprising all community-dwelling persons diagnosed with AD in Finland during 2005 to 2011 and their matched comparison persons without AD. After exclusion of persons with active cancer treatment, 62,074 persons with and 62,074 persons without AD were included in this study. Data were collected from nationwide registers. Opioids were used by 13,111 persons with and by 16,659 without AD. Overall long-term opioid use was more common among persons without AD (8.7%) than among persons with AD (7.2%, P < 0.0001). However, among opioid users, prevalence of long-term opioid use was slightly higher among persons with AD than among those without AD (34.2% vs 32.3%, respectively, P = 0.0004). Long-term use of transdermal opioids was more than 2-fold among opioid users with AD (13.2%) compared with users without AD (5.5%). Factors associated with long-term opioid use included AD, age ≥80 years, female sex, rheumatoid arthritis, osteoporosis, low socioeconomic position, history of substance abuse, and long-term benzodiazepine use. Prevalence of long-term opioid use was somewhat similar among both groups. Among persons with AD, long-term opioid use was strongly associated with transdermal opioids.
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212
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Telford A. Approaches to acute pain management in older people. Nurs Older People 2017; 29:32-41. [PMID: 29124918 DOI: 10.7748/nop.2017.e980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 11/09/2022]
Abstract
Pain is a diverse, individual experience and is associated with distress and suffering. Uncontrolled acute pain has been linked to delayed recovery and prolonged hospital stay. Nurses have a duty of care to their patients and acute pain management is integral to this. However, acute pain in older people can be difficult to manage, often because of under-reporting or difficulties in assessment. Older people have altered physiology often compounded by multiple co-morbidities and polypharmacy, all of which affect the appropriateness of, and available, pharmacological pain management strategies. In addition, older people are at greater risk of adverse drug reactions, drug interactions and side effects from analgesia. Consequently, non-pharmacological strategies should also be integral to pain management.
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Affiliation(s)
- Angela Telford
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
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213
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Geriatric palliative care: Meeting the needs of a growing population. Geriatr Nurs 2017; 39:225-229. [PMID: 29042070 DOI: 10.1016/j.gerinurse.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/23/2022]
Abstract
The implementation of effective geriatric palliative care (PC) services will be increasingly important as the number of patients ages ≥65 years continues to grow. However, literature characterizing the utilization of PC services by older adults remains scant. The objective of these analyses was to characterize the nature and outcomes of PC services for older adults. A retrospective analysis of records of inpatient PC consultations provided to patients ≥65 years at an academic hospital was performed (N = 743). Logistic regressions identified factors associated with goals of care discussions (GOC), end-of-life (EOL) coordination, and hospital readmission. Differences between older adult subgroups (i.e., 65-84 years and 85 years and older) were also examined. Discharge to home was associated with higher odds of readmission and discharge to hospice or having a GOC discussion was associated with lower odds of readmission. Those patients who were 85 years or older were significantly less likely to have cancer or to be referred for pain management, and more likely to be referred for GOC discussions and discharged to hospice. This study revealed dynamic factors associated with PC consultation for older adults. GOC discussions in initial PC consultations for older patients might reduce the odds of hospital readmission. Additionally, the needs of patients ages 85 and older appear distinct from the traditional PC cancer model.
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214
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Abstract
Treating pain in older adults can be complex because of the age-related physiologic changes, comorbidities, and polypharmacy. Thus, an individualized, multimodal treatment approach is recommended. Treatment plans should include pharmacologic and nonpharmacologic strategies. Several important clinical guidelines and expert panel statements are available to guide health care providers in the best practices for treating pain in older adults. This article provides evidence-based recommendations for pharmacological and non-pharmacological pain management in older adults.
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Affiliation(s)
- Ann L Horgas
- University of Florida, College of Nursing, PO Box 100197-HSC, Gainesville, FL 32610, USA.
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215
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Consensus multidisciplinaire d’experts en douleur et gériatrie : utilisation des antalgiques dans la prise en charge de la douleur de la personne âgée (hors anesthésie). ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.douler.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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216
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van den Berg-Wolf M, Burgoon T. Acupuncture and Cutaneous Medicine: Is It Effective? Med Acupunct 2017; 29:269-275. [PMID: 29067137 DOI: 10.1089/acu.2017.1227] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: In China, acupuncture has been used as a form of medical therapy for more than 2500 years. It is a part of traditional medical practice and is used to treat the entire spectrum of human and veterinary disease. Although dermatologic disease has received much less attention in worldwide acupuncture research than pain and musculoskeletal conditions, there is a growing body of evidence suggesting acupuncture's usefulness in this area. Objective: The aim of this article was to review the evidence in the literature regarding the usefulness of acupuncture in managing dermatologic illness. Results: Trials and case reports of patients using acupuncture have been published in the areas of atopic dermatitis and urticaria, herpes zoster, psoriasis, acne, melasma, and hyperhidrosis, as well as in promoting wound healing. Itch modulation by acupuncture has been the focus of recent research as itch is a predominant symptom in allergic skin diseases and leads to serious impairment of quality of life. Conclusions: Although more research is needed, acupuncture's use in cutaneous medicine is promising in the area of itch modulation, in treating atopic dermatitis and herpes zoster pain, and in promoting wound healing.
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217
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Castillón P, Veloso M, Gómez O, Salvador J, Bartra A, Anglés F. Fascia iliaca block for pain control in hip fracture patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:383-389. [PMID: 28890120 DOI: 10.1016/j.recot.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/17/2017] [Accepted: 07/03/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Pain treatment for patients with hip fracture has been based on the use of nonsteroidal anti-inflammatories and opioid derived drugs. These medications have been associated with multiple adverse effects. Fascia iliaca block is a recent pain management alternative for these patients. The objective of this study was to evaluate the effectiveness of fascia iliaca block performed in the emergency room (ER) for patients over 65years of age with hip fracture. MATERIALS AND METHODS A cohort of 216 patients, from January to December 2016, was studied prospectively. Analyzed variables were: pain upon arrival at ER, pain after fascia iliaca block, need for rescue medication, protocol compliance, delay in analgesia administration and delay for surgery. RESULTS Differences between visual analogue scale (VAS), before and after the fascia iliaca block, were statistically significant (P<.001). Pre-block VAS recorded was 6.16 (SD=2.82). The mean VAS reduction after the block was 2.99 (95%CI: 2.45-3.53%). Twenty-six percent of patients required morphine as rescue medication in the first 8hours after diagnosis. Compliance with protocol administration was of 84%. Fascia iliaca block was performed in a mean time of 16minutes (SD=10.33) after diagnosis. The median delay for surgery was 1 day (RIQ 25-75%: 1-2). CONCLUSION Fascia iliaca block is a reproducible, safe and effective technique for pain management. It is a keystone in pain treatment for patients with a proximal femur fracture at our institution. Other objectives in our pain management protocol include early analgesia administration and reduction of time to surgery.
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Affiliation(s)
- P Castillón
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España.
| | - M Veloso
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - O Gómez
- Servei de Anestesiologia i Reanimació, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - J Salvador
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - A Bartra
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - F Anglés
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
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Cabezón-Gutiérrez L, Viloria-Jiménez MA, Pérez-Cajaraville J, Álamo-González C, López-Trigo JA, Gil-Gregorio P. [Breakthrough cancer pain in the elderly]. Rev Esp Geriatr Gerontol 2017; 52:271-277. [PMID: 27979661 DOI: 10.1016/j.regg.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/15/2016] [Accepted: 10/24/2016] [Indexed: 11/24/2022]
Abstract
Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.
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Affiliation(s)
| | | | | | | | - José Antonio López-Trigo
- Servicio de Geriatría, Hospital Quirón de Málaga, Málaga, España; Presidente de la Sociedad Española de Geriatría y Gerontología
| | - Pedro Gil-Gregorio
- Servicio de Geriatría, Hospital Clínico Universitario San Carlos, Madrid, España; Coordinador del Comité de Expertos del Dolor de la Sociedad Española de Geriatría y Gerontología
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220
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Shade MY, Berger AM, Chaperon C, Haynatzki G, Sobeski L. Adverse drug events reported by rural older adults. Geriatr Nurs 2017; 38:584-588. [PMID: 28579081 DOI: 10.1016/j.gerinurse.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/14/2017] [Accepted: 04/24/2017] [Indexed: 01/08/2023]
Abstract
Adverse drug events (ADEs) impact the health and safety of older adults. ADEs may lead to unplanned medical visits that influence health and related costs. The purpose of this study was to explore ADEs reported by rural, community-dwelling older adults. Data were collected on 138 participants' demographics, physical and mental health, sleep, medications, and ADEs. One or more ADEs were reported by 48% of participants, including central nervous symptom disturbances (16%), dry mouth (12%), hoarseness, gastrointestinal irritation, and decreased libido (all 8%). Poor sleep and poor physical health were associated with higher reported ADEs (p < 0.05). Older adults (ages 79-99) and those with higher physical health were 60% less likely to report ADEs. Those with poorer sleep quality were 50% more likely to report ADEs. Viable strategies are needed to monitor and reduce ADEs in community-dwelling older adults who use multiple medications to manage poor health and poor sleep.
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Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Ann M Berger
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Claudia Chaperon
- University of Nebraska Medical Center College of Nursing-Omaha, 985330 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Gleb Haynatzki
- University of Nebraska Medical Center College of Public Health, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Linda Sobeski
- University of Nebraska Medical Center College of Pharmacy, 986045 Nebraska Medical Center, Omaha, NE 68198-6045, USA
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221
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Long-term use of proton pump inhibitors among community-dwelling persons with and without Alzheimer's disease. Eur J Clin Pharmacol 2017; 73:1149-1158. [PMID: 28577224 DOI: 10.1007/s00228-017-2273-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/24/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study is to determine the prevalence of use and long-term use (≥180 days) of proton pump inhibitors (PPIs) and associated factors among community-dwellers with and without Alzheimer's disease (AD). METHODS MEDALZ cohort encompassed all persons who received a verified diagnosis of AD in Finland during the years 2005-2011 and their age-, sex-, and region of residence-matched comparison persons, including 69,353 persons with and 69,353 persons without AD. Data was derived from several Finnish administrative registers. A mathematical modelling method, PRE2DUP, was used for converting dispensing data to drug use periods (when regular PPI use started and ended). Morbid conditions and concomitant drugs associated with use and long-term use of PPIs were assessed with logistic regression models. RESULTS Use of PPIs was more common among comparison persons than persons with AD (39.0 and 35.8%, respectively, p < 0.001), whereas long-term use of PPIs was more frequent among persons with than without AD (20.3 and 17.9%, respectively, p < 0.001). Factors related to long-term use of PPIs were female sex, history of gastrointestinal bleedings, AD, rheumatoid arthritis, cardiovascular disease, asthma/COPD and use of bisphosphonates, SSRIs and antithrombotic agents. Median follow-up time was 2.6 years among persons with AD and 3.5 years among persons without AD. Median duration of the first long-term PPI use was similar in both groups (1.4 years). CONCLUSION Long-term use of PPIs was common among persons with and without AD. Due to possible adverse events associated with the long-term use of PPIs, need for PPIs should be assessed regularly.
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Pereira M, Rafiq B, Chowdhury E, Babayev J, Boo H, Metwaly R, Sandilya P, Chusid E, Battaglia F. Anodal cerebellar tDCS modulates lower extremity pain perception. NeuroRehabilitation 2017; 40:195-200. [PMID: 28222543 DOI: 10.3233/nre-161404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies have investigated the use of transcranial direct current stimulation (tDCS) for pain management. The studies investigating therapeutic neuromodulation with tDCS for lower extremity pain are scarce and inconclusive. OBJECTIVE The aim of the present study was to analyze the effects of cerebellar tDCS on lower extremity sensory and pain thresholds in healthy volunteers. METHODS This was a single-blind crossover repeated-measure study. Utilizing randomized conditions, we examined the effects of anodal, cathodal and sham stimulation of the right cerebellum in 14 healthy volunteers on sensory and pain thresholds which were induced in the right leg using electrical stimulation. tDCS intensity was 2 mA and the duration of the stimulation was 10 minutes. RESULTS After anodal cerebellar stimulation the pain threshold of the ipsilateral leg was increased (p < 0.01). We could not detect any significant pain modulation with cathodal or sham stimulation (p > 0.05). Furthermore, no significant modulation of the sensory threshold was detected after anodal, cathodal or sham cerebellar tDCS (p > 0.05). CONCLUSIONS Our results indicate that anodal cerebellar tDCS with a reference electrode positioned over the buccinator area modulates pain processing in the ipsilateral leg. Further investigation is required to evaluate possible application in chronic pain patients.
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Affiliation(s)
- Manuel Pereira
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Basil Rafiq
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Einul Chowdhury
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Jacqueline Babayev
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - HyunJi Boo
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Rowan Metwaly
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Priam Sandilya
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Eileen Chusid
- Department of Pre-Clinical Sciences, New York College of Podiatric Medicine, New York, NY, USA
| | - Fortunato Battaglia
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
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Crowe M, Jordan J, Gillon D, McCall C, Frampton C, Jamieson H. The prevalence of pain and its relationship to falls, fatigue, and depression in a cohort of older people living in the community. J Adv Nurs 2017; 73:2642-2651. [DOI: 10.1111/jan.13328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Deborah Gillon
- Centre for Postgraduate Nursing Studies; University of Otago; Christchurch New Zealand
| | - Cate McCall
- Centre for Postgraduate Nursing Studies; University of Otago; Christchurch New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Hamish Jamieson
- Department of Medicine; University of Otago; Christchurch New Zealand
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The Efficacy of Acupuncture for the Treatment of Cervical Vertigo: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7597363. [PMID: 28659989 PMCID: PMC5474245 DOI: 10.1155/2017/7597363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/19/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022]
Abstract
Objective This study aims to evaluate the efficacy and safety of acupuncture for the treatment of cervical vertigo (CV). Methods Randomized controlled trials (RCTs) regarding effectiveness of acupuncture for treating CV were searched in 7 comprehensive databases prior to April 2016. The data analysis was performed by using RevMan version 5.3. Results A total of 10 studies with 914 participants were included. Results showed that acupuncture was more effective than conventional medicine therapy (CMT) in effectiveness, improvement rate of vertigo and headache, and increased average blood flow velocity of vertebral-basilar artery. In the subgroup analysis, the results did not change in different acupuncture methods and drug categories substantially. Sensitivity analysis demonstrated that the results of this meta-analysis were stable. Meanwhile, the long-term safety of acupuncture for CV still remains uncertain. GRADE analysis indicated that the quality of evidence for all outcomes was from very low to low which limited the value of the meta-analysis. Conclusion Based on the systematic review, acupuncture appeared to be a promising therapeutic approach for CV based on low or very low quality of evidence. However, large-scale and high-quality trials are required to provide stronger evidence for the conclusion.
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225
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Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 4:CD011279. [PMID: 28436583 PMCID: PMC5461882 DOI: 10.1002/14651858.cd011279.pub3] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. OBJECTIVES To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. METHODS We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. MAIN RESULTS We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews) actively reported adverse events. Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention. Only one review reported death separately to other adverse events: the intervention was protective against death (based on the available evidence), though did not reach statistical significance. AUTHORS' CONCLUSIONS The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.
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Affiliation(s)
| | | | - Clare Clarke
- Division of Population Health Sciences, University of DundeeNinewells Hospital & Medical SchoolKirsty Semple WayDundeeUKDD2 4DB
| | - Denis Martin
- Teesside UniversityInstitute of Health and Social CareParksideMiddlesbroughUKTS1 3BA
| | - Lesley A Colvin
- University of Edinburgh, Western General HospitalAnaesthesia & Pain MedicineEdinburghUK
| | - Blair H Smith
- University of DundeeDivision of Population Health SciencesDundeeUKDD2 4BF
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Dureja GP, Iyer RN, Das G, Ahdal J, Narang P. Evidence and consensus recommendations for the pharmacological management of pain in India. J Pain Res 2017; 10:709-736. [PMID: 28435313 PMCID: PMC5386610 DOI: 10.2147/jpr.s128655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case-control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.
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Affiliation(s)
| | - Rajagopalan N Iyer
- Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka
| | - Gautam Das
- Daradia Pain Clinic, Kolkata, West Bengal
| | - Jaishid Ahdal
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
| | - Prashant Narang
- Department of Medical Affairs, Janssen India, Johnson & Johnson Pvt Ltd, Mumbai, Maharashtra, India
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227
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Guerriero F. Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. World J Clin Cases 2017; 5:73-81. [PMID: 28352631 PMCID: PMC5352962 DOI: 10.12998/wjcc.v5.i3.73] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/25/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023] Open
Abstract
Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients.
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228
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Sanga P, Katz N, Polverejan E, Wang S, Kelly KM, Haeussler J, Thipphawong J. Long-Term Safety and Efficacy of Fulranumab in Patients With Moderate-to-Severe Osteoarthritis Pain: A Phase II Randomized, Double-Blind, Placebo-Controlled Extension Study. Arthritis Rheumatol 2017; 69:763-773. [PMID: 27748055 DOI: 10.1002/art.39943] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 09/20/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the long-term safety and efficacy of fulranumab in patients with knee or hip pain caused by moderate-to-severe chronic osteoarthritis (OA). METHODS In this phase II double-blind, placebo-controlled extension study, patients who were randomized in equal proportions to receive subcutaneous doses of either placebo or fulranumab (1 mg every 4 weeks, 3 mg every 8 weeks, 3 mg every 4 weeks, 6 mg every 8 weeks, or 10 mg every 8 weeks) in the 12-week double-blind efficacy phase and who completed this double-blind efficacy phase were eligible to continue the dosage throughout a 92-week double-blind extension phase, followed by a 24-week posttreatment follow-up period. Safety assessments included evaluation of treatment-emergent adverse events (TEAEs), pre-identified AEs of interest, and joint replacements. Efficacy assessments included changes from baseline to the end of the double-blind extension phase in scores on the patient's global assessment and the pain and physical function subscales of the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS Overall, 401 of the 423 patients who completed the 12-week double-blind efficacy phase entered the extension study. Long-term sustained improvements were observed in all efficacy parameters following fulranumab treatment (1 mg every 4 weeks, 3 mg every 4 weeks, and 10 mg every 8 weeks) as compared with placebo. Similar percentages of patients in both groups experienced TEAEs (88% taking placebo and 91% taking fulranumab; all phases). Across all fulranumab groups, arthralgia (21%) and OA (18%) (e.g., exacerbation of OA pain) were the most common TEAEs. The most common serious TEAEs were the requirement for knee (10%) and hip (7%) arthroplasty, with 80% occurring during the posttreatment follow-up period. Neurologic-related TEAEs (28%; all phases) were generally mild-to-moderate. Overall, 81 joint replacements were performed in 71 patients (8 [11%] receiving placebo and 63 [89%] receiving fulranumab); 15 patients (21%) had rapid progression of OA (RPOA). All cases of RPOA occurred in fulranumab-treated patients who were concurrently receiving nonsteroidal antiinflammatory drugs and occurred in joints with preexisting OA. CONCLUSION Long-term treatment with fulranumab was generally well-tolerated and efficacious. RPOA was observed as a safety signal. Future studies are warranted to demonstrate whether the risk of RPOA can be reduced in patients taking fulranumab.
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Affiliation(s)
- Panna Sanga
- Janssen Research & Development, Titusville, New Jersey
| | - Nathaniel Katz
- Analgesic Solutions, Natick, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts
| | | | - Steven Wang
- Janssen Research & Development, Titusville, New Jersey
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229
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Thaler E, Toledo F, Korte H. Can Direct Current Electrotherapy Be Used for Patients With Orthopedic Implants? Geriatr Orthop Surg Rehabil 2017; 8:44-48. [PMID: 28255511 PMCID: PMC5315240 DOI: 10.1177/2151458516681141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Although electrotherapy appears to have particularly interesting applications in the field of postoperative orthopedic rehabilitation, relatively little scientifically based research has been conducted in the area of electrotherapy with regard to safety involving patients with orthopedic implants. Method: Three electrotherapy forms were tested, such as high-volt stimulation (HVS), transcutaneous electric nerve stimulation (TENS), and galvanic current (GAL), using a model system containing a metal implant plate to evaluate whether heating in excess of 3°C would occur. Results: All changes in temperature for HVS, GAL, and TENS therapeutic electrical currents observed in our model system fall below the predefined 3°C. Conclusion: To the best of our knowledge, this is the first experimental based observation that prolonged exposure to a direct electrical current at therapeutic strength does not result in heating of metal titanium plates.
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Affiliation(s)
- Evangeline Thaler
- Division for Health and Socials Studies in Physiotherapy, University of Applied Sciences Hochschule Fresenius, Munich, Germany
| | - Felippe Toledo
- Division for Health and Socials Studies in Physiotherapy, University of Applied Sciences Hochschule Fresenius, Munich, Germany
| | - Holger Korte
- Division for Health and Social Studies, University of Applied Sciences Hochschule Fresenius, Munich, Germany
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230
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Samir S, Yllanes AP, Lallemand P, Brewer KL, Clemens S. Morphine responsiveness to thermal pain stimuli is aging-associated and mediated by dopamine D1 and D3 receptor interactions. Neuroscience 2017; 349:87-97. [PMID: 28257894 DOI: 10.1016/j.neuroscience.2017.02.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/16/2017] [Accepted: 02/20/2017] [Indexed: 01/09/2023]
Abstract
Morphine actions involve the dopamine (DA) D1 and D3 receptor systems (D1R and D3R), and the responses to morphine change with age. We here explored in differently aged wild-type (WT) and D3R knockout mice (D3KO) the interactions of the D1R/D3R systems with morphine in vivo at three different times of the animals' lifespan (2months, 1year, and 2years). We found that: (1) thermal pain withdrawal reflexes follow an aging-associated phenotype, with relatively longer latencies at 2months and shorter latencies at 1year, (2) over the same age range, a dysfunction of the D3R subtype decreases reflex latencies more than aging alone, (3) morphine altered reflex responses in a dose-dependent manner in WT animals and changed at its higher dose the phenotype of the D3KO animals from a morphine-resistant state to a morphine-responsive state, (4) block of D1R function had an aging-dependent effect on thermal withdrawal latencies in control animals that, in old animals, was stronger than that of low-dose morphine. Lastly, (5) block of D1R function in young D3KO animals mimicked the behavioral phenotype observed in the aged WT. Our proof-of-concept data from the rodent animal model suggest that, with age, block of D1R function may be considered as an alternative to the use of morphine, to modulate the response to painful stimuli.
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Affiliation(s)
- Sophia Samir
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Alexander P Yllanes
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Perrine Lallemand
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Kori L Brewer
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
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Samison LH, Randriatsarafara FM, Ralandison S. Joint pain epidemiology and analgesic usage in Madagascar. Pan Afr Med J 2017; 26:77. [PMID: 28491208 PMCID: PMC5410003 DOI: 10.11604/pamj.2017.26.77.11215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/06/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction To describe the epidemiology of joint pains and document analgesics usage in an African context. Methods Patients suffering from joint pain were recruited from nine sites located in Antananarivo, Madagascar, including 6 hospital services and 3 clinics. Doctors collected information on the etiology and characteristics of the patients’ pain. Analgesics prescribed by these doctors were also documented. Results In total, 400 patients were enrolled in the study (52.5% women, mean age of 42.34 years ± 17.7 [4-86]). Pain of mechanical type was found in 260 participants, 65%; 95% CI [60.1% to 69.6%] and inflammatory type pains in 128 cases 32%; 95% CI [27.5% to 36.9%]. Mixed pains were found in 12 patients (3%). The median duration of pain prior to the consultation was 6.5 days. The average pain intensity was 57.9 ± 19.9 mm of a total of 100 mm maximum on a visual analogue scale, VAS. The etiologies of mechanical type pains were dominated by fracture, common low back pain and tendonitis. Arthrosis was the dominant cause of inflammatory type pain, followed by rheumatoid arthritis and gout. NSAIDs (74.5%) were the most frequently prescribed analgesics followed by paracetamol (49.5%), weak opioids (23%) and corticosteroids (12.25%). Two-thirds of medical prescriptions (65.3%) were of combined analgesics. Conclusion These findings demonstrated that mechanical type pains were the main reason for consultations for joint pain in these situations in Antananarivo, Madagascar. The most frequently prescribed pain-relieving medications were NSAIDs, paracetamol, weak opioids and corticosteroids. This descriptive study may be a useful starting point for further epidemiological studies of pain in the African context.
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Affiliation(s)
- Luc Hervé Samison
- University of Antananarivo, Hospital Joseph Ravaoahangy Andrianavalona, Antananarivo, Madagascar
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[Pain medication in nursing home residents with and without cancer. Most frequently with metamizole]. Schmerz 2017; 29:276-84. [PMID: 25966865 DOI: 10.1007/s00482-015-0003-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pain is a highly prevalent symptom in nursing home residents. The analgesic pharmacotherapy of older adults is associated with challenges; however, studies from Germany examining the prescription pattern of analgesics in nursing home residents are rare. OBJECTIVES This study was carried out to examine the prescription of analgesics in nursing home residents with and without the diagnosis of cancer. MATERIAL AND METHODS Using health insurance claims data persons aged ≥ 65 years who were newly admitted to a nursing home between 2004 and 2009 and who survived at least the first 90 days after admission were included in the study. Cancer was identified by outpatient diagnoses of malignant neoplasms (ICD-10: C00-C97). Prescription drugs within the first 90 days after admission to a nursing home were analyzed which means that aspirin and acetaminophen were not taken into account. RESULTS A total of 5549 nursing home residents were included, who were on average 81.5 years old (56.8 % females). More than half (53.5 %) were assigned to care level I and 781 (14.1 %) were diagnosed with cancer. The study cohort received on average 7.8 different medications (with vs. without cancer: 8.6 vs. 7.6, respectively) and 43.8 % had prescriptions for analgesics (with vs. without cancer: 52.5 vs. 42.3 %, respectively). A total of 37.1 % were taking WHO step 1 analgesics (step 2: 11.4 % and step 3: 9.2 %). The proportion of persons receiving metamizole (dipyrone) was 28.3 % (with vs. without cancer: 35.6 vs. 27.1 %, respectively). Regarding all prescriptions, metamizole was by far the most frequently prescribed medication in nursing homes followed by melperone and omeprazole. CONCLUSION Approximately one third of nursing home residents received metamizole and most were long-term prescriptions. Considering that metamizole is associated with potentially life-threatening adverse effects, caution is indicated particularly when prescribed over long periods.
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Guerriero F, Reid MC. New opioid prescribing guidelines released in the US: what impact will they have in the care of older patients with persistent pain? Curr Med Res Opin 2017; 33:275-278. [PMID: 27786538 PMCID: PMC5472202 DOI: 10.1080/03007995.2016.1254603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Fabio Guerriero
- a Department of Internal Medicine and Medical Therapy , University of Pavia , Pavia , Italy
| | - M Carrington Reid
- b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
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Abstract
As the geriatric population increases in the United States, there is an increase in number of visits to emergency departments for end-of-life and palliative care. This provides the emergency physician with a unique opportunity to alleviate and prevent further suffering in this vulnerable population. Competency in communication strategies that support shared decision making and familiarity with medicolegal terminology increase physician confidence about addressing complaints at the end of life. Familiarity with evidence-based recommendations for symptom management of pain at the end of life aids the emergency physician in creating a positive experience for the patient and their loved ones.
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Affiliation(s)
- Alyssia McEwan
- Department of Emergency Medicine, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Suite 1B-25, Bronx, NY 10461, USA
| | - Joshua Z Silverberg
- Department of Emergency Medicine, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 6, Suite 1B-25, Bronx, NY 10461, USA.
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Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 1:CD011279. [PMID: 28087891 PMCID: PMC6469540 DOI: 10.1002/14651858.cd011279.pub2] [Citation(s) in RCA: 339] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. OBJECTIVES To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. METHODS We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. MAIN RESULTS We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews) actively reported adverse events. Based on the available evidence, most adverse events were increased soreness or muscle pain, which reportedly subsided after a few weeks of the intervention. Only one review reported death separately to other adverse events: the intervention was protective against death (based on the available evidence), though did not reach statistical significance. AUTHORS' CONCLUSIONS The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.
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Affiliation(s)
- Louise J Geneen
- University of DundeeDivision of Population Health SciencesDundeeUK
| | - R Andrew Moore
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordUKOX3 7LE
| | - Clare Clarke
- Division of Population Health Sciences, University of DundeeNinewells Hospital & Medical SchoolKirsty Semple WayDundeeUKDD2 4DB
| | - Denis Martin
- Teesside UniversityInstitute of Health and Social CareParksideMiddlesbroughUKTS1 3BA
| | - Lesley A Colvin
- University of Edinburgh, Western General HospitalAnaesthesia & Pain MedicineEdinburghUK
| | - Blair H Smith
- University of DundeeDivision of Population Health SciencesDundeeUK
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Felix RH, Almeida CBL, Cremaschi RC, Coelho FM, Santos FC. Pain-induced depression is related to overestimation of sleep quality in a very elderly population with pain. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:25-29. [DOI: 10.1590/0004-282x20160186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/28/2016] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: To study the quality of sleep in very elderly people with chronic pain. Methods: We investigated 51 very elderly people without dementia and with chronic pain according to the Geriatric Pain Measure. Katz and Lawton questionnaires were used to evaluate functionality. The Geriatric Depression Scale and Geriatric Psychosocial Assessment of Pain-induced Depression were also used. Self-perceptions of sleep and quality of sleep were checked using the Pittsburgh Sleep Quality Index. Results: Moderate pain was seen in 64.7% participants. The tracking of depression was positive for 41.2%. Poor quality of sleep was noted in 49% of them, but 82.3% perceived that they had a very good, or a good, sleep. The main factors associated with poor sleep quality were measurement of pain, self-perception of sleep, and pain-induced depression. Conclusion: Very elderly people with chronic pain, and without dementia, had a higher prevalence of poor sleep; however, they overestimated their sleep quality. Poor quality of sleep was associated with a poor self-perception of sleep and pain-induced depression.
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Older peoples' strategies for coping with chronic non-malignant pain: A qualitative meta-synthesis. Int J Nurs Stud 2016; 68:40-50. [PMID: 28073051 DOI: 10.1016/j.ijnurstu.2016.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/22/2016] [Accepted: 12/17/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies. OBJECTIVES To examine how older people cope with non-malignant chronic pain. DESIGN This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence. DATA SOURCES PubMed and Ovid Medline from 1995 to 2015. REVIEW METHODS Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings. RESULTS Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: 'adjusting to the inevitable', 'doing it my way without medication' and 'the importance of support in managing the struggle'. There was high confidence in the evidence for 'doing it my way without medication' and moderate confidence in the evidence for the other two meta-themes. CONCLUSION Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required.
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The Process of Motivating Oneself to Resist Being Controlled by Chronic Pain: A Qualitative Study of Japanese Older People Living in the Community. Pain Manag Nurs 2016; 18:42-49. [PMID: 27964910 DOI: 10.1016/j.pmn.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022]
Abstract
Perceptions and experiences of chronic pain in older adults have not been fully explored. This study aimed to explore experiences and perceptions of life with chronic pain among older Japanese adults in the community. The grounded theory approach was used to identify a process model of older people's perceptions and experiences of living with chronic pain. Twenty-four people were recruited via snowball sampling. Ten participants had suffered from pain for 30 years or more. Data were collected through semistructured, individual interviews. Responses were transcribed verbatim, coded, and clustered. Categories were integrated using the constant comparison method. A core category-motivating oneself to resist being controlled by chronic pain-emerged from the analysis of experiences among participants with chronic pain. Participants alternated between two phases: losing the self in pain (phase 1) and regaining the self in pain (phase 2). Flare-up pain was commonly experienced, and immobility and suffering led older adults to adopt several strategies to live with their pain. In phase 2, older participants adopted several strategies, such as "letting sleeping dogs lie" and "cutting corners." Their perceptions of and behaviors toward pain were often influenced by perceptions of their aging bodies. Nurses need to be aware of these conditions among older people with chronic pain and adjust their activities individually according to patient perceptions of their physical conditions.
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Marie BS, Arnstein P. Quality Pain Care for Older Adults in an Era of Suspicion and Scrutiny. J Gerontol Nurs 2016; 42:31-39. [PMID: 27898134 DOI: 10.3928/00989134-20161110-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022]
Abstract
In two decades, the pendulum has swung from focusing on the undertreatment of pain by prescribers who fail to use medically necessary opioid agents to an intense focus on overprescribing opioid medications and the harms they cause. Within these two extremes rests the older adult with pain and in need of safe and effective care. Today, health care providers are practicing in an era of scrutiny, with new guidelines and regulations superseding their compassion and clinical judgment about the best treatment options when older adults have pain across the care continuum. Media depicting opioid medications as lethal, unnecessary, and highly addictive that do not distinguish non-medical from therapeutic use or legitimately versus illegally obtained drugs are widely reported. These reports and legislative focus on treating addiction have silenced and further stigmatized older adults with persistent pain. Patients and professionals treating pain need to provide balance of multimodal pain management strategies to safely manage persistent pain based on a comprehensive assessment and personalized approach. [Journal of Gerontological Nursing, 42(12), 31-39.].
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Guerriero F, Bolier R, Van Cleave JH, Reid MC. Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know. J Gerontol Nurs 2016; 42:49-57. [PMID: 27898136 PMCID: PMC5472205 DOI: 10.3928/00989134-20161110-09] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/27/2016] [Indexed: 01/13/2023]
Abstract
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.4 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, "Pharmacological Approaches for the Management of Persistent Pain in Older Adults: What Nurses Need to Know" found on pages 49-57, 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 November 30, 2019. 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. Describe age-related barriers to pain assessment and key aspects of the assessment process. 2. Identify benefits and risks associated with commonly prescribed analgesic medications for the treatment of later life pain. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. The current article addresses pharmacological treatment issues regarding the management of persistent pain in later life, which is a worldwide problem associated with substantial disability. Recommendations from guidelines were reviewed and data are presented regarding the benefits and risks of commonly prescribed analgesic medications. The evidence base supports a stepwise approach with acetaminophen as first-line therapy for mild-to-moderate pain. Oral nonsteroidal anti-inflammatory drugs are not recommended for long-term use. In properly selected older patients, opioid drugs should be considered if pain is not adequately controlled. Careful surveillance to monitor for benefits and harms of therapy is critical, given that advancing age increases risk for adverse effects. Key aspects of the pain care process that nurses routinely engage in are covered, including conducting pain assessments prior to initiating therapy, addressing barriers to effective pain care, educating patients and family members about the importance of reducing pain, discussing treatment-related risks and benefits, and formulating strategies to monitor for treatment outcomes. Finally, a case is presented to illustrate issues that arise in the care of affected patients. [Journal of Gerontological Nursing, 42(12), 49-57.].
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Corbett A, Nunez KM, Smeaton E, Testad I, Thomas AJ, Closs SJ, Briggs M, Clifton L, Gjestsen MT, Lawrence V. The landscape of pain management in people with dementia living in care homes: a mixed methods study. Int J Geriatr Psychiatry 2016; 31:1354-1370. [PMID: 26898542 DOI: 10.1002/gps.4445] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/26/2015] [Accepted: 01/20/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study is to explore the current landscape of pain management in people with dementia living in care home settings. Pain is extremely common in this patient group, yet there is very limited guidance for healthcare professionals. METHODS Triangulation of stakeholder consultation and quality review of pain management guidance were performed. A review of existing pain management guidance was conducted using published quality criteria adapted for the field. Three focus group discussions were held with care home staff and two focus group discussions and an online survey with family carers. Data were subjected to thematic analysis to identify themes and sub-themes. Outcomes were reviewed by an expert panel, which gave recommendations. RESULTS Fifteen existing guidelines were identified, of which three were designed for use in dementia and none were tailored for care home settings. Thematic analysis revealed six major themes in current pain management in dementia: importance of person-centredness, current lack of pain awareness in staff, communication as a core element, disparities in staff responsibility and confidence, the need for consistency of care and current lack of staff training. In addition to the needs for practice, the expert panel identified promising pharmacological treatment candidates, which warrant clinical evaluation. CONCLUSIONS The findings of this study clearly articulate a need for an evidence-based pain management programme for care homes, which is informed by stakeholder input and based within a conceptual framework for this setting. There are novel opportunities for clinical trials of alternative analgesics for use in this patient group. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
| | | | - Emily Smeaton
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Ingelin Testad
- Centre for Age-Related Medicine (SESAM), Stavanger University, Stavanger, Norway
| | - Alan J Thomas
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - S Jose Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Michelle Briggs
- Centre for Pain Research, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Lei Clifton
- Centre for Statistics in Medicine (CSM), University of Oxford, UK
| | | | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Acevedo AT, Jackson A, Alter KE. Regional Rheumatic Disorders and Rehabilitation in Older Adults. Clin Geriatr Med 2016; 33:53-72. [PMID: 27886698 DOI: 10.1016/j.cger.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Musculoskeletal problems are the most frequently reported complaints among older adults living in the community. The impact of the aging process on skeletal muscles and joints can have a profound effect on the ability of individuals with and without disabilities to function. This article reviews the rehabilitation medicine approach to the evaluation of older adults with regional rheumatic disorders, and the rehabilitation medicine considerations for clinical interventions. Future research considerations are encouraged in order to gain a greater understanding of the subject matter and its impact on the provision of care and patients' quality of life.
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Affiliation(s)
- Ana T Acevedo
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA.
| | - Adrienne Jackson
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA
| | - Katharine E Alter
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Building 10, CRC, Room 1-1469, Bethesda, MD 20892-1604, USA
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Abstract
Given the current demographic changes there are an increasing number of elderly and very elderly patients in outpatient and inpatient care. Elderly and very elderly patients often suffer from pain and musculoskeletal conditions are a common cause of pain in the elderly. An effective pain management should not be withheld from elderly patients with rheumatic diseases. Untreated pain in elderly patients leads to functional impairment and immobility. In addition, the quality of life of patients is negatively affected and can lead to a loss of autonomy and/or social withdrawal. The treatment of elderly and very elderly patients is particularly challenging. There are special features that need to be considered in the choice of treatment. Altered pain presentation, comorbidities, nonadherence, polypharmacy and side effects of pain medications require a critical risk-benefit assessment and ongoing treatment monitoring of this special group of patients.
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Hamina A, Taipale H, Tanskanen A, Tolppanen AM, Tiihonen J, Hartikainen S. Differences in analgesic use in community-dwelling persons with and without Alzheimer's disease. Eur J Pain 2016; 21:658-667. [PMID: 27862681 DOI: 10.1002/ejp.969] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND There are conflicting findings about analgesic use among persons with cognitive impairment compared to cognitively intact older persons. The objective of our study was to investigate the prevalence of analgesic use in community-dwelling persons with and without Alzheimer's disease (AD), within six months after AD diagnosis and to find out factors associated with the use of analgesics and specific analgesic groups. METHOD We utilized data from register based MEDALZ (Medication use and Alzheimer's disease) cohort consisting of all community-dwelling persons diagnosed with AD during 2005-2011 in Finland and their matched comparison persons without AD. Altogether, 67,215 persons with AD and one comparison person for each case were included. Drug use data were collected from the Prescription Register and comorbidities from Special Reimbursement and Hospital Discharge Registers. RESULTS Statistically significant (p < 0.001) yet mostly small differences were found for analgesics use: analgesics were used by 34.9% and 33.5% of persons with and without AD, respectively. Paracetamol was the most frequently used analgesic both among persons with (25.0%) and without AD (19.1%). Persons with AD used less frequently NSAIDs (Nonsteroidal Anti-inflammatory Drugs) (13.2% vs. 17.3%) and mild opioids (5.0% vs. 7.1%), while the use of strong opioids was more common in comparison to persons without AD (1.3% vs. 1.1%, respectively). Analgesic users were more likely women, aged ≥80 years, had asthma/COPD, cardiovascular disease, diabetes, cancer, hip fracture, osteoporosis, rheumatoid arthritis, and lower socioeconomic position. CONCLUSION Further studies are needed to evaluate the adequateness of pain relief in older persons with and without AD. SIGNIFICANCE Persons with Alzheimer's disease (AD) used more frequently paracetamol and less frequently NSAIDs and mild opioids. A decreasing trend of NSAID use was observed among persons with AD during the study period.
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Affiliation(s)
- A Hamina
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - H Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - A Tanskanen
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - A-M Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - J Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - S Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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245
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Arnet I, Schacher S, Balmer E, Koeberle D, Hersberger KE. Poor adhesion of fentanyl transdermal patches may mimic end-of-dosage failure after 48 hours and prompt early patch replacement in hospitalized cancer pain patients. J Pain Res 2016; 9:993-999. [PMID: 27877065 PMCID: PMC5108613 DOI: 10.2147/jpr.s116091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context Renewal of fentanyl transdermal patch (transdermal therapeutic system [TTS]) should occur every 3 days (72 hours) according to manufacturer’s guidelines. Some studies mentioned patients reporting end-of-dose failure, and thus, some authors recommend shortening the interval of application to 2 days (48 hours). However, reasons for early replacement are mostly unknown. Objectives The objectives of this study were to assess the prevalence of early replacement of fentanyl TTS in a cancer center in Basel, Switzerland, and to assess the reasons for early replacement in stationary patients. Methods We retrieved all fentanyl TTS administered in a cancer center in Basel, Switzerland, between November 11, 2011, and January 31, 2015, from the electronic medical database. Results A total of 739 patients (mean age 71.4±11.5 years, 55% women) were administered 2,250 fentanyl TTS (dosage 6–500 µg/hour). Most replacements occurred after 72 hours (61.6%) and a few after 48 hours (7.4%). Patients with early replacement after 48 hours were significantly younger (63.8 years versus 71.5 years, p<0.001) and obtained higher mean dosages of fentanyl TTS (89 µg/hour versus 44.1 µg/hour, p<0.001) and rescue medication (calculated as oral morphine equivalent in milligrams: 185.1 mg versus 39.6 mg during the first 24 hours after replacement, p<0.001). No pharmacological rationale for early replacement was observed. According to 57 physicians, nurses, and pharmacists, the most often reasons for early TTS replacement were end-of-dosage pain (41.4%) and poor adhesion (31.4%). Conclusion In the absence of any physiological, pharmacological, or environmental reasons recorded in the database to explain an early replacement of fentanyl TTS, skin adhesion problems may point practical reasons and mimic end-of-dosage failure.
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Affiliation(s)
- Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel
| | - Sabrina Schacher
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel
| | - Eva Balmer
- Palliative Care Unit, Division of Oncology/Haematology, St Claraspital, Basel, Switzerland
| | - Dieter Koeberle
- Palliative Care Unit, Division of Oncology/Haematology, St Claraspital, Basel, Switzerland
| | - Kurt E Hersberger
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel
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246
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Abstract
Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies. The article concludes with a suggested approach to managing chronic pain in the older patient, incorporating goals and expectations for treatment as well as careful monitoring of medication adjustments.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 Northeast Pacific Avenue, Box 357630, Seattle, WA 98195, USA
| | - Nakia A Duncan
- Texas Tech University Health Sciences Center School of Pharmacy, 4500 South Lancaster Street, Building 7, Room 215, Dallas, TX, USA
| | - Una E Makris
- Division of Rheumatic Diseases, Department of Internal Medicine, VA North Texas Health Care System, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9169, USA.
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247
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Griffioen C, Willems EG, Kouwenhoven SM, Caljouw MAA, Achterberg WP. Physicians' Knowledge of and Attitudes Toward Use of Opioids in Long-Term Care Facilities. Pain Pract 2016; 17:625-632. [PMID: 27739258 DOI: 10.1111/papr.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufficient pain management in vulnerable older persons living in long-term care facilities is common, and opiophobia might contribute to this. As opiophobia and its related factors have not been investigated in long-term care, this study evaluates the degree of knowledge of opioids among elderly-care physicians (ECPs) and ECP trainees, as well as their attitudes and other factors possibly influencing the clinical use of opioids in these facilities. METHODS A questionnaire was designed and distributed among ECPs and ECP trainees by email, regional symposia, and all three university training faculties for elderly-care medicine in the Netherlands. RESULTS Respondents were 324 ECPs and 111 ECP trainees. Fear of addiction did not influence the prescription of opioids. Main barriers to the clinical use of opioids were patients' reluctance to take opioids (83.3%); unknown degree of pain (79.2%); and pain of unknown origin (51.4%). ECPs' average knowledge scores were sufficient: those who felt that their knowledge of opioids was poor scored lower than those who felt that their knowledge was good. CONCLUSIONS Factors identified in this study may help provide better pain management for vulnerable older persons living in a long-term care facility. Also, more patient information on the pros and cons of opioid use is needed, as well as appropriate tools for better clinical assessment of pain in a long-term care population.
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Affiliation(s)
- Charlotte Griffioen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eva G Willems
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sanne M Kouwenhoven
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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248
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Conrozier T, Bozgan AM, Bossert M, Sondag M, Lohse-Walliser A, Balblanc JC. Standardized Follow-up of Patients with Symptomatic Knee Osteoarthritis Treated with a Single Intra-articular Injection of a Combination of Cross-Linked Hyaluronic Acid and Mannitol. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:175-9. [PMID: 27688712 PMCID: PMC5036533 DOI: 10.4137/cmamd.s39432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The objective of this study is to obtain pilot data from daily practice conditions of a viscosupplement made of a cross-linked high-molecular-weight hyaluronic acid (HA) combined with mannitol in patients with knee osteoarthritis (KOA). METHODS The data of 40 consecutive patients, 29 women and 11 men, who were prospectively followed up for 6 months, using a standardized procedure, were retrospectively analyzed. All patients have received a single intra-articular injection of HAnox-M-XL (4.4 mL), viscosupplement made of a cross-linked HA (16 mg/mL) + mannitol (35 mg/mL), in the target knee. The primary outcome was safety. The secondary end points included 3- and 6-month change in the WOMAC pain (0–50) and WOMAC total (0–240) and patient’s global assessment (PGA). Patient’s self-assessment of treatment efficacy (0–3) and analgesic consumption were obtained at months 3 and 6. An intent-to-treat analysis was performed. RESULTS Mean (SD) age was 60.7 (13.9) years, and mean BMI was 28.6 (5.0). Kellgren–Lawrence radiological grade was I/II and III/IV in 13 and 27 of the subjects, respectively. The average WOMAC pain and WOMAC total scores at baseline were 21.5 (9.8) and 89.9 (42.8), respectively. Thirty-nine patients completed the follow-up. HAnox-M-XL was well tolerated; two patients experienced knee pain after injection, which resolved within three days. No treatment-related severe adverse event was reported. Mean (SD) variations in WOMAC pain and WOMAC total scores were −8.2 (8.9) and −38.4 (35.6), respectively, at month 6 (P = 0.001). PGA decreased from 5.5 (2.0) to 3.0 (2.2) (P = 0.006). Efficacy was rated as good or very good in 76.9% of the cases. Most of the regular analgesics users decreased their consumption. CONCLUSION Treatment with one injection of 4.4 mL HAnox-M-XL is effective to alleviate KOA symptoms over six months, without safety concern. Controlled trials are needed to confirm these pilot data.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Ana-Maria Bozgan
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Marie Bossert
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Maxime Sondag
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
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249
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Platts-Mills TF, Quigley BR, Duronio JP, Hoover MV, Burgh ET, LaMantia MA, Davis SM, Weaver MA, Zimmerman S. Development and Validation of a Brief Interactive Educational Video to Improve Outpatient Treatment of Older Adults' Acute Musculoskeletal Pain. J Am Geriatr Soc 2016; 64:880-1. [PMID: 27100584 DOI: 10.1111/jgs.14043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin R Quigley
- Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Joseph P Duronio
- Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Meredith V Hoover
- School of Medicine, University of South Carolina, Greenville, South Carolina
| | - Eric T Burgh
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sonia M Davis
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Mark A Weaver
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
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250
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Meneses SRF, Goode AP, Nelson AE, Lin J, Jordan JM, Allen KD, Bennell KL, Lohmander LS, Fernandes L, Hochberg MC, Underwood M, Conaghan PG, Liu S, McAlindon TE, Golightly YM, Hunter DJ. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthritis Cartilage 2016; 24:1487-99. [PMID: 27095418 DOI: 10.1016/j.joca.2016.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. METHODS We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. RESULTS Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. CONCLUSION Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities.
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Affiliation(s)
- S R F Meneses
- Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
| | - A P Goode
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - A E Nelson
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - J Lin
- Institute of Bone and Joint, Peking University People's Hospital, Peking, China
| | - J M Jordan
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Gillings School of Global Public Health, Department of Epidemiology, USA; Department of Orthopaedics, University of North Carolina at Chapel Hill, USA
| | - K D Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Health Services Research and Development Service, U.S. Department of Veterans Affairs Medical Center, Durham, NC, USA
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine (CHESM), Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - L S Lohmander
- Orthopaedics, Department of Clinical Sciences, Lund University, Sweden
| | - L Fernandes
- Department of Rehabilitation, Odense University Hospital, Odense C, Denmark
| | - M C Hochberg
- Department Epidemiology and Public Health, University of Maryland School of Medicine, and Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA
| | - M Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, UK
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - S Liu
- Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - T E McAlindon
- Department of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Y M Golightly
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - D J Hunter
- Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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