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Punches BE, Brown JL, Taul NK, Sall HA, Bakas T, Gillespie GL, Martin-Boone JE, Boyer EW, Lyons MS. Patient motivators to use opioids for acute pain after emergency care. FRONTIERS IN PAIN RESEARCH 2023; 4:1151704. [PMID: 37818444 PMCID: PMC10560756 DOI: 10.3389/fpain.2023.1151704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Patients are stakeholders in their own pain management. Factors motivating individuals to seek or use opioids therapeutically for treatment of acute pain are not well characterized but could be targeted to reduce incident iatrogenic opioid use disorder (OUD). Emergency departments (EDs) commonly encounter patients in acute pain for whom decisions regarding opioid therapy are required. Decision-making is necessarily challenged in episodic, unscheduled care settings given time pressure, limited information, and lack of pre-existing patient provider relationship. Patients may decline to take prescribed opioids or conversely seek opioids from other providers or non-medical sources. Methods Using a framework analysis approach, we qualitatively analyzed transcripts from 29 patients after discharge from an ED visit for acute pain at a large, urban, academic hospital in the midwestern United States to describe motivating factors influencing patient decisions regarding opioid use for acute pain. A semi-structured interview guide framed participant discussion in either a focus group or interview transcribed and analyzed with conventional content analysis. Results Four major themes emerged from our analysis including a) pain management literacy, b) control preferences, c) risk tolerance, and d) cues to action. Discussion Our findings suggest targets for future intervention development and a framework to guide the engagement of patients as stakeholders in their own acute pain management.
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Affiliation(s)
- Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, OH, United States
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L. Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, United States
| | - Natalie K. Taul
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hawa A. Sall
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, United States
| | | | | | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
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Rougereau G, Sandiford MH, Lévêque R, Ménigaux C, Bauer T, Hardy A. Management of Anxiety for Ambulatory Hallux Valgus Surgery With a Virtual Reality Hypnosis Mask: Randomized Controlled Trial. Foot Ankle Int 2023; 44:539-544. [PMID: 37118916 DOI: 10.1177/10711007231162816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of using virtual reality masks for the management of preoperative anxiety and its impact on postoperative and predischarge anxiety as well as postoperative analgesia during outpatient hallux valgus surgery. METHODS From June 2020 to September 2021, preoperative anxiety of patients scheduled for a percutaneous hallux valgus surgery were analyzed using the State Trait Anxiety Inventory (STAI) questionnaire completed during the consultation. All patients with major anxiety, defined as a STAI score above 40, were included in a randomized prospective comparative single-center study. Sixty patients were included in the study and randomized into 2 arms of 30 patients according to whether or not they underwent a preoperative hypnosis session with a virtual reality mask before surgery. RESULTS There was an improvement in the postoperative (42.5 vs 45.2, P < .04) and predischarge (25.3 vs 30.2 P < .03) anxiety scores in the group that used the mask before the procedure. There was a notable decrease in immediate higher-level postoperative analgesics such as morphine or ketamine (3.3% vs 26.6%, P < .03) in the arm using the mask. CONCLUSION In this study cohort undergoing percutaneous hallux valgus surgery, we found that use of a virtual reality hypnosis mask before surgery modestly reduced postoperative and predischarge anxiety as well as early postoperative consumption of higher-level analgesics in adults with significant preoperative anxiety. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
- Department of Orthopedic Surgery, Hospital Pitié Salpêtrière, Sorbonne University, Paris, France
| | - Marie Hélène Sandiford
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Robin Lévêque
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Christophe Ménigaux
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Thomas Bauer
- Department of Orthopedic Surgery, Hospital Ambroise Paré, UVSQ University, Boulogne-Billancourt, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, Paris, France
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Jayakumar P, Moore MG, Furlough KA, Uhler LM, Andrawis JP, Koenig KM, Aksan N, Rathouz PJ, Bozic KJ. Comparison of an Artificial Intelligence-Enabled Patient Decision Aid vs Educational Material on Decision Quality, Shared Decision-Making, Patient Experience, and Functional Outcomes in Adults With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2037107. [PMID: 33599773 PMCID: PMC7893500 DOI: 10.1001/jamanetworkopen.2020.37107] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Decision aids can help inform appropriate selection of total knee replacement (TKR) for advanced knee osteoarthritis (OA). However, few decision aids combine patient education, preference assessment, and artificial intelligence (AI) using patient-reported outcome measurement data to generate personalized estimations of outcomes to augment shared decision-making (SDM). OBJECTIVE To assess the effect of an AI-enabled patient decision aid that includes education, preference assessment, and personalized outcome estimations (using patient-reported outcome measurements) on decision quality, patient experience, functional outcomes, and process-level outcomes among individuals with advanced knee OA considering TKR in comparison with education only. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial at a single US academic orthopedic practice included 129 new adult patients presenting for OA-related knee pain from March 2019 to January 2020. Data were analyzed from April to May 2020. INTERVENTION Patients were randomized into a group that received a decision aid including patient education, preference assessment, and personalized outcome estimations (intervention group) or a group receiving educational material only (control group) alongside usual care. MAIN OUTCOMES AND MEASURES The primary outcome was decision quality, measured using the Knee OA Decision Quality Instrument (K-DQI). Secondary outcomes were collaborative decision-making (assessed using the CollaboRATE survey), patient satisfaction with consultation (using a numerical rating scale), Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) score, consultation time, TKR rate, and treatment concordance. RESULTS A total of 69 patients in the intervention group (46 [67%] women) and 60 patients in the control group (37 [62%] women) were included in the analysis. The intervention group showed better decisional quality (K-DQI mean difference, 20.0%; SE, 3.02; 95% CI, 14.2%-26.1%; P < .001), collaborative decision-making (CollaboRATE, 8 of 69 [12%] vs 28 of 60 [47%] patients below median; P < .001), satisfaction (numerical rating scale, 9 of 65 [14%] vs 19 of 58 [33%] patients below median; P = .01), and improved functional outcomes at 4 to 6 months (mean [SE] KOOS JR, 4.9 [2.24] points higher in intervention group; 95% CI, 0.8-9.0 points; P = .02). The intervention did not significantly affect consultation time (mean [SE] difference, 2.23 [2.18] minutes; P = .31), TKR rates (16 of 69 [23%] vs 7 of 60 [12%] patients; P = .11), or treatment concordance (58 of 69 [84%] vs 44 of 60 [73%] patients; P = .19). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, an AI-enabled decision aid significantly improved decision quality, level of SDM, satisfaction, and physical limitations without significantly impacting consultation times, TKR rates, or treatment concordance in patients with knee OA considering TKR. Decision aids using a personalized, data-driven approach can enhance SDM in the management of knee OA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03956004.
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Affiliation(s)
| | - Meredith G. Moore
- Dell Medical School at the University of Texas at Austin, Austin
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kenneth A. Furlough
- Dell Medical School at the University of Texas at Austin, Austin
- Chicago Medical School, North Chicago, Illinois
| | - Lauren M. Uhler
- Dell Medical School at the University of Texas at Austin, Austin
| | - John P. Andrawis
- Dell Medical School at the University of Texas at Austin, Austin
- Harbor-UCLA Medical Center, West Carson, California
| | - Karl M. Koenig
- Dell Medical School at the University of Texas at Austin, Austin
| | - Nazan Aksan
- Dell Medical School at the University of Texas at Austin, Austin
| | - Paul J. Rathouz
- Dell Medical School at the University of Texas at Austin, Austin
| | - Kevin J. Bozic
- Dell Medical School at the University of Texas at Austin, Austin
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van der Sluis G, Jager J, Punt I, Goldbohm A, Meinders MJ, Bimmel R, van Meeteren NL, Nijhuis-van Der Sanden MWG, Hoogeboom TJ. Current Status and Future Prospects for Shared Decision Making Before and After Total Knee Replacement Surgery-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020668. [PMID: 33466879 PMCID: PMC7829744 DOI: 10.3390/ijerph18020668] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients' decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients' decisional needs and preferences. From these, we identified four domains that affected the patients' decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.
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Affiliation(s)
- Geert van der Sluis
- Department of Health Strategy and Innovation, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
- Correspondence: ; Tel.: +31-512-588-245; Fax: +31-512-588-347
| | - Jelmer Jager
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department of Physical Therapy, Onze Lieve Vrouwe Gasthuis (OLVG), Hospital Amsterdam, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands
| | - Ilona Punt
- Department of Orthopaedics, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- Department of Surgery and Trauma Surgery and Research School NUTRIM, Maastricht University and Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | | | - Marjan J. Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
| | - Richard Bimmel
- Department of Orthopedics and Traumatology, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, 9202 NN Drachten, The Netherlands;
| | - Nico L.U. van Meeteren
- Topsector Life Sciences and Health (Health~Holland), Laan van Nieuw Oost-Indie 334, 2693 CE the Hague, The Netherlands;
- Department of Anesthesiology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Maria W. G. Nijhuis-van Der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
| | - Thomas J. Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
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Bande D, Moltó L, Pereira JA, Montes A. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg 2020; 20:147. [PMID: 32631293 PMCID: PMC7336434 DOI: 10.1186/s12893-020-00805-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study. Methods Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years. Results In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics. Conclusion CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL. Trial registration ClinicalTrials.gov NCT01510496.
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Affiliation(s)
- David Bande
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain.
| | - Luis Moltó
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain
| | - Jose Antonio Pereira
- General Surgery Department, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Departament de Ciéncies Experimentals i de la Salut (CEXS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Montes
- Pain Clínic, Department of Anaesthesiology, Institut Municipal d'Investigació Médica. Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Martím 25-29, 08003, Barcelona, Spain
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