1
|
Langford L, Latchford G, Mulvey M. Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study. J Cancer Surviv 2024:10.1007/s11764-024-01533-2. [PMID: 38285112 DOI: 10.1007/s11764-024-01533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer. DESIGN AND METHODS A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed. RESULTS Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003). CONCLUSIONS The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity. IMPLICATIONS FOR CANCER SURVIVORS These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.
Collapse
Affiliation(s)
- Lewis Langford
- Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK.
- Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Gary Latchford
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Mulvey
- Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
2
|
Milkias M, Mekonnen S, Ahmed S, Getachew H, Adamu Y, Mola S, Gugsa T. Evidence-based guideline on chronic postsurgical pain management in adult patients in resource-restricted setting, 2023: systematic review and guideline. Ann Med Surg (Lond) 2023; 85:5593-5603. [PMID: 37915690 PMCID: PMC10617887 DOI: 10.1097/ms9.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 11/03/2023] Open
Abstract
Background Chronic postsurgical pain (CPSP) after tissue trauma is frequent and may have a long-lasting impact on the functioning and quality of life. The development of CPSP increases the burden on both the patient and the community. This review aims to systematically review articles and, lastly, pull an evidence-based guideline for CPSP management in adult patients in resource-limited areas. Methodology The review was reported based on preferred reporting items for the systemic review and meta-analysis (PRISMA) protocol. A literature search was conducted from the Cochrane, PubMed/Medline, and Google Scholar databases, and other gray literature from 2010 to 2022. The conclusion was made based on the level of evidence. Results A total of 3521 articles were identified through the database by searching strategies. Finally, by filtering duplicates unrelated to the topics, 22 articles (9 meta-analyses and systematic reviews, 12 systematic reviews, and one cohort study) were selected on the management of CPSP in adult patients. Filtering was made based on the intervention, outcome data of the population, and methodological quality. Conclusion Given the complexity and multidimensional nature of chronic postsurgical pain, effective assessment, and management require a comprehensive, multiaxial approach. Adequate preoperative preparation and counseling, potential risk identification and optimization, and use of a multimodal approach, and noninvasive surgical techniques are crucial in reducing the development of chronic postsurgical pain.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Tesfaye Gugsa
- Surgery Department, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| |
Collapse
|
3
|
Dreesmann NJ, Jung W, Shebaili M, Thompson HJ. Kidney Donor Perspectives on Acute Postoperative Pain Management. Clin Nurs Res 2023; 32:1124-1133. [PMID: 36912100 DOI: 10.1177/10547738231156151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed.
Collapse
|
4
|
Benes LL, Keefe FJ, DeBar LL. Treating Persistent Pain: A Nurse Co-Led, Interdisciplinary Model for Primary Care. Pain Manag Nurs 2022; 23:728-736. [PMID: 35922272 PMCID: PMC9771916 DOI: 10.1016/j.pmn.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
The public health crisis of chronic pain has only increased in recognition since the Institute of Medicine's (IOM) Relieving Pain in America (2011) called for a cultural transformation in the way pain is viewed, treated, and put forward specific recommendations for action. The National Pain Strategy (NPS) provides a roadmap for putting these recommendations into practice. We implemented a program that placed nurses and behavioral specialists at the head of an interdisciplinary team utilizing best practices. In this program, nurses enacted the NPS recommendations to advance care for patients with persistent pain on long-term opioid treatment. This program promoted professional growth in nurses along with fostering success for patients. Compared with patients receiving usual care, patients in the program achieved greater reductions in pain severity, pain-related disability, and pain-related functional interference and reported greater satisfaction with pain-related care and primary care services. This article will detail the NPS-aligned practice approaches these nurses and their teams used, describe the training for the nurses, and speak to opportunities to enhance the nurse's capacity for this role in hopes of providing a model for the future implementation of an NPS-based approach by nurses.
Collapse
Affiliation(s)
| | - Frank J Keefe
- Duke University, School of Medicine, Durham, North Carolina
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| |
Collapse
|
5
|
Teaming in Interdisciplinary Chronic Pain Management Interventions in Primary Care: a Systematic Review of Randomized Controlled Trials. J Gen Intern Med 2022; 37:1501-1512. [PMID: 35239110 PMCID: PMC9086072 DOI: 10.1007/s11606-021-07255-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Current pain management recommendations emphasize leveraging interdisciplinary teams. We aimed to identify key features of interdisciplinary team structures and processes associated with improved pain outcomes for patients experiencing chronic pain in primary care settings. METHODS We searched PubMed, EMBASE, and CINAHL for randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (e.g., BPI total pain, GCPS pain intensity, RMDQ pain-related disability), include primary care as an intervention setting, and demonstrate some evidence of teamwork or teaming; specifically, they needed to involve at least two clinicians interacting with each other and with patients in an ongoing process over at least two timepoints. We assessed study quality with the Cochrane Risk of Bias tool. We narratively synthesized intervention team structures and processes, comparing among interventions that reported a clinically meaningful improvement in patient-reported pain outcomes defined by the minimal clinically important difference (MCID). RESULTS We included 13 total interventions in our review, of which eight reported a clinically meaningful improvement in at least one patient-reported pain outcome. No included studies had an overall high risk of bias. We identified the role of a care manager as a common structural feature of the interventions with some clinical effect on patient-reported pain. The team processes involving clinicians varied across interventions reporting clinically improved pain outcomes. However, when analyzing team processes involving patients, six of the interventions with some clinical effect on pain relied on pre-scheduled phone calls for continuous patient follow-up. DISCUSSION Our review suggests that interdisciplinary interventions incorporating teamwork and teaming can improve patient-reported pain outcomes in comparison to usual care. Given the current evidence, future interventions might prioritize care managers and mechanisms for patient follow-up to help bridge the gap between clinical guidelines and the implementation of interdisciplinary, team-based chronic pain care.
Collapse
|
6
|
Update on Interventional Management of Neuropathic Pain: A Delphi Consensus of the Spanish Pain Society Neuropathic Pain Task Force. Medicina (B Aires) 2022; 58:medicina58050627. [PMID: 35630044 PMCID: PMC9146461 DOI: 10.3390/medicina58050627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives: Interventional management of neuropathic pain (NP) is available to the patients who do not obtain satisfactory pain relief with pharmacotherapy. Evidence supporting this is sparse and fragmented. We attempted to summarize and critically appraise the existing data to identify strategies that yield the greatest benefit, guide clinicians, and identify areas that merit further investigation. Material and Methods: A two-round Delphi survey that involved pain clinic specialists with experience in the research and management of NP was done over an ad hoc 26-item questionnaire made by the authors. Consensus on each statement was defined as either at least 80% endorsement or rejection after the 2nd round. Results: Thirty-five and 29 panelists participated in the 1st and 2nd round, respectively. Consensus was reached in 20 out of 26 statements. There is sufficient basis to treat postherpetic neuralgias and complex regional pain syndromes with progressive levels of invasiveness and failed back surgery syndrome with neuromodulation. Radiculopathies and localized NP can be treated with peripheral blocks, neuromodulation, or pulsed radiofrequency. Non-ablative radiofrequency and non-paresthetic neuromodulation are efficacious and better tolerated than ablative and suprathreshold procedures. Conclusions: A graded approach, from least to most invasive interventions has the potential to improve outcomes in many patients with common refractory NP conditions. Preliminary promising data warrant further research on new indications, and technical advances might enhance the safety and efficacy of current and future therapies.
Collapse
|
7
|
Rahimian Bougar M, Veiskarami HA, Khodarahimi S, Izadpanah A, Sadeghi M, Nazari N. Effectiveness of Three Physical Treatments on Pain Perception and Emotional State in Males with Chronic Joint Pain. J Clin Psychol Med Settings 2022; 29:785-797. [DOI: 10.1007/s10880-021-09835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
|
8
|
Cohen SP, Doshi TL, Kurihara C, Reece D, Dolomisiewicz E, Phillips CR, Dawson T, Jamison D, Young R, Pasquina PF. Multicenter study evaluating factors associated with treatment outcome for low back pain injections. Reg Anesth Pain Med 2021; 47:89-99. [PMID: 34880117 DOI: 10.1136/rapm-2021-103247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting. METHODS We prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success). RESULTS 346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient -0.32, 95% CI -0.48 to -0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses. CONCLUSIONS Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate. TRIAL REGISTRATION NUMBER NCT02329951.
Collapse
Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA .,Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tina L Doshi
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Connie Kurihara
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David Reece
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Edward Dolomisiewicz
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Timothy Dawson
- Department of Anesthesiology, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - David Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ryan Young
- Department of Surgery, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Paul F Pasquina
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| |
Collapse
|
9
|
Slawek DE, Syed M, Cunningham CO, Zhang C, Ross J, Herman M, Sohler N, Minami H, Levin FR, Arnsten JH, Starrels JL. Pain catastrophizing and mental health phenotypes in adults with refractory chronic pain: A latent class analysis. J Psychiatr Res 2021; 145:102-110. [PMID: 34890916 PMCID: PMC9160202 DOI: 10.1016/j.jpsychires.2021.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/12/2023]
Abstract
Chronic pain, pain catastrophizing, and mental health disorders such as anxiety or depression frequently occur together and are challenging to treat. To help understand the relationship between these conditions, we sought to identify distinct phenotypes associated with worse pain and function. In a cohort of people with chronic pain on opioids seeking medical cannabis in New York, we conducted latent class analysis to identify clusters of participants based on pain catastrophizing and mental health symptoms of depression, anxiety, post-traumatic stress disorder (PTSD) and attention deficit/hyperactivity disorder (ADHD). We then compared clusters with respect to sociodemographic and clinical characteristics using descriptive statistics. Among 185 participants, we identified four discrete groups: low pain catastrophizing and low mental health symptoms (49% of participants), low pain catastrophizing and ADHD-predominant mental health symptoms (11%), high pain catastrophizing and anxiety-predominant mental health symptoms (11%), and high pain catastrophizing and high mental health symptoms (30%). The group with high pain catastrophizing and high mental health symptoms had the worst pain intensity and interference, disability, insomnia, and quality of life, compared to the two groups with lower pain catastrophizing, though not all differences were statistically significant. Our findings highlight the importance of identifying and addressing pain catastrophizing in patients with comorbid chronic pain and mental health symptoms.
Collapse
Affiliation(s)
- Deepika E Slawek
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA.
| | - Madiha Syed
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | | | - Chenshu Zhang
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Merrill Herman
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | - Nancy Sohler
- School of Medicine, City University of New York, New York, NY, USA
| | - Haruka Minami
- Psychology Department, Fordham University, Bronx, NY, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| |
Collapse
|
10
|
Mardian AS, Hanson ER, Villarroel L, Karnik AD, Sollenberger JG, Okvat HA, Dhanjal-Reddy A, Rehman S. Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care. PAIN MEDICINE 2021; 21:1168-1180. [PMID: 31909793 DOI: 10.1093/pm/pnz336] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Much of the pain care in the United States is costly and associated with limited benefits and significant harms, representing a crisis of value. We explore the current factors that lead to low-value pain care within the United States and provide an alternate model for pain care, as well as an implementation example for this model that is expected to produce high-value pain care. METHODS From the perspective of aiming for high-value care (defined as care that maximizes clinical benefit while minimizing harm and cost), we describe the current evidence practice gap (EPG) for pain care in the United States, which has developed as current clinical care diverges from existing evidence. A discussion of the biomedical, biopsychosocial, and sociopsychobiological (SPB) models of pain care is used to elucidate the origins of the current EPG and the unconscious factors that perpetuate pain care systems despite poor results. RESULTS An interprofessional pain team within the Veterans Health Administration is described as an example of a pain care system that has been designed to deliver high-value pain care and close the EPG by implementing the SPB model. CONCLUSIONS Adopting and implementing a sociopsychobiological model may be an effective approach to address the current evidence practice gap and deliver high-value pain care in the United States. The Phoenix VA Health Care System's Chronic Pain Wellness Center may serve as a template for providing high-value, evidence-based pain care for patients with high-impact chronic pain who also have medical, mental health, and opioid use disorder comorbidities.
Collapse
Affiliation(s)
- Aram S Mardian
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Eric R Hanson
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Lisa Villarroel
- Arizona Department of Health Services, Phoenix, Arizona, USA
| | - Anita D Karnik
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - John G Sollenberger
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | | | - Amrita Dhanjal-Reddy
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Shakaib Rehman
- Phoenix VA Health Care System, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| |
Collapse
|
11
|
Dekker AB, Teunis T, Schipper I, Ring D. Development of a Short Form of the Negative Pain Thoughts Questionnaire (NPTQ). J Bone Joint Surg Am 2021; 103:439-444. [PMID: 33337821 DOI: 10.2106/jbjs.20.00571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Thoughts affect pain intensity and the magnitude of activity intolerance for a given nociception. The Negative Pain Thoughts Questionnaire (NPTQ) measures common unhelpful cognitive biases regarding pain. A shorter version of the NPTQ could be used in daily practice to improve health by identifying important misconceptions. METHODS One hundred and thirty-seven patients seeking specialty musculoskeletal care completed questionnaires addressing demographics, negative pain thoughts, worst-case thinking, resiliency, the magnitude of self-reported activity intolerance, and pain intensity. Patients were randomly allocated to a learning cohort (110 patients, 80%) and a validation cohort (27 patients, 20%). Based on factor analysis of the learning cohort, 4 questions were selected to create the NPTQ short form (NPTQ-SF). Floor and ceiling effects of the NPTQ and NPTQ-SF were analyzed. Psychometric properties of the NPTQ-SF were tested with use of Spearman correlations with the NPTQ. The internal consistency of the NPTQ and NPTQ-SF was analyzed with use of the Cronbach α coefficient. To test external validity, we calculated Spearman correlations with pain intensity, activity intolerance, the Pain Catastrophizing Scale, and the Brief Resiliency Scale in the validation cohort. RESULTS The Cronbach α was 0.90 for the NPTQ and 0.85 for the NPTQ-SF. The Spearman correlation between NPTQ and NPTQ-SF scores was 0.91 in the learning cohort and 0.93 in the validation cohort. In the validation cohort, there was no difference in the strength of the correlations of the NPTQ and NPTQ-SF with other questionnaires. CONCLUSIONS These findings support the use of a brief, 4-question measure of unhelpful cognitive biases regarding pain in both research and patient care. The NPTQ-SF would benefit from external validation in an independent cohort. CLINICAL RELEVANCE The notable influence of common misconceptions (i.e., cognitive bias) on musculoskeletal symptoms can be measured with a brief questionnaire and used as a point of discussion with patients.
Collapse
Affiliation(s)
- Anne-Britt Dekker
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Teun Teunis
- University Medical Center Utrecht, the Netherlands
| | - Inger Schipper
- Department of Surgery, Leids Universitair Medisch Centrum at Leiden, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| |
Collapse
|
12
|
Coyne KS, Barsdorf AI, Currie BM, Poon JL, Mazière JY, Pierson RF, Butler SF, Schnoll SH, Farrar JT, Fisher HJ, Franks MJ. Insight into chronic pain in the United States: descriptive results from the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) validation study. Curr Med Res Opin 2021; 37:483-492. [PMID: 33331191 DOI: 10.1080/03007995.2020.1865889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A chronic pain patient sample living in the United States who participated in a cross-sectional study to evaluate the validity and reproducibility of the Prescription Opioid Misuse and Abuse Questionnaire is characterized. METHODS Patients with chronic pain identified through electronic medical records as refilling at least one opioid prescription within the prior 3 months were recruited from five United States Department of Defense Military Health System clinics. Patients completed the Prescription Opioid Misuse and Abuse Questionnaire, Brief Pain Inventory-Short Form, Medical Outcomes Study: 36-item Short Form, and sociodemographic questions online. Clinical characteristics and electronic medical records for 1 year prior to consent were collected. RESULTS 809 (86.2%) participants completed the Prescription Opioid Misuse and Abuse Questionnaire. Mean (± standard deviation) age was 55.4 ± 12.7 years; the majority female (55.5%) and white (74.8%). Mean duration of chronic pain was 14.7 ± 10.5 years; the most common pain conditions were lower back pain (76.6%), neck or shoulder pain (60.3%), and osteoarthritis (38.7%). The most commonly prescribed opioids were oxycodone (35.7%), tramadol (34.5%), and hydrocodone (26.9%); 54.8% took one opioid, 44.9% took 2 or more opioids. DISCUSSION Participants' health status was poor; pain severity and interference were moderate. Electronic medical record data revealed high healthcare resource utilization. This chronic pain population was severely impacted by their pain condition(s).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | |
Collapse
|
13
|
McGarrigle L, Wesson C, DeAmicis L, Connoly S, Ferreira N. Psychological mediators in the relationship between paediatric chronic pain and adjustment: An investigation of acceptance, catastrophising and kinesiophobia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
14
|
Ahmed S, Zidarov D, Eilayyan O, Visca R. Prospective application of implementation science theories and frameworks to inform use of PROMs in routine clinical care within an integrated pain network. Qual Life Res 2020; 30:3035-3047. [PMID: 32876812 PMCID: PMC8528775 DOI: 10.1007/s11136-020-02600-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The objective of this study is to present the implementation science approaches that were used before implementing electronic patient-reported outcome measures (ePROMs) across an integrated chronic pain network that includes primary, rehabilitation, and hospital-based care. METHODS The Theoretical Domains Framework (TDF) was used to identify potential barriers and enablers to the use of ePROMS by primary care clinicians. In rehabilitation and tertiary care, the Consolidated Framework for Implementation (CFIR) was used to guide the identification of determinants of implementations, through observation of workflow, patient and clinician surveys, and clinician interviews. A mixed-method concurrent design comprising a quantitative and qualitative analysis was used. The results were reviewed by a steering committee to iteratively inform the ePROM implementation plan. The Proctor framework of evaluation was used to guide the development of an evaluation plan for the implementation of ePROMs in the integrated chronic pain network. RESULTS Both frameworks provided similar results with respect to healthcare provider knowledge, behaviour, and experience interpreting PROM scores. The TDF and CFIR frameworks differed in identifying organizational-level determinants. The resultant implementation plan was structured around the adoption of PROMs to inform individual treatment planning and quality improvement. The evaluation plan focused on implementation and impact outcomes to evaluate the ePROM intervention. CONCLUSIONS The TDF and CFIR guided the development of a multi-component knowledge translation and training intervention that will address multiple gaps and barriers to implementation of PROMs across the integrated network. The ePROM intervention will aim to increase clinicians' knowledge and skills and foster best practices.
Collapse
Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada. .,Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada. .,Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada. .,Institut Universitaire Sur La réadaptation en déficience Physique de Montréal, Centre intégré Universitaire de santé Et de Services Sociaux du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Québec, Canada. .,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Diana Zidarov
- Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada.,Institut Universitaire Sur La réadaptation en déficience Physique de Montréal, Centre intégré Universitaire de santé Et de Services Sociaux du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Québec, Canada.,Faculté de Médecine, Université de Montréal, École de réadaptation, Montréal, Canada
| | - Owis Eilayyan
- Faculty of Medicine, School of Physical & Occupational Therapy, McGill University, Montréal, QC, Canada.,Center for Outcome Research and Evaluation, Clinical Epidemiology, McGill University Health Center, McGill University, Montréal, QC, Canada.,Centre de Recherche Interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montréal, QC, Canada
| | - Regina Visca
- RUISSS McGill Centre of Expertise in Chronic Pain, Montréal, Canada.,Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| |
Collapse
|
15
|
Duckworth J, Matar HE, Divecha H, Wynn Jones H, Board TN. Preoperative pain catastrophisation may predict worse patient-reported outcomes after primary hip arthroplasty: A pilot study. J Orthop 2020; 20:186-189. [PMID: 32025146 PMCID: PMC6997509 DOI: 10.1016/j.jor.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/19/2020] [Indexed: 11/24/2022] Open
Abstract
AIM to investigate the relationship between pain catastrophising and patient-reported clinical outcomes following primary total hip arthroplasty. MATERIALS AND METHODS prospective consecutive study of 103 patients who completed preoperative Pain Catastrophisation Score (PCS), preoperative and 12-month postoperative Oxford Hip Score (OHS). Correlation analysis was carried out between the improvement in OHS (mean difference between pre- and postoperative scores) and the mean preoperative PCS score using the Pearson's r rank test. Multiple linear regression was then performed using the postoperative OHS as the outcome variable against a number of predictor variables. RESULTS there were 37 males and 66 females with average age of 60.5 years (range 22-84). Mean preoperative PCS score was 16.3 (±13.6; range 0-49). Mean preoperative OHS was 16.5 (±3.5) which had improved at 12-months postoperatively to a mean 38.1 (±11.1). The difference was statistically significant (P < 0.0001). Preoperative PCS scores were correlated with the OHS improvement at 12-months which revealed a weak negative correlation Pearson's correlation coefficient r = - 0.248 (P = 0.0114). Preoperative PCS score, predictor variable, had statistically significant relationship with the postoperative OHS (P = 0.0207). The regression coefficient for the PCS was -0.25, therefore for each unit increase in the preoperative PCS score there was a 0.25 unit decrease in the postoperative OHS score. CONCLUSION pain catastrophising appear to predict poorer postoperative patient-reported outcome measures. Further research is needed to evaluate the value of early identification of high-risk patients and the role of preoperative involvement of pain specialists and its effects on postoperative outcomes.
Collapse
Affiliation(s)
| | - Hosam E. Matar
- Centre for Hip Surgery, Wrightington Hospital, Wigan, WN6 9EP, United Kingdom
| | | | | | | |
Collapse
|
16
|
Shanthanna H, Bhatia A, Radhakrishna M, Belley-Cote E, Vanniyasingam T, Thabane L, Busse JW. Interventional pain management for chronic pain: a survey of physicians in Canada. Can J Anaesth 2020; 67:343-352. [PMID: 31802414 DOI: 10.1007/s12630-019-01547-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook this survey to explore patterns, training, and attributes of IPM practice. METHODS We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain. RESULTS Of 777 physicians contacted, 256 (33%) responded: 45 (6%) declined to participate and 211 (27%) agreed to participate; the number of participants answering any given question varied. One hundred and sixty-nine of 194 (87%) practiced IPM and 103 of 194 (53%) managed only non-cancer pain. Pain management training of ≥ six months was associated with higher odds of IPM training (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.32 to 6.7), but not necessarily ongoing IPM practice (OR, 1.97; 95% CI, 0.74 to 5.3). A substantial percentage of physicians (108 of 168 [64%]) practiced IPM based only on training received during either their base residency program or courses. Only 48 of 186 (26%) felt that there were adequate opportunities for IPM training, and 69 of 186 (37%) believed that their colleagues practiced IPM in accordance with the best current evidence. CONCLUSIONS Our survey indicates that IPM practice and training were not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.
Collapse
Affiliation(s)
- Harsha Shanthanna
- The Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
- The Research Institute of St Joseph's Hospital, Hamilton, ON, Canada.
- Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | - Anuj Bhatia
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The Department of Anesthesia and Pain Management, University of Toronto, Toronto, ON, Canada
| | - Mohan Radhakrishna
- The Department of Physical Medicine and Rehabilitation, McGill University, Montreal, QC, Canada
| | - Emilie Belley-Cote
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joseph's Hospital, Hamilton, ON, Canada
| | - Jason W Busse
- The Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
17
|
Gruß I, Firemark A, Mayhew M, McMullen CK, DeBar LL. Taking opioids in times of crisis: Institutional oversight, chronic pain and suffering in an integrated healthcare delivery system in the U.S. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:62-68. [PMID: 31536957 PMCID: PMC6893145 DOI: 10.1016/j.drugpo.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Opioid treatment for chronic pain has garnered heightened public attention and political pressure to control a devastating public health crisis in the United States (U.S.). Resulting policy changes, together with ongoing public and political attention, have pushed health care systems and providers to lower doses or deprescribe and taper patients off opioids. However, little attention has been paid to the impact of such practice changes on patients who had relied on opioid treatment to manage their chronic pain. The aim of this article is to explore experiences with opioid-related care under aggressive tapering efforts and concomitant heightened monitoring and institutional oversight among patients with chronic pain in an integrated delivery system through in-depth interviews. METHODS We interviewed 97 patients with chronic pain who were assigned to the usual care arm of the Pain Program for Active Coping and Training (PPACT) study. These patients had been prescribed opioids as part of their treatment regimens and taken opioids closely monitored by their health care providers. We followed the framework method for coding and analysing transcripts using NVivo 12. RESULTS The experiences of these patients during this period of change can be understood through three interconnected themes: (1) many patients taking opioids experience debilitating physical side effects; (2) navigating opioid treatment contributes to significant emotional distress among many patients with chronic pain and; (3) the quality of patients' relationship with their primary care provider can be negatively affected by negotiations regarding long-term opioid treatment for chronic pain. CONCLUSION We highlight the importance of utilizing communication approaches that are patient-centered and include shared decision making during the tapering and/or deprescribing processes of opioids and ensuring alternative pain treatments are available to patients with chronic pain.
Collapse
Affiliation(s)
- Inga Gruß
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States.
| | - Alison Firemark
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States.
| | - Meghan Mayhew
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States.
| | - Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States.
| | - Lynn L DeBar
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466, United States.
| |
Collapse
|
18
|
Twomey D, Stuart S, Baker K. Pain in Parkinson's disease: the lived experience. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.6.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Doireann Twomey
- Senior neurological physiotherapist, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle Upon Tyne, UK
| | - Samuel Stuart
- Research associate, Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne; Newastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Baker
- Senior lecturer in physiotherapy, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle Upon Tyne, UK
| |
Collapse
|
19
|
DeBar L, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Mayhew M, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) - Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials 2018; 67:91-99. [PMID: 29522897 PMCID: PMC5931339 DOI: 10.1016/j.cct.2018.02.015] [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] [Received: 09/07/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. METHODS/DESIGN This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. DISCUSSION This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592.
Collapse
Affiliation(s)
- Lynn DeBar
- Kaiser Permanente Center for Health Research, Portland, OR, United States.
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland, OR, United States; University of Portland, School of Nursing, Portland, OR, United States
| | - Allison Bonifay
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Richard A Deyo
- Oregon Health and Science University, School of Medicine, Portland, OR, United States
| | - Charles R Elder
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Francis J Keefe
- Duke University, School of Medicine, Durham, NC, United States
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Ashli Owen-Smith
- Georgia State University, School of Public Health, Atlanta, GA, United States; Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, GA, United States
| | - David H Smith
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Connie M Trinacty
- Kaiser Permanente Center for Health Research, Honolulu, HI, United States
| | - William M Vollmer
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| |
Collapse
|
20
|
Complex pain in children and young people; part 2: management. BJA Educ 2018; 18:82-88. [DOI: 10.1016/j.bjae.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
|
21
|
Brain-to-brain coupling during handholding is associated with pain reduction. Proc Natl Acad Sci U S A 2018; 115:E2528-E2537. [PMID: 29483250 DOI: 10.1073/pnas.1703643115] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The mechanisms underlying analgesia related to social touch are not clear. While recent research highlights the role of the empathy of the observer to pain relief in the target, the contribution of social interaction to analgesia is unknown. The current study examines brain-to-brain coupling during pain with interpersonal touch and tests the involvement of interbrain synchrony in pain alleviation. Romantic partners were assigned the roles of target (pain receiver) and observer (pain observer) under pain-no-pain and touch-no-touch conditions concurrent with EEG recording. Brain-to-brain coupling in alpha-mu band (8-12 Hz) was estimated by a three-step multilevel analysis procedure based on running window circular correlation coefficient and post hoc power of the findings was calculated using simulations. Our findings indicate that hand-holding during pain administration increases brain-to-brain coupling in a network that mainly involves the central regions of the pain target and the right hemisphere of the pain observer. Moreover, brain-to-brain coupling in this network was found to correlate with analgesia magnitude and observer's empathic accuracy. These findings indicate that brain-to-brain coupling may be involved in touch-related analgesia.
Collapse
|
22
|
Bagg MK, McAuley JH, Moseley GL, Wand BM. Recent data from radiofrequency denervation trials further emphasise that treating nociception is not the same as treating pain. Br J Sports Med 2018; 53:841-842. [PMID: 29351958 DOI: 10.1136/bjsports-2017-098510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew K Bagg
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,New College Village, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Benedict Martin Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| |
Collapse
|
23
|
Interventional Pain Management in Multidisciplinary Chronic Pain Clinics: A Prospective Multicenter Cohort Study with One-Year Follow-Up. PAIN RESEARCH AND TREATMENT 2017; 2017:8402413. [PMID: 29163990 PMCID: PMC5661079 DOI: 10.1155/2017/8402413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/18/2017] [Indexed: 01/27/2023]
Abstract
Background Interventional Pain Management (IPM) is performed in multidisciplinary chronic pain clinics (MCPC), including a range of invasive techniques to diagnose and treat chronic pain (CP) conditions. Current patterns of use of those techniques in MCPC have not yet been reported. Objective We aimed to describe quantitatively and qualitatively the use of IPM and other therapeutic procedures performed on-site at four Portuguese MCPC. Methods A prospective cohort study with one-year follow-up was performed in adult patients. A structured case report form was systematically completed at baseline and six and 12 months. Results Among 808 patients referred to the MCPC, 17.2% had been prescribed IPM. Patients with IPM were on average younger and had longer CP duration and lower levels of maximum pain and pain interference/disability. The three main diagnoses were low back pain (n = 28), postoperative CP, and knee pain (n = 16 each). From 195 IPM prescribed, nerve blocks (n = 108), radiofrequency (n = 31), and viscosupplementation (n = 22) were the most prevalent. Some IPM techniques were only available in few MCPC. One MCPC did not provide IPM. Conclusions IPM are seldom prescribed in Portuguese MCPC. Further studies on IPM safety and effectiveness are necessary for clear understanding the role of these techniques in CP management.
Collapse
|
24
|
Bloor LE, Fisher C, Grix B, Zaleon CR, Wice S. Conjoint Sessions With Clinical Pharmacy and Health Psychology for Chronic Pain: Enhancing Participation in Behavioral Management. Fed Pract 2017; 34:35-41. [PMID: 30766271 PMCID: PMC6370402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This quality improvement project suggests the utility of an interdisciplinary, coordinated team approach to chronic pain management and behavioral health services.
Collapse
Affiliation(s)
- Lindsey E Bloor
- , , , and are clinical psychologists, and Dr. Zaleon is a clinical pharmacy specialist, all at the VA Ann Arbor Healthcare System in Michigan. Dr. Bloor also is an assistant clinical professor in the psychiatry department at the University of Michigan Medical School in Ann Arbor
| | - Carolyn Fisher
- , , , and are clinical psychologists, and Dr. Zaleon is a clinical pharmacy specialist, all at the VA Ann Arbor Healthcare System in Michigan. Dr. Bloor also is an assistant clinical professor in the psychiatry department at the University of Michigan Medical School in Ann Arbor
| | - Bethany Grix
- , , , and are clinical psychologists, and Dr. Zaleon is a clinical pharmacy specialist, all at the VA Ann Arbor Healthcare System in Michigan. Dr. Bloor also is an assistant clinical professor in the psychiatry department at the University of Michigan Medical School in Ann Arbor
| | - Carolyn R Zaleon
- , , , and are clinical psychologists, and Dr. Zaleon is a clinical pharmacy specialist, all at the VA Ann Arbor Healthcare System in Michigan. Dr. Bloor also is an assistant clinical professor in the psychiatry department at the University of Michigan Medical School in Ann Arbor
| | - Sarah Wice
- , , , and are clinical psychologists, and Dr. Zaleon is a clinical pharmacy specialist, all at the VA Ann Arbor Healthcare System in Michigan. Dr. Bloor also is an assistant clinical professor in the psychiatry department at the University of Michigan Medical School in Ann Arbor
| |
Collapse
|
25
|
The association of catastrophizing with quality-of-life outcomes in patients with irritable bowel syndrome. Qual Life Res 2017; 26:2161-2170. [PMID: 28324323 PMCID: PMC5509838 DOI: 10.1007/s11136-017-1554-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/15/2022]
Abstract
Background Catastrophizing is a cognitive process characterized by a propensity to concentrate on and magnify the value of an actual or anticipated painful stimulus and negatively assesses one’s ability to cope. Catastrophizing is an important predictor of pain-related outcomes. A cornerstone symptom of irritable bowel syndrome (IBS) is abdominal pain or discomfort. Also individuals with IBS have been reported to have a tendency to catastrophize. In a sample of individuals who suffer from IBS, we hypothesized that those individuals who catastrophize (catastrophizers) would have worse outcomes as compared to those who do not catastrophize (non-catastrophizers). Methods One hundred and one adults with IBS (79% female, mean age 42 years, 97% Caucasian) were recruited from outpatient clinics and data were collected through self-report measures. Catastrophizing was measured with the catastrophizing subscale of the Coping Strategies Questionnaire, illness representations were measured with The Revised Illness Perception Questionnaire (IPQ-R), psychological distress was measured with the Brief Symptom Inventory 18 (BSI-18), and health-related quality of life was measured using the Irritable Bowel Syndrome-Quality of Life (IBS-QOL) measure. Descriptive statistics, correlations, and multiple linear regression analyses were completed to describe participants, the associations of the variables of interest, and the unique relationship between psychosocial variables and HRQOL. Results Overall, participants reported poor HRQOL (M = 63.32, range 0–100). Catastrophizers differed significantly on IBS-QOL from non-catastrophizers (M = 48.98 vs. non-catastrophizers M = 78.53; p < 0.001), BSI-18 (M = 21.35 vs. non-catastrophizers M = 6.76; p < 0.001), and IPQ-R, specifically the consequences (M = 21.75 vs. non-catastrophizers M = 17.20; p < 0.001) and emotional representations (M = 20.90 vs. non-catastrophizers M = 15.43; p < 0.001). Catastrophizing was positively correlated with the consequences (r = .54; p < 0.01) and emotional representations (r = .65; p < 0.01) and negatively correlated with total HRQOL (r = −0.76; p < 0.01). Conclusion The findings indicated that participants who catastrophized reported worse psychosocial and functional outcomes. Thus, catastrophizing, in addition to psychological distress variables, may be an important factor to address in optimizing health outcomes in individuals with IBS. In addition, illness perceptions were strongly related to catastrophizing and HRQOL; assessment and integration of illness perceptions as well as catastrophizing into the management of individuals who suffer with IBS may maximize the health outcomes.
Collapse
|
26
|
Unique Contributions of Acceptance and Catastrophizing on Chronic Pain Adaptation. Int J Behav Med 2017; 24:542-551. [DOI: 10.1007/s12529-017-9646-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
27
|
Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L. Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health. THE GERONTOLOGIST 2017; 56 Suppl 2:S243-55. [PMID: 26994264 DOI: 10.1093/geront/gnw002] [Citation(s) in RCA: 373] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.
Collapse
Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. Arthritis and Osteoporosis Victoria, Caulfield South, Melbourne, Australia.
| | - Marita J Cross
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
| | - Damian G Hoy
- School of Population Health, University of Queensland, Herston, Brisbane, Australia. Secretariat of the Pacific Community, Public Health Division, Noumea, New Caledonia
| | - Lídia Sànchez-Riera
- Institut d'Investigació, Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Department Reumatologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fiona M Blyth
- Concord Clinical School, University of Sydney and Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, New South Wales, Australia
| | - Anthony D Woolf
- Bone and Joint Research Office, The Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Lyn March
- Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital Department of Rheumatology, St Leonards, New South Wales, Australia
| |
Collapse
|
28
|
Jull G. Biopsychosocial model of disease: 40 years on. Which way is the pendulum swinging? Br J Sports Med 2017; 51:1187-1188. [PMID: 28062465 DOI: 10.1136/bjsports-2016-097362] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/04/2022]
|
29
|
Coyne KS, Currie BM, Donevan S, Brodsky M, Asmus MJ, Krichbaum DW, Cappelleri JC, Hegeman-Dingle R, Sadosky A, Whipple SZ, Burbridge C, Mulhem E, Hillenberg JB. Psychometric validation of the electronic chronic pain questions (eCPQ) in a primary care setting. Curr Med Res Opin 2017; 33:137-148. [PMID: 27829303 DOI: 10.1080/03007995.2016.1240666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Collecting data that helps evaluate different types of pain may improve physicians' decision-making with regard to treatment selection and on-going monitoring of patients. To date, no chronic pain assessments have been widely implemented in primary care. The aim of this study was to psychometrically validate the electronic Chronic Pain Questions (eCPQ) in a primary care setting. RESEARCH DESIGN AND METHODS All men and women ≥18 years arriving at two similar primary care clinics in southeastern Michigan were invited to participate. Clinic staff verbally administered the eCPQ to patients and recorded their answers into the electronic medical record (EMR) prior to physician consultation with results available for physician review. Concurrent validity was assessed using Spearman correlations between eCPQ and patient-completed ancillary measures. Known-group validity was assessed by stratifying patients on self-reported chronic pain as well as by pain diagnosis (i.e. ICD-9 codes). To compare patients with chronic pain versus no chronic pain t-tests and chi-square tests were performed. Reproducibility was assessed between interviewer- and self-administration over time. RESULTS A total of 534 patients were invited to participate and 455 patients consented to take part in the study (85.2% response rate); 395 patients had analyzable eCPQ data; 70.1% were Caucasian; 68.1% female; mean age was 43.4; 52.7% (n = 208) self-reported chronic pain. Correlations between eCPQ and ancillary measures supported concurrent validity. Excellent discrimination between groups was evidenced based on self-reported chronic pain and ICD-9 diagnosis. Patients with self-reported chronic pain reported significantly (p < .0001) higher pain ratings and greater interference with usual activities, sleep, and mood than those without chronic pain. Test-retest reliability between modes (interviewer- vs. self-administration) was excellent as was reproducibility based on self-administration of the eCPQ at two separate time points. Key limitations: Discriminant validity was determined by comparing participants based on ICD codes. Utilizing ICD codes to identify individuals with chronic pain may not be a reliable approach as it is dependent upon providers accurately and consistently entering chronic pain diagnoses in the EMR. CONCLUSIONS The eCPQ has sound psychometric measurement properties, including concurrent validity, discriminant validity, and reproducibility. The eCPQ appears to be useful to identify patients with chronic pain and to assess and monitor symptoms over time.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Elie Mulhem
- d Oakland University William Beaumont School of Medicine , Rochester , MI , USA
| | - J Bruce Hillenberg
- d Oakland University William Beaumont School of Medicine , Rochester , MI , USA
| |
Collapse
|
30
|
Coyne KS, Currie BM, Donevan S, Cappelleri JC, Hegeman-Dingle R, Abraham L, Thompson C, Sadosky A, Brodsky M. Discriminating between neuropathic pain and sensory hypersensitivity using the Chronic Pain Questions (CPQ). Postgrad Med 2016; 129:22-31. [DOI: 10.1080/00325481.2017.1267538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Sean Donevan
- Global Medical Affairs, Pfizer Inc, New York, NY, USA
| | | | | | - Lucy Abraham
- Outcomes & Evidence, Global Health & Value, Pfizer Ltd, Tadworth, UK
| | | | | | | |
Collapse
|
31
|
Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, Hanno P, Fraser MO, Homma Y, Garrido G, Gomes MJ, Elneil S, van de Merwe JP, Lin ATL, Tomoe H. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn 2016; 36:984-1008. [PMID: 27564065 DOI: 10.1002/nau.23072] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Abstract
AIMS Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. METHODS A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement. RESULTS The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation. CONCLUSION The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Kristene E Whitmore
- Chair of Urology and Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jane M Meijlink
- International Painful Bladder Foundation, Naarden, Netherlands
| | - Marcus J Drake
- Department of Urology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Helena Frawley
- Physiotherapy at La Trobe University, Melbourne, Cabrini Health, Melbourne, Australia
| | - Jørgen Nordling
- Department of Urology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Philip Hanno
- Department of Urology, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew O Fraser
- Department of Urology Surgery, Duke University and Durham Veterans Affairs Medical Centers, Durham, North Carolina
| | - Yukio Homma
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | - Gustavo Garrido
- Head of Voiding Dysfunctions and Urodynamics Section, Urology Division, Hospital de Clínicas, University of Buenos Aires, Argentina
| | - Mario J Gomes
- Department of Urology, St. António Hospital, Oporto, Portugal
| | - Sohier Elneil
- Department of Urogynecology, University College Hospital, National Hospital for Neurology and Neurosurgery, GB
| | | | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Hikaru Tomoe
- Department of Urogynecology, Chair of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Japan
| |
Collapse
|
32
|
Craner JR, Sperry JA, Evans MM. The Relationship Between Pain Catastrophizing and Outcomes of a 3-Week Comprehensive Pain Rehabilitation Program. PAIN MEDICINE 2016; 17:2026-2035. [DOI: 10.1093/pm/pnw070] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
33
|
Craner JR, Skipper RR, Gilliam WP, Morrison EJ, Sperry JA. Patients' perceptions of a chronic pain rehabilitation program: changing the conversation. Curr Med Res Opin 2016; 32:879-83. [PMID: 26824738 DOI: 10.1185/03007995.2016.1149053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Research supports the effectiveness of comprehensive approaches to chronic pain treatment, including behavioral management and physical reconditioning. However, less is known about patients' perceptions of this treatment approach. The current study evaluated patient perceptions and treatment outcomes utilizing both qualitative and quantitative data collection. Methods A total of 498 adult patients (≥18 years of age; Mage = 49.1) completed an intensive outpatient interdisciplinary chronic pain rehabilitation program, completed survey measures at admission and discharge, and were asked open-ended questions about their treatment experience at discharge. Results Patients reported significant decreases in pain severity, t(488) = 23.08, p < .001, and pain-related interference, t(488) = 24.28, p < .001, at discharge. Patients endorsed self-management strategies, particularly relaxation skills (85%), moderation and/or modification (47%), and exercise, stretching and/or physical therapy (39%) as the most important aspects of treatment. Conclusions Patients perceive behavioral skills to manage pain and physical reconditioning to be important components of a successful pain rehabilitation program. These findings can inform conversations with both physicians and patients about the importance of biopsychosocial approaches to pain management. Key limitations include a lack of racial/ethnic diversity, use of anonymous data that cannot be linked directly to patient outcomes, and reliance on self-report data.
Collapse
|
34
|
Meissner W, Coluzzi F, Fletcher D, Huygen F, Morlion B, Neugebauer E, Montes A, Pergolizzi J. Improving the management of post-operative acute pain: priorities for change. Curr Med Res Opin 2015; 31:2131-43. [PMID: 26359332 DOI: 10.1185/03007995.2015.1092122] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain. At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue.
Collapse
Affiliation(s)
- Winfried Meissner
- a a Leiter der Sektion Schmerz, Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum der FSU Jena , Germany
| | - Flaminia Coluzzi
- b b Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Dominique Fletcher
- c c Service Anesthésie Réanimation, Hôpital Raymond Poincare , Garches , France
| | - Frank Huygen
- d d University Hospital , Rotterdam , The Netherlands
| | | | - Edmund Neugebauer
- f f Faculty of Health , School of Medicine, Witten/Herdecke University , Cologne , Germany
| | | | - Joseph Pergolizzi
- h h Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA
- i i Naples Anesthesia and Pain Associates , Naples , FL , USA
| |
Collapse
|
35
|
Guck TP, Burke RV, Rainville C, Hill-Taylor D, Wallace DP. A brief primary care intervention to reduce fear of movement in chronic low back pain patients. Transl Behav Med 2015; 5:113-21. [PMID: 25729460 DOI: 10.1007/s13142-014-0292-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fear avoidance model of chronic pain-based interventions are effective, but have not been successfully implemented into primary care. It was hypothesized that speed walking times and key measures of the fear avoidance model would improve following the brief intervention delivered in primary care. A brief primary care-based intervention (PCB) that included a single educational session, speed walking (an in vivo desensitization exposure task), and visual performance feedback was designed to reduce fear avoidance beliefs and improve function in 4 patients with chronic low back pain. A multiple baseline across subjects with a changing criterion design indicated that speed walking times improved from baseline only after the PCB intervention was delivered. Six fear avoidance model outcome measures improved from baseline to end of study and five of six outcome measures improved from end of study to follow-up. This study provides evidence for the efficacy of a brief PCB fear avoidance intervention that was successfully implemented into a busy clinic for the treatment of chronic pain.
Collapse
Affiliation(s)
- Thomas P Guck
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Raymond V Burke
- The Prevention Group; Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE USA
| | - Christopher Rainville
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Dreylana Hill-Taylor
- Department of Family Medicine, Creighton University School of Medicine, 1319 Leavenworth Street, Omaha, NE 68102 USA
| | - Dustin P Wallace
- Integrative Pain Management, Children's Mercy Hospitals and Clinics, School of Medicine, University of Kansas City-Missouri, Omaha, NE USA
| |
Collapse
|
36
|
Harden RN, Argoff CE, Williams DA. Intrathecal opioids for chronic pain: a call for evidence. PAIN MEDICINE 2014; 15:1823-4. [PMID: 25279707 DOI: 10.1111/pme.12576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Norman Harden
- Center for Pain Studies, Rehabilitation Institute of Chicago, Chicago, Illinois, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, Illinois, USA; Department of Physical Therapy and Movement Sciences, Northwestern University, Evanston, Illinois, USA
| | | | | |
Collapse
|
37
|
Peterson JC, Smith KA, Khan T, Arnold PM. The interdisciplinary management of spinal disorders: A review of outcomes. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.trap.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
38
|
Translational behavioral pain management: new directions and new opportunities. Transl Behav Med 2013; 2:19-21. [PMID: 24073094 DOI: 10.1007/s13142-012-0117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
39
|
Friedberg F, Williams DA, Collinge W. Lifestyle-oriented non-pharmacological treatments for fibromyalgia: a clinical overview and applications with home-based technologies. J Pain Res 2012; 5:425-35. [PMID: 23166446 PMCID: PMC3500923 DOI: 10.2147/jpr.s35199] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Fibromyalgia (FM) is a persistent and disabling widespread pain condition often accompanied by chronic fatigue, cognitive problems, sleep disturbance, depression, anxiety, and headache. To date, the most thoroughly studied non-pharmacological approaches to managing FM are those with a focus on changing patient activities and beliefs that affect the illness. These interventions are intended to facilitate enduring improvement in pain and functional status. Lifestyle-oriented treatments include patient education, aerobic or other physical exercise, and cognitive-behavioral therapy (CBT). These interventions in FM can be delivered in medical or behavioral health care settings by trained professionals, through patient-oriented treatment manuals, or via remote-access technologies. Non-pharmacological treatments, in particular exercise and CBT, have yielded effect sizes and cost–benefit ratios comparable to medications. This paper describes lifestyle-oriented non-pharmacological treatments for FM and highlights selected literature reviews of these interventions. In addition, behavioral and practical issues are addressed that may affect these non-pharmacological treatments, including patient expectations, participant burden, and treatment availability. Recommendations are made to facilitate these interventions and potentially improve outcomes. In particular, the increasing availability of convenient home-based mobile technologies to deliver these non-pharmacological treatments is described.
Collapse
Affiliation(s)
- Fred Friedberg
- Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York
| | | | | |
Collapse
|
40
|
Debar LL, Kindler L, Keefe FJ, Green CA, Smith DH, Deyo RA, Ames K, Feldstein A. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med 2012; 2:523-530. [PMID: 23440672 DOI: 10.1007/s13142-012-0163-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain.
Collapse
Affiliation(s)
- Lynn L Debar
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Harden RN, Argoff CE, Williams DA. Intrathecal Opioids for Chronic Pain: A Call for Evidence. PAIN MEDICINE 2012; 13:987-8. [DOI: 10.1111/j.1526-4637.2012.01456.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|