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Aoyagi K, Neogi T. Reply. Arthritis Care Res (Hoboken) 2024. [PMID: 38922766 DOI: 10.1002/acr.25384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
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Nunes JC, Costa GPA, Weleff J, Rogan M, Compton P, De Aquino JP. Assessing pain in persons with opioid use disorder: Approaches, techniques and special considerations. Br J Clin Pharmacol 2024. [PMID: 38556851 DOI: 10.1111/bcp.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/30/2024] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Pain and opioid use disorder (OUD) are inextricably linked, as the former can be a risk factor for the development of the latter, and over a third of persons with OUD suffer concomitant chronic pain. Assessing pain among people with OUD is challenging, because ongoing opioid use brings changes in pain responses and most pain assessment tools have not been validated for this population. In this narrative review, we discuss the fundamentals of pain assessment for populations with OUD. First, we describe the biological, psychological and social aspects of the pain experience among people with OUD, as well as how opioid-related phenomena may contribute to the pain experience in this population. We then review methods to assess pain, including (1) traditional self-reported methods, such visual analogue scales and structured questionnaires; (2) behavioural observations and physiological indicators; (3) and laboratory-based approaches, such as quantitative sensory testing. These methods are considered from a perspective that encompasses both pain and OUD. Finally, we discuss strategies for improving pain assessment in persons with OUD and implications for future research, including educational strategies for multidisciplinary teams. We highlight the substantial gaps that persist in this literature, particularly regarding the applicability of current pain assessment methods to persons with OUD, as well as the generalizability of the existing results from adjacent populations on chronic opioid therapy but without OUD. As research linking pain and OUD evolves, considering the needs of diverse populations with complex psychosocial backgrounds, clinicians will be better equipped to reduce these gaps.
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Affiliation(s)
- Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriel P A Costa
- Faculty of Medicine, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Rogan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Connecticut, USA
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Aoyagi K, Jafarzadeh SR, Carlesso L, Law LF, Lewis CE, Nevitt M, Neogi T. Mediating Effect of Pain Sensitization on the Paradoxical Relation of Taking Opioids to Pain Severity in Knee Osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2024; 76:403-408. [PMID: 37750238 PMCID: PMC10922135 DOI: 10.1002/acr.25244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE One of the less understood adverse effects while taking opioids is the paradoxical increase in pain, known as opioid-induced hyperalgesia (OIH). We sought to determine whether pain sensitization mediates the relation of taking an opioid to pain severity in people with knee osteoarthritis (OA). METHODS We included participants in a National Institutes of Health-funded cohort study of people with or at risk of knee OA. Participants were categorized into opioid and nonopioid analgesic groups at baseline. Western Ontario McMaster Universities OA Index (WOMAC) pain two years later was assessed as the outcome. We used causal mediation analysis to assess the mediating role of pain sensitization, quantified by changes in pressure pain threshold (PPT) at the wrist and patella over two years, on the effect of taking an opioid on WOMAC pain two years later. RESULTS We included 296 participants who took opioids and 1,070 participants who took nonopioid analgesics. Compared with taking nonopioid analgesics, taking opioids was associated with greater pain two years later. This relation was mediated by 0.05- and 0.08-unit changes in wrist PPT (95% confidence interval [CI] 0.01-0.10) and patellar PPT (95% CI 0.02-0.14), respectively. When we assessed any worsening in WOMAC pain score over two years, taking opioids, compared with taking nonopioid analgesics, had 2% and 5% higher odds of experiencing any worsening pain mediated by changes in wrist PPT (95% CI 0.99-1.04) and patellar PPT (95% CI 1.01-1.09), respectively. CONCLUSION Pain sensitization had small mediating effects on the paradoxical phenomenon of OIH, suggesting that pain sensitization may not play a major role and/or that PPT is an inadequate tool to assess OIH.
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Affiliation(s)
- Kosaku Aoyagi
- University of Texas at El Paso, El Paso, TX, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | | | | | | | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
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Alami K, Ghasemi E, Semnanian S, Azizi H. Adolescent morphine exposure changes the endogenous vlPAG opioid response to inflammatory pain in rats. Dev Psychobiol 2024; 66:e22447. [PMID: 38131239 DOI: 10.1002/dev.22447] [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: 05/26/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
Adolescence is one of the most critical periods for brain development, and exposure to morphine during this period can have long-life effects on pain-related behaviors. The opioid system in the periaqueductal gray (PAG) is highly vulnerable to drug exposure. However, the impact of adolescent morphine exposure (AME) on the endogenous opioid system in the PAG is currently unknown. This study aims to investigate the long-lasting effects of AME on the endogenous opioid system and its involvement in altering nociceptive behaviors. Adolescent rats were given escalating doses of morphine (2.5-25 mg/kg, subcutaneous) or an equal volume of saline twice daily for 10 consecutive days (PND 31-40). After a 30-day washout period, adult rats underwent formalin tests following microinjection of morphine, naloxone, or saline into the ventrolateral PAG (vlPAG) region. The results indicated that morphine microinjection into the vlPAG of the adolescent morphine-treated group significantly reduced the nociceptive score. However, the analgesic response to morphine in this group was significantly lower compared to the saline-treated group during adolescence. Additionally, the nociceptive score significantly increased following naloxone but not saline microinjection into the vlPAG of the saline-treated group during adolescence, rather than the morphine-treated one. These findings indicate that AME has long-lasting effects on the endogenous opioid system in the vlPAG, which can consequently alter behaviors related to inflammatory pain in adulthood.
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Affiliation(s)
- Kawsar Alami
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Elmira Ghasemi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saeed Semnanian
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hossein Azizi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Olsen CM, Glaeser BL, Szabo A, Raff H, Everson CA. The effects of sleep restriction during abstinence on oxycodone seeking: Sex-dependent moderating effects of behavioral and hypothalamic-pituitary-adrenal axis-related phenotypes. Physiol Behav 2023; 272:114372. [PMID: 37805135 PMCID: PMC10841994 DOI: 10.1016/j.physbeh.2023.114372] [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: 07/27/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
During opioid use and abstinence, sleep disturbances are common and are thought to exacerbate drug craving. In this study, we tested the hypothesis that sleep restriction during abstinence from oxycodone self-administration would increase drug seeking during extinction and footshock reinstatement tests. We also performed behavioral phenotyping to determine if individual variation in responses to stressors and/or pain are associated with oxycodone seeking during abstinence, as stress, pain and sleep disturbance are often co-occurring phenomena. Sleep restriction during abstinence did not have selective effects on oxycodone seeking for either sex in extinction and footshock reinstatement tests. Some phenotypes were associated with drug seeking; these associations differed by sex and type of drug seeking assessment. In female rats, pain-related phenotypes were related to high levels of drug seeking during the initial extinction session. In male rats, lower anxiety-like behavior in the open field was associated with greater drug seeking, although this effect was lost when correcting for oxycodone intake. Adrenal sensitivity prior to oxycodone exposure was positively associated with footshock reinstatement in females. This work identifies sex-dependent relationships between HPA axis function and opioid seeking, indicating that HPA axis function could be a therapeutic target for the treatment of opioid use disorder, with tailored approaches based on sex. Sleep disturbance during abstinence did not appear to be a major contributing factor to opioid seeking.
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Affiliation(s)
- Christopher M Olsen
- Departments of Pharmacology & Toxicology and Neurosurgery, Neuroscience Research Center, Medical College of Wisconsin, 8701 Watertown Plank, Milwaukee, WI 53226, USA.
| | - Breanna L Glaeser
- Department of Pharmacology & Toxicology and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hershel Raff
- Department of Medicine (Endocrinology and Molecular Medicine), Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA; Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, Milwaukee, WI, USA
| | - Carol A Everson
- Department of Medicine (Endocrinology and Molecular Medicine) and Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
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Jamison RN, Edwards RR, Brown R, Barrett BP, Burzinski CA, Lennon RP, Nakamura Y, Schiefelbein T, Garland EL, Zgierska AE. Risk Factors for Self-Harm Ideation Among Persons Treated With Opioids for Chronic Low Back Pain. Clin J Pain 2023; 39:643-653. [PMID: 37712325 PMCID: PMC10695275 DOI: 10.1097/ajp.0000000000001161] [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: 03/11/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Chronic pain is a significant health concern that adversely affects all aspects of life, including emotional well-being. Opioids are prescribed for the management of refractory, severe chronic pain, although they have been associated with adverse effects, including addiction and overdose. The aim of this study was to examine factors that predict thoughts of self-harm among adults with chronic pain who are prescribed opioids. MATERIALS AND METHODS Seven hundred sixty-five (N=765) persons with opioid-treated chronic lower back pain completed the Current Opioid Misuse Measure (COMM) and other validated questionnaires as part of a larger study. Response to 1 question from the COMM ("How often have you seriously thought about hurting yourself?") was used to assess suicide risk on a 5-point scale (0=never; 4=very often). RESULTS Participants were categorized into 3 groups according to their responses to the self-harm question: never (N=628; 82.1%), seldom or sometimes (N=74; 9.7%), and often or very often (N=63; 8.2%). Multivariate adjusted odds ratio (aOR) analyses indicated that reports of alcohol or drug overuse within the past month (aOR=1.41,[95% CI 1.11-1.78]), posttraumatic stress (PTSD; aOR=1.24,[1.07 to 1.44]), pain catastrophizing (aOR=1.03,[1.01 to 1.05]), not loving oneself (aOR=0.99,[.98-1.00]) and poor perceived mental health (aOR=0.94,[.92 to 97]) were most associated with thoughts of self-harm. Importantly, the ideation frequency of self-harm was highest among individuals treated with higher daily doses of opioids. DISCUSSION These results support the need for continued monitoring of adults treated with opioids for chronic pain, particularly among those on high-dose opioids who present with increased negative affect and concerns of substance misuse.
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Affiliation(s)
- Robert N. Jamison
- Harvard Medical School, Brigham and Women’s Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA 02467
| | - Robert R. Edwards
- Harvard Medical School, Brigham and Women’s Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA 02467
| | - Roger Brown
- University of Wisconsin-Madison, School of Medicine and Public Health, and University of Wisconsin-Madison, School of Nursing, 1100 Delaplaine Court, Madison, WI 53715
| | - Bruce P. Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, and University of Wisconsin-Madison, School of Nursing, 1100 Delaplaine Court, Madison, WI 53715
| | - Cindy A. Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, and University of Wisconsin-Madison, School of Nursing, 1100 Delaplaine Court, Madison, WI 53715
| | - Robert P. Lennon
- Pennsylvania State University College of Medicine, Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA 17033
| | - Yoshio Nakamura
- University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, 615 Arapeen Drive, Suite 200, Salt Lake City, UT 84108
| | - Tony Schiefelbein
- Pennsylvania State University College of Medicine, Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA 17033
| | - Eric L. Garland
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT 84112
| | - Aleksandra E. Zgierska
- Pennsylvania State University College of Medicine, Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA 17033
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Kuzu D, Valentine TR, Kratz AL. Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1176-1182. [PMID: 37243707 PMCID: PMC10546481 DOI: 10.1093/pm/pnad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms). DESIGN Micro-longitudinal design. SETTING/SUBJECTS Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia. METHODS Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days. RESULTS Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue. CONCLUSION Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.
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Affiliation(s)
- Duygu Kuzu
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Thomas R Valentine
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI 48109,United States
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Wolitzky-Taylor K, Mooney LJ, Otto MW, Metts A, Parsons EM, Hanano M, Ram R. Augmenting the efficacy of benzodiazepine taper with telehealth-delivered cognitive behavioral therapy for anxiety disorders in patients using prescription opioids: A pilot randomized controlled trial. Contemp Clin Trials 2023; 133:107334. [PMID: 37730196 PMCID: PMC10960249 DOI: 10.1016/j.cct.2023.107334] [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: 05/25/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
The risks of concomitant benzodiazepine (BZ) and opioid use are significant. Despite the urgent need to reduce BZ use among patients taking opioids, no treatment intervention research to our knowledge has addressed treatment for this concurrent, high-risk use. The current study will evaluate the efficacy of augmenting BZ taper procedures with CBT for anxiety disorders that has been adapted specifically for patients with concomitant BZ and opioid use (either use as prescribed or misuse), a high-risk patient population. Research combining rapidly scalable behavioral interventions ancillary to pharmacological approaches delivered via telehealth in primary care settings is innovative and important given concerning trends in rising prevalence of BZ/opioid co-prescription, BZ-associated overdose deaths, and known barriers to implementation of behavioral health interventions in primary care. CBT delivery using telehealth has the potential to aid adherence and promote access and dissemination of procedures in primary care. Lastly, the current study will utilize an experimental therapeutics approach to preliminarily explore the mechanism of action for the proposed interventions. The overall aim of the present pilot randomized controlled trial is to examine the feasibility and preliminary efficacy of a BZ taper with CBT for anxiety disorders adapted for patients with concomitant BZ (BZT + CBT) and opioid use to a BZ taper with a control health education program (BZT + HE) in a sample of individuals (N = 54) who have been prescribed and are taking benzodiazepines and opioids for at least 3 months prior to baseline and experience anxious distress. Screening and outcome measures, methods, and implications are described. Trial Registration: ClinicalTrials.gov (NCT05573906).
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Affiliation(s)
| | - Larissa J Mooney
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, USA
| | - Michael W Otto
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | | | - E Marie Parsons
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - Maria Hanano
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
| | - Reuben Ram
- UCLA Toluca Lake Clinic, Los Angeles, CA, USA
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Rigatti M, Chapman B, Chai PR, Smelson D, Babu K, Carreiro S. Digital Biomarker Applications Across the Spectrum of Opioid Use Disorder. COGENT MENTAL HEALTH 2023; 2:2240375. [PMID: 37546179 PMCID: PMC10399596 DOI: 10.1080/28324765.2023.2240375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Opioid use disorder (OUD) is one of the most pressing public health problems of the past decade, with over eighty thousand overdose related deaths in 2021 alone. Digital technologies to measure and respond to disease states encompass both on- and off-body sensors. Such devices can be used to detect and monitor end-user physiologic or behavioral measurements (i.e. digital biomarkers) that correlate with events of interest, health, or pathology. Recent work has demonstrated the potential of digital biomarkers to be used as a tools in the prevention, risk mitigation, and treatment of opioid use disorder (OUD). Multiple physiologic adaptations occur over the course of opioid use, and represent potential targets for digital biomarker based monitoring strategies. This review explores the current evidence (and potential) for digital biomarkers monitoring across the spectrum of opioid use. Technologies to detect opioid administration, withdrawal, hyperalgesia and overdose will be reviewed. Driven by empirically derived algorithms, these technologies have important implications for supporting the safe prescribing of opioids, reducing harm in active opioid users, and supporting those in recovery from OUD.
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Affiliation(s)
- Marc Rigatti
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Brittany Chapman
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Peter R Chai
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - David Smelson
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, USA
| | - Kavita Babu
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Stephanie Carreiro
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA, USA
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Li R, Holley AL, Palermo TM, Ohls O, Edwards RR, Rabbitts JA. Feasibility and reliability of a quantitative sensory testing protocol in youth with acute musculoskeletal pain postsurgery or postinjury. Pain 2023; 164:1627-1638. [PMID: 36727891 PMCID: PMC10277219 DOI: 10.1097/j.pain.0000000000002865] [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: 08/17/2022] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Quantitative sensory testing (QST) is increasingly used in pediatric chronic pain; however, assessment in youth with acute musculoskeletal (MSK) pain is limited. This study evaluated the feasibility, reliability, and sources of variability of a brief QST protocol in 2 clinical samples of youth with acute MSK pain. Participants were 277 youth (M age = 14.5 years, SD = 2.0, range = 11-18 years, 59% female, 81% non-Hispanic) across 3 geographic study sites who completed a QST protocol assessing pressure and thermal pain sensitivity, temporal summation of pain, and conditioned pain modulation 8 weeks after MSK surgery (n = 100) or within 4 weeks after an acute MSK injury (n = 177). High feasibility was demonstrated by protocol completion rates ranging from 97.5% to 100% for each task, with 95.3% of youth completing all tasks. Reliability was high, with reliability coefficients of >0.97 for 7 out of 8 QST parameters and minimal influence of examiner or participating site effects. Younger youth had lower pressure and heat pain thresholds (11-12 vs 13-18 years, d = -0.80 to -0.56) and cold pain tolerance (d = -0.33). Hispanic youth had higher pressure and heat pain thresholds (d = 0.37-0.45) and pain ratings for cold pain tolerance (d = 0.54) compared with non-Hispanic youth. No significant differences were observed in QST values by sex or personal contextual factors at the time of assessment (momentary pain, menstrual period, use of pain medications). Overall findings demonstrate feasibility of a brief QST protocol with youth with diverse acute MSK pain and data provide initial support for the reliability of this QST protocol for multisite research studies.
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Affiliation(s)
- Rui Li
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Amy L. Holley
- Division of Psychology, Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR, United States
| | - Tonya M. Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Olivia Ohls
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Massachusetts, United States
| | - Jennifer A. Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, United States
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11
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Wilson SC, Shaffer JA, Wachholtz AB. Distress Tolerance in the Comorbid Chronic Pain and Opioid Use Disorder Population. J Addict Med 2023; 17:e164-e171. [PMID: 37267174 PMCID: PMC10148917 DOI: 10.1097/adm.0000000000001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The risk of opioid addiction among people with chronic pain is elevated in those using opioids to self-medicate physical or emotional pain or distress. The purpose of this study is to test the main effect of distress tolerance (DT) on opioid use disorder (OUD) status in people with chronic pain, and the potential moderating effect of DT in the relationship between known addiction risk factors and the development of OUD. METHODS One hundred twenty people with chronic pain were recruited to 1 of 3 groups according to their opioid use status (ie, current methadone or buprenorphine/naloxone for OUD [n = 60], history of OUD but current prolonged opioid abstinence [n = 30, mean abstinence = 121 weeks, SD = 23.3], and opioid naive [n = 30]). Participants completed self-report measures and a cold pressor task. Multinomial logistic regression analyses were used to test if DT associated with OUD status in people with chronic pain and to compare DT to other known indicators of OUD risk. Multinomial linear regression analyses were used to test the moderation effects of DT on the relationship between various risk factors and OUD in people with chronic pain. RESULTS Analyses revealed that DT was significantly related to OUD status but did not moderate the effects of most OUD risk factors. CONCLUSIONS These results suggest that decreasing distress (eg, pain levels, craving responses, etc) may be more effective than improving tolerance to distress for the comorbid chronic pain and OUD population.
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Affiliation(s)
- Sarah C Wilson
- From the Department of Psychology, University of Colorado Denver, Denver, CO (SCW, JAS, ABW); Division of Addiction and Psychiatry, University of Colorado Medical School, Aurora, CO (ABW); and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA (ABW)
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12
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Chang WJ, Jenkins LC, Humburg P, Schabrun SM. Human assumed central sensitization in people with acute non-specific low back pain: A cross-sectional study of the association with brain-derived neurotrophic factor, clinical, psychological and demographic factors. Eur J Pain 2023; 27:530-545. [PMID: 36585941 DOI: 10.1002/ejp.2078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Early evidence suggests human assumed central sensitization (HACS) is present in some people with acute low back pain (LBP). Factors influencing individual variation in HACS during acute LBP have not been fully explored. We aimed to examine the evidence for HACS in acute LBP and the contribution of brain-derived neurotrophic factor (BDNF), clinical, psychological and demographic factors to HACS. METHODS Participants with acute LBP (<6 weeks after pain onset, N = 118) and pain-free controls (N = 57) from a longitudinal trial were included. Quantitative sensory testing including pressure and heat pain thresholds and conditioned pain modulation, BDNF serum concentration and genotype and questionnaires were assessed. RESULTS There were no signs of HACS during acute LBP at group level when compared with controls. Sensory measures did not differ when compared between controls and LBP participants with different BDNF genotypes. Two LBP subgroups with distinct sensory profiles were identified. Although one subgroup (N = 60) demonstrated features of HACS including pressure/heat pain hypersensitivity at a remote site and deficient conditioned pain modulation, pain severity and disability did not differ between the two subgroups. Variation in sensory measures (~33%) was partially explained by BDNF genotype, sex, age and psychological factors. CONCLUSIONS This study confirms that HACS is present in some people with acute LBP, but this was not associated with pain or disability. Further, no relationship was observed between BDNF and HACS in acute LBP. More research is needed to understand factors contributing to individual variation in sensory measures in LBP. SIGNIFICANCE Human assumed central sensitization (HACS) is present in acute low back pain (LBP) but factors contributing to individual variation are not fully explored. This study investigated the relationship between factors such as brain derived neurotrophic factor (BDNF) and HACS in acute LBP. Our findings indicate that HACS was present in specific LBP subgroups but BDNF was unrelated to HACS. Combinations of BDNF genotype, demographic and psychological factors explained a small proportion of the variation in sensory measures during acute LBP.
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Affiliation(s)
- Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke C Jenkins
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Humburg
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, New South Wales, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Mindfulness-Oriented Recovery Enhancement for Addictive Behavior, Psychiatric Distress, and Chronic Pain: A Multilevel Meta-Analysis of Randomized Controlled Trials. Mindfulness (N Y) 2022; 13:2396-2412. [PMID: 36124231 PMCID: PMC9476401 DOI: 10.1007/s12671-022-01964-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
Objectives Methods Results Conclusions Meta-analysis Pre-registration: PROSPERO #CRD42022319006 Supplementary Information
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Meints SM, Garcia RG, Schuman-Olivier Z, Datko M, Desbordes G, Cornelius M, Edwards RR, Napadow V. The Effects of Combined Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation and Mindfulness Meditation for Chronic Low Back Pain: A Pilot Study. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1570-1581. [PMID: 35148407 PMCID: PMC9434172 DOI: 10.1093/pm/pnac025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain. DESIGN Pilot feasibility and acceptability study. SETTING Pain management center at large academic medical center. SUBJECTS Nineteen adults with CLBP and previous MM training. METHODS Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST. RESULTS MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham. CONCLUSIONS Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Ronald G Garcia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael Datko
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Gaelle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Marise Cornelius
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Vitaly Napadow
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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15
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ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Scoping Review of Psychological and Psychosocial Constructs and Outcome Measures Reported in Tendinopathy Clinical Trials. J Orthop Sports Phys Ther 2022; 52:375-388. [PMID: 35647878 DOI: 10.2519/jospt.2022.11005] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research. DESIGN Scoping review. LITERATURE SEARCH We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors. STUDY SELECTION Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation. DATA SYNTHESIS We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field. RESULTS Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were work-related outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct. CONCLUSION There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. J Orthop Sports Phys Ther 2022;52(6):375-388. doi:10.2519/jospt.2022.11005.
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Parisi A, Landicho HL, Hudak J, Leknes S, Froeliger B, Garland EL. Emotional distress and pain catastrophizing predict cue-elicited opioid craving among chronic pain patients on long-term opioid therapy. Drug Alcohol Depend 2022; 233:109361. [PMID: 35278786 PMCID: PMC9466292 DOI: 10.1016/j.drugalcdep.2022.109361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status. MATERIALS AND METHODS Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively. RESULTS Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing. CONCLUSIONS Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone.
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Affiliation(s)
- Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Hannah Louise Landicho
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Justin Hudak
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Siri Leknes
- Department of Psychology, University of Oslo, USA
| | - Brett Froeliger
- Department of Psychiatry; Department of Psychological Sciences, University of Missouri, USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
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Ortego G, Lluch E, Herrero P, Boudreau SA, Doménech-García V. Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study. J Clin Med 2022; 11:jcm11051346. [PMID: 35268437 PMCID: PMC8911229 DOI: 10.3390/jcm11051346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls. METHODS A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls. RESULTS After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found. DISCUSSION Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP.
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Affiliation(s)
- Gorka Ortego
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain; (G.O.); (V.D.-G.)
| | - Enrique Lluch
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Physiotherapy in Motion, Multi-Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Brussels “Pain in Motion” International Research Group, Departments of Human Physiology and Rehabilitation Sciences, Vrije Universiteit Brussels, 1050 Ixelles, Belgium
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-646168248
| | - Shellie Ann Boudreau
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
| | - Victor Doménech-García
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain; (G.O.); (V.D.-G.)
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Jamison RN, Edwards RR, Curran S, Wan L, Ross EL, Gilligan CJ, Gozani SN. Effects of Wearable Transcutaneous Electrical Nerve Stimulation on Fibromyalgia: A Randomized Controlled Trial. J Pain Res 2021; 14:2265-2282. [PMID: 34335055 PMCID: PMC8318714 DOI: 10.2147/jpr.s316371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Fibromyalgia is a chronic condition characterized by widespread pain and interference with daily activities. The aim of this study is to assess the benefit of transcutaneous electrical nerve stimulation (TENS) for persons diagnosed with fibromyalgia. Patients and Methods Adults meeting diagnostic criteria for fibromyalgia were randomized in a double-blind trial to receive either an active (n=62) or sham (n=57) wearable TENS device for 3-months. Subjects were classified as having lower or higher pain sensitivity by Quantitative Sensory Testing (QST). Patient Global Impression of Change (PGIC, primary outcome) and secondary efficacy measures including Fibromyalgia Impact Questionnaire (FIQR), Brief Pain Inventory (BPI) and painDETECT questionnaire (PDQ) were assessed at baseline, 6-weeks and 3-months. Treatment effects were determined by a mixed model for repeated measures (MMRM) analysis of the intention-to-treat (ITT) population (N=119). A pre-specified subgroup analysis of pain sensitivity was conducted using an interaction term in the model. Results No differences were found between active and sham treatment on PGIC scores at 3-months (0.34, 95% CI [−0.37, 1.04], p=0.351) in the ITT population. However, in subjects with higher pain sensitivity (n=60), PGIC was significantly greater for active treatment compared to sham (1.19, 95% CI [0.24, 2.13], p=0.014). FIQR total score (−7.47, 95% CI [−12.46, −2.48], p=0.003), FIQR pain item (−0.62, 95% CI [−1.17, −0.06], p=0.029), BPI Interference (−0.70, 95% CI [−1.30, −0.11], p=0.021) and PDQ (−1.69, 95% CI [−3.20, −0.18], p=0.028) exhibited significant improvements for active treatment compared to sham in the ITT population. Analgesics use was stable and comparable in both groups. Conclusion This study demonstrated modest treatment effects of reduced disease impact, pain and functional impairment from wearable TENS in individuals with fibromyalgia. Subjects with higher pain sensitivity exhibited larger treatment effects than those with lower pain sensitivity. Wearable TENS may be a safe treatment option for people with fibromyalgia. Clinicaltrials.gov Registration NCT03714425.
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Affiliation(s)
- Robert N Jamison
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Samantha Curran
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Limeng Wan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
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Associations Among Sleep Disturbance, Pain Catastrophizing, and Pain Intensity for Methadone-maintained Patients With Opioid Use Disorder and Chronic Pain. Clin J Pain 2021; 36:641-647. [PMID: 32482968 DOI: 10.1097/ajp.0000000000000848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study examined the cross-sectional associations among pain intensity, pain catastrophizing, and sleep disturbance among patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD) and reporting co-occurring chronic pain. MATERIALS AND METHODS Participants were 89 individuals with OUD and chronic pain drawn from a larger cross-sectional study of 164 MMT patients who completed a battery of self-report measures. The authors conducted 6 mediation models to test all possible pathways (ie, each variable tested as an independent variable, mediator, or dependent variable). RESULTS The only significant mediation effect was an indirect effect of sleep disturbance on pain intensity through pain catastrophizing. That is, greater sleep disturbance was associated with greater pain catastrophizing, which in turn was associated with greater pain intensity. DISCUSSION Altogether, findings suggest that the sleep disturbance to pain catastrophizing to pain intensity pathway may be a key mechanistic pathway exacerbating pain issues among MMT patients with OUD and chronic pain. These results suggest that interventions targeting sleep disturbance may be warranted among MMT patients with OUD and chronic pain. Future work in this area with longitudinal data is warranted.
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20
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Compton PA, Wasser TE, Cheatle MD. Increased Experimental Pain Sensitivity in Chronic Pain Patients Who Developed Opioid Use Disorder. Clin J Pain 2021; 36:667-674. [PMID: 32520815 DOI: 10.1097/ajp.0000000000000855] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although the great majority of individuals who take opioids for chronic pain use them appropriately and to good effect, a certain minority will develop the problematic outcome of opioid use disorder (OUD). Characteristics associated with the development of OUD in individuals with chronic pain have been described; however, relatively unexplored is how sensitivity to pain is associated with OUD outcomes. MATERIALS AND METHODS We examined for differences in response to static and dynamic experimental pain stimuli between individuals with chronic nonmalignant pain who developed OUD after starting opioid therapy (n=20) and those on opioid therapy who did not (n=20). During a single experimental session, participants underwent cold pressor and quantitative sensory testing pain assays, and objective and subjective responses were compared between groups; the role of pain catastrophizing in mediating pain responses was examined. RESULTS Results suggested that both groups of opioid-dependent patients were similarly hyperalgesic to the cold pressor pain stimulus, with nonparametric testing revealing worsened central pain sensitization (temporal summation) in those who developed OUD. Significant group differences were evident on subjective ratings of experimental pain, such that those who developed OUD rated the pain as more severe than those who did not. Pain catastrophizing was unrelated to pain responses. DISCUSSION Despite the small sample size and cross-sectional design, these findings suggest that experimental pain testing may be a novel technique in identifying patients with chronic pain likely to develop OUD, in that they are likely to evidence exacerbated temporal summation and to rate the associated pain as more severe.
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Affiliation(s)
- Peggy A Compton
- Department of Family and Community Health, School of Nursing
| | | | - Martin D Cheatle
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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21
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Zvolensky MJ, Rogers AH, Garey L, Shepherd JM, Ditre JW. Opioid Misuse among Smokers with Chronic Pain: Relations with Substance Use and Mental Health. Behav Med 2021; 47:335-343. [PMID: 34719341 DOI: 10.1080/08964289.2020.1742642] [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] [Indexed: 10/24/2022]
Abstract
Opioid misuse is a significant public health concern with substantial medical, social, and economic costs. Cross cutting the personal and societal effects of this current crisis, opioid misuse is associated with poorer physical and mental health outcomes that impair function across numerous life domains. Importantly, opioid misuse disproportionately affects persons with chronic pain and individuals who smoke tobacco. Despite the higher risk for smokers with chronic pain to engage in opioid misuse, little work has examined how opioid misuse may be related to mental health problems, including other substance use, among this vulnerable group. The current study examined opioid misuse as a predictor of substance use and mental health problems among 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily cigarette smokers with chronic pain who currently use opioids. Results indicated that opioid misuse is associated with greater tobacco (13% of variance), alcohol (27% of variance), and cannabis (22% of variance) problems, as well as anxiety (26% of variance) and depressive symptoms (26% of variance). These results highlight the potential importance of opioid misuse in terms of concurrent substance and mental health problems among smokers with chronic pain. Future work is needed to explicate directionality and temporal ordering in the observed relations.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Justin M Shepherd
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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22
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Jamison RN, Curran S, Wan L, Ross EL, Gilligan CJ, Edwards RR. Higher Pain Sensitivity Predicts Efficacy of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Persons With Fibromyalgia: A Randomized Double-Blind Sham-Controlled Trial. Neuromodulation 2021; 25:1410-1420. [PMID: 34056781 DOI: 10.1111/ner.13463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated the efficacy of a transcutaneous electrical nerve stimulation (TENS) device (Quell®) for persons with symptoms due to fibromyalgia (FM). MATERIALS AND METHODS One hundred nineteen (N = 119) subjects were randomly assigned to use an active (N = 62) or sham (N = 57) TENS for three months. All subjects completed baseline questionnaires and were administered quantitative sensory testing (QST). Subjects completed the Patients' Global Impression of Change (PGIC, primary outcome measure) and other mailed questionnaires (secondary outcome measures) at six weeks and three months. RESULTS The subjects averaged 50.4 ± 13.5 years of age, 93.3% were female, and 79.8% were Caucasian. Most showed benefit from using the TENS, but no differences between groups were found on the primary outcome measure after three months (active 3.87 ± 1.85, sham 3.73 ± 1.80, 95% confidence interval [CI] [-0.60, 0.88], p = 0.707). Those with more hypersensitivity showed most improvement on the PGIC at six weeks (0.22, 95% CI [0.01, 0.43], p = 0.042) and three months (0.20, 95% CI [0.00, 0.41], p = 0.049) and among those with higher sensitivity based on QST, the active TENS group showed the most benefit with TENS compared with the sham treatment (1.20, 95% CI [0.22, 2.18], p = 0.017). No TENS-related serious adverse events were reported. Subjects in the sham group correctly identified their treatment 87.5% of the time, while, surprisingly, subjects in the active group correctly identified their treatment only 17.4% of the time. CONCLUSION This study found no differences between those who were exposed to maximal-frequency active stimulation or minimal-frequency sham stimulation from a wearable TENS in reducing FM-related symptoms. However, those with greater hypersensitivity showed most benefit from TENS. Additional studies to help determine the role individual differences play in the use of TENS in managing FM-related symptoms are needed.
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Affiliation(s)
- Robert N Jamison
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Samantha Curran
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Limeng Wan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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Jiang S, Xia R, Yan L, Bai J. Successful Reversal of Opioid-Induced Hyperalgesia and Allodynia with Duloxetine. PAIN MEDICINE 2021; 22:1010-1012. [PMID: 32594130 DOI: 10.1093/pm/pnaa184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shuang Jiang
- Department of Internal Medicine (Psychology Clinic), Cancer Hospital of China Medical University, Shenyang, Liaoning Province, P R China
| | - Rong Xia
- Department of Internal Medicine (Psychology Clinic), Cancer Hospital of China Medical University, Shenyang, Liaoning Province, P R China
| | - Lihui Yan
- Department of Internal Medicine (Pain Clinic), Cancer Hospital of China Medical University, Shenyang, Liaoning Province, P R China
| | - Jinghui Bai
- Department of Internal Medicine (VIP Ward), Cancer Hospital of China Medical University, Shenyang, Liaoning Province, P R China
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Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions. Pain 2021; 161:2659-2666. [PMID: 33197164 DOI: 10.1097/j.pain.0000000000001988] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pain Acceptance Creates an Emotional Context That Protects against the Misuse of Prescription Opioids: A Study in a Sample of Patients with Chronic Noncancer Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063054. [PMID: 33809628 PMCID: PMC8002364 DOI: 10.3390/ijerph18063054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 02/05/2023]
Abstract
There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical model in which pain acceptance would regulate pain sensations and pain-related thoughts and emotions, which would be related to opioid misuse. The sample comprised 140 chronic pain patients attending two hospitals. All patients were receiving pharmacological treatment, including opioid analgesics. Structural equation modelling analyses showed a significant association between higher pain acceptance and lower pain intensity and catastrophizing, and lower levels of anxiety and depression. Only higher anxiety and depression were significantly associated with increased opioid misuse. The results suggest that levels of anxiety, depression, and pain acceptance must be assessed before opioids are prescribed. Pain acceptance implies a relationship with internal events that protects against anxiety and depression and thus against opioid misuse. Acceptance and Commitment Therapy appears to be particularly appropriate for these patients.
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain Catastrophizing, Opioid Misuse, Opioid Use, and Opioid Dose in People With Chronic Musculoskeletal Pain: A Systematic Review. THE JOURNAL OF PAIN 2021; 22:879-891. [PMID: 33581324 DOI: 10.1016/j.jpain.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 02/07/2021] [Indexed: 12/20/2022]
Abstract
The objective of this study was to analyze the cross-sectional and longitudinal association between pain catastrophizing and opioid misuse, opioid use, and opioid dose in people with chronic musculoskeletal pain. For this systematic review, CINAHL, Embase, PsycINFO, PubMed, manual searches, and grey literature were searched from inception to May 2020. Observational studies were included if they evaluated the association between pain catastrophizing and opioid dose, opioid use, and/or opioid misuse in people with chronic musculoskeletal pain. Two reviewers independently performed the study selection, data extraction, risk of bias assessment, and the certainty of the evidence judgment. Seven observational studies (all cross-sectional designs) satisfied the eligibility criteria, with a total sample of 2,160 participants. Pain catastrophizing was associated with opioid misuse. The results were inconsistent regarding the association between pain catastrophizing and opioid use. A lack of association was found considering pain catastrophizing and the opioid dose. However, the presence of risk of bias and imprecision was serious across the included studies, and therefore, the overall certainty of the evidence was judged as very low for all the outcome measures. This report concludes that pain catastrophizing seem to be associated with opioid misuse in people with chronic musculoskeletal pain. However, the very low certainty of the current evidence confers to interpret the finding of this review as exclusively informative. PERSPECTIVE: This article shows that pain catastrophizing seem to be associated with opioid misuse in people with chronic musculoskeletal pain. The overall certainty of the evidence was judged to be very low, thus, these results should be interpreted with caution.
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Affiliation(s)
| | - Mar Flores-Cortes
- Physiotherapy Department, Faculty of Health Sciences, University of Malaga, Malaga, Spain.
| | - Jose Miguel Morales-Asencio
- IBIMA, Institute of Biomedical Research of Malaga, Malaga, Spain; Nursing Department, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Alejandro Luque-Suarez
- Physiotherapy Department, Faculty of Health Sciences, University of Malaga, Malaga, Spain; IBIMA, Institute of Biomedical Research of Malaga, Malaga, Spain
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Rieb LM, DeBeck K, Hayashi K, Wood E, Nosova E, Milloy MJ. Withdrawal-associated injury site pain prevalence and correlates among opioid-using people who inject drugs in Vancouver, Canada. Drug Alcohol Depend 2020; 216:108242. [PMID: 32861135 PMCID: PMC7850369 DOI: 10.1016/j.drugalcdep.2020.108242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pain can return temporarily to old injury sites during opioid withdrawal. The prevalence and impact of opioid withdrawal-associated injury site pain (WISP) in various groups is unknown. METHODS Using data from observational cohorts, we estimated the prevalence and correlates of WISP among opioid-using people who inject drugs (PWID). Between June and December 2015, data on WISP and opioid use behaviours were elicited from participants in three ongoing prospective cohort studies in Vancouver, Canada, who were aged 18 years and older and who self-reported at least daily injection of heroin or non-medical presciption opioids. RESULTS Among 631 individuals, 276 (43.7 %) had a healed injury (usually pain-free), among whom 112 (40.6 %) experienced WISP, representing 17.7 % of opioid-using PWID interviewed. In a multivariable logistic regression model, WISP was positively associated with having a high school diploma or above (Adjusted Odds Ratio [AOR] = 2.23, 95 % Confidence Interval [CI]: 1.31-3.84), any heroin use in the last six months (AOR = 2.00, 95 % CI: 1.14-3.57), feeling daily pain that required medication (AOR = 2.06, CI: 1.18-3.63), and negatively associated with older age at first drug use (AOR = 0.96, 95 % CI: 0.93-0.99). Among 112 individuals with WISP, 79 (70.5 %) said that having this pain affected their opioid use behaviour, of whom 57 (72.2 %) used more opioids, 19 (24.1 %) avoided opioid withdrawal, while 3 (3.8 %) no longer used opioids to avoid WISP. CONCLUSIONS WISP is prevalent among PWID with a previous injury, and may alter opioid use patterns. Improved care strategies for WISP are warrented.
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Affiliation(s)
- Launette Marie Rieb
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, Canada
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Office 3269, Vancouver, British Columbia, Canada,British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, British Columbia, Canada,Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, Burnaby, British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, British Columbia, Canada,Department of Medicine, University of British Columbia, 2775 Laurel Street, 10thFloor, Vancouver, British Columbia, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, 10thFloor, Vancouver, British Columbia, Canada.
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Mannes ZL, Dunne EM, Ferguson EG, Cottler LB, Ennis N. History of opioid use as a risk factor for current use and mental health consequences among retired National Football League athletes: A 9-year follow-up investigation. Drug Alcohol Depend 2020; 215:108251. [PMID: 32916451 PMCID: PMC7590231 DOI: 10.1016/j.drugalcdep.2020.108251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many retired National Football League (NFL) athletes manage pain with opioids during their playing careers and in retirement, though the longitudinal association between opioid use and health outcomes pertinent to an NFL career are not yet known. This study aimed to assess the relationship between opioid use in 2010 and current use, depressive symptoms, and health related quality of life (HRQoL) among NFL retirees. METHODS Former NFL athletes from the Retired NFL Players Association initially recruited in 2010 for a study examining risk factors of opioid use and misuse were re-contacted (N = 89) from 2018 to 2019 and administered measures of pain, opioid use, depressive symptoms, and HRQoL. Binomial regression examined the association between 2010 opioid use with current use, moderate-severe depressive symptoms, and average and above HRQoL (physical and mental) while controlling for covariates. RESULTS Nearly 50 % of retirees using opioids in 2010 currently used. Compared to non-users, retirees who used opioids in 2010 had greater odds of current use (AOR: 3.71, 95 % CI: 1.02-13.56, p = 0.046) and experiencing moderate-severe depressive symptoms (AOR: 5.93, 95 % CI: 1.15-30.54, p = 0.033). Retirees reporting use in 2010 also evidenced lower odds of reporting average or above mental HRQoL (AOR: 0.13, 95 % CI: 0.03-0.67, p = 0.015) compared to non-users. CONCLUSIONS This study showed that among NFL retirees, early retirement opioid use predicted current use and deleterious effects on mental health, including moderate-severe depressive symptoms approximately nine years later. This investigation further supports the importance of early intervention of pain and opioid use among this population.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States.
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building West, Suite 309, 164 Summit Ave, Providence, RI, 02906, United States; Alpert Medical School, Brown University, Providence, RI, 02906, United States
| | - Erin G Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, United States
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, 32310, United States
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Meints SM, Edwards RR, Gilligan C, Schreiber KL. Behavioral, Psychological, Neurophysiological, and Neuroanatomic Determinants of Pain. J Bone Joint Surg Am 2020; 102 Suppl 1:21-27. [PMID: 32251127 PMCID: PMC8272523 DOI: 10.2106/jbjs.20.00082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samantha M. Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Gilligan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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As-Sanie S, Soliman AM, Evans K, Erpelding N, Lanier R, Katz NP. Healthcare utilization and cost burden among women with endometriosis by opioid prescription status in the first year after diagnosis: a retrospective claims database analysis. J Med Econ 2020; 23:371-377. [PMID: 31856613 DOI: 10.1080/13696998.2019.1707212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: Opioids do not represent standard therapy for endometriosis; however, women with endometriosis are frequently prescribed an opioid to manage related abdominal or pelvic pain. The aim of this study was to evaluate the impact of opioid use on endometriosis-related economic and healthcare burden in the United States.Materials and methods: We performed a retrospective, propensity-matched cohort analysis of the Truven MarketScan Commercial database from 1 January 2011 to 31 December 2016. Eligible women had at least 1 inpatient or 2 outpatient codes for endometriosis and 12 months of continuous enrollment before and after the index date (i.e. first recorded endometriosis diagnosis). The primary analysis examined healthcare costs and utilization for 12 months after the index date in women who filled at least 1 opioid prescription versus those who did not. The secondary analysis examined healthcare costs and utilization by the pattern of opioid use.Results: The primary analysis matched 43,516 women across 2 groups and the secondary analysis matched 13,230 women across 5 groups. In the primary analysis, total 12-month healthcare costs were significantly higher in the opioid group compared to the non-opioid group ($29,236.00 vs. $18,466.00, respectively; p < .001); the same pattern was observed for all healthcare utilization parameters. In the secondary analysis, higher morphine equivalent daily dose and proportion of days covered were associated with the highest healthcare costs and utilization compared to the non-opioid group.Limitations: Retrospective design and inability to confirm whether filled opioid prescriptions were actually taken.Conclusions: Filling an opioid prescription within 1 year after an endometriosis diagnosis was associated with significant excess healthcare burden. Patients prescribed an opioid may experience inadequate symptom management and benefit from the use of disease-specific, non-opioid therapies.
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Affiliation(s)
- S As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | | | - K Evans
- WCG Analgesic Solutions, Wayland, MA, USA
| | | | - R Lanier
- Canopy Growth Corporation, Smith Falls, ON, Canada
| | - N P Katz
- WCG Analgesic Solutions, Wayland, MA, USA
- Department of Anesthesiology, Tufts University School of Medicine, Boston, MA, USA
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McConnell PA, Garland EL, Zubieta J, Newman‐Norlund R, Powers S, Froeliger B. Impaired frontostriatal functional connectivity among chronic opioid using pain patients is associated with dysregulated affect. Addict Biol 2020; 25:e12743. [PMID: 30945801 DOI: 10.1111/adb.12743] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/21/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
Preclinical studies have shown effects of chronic exposure to addictive drugs on glutamatergic-mediated neuroplasticity in frontostriatal circuitry. These initial findings have been paralleled by human functional magnetic resonance imaging (fMRI) research demonstrating weaker frontostriatal resting-state functional connectivity (rsFC) among individuals with psychostimulant use disorders. However, there is a dearth of human imaging literature describing associations between long-term prescription opioid use, frontostriatal rsFC, and brain morphology among chronic pain patients. We hypothesized that prescription opioid users with chronic pain, as compared with healthy control subjects, would evidence weaker frontostriatal rsFC coupled with less frontostriatal gray matter volume (GMV). Further, those opioid use-related deficits in frontostriatal circuitry would be associated with negative affect and drug misuse. Prescription opioid users with chronic pain (n = 31) and drug-free healthy controls (n = 30) underwent a high-resolution anatomical and an eyes-closed resting-state functional scan. The opioid group, relative to controls, exhibited weaker frontostriatal rsFC, and less frontostriatal GMV in both L.NAc and L.vmPFC. Frontostriatal rsFC partially mediated group differences in negative affect. Within opioid users, L.NAc GMV predicted opioid misuse severity. The current study revealed that prescription opioid use in the context of chronic pain is associated with functional and structural abnormalities in frontostriatal circuitry. These results suggest that opioid use-related abnormalities in frontostriatal circuitry may undergird disturbances in affect that may contribute to the ongoing maintenance of opioid use and misuse. These findings warrant further examination of interventions to treat opioid pathophysiology in frontostriatal circuitry over the course of treatment.
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Affiliation(s)
- Patrick A. McConnell
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention DevelopmentUniversity of Utah Salt Lake City Utah USA
- College of Social WorkUniversity of Utah Salt Lake City Utah USA
| | - Jon‐Kar Zubieta
- Department of PsychiatryUniversity of Utah Salt Lake City Utah USA
- University Neuropsychiatric InstituteUniversity of Utah Salt Lake City Utah USA
| | - Roger Newman‐Norlund
- Department of PsychologyUniversity of South Carolina Columbia South Carolina USA
| | - Shannon Powers
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
| | - Brett Froeliger
- Department of NeuroscienceMedical University of South Carolina Charleston South Carolina USA
- Hollings Cancer CenterMedical University of South Carolina Charleston South Carolina USA
- Center for Biomedical ImagingMedical University of South Carolina Charleston South Carolina USA
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32
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Price-Haywood EG, Burton J, Burstain T, Harden-Barrios J, Lefante J, Shi L, Jamison RN, Bazzano A, Bazzano L. Clinical Effectiveness of Decision Support for Prescribing Opioids for Chronic Noncancer Pain: A Prospective Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:157-163. [PMID: 32113620 PMCID: PMC7061936 DOI: 10.1016/j.jval.2019.09.2748] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVES This prospective cohort study examines the clinical effectiveness of electronic medical record clinical decision support (EMR CDS) for opioid prescribing. METHODS Data analysis included primary care patients with chronic opioid therapy for noncancer pain seen within an integrated health delivery system in Louisiana between January 2017 and October 2018. EMR CDS incorporated an opioid health maintenance tool to display the status of risk mitigation, and the medication order embedded the morphine equivalent daily dose (MEDD) calculator and a hyperlink to the Louisiana pharmacy drug monitoring program. Outcome measures included change in the average MEDD and rates of opioid risk mitigation, hospitalization, and emergency department use. RESULTS Among 14 221 patients, 9% had prescriptions with an average MEDD ≥90 mg. There were no significant changes in MEDD after EMR CDS implementation. Increasing age, Charlson Comorbidity Index score, female sex, black non-Hispanic race, non-opioid pain medication co-prescriptions, and specialty referrals were associated with a lower odds of MEDD ≥90 (high-dose threshold). Medicare or self-pay, substance abuse history, and pain agreements were associated with increased odds of prescribing above this high-dose threshold. After incorporation of EMR CDS, patients had higher rates of urine drug screens (17% vs 7%) and naloxone prescriptions (3% vs 1%, all P < .001). In addition, specialty referrals to physical or occupational therapy, orthopedics, neurology, and psychiatry or psychology increased in the postintervention period. Although emergency department use decreased (rate ratio 0.92; 95% confidence interval 0.89-0.95), hospitalization rates did not change. CONCLUSIONS EMR CDS improved adherence to opioid risk mitigation strategies. Further research examining which practice redesign interventions effectively reduce high-dose opioid prescribing is needed.
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Affiliation(s)
- Eboni G Price-Haywood
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA; Ochsner Clinical School, University of Queensland, New Orleans, LA, USA.
| | - Jeffrey Burton
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA
| | - Todd Burstain
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA
| | - Jewel Harden-Barrios
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA
| | - John Lefante
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lizheng Shi
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Robert N Jamison
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandra Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lydia Bazzano
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, LA, USA; Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Morasco BJ, Smith N, Dobscha SK, Deyo RA, Hyde S, Yarborough BJH. Outcomes of prescription opioid dose escalation for chronic pain: results from a prospective cohort study. Pain 2020; 161:1332-1340. [DOI: 10.1097/j.pain.0000000000001817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Are Signs of Central Sensitization in Acute Low Back Pain a Precursor to Poor Outcome? THE JOURNAL OF PAIN 2019; 20:994-1009. [DOI: 10.1016/j.jpain.2019.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/13/2019] [Accepted: 03/02/2019] [Indexed: 12/20/2022]
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Tu Y, Zhang B, Cao J, Wilson G, Zhang Z, Kong J. Identifying inter-individual differences in pain threshold using brain connectome: a test-retest reproducible study. Neuroimage 2019; 202:116049. [PMID: 31349067 DOI: 10.1016/j.neuroimage.2019.116049] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/23/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
Individuals are unique in terms of brain and behavior. Some are very sensitive to pain, while others have a high tolerance. However, how inter-individual intrinsic differences in the brain are related to pain is unknown. Here, we performed longitudinal test-retest analyses to investigate pain threshold variability among individuals using a resting-state fMRI brain connectome. Twenty-four healthy subjects who received four MRI sessions separated by at least 7 days were included in the data analysis. Subjects' pain thresholds were measured using two modalities of experimental pain (heat and pressure) on two different locations (heat pain: leg and arm; pressure pain: leg and thumbnail). Behavioral results showed strong inter-individual variability and strong within-individual stability in pain threshold. Resting state fMRI data analyses showed that functional connectivity profiles can accurately identify subjects across four sessions, indicating that an individual's connectivity profile may be intrinsic and unique. By using multivariate pattern analyses, we found that connectivity profiles could be used to predict an individual's pain threshold at both within-session and between-session levels, with the most predictive contribution from medial-frontal and frontal-parietal networks. These results demonstrate the potential of using a resting-state fMRI brain connectome to build a 'neural trait' for characterizing an individual's pain-related behavior, and such a 'neural trait' may eventually be used to personalize clinical assessments.
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Affiliation(s)
- Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Binlong Zhang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jin Cao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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In Vitro Nociceptor Neuroplasticity Associated with In Vivo Opioid-Induced Hyperalgesia. J Neurosci 2019; 39:7061-7073. [PMID: 31300521 DOI: 10.1523/jneurosci.1191-19.2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 11/21/2022] Open
Abstract
Opioid-induced hyperalgesia (OIH) is a serious adverse event produced by opioid analgesics. Lack of an in vitro model has hindered study of its underlying mechanisms. Recent evidence has implicated a role of nociceptors in OIH. To investigate the cellular and molecular mechanisms of OIH in nociceptors, in vitro, subcutaneous administration of an analgesic dose of fentanyl (30 μg/kg, s.c.) was performed in vivo in male rats. Two days later, when fentanyl was administered intradermally (1 μg, i.d.), in the vicinity of peripheral nociceptor terminals, it produced mechanical hyperalgesia (OIH). Additionally, 2 d after systemic fentanyl, rats had also developed hyperalgesic priming (opioid-primed rats), long-lasting nociceptor neuroplasticity manifested as prolongation of prostaglandin E2 (PGE2) hyperalgesia. OIH was reversed, in vivo, by intrathecal administration of cordycepin, a protein translation inhibitor that reverses priming. When fentanyl (0.5 nm) was applied to dorsal root ganglion (DRG) neurons, cultured from opioid-primed rats, it induced a μ-opioid receptor (MOR)-dependent increase in [Ca2+]i in 26% of small-diameter neurons and significantly sensitized (decreased action potential rheobase) weakly IB4+ and IB4- neurons. This sensitizing effect of fentanyl was reversed in weakly IB4+ DRG neurons cultured from opioid-primed rats after in vivo treatment with cordycepin, to reverse of OIH. Thus, in vivo administration of fentanyl induces nociceptor neuroplasticity, which persists in culture, providing evidence for the role of nociceptor MOR-mediated calcium signaling and peripheral protein translation, in the weakly IB4-binding population of nociceptors, in OIH.SIGNIFICANCE STATEMENT Clinically used μ-opioid receptor agonists such as fentanyl can produce hyperalgesia and hyperalgesic priming. We report on an in vitro model of nociceptor neuroplasticity mediating this opioid-induced hyperalgesia (OIH) and priming induced by fentanyl. Using this model, we have found qualitative and quantitative differences between cultured nociceptors from opioid-naive and opioid-primed animals, and provide evidence for the important role of nociceptor μ-opioid receptor-mediated calcium signaling and peripheral protein translation in the weakly IB4-binding population of nociceptors in OIH. These findings provide information useful for the design of therapeutic strategies to alleviate OIH, a serious adverse event of opioid analgesics.
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The association between endogenous opioid function and morphine responsiveness: a moderating role for endocannabinoids. Pain 2019; 160:676-687. [PMID: 30562268 DOI: 10.1097/j.pain.0000000000001447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We sought to replicate previous findings that low endogenous opioid (EO) function predicts greater morphine analgesia and extended these findings by examining whether circulating endocannabinoids and related lipids moderate EO-related predictive effects. Individuals with chronic low-back pain (n = 46) provided blood samples for endocannabinoid analyses, then underwent separate identical laboratory sessions under 3 drug conditions: saline placebo, intravenous (i.v.) naloxone (opioid antagonist; 12-mg total), and i.v. morphine (0.09-mg/kg total). During each session, participants rated low-back pain intensity, evoked heat pain intensity, and nonpain subjective effects 4 times in sequence after incremental drug dosing. Mean morphine effects (morphine-placebo difference) and opioid blockade effects (naloxone-placebo difference; to index EO function) for each primary outcome (low-back pain intensity, evoked heat pain intensity, and nonpain subjective effects) were derived by averaging across the 4 incremental doses. The association between EO function and morphine-induced back pain relief was significantly moderated by endocannabinoids [2-arachidonoylglycerol (2-AG) and N-arachidonoylethanolamine (AEA)]. Lower EO function predicted greater morphine analgesia only for those with relatively lower endocannabinoids. Endocannabinoids also significantly moderated EO effects on morphine-related changes in visual analog scale-evoked pain intensity (2-AG), drug liking (AEA and 2-AG), and desire to take again (AEA and 2-AG). In the absence of significant interactions, lower EO function predicted significantly greater morphine analgesia (as in past work) and euphoria. Results indicate that EO effects on analgesic and subjective responses to opioid medications are greatest when endocannabinoid levels are low. These findings may help guide development of mechanism-based predictors for personalized pain medicine algorithms.
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Kneeland ET, Griffin ML, Taghian N, Weiss RD, McHugh RK. Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:488-494. [DOI: 10.1080/00952990.2019.1581793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Elizabeth T. Kneeland
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nadine Taghian
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Jamison RN, Wan L, Edwards RR, Mei A, Ross EL. Outcome of a High-Frequency Transcutaneous Electrical Nerve Stimulator (hfTENS) Device for Low Back Pain: A Randomized Controlled Trial. Pain Pract 2019; 19:466-475. [PMID: 30636101 DOI: 10.1111/papr.12764] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This controlled trial examined the benefit of a high-frequency transcutaneous electrical nerve stimulation (hfTENS) device (the Quell, NeuroMetrix, Inc., Waltham, MA, U.S.A.) for patients with chronic low back pain (CLBP). METHODS Thirty-five (n = 35) participants were randomly assigned to use the device each day for 3 months (experimental group) and were compared with 33 subjects without the device (treatment-as-usual control group). All patients were instructed to complete baseline questionnaires and were assessed on thresholds of pressure pain and mechanical temporal summation as part of standardized quantitative sensory testing (QST). The subjects also uploaded smartphone applications (apps) for tracking use of the hfTENS and for daily pain assessment. Each participant completed weekly phone interviews, was prompted to complete daily pain app assessments, and was asked to repeat the baseline questionnaires again after 6 weeks and 3 months. RESULTS Sixty percent of the subjects were female, 77.9% were Caucasian, and the average age was 46.2 years. Significant reductions in pain intensity (P < 0.01) and activity interference (P < 0.025) and significant improvements in pain catastrophizing (P < 0.025) were noted in the experimental group compared with the control group. No group differences were found on depression, anxiety, or pain-related disability. Older subjects with a longer duration of pain tended to use the hfTENS more often. Subjects who showed greater sensitivity based on QST results revealed increased use of the hfTENS (P < 0.025) and tended to believe that the hfTENS was more helpful in reducing their back pain, but these findings did not reach significance (P = 0.09). CONCLUSION These results suggest that hfTENS can have a moderate effect in reducing pain and improving quality of life in low back pain patients. Further trials designed to determine the mechanism of action of the hfTENS are needed.
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Affiliation(s)
- Robert N Jamison
- Pain Management Center, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, U.S.A
| | - Limeng Wan
- Pain Management Center, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, U.S.A
| | - Robert R Edwards
- Pain Management Center, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, U.S.A
| | - Anna Mei
- Pain Management Center, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, U.S.A
| | - Edgar L Ross
- Pain Management Center, Harvard Medical School, Brigham and Women's Hospital, Chestnut Hill, Massachusetts, U.S.A
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Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the novel added value of neurophysiological pain sensitivity within the fear-avoidance model of pain. Eur J Pain 2019; 23:957-972. [PMID: 30648781 DOI: 10.1002/ejp.1364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/09/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The fear-avoidance model (FAM) is a leading theoretical paradigm for explaining persistent pain following musculoskeletal injury. The model suggests that as injuries heal, pain-related outcomes are increasingly determined by psychological, rather than physiological factors. Increasing literature, however, suggests that neurophysiological processes related to pain sensitivity also play an important role in chronicity. To date, there has been limited research that has specifically explored the role of pain sensitivity within the FAM. This study addresses this gap by evaluating whether clinical measures of pain sensitivity help explain FAM-related outcomes, beyond model-relevant psychological predictors. METHODS The study sample consisted of 80 adults with chronic and widespread musculoskeletal pain. Participants completed a single testing session that included measures of all of the major constructs of the FAM, including pain catastrophizing, pain-related fear, activity avoidance (self-report and functional measures), pain-related disability, depression and pain severity, as well as a battery of quantitative sensory testing that included measures of pressure pain threshold and temporal summation of mechanical pain across eight body sites. RESULTS A series of hierarchical regression analyses revealed that after controlling for the psychological predictors of the FAM, indices of pain sensitivity significantly predicted 4 of the 5 FAM-related outcomes (p < 0.05). Depression was the only outcome not significantly predicted by pain sensitivity. Interestingly, measures of pain sensitivity, but not FAM psychological factors, predicted the functional measure of activity avoidance. CONCLUSIONS These findings provide further evidence for the importance of neurophysiological factors within the FAM and have important clinical and theoretical implications. SIGNIFICANCE This study provides evidence for the unique and added value of neurophysiological factors within the Fear Avoidance Model of pain and for the importance of integrating both sensory and psychological factors within both theoretical paradigms and clinical management strategies.
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Affiliation(s)
- Zakir Uddin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Arthur Woznowski-Vu
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Daniel Flegg
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Andrea Aternali
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Rebekah Wickens
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Greenwald MK. Anti-stress neuropharmacological mechanisms and targets for addiction treatment: A translational framework. Neurobiol Stress 2018; 9:84-104. [PMID: 30238023 PMCID: PMC6138948 DOI: 10.1016/j.ynstr.2018.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022] Open
Abstract
Stress-related substance use is a major challenge for treating substance use disorders. This selective review focuses on emerging pharmacotherapies with potential for reducing stress-potentiated seeking and consumption of nicotine, alcohol, marijuana, cocaine, and opioids (i.e., key phenotypes for the most commonly abused substances). I evaluate neuropharmacological mechanisms in experimental models of drug-maintenance and relapse, which translate more readily to individuals presenting for treatment (who have initiated and progressed). An affective/motivational systems model (three dimensions: valence, arousal, control) is mapped onto a systems biology of addiction approach for addressing this problem. Based on quality of evidence to date, promising first-tier neurochemical receptor targets include: noradrenergic (α1 and β antagonist, α2 agonist), kappa-opioid antagonist, nociceptin antagonist, orexin-1 antagonist, and endocannabinoid modulation (e.g., cannabidiol, FAAH inhibition); second-tier candidates may include corticotropin releasing factor-1 antagonists, serotonergic agents (e.g., 5-HT reuptake inhibitors, 5-HT3 antagonists), glutamatergic agents (e.g., mGluR2/3 agonist/positive allosteric modulator, mGluR5 antagonist/negative allosteric modulator), GABA-promoters (e.g., pregabalin, tiagabine), vasopressin 1b antagonist, NK-1 antagonist, and PPAR-γ agonist (e.g., pioglitazone). To address affective/motivational mechanisms of stress-related substance use, it may be advisable to combine agents with actions at complementary targets for greater efficacy but systematic studies are lacking except for interactions with the noradrenergic system. I note clinically-relevant factors that could mediate/moderate the efficacy of anti-stress therapeutics and identify research gaps that should be pursued. Finally, progress in developing anti-stress medications will depend on use of reliable CNS biomarkers to validate exposure-response relationships.
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Affiliation(s)
- Mark K. Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, 48201, USA
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Martel MO, Petersen K, Cornelius M, Arendt-Nielsen L, Edwards R. Endogenous Pain Modulation Profiles Among Individuals With Chronic Pain: Relation to Opioid Use. THE JOURNAL OF PAIN 2018; 20:462-471. [PMID: 30385319 DOI: 10.1016/j.jpain.2018.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
It is generally assumed that individuals exhibiting high pain inhibition also tend to exhibit low pain facilitation, but little research has examined this association in individuals with pain. The aims of this cross-sectional study were 1) to examine the association between measures of conditioned pain modulation (CPM) and temporal summation (TS) in individuals with chronic pain, and 2) to examine whether this association was moderated by demographic (age, sex), psychological (depression, catastrophizing), or medication-related (opioid use) variables. Individuals (N= 190) with back or neck pain completed questionnaires and underwent a series of quantitative sensory testing procedures assessing CPM and TS. Results indicated that individuals with higher levels of CPM showed lower levels of TS, r = -.20, P < .01. Analyses, however, revealed that the magnitude of this association was substantially weaker among opioid users (r= -.08, NS) than nonusers (r= -.34, P < .01). None of the demographic or psychological variables included in our study influenced the association between CPM and TS. The magnitude of CPM was lower for opioid users than nonusers, suggesting that opioid use might dampen the functioning of endogenous pain-inhibitory systems and possibly contribute to a discordance between measures of pain inhibition and pain facilitation. PERSPECTIVE: Results of the present study indicated that greater endogenous pain-inhibitory capacity is associated with lower levels of pain facilitation. This association, however, was not significant among opioid users, suggesting that opioids might compromise the functioning and interrelationship between endogenous pain modulatory systems.
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Affiliation(s)
- Marc O Martel
- Faculty of Dentistry; Department of Anesthesia, McGill University, Montreal, Canada.
| | - Kristian Petersen
- Center for Neuroplasticity and Pain (CNAP), SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Marise Cornelius
- Center for Neuroplasticity and Pain (CNAP), SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- SMI, Department of Health Sciences and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Robert Edwards
- Center for Neuroplasticity and Pain (CNAP), SMI®, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Meints SM, Wang V, Edwards RR. Sex and Race Differences in Pain Sensitization among Patients with Chronic Low Back Pain. THE JOURNAL OF PAIN 2018; 19:1461-1470. [PMID: 30025944 DOI: 10.1016/j.jpain.2018.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
Growing evidence suggests that chronic low back pain (CLBP) is associated with pain sensitization, and that there are sex and race disparities in CLBP. Given the sex and race differences in pain sensitization, this has been hypothesized as a mechanism contributing to the sex and race disparities in CLBP. This study examined sex and race differences in pain sensitization among patients with CLBP, as well as the role of catastrophizing as a potential mediator of those differences. The study found that compared with men, women required less pressure to produce deep muscle pain and rated mechanical punctate pain as more painful. Compared with non-Hispanic white patients, black patients demonstrated greater pain sensitivity for measures of deep muscle hyperalgesia and mechanical punctate pain. Furthermore, catastrophizing partially mediated the race differences in deep muscle pain such that black participants endorsed greater pain catastrophizing, which partially accounted for their increased sensitivity to, and temporal summation of, deep muscle pain. Taken together, these results support the need to further examine the role of catastrophizing and pain sensitization in the context of sex and race disparities in the experience of CLBP. PERSPECTIVE: This study identifies sex and race differences in pain sensitization among patients with CLBP. Further, it recognizes the role of catastrophizing as a contributor to such race differences. More research is needed to further dissect these complex relationships.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts..
| | - Victor Wang
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, Massachusetts
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Lee J, Protsenko E, Lazaridou A, Franceschelli O, Ellingsen DM, Mawla I, Isenburg K, Berry MP, Galenkamp L, Loggia ML, Wasan AD, Edwards RR, Napadow V. Encoding of Self-Referential Pain Catastrophizing in the Posterior Cingulate Cortex in Fibromyalgia. Arthritis Rheumatol 2018; 70:1308-1318. [PMID: 29579370 DOI: 10.1002/art.40507] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/20/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Pain catastrophizing is a common feature of chronic pain, including fibromyalgia (FM), and is strongly associated with amplified pain severity and disability. While previous neuroimaging studies have focused on evoked pain response modulation by catastrophizing, the brain mechanisms supporting pain catastrophizing itself are unknown. We designed a functional magnetic resonance imaging (fMRI)-based pain catastrophizing task whereby patients with chronic pain engaged in catastrophizing-related cognitions. We undertook this study to test our hypothesis that catastrophizing about clinical pain would be associated with amplified activation in nodes of the default mode network (DMN), which encode self-referential cognition and show altered functioning in chronic pain. METHODS During fMRI, 31 FM patients reflected on how catastrophizing (CAT) statements (drawn from the Pain Catastrophizing Scale) impact their typical FM pain experience. Response to CAT statements was compared to response to matched neutral (NEU) statements. RESULTS During statement reflection, higher fMRI signal during CAT statements than during NEU statements was found in several DMN brain areas, including the ventral (posterior) and dorsal (anterior) posterior cingulate cortex (vPCC and dPCC, respectively). Patients' ratings of CAT statement applicability were correlated solely with activity in the vPCC, a main DMN hub supporting self-referential cognition (r = 0.38, P < 0.05). Clinical pain severity was correlated solely with activity in the dPCC, a PCC subregion associated with cognitive control and sensorimotor processing (r = 0.38, P < 0.05). CONCLUSION These findings provide evidence that the PCC encodes pain catastrophizing in FM and suggest distinct roles for different PCC subregions. Understanding the brain circuitry encoding pain catastrophizing in FM will prove to be important in identifying and evaluating the success of interventions targeting negative affect in chronic pain management.
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Affiliation(s)
| | | | - Asimina Lazaridou
- Harvard Medical School, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston
| | - Olivia Franceschelli
- Harvard Medical School, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston
| | | | | | | | | | - Laura Galenkamp
- Harvard Medical School, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston
| | | | - Ajay D Wasan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and Massachusetts General Hospital, Boston
| | - Robert R Edwards
- Harvard Medical School, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston
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Lazaridou A, Martel MO, Cahalan CM, Cornelius MC, Franceschelli O, Campbell CM, Haythornthwaite JA, Smith M, Riley J, Edwards RR. The impact of anxiety and catastrophizing on interleukin-6 responses to acute painful stress. J Pain Res 2018; 11:637-647. [PMID: 29636630 PMCID: PMC5880517 DOI: 10.2147/jpr.s147735] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To examine the influence of anxiety and pain-related catastrophizing on the time course of acute interleukin-6 (IL-6) responses to standardized noxious stimulation among patients with chronic pain. Methods Data were collected from 48 participants in the following demographically matched groups: patients with chronic pain (n=36) and healthy controls (n=12). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical and thermal stimuli during two separate visits, in a randomized order. One visit consisted of standard, moderately painful QST procedures, while the other visit involved nonpainful analogs to these testing procedures. Blood samples were taken at baseline, and then for up to 2 hours after QST in order to study the time course of IL-6 responses. Results Results of multilevel analyses revealed that IL-6 responses increased across assessment time points in both visits (p<0.001). While patients with chronic pain and healthy controls did not differ in the magnitude of IL-6 responses, psychological factors influenced IL-6 trajectories only in the chronic pain group. Among patients, increases in catastrophizing over the course of the QST session were associated with elevated IL-6 responses only during the painful QST session (p<0.05). When controlling for anxiety, results indicated that the main multilevel model among patients remained significant (p<0.05). Conclusion Under specific conditions (eg, application of a painful stressor), catastrophizing may be associated with amplified proinflammatory responses in patients with persistent pain. These findings suggest that psychosocial interventions that reduce negative pain-related cognitions may benefit patients’ inflammatory profiles.
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Affiliation(s)
- Asimina Lazaridou
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - Marc O Martel
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - Christine M Cahalan
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - Marise C Cornelius
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - Olivia Franceschelli
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Smith
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Riley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Robert R Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, USA
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Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Effect of Stimulus Type, Sleep, and Psychological and Lifestyle Factors. THE JOURNAL OF PAIN 2018; 19:942.e1-942.e18. [PMID: 29597080 DOI: 10.1016/j.jpain.2018.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 02/08/2023]
Abstract
Generalized hyperalgesia and impaired pain modulation are reported in chronic low back pain (LBP). Few studies have tested whether these features are present in the acute phase. This study aimed to test for differences in pain presentation in early-acute LBP and evaluate the potential contribution of other factors to variation in sensitivity. Individuals within 2 weeks of onset of acute LBP (n = 126) and pain-free controls (n = 74) completed questionnaires related to their pain, disability, behavior, and psychological status before undergoing conditioned pain modulation (CPM) and pain threshold (heat, cold, and pressure) testing at the back and forearm/thumb. LBP participants were more sensitive to heat and cold at both sites and pressure at the back than controls, without differences in CPM. Only those with high-pain (numeric rating scale ≥4) were more sensitive to heat at the forearm and pressure at the back. Four subgroups with distinct features were identified: "high sensitivity," "low CPM efficacy," "high sensitivity/low CPM efficacy," and "low sensitivity/high CPM efficacy." Various factors such as sleep and alcohol were associated with each pain measure. Results provide evidence for generalized hyperalgesia in many, but not all, individuals during acute LBP, with variation accounted for by several factors. Specific pain phenotypes provide candidate features to test in longitudinal studies of LBP outcome. PERSPECTIVE Sensory changes indicative of increased/decreased central processing of pain and nociceptive input presented differently between individuals with acute LBP and were related to factors such as sleep and alcohol. This may underlie variation in outcome and suggest potential for early identification of individuals with poor long-term outcome.
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Klyne DM, Barbe MF, van den Hoorn W, Hodges PW. ISSLS PRIZE IN CLINICAL SCIENCE 2018: longitudinal analysis of inflammatory, psychological, and sleep-related factors following an acute low back pain episode-the good, the bad, and the ugly. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:763-777. [PMID: 29460011 DOI: 10.1007/s00586-018-5490-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/20/2018] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE To determine whether systemic cytokines and C-reactive protein (CRP) during an acute episode of low back pain (LBP) differ between individuals who did and did not recover by 6 months and to identify sub-groups based on patterns of inflammatory, psychological, and sleep features associated with recovery/non-recovery. Systemic inflammation is observed in chronic LBP and may contribute to the transition from acute to persistent LBP. Longitudinal studies are required to determine whether changes present early or develop over time. Psychological and/or sleep-related factors may be related. METHODS Individuals within 2 weeks of onset of acute LBP (N = 109) and pain-free controls (N = 55) provided blood for assessment of CRP, tumor necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-1β, and completed questionnaires related to pain, disability, sleep, and psychological status. LBP participants repeated measurements at 6 months. Biomarkers were compared between LBP and control participants at baseline, and in longitudinal (baseline/6 months) analysis, between unrecovered (≥pain and disability), partially recovered (reduced pain and/or disability) and recovered (no pain and disability) participants at 6 months. We assessed baseline patterns of inflammatory, psychological, sleep, and pain data using hierarchical clustering and related the clusters to recovery (% change in pain) at 6 months. RESULTS CRP was higher in acute LBP than controls at baseline. In LBP, baseline CRP was higher in the recovered than non-recovered groups. Conversely, TNF was higher at both time-points in the non-recovered than recovered groups. Two sub-groups were identified that associated with more ("inflammatory/poor sleep") or less ("high TNF/depression") recovery. CONCLUSIONS This is the first evidence of a relationship between an "acute-phase" systemic inflammatory response and recovery at 6 months. High inflammation (CRP/IL-6) was associated with good recovery, but specific elevation of TNF, along with depressive symptoms, was associated with bad recovery. Depression and TNF may have a two-way relationship. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- David M Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Temple University, Philadelphia, USA
| | - Wolbert van den Hoorn
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Paul W Hodges
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
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Simopoulos T, Leffler D, Barnett S, Campbell D, Lian SJ, Gill JS. Prospective Assessment of Pain and Comfort in Chronic Pain Patients Undergoing Interventional Pain Management Procedures. PAIN MEDICINE 2018; 19:336-347. [PMID: 28431040 DOI: 10.1093/pm/pnx064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Interventional pain management procedures have an important role in the management of chronic pain. The present study seeks to identify the proportion of patients who experience severe pain during pain procedures either with or without sedation. There is then an attempt to identify any association of high pain levels with factors such as age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, and baseline pharmaceuticals taken for both pain and/or mood disorder management. Methods This is a prospective survey study evaluating patients' discomfort during interventional pain procedures in an outpatient academic facility. Patient discomfort was assessed by the PROcedural Sedation Assessment Survey (PROSAS) and modified for nonsedation cases. Results There were 155 patients in the survey, with 20 of these receiving nonspinal injections. Of the remaining 135 patients who underwent spinal injections, only 10 received conscious sedation. On average, 14.2% experienced severe pain during spinal injections, whereas 20% experienced severe pain with nonspinal injections. Though few patients received conscious sedation, most of these (60%) experienced high levels of pain. There was no correlation between level of procedural pain with age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, or medication type used. Conclusions The majority of patients who undergo nonsedated interventional pain management procedures do not experience severe pain. There is a small but appreciable group of subjects who seem to experience severe pain that cannot be correlated to any particular clinical characteristic in a standard patient evaluation. Even with standard conscious sedation, there is no clear best method to ensure patient comfort for this high-pain level group.
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Affiliation(s)
- Thomas Simopoulos
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | | | - Sheila Barnett
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | | | | | - Jatinder S Gill
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
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Thakral M, Walker RL, Saunders K, Shortreed SM, Parchman M, Hansen RN, Ludman E, Sherman KJ, Dublin S, Von Korff M. Comparing Pain and Depressive Symptoms of Chronic Opioid Therapy Patients Receiving Dose Reduction and Risk Mitigation Initiatives With Usual Care. THE JOURNAL OF PAIN 2017; 19:111-120. [PMID: 29038060 DOI: 10.1016/j.jpain.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/30/2017] [Accepted: 09/30/2017] [Indexed: 01/30/2023]
Abstract
Dose reduction and risk mitigation initiatives have been recommended to reduce opioid-related risks among patients receiving chronic opioid therapy (COT), but questions remain over whether these initiatives worsen pain control and quality of life. In 2014 to 2015, we interviewed 1,588 adult COT patients within a health care system in Washington State and compared those who received dose reduction and risk mitigation initiatives in primary care clinics (intervention) with patients in comparable health care settings without initiatives (control). The primary outcomes were pain assessed using the pain, enjoyment, and general activity (PEG) scale, a 3-item scale to assess global pain intensity and interference, with secondary measures including depression (Patient Health Questionnaire-8 scale). Generalized estimating equations for linear regression models were used to estimate differences in mean scores between intervention and control sites. Estimated differences, adjusted for patient characteristics and weighted for nonresponse, between patients at intervention and control clinics were not clinically significant for the PEG (-.03, 95% confidence interval = -.25 to .19) or Patient Health Questionnaire-8 (-.64, 95% confidence interval = -1.19 to -.08). We found no evidence that COT patients in clinics with dose reduction and risk mitigation initiatives had clinically meaningful differences in pain intensity, interference with activities and enjoyment of life, or depressive symptoms compared with control health care settings. PERSPECTIVE This article evaluates the effect of dose reduction and risk mitigation initiatives, such as those recently recommended by the Centers for Disease Control and Prevention, to reduce risks associated with COT on global pain and interference, depressive symptoms, and perceived pain relief and bothersomeness of side effects.
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Affiliation(s)
- Manu Thakral
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington.
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Kathleen Saunders
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington
| | - Michael Parchman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Ryan N Hansen
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Departments of Pharmacy and Health Services, University of Washington, Seattle, Washington
| | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Jamison RN, Mei A, Edwards RR, Ross EL. Efficacy of Vibrating Gloves for Chronic Hand Pain due to Osteoarthritis. PAIN MEDICINE 2017; 19:1044-1057. [DOI: 10.1093/pm/pnx230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robert N Jamison
- Department of Anesthesiology, Pain Management Center, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Anna Mei
- Department of Anesthesiology, Pain Management Center, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Edgar L Ross
- Department of Anesthesiology, Pain Management Center, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
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