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Sedney CL, Okakpu U, Dekeseredy P, Pollini RA, Rosenow JM, Haggerty T. Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State. Cureus 2024; 16:e57389. [PMID: 38694664 PMCID: PMC11061822 DOI: 10.7759/cureus.57389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/04/2024] Open
Abstract
Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas, disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.
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Affiliation(s)
- Cara L Sedney
- Neurosurgery, West Virginia University, Morgantown, USA
| | | | | | - Robin A Pollini
- Behavioral Medicine and Psychiatry, Epidemiology and Biostatistics, Public Health, West Virginia University, Morgantown, USA
| | - Joshua M Rosenow
- Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Treah Haggerty
- Family Medicine, West Virginia University, Morgantown, USA
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Vega E, Rivera G, Echevarria GC, Prylutskyy Z, Perez J, Ingelmo P. Interventional procedures in children and adolescents with chronic non-cancer pain as part of a multidisciplinary pain treatment program. Paediatr Anaesth 2018; 28:999-1006. [PMID: 30251303 DOI: 10.1111/pan.13494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/15/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non-cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. AIMS The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non-cancer pain in the setting of a multidisciplinary pain treatment program. METHODS We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short-term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long-term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. RESULTS Seventy-six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty-six of 202 therapeutics blocks (82%) were associated with a short-term benefit. Seventy-two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. CONCLUSION The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.
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Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Gonzalo Rivera
- Department of Anesthesia, Clinica Las Condes, Santiago, Chile
| | - Ghislaine C Echevarria
- Department of Anesthesia, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York
| | - Zakhar Prylutskyy
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Jordi Perez
- Department of Anesthesia, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,Alan Edwards Pain Management Unit, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada
| | - Pablo Ingelmo
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,CIMPARC (Consortium of Multidisciplinary Pain Researchers and Clinicians), Parma, Italy
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Vega E, Beaulieu Y, Gauvin R, Ferland C, Stabile S, Pitt R, Gonzalez Cardenas VH, Ingelmo PM. Chronic non-cancer pain in children: we have a problem, but also solutions. Minerva Anestesiol 2018; 84:1081-1092. [PMID: 29745621 DOI: 10.23736/s0375-9393.18.12367-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic non-cancer pain in children and adolescents has been described as "a modern public health disaster" that has generated significant medical and economic burdens within society. Seen as a disease in its own right, chronic pain has short and long-term consequences that impact not only the patient's health but also that of friends and families, due to significant parenting stress and disruptions in family life and structure. The evidence supporting pharmacological treatments and interventional procedures is limited, and no single strategy has been shown to be completely effective in children with chronic non-cancer pain. Therefore, considering the multifactorial nature of chronic pain, these patients should be treated with a multidisciplinary, balanced approach that seeks a primary outcome of improved functioning rather than of pain reduction. Using a bio-psycho-social approach, a multidisciplinary team, including a physiotherapist, nurse, social worker, psychologist, and physician, has been effective in achieving this outcome of improved functioning in children and adolescents with chronic pain. In this review, we discuss the impact, associated conditions, and evolution of chronic pain, along with the crucial role of every member of a multidisciplinary chronic pain clinic involved in the care of the children and adolescents with chronic non-cancer pain.
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Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yves Beaulieu
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rachel Gauvin
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Catherine Ferland
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Stephanie Stabile
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rebecca Pitt
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Victor H Gonzalez Cardenas
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,University Foundation for Health Sciences, Bogotá, Colombia
| | - Pablo M Ingelmo
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada - .,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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Interventional Pain Management in Multidisciplinary Chronic Pain Clinics: A Prospective Multicenter Cohort Study with One-Year Follow-Up. PAIN RESEARCH AND TREATMENT 2017; 2017:8402413. [PMID: 29163990 PMCID: PMC5661079 DOI: 10.1155/2017/8402413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/18/2017] [Indexed: 01/27/2023]
Abstract
Background Interventional Pain Management (IPM) is performed in multidisciplinary chronic pain clinics (MCPC), including a range of invasive techniques to diagnose and treat chronic pain (CP) conditions. Current patterns of use of those techniques in MCPC have not yet been reported. Objective We aimed to describe quantitatively and qualitatively the use of IPM and other therapeutic procedures performed on-site at four Portuguese MCPC. Methods A prospective cohort study with one-year follow-up was performed in adult patients. A structured case report form was systematically completed at baseline and six and 12 months. Results Among 808 patients referred to the MCPC, 17.2% had been prescribed IPM. Patients with IPM were on average younger and had longer CP duration and lower levels of maximum pain and pain interference/disability. The three main diagnoses were low back pain (n = 28), postoperative CP, and knee pain (n = 16 each). From 195 IPM prescribed, nerve blocks (n = 108), radiofrequency (n = 31), and viscosupplementation (n = 22) were the most prevalent. Some IPM techniques were only available in few MCPC. One MCPC did not provide IPM. Conclusions IPM are seldom prescribed in Portuguese MCPC. Further studies on IPM safety and effectiveness are necessary for clear understanding the role of these techniques in CP management.
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Zhang S, Kartha S, Lee J, Winkelstein BA. Techniques for Multiscale Neuronal Regulation via Therapeutic Materials and Drug Design. ACS Biomater Sci Eng 2017; 3:2744-2760. [DOI: 10.1021/acsbiomaterials.7b00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
| | - Jasmine Lee
- Department of Physics and Astronomy, University of Pennsylvania, 209 S. 33rd Street, David Rittenhouse Laboratory, Philadelphia, Pennsylvania 19104, United States
| | - Beth A. Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 S. 33rd Street, 240 Skirkanich
Hall, Philadelphia, Pennsylvania 19104, United States
- Department
of Neurosurgery, University of Pennsylvania, Stemmler Hall, 3450 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
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Ventolini G. A New Line of Attack in Provoked Vulvodynia Management: Pain Neuromodulation? J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University and Health Sciences Center Permian Basin, Odessa, TX
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Pleticha J, Maus TP, Beutler AS. Future Directions in Pain Management: Integrating Anatomically Selective Delivery Techniques With Novel Molecularly Selective Agents. Mayo Clin Proc 2016; 91:522-33. [PMID: 27046525 DOI: 10.1016/j.mayocp.2016.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 01/12/2023]
Abstract
Treatment for chronic, locoregional pain ranks among the most prevalent unmet medical needs. The failure of systemic analgesic drugs, such as opioids, is often due to their off-target toxicity, development of tolerance, and abuse potential. Interventional pain procedures provide target specificity but lack pharmacologically selective agents with long-term efficacy. Gene therapy vectors are a new tool for the development of molecularly selective pain therapies, which have already been proved to provide durable analgesia in preclinical models. Taken together, advances in image-guided delivery and gene therapy may lead to a new class of dual selective analgesic treatments integrating the molecular selectivity of analgesic genes with the anatomic selectivity of interventional delivery techniques.
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Affiliation(s)
- Josef Pleticha
- Department of Anesthesiology and Oncology, Mayo Clinic, Rochester, MN
| | | | - Andreas S Beutler
- Department of Anesthesiology and Oncology, Mayo Clinic, Rochester, MN
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