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Jakobsen MAS, Tørmoen TL, Klarare A, Steindal SA. Home care for patients with opioid use disorders: A qualitative study of registered nurses' experiences of pain management. Nurs Open 2024; 11:e2212. [PMID: 38867380 PMCID: PMC11168962 DOI: 10.1002/nop2.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
AIM To explore registered nurses' experiences with pain management in patients with opioid use disorder (OUD) in home care. DESIGN Qualitative explorative-descriptive design. METHODS Data were collected via nine individual semi-structured interviews with registered nurses working in home care meeting patients with OUD. Data were analysed using systematic text condensation. RESULTS Three categories were identified: Reciprocity in relationships and a professional approach enhance pain management; Discrepancies between guidelines, patient-reported pain and RNs' observations challenge pain management; and Interprofessional collaboration makes or breaks pain management.
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Affiliation(s)
- Mari Asalie Skrenes Jakobsen
- Department for Postgraduate StudiesLovisenberg Diaconal University CollegeOsloNorway
- Øren Home Care ServicesDrammenNorway
| | - Tone Løvås Tørmoen
- Department for Postgraduate StudiesLovisenberg Diaconal University CollegeOsloNorway
- Eidskog Home Care ServicesEidskogNorway
| | - Anna Klarare
- Department of Health Care SciencesMarie Cederschiöld UniversityStockholmSweden
- Department of Women's and Children's Health, Healthcare Sciences and e‐HealthUppsala UniversityUppsalaSweden
| | - Simen A. Steindal
- Department for Postgraduate StudiesLovisenberg Diaconal University CollegeOsloNorway
- Faculty of Health Studies, Institute of NursingVID Specialized UniversityOsloNorway
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Kyei EF, Zhang L, Leveille S. A Conceptual Analysis of Opioid Use Disorder in Chronic Noncancer Pain Using Rodger's Evolutionary Approach. Pain Manag Nurs 2024:S1524-9042(24)00138-3. [PMID: 38729848 DOI: 10.1016/j.pmn.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 02/15/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aims to examine the complex nature of opioid use disorder (OUD) in chronic noncancer pain (CNCP) by exploring its antecedents, attributes, consequences, and interrelated concepts. DESIGN A systematic literature review was conducted to gather relevant studies published between 2015 and 2022, utilizing the CINAHL, MEDLINE, PsycINFO, and PubMed databases. DATA SOURCES The selected databases provided a comprehensive range of articles related to OUD in CNCP, ensuring a comprehensive topic analysis. METHODS Twenty-two articles meeting the inclusion criteria were included in the analysis. These articles were critically reviewed and analyzed to identify key themes and concepts related to OUD in CNCP. RESULTS The findings of this study shed light on the multifaceted aspects of OUD in CNCP, including its antecedents, such as goals of physical function improvement, prescription of opioids for CNCP, social influences, and mental health dynamics. The attributes of OUD in CNCP were identified as chronic pain, noncancer pain, opioid use, misuse, and abuse. OUD's consequences in CNCP include impaired functioning, increased health risks, psychological distress, social challenges, and economic burden. CONCLUSION Understanding the complexity of OUD in CNCP is crucial for improving patient outcomes. Collaborative efforts among healthcare systems, regulatory bodies, and professional organizations are needed to develop policies promoting safe and effective pain management while mitigating risks associated with opioid use in CNCP. IMPLICATIONS FOR PRACTICE Implementing policy recommendations derived from this study enhances care and outcomes for individuals with CNCP. By addressing complex issues of OUD in CNCP and adopting evidence-based practices, healthcare providers can optimize pain management and promote well-being in CNCP patients.
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Affiliation(s)
- Evans F Kyei
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.
| | - Lingling Zhang
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
| | - Suzanne Leveille
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
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3
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Peta D. Substance Use Disorders and Addiction in the Emergency Care Setting. J Emerg Nurs 2024; 50:469-472. [PMID: 38705707 DOI: 10.1016/j.jen.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 05/07/2024]
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MacLean RR, Spinola S, Pittman B, Meyerovich J, Szollosy SK, Wolkowicz NR, Minnix S, Sofuoglu M. The relationship of pain intensity and opioid craving with delayed methadone dose: A preliminary study of individuals with opioid use disorder. Br J Clin Pharmacol 2024. [PMID: 38439592 DOI: 10.1111/bcp.16027] [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: 10/02/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS Despite a strong theoretical link between opioid craving and pain, little is known about the temporal relationship between pain and craving and the acute experience of pain in the context of methadone treatment. Using a cross-over design, the current study evaluated the time course of pain and craving and objective experience of pain as a function of the last methadone dose. METHODS Participants (n = 20) presented for the study in the morning and either received methadone dose as scheduled or delayed dose until the afternoon. During the 4-h study visit, participants completed a series of tasks, including repeated assessment of pain and craving at 0, +40, +70, +130, +160 and +240 min and a cold pressor test (CPT) at +15 and +220 min. RESULTS Separate mixed model results demonstrated no effect of dosing condition on craving; however, there was a significant dosing condition by time interaction (F(5,209) = 3.38, P = .006) such that pain increased over time in the delayed methadone condition but decreased in time in the scheduled methadone condition. A mixed model predicting self-reported pain revealed a three-way interaction between dosing condition, craving and time (F(5,197) = 2.39, P = .039) explained by a positive association between craving and pain at each time point (except 240 min) in delayed condition (P-range = .004-.0001). A separate mixed model on CPT data indicated a significant condition by time interaction such that pain threshold decreased in the delayed, but not scheduled, condition (F(1,57) = 4.01, P = .050). CONCLUSIONS These preliminary findings highlight the potential for increased risks after even a short delay in receiving a methadone dose.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Suzanne Spinola
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian Pittman
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Noah R Wolkowicz
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stacy Minnix
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale University School of Medicine, New Haven, Connecticut, USA
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5
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Koller D, Friligkou E, Stiltner B, Pathak GA, Løkhammer S, Levey DF, Zhou H, Hatoum AS, Deak JD, Kember RL, Treur JL, Kranzler HR, Johnson EC, Stein MB, Gelernter J, Polimanti R. Pleiotropy and genetically inferred causality linking multisite chronic pain to substance use disorders. Mol Psychiatry 2024:10.1038/s41380-024-02446-3. [PMID: 38355787 DOI: 10.1038/s41380-024-02446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Individuals suffering from chronic pain develop substance use disorders (SUDs) more often than others. Understanding the shared genetic influences underlying the comorbidity between chronic pain and SUDs will lead to a greater understanding of their biology. Genome-wide association statistics were obtained from the UK Biobank for multisite chronic pain (MCP, Neffective = 387,649) and from the Million Veteran Program and the Psychiatric Genomics Consortium meta-analyses for alcohol use disorder (AUD, Neffective = 296,974), cannabis use disorder (CanUD, Neffective = 161,053), opioid use disorder (OUD, Neffective = 57,120), and problematic tobacco use (PTU, Neffective = 270,120). SNP-based heritability was estimated for each of the traits and genetic correlation (rg) analyses were performed to assess MCP-SUD pleiotropy. Bidirectional Mendelian Randomization analyses evaluated possible causal relationships. Finally, to identify and characterize individual loci, we performed a genome-wide pleiotropy analysis and a brain-wide analysis using imaging phenotypes available from the UK Biobank. MCP was positively genetically correlated with AUD (rg = 0.26, p = 7.55 × 10-18), CanUD (rg = 0.37, p = 8.21 × 10-37), OUD (rg = 0.20, p = 1.50 × 10-3), and PTU (rg = 0.29, p = 8.53 × 10-12). Although the MR analyses supported bi-directional relationships, MCP had larger effects on AUD (pain-exposure: beta = 0.18, p = 8.21 × 10-4; pain-outcome: beta = 0.07, p = 0.018), CanUD (pain-exposure: beta = 0.58, p = 2.70 × 10-6; pain-outcome: beta = 0.05, p = 0.014) and PTU (pain-exposure: beta = 0.43, p = 4.16 × 10-8; pain-outcome: beta = 0.09, p = 3.05 × 10-6) than the reverse. The genome-wide analysis identified two SNPs pleiotropic between MCP and all SUD investigated: IHO1 rs7652746 (ppleiotropy = 2.69 × 10-8), and CADM2 rs1248857 (ppleiotropy = 1.98 × 10-5). In the brain-wide analysis, rs7652746 was associated with multiple cerebellum and amygdala imaging phenotypes. When analyzing MCP pleiotropy with each SUD separately, we found 25, 22, and 4 pleiotropic variants for AUD, CanUD, and OUD, respectively. To our knowledge, this is the first large-scale study to provide evidence of potential causal relationships and shared genetic mechanisms underlying MCP-SUD comorbidity.
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Affiliation(s)
- Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain.
| | - Eleni Friligkou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Solveig Løkhammer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Alexander S Hatoum
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Crowe RP, Kennel J, Fernandez AR, Burton BA, Wang HE, Van Vleet L, Bourn SS, Myers JB. Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures. Ann Emerg Med 2023; 82:535-545. [PMID: 37178100 DOI: 10.1016/j.annemergmed.2023.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/20/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate racial and ethnic disparities in out-of-hospital analgesic administration, accounting for the influence of clinical characteristics and community socioeconomic vulnerability, among a national cohort of patients with long bone fractures. METHODS Using the 2019-2020 ESO Data Collaborative, we retrospectively analyzed emergency medical services (EMS) records for 9-1-1 advanced life support transport of adult patients diagnosed with long bone fractures at the emergency department. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for out-of-hospital analgesic administration by race and ethnicity, accounting for age, sex, insurance, fracture location, transport time, pain severity, and scene Social Vulnerability Index. We reviewed a random sample of EMS narratives without analgesic administration to identify whether other clinical factors or patient preferences could explain differences in analgesic administration by race and ethnicity. RESULTS Among 35,711 patients transported by 400 EMS agencies, 81% were White, non-Hispanic, 10% were Black, non-Hispanic, and 7% were Hispanic. In crude analyses, Black, non-Hispanic patients with severe pain were less likely to receive analgesics compared with White, non-Hispanic patients (59% versus 72%; Risk Difference: -12.5%, 95% CI: -15.8% to -9.9%). After adjustment, Black, non-Hispanic patients remained less likely to receive analgesics compared with White, non-Hispanic patients (aOR:0.65, 95% CI:0.53 to 0.79). Narrative review identified similar rates of patients declining analgesics offered by EMS and analgesic contraindications across racial and ethnic groups. CONCLUSIONS Among EMS patients with long bone fractures, Black, non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics compared with White, non-Hispanic patients. These disparities were not explained by differences in clinical presentations, patient preferences, or community socioeconomic conditions.
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Affiliation(s)
| | - Jamie Kennel
- Oregon Health and Science University, Portland, OR; Oregon Institute of Technology, Wilsonville, OR
| | | | | | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
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Pavone K, Gorgol H, Rust V, Bronski M, Labelle C, Compton P. Exploring the postoperative pain experiences of individuals with opioid use disorder and the nurses providing care in the USA: A qualitative descriptive study protocol. BMJ Open 2023; 13:e072187. [PMID: 37848308 PMCID: PMC10583043 DOI: 10.1136/bmjopen-2023-072187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The goal of this study is to gain firsthand insights from individuals with a history of opioid use disorder (OUD) using medication for OUD on their experiences with postoperative pain care. This study also seeks to describe the experiences of nurses caring for individuals with OUD, and the challenges they may face managing complaints of pain in this population. Research suggests that hospitals can significantly enhance the quality of the care they deliver by investigating an individual's experience in the care setting. These insights will allow for the development of strategies for nurses to deepen their understanding of and, therefore, advocate and improve care for, this vulnerable and often stigmatised population. METHODS AND ANALYSIS A qualitative descriptive study will be conducted consisting of a prescreening and demographics questionnaire, and individual semistructured interviews with approximately 10-15 individuals with OUD having recently undergone surgery and 10-15 nurses providing care for this population for a total of 20-30 interviews. This approach involves the collection of separate but complementary data (ie, perceptions of individuals with OUD and nurses) concerning the phenomena of postoperative pain management. Sampling will continue until data saturation is reached. Descriptive statistics and thematic analysis will then be used. Reporting will adhere to the Standards for Reporting Qualitative Research checklist. ETHICS AND DISSEMINATION This study received approval from the Institutional Review Board at Northeastern University. Alongside peer-reviewed journal publications, the findings will be presented at relevant conferences, and a plain language summary will be distributed to the study participants.
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Affiliation(s)
- Kara Pavone
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Hilary Gorgol
- Bouve College of Health Sciences, School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Victoria Rust
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, Massachusetts, USA
| | - Mary Bronski
- Bouve College of Health Sciences, School of Nursing, Northeastern University, Boston, Massachusetts, USA
| | - Colleen Labelle
- Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, Massachusetts, USA
| | - Peggy Compton
- College of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wilson M, McKennon S, Remsberg CM, Bindler RJ, Anderson J, Klein TA, Kobayashi R, Miller JC, DeWitt DE. Interprofessional Education to Address Substance Use among Adults with Persistent Pain: A Pre-Post Program Evaluation. Pain Manag Nurs 2023; 24:558-566. [PMID: 37455185 DOI: 10.1016/j.pmn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized. AIM To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use. METHODS A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data. RESULTS The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy). CONCLUSIONS Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.
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Affiliation(s)
- Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington.
| | - Skye McKennon
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Connie M Remsberg
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Ross J Bindler
- College of Nursing, Washington State University, Spokane, Washington
| | - Jennifer Anderson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Tracy A Klein
- College of Nursing, Washington State University, Vancouver, Washington
| | - Rie Kobayashi
- School of Social Work, Eastern Washington University, Cheney, Washington
| | - Jennifer C Miller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington
| | - Dawn E DeWitt
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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Fleck DE, Wilson M, Lewis D, Welge JA, Arya G, Sathyan A, Cohen K, John Winhusen T. Neurocognitive predictors of adherence to an online pain self-management program adjunct to long-term opioid therapy. J Clin Exp Neuropsychol 2023; 45:242-254. [PMID: 37278690 PMCID: PMC10526690 DOI: 10.1080/13803395.2023.2221396] [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: 12/15/2022] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION While pain self-management programs can significantly improve patient outcomes, poor adherence is common and the need for research on predictors of adherence has been noted. A potential, but commonly overlooked, predictor is cognitive function. Our aim, then, was to examine the relative influence of various cognitive functional domains on engagement with an online pain self-management program. METHOD A secondary analysis of a randomized controlled trial testing the impact of E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program) plus treatment as usual, relative to treatment as usual alone, on pain and opioid dose outcomes in adults receiving long-term opioid therapy of morphine equivalence dose ≥20 mg; 165 E-health participants who completed an on-line neurocognitive battery were included in this sub-analysis. A variety of demographic, clinical, and symptom rating scales were also examined. We hypothesized that better processing speed and executive functions at baseline would predict engagement with the 4-month E-health subscription. RESULTS Ten functional cognitive domains were identified using exploratory factor analysis and the resultant factor scores applied for hypothesis testing. The strongest predictors of E-health engagement were selective attention, and response inhibition and speed domains. An explainable machine learning algorithm improved classification accuracy, sensitivity, and specificity. CONCLUSIONS The results suggest that cognition, especially selective attention, inhibitory control, and processing speed, is predictive of online chronic pain self-management program engagement. Future research to replicate and extend these findings seems warranted. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT03309188.
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Affiliation(s)
- David E. Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marian Wilson
- Washington State University College of Nursing, Spokane, WA, USA
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Daniel Lewis
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey A. Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grace Arya
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anoop Sathyan
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH, USA
| | - Kelly Cohen
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati College of Engineering and Applied Science, Cincinnati, OH, USA
| | - T. John Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Sowicz TJ, Compton P, Matteliano D, Oliver J, Strobbe S, St Marie B, Turner HN, Wilson M. Pain Management and Substance Use Disorders: A Position Statement. J Addict Nurs 2023; 34:5-7. [PMID: 36857542 PMCID: PMC10112542 DOI: 10.1097/jan.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
ABSTRACT The American Society for Pain Management Nursing and the International Nurses Society on Addictions hold the position that persons with co-occurring pain and substance use disorder have the right to be treated with dignity and respect and receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Nonopioid and nonpharmacological approaches to pain management are recommended. Opioids should not be withheld from anyone if necessary to treat pain, and a team-based approach, including pain and addiction specialists, should be utilized when possible. Pain management should include interventions aimed at minimizing the risk for relapse or escalation of problematic substance use and actively involve the person and their support persons in the plan of care. Institutions should establish policies and procedures that support this position statement.
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Sowicz TJ, Compton P, Matteliano D, Oliver J, Strobbe S, St Marie B, Turner HN, Wilson M. Pain Management and Substance Use Disorders. Pain Manag Nurs 2022; 23:691-692. [PMID: 36202737 PMCID: PMC9772122 DOI: 10.1016/j.pmn.2022.08.015] [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: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
The American Society for Pain Management Nursing and the International Nurses Society on Addictions hold the position that persons with co-occurring pain and substance use disorder have the right to be treated with dignity and respect, and receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Non-opioid and nonpharmacological approaches to pain management are recommended. Opioids should not be withheld from anyone if necessary to treat pain, and a team-based approach, including pain and addiction specialists, should be utilized when possible. Pain management should include interventions aimed at minimizing the risk for relapse or escalation of problematic substance use, and actively involve the person and their support persons in the plan of care. Institutions should establish policies and procedures that support this position statement.
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Affiliation(s)
| | - Peggy Compton
- University of Pennsylvania School of Nursing, van Ameringen Chair in Psychiatric and Mental Health Nursing, Philadelphia, Pennsylvania
| | | | - June Oliver
- Swedish Hospital, University of Illinois, Chicago, Illinois
| | - Stephen Strobbe
- University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Helen N Turner
- Oregon Health & Science University School of Nursing, Portland, Oregon
| | - Marian Wilson
- Washington State University College of Nursing, Spokane, Washington
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12
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Nursing Leadership in Innovation. Pain Manag Nurs 2022; 23:89-90. [PMID: 35307172 DOI: 10.1016/j.pmn.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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