1
|
Khan R, Laumet G, Leinninger GM. Hungry for relief: Potential for neurotensin to address comorbid obesity and pain. Appetite 2024; 200:107540. [PMID: 38852785 DOI: 10.1016/j.appet.2024.107540] [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: 02/01/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Chronic pain and obesity frequently occur together. An ideal therapy would alleviate pain without weight gain, and most optimally, could promote weight loss. The neuropeptide neurotensin (Nts) has been separately implicated in reducing weight and pain but could it be a common actionable target for both pain and obesity? Here we review the current knowledge of Nts signaling via its receptors in modulating body weight and pain processing. Evaluating the mechanism by which Nts impacts ingestive behavior, body weight, and analgesia has potential to identify common physiologic mechanisms underlying weight and pain comorbidities, and whether Nts may be common actionable targets for both.
Collapse
Affiliation(s)
- Rabail Khan
- Neuroscience Program, Michigan State University, East Lansing, MI, 48824, USA
| | - Geoffroy Laumet
- Neuroscience Program, Michigan State University, East Lansing, MI, 48824, USA; Department of Physiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Gina M Leinninger
- Neuroscience Program, Michigan State University, East Lansing, MI, 48824, USA; Department of Physiology, Michigan State University, East Lansing, MI, 48824, USA.
| |
Collapse
|
2
|
Brezic N, Gligorevic S, Candido KD, Knezevic NN. Assessing suicide risk in chronic pain management: a narrative review across drug classes. Expert Opin Drug Saf 2024:1-21. [PMID: 39126380 DOI: 10.1080/14740338.2024.2391999] [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: 02/26/2024] [Revised: 06/28/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk. AREAS COVERED This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions. EXPERT OPINION While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.
Collapse
Affiliation(s)
- Nebojsa Brezic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
| | - Strahinja Gligorevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
| | - Kenneth D Candido
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL, USA
- Department of Anesthesiology, University of Illinois, Chicago, IL, USA
- Department of Surgery, University of Illinois, Chicago, IL, USA
| |
Collapse
|
3
|
Cihan E, Dilara Durmaz E, Arca M, Sahbaz Pirincci C. Comparing Relationships Between Pain Coping Levels and Pain, Functional Capacity, and Disability Among Patients with Fibromyalgia and Healthy Controls. Percept Mot Skills 2024:315125241272677. [PMID: 39121018 DOI: 10.1177/00315125241272677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
We compared the relationships between pain coping levels and pain, functional capacity, and disability among 48 patients with fibromyalgia and 48 healthy control participants. Specific characteristics of those diagnosed with fibromyalgia syndrome were documented. Participants were evaluated with the Visual Analog Scale (VAS), Pain Coping Scale (PCQ), Pain Disability Index (PDI), and Fibromyalgia Impact Questionnaire (FIQ). According to the 10 cm long VAS, fibromyalgia patients recorded pain intensity at 7 cm, significantly higher than in the control group (p < .001). All sub-scores of the PDI score were higher among patients with fibromyalgia compared to controls (p < .001). Scores on the PCQ score were higher for patients with fibromyalgia than controls on the sub-parameters of helplessness (p < .001) and medical remedies (p < .001). Functionality was lower among patients than controls (p < .001). Pain coping and pain-related disability (in areas of recreation, social activity, sexual behavior, total score) were significantly related in patients with fibromyalgia. These findings underscore the importance of comprehensive pain management and customized interventions for fibromyalgia patients to address their elevated pain intensity, reduced functionality, increased pain-related disability, and variable coping mechanisms compared to healthy controls. Understanding these correlations between pain coping strategies, functional status, and disability levels can help optimize treatment approaches and improve the quality of life for individuals living with fibromyalgia.
Collapse
Affiliation(s)
- Emine Cihan
- Department of Therapy and Rehabilitation, Vocational School of Health Sciences, Physiotherapy Program, Selçuk University, Konya, Turkey
| | - Elif Dilara Durmaz
- Physiotherapy and Rehabilitation Clinic, Karaman Training and Research Hospital, Karaman, Turkey
| | - Muhammed Arca
- Department of Physiotherapy and Rehabilitation, University of Health Sciences, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Cansu Sahbaz Pirincci
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
4
|
Gozzi N, Preatoni G, Ciotti F, Hubli M, Schweinhardt P, Curt A, Raspopovic S. Unraveling the physiological and psychosocial signatures of pain by machine learning. MED 2024:S2666-6340(24)00298-8. [PMID: 39116869 DOI: 10.1016/j.medj.2024.07.016] [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: 02/23/2024] [Revised: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Pain is a complex subjective experience, strongly impacting health and quality of life. Despite many attempts to find effective solutions, present treatments are generic, often unsuccessful, and present significant side effects. Designing individualized therapies requires understanding of multidimensional pain experience, considering physical and emotional aspects. Current clinical pain assessments, relying on subjective one-dimensional numeric self-reports, fail to capture this complexity. METHODS To this aim, we exploited machine learning to disentangle physiological and psychosocial components shaping the pain experience. Clinical, psychosocial, and physiological data were collected from 118 chronic pain and healthy participants undergoing 40 pain trials (4,697 trials). FINDINGS To understand the objective response to nociception, we classified pain from the physiological signals (accuracy >0.87), extracting the most important biomarkers. Then, using multilevel mixed-effects models, we predicted the reported pain, quantifying the mismatch between subjective level and measured physiological response. From these models, we introduced two metrics: TIP (subjective index of pain) and Φ (physiological index). These represent possible added value in the clinical process, capturing psychosocial and physiological pain dimensions, respectively. Patients with high TIP are characterized by frequent sick leave from work and increased clinical depression and anxiety, factors associated with long-term disability and poor recovery, and are indicated for alternative treatments, such as psychological ones. By contrast, patients with high Φ show strong nociceptive pain components and could benefit more from pharmacotherapy. CONCLUSIONS TIP and Φ, explaining the multidimensionality of pain, might provide a new tool potentially leading to targeted treatments, thereby reducing the costs of inefficient generic therapies. FUNDING RESC-PainSense, SNSF-MOVE-IT197271.
Collapse
Affiliation(s)
- Noemi Gozzi
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Federico Ciotti
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland
| | - Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092 Zürich, Switzerland; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria.
| |
Collapse
|
5
|
Esposto M, Pellicciari L, Cecchetto S, Chiarotto A, Testa M, Turolla A, Polli A. Italian versions of the Neurophysiology of Pain Questionnaire (NPQ): psychometric properties and an investigation on the understanding of pain neurophysiology in physical therapists. Musculoskelet Sci Pract 2024; 72:102957. [PMID: 38642475 DOI: 10.1016/j.msksp.2024.102957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/29/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES The Neurophysiology of Pain Questionnaire (NPQ) is widely used to assess pain knowledge among clinicians and patients with pain, but an Italian version is not available. This study aimed to translate and cross-culturally adapt the NPQ into Italian, to test its psychometric properties, to assess the knowledge of Italian physical therapists (PTs) on pain, and to evaluate which characteristics are associated with pain knowledge. METHODS The NPQ was translated into Italian, integrated with some additional questions (IT-NPQ-New), and sent by email via the Italian Association of Physiotherapy newsletter. Rasch analysis (RA) was used to test the psychometric properties of the Italian versions. Multivariable regression analyses were used to check for associations between participants' characteristics and their NPQ scores. RESULTS A sample of 753 PTs completed the survey. RA of the NPQ-19 and IT-NPQ-New revealed that 10 (IT-NPQ-10) and 18 (IT-NPQ-18) items fit the model. Both questionnaires showed good psychometric properties. The overall median score among Italian PTs was 6.0 [5.0-7.0] and 11.0 [9.0-13.0] points for the IT-NPQ-10 and the IT-NPQ-18, respectively. These scores were statistically different among groups according to gender, age, years of professional activity, post-graduate specialization and days attended of targeted pain courses, with the latter being the most influential variable. CONCLUSIONS Italian PTs now dispose of two tools to assess their basic knowledge related to pain science. Our study also showed that pain knowledge among Italian PTs needs improvement, especially considering recent biopsychosocial approaches to pain.
Collapse
Affiliation(s)
- Massimo Esposto
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, C/o Cardarelli Hospital, C/da Tappino, 86100, Campobasso, Italy
| | | | - Simone Cecchetto
- Health Professional and Rehabilitation Service APSS Trento, Trento, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Polli
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology, and Anatomy, Vrije Universiteit Brussel (VUB), Centre for Environment & Health, Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Research Foundation - Flanders (FWO), Belgium
| |
Collapse
|
6
|
Mibu A, Manfuku M, Nishigami T, Yamashita H, Imai R, Kanamori H, Sumiyoshi K. Association of Aromatase Inhibitor-Induced Musculoskeletal Symptoms with Central Sensitization-Related Symptoms: A Cross-Sectional Study. Breast Care (Basel) 2024; 19:207-214. [PMID: 39185132 PMCID: PMC11341075 DOI: 10.1159/000539867] [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: 12/13/2023] [Accepted: 06/16/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Aromatase inhibitor (AI)-induced musculoskeletal symptoms (AIMSS) can decrease health-related quality of life and lead to discontinuation of AI therapy for postmenopausal women with breast cancer (BC). Although central sensitization (CS) may contribute to AIMSS, the relevance of CS-related symptoms to AIMSS has not been fully clarified. This study aimed to investigate the relationship between AIMSS and CS-related symptoms in women with BC who received AI therapy. Methods This cross-sectional study recruited women who underwent BC surgery before at least 1 year and were taking AI for at least 6 months. Participants were assessed for joint pain and CS-related symptoms using the central sensitization inventory (CSI). The severity of CS-related symptoms was classified into three groups, and the prevalence of AIMSS was calculated. Multiple logistic regression analysis was used to assess the relationship between AIMSS and factors of possible relevance to AIMSS, including CSI severity. Results Of the 73 women who were included in this study, 31 (42.4%) were categorized into the AIMSS group and 42 (57.6%) into the non-AIMSS group. Participants with a history of chemotherapy and higher CSI score were significantly more likely to have AIMSS. Multiple logistic regression analysis showed that a history of chemotherapy (odds ratio = 4.21) and higher CSI severity (odds ratio = 13.43) had significantly associated with AIMSS. Conclusion CS-related symptoms assessed using CSI may be strongly associated with AIMSS. Further longitudinal studies to investigate the causal relationship and effectiveness of CS-targeted interventions are needed to prevent and treat AIMSS effectively.
Collapse
Affiliation(s)
- Akira Mibu
- Department of Physical Therapy, Konan Women’s University, Kobe, Japan
| | - Masahiro Manfuku
- Department of Rehabilitation, Breast Care Sensyu Clinic, Kishiwada, Japan
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Mihara, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara, Japan
| | - Hirofumi Yamashita
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Mihara, Japan
- Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Higashihiroshima, Japan
| | - Ryota Imai
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Japan
| | - Hiroe Kanamori
- Department of Breast Surgery, Breast Care Sensyu Clinic, Kishiwada, Japan
| | - Kazuhiro Sumiyoshi
- Department of Breast Surgery, Breast Care Sensyu Clinic, Kishiwada, Japan
| |
Collapse
|
7
|
Woo K. The Chronic Wound-Related Pain Model: Holistic Assessment and Person-Centered Treatment. Clin Geriatr Med 2024; 40:501-514. [PMID: 38960540 DOI: 10.1016/j.cger.2023.12.013] [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] [Indexed: 07/05/2024]
Abstract
Chronic wound-related pain is a complex biopsychosocial experience that is experienced spontaneously at rest and exacerbated during activities. Tissue debridement, trauma at dressing change, increased bioburden or infection, exposure of periwound skin to moisture, and related treatment can modulate chronic wound-related pain. Clinicians should consider multimodal and multidisciplinary management approach that take into account the biology, emotions, cognitive thinking, social environment, and other personal determinants of pain. Unresolved pain can have a significant impact on wound healing, patients' adherence to treatment, and individual's quality of life.
Collapse
Affiliation(s)
- Kevin Woo
- Faculty of Health Sciences, Queen's University, 92 Barrie Street, Kingston, Ontario K7L 3N6, Canada.
| |
Collapse
|
8
|
Arévalo-Martínez A, Barbosa-Torres C, Moreno-Manso JM, Cantillo-Cordero P, García-Baamonde ME, Díaz-Muñoz CL. Systematic Review of the Psychopathological Symptomatology and Neuropsychological Disorders of Chronic Primary Musculoskeletal Pain. Healthcare (Basel) 2024; 12:1465. [PMID: 39120169 PMCID: PMC11311596 DOI: 10.3390/healthcare12151465] [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: 05/15/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
Chronic pain can develop without tissue damage, injury, or underlying illness. There are several intervening biological, psychological, and social factors involved in its appearance that significantly affect the activities of daily life. It is also associated with significant emotional anxiety and/or functional disability. This review systematically analyses works published in the last five years that evaluate the psychopathological symptomatology and neuropsychological disorders of chronic primary musculoskeletal pain (CPMP). A bibliographic search was carried out to identify articles published in English between January 2018 and March 2023 using the Medline, Scopus, PsycInfo, and Pubmed databases. Twenty articles were obtained using the PRISMA selection method. The main results of this study provided evidence of the presence of moderate and severe chronic pain in patients suffering from musculoskeletal pain. This increase in the intensity of pain correlates with greater psychopathological symptomatology, such as depression, anxiety, insomnia, lack of attention, and hyperactivity/impulsiveness, as well as the use of maladaptive coping strategies. Furthermore, there exists dysfunction in the cerebral structures related to attention and the processing of pain in patients with CPMP. This review may help to develop and optimise the multidisciplinary treatments adapted to the deficits caused by this illness.
Collapse
Affiliation(s)
- Alejandro Arévalo-Martínez
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain; (A.A.-M.); (J.M.M.-M.); (P.C.-C.); (M.E.G.-B.)
| | - Carlos Barbosa-Torres
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain; (A.A.-M.); (J.M.M.-M.); (P.C.-C.); (M.E.G.-B.)
| | - Juan Manuel Moreno-Manso
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain; (A.A.-M.); (J.M.M.-M.); (P.C.-C.); (M.E.G.-B.)
| | - Pilar Cantillo-Cordero
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain; (A.A.-M.); (J.M.M.-M.); (P.C.-C.); (M.E.G.-B.)
| | - María Elena García-Baamonde
- Department of Psychology, Faculty of Education and Psychology, University of Extremadura, 06071 Badajoz, Spain; (A.A.-M.); (J.M.M.-M.); (P.C.-C.); (M.E.G.-B.)
| | - César Luis Díaz-Muñoz
- Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, 06071 Badajoz, Spain;
| |
Collapse
|
9
|
Sheykhangafshe FB, Farahani H, Watson P. Using exploratory graph analysis (EGA) in validating the structure of the Perth alexithymia questionnaire in Iranians with chronic pain. Front Psychol 2024; 15:1400340. [PMID: 39021647 PMCID: PMC11253556 DOI: 10.3389/fpsyg.2024.1400340] [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] [Received: 04/11/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Background Chronic pain's influence on emotional well-being can be significant. It may evoke feelings of despair, frustration, nervousness, and melancholy in individuals, which often manifest as reactions to enduring pain and disruptions in their daily lives. In this study, we seek to perform Bootstrap Exploratory Graph Analysis (EGA) on the Persian Version of the Perth Alexithymia Questionnaire (PAQ) in a cohort of people with chronic pain. Methods The research concentrated on the population of individuals encountering chronic pain within Tehran province from 2022 to 2023. Ultimately, the analysis comprised information from 234 male participants (with a mean age of 30.59, SD = 6.84) and 307 female participants (with a mean age of 30.16, SD = 6.65). After data collection, statistical analysis was conducted using the EGAnet2.0.4 package in R.4.3.2 software. Results The outcome of bootstrapped EGA unveiled a two-dimensional configuration of the PAQ comprising Factor 1 denoted as negative difficulty in describing and identifying feelings (N-DDIF) and Factor 2 characterized as general-externally orientated thinking (GEOT), representing robust structural integrity and item consistency (all items have stabilities > 0.70). Conclusion These findings endorse the validity of the PAQ, as evidenced by its confirmation in a broader sample using a novel methodology consistent with existing literature on two-factor decentering models.
Collapse
Affiliation(s)
| | - Hojjatollah Farahani
- Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, Cambridge University, Cambridge, United Kingdom
| |
Collapse
|
10
|
Haun JN, Schneider T, Ballistrea LM, McMahon-Grenz J, Melillo C, Benzinger R, Paykel JM. Veterans' lived experiences with the VA's Whole Health system and perceived impact on dimensions of wellness. Explore (NY) 2024; 20:554-561. [PMID: 38184376 DOI: 10.1016/j.explore.2023.12.013] [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: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
RESEARCH QUESTION What are the lived experiences and wellness related outcomes of veterans engaged in the Department of Veterans' Affairs (VA) Whole Health (WH) system of care? THEORETICAL FRAMEWORK This qualitative work was conducted with a pragmatic phenomenological approach to understand patients' lived experience within the WH system of care. Data were contextualized within a multi-dimensional wellness model. METHODOLOGY This descriptive quality improvement project used semi-structured telephone interviews. Interview script elicited veterans' WH participation experiences and perceived wellness related outcomes. CONTEXT Data were collected within a WH Service, at a large Veterans Health Administration Hospital in the Southeast United States. SAMPLE SELECTION Data were collected with a purposive sample of veterans that participated in at least 2 WH activities. DATA COLLECTION Patients were recruited by WH clinical team collaborators to participate in qualitative data collection. ANALYSIS AND INTERPRETATION Rapid content analysis and interpretation of results were conducted in alignment with dimensions of wellness constructs. MAIN RESULTS WH offers veterans' non-pharmacological tools to improve mental, physical, and social wellness. Participants (n = 50) represented the larger veteran population. Most veterans perceived a positive WH experience with improvement of three primary dimensions including mental and emotional, physical, and social wellness - impacts on other dimensions gleaned less perceived impact. Veterans reported adopting mindfulness and coping strategies, better mobility, pain management, and sleep quality, and enhanced social engagement. Even those who did benefit personally from all aspects of WH, felt the services are needed to support the larger veteran population. Reduced suicidal ideation and pain medication use emerged as a WH effect among approximately 10% of the sample.
Collapse
Affiliation(s)
- Jolie N Haun
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Tali Schneider
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States
| | - Lisa M Ballistrea
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States
| | - Julie McMahon-Grenz
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States
| | - Christine Melillo
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States
| | - Rachel Benzinger
- Research and Development Service, James A. Haley Veterans' Hospital, Research Service, 8900 Grand Oak Circle, Tampa, FL 33637, United States.
| | - Jacquelyn M Paykel
- Whole Health Service, James A. Haley Veterans Hospital, Tampa, FL 33637, United States
| |
Collapse
|
11
|
Stubhaug A, Hansen JL, Hallberg S, Gustavsson A, Eggen AE, Nielsen CS. The costs of chronic pain-Long-term estimates. Eur J Pain 2024; 28:960-977. [PMID: 38214661 DOI: 10.1002/ejp.2234] [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: 09/11/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain. METHODS The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence. RESULTS In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss. CONCLUSION Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain. SIGNIFICANCE This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.
Collapse
Affiliation(s)
- Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Liseth Hansen
- Quantify Research, Stockholm, Sweden
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
12
|
Zeng Y, Sun ML, Liu D, Huang Y, Xie S, Zhao YX, Wu ZX, Liu Y, Ma G, Xie L, Dang YT, Hao LY, Wang QH, Wang HJ, Yang L, Xue ZY, Pan ZQ. Kv3.1 Interaction with UBR5 Is Required for Chronic Inflammatory Pain. Mol Neurobiol 2024:10.1007/s12035-024-04259-5. [PMID: 38865078 DOI: 10.1007/s12035-024-04259-5] [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: 02/01/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024]
Abstract
Chronic inflammatory pain caused by neuronal hyperactivity is a common and refractory disease. Kv3.1, a member of the Kv3 family of voltage-dependent K+ channels, is a major determinant of the ability of neurons to generate high-frequency action potentials. However, little is known about its role in chronic inflammatory pain. Here, we show that although Kv3.1 mRNA expression was unchanged, Kv3.1 protein expression was decreased in the dorsal spinal horn of mice after plantar injection of complete Freund's adjuvant (CFA), a mouse model of inflammatory pain. Upregulating Kv3.1 expression alleviated CFA-induced mechanical allodynia and heat hyperalgesia, whereas downregulating Kv3.1 induced nociception-like behaviors. Additionally, we found that ubiquitin protein ligase E3 component n-recognin 5 (UBR5), a key factor in the initiation of chronic pain, binds directly to Kv3.1 to drive its ubiquitin degradation. Intrathecal injection of the peptide TP-CH-401, a Kv3.1 ubiquitination motif sequence, rescued the decrease in Kv3.1 expression and Kv currents through competitive binding to UBR5, and consequently attenuated mechanical and thermal hypersensitivity. These findings demonstrate a previously unrecognized pathway of Kv3.1 abrogation by UBR5 and indicate that Kv3.1 is critically involved in the regulation of nociceptive behavior. Kv3.1 is thus a promising new target for treating inflammatory pain.
Collapse
Affiliation(s)
- Ying Zeng
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Meng-Lan Sun
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Di Liu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Huang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Shan Xie
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Ya-Xuan Zhao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Zi-Xuan Wu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Ya Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Gan Ma
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Ling Xie
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Yu-Tao Dang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Ling-Yun Hao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Qi-Hui Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Hong-Jun Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Li Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China
| | - Zhou-Ya Xue
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China.
- Department of Anesthesiology, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng, Yancheng, 224008, China.
| | - Zhi-Qiang Pan
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Tong Shan Road no. 209, Xuzhou, 221004, Jiangsu Province, China.
| |
Collapse
|
13
|
Sidiq M, Muzaffar T, Janakiraman B, Masoodi S, Vasanthi RK, Ramachandran A, Bansal N, Chahal A, Kashoo FZ, Rizvi MR, Sharma A, Rai RH, Verma R, Sharma M, Alam S, Vajrala KR, Sharma J, Muthukrishnan R. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial. PLoS One 2024; 19:e0294302. [PMID: 38805446 PMCID: PMC11132453 DOI: 10.1371/journal.pone.0294302] [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: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. METHODS The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. FINDINGS Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). CONCLUSION The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain.
Collapse
Affiliation(s)
- Mohammad Sidiq
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Tufail Muzaffar
- Departmet of Physical Medicine & Rehabilitation, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Balamurugan Janakiraman
- SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chennai, Tamil Nadu, India
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Shariq Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | | | - Arunachalam Ramachandran
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Nitesh Bansal
- Jindal School of Public Health & Human Development, O P Jindal Global University, Sonipat, Haryana, India
| | - Aksh Chahal
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Moattar Raza Rizvi
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Ankita Sharma
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Richa Hirendra Rai
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Rituraj Verma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Monika Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Sajjad Alam
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Krishna Reddy Vajrala
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Jyoti Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | | |
Collapse
|
14
|
Pinto BM, Tavares I, Pozza DH. Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:686. [PMID: 38792869 PMCID: PMC11122846 DOI: 10.3390/medicina60050686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.
Collapse
Affiliation(s)
- Beatriz Manarte Pinto
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
| | - Isaura Tavares
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| | - Daniel Humberto Pozza
- Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal; (B.M.P.); (I.T.)
- Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-135 Porto, Portugal
| |
Collapse
|
15
|
Huo L, Liu G, Deng B, Xu L, Mo Y, Jiang S, Tao J, Bai H, Wang L, Yang X, Yang J, Mu X. Effect of use of NSAIDs or steroids during the acute phase of pain on the incidence of chronic pain: a systematic review and meta-analysis of randomised trials. Inflammopharmacology 2024; 32:1039-1058. [PMID: 38153536 PMCID: PMC11006744 DOI: 10.1007/s10787-023-01405-8] [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: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND This study is the first to summarize the evidence on how the use of anti-inflammatory drugs during acute pain has an impact on the development of chronic pain. METHODS Randomized controlled trials retrieved from nine databases included anti-inflammatory drugs (NSAIDs or steroids) versus non-anti-inflammatory drugs in patients with acute pain and reported the incidence of chronic pain. No specified date, age, sex, or language restrictions. Subgroup analyses were performed according to pain classification, follow-up time, and medication. The GRADE method was used to evaluate quality of evidence. RESULTS A total of 29 trials (5220 patients) were included. Steroids or NSAIDs did not reduce the incidence of chronic nociceptive pain. Steroid use in acute phase significantly reduced the incidence of chronic neuropathic pain. In subgroup analysis, benefits were observed for methylprednisolone and dexamethasone, with some adverse effects. Steroids or NSAIDs were statistically significant in reducing pain intensity over 1 year, but the effect size was too small, and whether the long-term effect is clinically relevant needs to be further studied. CONCLUSION Quality of the evidence was low to moderate. No drug can be recommended to prevent chronic nociceptive pain. Injections of steroids (methylprednisolone or dexamethasone) during the acute phase reduce the incidence of chronic neuropathic pain, but most included studies also used local anesthetics. The results are indirect and need to be interpreted with caution. The pooled data effect sizes for pain intensity were small, so the clinical relevance was unclear. Study registration PROSPERO (CRD42022367030).
Collapse
Affiliation(s)
- Luyao Huo
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Gang Liu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bowen Deng
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Division of Intelligent and Biomechanical System, State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Lin Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yanjun Mo
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shengyuan Jiang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jingwei Tao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Huizhong Bai
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Li Wang
- Beijing An Yuan Quan Lv Medical Research Institute, Beijing, China
| | | | - Jizhou Yang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| |
Collapse
|
16
|
Xu J, Zhang H, Chen D, Xu K, Li Z, Wu H, Geng X, Wei X, Wu J, Cui W, Wei S. Looking for a Beam of Light to Heal Chronic Pain. J Pain Res 2024; 17:1091-1105. [PMID: 38510563 PMCID: PMC10953534 DOI: 10.2147/jpr.s455549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
Chronic pain (CP) is a leading cause of disability and a potential factor that affects biological processes, family relationships, and self-esteem of patients. However, the need for treatment of CP is presently unmet. Current methods of pain management involve the use of drugs, but there are different degrees of concerning side effects. At present, the potential mechanisms underlying CP are not completely clear. As research progresses and novel therapeutic approaches are developed, the shortcomings of current pain treatment methods may be overcome. In this review, we discuss the retinal photoreceptors and brain regions associated with photoanalgesia, as well as the targets involved in photoanalgesia, shedding light on its potential underlying mechanisms. Our aim is to provide a foundation to understand the mechanisms underlying CP and develop light as a novel analgesic treatment has its biological regulation principle for CP. This approach may provide an opportunity to drive the field towards future translational, clinical studies and support pain drug development.
Collapse
Affiliation(s)
- Jialing Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hao Zhang
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Dan Chen
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Kaiyong Xu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Zifa Li
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Hongyun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xiwen Geng
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Xia Wei
- NMPA Key Laboratory for Research and Evaluation of Generic Drugs, Shandong Institute for Food and Drug Control, Ji’nan, Shandong, People’s Republic of China
| | - Jibiao Wu
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Wenqiang Cui
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| | - Sheng Wei
- The Key Laboratory of Traditional Chinese Medicine Classic Theory of Ministry of Education, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
- Chinese Medicine and Brain Science Interdisciplinary Research Institute, Shandong University of Traditional Chinese Medicine, Ji’nan, Shandong, People’s Republic of China
| |
Collapse
|
17
|
Wang Y, Hu S, Chen Y, Chen M, Zhang D, Liu W, Chen C, Gan Y, Luo M, Ke B. Discovery of a novel series of pyridone amides as Na V1.8 inhibitors. Bioorg Med Chem Lett 2024; 101:129655. [PMID: 38350529 DOI: 10.1016/j.bmcl.2024.129655] [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: 11/30/2023] [Revised: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/15/2024]
Abstract
The NaV1.8 channel, mainly found in the peripheral nervous system, is recognized as one of the key factors in chronic pain. The molecule VX-150 was initially promising in targeting this channel, but the phase II trials of VX-150 did not show expected pain relief results. By analyzing the interaction mode of VX-150 and NaV1.8, we developed two series with a total of 19 molecules and examined their binding affinity to NaV1.8 in vitro and analgesic effect in vivo. One compound, named 2j, stood out with notable activity against the NaV1.8 channel and showed effective pain relief in models of chronic inflammatory pain and neuropathic pain. Our research points to 2j as a strong contender for developing safer pain-relief treatments.
Collapse
Affiliation(s)
- Yanfang Wang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Shilong Hu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuhao Chen
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Meiyuan Chen
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Di Zhang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wencheng Liu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Chunxia Chen
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yu Gan
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Menglan Luo
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Bowen Ke
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
18
|
Adler L, Cohen B, Shapiro Ben Daviv S, Liran O, Rahamim-Cohen D, Nakhleh A, Shahar A, Azuri J. Use of prescription opioids in Israel and socio-economic correlations between 2010 and 2020. Isr J Health Policy Res 2024; 13:12. [PMID: 38449021 PMCID: PMC10918956 DOI: 10.1186/s13584-024-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The use of opioids has increased dramatically over the past several years in Israel. The aim of this study was to explore the trends of opioid consumption in Israel over a decade (2010-2020) stratified by socioeconomic status (SES), residence in the periphery, and ethnic background. METHODS This cross-sectional study included all adult Maccabi Healthcare Services (MHS) patients who filled at least one prescription for opioids during the past decade. In order to standardize dosages and compare different opioid medications, we used the Morphine Milligram Equivalent (MME) conversion factor. We performed The Mann-Kendall test with autocorrelation correction to assess each trend. We then checked the differences between the trends with the Mann-Whitney test (for periphery) and the Kruskal Wallis (for SES and ethnic background). RESULTS Between the years 2010-2020, 261,270 MHS members met the study's inclusion criteria. The proportions of opioids consumption were 23.9/1000 patients in 2010 and 27.6/1000 patients in 2020, representing a 15% increase. The average daily consumption of opioids was 4.6 and 10.5 MME in 2010 and 2020, respectively, an increase of 227%. The daily MME during 2020 was higher for residents of the periphery compared to non-periphery residents (daily MME of 14.0 compared to 10.1, respectively). Average daily MME increased gradually during the study period for all levels of SES; the values were highest for the low SES group and the lowest for the high SES group (daily MME in 2020 for the lowest, middle, and high SES groups were 15.2 vs. 11.8 vs. 6.7 respectively). CONCLUSIONS This study highlights that the primary concern in the increase of opioid use is the increasing dosages. The increase in the number of patients using opioids is also significant but to a minor extent. These phenomena disproportionately impact vulnerable populations. Education programs should be offered to physicians regarding the possible harms of long-term use of opioids. These programs should emphasize the risk factors associated with the development of opioid use disorder (OUD) and the caution needed when increasing dosages or switching to higher-potency drugs. Pain clinics and centers for rehabilitation for patients with chronic pain or OUD should be available, not only in central areas but also in the periphery of the country. These clinics and centers should use a holistic approach and a multidisciplinary team that includes specialists in pain and addiction. They should be financially accessible for patients from low SES group and provide solutions in multiple languages.
Collapse
Affiliation(s)
- Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel.
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Bar Cohen
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ben Gurion University, Beer Sheva, Israel
| | - Shirley Shapiro Ben Daviv
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Liran
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Afif Nakhleh
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Arnon Shahar
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Joseph Azuri
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
19
|
Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [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: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
Collapse
Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
| |
Collapse
|
20
|
Wi D, Park C, Ransom JC, Flynn DM, Doorenbos AZ. A network analysis of pain intensity and pain-related measures of physical, emotional, and social functioning in US military service members with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:231-238. [PMID: 37944054 PMCID: PMC10906708 DOI: 10.1093/pm/pnad148] [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: 05/08/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The purpose of this study was to apply network analysis methodology to better understand the relationships between pain-related measures among people with chronic pain. METHODS We analyzed data from a cross-sectional sample of 4614 active duty service members with chronic pain referred to 1 military interdisciplinary pain management center between 2014 and 2021. Using a combination of Patient-Reported Outcomes Measurement Information System measures and other pain-related measures, we applied the "EBICglasso" algorithm to create regularized partial correlation networks that would identify the most influential measures. RESULTS Pain interference, depression, and anxiety had the highest strength in these networks. Pain catastrophizing played an important role in the association between pain and other pain-related health measures. Bootstrap analyses showed that the networks were very stable and the edge weights accurately estimated in 2 analyses (with and without pain catastrophizing). CONCLUSIONS Our findings offer new insights into the relationships between symptoms using network analysis. Important findings highlight the strength of association between pain interference, depression and anxiety, which suggests that if pain is to be treated depression and anxiety must also be addressed. What was of specific importance was the role that pain catastrophizing had in the relationship between pain and other symptoms suggesting that pain catastrophizing is a key symptom on which to focus for treatment of chronic pain.
Collapse
Affiliation(s)
- Dahee Wi
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, United States
| | - Chang Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, United States
| | - Jeffrey C Ransom
- Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Joint Base Lewis-McChord, WA 98431, United States
| | - Diane M Flynn
- Physical Performance Service Line, Madigan Army Medical Center, Interdisciplinary Pain Management Center, Joint Base Lewis-McChord, WA 98431, United States
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, United States
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, United States
| |
Collapse
|
21
|
Rojas-Galleguillos F, Clark-Hormazábal C, Méndez-Fuentes E, Guede-Rojas F, Mendoza C, Riveros Valdés A, Carvajal-Parodi C. Exercise-induced hypoalgesia in chronic neck pain: A narrative review. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:37-47. [PMID: 38463669 PMCID: PMC10918364 DOI: 10.1016/j.smhs.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 03/12/2024] Open
Abstract
Chronic neck pain (CNP) is a worldwide health problem with several risk factors. One of the most widely used treatments for managing this condition is therapeutic exercise, which could generate a response called exercise-induced hypoalgesia (EIH). There is no consensus on the best exercise modality to induce hypoalgesia. Therefore, this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP. We included articles on EIH and CNP in patients older than 18 years, with pain for more than three months, where the EIH response was measured. Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded. The studies reviewed reported variable results. Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity; however, in people with chronic pain, the response is variable. Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity, others found no clinical response, and some even reported EIH with decreased pain and increased sensitivity. EIH is an identifiable, stimulable, and helpful therapeutic response in people with pain. More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon. In addition, it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.
Collapse
Affiliation(s)
- Fernando Rojas-Galleguillos
- Universidad San Sebastián, Programa Magíster en Kinesiología Musculoesquelética, Lientur #1457, Concepción, Chile
| | - Cecilia Clark-Hormazábal
- Universidad San Sebastián, Programa Magíster en Kinesiología Musculoesquelética, Lientur #1457, Concepción, Chile
| | - Eduardo Méndez-Fuentes
- Universidad San Sebastián, Programa Magíster en Kinesiología Musculoesquelética, Lientur #1457, Concepción, Chile
| | - Francisco Guede-Rojas
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, 7591538, Chile
| | - Cristhian Mendoza
- Universidad San Sebastián, Laboratorio de Neurobiologí, Facultad de Odontología y Ciencias de la Rehabilitación, Lientur #1457, Concepción, Chile
| | - Andrés Riveros Valdés
- Universidad San Sebastián, Departamento de Ciencias Morfológicas, Facultad de Medicina y Ciencia, Lientur #1457, Concepción, Chile
| | - Claudio Carvajal-Parodi
- Universidad San Sebastián, Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Rehabilitación, Lientur #1457, Concepción, Chile
| |
Collapse
|
22
|
Anderson M, McCracken LM, Scott W. An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain. Front Psychol 2024; 15:1322723. [PMID: 38379625 PMCID: PMC10876841 DOI: 10.3389/fpsyg.2024.1322723] [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] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes. Materials and methods Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431). Results The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not. Discussion The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.
Collapse
Affiliation(s)
- Madeleine Anderson
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Whitney Scott
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
23
|
Kureshi S, Mendizabal M, Francis J, Djalilian HR. Conservative Management of Acute Sports-Related Concussions: A Narrative Review. Healthcare (Basel) 2024; 12:289. [PMID: 38338173 PMCID: PMC10855441 DOI: 10.3390/healthcare12030289] [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: 12/11/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.
Collapse
Affiliation(s)
- Sohaib Kureshi
- Neurosurgical Medical Clinic, San Diego, CA 92111, USA
- TBI Virtual, San Diego, CA 92111, USA
| | | | | | - Hamid R. Djalilian
- TBI Virtual, San Diego, CA 92111, USA
- Departments of Otolaryngology, Neurological Surgery, and Biomedical Engineering, University of California, Irvine, CA 92697, USA
| |
Collapse
|
24
|
de C Williams AC, McGrigor H. A thematic synthesis of qualitative studies and surveys of the psychological experience of painful endometriosis. BMC Womens Health 2024; 24:50. [PMID: 38238741 PMCID: PMC10795225 DOI: 10.1186/s12905-023-02874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Endometriosis is a widespread problem in women of reproductive age, causing cyclical and non-cyclical pain in the pelvis and elsewhere, and associated with fatigue, fertility problems, and other symptoms. As a chronic pain problem, psychological variables are important in adjustment and quality of life, but have not been systematically studied. METHODS A systematic search of multiple databases was conducted to obtain surveys and qualitative studies of women's experience of pain from endometriosis. Surveys were combined narratively; qualitative studies were combined by thematic synthesis, and the latter rated for methodological quality. RESULTS Over 2000 records were screened on title and abstract, and provided 22 surveys and 33 qualitative studies from which accounts could be extracted of the psychological components of pain in endometriosis. Surveys mostly addressed quality of life in endometriosis, with poorer quality of life associated with higher levels of pain and of distress, but few referred to coherent psychological models. Qualitative studies focused rather on women's experience of living with endometriosis, including trajectories of diagnosis and treatment, with a few addressing meaning and identity. Thematic synthesis provided 10 themes, under the groupings of internal experience of endometriosis (impact on body, emotions, and life); interface with the external world (through self-regulation and social regulation); effects on interpersonal and social life, and encounters with medical care. CONCLUSIONS The psychological components of pain from endometriosis only partly corresponded with standard psychological models of pain, derived from musculoskeletal pain studies, with fewer fears about physical integrity and more about difficulties of managing pain and other symptoms in social settings, including work. Better understanding of the particular psychological threats of endometriosis, and integration of this understanding into medical care with opportunities for psychologically-based pain management, would substantially improve the experience and quality of life of women with painful endometriosis.
Collapse
Affiliation(s)
- Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK.
| | - Honor McGrigor
- Research Dept of Clinical, Educational & Health Psychology, University College London, Gower St, London, WC1E 6BT, UK
| |
Collapse
|
25
|
Manhapra A, Zhou B, Rhee TG, Rosenheck RA. Is psychiatric diagnostic remission associated with reduced prevalence of moderate to severe pain interference and improved functioning among adults with lifetime psychiatric disorders? J Affect Disord 2024; 344:585-591. [PMID: 37863364 DOI: 10.1016/j.jad.2023.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/23/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Chronic pain and non-substance use psychiatric disorders (PD) are common comorbidities, both associated with impaired functioning. However, whether and how the prevalence of pain differs in remitted PD compared to past-year PD has been little studied. METHODS In this observational study using data from the National Epidemiologic Survey on Alcohol and Related Conditions III, we compared the prevalence of moderate/severe pain interference (PI) in past-year Vs remitted PD among adults with any lifetime PD. We further studied the association of both PI and PD remission with mental and physical function. RESULTS In a sample representative of 77.9 million US adults with lifetime PDs, 31.7 % met criteria for PD remission. The prevalence and adjusted odds of PI was substantially lower among those with remitted PD compared to past-year PD (21.97 % Vs 35.02 %; p < .0001; Odds ratio 0.58, 95 % confidence interval = 0.51-0.66). While PI was independently associated with poorer mental functioning (Regression coefficient (RC) = -4.43, standard error (SE) = 0.33; p < .0001), PD remission was associated with higher mental functioning (RC = 4.79, SE = 0.24; p < .0001). Both PI and PD remission were independently associated with lower physical functioning, but the association was substantially stronger with PI (RC = -15.04, SE 0.27; p < .0001) than PD remission (RC = -0.37, SE 0.15; p = .016). CONCLUSIONS The negative association of PD remission with PI and their strong associations with mental functioning, albeit in opposite directions, raises the need to further examine PD as a contributing factor in chronic pain and as a target in its treatment.
Collapse
Affiliation(s)
- Ajay Manhapra
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Hampton VA Medical center, Hampton, VA, United States of America; Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, VA, United States of America.
| | - Bin Zhou
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, United States of America
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| |
Collapse
|
26
|
Vali R, Azadi A, Tizno A, Farkhondeh T, Samini F, Samarghandian S. miRNA contributes to neuropathic pains. Int J Biol Macromol 2023; 253:126893. [PMID: 37730007 DOI: 10.1016/j.ijbiomac.2023.126893] [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: 05/13/2023] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
Neuropathic pain (NP) is a kind of chronic pain caused by direct injury to the peripheral or central nervous system (CNS). microRNAs (miRNAs) are small noncoding RNAs that mostly interact with the 3 untranslated region of messenger RNAs (mRNAs) to regulate the expression of multiple genes. NP is characterized by changes in the expression of receptors and mediators, and there is evidence that miRNAs may contribute to some of these alterations. In this review, we aimed to fully comprehend the connection between NP and miRNA; and also, to establish a link between neurology, biology, and dentistry. Studies have shown that targeting miRNAs may be an effective therapeutic strategy for the treatment of chronic pain and potential target for the prevention of NP.
Collapse
Affiliation(s)
- Reyhaneh Vali
- Department of Biology, Faculty of Modern Science, Tehran Medical Branch, Islamic Azad University, Tehran, Iran; Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Azadi
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashkan Tizno
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Farkhondeh
- Neuroscience Research Center, Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariborz Samini
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran
| | - Saeed Samarghandian
- Department of Toxicology and Pharmacology, School of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran.
| |
Collapse
|
27
|
Rahman S, Kidwai A, Rakhamimova E, Elias M, Caldwell W, Bergese SD. Clinical Diagnosis and Treatment of Chronic Pain. Diagnostics (Basel) 2023; 13:3689. [PMID: 38132273 PMCID: PMC10743062 DOI: 10.3390/diagnostics13243689] [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: 07/18/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved. Furthermore, it is a tremendous financial strain on the healthcare system, as over USD 100 billion is spent yearly in the United States on healthcare costs related to pain management and opioids. This exceeds the costs of diabetes, heart disease, and cancer-related care combined. Being able to properly diagnose, manage, and treat chronic pain conditions can substantially lower morbidity, mortality, and healthcare costs in the United States. This review will outline the current definitions, biopsychosocial model, subclassifications, somatosensory assessments, imaging, clinical prediction models, and treatment modalities associated with chronic pain.
Collapse
Affiliation(s)
| | | | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.R.); (A.K.); (E.R.); (M.E.); (W.C.)
| |
Collapse
|
28
|
Hunter R, Beattie M, O'Malley C, Gorely T. Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances. PEC INNOVATION 2023; 3:100175. [PMID: 38213759 PMCID: PMC10782115 DOI: 10.1016/j.pecinn.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 01/13/2024]
Abstract
Objective Chronic low back pain places a significant burden on healthcare services and sufferers. Clinical guidelines state that it is a condition that requires self-management. This realist synthesis explores how a mobile app could help people to self-manage chronic low back pain. Method Six databases and several non-academic sources were searched. In addition, nineteen realist interviews were conducted with stakeholders. Sources were selected and appraised for relevancy, richness, and rigour. Data was coded with analytical memos making retroductive inferences. Causal explanations were presented in context-mechanism-outcome configurations to form three programme theories. Results Data from 57 sources was synthesised to create 16 context-mechanism-outcome configurations and presented as three refined programme theories. The findings suggest people need to feel believed before they will engage with a self-management app. For those who feel abandoned by the healthcare service, a self-management app for chronic low back pain can be a valuable source of ongoing support and reduce feelings of social isolation. Conclusion A self-management app, if introduced appropriately and as adjunct to care, can be an empowering tool to self-manage chronic low back pain. Innovation Using input from key stakeholders enhances our understanding of the hidden generative mechanisms underpinning a programme's success or failure.
Collapse
Affiliation(s)
- Rebecca Hunter
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Michelle Beattie
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Chris O'Malley
- Specialist Librarian (Learning and Information Services), University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Trish Gorely
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| |
Collapse
|
29
|
Manjarres Z, Calvo M, Pacheco R. Regulation of Pain Perception by Microbiota in Parkinson Disease. Pharmacol Rev 2023; 76:7-36. [PMID: 37863655 DOI: 10.1124/pharmrev.122.000674] [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: 06/24/2022] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023] Open
Abstract
Pain perception involves current stimulation in peripheral nociceptive nerves and the subsequent stimulation of postsynaptic excitatory neurons in the spinal cord. Importantly, in chronic pain, the neural activity of both peripheral nociceptors and postsynaptic neurons in the central nervous system is influenced by several inflammatory mediators produced by the immune system. Growing evidence has indicated that the commensal microbiota plays an active role in regulating pain perception by either acting directly on nociceptors or indirectly through the modulation of the inflammatory activity on immune cells. This symbiotic relationship is mediated by soluble bacterial mediators or intrinsic structural components of bacteria that act on eukaryotic cells, including neurons, microglia, astrocytes, macrophages, T cells, enterochromaffin cells, and enteric glial cells. The molecular mechanisms involve bacterial molecules that act directly on neurons, affecting their excitability, or indirectly on non-neuronal cells, inducing changes in the production of proinflammatory or anti-inflammatory mediators. Importantly, Parkinson disease, a neurodegenerative and inflammatory disorder that affects mainly the dopaminergic neurons implicated in the control of voluntary movements, involves not only a motor decline but also nonmotor symptomatology, including chronic pain. Of note, several recent studies have shown that Parkinson disease involves a dysbiosis in the composition of the gut microbiota. In this review, we first summarize, integrate, and classify the molecular mechanisms implicated in the microbiota-mediated regulation of chronic pain. Second, we analyze the changes on the commensal microbiota associated to Parkinson disease and propose how these changes affect the development of chronic pain in this pathology. SIGNIFICANCE STATEMENT: The microbiota regulates chronic pain through the action of bacterial signals into two main locations: the peripheral nociceptors and the postsynaptic excitatory neurons in the spinal cord. The dysbiosis associated to Parkinson disease reveals increased representation of commensals that potentially exacerbate chronic pain and reduced levels of bacteria with beneficial effects on pain. This review encourages further research to better understand the signals involved in bacteria-bacteria and bacteria-host communication to get the clues for the development of probiotics with therapeutic potential.
Collapse
Affiliation(s)
- Zulmary Manjarres
- Laboratorio de Neuroinmunología, Centro Científico y Tecnológico de Excelencia Ciencia & Vida, Fundación Ciencia & Vida, Santiago, Chile (Z.M., R.P.); Facultad de Ciencias Biológicas (Z.M., M.C.) and División de Anestesiología, Escuela de Medicina (M.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for the Study of Pain, Santiago, Chile (Z.M., M.C.); and Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile (R.P.)
| | - Margarita Calvo
- Laboratorio de Neuroinmunología, Centro Científico y Tecnológico de Excelencia Ciencia & Vida, Fundación Ciencia & Vida, Santiago, Chile (Z.M., R.P.); Facultad de Ciencias Biológicas (Z.M., M.C.) and División de Anestesiología, Escuela de Medicina (M.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for the Study of Pain, Santiago, Chile (Z.M., M.C.); and Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile (R.P.)
| | - Rodrigo Pacheco
- Laboratorio de Neuroinmunología, Centro Científico y Tecnológico de Excelencia Ciencia & Vida, Fundación Ciencia & Vida, Santiago, Chile (Z.M., R.P.); Facultad de Ciencias Biológicas (Z.M., M.C.) and División de Anestesiología, Escuela de Medicina (M.C.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Nucleus for the Study of Pain, Santiago, Chile (Z.M., M.C.); and Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile (R.P.)
| |
Collapse
|
30
|
Valenza-Peña G, Martín-Núñez J, Heredia-Ciuró A, Navas-Otero A, López-López L, Valenza MC, Cabrera-Martos I. Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:3161. [PMID: 38132051 PMCID: PMC10743108 DOI: 10.3390/healthcare11243161] [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: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions.
Collapse
Affiliation(s)
| | | | | | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (G.V.-P.); (J.M.-N.); (A.H.-C.); (M.C.V.); (I.C.-M.)
| | | | | |
Collapse
|
31
|
Tamargo JA, Strath LJ, Karanth SD, Spector AL, Sibille KT, Anton S, Cruz-Almeida Y. Food insecurity is associated with chronic pain and high-impact chronic pain in the USA. Public Health Nutr 2023; 27:e7. [PMID: 38087858 PMCID: PMC10830368 DOI: 10.1017/s1368980023002732] [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: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study evaluated whether food insecurity (US Adult Food Security Survey) was associated with chronic pain (≥ 3 months) and high-impact chronic pain (i.e. pain that limits work and life) among US adults. DESIGN Cross-sectional analysis. SETTING Nationally representative sample of non-institutionalised adults in the USA. PARTICIPANTS 79 686 adults from the National Health Interview Survey (2019-2021). RESULTS Marginal, low and very low food security were associated with increased prevalence odds of chronic pain (OR: 1·58 (95 % CI 1·44, 1·72), 2·28 (95 % CI 2·06, 2·52) and 3·37 (95 % CI 3·01, 3·78), respectively) and high-impact chronic pain (OR: 1·28 (95 % CI 1·14, 1·42), 1·55 (95 % CI 1·37, 1·75) and 1·90 (95 % CI 1·65, 2·18), respectively) in a dose-response fashion (P-trend < 0·0001 for both), adjusted for sociodemographic, socio-economic and clinically relevant factors. Participation in Supplemental Nutrition Assistance Program (SNAP) and age modified the association between food insecurity and chronic pain. CONCLUSIONS These findings illustrate the impact of socio-economic factors on chronic pain and suggest that food insecurity may be a social determinant of chronic pain. Further research is needed to better understand the complex relationship between food insecurity and chronic pain and to identify targets for interventions. Moreover, the consideration of food insecurity in the clinical assessment of pain and pain-related conditions among socio-economically disadvantaged adults may be warranted.
Collapse
Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Larissa J Strath
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Antoinette L Spector
- College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| |
Collapse
|
32
|
Martineau DB, Fornasini M, Suárez D, Paz M, Valarezo C, Loor E, Guerrero M, Baldeon ME. Epidemiology of non-oncological high-impact chronic pain in Ecuadorian adults in 2022. Pain Manag 2023; 13:689-699. [PMID: 38193278 DOI: 10.2217/pmt-2023-0055] [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: 01/10/2024] Open
Abstract
Background: There are limited data on non-oncological high-impact chronic pain (HICP) in Ecuador; we report the epidemiological characteristics of HICP. Materials & methods: In this cross-sectional study, we included a random sample of adult individuals who had cell phones. Results & conclusion: The weighted prevalence of HICP was 9.0%: 12.3% for women and 5.6% for men (p = 0.001). HICP was more frequently localized in the lower back and affected the economically active population. Nonsteroidal anti-inflammatory drugs were more commonly used; however, 61% of patients indicated that the effectiveness of their management was low. Overall, HICP had a negative impact on daily life activities. The effectiveness of the current treatment was low and should include an integrated approach.
Collapse
Affiliation(s)
- Debora B Martineau
- Postgrado de Anestesiología en la Pontificia Universidad Católica del Ecuador (PUCE) Quito, Ecuador
- Postgrago de Anestesiología y Neurocirugia en la Universidad San Francisco de Quito, Quito Ecuador
| | - Marco Fornasini
- Facultad de Ciencias de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Daniela Suárez
- Facultad de Ciencias de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Mario Paz
- Facultad de Ciencias de la Salud, Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Cinthia Valarezo
- Postgrado de Anestesiología en la Pontificia Universidad Católica del Ecuador (PUCE) Quito, Ecuador
| | - Enrique Loor
- Facultad de Ciencias de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Manuel E Baldeon
- Facultad de Ciencias de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| |
Collapse
|
33
|
Dou Z, Su N, Zhou Z, Mi A, Xu L, Zhou J, Sun S, Liu Y, Hao M, Li Z. Modulation of visceral pain by brain nuclei and brain circuits and the role of acupuncture: a narrative review. Front Neurosci 2023; 17:1243232. [PMID: 38027491 PMCID: PMC10646320 DOI: 10.3389/fnins.2023.1243232] [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] [Received: 06/20/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Visceral pain is a complex and heterogeneous pain condition that is often associated with pain-related negative emotional states, including anxiety and depression, and can exert serious effects on a patient's physical and mental health. According to modeling stimulation protocols, the current animal models of visceral pain mainly include the mechanical dilatation model, the ischemic model, and the inflammatory model. Acupuncture can exert analgesic effects by integrating and interacting input signals from acupuncture points and the sites of pain in the central nervous system. The brain nuclei involved in regulating visceral pain mainly include the nucleus of the solitary tract, parabrachial nucleus (PBN), locus coeruleus (LC), rostral ventromedial medulla (RVM), anterior cingulate cortex (ACC), paraventricular nucleus (PVN), and the amygdala. The neural circuits involved are PBN-amygdala, LC-RVM, amygdala-insula, ACC-amygdala, claustrum-ACC, bed nucleus of the stria terminalis-PVN and the PVN-ventral lateral septum circuit. Signals generated by acupuncture can modulate the central structures and interconnected neural circuits of multiple brain regions, including the medulla oblongata, cerebral cortex, thalamus, and hypothalamus. This analgesic process also involves the participation of various neurotransmitters and/or receptors, such as 5-hydroxytryptamine, glutamate, and enkephalin. In addition, acupuncture can regulate visceral pain by influencing functional connections between different brain regions and regulating glucose metabolism. However, there are still some limitations in the research efforts focusing on the specific brain mechanisms associated with the effects of acupuncture on the alleviation of visceral pain. Further animal experiments and clinical studies are now needed to improve our understanding of this area.
Collapse
Affiliation(s)
- Zhiqiang Dou
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Na Su
- First Clinical Medicine College, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Ziyang Zhou
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Aoyue Mi
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Luyao Xu
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Jiazheng Zhou
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Sizhe Sun
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Yanyi Liu
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Mingyao Hao
- External Treatment Center of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji’nan, China
| | - Zhaofeng Li
- College of Acupuncture and Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Ji’nan, China
- International Office, Shandong University of Traditional Chinese Medicine, Ji’nan, China
| |
Collapse
|
34
|
Calvo S, González C, Lapuente-Hernández D, Cuenca-Zaldívar JN, Herrero P, Gil-Calvo M. Are physical therapy interventions effective in improving sleep in people with chronic pain? A systematic review and multivariate meta-analysis. Sleep Med 2023; 111:70-81. [PMID: 37725862 DOI: 10.1016/j.sleep.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Chronic pain exerts an enormous personal and economic burden, with sleep disturbances being one of the most reported problems by adults with chronic pain. The aim of this study was to analyse whether different physical therapy interventions could lead to improvements in sleep quality and pain intensity in individuals with chronic pain, as well as if there is any association. A systematic review and a univariate and multivariate meta-analysis were carried out according to the PRISMA guidelines. A search in PubMed, Scopus and Web of Science databases was performed. Six randomised controlled trials were included in the review and four of them were included in the meta-analysis; all of them with a moderate to high methodological quality. Data from adult participants with chronic pain after different physical therapy interventions was extracted. For the meta-analysis, the Insomnia Severity Index and the Numerical Rating Scale were considered. Results from the qualitative and quantitative analysis showed that most of the physical therapy interventions included had higher improvements in the intervention group than in the control group, although the effect size was not statistically significant (univariate for sleep quality: -0.08 [-0.34, 0.18], p = 0.46; univariate for pain intensity: -0.47 [-1.24, 0.30], p = 0.18; multivariate for both outcomes: -0.27). More studies are still needed to determine which physical therapy interventions are effective to improve sleep in people with chronic pain and if there are patients with specific characteristics who may benefit more than others.
Collapse
Affiliation(s)
- Sandra Calvo
- iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; iHealthy Research Group, IIS Aragon, Zaragoza, Spain.
| | - Cristina González
- iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Diego Lapuente-Hernández
- iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; iHealthy Research Group, IIS Aragon, Zaragoza, Spain.
| | - Juan Nicolás Cuenca-Zaldívar
- Universidad de Alcalá, Facultad de Medicina y Ciencias de la Salud, Departamento de Enfermería y Fisioterapia, Grupo de Investigación en Fisioterapia y Dolor, 28801 Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), Madrid, Spain; Primary Health Center "El Abajón", Las Rozas de Madrid, Spain.
| | - Pablo Herrero
- iHealthy Research Group, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; iHealthy Research Group, IIS Aragon, Zaragoza, Spain.
| | - Marina Gil-Calvo
- iHealthy Research Group, IIS Aragon, Zaragoza, Spain; Faculty of Physical Activity and Sports Sciences, AMRED, Universidad de León, León, Spain.
| |
Collapse
|
35
|
Sow Y, Salame N, Siira MR, Flowers N, Garg A, Patzer RE, Kavalieratos D, Curseen KA, Chen S, Orenstein LAV. Healthcare experiences among patients with hidradenitis suppurativa: a qualitative study. Br J Dermatol 2023; 189:624-626. [PMID: 37399246 PMCID: PMC10599793 DOI: 10.1093/bjd/ljad215] [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: 02/17/2023] [Revised: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 07/05/2023]
Abstract
In this qualitative study, 21 adults living with hidradenitis suppurativa (HS) were interviewed about their healthcare experiences. Participants detailed how delay in diagnosis, lack of provider knowledge, inadequate pain management, poor access to care and stigmatization negatively affected their interactions with the healthcare system. Improving disease knowledge among providers, proactively addressing HS-related pain and coordinating access to multidisciplinary care may improve healthcare experiences among individuals living with HS.
Collapse
Affiliation(s)
- Yacine Sow
- Morehouse School of Medicine, Atlanta, GA
| | | | | | | | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | | | - Kimberly A Curseen
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Suephy C Chen
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | | |
Collapse
|
36
|
Baker TA, Booker SQ, Janevic MR. A progressive agenda toward equity in pain care. Health Psychol Behav Med 2023; 11:2266221. [PMID: 37818413 PMCID: PMC10561565 DOI: 10.1080/21642850.2023.2266221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
Background: There are inconsistencies documenting the pain experience of Black adults and other racially minoritized populations. Often disregarded, pain among these groups is characterized by misconceptions, biases, and discriminatory practices, which may lead to inequitable pain care. Methods: To address this issue, this professional commentary provides an overview of pain reform and the need to declare chronic pain as a critical public health issue, while requiring that equity be a key focus in providing comprehensive pain screening and standardizing epidemiological surveillance to understand the prevalence and incidence of pain. Results and Conclusions: This roadmap is a call to action for all sectors of research, practice, policy, education, and advocacy. More importantly, this progressive agenda is timely for all race and other marginalized groups and reminds us that adequate treatment of pain is an obligation that cannot be the responsibility of one person, community, or institution, but rather a collective responsibility of those willing to service the needs of all individuals.
Collapse
Affiliation(s)
- Tamara A. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Staja Q. Booker
- College of Nursing, The University of Florida, Gainesville, FL, USA
| | - Mary R. Janevic
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
37
|
Lee MJ, Pradeep A, Lobner K, Badaki-Makun O. The effect of nature exposure on pain experience and quality of life in patients with chronic pain: A systematic review and meta-analysis protocol. PLoS One 2023; 18:e0291053. [PMID: 37768931 PMCID: PMC10538778 DOI: 10.1371/journal.pone.0291053] [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: 10/05/2022] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Chronic pain is a complex condition with short and long-term effects on physical and psychosocial health. Nature exposure therapy has been investigated as a potential non-pharmacological intervention to improve physical and emotional health of individuals with chronic pain. This proposed systematic review aims to examine the effects of nature exposure therapy on pain experience and quality of life in patients with chronic pain. METHODS Studies will be identified by searching the MEDLINE, Embase and Cumulative Index for Nursing and Allied Health Literature (CINAHL) databases. All included studies will be required to be interventional controlled trials comparing nature exposure therapy to placebo or standard care in patients with chronic pain. Primary outcomes for this review will be pain intensity and quality of life scores. Secondary outcomes will include self-efficacy, depression and pain-related anxiety scores. If 2 or more studies are included, results will be pooled for meta-analysis. If meta-analysis is not possible, the results will be presented in a narrative form. DISCUSSION Given the adverse effects of opioid use, non-pharmacological interventions are a necessary alternative to treat patients with chronic pain. Nature exposure therapy is an intriguing example of such an intervention. We hope that this systematic review will guide future clinical decision-making for patients with chronic pain and provide evidence for or against the need for natural spaces and improved urban planning. TRIAL REGISTRATION PROSPERO registration number: CRD42021226949.
Collapse
Affiliation(s)
- Matthew J. Lee
- Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America
| | - Aishwarya Pradeep
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States of America
| | - Katie Lobner
- Johns Hopkins Welch Medical Library, Baltimore, Maryland, United States of America
| | - Oluwakemi Badaki-Makun
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
38
|
Eiamtanasate S, Smithiseth K, Zinboonyahgoon N, Korwisi B, Barke A, Rief W, Treede RD. The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting. Pain 2023; 164:2009-2015. [PMID: 37027141 DOI: 10.1097/j.pain.0000000000002899] [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: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 04/08/2023]
Abstract
ABSTRACT The International Classification of Diseases ( ICD ) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD ( ICD-10 ), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11 . The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.
Collapse
Affiliation(s)
- Sarasate Eiamtanasate
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Beatrice Korwisi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Antonia Barke
- Clinical Psychology and Psychological Intervention, Institute of Psychology, University Duisburg-Essen, Essen, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Mannheim Center for Translational Neurosciences, Heidelberg University, Mannheim, Germany
| |
Collapse
|
39
|
Roberts A. The biopsychosocial model: Its use and abuse. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:367-384. [PMID: 37067677 PMCID: PMC10107555 DOI: 10.1007/s11019-023-10150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
The biopsychosocial model (BPSM) is increasingly influential in medical research and practice. Several philosophers and scholars of health have criticized the BPSM for lacking meaningful scientific content. This article extends those critiques by showing how the BPSM's epistemic weaknesses have led to certain problems in medical discourse. Despite its lack of content, many researchers have mistaken the BPSM for a scientific model with explanatory power. This misapprehension has placed researchers in an implicit bind. There is an expectation that applications of the BPSM will deliver insights about disease; yet the model offers no tools for producing valid (or probabilistically true) knowledge claims. I argue that many researchers have, unwittingly, responded to this predicament by developing certain patterns of specious argumentation I call "wayward BPSM discourse." The arguments of wayward discourse share a common form: They appear to deliver insights about disease gleaned through applications of the BPSM; on closer inspection, however, we find that the putative conclusions presented are actually assertions resting on question-begging arguments, appeals to authority, and conceptual errors. Through several case studies of BPSM articles and literatures, this article describes wayward discourse and its effects. Wayward discourse has introduced into medicine forms of conceptual instability that threaten to undermine various lines of research. It has also created a potentially potent vector of medicalization. Fixing these problems will likely require reimposing conceptual rigor on BPSM discourse.
Collapse
Affiliation(s)
- Alex Roberts
- Department of Political Science, University of South Dakota, Vermillion, SD, USA.
| |
Collapse
|
40
|
Kalinina AD, Rogachevskii IV, Samosvat DM, Zegrya GG, Butkevich IP, Mikhailenko VA, Plakhova VB, Penniyaynen VA, Podzorova SA, Krylov BV. Analgesic Effect of the Lysine-Containing Short Peptide Is Due to Modulation of the Na V1.8 Channel Activation Gating System. Life (Basel) 2023; 13:1800. [PMID: 37763204 PMCID: PMC10533133 DOI: 10.3390/life13091800] [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: 07/08/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The present work continues our recent series of articles that aim to elucidate the ligand-receptor binding mechanism of short cationic peptides to the NaV1.8 channel in the nociceptive neuron. The applied methodological approach has involved several methods: the patch-clamp experimental evaluation of the effective charge of the NaV1.8 channel activation gating system, the organotypic tissue culture method, the formalin test, and theoretical conformational analysis. The lysine-containing short peptide Ac-KEKK-NH2 has been shown to effectively modulate the NaV1.8 channel activation gating system. As demonstrated by the organotypic tissue culture method, the studied short peptide does not trigger the downstream signaling cascades controlling neurite outgrowth and should not be expected to evoke adverse side effects. Conformational analysis of the Ac-KEKK-NH2 molecule has revealed that the distances between the positively charged amino groups of the lysine side chains are equal to 11-12 Å. According to the previously suggested mechanism of ligand-receptor binding of short peptides to the NaV1.8 channel molecule, Ac-KEKK-NH2 should exhibit an analgesic effect, which has been confirmed by the formalin test. The data obtained unequivocally indicate that the studied lysine-containing short peptide is a promising candidate for the role of a novel analgesic medicinal substance.
Collapse
Affiliation(s)
- Arina D. Kalinina
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Ilya V. Rogachevskii
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Dmitriy M. Samosvat
- Ioffe Institute, Russian Academy of Sciences, 194021 Saint Petersburg, Russia
| | - Georgy G. Zegrya
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
- Ioffe Institute, Russian Academy of Sciences, 194021 Saint Petersburg, Russia
| | - Irina P. Butkevich
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Viktor A. Mikhailenko
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Vera B. Plakhova
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Valentina A. Penniyaynen
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Svetlana A. Podzorova
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| | - Boris V. Krylov
- Pavlov Institute of Physiology, Russian Academy of Sciences, 199034 Saint Petersburg, Russia (V.B.P.)
| |
Collapse
|
41
|
Gray E, Erickson M, Bindler R, Eti DU, Wilson M. Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain. Pain Manag Nurs 2023; 24:469-476. [PMID: 37179236 PMCID: PMC10524526 DOI: 10.1016/j.pmn.2023.04.002] [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: 09/14/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management. AIMS The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements. METHODS A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis. RESULTS Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate. CONCLUSIONS Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.
Collapse
Affiliation(s)
- Emily Gray
- College of Nursing, Washington State University, Spokane, Washington.
| | - Morgan Erickson
- College of Nursing, Washington State University, Spokane, Washington
| | - Ross Bindler
- College of Nursing, Washington State University, Spokane, Washington
| | - Deborah U Eti
- College of Nursing, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington
| |
Collapse
|
42
|
Borsutzky S, Moritz S, Hottenrott B, Gehlenborg J. A self-guided Internet-based intervention for individuals with chronic pain and depressive symptoms: study protocol of a randomized controlled trial. Trials 2023; 24:453. [PMID: 37434163 DOI: 10.1186/s13063-023-07440-8] [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: 03/24/2022] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Despite the existence of evidence-based therapy options for the treatment of chronic pain and comorbid depressive symptoms (e.g., CBT), many individuals remain untreated. Treatment gaps result from a lack of specialists, patient fear of stigmatization, or patient immobility. Internet-based self-help interventions could serve as an anonymous and flexible alternative treatment option. In a pilot study, chronic pain patients with comorbid depressive symptoms who used a generic Internet-based depression program showed a significant reduction in depressive symptoms (but not pain symptoms) compared to a waitlist control group. Based on these findings, we developed the low-threshold, anonymous, and cost-free Internet-based self-help intervention Lenio that is tailored to the specific needs of chronic pain patients with comorbid depressive symptoms. Lenio is accompanied by the smartphone application (app) COGITO designed to increase therapeutic success. With Lenio and COGITO addressing both chronic pain and depressive symptoms, the trial aims to increase treatment effects of online interventions for chronic pain patients by reducing both depressive symptoms and pain. METHODS The effectiveness of the Internet-based self-help intervention and accompanying smartphone app will be evaluated in a randomized controlled trial (RCT). A total of 300 participants will be randomized into an intervention group (Lenio/COGITO), an active control group (depression-focused smartphone app), or a waitlist control group. Assessments will be done at baseline, after an 8-week intervention period (post), and after 16 weeks (follow-up). The primary outcome is the post-assessment reduction in "pain impairment" (mean value of impairment in daily life, free time, and work) as assessed by the DSF (German pain questionnaire). Secondary outcomes will include the reduction in depressive symptoms as well as in the severity of pain. DISCUSSION Lenio is one of the first Internet-based interventions to reduce chronic pain and depression that will be empirically evaluated. Internet-based interventions could offer a promising alternative to conventional face-to-face psychotherapy in the treatment of chronic pain patients. The primary objective of the current study is to add essential insight into the feasibility, effectiveness, and acceptance of Internet-based interventions for people with chronic pain and depressive symptoms. TRIAL REGISTRATION DRKS-ID DRKS00026722, Registered on October 6th, 2021.
Collapse
Affiliation(s)
- Swantje Borsutzky
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
43
|
Cao W, Chen J, Wu L, Xu YH, Meng Y, Li X, Zheng Z, Chu X. A Novel Molecular Reservoir Based on Reverse Self-Assembled Liquid Crystals - A New Strategy for Prolonging the Duration in Action of Analgesics. J Pharm Sci 2023; 112:1985-1996. [PMID: 37088153 DOI: 10.1016/j.xphs.2023.04.010] [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: 12/09/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this study was to develop liquid crystal (LC) precursors to obtain novel long-acting analgesics for injection based on depot systems and compare the difference between the cubic and hexagonal precursors in delivering Diclofenac sodium (DS). METHODS Diclofenac sodium liquid crystal precursor injections were prepared and characterized, followed by in vitro release, pharmacodynamic, and pharmacokinetic studies. RESULTS The optimal formulations were prepared with a ratio of Phytantriol/ethanol/water as 76:19:5 for cubic LC precursors, and a ratio of Phytantriol/ethanol/water/Vitamine-E acetate as 72:18:5:5 for hexagonal, both loading various drug dosages (2.5%, 3.75% and 5%), respectively. Polarized light microscopy and small angle diffraction confirmed that the precursors were isotropic fluids and transformed into gels with Pn3m or HII framework in water. Rheological studies have shown that precursors belong to Newtonian fluids and gels to pseudoplastic fluids. The release showed that the DS in the commercial injection (DS-inj) was completely liberated within 6 h, whereas only 46.55% and 49.73% of the DS in 2.5% cubic precursors and 2.5% hexagonal precursors were freed, respectively. Pharmacodynamic studies have shown that cubic, hexagonal and DS-inj raised the pain threshold in mice by 169.4%, 157.3% and 113.79%, respectively. The mean retention times of DS in cubic and hexagonal were 3.16 and 2.67 times longer than DS-inj, respectively, according to pharmacokinetic results. CONCLUSION In conclusion, cubic and hexagonal are both promising analgesic sustained release formulations. In addition, based only on the current comparison, cubic seems to have a better long-acting effect.
Collapse
Affiliation(s)
- Wenxuan Cao
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Jingbao Chen
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Long Wu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Yu Hang Xu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Yun Meng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China
| | - Xiang Li
- Anhui Province Institute for Food and Drug Control, Hefei, Anhui, 230012, China
| | - Zhiyun Zheng
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China; Engineering Technology Research Center of Modernized Pharmaceutics, Anhui Education Department (AUCM) , Hefei, Anhui, 230012, China
| | - Xiaoqin Chu
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei 230012, China; Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei 230012, China; Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application, Hefei, 230012, China; Engineering Technology Research Center of Modernized Pharmaceutics, Anhui Education Department (AUCM) , Hefei, Anhui, 230012, China.
| |
Collapse
|
44
|
Serra S, Spampinato MD, Riccardi A, Guarino M, Fabbri A, Orsi L, De Iaco F. Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach. J Clin Med 2023; 12:4357. [PMID: 37445392 DOI: 10.3390/jcm12134357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.
Collapse
Affiliation(s)
- Sossio Serra
- Emergency Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy
| | | | | | - Mario Guarino
- UOC MEU Ospedale CTO-AORN dei Colli Napoli, 80131 Napoli, Italy
| | - Andrea Fabbri
- Emergency Department, AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, Italy
| | - Luciano Orsi
- Palliative Care Physician and Scientific Director of "Rivista Italiane di Cure Palliative", 26013 Crema, Italy
| | - Fabio De Iaco
- Struttura Complessa di Medicina di Emergenza Urgenza Ospedale Maria Vittoria, ASL Città di Torino, 10144 Torino, Italy
| |
Collapse
|
45
|
Lamerato L, Shah V, Abraham L, Cappelleri JC, DeLor B, Ellsworth SR, Hegeman-Dingle R, Park PW. Impact of Electronic Chronic Pain Questions on patient-reported outcomes and healthcare utilization, and attitudes toward eCPQ use among patients and physicians: prospective pragmatic study in a US general practice setting. Front Med (Lausanne) 2023; 10:933975. [PMID: 37425316 PMCID: PMC10323749 DOI: 10.3389/fmed.2023.933975] [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] [Received: 05/01/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Objective The Electronic Chronic Pain Questions (eCPQ) has been developed to help healthcare providers systematically capture chronic pain data. This study evaluated the impact of using the eCPQ on patient-reported outcomes (PROs) and healthcare resource utilization (HCRU) in a primary care setting, and patient and physician perceptions regarding use of, and satisfaction with, the eCPQ. Methods This was a prospective pragmatic study conducted at the Internal Medicine clinic within the Henry Ford Health (HFH) Detroit campus between June 2017 and April 2020. Patients (aged ≥18 years) attending the clinic for chronic pain were allocated to an Intervention Group to complete the eCPQ in addition to regular care, or a control group to receive regular care only. The Patient Health Questionnaire-2 and a Patient Global Assessment were assessed at baseline, 6-months, and 12-months study visits. HCRU data were extracted from the HFH database. Telephone qualitative interviews were conducted with randomly selected patients and physicians who used the eCPQ. Results Two hundred patients were enrolled, 79 in each treatment group completed all 3 study visits. No significant differences (p > 0.05) were found in PROs and HCRU between the 2 groups. In qualitative interviews, physicians and patients reported the eCPQ as useful, and using the eCPQ improved patient-clinician interactions. Conclusion Adding the eCPQ to regular care for patients with chronic pain did not significantly impact the PROs assessed in this study. However, qualitative interviews suggested that the eCPQ was a well-accepted and potentially useful tool from a patient and physician perspective. By using the eCPQ, patients were better prepared when they attended a primary care visit for their chronic pain and the quality of patient-physician communication was increased.
Collapse
Affiliation(s)
| | - Vinay Shah
- Henry Ford Health, Detroit, MI, United States
| | | | | | | | | | | | | |
Collapse
|
46
|
Small Fiber Neuropathy: A Clinical and Practical Approach. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
47
|
Golibkhon A, Akbar Gafur Ugli B, Makhamadjonov Farkhod Ugli M. Opioid Agents and Cardiac Arrhythmia: A Literature Review. Cureus 2023; 15:e38007. [PMID: 37228540 PMCID: PMC10207988 DOI: 10.7759/cureus.38007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/22/2023] [Indexed: 05/27/2023] Open
Abstract
Opioids are compounds that cause similar effects to morphine by binding to its receptors. Opioids can be synthetic, semi-synthetic, or natural and can easily bind to the receptors of opioids in order to depict their effects, which may vary depending upon the exposure of the drug and its dose. However, several side effects of opioids can also be observed, with the most crucial being their impact on the heart's electrical activity. This review majorly focuses on opioids' impact on the prolongation of the QT curve and their arrhythmogenic susceptibility. Articles published up to the year 2022 in various databases were identified and searched with the use of keywords. Search terms included "cardiac arrhythmias," "QT interval," "opioids," "opioid dependence," and "torsade de pointes (TdP)". These terms highlight the impact of each opioid agent on the activity of the heart on an electrocardiogram. The results of the available data depict that opioids, such as methadone, pose higher risks, even when taken in smaller amounts, and have the capability for QT interval prolongation and TdP development. A variety of opioids, i.e., oxycodone and tramadol, are considered as intermediary risk drugs and can build long QT intervals and TdP in large doses. Several other opioids are considered low-risk drugs, including buprenorphine and morphine, which lead to no production of TdP and QT interval prolongation in daily routine doses. Evidence indicates a high risk of sinus bradycardia, atrial fibrillation, cardiac block, and supra-ventricular arrhythmias in opium consumers. This literature review will play a key role in determining the association between the use of opioids and cardiac arrhythmias. It will further highlight the practical implications of opioids for the management of cardiac issues based on their dose, frequency, and intensity. Moreover, it will also depict the adverse effects of opioids along with their dose-specific relationship. Opioids display disparate cardiac arrhythmogenicity, and methadone contains a greater ability to induce long QT intervals and hazardous arrhythmias at conventional doses. In order to reduce arrhythmogenic risk, opioids taken in large amounts should be monitored with a regular electrocardiogram in high-risk consumers, i.e., patients on opioid maintenance.
Collapse
Affiliation(s)
- Azamatov Golibkhon
- Department of General Internal Medicine, Almalyk City Central Family Outpatient Hospital, Almalyk, UZB
| | | | | |
Collapse
|
48
|
Liang H, Fang Y. Chronic pain increases the risk of motoric cognitive risk syndrome at 4 years of follow-up: evidence from the China Health and Retirement Longitudinal Study. Eur J Neurol 2023; 30:831-838. [PMID: 36617534 DOI: 10.1111/ene.15677] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Slower gait speed and subjective cognitive concerns are characteristics of the motoric cognitive risk (MCR) syndrome. This study aimed to examine if changes in pain may be hallmarks of early MCR, through investigating the magnitude of the association of chronic pain and the risk of MCR at 4 years follow-up. METHODS In total, 3711 participants without dementia or any mobility disability aged ≥60 years were studied, including 1413 with chronic pain, enrolled in the China Health and Retirement Longitudinal Study, a prospective cohort study. MCR assessed at wave 1 (2011) and wave 3 (2015) was used as the exposure. Cox regression analysis was used to examine the longitudinal association between chronic pain and MCR after adjusting for individual factors, behaviors/physiology factors and societal factors. Four years later, the incident MCR was evaluated. RESULTS After adjusting for individual factors, chronic pain was found to increase the risk of MCR development over time by about 1.5 times (hazard ratio 1.562, 95% confidence interval 1.228-1.986; p < 0.001) and to be linked with incident MCR at baseline (odds ratio 1.397, 95% confidence interval 1.149-1.698; p < 0.001). These associations remained substantial when behaviors/physiology factors and societal factors were taken into account in the analytical models. CONCLUSIONS The findings of our study imply that incident MCR may be exacerbated by chronic pain. Further exploration is required to find out whether chronic pain is a modifiable risk factor for MCR.
Collapse
Affiliation(s)
- Haixu Liang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, Xiamen University, Xiamen, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province University, Xiamen University, Xiamen, China
| |
Collapse
|
49
|
Artacho-Cordón F, Lorenzo Hernando E, Pereira Sánchez A, Quintas-Marquès L. Conceptos actuales en dolor y endometriosis: diagnóstico y manejo del dolor pélvico crónico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
50
|
Li JX, Wang X, Henry A, Anderson CS, Hammond N, Harris K, Liu H, Loffler K, Myburgh J, Pandian J, Smyth B, Venkatesh B, Carcel C, Woodward M. Sex differences in pain expressed by patients across diverse disease states: individual patient data meta-analysis of 33,957 participants in 10 randomized controlled trials. Pain 2023:00006396-990000000-00275. [PMID: 36972472 DOI: 10.1097/j.pain.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/28/2022] [Indexed: 03/29/2023]
Abstract
ABSTRACT The experience of pain is determined by many factors and has a significant impact on quality of life. This study aimed to determine sex differences in pain prevalence and intensity reported by participants with diverse disease states in several large international clinical trials. Individual participant data meta-analysis was conducted using EuroQol-5 Dimension (EQ-5D) questionnaire pain data from randomised controlled trials published between January 2000 and January 2020 and undertaken by investigators at the George Institute for Global Health. Proportional odds logistic regression models, comparing pain scores between females and males and fitted with adjustments for age and randomized treatment, were pooled in a random-effects meta-analysis. In 10 trials involving 33,957 participants (38% females) with EQ-5D pain score data, the mean age ranged between 50 and 74. Pain was reported more frequently by females than males (47% vs 37%; P < 0.001). Females also reported greater levels of pain than males (adjusted odds ratio 1.41, 95% CI 1.24-1.61; P < 0.001). In stratified analyses, there were differences in pain by disease group (P for heterogeneity <0.001), but not by age group or region of recruitment. Females were more likely to report pain, and at a higher level, compared with males across diverse diseases, all ages, and geographical regions. This study reinforces the importance of reporting sex-disaggregated analysis to identify similarities and differences between females and males that reflect variable biology and may affect disease profiles and have implications for management.
Collapse
|