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Cáceres-Matos R, Gil-García E, Vázquez-Santiago S, Cabrera-León A. The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey. Eur J Public Health 2024; 34:639-645. [PMID: 38750626 PMCID: PMC11293836 DOI: 10.1093/eurpub/ckae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). METHODS Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. RESULTS People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. CONCLUSIONS Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.
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Affiliation(s)
- Rocío Cáceres-Matos
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Eugenia Gil-García
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Soledad Vázquez-Santiago
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Virgen Macarena University Hospital, Seville, Spain
| | - Andrés Cabrera-León
- Andalusian School of Public Health, Cuesta del Observatorio, Granada, Spain
- Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Institute of Biomedical Research ibs.GRANADA, Granada, Spain
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Abberger B, Grauer T, Kieselbach K. The Use of Telemedicine in an Interdisciplinary Pain Center in the Years 2020 and 2021 in Germany: Effects of the COVID-19 Pandemic. Telemed J E Health 2024. [PMID: 39069915 DOI: 10.1089/tmj.2024.0192] [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: 07/30/2024] Open
Abstract
Introduction: COVID-19 changed the management of patients with chronic pain. The increased utilization of telemedicine was recommended as a solution. Telemedicine provides medical services by overcoming the geographical distance between practitioner and patient and makes it possible to continue treating the patients with a high level of safety for patients and staff. The aim of our study is to investigate the data on the use of telemedicine in an interdisciplinary pain center in the years 2020 and 2021. Methods: Every patient contact in 2020 and 2021 with the interdisciplinary pain center was registered. Dataset consists of 4,156 patient contacts (N = 1,996 in the year 2020; N = 2,160 in the year 2021). For each patient contact, we collected data on age, sex, place of residence, and the reason or type of the contact. In addition, the incidence rates were used as a data source for the COVID-19 development. Results: In 2020, there was a significant decrease in face-to-face contacts (85.0% to 59.4%) and a significant increase in telemedicine use (especially video calls 0.6% to 20.0%). The use of telemedicine had a temporary peak at the beginning of 2021 (first quarter of 2021: 41.2%). The trend generally reversed during 2021: face-to-face contacts increased again (25.5% to 58.9%) and telemedicine decreased (mainly video calls 41.2% to 25.9%). Conclusion: The results show that telemedicine was successfully implemented in an interdisciplinary pain center during 2020 and 2021. In addition to the software requirements and the data protection, the aspect of digital literacy appears to be relevant. There seems to be a need for an implementation plan in pain centers that includes guidelines for the use of telemedicine.
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Affiliation(s)
- Birgit Abberger
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
| | - Tom Grauer
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
| | - Kristin Kieselbach
- Interdisciplinary Pain Center, University Medical Center Freiburg, Freiburg, Germany
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Kieselbach K, Fauler I, Abberger B. Patients With Chronic Pain: The Aspect Of Negative Body Image. Psychother Psychosom Med Psychol 2024. [PMID: 38885658 DOI: 10.1055/a-2322-8484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Negative body image is an increasingly important factor in chronic pain disorders; particularly because the two conditions mutually influence each other. Our study examines body-image-related attitudes and comorbid psychic symptoms in patients with chronic pain disorders. METHODS AND MEASURES 188 patients with chronic pain answered the Dresden body image questionnaire (DKB-35), the Hospital Anxiety and Depression Scale (HADS) and the Beck's Depression Inventory (BDI). RESULTS The mean values of the DKB-35 subscales range between 2.24 und 3.29. The subscale "vitality" has the lowest mean value. BDI and HADS correlated significantly with the DKB-35 subscales. The subscale "body-acceptance" intercorrelated high with the two subscales "vitality" and "self-aggrandizement". CONCLUSION Our findings verify that chronic pain is strongly associated with negative body image. The issues of vitality and psychological symptoms seem particularly central in this complex interaction. The biopsycho-social model and the avoidance-endurance approach to chronic pain offer important ideas for explanation and treatment.
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Affiliation(s)
| | - Ingrid Fauler
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg
| | - Birgit Abberger
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg
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Abberger B, Kieselbach K. Rasch analysis of the Depression, Anxiety, and Stress Scale in patients with chronic pain. J Psychosom Res 2024; 178:111597. [PMID: 38277894 DOI: 10.1016/j.jpsychores.2024.111597] [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: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Questionnaires are commonly used to assess and screen pain-related, psychological symptoms in patients with chronic pain. In Germany, the "German pain questionnaire" provided by the German Pain Society used for this purpose includes the Depression, Anxiety, and Stress Scale (DASS). This study aims to analyze the DASS by fitting its data to the Rasch model to test the psychometric quality. STUDY DESIGN AND SETTING In this cross-sectional study, 932 patients with chronic pain answered the DASS. The 21-item short version was tested via Rasch analysis using the parameters threshold order, fit to the model, Differential Item Functioning, unidimensionality and reliability. RESULTS The Rasch analysis results showed a low reliability, misfitting items, Differential Item Functioning or multidimensionality. It was necessary to remove items from the subscales to improve fit to the Rasch model. A revised depression subscale of the DASS-21 was the only scale that achieved all the required psychometric parameters. The summation of all items to a total scale was not supported. CONCLUSION More research is required on somatic free measurement of psychological symptoms in patients with chronic pain. The results demonstrate that the development of a new instrument or a revision of existing instruments for screening of psychological symptoms in chronic pain are needed.
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Affiliation(s)
- Birgit Abberger
- Interdisciplinary Pain Center, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
| | - Kristin Kieselbach
- Interdisciplinary Pain Center, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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5
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Siaton BC, Hogans BB, Frey-Law LA, Brown LM, Herndon CM, Buenaver LF. Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument. FRONTIERS IN PAIN RESEARCH 2024; 5:1254792. [PMID: 38455875 PMCID: PMC10918012 DOI: 10.3389/fpain.2024.1254792] [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: 07/07/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Pain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging-Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives. Methods Mixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement. Results Scoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: "major medical", i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min. Conclusion This study, developing and pilot testing our "Pain in Aging-Educational Assessment of Need" (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed.
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Affiliation(s)
- Bernadette C. Siaton
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
| | - Beth B. Hogans
- Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Laura A. Frey-Law
- Department of Physical Therapy and Rehabilitative Science, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Lana M. Brown
- Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Christopher M. Herndon
- Department of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, United States
- Department of Family and Community Medicine, St. Louis University School of Medicine, St. Louis, MO, United States
| | - Luis F. Buenaver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Stoppok P, Teufel M, Jahre L, Rometsch C, Müßgens D, Bingel U, Skoda EM, Bäuerle A. Determining the Influencing Factors on Acceptance of eHealth Pain Management Interventions Among Patients With Chronic Pain Using the Unified Theory of Acceptance and Use of Technology: Cross-sectional Study. JMIR Form Res 2022; 6:e37682. [PMID: 35976199 PMCID: PMC9434396 DOI: 10.2196/37682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Chronic pain is a complex disease with high prevalence rates, and many individuals who are affected do not receive adequate treatment. As a complement to conventional therapies, eHealth interventions could provide many benefits to a multimodal treatment approach for patients with chronic pain, whereby future use is associated with the acceptance of these interventions. Objective This study aims to assess the acceptance of eHealth pain management interventions among patients with chronic pain and identify the influencing factors on acceptance. A further objective of the study is to evaluate the viability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and compare it with its extended version in terms of explained variance of acceptance. Methods We performed a cross-sectional web-based study. In total, 307 participants with chronic pain, as defined according to the International Association for the Study of Pain criteria, were recruited through flyers, posters, and web-based inquiries between December 2020 and July 2021. In addition to sociodemographic and medical data, the assessment included validated psychometric instruments and an extended version of the well-established UTAUT model. For statistical analyses, group comparisons and multiple hierarchical regression analyses were performed. Results The acceptance of eHealth pain management interventions among patients with chronic pain was overall moderate to high (mean 3.67, SD 0.89). There was significant difference in acceptance among age groups (W=9674.0; r=0.156; P=.04). Effort expectancy (β=.37; P<.001), performance expectancy (β=.33; P<.001), and social influence (β=.34; P<.001) proved to be the most important predictors of acceptance. The extended UTAUT (including the original UTAUT factors as well as sociodemographic, medical, and eHealth-related factors) model explained 66.4% of the variance in acceptance, thus supporting the viability of the model. Compared with the original UTAUT model (performance expectancy, effort expectancy, and social influence), the extended model explained significantly more variance (F25,278=1.74; P=.02). Conclusions Given the association between acceptance and future use, the knowledge of the influencing factors on acceptance should be used in the development and promotion of eHealth pain management interventions. Overall, the acceptance of eHealth pain management interventions was moderate to high. In total, 8 predictors proved to be significant predictors of acceptance. The UTAUT model is a valuable instrument for determining acceptance as well as the factors that influence acceptance of eHealth pain management interventions among patients with chronic pain. The extended UTAUT model provided the greatest predictive value for acceptance.
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Affiliation(s)
- Paula Stoppok
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Lisa Jahre
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Caroline Rometsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Diana Müßgens
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
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7
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Engi Z, Benkő R, Soós G, Szok D, Csenki M, Csüllög E, Balog A, Csupor D, Viola R, Doró P, Matuz M. Trends in Opioid Utilisation in Hungary, 2006-2020: A Nationwide Retrospective Study with Multiple Metrics. Eur J Pain 2022; 26:1896-1909. [PMID: 35848717 PMCID: PMC9541344 DOI: 10.1002/ejp.2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Opioid use is well-documented in several countries: some countries struggle with overuse while others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilisation in ambulatory care between 2006 and 2020. METHODS We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilisation trends, using three volume-based metrics (defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year). We stratified data based on administration routes, analgesic potency and reimbursement categories. RESULTS Total opioid utilisation increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID). CONCLUSIONS Our low utilisation numbers might indicate underuse of opioid analgesia, especially for cancer pain.
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Affiliation(s)
- Z Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - R Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary.,Emergency Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - G Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - D Szok
- Department of Neurology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - M Csenki
- Department of Oncotherapy, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - E Csüllög
- Department of Anesthesiology and Intensive Care, Albert Szent-Györgyi Health Center, 6725, University of Szeged, Szeged, Hungary
| | - A Balog
- Department of Rheumatology and Immunology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - D Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, 7624, Pécs, Hungary
| | - R Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - P Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - M Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
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8
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Chronischer Schmerz als existenzielle Herausforderung. Schmerz 2022; 37:116-122. [PMID: 35286464 PMCID: PMC10102092 DOI: 10.1007/s00482-022-00632-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas biopsychosoziale Schmerzkonzept stellt gegenwärtig den Schwerpunkt schmerztherapeutischer Behandlungsprogramme dar. Jedoch kann damit die Komplexität chronischer Schmerzen, insbesondere ihre Bedeutung für die Betroffenen, nur unzureichend erfasst werden. Denn ein Kernaspekt des Phänomens chronischer Schmerz wird bislang nur in Einzelfällen berücksichtigt: sein existenzieller Charakter. Chronische Schmerzen können das Selbst- und Weltverständnis, die Lebenswünsche und -ziele, letztlich die gesamte Integrität der Betroffenen bedrohen. Selbstaussagen Erkrankter zeigen, dass chronischer Schmerz immer ein existenzielles Widerfahrnis darstellt und den Menschen in seiner Gesamtheit erfasst. Dies wird durch zwei Aspekte deutlich: zum einen durch die existenzielle Verzweiflung am Schmerz, zum anderen durch Fragen der Sinngebung und Neuorientierung. Allerdings berücksichtigen gängige Therapiekonzepte den existenziellen Charakter mit derartigen Herausforderungen bislang nicht adäquat. Chronischer Schmerz sollte daher stets unter einer umfassenden Perspektive wahrgenommen und behandelt werden. Hierbei sind die Aspekte Einzigartigkeit anerkennen, zum Ausdruck verhelfen und dem Er-leben Raum geben zur Unterstützung Erkrankter in ihrer Auseinandersetzung mit dem Schmerz besonders zu berücksichtigen.
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9
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Kindl G, Teichmüller K, Escolano-Lozano F, Birklein F, Rittner HL. Pain, disability, and lifestyle: Patients with complex regional pain syndrome compared to chronic musculoskeletal pain - a retrospective analysis. Eur J Pain 2021; 26:719-728. [PMID: 34958709 DOI: 10.1002/ejp.1900] [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: 07/13/2021] [Revised: 10/11/2021] [Accepted: 12/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is an orphan disease occurring as a complication after trauma. Due to its acute onset and the typical clinical presentation of the inflammatory and autonomous signs, it is an eye-catching chronic pain disease affecting also young and working people. In social media and the internet, high pain severity and unfavorable prognosis is often empathized. METHODS Here, we compared epidemiological, pain and lifestyle factors of 223 CPRS patients from the "ncRNAPain" cohort with 255 patients with chronic musculoskeletal pain (MSK). MSK patients were recruited at the beginning of a multimodal pain therapy program. We searched for factors predicting pain intensity. RESULTS Both chronic pain diseases affected women in middle age. Patients with MSK were more obese, drank more alcohol and were less educated (Pearson Chi-square Test or Mann-Whitney/U-Test). Both groups smoked more than healthy people in the OECD (Organization for Economic Cooperation and Development). Mann-Whitney/U-Test confirmed that CRPS patients did not have more severe pain and did not suffer more from pain-related disability than patients with MSK. CRPS patients also had less psychiatric comorbidities. Multiple linear regression analysis revealed that group assignment, depressive characteristics, body mass index, average alcohol consumption and smoking predicted higher pain ratings, while disease duration, anxiety symptoms or gender had no influence on pain intensity. CONCLUSION In summary our study supports a more optimistic view on pain in CRPS patients in comparison to MSK and identifies lifestyle factors which might contribute to the pathophysiology like smoking and drinking. Important next steps are the identification of CRPS patients at risk for chronification or - vice versa - with protective factors for pain resolution.
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Affiliation(s)
- Gudrun Kindl
- Center for Interdisciplinary Pain Medicine, Department of Anesthesiology, University Hospital of Würzburg, Würzburg, Germany
| | - Karolin Teichmüller
- Center for Interdisciplinary Pain Medicine, Department of Anesthesiology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Frank Birklein
- Department of Neurology, University Hospital of Mainz, Mainz, Germany
| | - Heike L Rittner
- Center for Interdisciplinary Pain Medicine, Department of Anesthesiology, University Hospital of Würzburg, Würzburg, Germany
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10
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The prevalence of chronic pain in young adults: a systematic review and meta-analysis. Pain 2021; 163:e972-e984. [PMID: 34817439 DOI: 10.1097/j.pain.0000000000002541] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Prior systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (i.e., school-age) and adult (i.e., middle-age) age groups. To our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals that fall in between established boundaries of "childhood" and "adulthood" - known as young adulthood. The goal of this research was to meta-analyze prevalence data on pain in young adults based on available data published between 2008 and 2020. Searches were identified with MEDLINE, Embase, and PsycINFO. We included general population and university-based studies presenting prevalence estimates of chronic pain (pain lasting ≥3 months) in young adults. We identified 43 articles providing prevalence estimates across a combined population of 97,437 young adult respondents (age range: 15-34), with studies undertaken in 22 countries. Available data allowed for stratification of prevalence according to pain condition. The overall pooled random-effect prevalence rate of chronic pain in young adults was 11.6%, suggesting that 1 in every 9 young adults experience chronic pain worldwide. Prevalence rates varied considerably according to pain condition. Estimates did not vary according to sex, geographic location, and several study methodological characteristics (i.e., population type, sampling area, sampling year, investigation period, assessment method). Overall, young adult chronic pain is common and should be recognized as a major public health concern. Considering the difficulties young adults face accessing adult healthcare, greater attention is needed to develop transition programs and evidence-based treatments tailored to the unique needs of this age group.
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11
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain 2021; 162:2737-2749. [PMID: 33902092 DOI: 10.1097/j.pain.0000000000002264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
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Affiliation(s)
- Heather E Foley
- Centre for Pain and Disability Management, Adult Rehabilitation, Geriatrics and Palliative Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Analytics and Information Services Department, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Michelle Ploughman
- Division of Biomedical Sciences, Physical Medicine and Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Richard Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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12
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Cao X, Chen Z, Wu L, Zhou J. Co-occurrence of chronic pain, depressive symptoms, and poor sleep quality in a health check-up population in China:A multicenter survey. J Affect Disord 2021; 281:792-798. [PMID: 33229026 DOI: 10.1016/j.jad.2020.11.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to investigate the cooccurrence of chronic pain (CP), depressive symptoms, and poor sleep quality in terms of prevalence and associated factors in a nationwide health check-up population in China. METHODS This multicenter cross-sectional survey was performed in 2017. All the participants aged ≥18 years from eight health check-up institutions in 6 provinces and cities were invited to complete a self-report health questionnaire through online resources. RESULTS 132,444 participants completed the online survey and the overall prevalence of CP and that of the three symptoms were 11.0% (95% confidence interval [95% CI]: 10.8-11.1) and 2.7% (95% CI: 2.6-2.8), respectively. The cooccurrence of all three symptoms increased with age, being higher in the female, widowed, unemployed, and lower education level groups. The respondents with multiple symptoms reported poorer self-rated health. Binary logistic regression analyses identified female sex (adjusted odds ratio [aOR]: 1.51; 95% CI: 1.42-1.62), a widowed status (aOR: 1.39; 95% CI: 1.04-1.84), a lower education level (aORs ranging from 1.46 to 2.47), and having one or more chronic diseases (aORs ranging from 1.43 to 2.02) to be significantly associated with reporting all three symptoms (all P ˂0.05). While long-term medication and regular exercise were the protective factors. CONCLUSION This study suggests that the cooccurrence of the three symptoms accounts for a certain proportion of the Chinese health check-up population. Integrated interventions that address CP and mental health cooccurrence may be an essential target for heath management in this population to tackle this considerable burden.
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Affiliation(s)
- Xia Cao
- Health Management Center, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Hunan Province, China 410013
| | - Zhiheng Chen
- Health Management Center, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Hunan Province, China 410013
| | - Liuxin Wu
- Zhongguancun Xinzhiyuan Health Management Institute, Beijing, China 100011
| | - Jiansong Zhou
- Health Management Center, Health Management Research Center of Central South University, The Third Xiangya Hospital, Central South University, Hunan Province, China 410013; National Clinical Research Center for Mental Disorders, and Department of Psychaitry, The Second Xiangya Hospital of Central South University, Hunan Province, China 410011.
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Nguyen TNM, Laetsch DC, Chen LJ, Haefeli WE, Meid AD, Brenner H, Schöttker B. Pain severity and analgesics use in the community-dwelling older population: a drug utilization study from Germany. Eur J Clin Pharmacol 2020; 76:1695-1707. [PMID: 32648116 PMCID: PMC7661425 DOI: 10.1007/s00228-020-02954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023]
Abstract
Purpose Chronic pain is common in the older population and a significant public health concern. However, comprehensive studies on analgesics use in this age group from Germany are scarce. This study aims to give a comprehensive overview on the use of the most common therapeutic groups of analgesics in community-dwelling older adults from Germany. Methods A cross-sectional study was carried out using data from a German cohort of 2038 community-dwelling adults aged 63–89 years. Descriptive statistics and logistic regression models were applied to assess the utilization of analgesics by age, sex, pain severity, pain duration, and locations. Results One out of four study participants was suffering from high-intensity or disabling pain. Approximately half of those taking analgesics still reported to suffer from high-intensity or disabling pain. Among analgesics users, occasional non-steroidal anti-inflammatory drugs (NSAIDs) use was the most frequent pain therapy (in 43.6% of users), followed by metamizole (dipyrone) use (16.1%), regular NSAIDs use (12.9%), strong opioids use (12.7%), and weak opioids use (12.0%). In multivariate logistic regression models, higher age, higher pain severity, longer pain duration, abdominal pain, and back pain were statistically significantly associated with opioids use. Metamizole use was also statistically significantly associated with higher pain severity but inversely associated with pain duration. Conclusions A significant number of older German adults are affected by high-intensity and disabling chronic pain despite receiving analgesics. Long-term studies are needed to compare the effectiveness and safety of different treatments for chronic pain in older adults. Electronic supplementary material The online version of this article (10.1007/s00228-020-02954-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thi Ngoc Mai Nguyen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Dana Clarissa Laetsch
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Li-Ju Chen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.
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Drissi I, Woods WA, Woods CG. Understanding the genetic basis of congenital insensitivity to pain. Br Med Bull 2020; 133:65-78. [PMID: 32219415 PMCID: PMC7227775 DOI: 10.1093/bmb/ldaa003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION OR BACKGROUND Congenital insensitivity to pain (CIP) is caused by extremely rare Mendelian genetic disorders. CIP individuals demonstrate the unexpectedly severe consequences of painlessness. Although only a small number of causative conditions and genes are known, most have led to profound insights into human nociception. CIP gene discovery is catalyzing the manufacture of completely new classes of analgesics, and these are needed as alternatives to synthetic highly potent opioids. SOURCES OF DATA Pubmed.gov peer-reviewed journal articles and reviews. AREAS OF AGREEMENT The importance of nerve growth factor-tropomyosin receptor kinase A (NGF-TRKA) signalling for nociceptor genesis and subsequent pain sensing.New analgesics can be generated from knowledge of the NGF-TRKA nociceptor pathway.Increased susceptibility to Staphylococcus aureus infection is a consequence of deficient NGF-TRKA signalling.Mutations in the voltage-gated sodium channels SCN9A and SCN11A can cause congenital painlessness, and in contradistinction, other mutations can cause episodic neuropathic pain. SCN9A/Nav1.7 is an analgesic target. SCN11A/Nav1.9 is unlikely to be an analgesic target.There are further Mendelian causes of painlessness to be discovered. AREAS OF CONTROVERSY Which NGF-TRKA intracellular signalling pathways operate in nociceptor development and which in post-natal pain sensing?Why have no clinically effective Nav1.7 antagonist been generated? SCN9A-CIP causes analgesia, at least in part, through endogenous opioids.Why do all CIP phenotypes involve a complete loss of all types of nociception? AREAS TIMELY FOR DEVELOPING RESEARCH PRDM12 as an analgesic target.Discovery of the function and analgesic potential of new CIP genes.Can NGF-TRKA be used in the treatment of S. aureus?
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Affiliation(s)
- Ichrak Drissi
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, The Keith Peters Building, Hills Road, Cambridge CB2 0XY, UK
| | - William Aidan Woods
- School of Medicine, David Weatherall building, University Road, Keele University, Staffordshire ST5 5BG, UK
| | - Christopher Geoffrey Woods
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge Biomedical Campus, The Keith Peters Building, Hills Road, Cambridge CB2 0XY, UK
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Welsch P, Petzke F, Klose P, Häuser W. Opioids for chronic osteoarthritis pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks double‐blind duration. Eur J Pain 2020; 24:685-703. [DOI: 10.1002/ejp.1522] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/23/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Patrick Welsch
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
| | - Frank Petzke
- Pain Medicine Department of Anesthesiology University Medical Center Göttingen Göttingen Germany
| | - Petra Klose
- Department Internal and Integrative Medicine Kliniken Essen‐Mitte Faculty of Medicine University of Duisburg‐Essen Essen Germany
| | - Winfried Häuser
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
- Department Psychosomatic Medicine and Psychotherapy Technische Universität München Munich Germany
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16
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Sommer C, Klose P, Welsch P, Petzke F, Häuser W. Opioids for chronic non‐cancer neuropathic pain. An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks duration. Eur J Pain 2019; 24:3-18. [DOI: 10.1002/ejp.1494] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Claudia Sommer
- Department of Neurology University of Würzburg Würzburg Germany
| | - Petra Klose
- Department Internal and Integrative Medicine Faculty of Medicine University of Duisburg‐Essen Essen Germany
| | - Patrick Welsch
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
| | - Frank Petzke
- Pain Medicine Department of Anesthesiology University Medical Center Göttingen Göttingen Germany
| | - Winfried Häuser
- Health Care Center for Pain Medicine and Mental Health Saarbrücken Germany
- Department Psychosomatic Medicine and Psychotherapy Technische Universit€at München München Germany
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[Cannabis-based medicines for chronic pain: indications, selection of drugs, effectiveness and safety : Experiences of pain physicians in Saarland]. Schmerz 2019; 33:399-406. [PMID: 31201550 DOI: 10.1007/s00482-019-0383-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are uncertainties among physicians with respect to the indications, selection of drugs, effectiveness and safety of cannabis-based medicines for chronic pain. METHODS All statutory health insurance pain physicians in Saarland were asked to complete a self-developed questionnaire assessing their experiences with cannabis-based medicines, which they prescribed between 10 March 2017 and 30 November 2018 for adult patients with chronic cancer and non-cancer pain. RESULTS All statutory health insurance pain physicians participated in the survey and 13 out of 20 reported having prescribed cannabis-based medicines. The most frequent reasons for prescriptions in 136 patients (1.9% of the patients of the institutions) were failure of established treatment (73%) and desire of the patient (63%). In 35% of patients the type of pain was nociceptive, in 34% neuropathic, in 29% nociceptive and neuropathic and in 13% nociplastic. Dronabinol was prescribed for 95% of the patients and 71% were responders (clinically relevant reduction of pain or of other symptoms). In 29% of patients treatment was terminated due to either a lack of efficacy or adverse events. CONCLUSION Statutory health insurance pain physicians in Saarland were reluctant to prescribe cannabis-based medicines. Dronabinol was effective and well-tolerated in the majority of the highly selected patients.
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Pfingsten M, Arnold B, Böger A, Brinkschmidt T, Casser HR, Irnich D, Kaiser U, Klimczyk K, Lutz J, Schiltenwolf M, Seeger D, Zernikow B, Sabatowski R. Sektorenübergreifende interdisziplinäre multimodale Schmerztherapie. Schmerz 2019; 33:191-203. [DOI: 10.1007/s00482-019-0374-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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19
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20
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Hess AS, Abd-Elsayed A. Observational Studies: Uses and Limitations. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cabrera-León A, Cantero-Braojos MÁ, Garcia-Fernandez L, Guerra de Hoyos JA. Living with disabling chronic pain: results from a face-to-face cross-sectional population-based study. BMJ Open 2018; 8:e020913. [PMID: 30420342 PMCID: PMC6252717 DOI: 10.1136/bmjopen-2017-020913] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 08/18/2018] [Accepted: 08/22/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To estimate the prevalence of disabling chronic pain (DCP) in Spanish adults, to analyse its characteristics, to determine its multimorbidity and to identify its associated factors. SETTINGS 2011 Andalusian Health Survey, a cross-sectional population survey based on face-to-face home interviews. PARTICIPANTS 6507 people aged 16 years or older and living in Andalusia, Spain. OUTCOMES The response variable was disabling chronic pain. Multivariate multinomial logistic regression models were used to analyse the association of factors with disabling chronic pain. The sample design was considered throughout the statistical analysis. RESULTS The prevalence of disabling chronic pain in the Spanish adult population was 11.36% (95% CI 11.23 to 11.49), while that of non-disabling chronic pain was 5.67% (95% CI 5.57 to 5.77). Disabling chronic pain was associated with high multimorbidity (especially in women (51%) and in the elderly (70%) with three or more additional chronic diseases), as well as with disadvantaged social status (such as female gender (OR=2.12), advanced age (OR10-year increase=1.28), unemployment (OR=1.33), manual work (OR=1.26), low income (OR=1.14) and reduced emotional social support (OR=1.04)). Other influential factors were tobacco consumption (OR=1.42), sleeping ≤7 hours (OR=1.2)], environmental or work conditions (OR=1.16) and quality of life (ORmental=1.21, ORphysical=2.37). CONCLUSIONS The population with disabling chronic pain was associated with multimorbidity, vulnerable social status and an impaired quality of life. In contrast, the population with non-disabling chronic pain showed almost no differences when compared with the population without chronic pain. The association between DCP and mental disorders highlights the need for psychosocial services in the management of chronic pain.
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Affiliation(s)
- Andrés Cabrera-León
- Escuela Andaluza de Salud Pública, Granada, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Estadística e Investigación Operativa, Instituto de Matemáticas (IEMath-GR), Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
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Cabrera-Leon A, Cantero-Braojos MÁ. [Impact of disabling chronic pain: results of a cross-sectional population study with face-to-face interview]. Aten Primaria 2018; 50:527-538. [PMID: 29102446 PMCID: PMC6839206 DOI: 10.1016/j.aprim.2017.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/22/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the impact of disabling chronic pain (DCP) on quality of life, work, consumption of medication and usage of health services. DESIGN Cross-sectional population study with face-to-face interview. SETTING Andalusian Health Survey (2011 edition). PARTICIPANTS 6,507 people over the age of 16 (p=q=0.5; confidence level=95%; sampling error=1.49, design effect=1.52). INTERVENTIONS Not applicable. MAIN MEASUREMENTS Dependent variable: DCP: population limited in their activity by any of the CP specified in the survey. INDEPENDENT VARIABLES quality of life, absence from work, consumption of medication and utilization of health services. RESULTS Compared to a population without CP, DCP impact is 6 points less on the mental quality of life and 12 points on the physical one, medication consumption is triple, health services utilization is almost double, and long absence from work is triple. On the other hand, a population with nondisabling chronic pain (nDCP) presents similar results to a population without CP. CONCLUSIONS We have considered DCP as another CP category because of its huge impact, as is shown in our study, on the study variables. On the contrary, the population with nDCP does not obtain significant impact differences when compared to the population without CP. Therefore, we believe that Primary Care and Public Health should lead different prevention strategies for DCP as well as for the identification of the nDCP population to decrease its possible deterioration towards DCP.
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Affiliation(s)
- Andrés Cabrera-Leon
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, España; Centro de Investigación Biomédica en Red de Salud Pública y Epidemiología (CIBERESP), Madrid, España
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Dapunt U, Gantz S, Zhuk A, Gather K, Wang H, Schiltenwolf M. Quantitative sensory testing in physically active individuals and patients who underwent multidisciplinary pain therapy in the longitudinal course. J Pain Res 2018; 11:2323-2330. [PMID: 30410387 PMCID: PMC6200080 DOI: 10.2147/jpr.s173000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to evaluate possible differences of quantitative sensory testing (QST) results in healthy individuals (group control, n=20), physically active individuals (group sport, n=30) and in patients suffering from chronic musculoskeletal pain (group pain, n=30). Methods Thermal detection thresholds, thermal pain thresholds and blunt pressure pain thresholds were measured at various sites (T0). Additionally, group pain was treated in multidisciplinary pain therapy for 4 weeks. All groups were retested after 4 weeks to evaluate the reliability of QST measurements and to investigate possible early changes following treatment (T1). Results Importantly, QST-measurements showed stable test results for group sport and group control at both time points. Athletes demonstrated the highest pain thresholds in general (cold pain threshold mean in degree Celsius for the hand: 5.76, lower back right: 7.25, lower back left: 7.53; heat pain threshold mean in degree Celsius for the hand: 46.08, lower back right: 45.77, lower back left: 45.70; and blunt pressure pain mean in kilograms for the hand: 3.54, lower back right: 5.26, lower back left: 5.46). Patients who underwent therapy demonstrated significant differences at T1 (cold pain threshold hand mean in degree Celsius for the hand: 11.12 [T0], 15.12 [T1]; and blunt pressure pain mean in kilograms for the lower back right: 2.87 [T0], 3.56 [T1]). They were capable of enduring higher blunt pressure, but on the other hand cold pain tolerance had decreased (P=0.045 and P=0.019, respectively). Conclusions In conclusion, we were able to demonstrate significant differences of QST results among the three groups and we detected early changes following multidisciplinary pain therapy, which will be discussed.
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Affiliation(s)
- Ulrike Dapunt
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
| | - Simone Gantz
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
| | - Anastasiya Zhuk
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
| | - Katharina Gather
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
| | - Haili Wang
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
| | - Marcus Schiltenwolf
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse, Heidelberg, Germany,
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Scala E, Decosterd I, Faouzi M, Burnand B, Rodondi PY. Level of readiness of chronic pain patients to practise active self-care. Eur J Pain 2018; 22:1800-1812. [PMID: 29956872 DOI: 10.1002/ejp.1276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Given the limited alleviation of chronic pain with pharmacological treatments, various nonpharmacological and self-care approaches are often proposed that require patients' motivation. OBJECTIVE To evaluate the level of readiness (LOR) to practise different types of active self-care among chronic pain patients. METHOD A quantitative cross-sectional survey was conducted among all chronic pain patients seeking care at the Pain Center of an academic hospital from June 2013 to March 2015. Sociodemographic data, pain characteristics, treatments and the LOR to practise active self-care were investigated. RESULTS Among the 1524 eligible patients, 639 (41.9%) were included. The median pain duration was 8.5 years (interquartile range = 7.5). Two-thirds (63.7%) of the patients reported high pain-related disability, and 64.6% had used opioids during the previous six months. Most patients had a high (44.1%) or moderate (24.6%) LOR to practise active self-care. Multivariable multinomial regression analysis showed that independent factors associated with a high LOR were a higher level of education (relative risk ratio (RRR) = 3.42, 95% confidence interval (CI): 1.90-6.13, p < 0.001), unemployed status due to medical condition (RRR = 2.92, 95% CI: 1.30-6.56, p = 0.009), the use of dietary supplements 'against pain' (RRR = 2.77, 95% CI: 1.52-5.04, p = 0.001) and neuropathic pain characteristics (RRR = 1.80, 95% CI: 1.40-3.12, p = 0.036). Older age was a factor predicting a lower LOR (RRR = 0.97, 95% CI: 0.94-0.99, p = 0.039). Long-term chronic pain, severe pain-related disability and the presence of a mood disorder were not associated with a lower LOR. CONCLUSION Most chronic pain patients, including those severely affected, indicated their readiness to practise active self-care methods. SIGNIFICANCE Most chronic pain patients, even those severely affected, appeared to be ready to practise active self-care therapies and we believe that further studies are needed to investigate their impact on pain and quality of life.
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Affiliation(s)
- E Scala
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - I Decosterd
- Pain Center and Center for integrative and complementary medecine (CEMIC), Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Faouzi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - B Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P-Y Rodondi
- Institute of Social and Preventive Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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Liu XK, Xiao SY, Zhou L, Hu M, Zhou W, Liu HM. Sleep quality and covariates as predictors of pain intensity among the general population in rural China. J Pain Res 2018; 11:857-866. [PMID: 29731663 PMCID: PMC5927145 DOI: 10.2147/jpr.s156731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aims of this study were to investigate the distribution of sleep quality and its relationship with the prevalence of pain among rural Chinese people and to explore the association between sleep quality and pain intensity among the general population in real-life settings. Methods This cross-sectional survey included a total of 2052 adults from rural areas in Liuyang, Hunan Province, recruited through random multistage sampling. The distributions of sleep quality and pain prevalence among the participants over a 4-week period were described. Because of multicollinearity among variables, the influence of self-rated sleep quality and psychosocial covariates on pain intensity was explored using a ridge regression model. Results The data showed that participants reporting all categories of sleep quality experienced some degree of pain. Sleep quality, along with physical and mental health, was a negative predictor of pain intensity among the general population. Symptoms of depression positively predicted pain intensity. Conclusion Poor sleep quality increased pain intensity among the participants. Both previous research and the present data suggest that improving sleep quality may significantly decrease pain intensity in the general population. The relationship between sleep and pain may be bidirectional. This finding also suggests that treatment for sleep disorders and insomnia should be addressed in future efforts to alleviate pain intensity.
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Affiliation(s)
- Xiao-Kun Liu
- Mental Health Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shui-Yuan Xiao
- Mental Health Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Liang Zhou
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mi Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Wei Zhou
- Hospital Administration Institute, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui-Ming Liu
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
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Drebenstedt C, Schuler M. [Status and perspectives of pain and pain therapy in old age : Plea for better care of geriatric pain patients]. Z Gerontol Geriatr 2017; 50:680-684. [PMID: 28936636 DOI: 10.1007/s00391-017-1306-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Corinna Drebenstedt
- St. Marien Hospital Friesoythe, St. Marien-Str. 1, 26169, Friesoythe, Deutschland.
| | - Matthias Schuler
- Diakonissenkrankenhaus Mannheim, Speyerer Str. 91-93, 68163, Mannheim, Deutschland
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Erlenwein J, Müller M, Falla D, Przemeck M, Pfingsten M, Budde S, Quintel M, Petzke F. Clinical relevance of persistent postoperative pain after total hip replacement - a prospective observational cohort study. J Pain Res 2017; 10:2183-2193. [PMID: 28919814 PMCID: PMC5593409 DOI: 10.2147/jpr.s137892] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The development of persistent postoperative pain may occur following surgery, including total hip replacement. Yet, the prevalence may depend on the definition of persistent pain. This observational cohort study explored whether the prevalence of persistent pain after total hip replacement differs depending on the definition of persistent pain and evaluated the impact of ongoing pain on the patient's quality of life 6 months after surgery. PATIENTS AND METHODS Pre- and postoperative characteristics of 125 patients undergoing elective total hip replacement were assessed and 104 patients were available for the follow-up interview, 6 months after surgery. RESULTS Six months after surgery, between 26% and 58% of patients still reported hip pain - depending on the definition of persistent pain. Patients with moderate-to-severe persistent pain intensity (>3 on a numerical rating scale) were more restricted in their daily life activities (Chronic Pain Grade - disability score) but did not differ in reported quality of life (Short-Form 12) from those with no pain or milder pain intensity. Maximal preoperative pain intensity and body mass index were the only independent factors influencing daily function 6 months after total hip replacement. CONCLUSION These findings support a high prevalence of persistent postoperative pain after total hip replacement and a large variability depending on the definition used. There was a close relation between physical functioning and pain as well as relevance of the patient's psychological state at the time of the operation.
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Affiliation(s)
- Joachim Erlenwein
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Martin Müller
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Deborah Falla
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany.,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Michael Przemeck
- Department of Anesthesiology and Intensive Care, Annastift, Hannover
| | - Michael Pfingsten
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Stefan Budde
- Department of Orthopedic Surgery, Medical School Hannover, Hannover, Germany
| | - Michael Quintel
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Frank Petzke
- Department of Anesthesiology, Pain Clinic, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
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Marck CH, De Livera AM, Weiland TJ, Jelinek PL, Neate SL, Brown CR, Taylor KL, Khan F, Jelinek GA. Pain in People with Multiple Sclerosis: Associations with Modifiable Lifestyle Factors, Fatigue, Depression, Anxiety, and Mental Health Quality of Life. Front Neurol 2017; 8:461. [PMID: 28928713 PMCID: PMC5591834 DOI: 10.3389/fneur.2017.00461] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/21/2017] [Indexed: 01/05/2023] Open
Abstract
Background People with multiple sclerosis (MS) often experience pain, which can interfere with mobility, employment, and quality of life (QOL). Methods This cross-sectional study explored associations between pain, demographic, disease, and modifiable lifestyle factors in an international sample of people with MS recruited online. Results Substantial pain, of moderate/severe intensity and interfering at least moderately with work/household or enjoyment of life in the past 4 weeks, was reported by 682/2,362 (28.9%). Substantial pain was associated with fatigue (odds ratio (OR): 6.7, 95% confidence interval (CI): 4.9,9.3), depression (OR:4.0, 95% CI:3.2,5.1), anxiety (OR:2.4, 95% CI:1.9,2.9), and lower mental health QOL (Mean Difference: −14.7, 95% CI:−16.6,−12.8). Regression analyses showed that smoking (OR: 2.0, 95% CI:1.35,2.87) and obesity (OR:2.1, 95% CI: 1.5,2.8), moderate alcohol use (OR: 0.7, 95% CI:0.5,0.9), moderate (OR 0.7, 95% CI: 0.55,0.98) or high (OR 0.6, 95% CI: 0.4,0.8) physical activity level, and healthy diet (OR 0.8, 95% CI: 0.75,0.95, per 10 points) were associated with substantial pain. Conclusion Our results show clear associations with modifiable lifestyle factors and substantial pain in MS. These factors are already considered in the prevention and management of pain in other populations but have not previously been considered in MS. Conversely, pain and associated common MS comorbidities, such as depression, anxiety, and fatigue, may hamper efforts to start or maintain healthy behaviors. Strategies to overcome these barriers need to be considered. Further research should clarify the direction of these associations.
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Affiliation(s)
- Claudia H Marck
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alysha M De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Biostatistics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Pia L Jelinek
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Sandra L Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Chelsea R Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Keryn L Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Fary Khan
- Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Prevalence and Characteristics of Chronic Intensive Care-Related Pain: The Role of Severe Sepsis and Septic Shock. Crit Care Med 2017; 44:1129-37. [PMID: 26958751 DOI: 10.1097/ccm.0000000000001635] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE There is only limited knowledge about chronic pain conditions resulting from critical care. Experimental and clinical data suggest a close relationship between inflammation and pain perception. Since sepsis is the most severe form of systemic inflammation, the primary objective was to evaluate chronic pain states and functional impairment of septic and nonseptic patients 6 months after discharge from ICU. Second, we aimed to obtain the total prevalence and characteristics of chronic ICU-related pain. DESIGN Case-control study. SETTING Observational study in long-term survivors of mixed surgical and medical ICUs. PATIENTS Septic and nonseptic survivors of critical care (n = 207) and healthy controls (n = 46). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected comprehensive information on patients' past and present pain 6 months after ICU discharge by means of the German pain questionnaire. Pain intensity levels and pain interference ratings were compared between septic and nonseptic patients and healthy controls. We found no differences in prevalence, severity, and interference of pain between septic and nonseptic patients. However, both patient groups differed significantly from controls. In secondary analysis, a third of all patients reported chronic clinically relevant pain associated with the ICU stay 6 months after ICU discharge. Half of these patients experienced chronic pain conditions before ICU admission and reported additional sources of pain. Most important, 16% of all patients had no preexisting pain condition and now experience chronic ICU-related pain. The majority of patients with chronic ICU-related pain reported a high degree of disabling pain, limiting daily activities. CONCLUSIONS A high percentage of former ICU patients develop chronic pain conditions associated with critical care. These patients differ significantly from control data in terms of pain intensity and show high levels of interference with pain. The presence of sepsis per se seems to play a marginal role for the development of chronic ICU-related pain.
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Abstract
From the point of view of healthcare policies, improvement in pain care has been required for years; however, there is a great discrepancy between the current need for pain care and the actual provision by healthcare services. This article seeks to demonstrate that while healthcare policies are one of the critical factors involved, a variety of conceptual, diagnostic and therapeutic causes should also be taken into account. Firstly, considering that pain care is primarily concerned with the suffering of pain by patients, the focus lies with their conscious experience in order to define the patients' understanding of pain. Additionally, in this article current biomedical and psychosocial comprehension concerning chronic pain will be illustrated and why it is necessary to broaden our horizons in order to do justice to patients with chronic pain.
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Affiliation(s)
- W Koppert
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-str. 1, 30625, Hannover, Deutschland.
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Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population. Pain 2017; 157:1122-1131. [PMID: 26780493 DOI: 10.1097/j.pain.0000000000000489] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pain related to cancer or treatment is a critical quality of life issue for breast cancer survivors. In a prospective study of 375 patients with breast cancer (enrolled during 2008-2014), we characterized the risk factors for adjuvant radiotherapy (RT)-associated pain. Pain score was assessed at pre-RT and post-RT as the mean of 4 pain severity items (ie, pain at its worst, least, average, and now) from the Brief Pain Inventory with 11-point numeric rating scale (0-10). Pain scores of 4 to 10 were considered clinically relevant pain. The study consists of 58 non-Hispanic whites (15%), 78 black or African Americans (AA; 21%), and 239 Hispanic whites (HW; 64%). Overall, the prevalence of pre-RT, post-RT, and RT-associated clinically relevant pain was 16%, 31% and 20%, respectively. In univariate analysis, AA and HW had significantly higher pre-RT and post-RT pain than non-Hispanic whites. In multivariable logistic regression analysis, pre-RT pain was significantly associated with HW and obesity; post-RT pain was significantly associated with AA, HW, younger age, ≥2 comorbid conditions, above-median hotspot volume receiving >105% prescribed dose, and pre-RT pain score ≥4. Radiotherapy-associated pain was significantly associated with AA (odds ratio [OR] = 3.27; 95% confidence interval [CI] = 1.09-9.82), younger age (OR = 2.44, 95% CI = 1.24-4.79), and 2 or ≥3 comorbid conditions (OR = 3.06, 95% CI = 1.32-7.08; OR = 4.61, 95% CI = 1.49-14.25, respectively). These risk factors may help to guide RT decision-making process, such as hypofractionated RT schedule. Furthermore, effective pain management strategies are needed to improve quality of life in patients with breast cancer with clinically relevant pain.
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Allen SA, Dal Grande E, Abernethy AP, Currow DC. Two colliding epidemics - obesity is independently associated with chronic pain interfering with activities of daily living in adults 18 years and over; a cross-sectional, population-based study. BMC Public Health 2016; 16:1034. [PMID: 27716147 PMCID: PMC5045593 DOI: 10.1186/s12889-016-3696-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/22/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic pain interfering with activities of daily living is highly prevalent in the community. More than 600 million people worldwide are obese. The aim of this paper is to assess if such chronic pain is associated independently with obesity across the adult population, having controlled for other key factors. METHODS The South Australian Health Omnibus is an annual, population-based, cross-sectional study. Data on 2616 participants were analysed for episodes of daily pain for three of the preceding six months. Obesity was derived from self-reported height and weight. Multivariable logistic regression analysed the associations between chronic pain interfering with activities of daily living, body mass index (BMI) and key socio-demographic factors. RESULTS Chronic pain interfering with activities of daily living peaks in people ≥75 years of age while obesity peaks in the 45-54 age group. Pain and obesity together peak in the 55-74 year age group. In the adjusted multinominal logistic regression model, compared to those with no pain, there was a strong association between obesity and pain that interfered moderately or extremely with day-to-day activities (OR 2.25; 95 % CI 1.57-3.23; p < 0.001) having controlled for respondents' age, gender, rurality, country of birth and highest educational attainment. People over 65 years of age and those with lower educational levels were more likely to experience such chronic pain related to obesity. CONCLUSION This study demonstrates a strong association between chronic pain and obesity/morbid obesity in the South Australian population. Prospective, longitudinal data are needed to understand the dynamic interaction between these two prevalent conditions.
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Affiliation(s)
- Sharon A Allen
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, Adelaide, Australia.
| | - Eleonora Dal Grande
- Population Research and Outcomes Studies Unit, Discipline of Medicine, Health Sciences Faculty, Adelaide University, Adelaide, Australia
| | - Amy P Abernethy
- Discipline, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, Australia.,Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA
| | - David C Currow
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, Adelaide, Australia.,Discipline, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, Australia
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Erlenwein J, Thoms KM, Brandebusemeyer F, Pfingsten M, Mansur A, Quintel M, Schön MP, Petzke F. Pre-Existing Chronic Pain Influences the Severity of Acute Herpes Zoster Pain—A Prospective Observational Cohort Study. PAIN MEDICINE 2016; 17:1317-1328. [DOI: 10.1093/pm/pnv116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mpinga EK, Kandala NB, Hasselgård-Rowe J, Tshimungu Kandolo F, Verloo H, Bukonda NKZ, Chastonay P. Estimating the Costs of Torture: Challenges and Opportunities. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:567-581. [PMID: 26385586 DOI: 10.1007/s40258-015-0196-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Due to its nature, extent and consequences, torture is considered a major public health problem and a serious violation of human rights. Our study aims to set the foundation for a theoretical framework of the costs related to torture. It examines existing challenges and proposes some solutions. Our proposed framework targets policy makers, human rights activists, professionals working in programmes, centres and rehabilitation projects, judges and lawyers, survivors of torture and their families and anyone involved in the prevention and fight against this practice and its consequences. We adopted a methodology previously used in studies investigating the challenges in measuring and valuing productivity costs in health disorders. We identify and discuss conceptual, methodological, political and ethical challenges that studies on the economic and social costs of torture pose and propose alternatives in terms of possible solutions to these challenges. The economic dimension of torture is rarely debated and integrated in research, policies and programmes. Several challenges such as epistemological, methodological, ethical or political ones have often been presented as obstacles to cost studies of torture and as an excuse for not investigating this dimension. In identifying, analysing and proposing solutions to these challenges, we intend to stimulate the integration of the economic dimension in research and prevention of torture strategies.
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Affiliation(s)
- Emmanuel Kabengele Mpinga
- Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Campus Biotech, Chemin des Mines 9, 1211, Geneva 20, Switzerland.
| | - Ngianga-Bakwin Kandala
- Health Economics and Evidence Synthesis Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - Jennifer Hasselgård-Rowe
- Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Campus Biotech, Chemin des Mines 9, 1211, Geneva 20, Switzerland
| | - Félicien Tshimungu Kandolo
- Departement of Public Health, Epidemiology and Health Systems, Institut Supérieur des Techniques Médicales, Kinshasa, Democratic Republic of Congo
| | - Henk Verloo
- Department of Health Sciences La Source, University of Applied Sciences, Lausanne, Switzerland
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Abstract
Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described.
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