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Encinosa W, Bernard D, Valdez RB. Heavy Versus Light Smoking: Its Association With Opioid Use, Chronic Pain, and Mental Health. Am J Prev Med 2024:S0749-3797(24)00249-6. [PMID: 39025246 DOI: 10.1016/j.amepre.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION There is much concern that substance use treatment programs are rarely integrated with smoking cessation programs. Here, the first national statistics are presented on the connection between heavy vs. light smoking and the opioid epidemic. METHODS Using the 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey, N=81,400 adults-years, logit regressions estimate the impact of heavy vs. light smoking on opioid use, chronic pain, work limitations due to pain, and poor mental health. Analyses were conducted from October 2023 to May 2024. RESULTS Only 37 percent of the population has ever smoked, but they used 69% of the nation's annual prescription opioids. Adults who smoked more than 5 cigarettes a day composed 12% of the population but used about the same number of opioids as the 63% of the population who never smoked. Adults who formerly smoked used 16% fewer opioids than adults who currently smoke (p<0.01). The percent with chronic pain during the year varied from 12.2% for adults who never smoked to 14.2% for light smoking, to 16.5% for those smoking more than a pack a day (p<0.01). Severe work limitations due to pain varied from 7.3% for adults who never smoked to 16.9% for those smoking more than a pack a day (p<0.01). Adults smoking more than a pack a day were twice as likely to report fair or poor mental health compared to those who never smoked (29.2% vs 13.6%) (p<0.01). CONCLUSIONS As nations deal with the opioid epidemic, integrating smoking cessation programs into substance abuse treatment programs appears prudent.
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Angarita-Fonseca A, Lacasse A, Choinière M, Kaboré JL, Sylvestre MP, Dinkou GDT, Bruneau J, Martel MO, Hovey R, Motulsky A, Rahme E, Pagé MG. Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics. Pharmacoepidemiol Drug Saf 2024; 33:e5706. [PMID: 37800356 DOI: 10.1002/pds.5706] [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: 09/30/2022] [Revised: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Manon Choinière
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Luc Kaboré
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Canada
| | - Marie-Pierre Sylvestre
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
| | | | - Julie Bruneau
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Marc O Martel
- Department of Anesthesia, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Elham Rahme
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - M Gabrielle Pagé
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Galán S, de la Vega R, Esteve R, López-Martínez AE, Fernández Baena M, Ramírez-Maestre C. Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study. FRONTIERS IN PAIN RESEARCH 2023; 4:1269018. [PMID: 37928367 PMCID: PMC10621745 DOI: 10.3389/fpain.2023.1269018] [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: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Background Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication. Methods Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse. Results The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11). Conclusions This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted. Significance This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.
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Affiliation(s)
- Santiago Galán
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Málaga, Spain
| | - Rocío de la Vega
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Rosa Esteve
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | - Alicia E. López-Martínez
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
| | | | - Carmen Ramírez-Maestre
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Personalidad, Evaluación y tratamiento Psicológico, Facultad de Psicología y Logopedia, Andalucía Tech, Universidad de Málaga (Spain), Málaga, Spain
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Wilson SC, Shaffer JA, Wachholtz AB. Distress Tolerance in the Comorbid Chronic Pain and Opioid Use Disorder Population. J Addict Med 2023; 17:e164-e171. [PMID: 37267174 PMCID: PMC10148917 DOI: 10.1097/adm.0000000000001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The risk of opioid addiction among people with chronic pain is elevated in those using opioids to self-medicate physical or emotional pain or distress. The purpose of this study is to test the main effect of distress tolerance (DT) on opioid use disorder (OUD) status in people with chronic pain, and the potential moderating effect of DT in the relationship between known addiction risk factors and the development of OUD. METHODS One hundred twenty people with chronic pain were recruited to 1 of 3 groups according to their opioid use status (ie, current methadone or buprenorphine/naloxone for OUD [n = 60], history of OUD but current prolonged opioid abstinence [n = 30, mean abstinence = 121 weeks, SD = 23.3], and opioid naive [n = 30]). Participants completed self-report measures and a cold pressor task. Multinomial logistic regression analyses were used to test if DT associated with OUD status in people with chronic pain and to compare DT to other known indicators of OUD risk. Multinomial linear regression analyses were used to test the moderation effects of DT on the relationship between various risk factors and OUD in people with chronic pain. RESULTS Analyses revealed that DT was significantly related to OUD status but did not moderate the effects of most OUD risk factors. CONCLUSIONS These results suggest that decreasing distress (eg, pain levels, craving responses, etc) may be more effective than improving tolerance to distress for the comorbid chronic pain and OUD population.
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Affiliation(s)
- Sarah C Wilson
- From the Department of Psychology, University of Colorado Denver, Denver, CO (SCW, JAS, ABW); Division of Addiction and Psychiatry, University of Colorado Medical School, Aurora, CO (ABW); and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA (ABW)
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Moisset X, Pagé MG, Pereira B, Choinière M. Pharmacological treatments of neuropathic pain: real-life comparisons using propensity score matching. Pain 2022; 163:964-974. [PMID: 34985849 DOI: 10.1097/j.pain.0000000000002461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/18/2021] [Indexed: 01/20/2023]
Abstract
ABSTRACT Studies comparing different drug treatments for chronic neuropathic pain (NP) are very limited. We, therefore, examined 4 recommended treatments, namely, antidepressants (duloxetine, venlafaxine, and tricyclic antidepressants), antiepileptics (gabapentine and pregabalin), weak opioids, and strong opioids, among patients with NP evaluated before first visit in a tertiary pain treatment centre and 6 months later. Patients with both a clinical diagnosis of NP and a DN4 score ≥3/7 were selected from patients enrolled in the Quebec Pain Registry. Each participant was assigned an inverse weighting of the probability of receiving any NP treatment, taking into account their age, sex, baseline pain intensity, pain duration, pain catastrophizing tendency, education level, employment, and comedications at 6-month follow-up (M6). Patients were considered as improved if they presented at least a 30% reduction on average pain intensity at M6 compared with baseline. A total of 944 patients completed both baseline and M6 evaluations. Overall, 23.0% of patients were significantly improved for pain intensity at M6. There was no significant difference in proportions patients taking or not antidepressants, gabapentinoids, or weak opioids. Among patients taking strong opioids (N = 288), 13.9% (N = 40/288) were improved vs 27.0% (177/656) of those who were not on opioids (P < 0.004). Inverse probability of treatment weighting confirmed that the proportion of patients who improved was significantly lower among those taking strong opioids compared with those who did not (P < 0.001). In conclusion, long-term use of strong opioids is a treatment suited for a limited proportion of patients with chronic NP.
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Affiliation(s)
- Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - M Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, QC, Canada
| | - Bruno Pereira
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Mansoori M, Zarei MR, Chamani G, Nazeri M, Mohammadi F, Alavi SS, Shabani M. Chronic migraine caused a higher rate of tendency to cannabinoid agonist compared to morphine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020185. [PMID: 33525279 PMCID: PMC7927472 DOI: 10.23750/abm.v91i4.8799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
Abstract
Opioid and cannabinoid systems have considerable roles in the modulation of chronic pain as well as regulation reward circuit and addiction responses. This study investigated the effect of nitroglycerin (NTG)-induced migraine attack on the acquisition of morphine and cannabinoid-induced conditioned place preference (CPP) in male rats. Adult male rats (230-250 gr) were used. Experimental groups were included (n=10): control, opioid receptor agonist morphine (10 mg/kg), WIN55,212-2 (1 mg/kg) as a cannabinoid receptor agonist, NTG + morphine (10 mg/kg) and NTG + WIN55,212-2 (1 mg/kg). Nitroglycerin (10 mg/kg) was used to induce migraine attacks every other day for 9 days. After migraine induction, conditioning performance was assessed by CPP test. During conditioning days, morphine and WIN55,212-2 were injected subcutaneously and intraperitoneally, respectively. Anxiety and locomotor activity were evaluated using open field test (OFT). According to data, conditioning score for morphine-treated rats was significantly decreased following NTG-induced migraine (p<0.01). However, NTG-induced migraine was able to increase the conditioning score in WIN55,212-2 as compared to the control group (p<0.05). In OFT, there were no significant differences in locomotor activity and grooming behaviors between experimental groups. However, time spent in the center of the OFT box was significantly decreased in NTG plus morphine-treated rats as compared to control (p<0.05). Moreover, rearing response in NTG - treated groups which received either morphine or WIN55,212-2 decreased as compared to the control group (p<0.01). NTG induced migraine prompts a decrease in morphine and an increase in cannabinoid performances. So, these compounds’ effects on drug dependency during migraine attacks may occur at different mechanisms. (www.actabiomedica.it)
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Affiliation(s)
- Mojdeh Mansoori
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran.
| | - Mohammad Reza Zarei
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran.
| | - Goli Chamani
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran.
| | - Masoud Nazeri
- Department of Oral Medicine and Orofacial Pain, Kerman School of Dentistry, Kerman Oral and Dental Diseases Research Center, Kerman, Iran.
| | - Fatemeh Mohammadi
- Intracellular Recording Lab, Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.
| | - Samane Sadat Alavi
- 3Afzalipour faculty of Medicine, Kerman University of Medical Science, Kerman, Iran.
| | - Mohammad Shabani
- Intracellular Recording Lab, Kerman Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.
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Clark MR, Hurley RW, Adams MCB. Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:1382-1395. [PMID: 29408996 PMCID: PMC7191882 DOI: 10.1093/pm/pnx332] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population. DESIGN A cross-sectional descriptive study. SETTING Academic tertiary pain management center. SUBJECTS A total of 225 consecutive new patients, aged 18 years or older. METHODS Data collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status. RESULTS In this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than the low-risk group. The only risk variable associated with aberrant behavior was personal history of prescription drug misuse. CONCLUSIONS The self-report ORT was not a valid test for the prediction of future aberrant behaviors in this academic pain management population. The original risk categories (low, medium, high) were not supported in the either the self-reported version or the enhanced version; however, the enhanced data were able to differentiate between high- and low-risk patients. Unfortunately, without technological automation, the enhanced ORT suffers from practical limitations. The self-report ORT may not be a valid tool in current pain populations; however, modification into a binary (high/low) score system needs further study.
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Affiliation(s)
- Meredith R Clark
- Division of Pain Medicine, Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Robert W Hurley
- Section of Pain Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Drive, Winston-Salem, North Carolina, USA
| | - Meredith C B Adams
- Section of Pain Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Medical Center Drive, Winston-Salem, North Carolina, USA
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Guildford BJ, Daly-Eichenhardt A, Hill B, Sanderson K, McCracken LM. Analgesic reduction during an interdisciplinary pain management programme: treatment effects and processes of change. Br J Pain 2017; 12:72-86. [PMID: 29796259 DOI: 10.1177/2049463717734016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Long-term use of opioid medication is associated with a host of negative effects on health and quality of life. Guidelines state that people with chronic pain taking high doses of opioids without benefit should be supported to discontinue them. Little research has investigated psychological processes associated with analgesic use and tapering. This study investigated (1) analgesic use pre- and post-participation in an interdisciplinary pain management programme and its relationship to functioning and (2) psychological processes associated with analgesic use. Opioid use was associated with poorer functioning at baseline. Participating in an interdisciplinary pain management programme was associated with reductions in opioid dose and number of classes of analgesics used. Reductions in analgesic use were associated with improvements in functioning. Psychological inflexibility was associated with using higher doses of opioid medication and with using a greater number of classes of analgesics. Psychological flexibility appears relevant in explaining analgesic use. Future research could focus on targeting this process to improve tapering outcomes.
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Affiliation(s)
- Beth J Guildford
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre, King's Health Partners, London, UK
| | - Aisling Daly-Eichenhardt
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bethany Hill
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Sanderson
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lance M McCracken
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Development and Implementation of a Registry of Patients Attending Multidisciplinary Pain Treatment Clinics: The Quebec Pain Registry. Pain Res Manag 2017; 2017:8123812. [PMID: 28280406 PMCID: PMC5322414 DOI: 10.1155/2017/8123812] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 11/28/2016] [Indexed: 01/15/2023]
Abstract
The Quebec Pain Registry (QPR) is a large research database of patients suffering from various chronic pain (CP) syndromes who were referred to one of five tertiary care centres in the province of Quebec (Canada). Patients were monitored using common demographics, identical clinical descriptors, and uniform validated outcomes. This paper describes the development, implementation, and research potential of the QPR. Between 2008 and 2013, 6902 patients were enrolled in the QPR, and data were collected prior to their first visit at the pain clinic and six months later. More than 90% of them (mean age ± SD: 52.76 ± 4.60, females: 59.1%) consented that their QPR data be used for research purposes. The results suggest that, compared to patients with serious chronic medical disorders, CP patients referred to tertiary care clinics are more severely impaired in multiple domains including emotional and physical functioning. The QPR is also a powerful and comprehensive tool for conducting research in a “real-world” context with 27 observational studies and satellite research projects which have been completed or are underway. It contains data on the clinical evolution of thousands of patients and provides the opportunity of answering important research questions on various aspects of CP (or specific pain syndromes) and its management.
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