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Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol 2024; 20:347-363. [PMID: 38755449 DOI: 10.1038/s41582-024-00966-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Nociplastic pain is a mechanistic term used to describe pain that arises or is sustained by altered nociception, despite the absence of tissue damage. Although nociplastic pain has distinct pathophysiology from nociceptive and neuropathic pain, these pain mechanisms often coincide within individuals, which contributes to the intractability of chronic pain. Key symptoms of nociplastic pain include pain in multiple body regions, fatigue, sleep disturbances, cognitive dysfunction, depression and anxiety. Individuals with nociplastic pain are often diffusely tender - indicative of hyperalgesia and/or allodynia - and are often more sensitive than others to non-painful sensory stimuli such as lights, odours and noises. This Review summarizes the risk factors, clinical presentation and treatment of nociplastic pain, and describes how alterations in brain function and structure, immune processing and peripheral factors might contribute to the nociplastic pain phenotype. This article concludes with a discussion of two proposed subtypes of nociplastic pain that reflect distinct neurobiological features and treatment responsivity.
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Affiliation(s)
- Chelsea M Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Eoin Kelleher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anushka Irani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Division of Rheumatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Hall OT, Rausch J, Entrup P, Lagisetty P, Bryan C, Black L, Moreno J, Gorka S, Phan KL, Clauw DJ. Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder. THE JOURNAL OF PAIN 2024; 25:104467. [PMID: 38219852 DOI: 10.1016/j.jpain.2024.01.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/25/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale-the Pain-Motivated Drinking Scale (PMDS)-was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol "to get relief from physical pain" at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PERSPECTIVE: Nociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Johnathan Rausch
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Parker Entrup
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Pooja Lagisetty
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Craig Bryan
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Lora Black
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jose Moreno
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Stephanie Gorka
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - K Luan Phan
- Department of Psychiatry & Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
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He J, Wilson JM, Fields KG, Mikayla Flowers Zachos K, Franqueiro AR, Reale SC, Farber MK, Bateman BT, Edwards RR, Rathmell JP, Soens M, Schreiber KL. Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires. Anesthesiology 2024; 140:701-714. [PMID: 38207329 PMCID: PMC10939890 DOI: 10.1097/aln.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models. METHODS In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery. RESULTS A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain. CONCLUSIONS The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Jenna M. Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kara G. Fields
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - K. Mikayla Flowers Zachos
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Angelina R. Franqueiro
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Sharon C. Reale
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Michaela K. Farber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - James P. Rathmell
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
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Minhas D. Pain mechanisms for the practicing rheumatologist. Best Pract Res Clin Rheumatol 2024:101942. [PMID: 38521633 DOI: 10.1016/j.berh.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
Pain in rheumatic diseases transcends the traditional nociceptive paradigm, incorporating complex interactions between nociceptive, neuropathic, and nociplastic mechanisms, as well as significant psychosocial factors. Advances in understanding chronic pain highlight the role of peripheral and central sensitization, and the emergence of nociplastic pain-a result of altered central nervous system processing. This modern perspective acknowledges the influence of mood disorders, environmental stressors, and cognitive patterns like catastrophizing, revealing the intricate interplay between biological, psychological, and social determinants of pain. Research emphasizes the brain's pivotal role in pain perception, underscoring the importance of comprehensive approaches that integrate medical, psychological, and social interventions to address the multifaceted nature of chronic pain in rheumatic diseases effectively.
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Affiliation(s)
- Deeba Minhas
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Cetera GE, Merli CEM, Barbara G, Caia C, Vercellini P. Questionnaires for the Assessment of Central Sensitization in Endometriosis: What Is the Available Evidence? A Systematic Review with a Narrative Synthesis. Reprod Sci 2024; 31:633-644. [PMID: 37751146 PMCID: PMC10912156 DOI: 10.1007/s43032-023-01343-4] [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: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
It has been suggested that central sensitization (CS) may be involved in the failure of standard medical and surgical treatment to relieve endometriosis-related pain. However, there is no gold standard for the diagnosis of CS, and self-reported questionnaires are used as diagnostic surrogates. The main objective of this review was to identify all CS questionnaires used in clinical endometriosis studies. The secondary objective was to qualitatively analyze strengths and weaknesses of each questionnaire. A PubMed and EMBASE systematic literature search conducted in April 2023 using the terms "endometriosis; central pain; central sensitization; questionnaire; patient-reported outcome measure; screening tool" identified 122 publications: six articles were included in the review. The Central Sensitization Inventory (CSI) is the most frequently used questionnaire for the detection of CS in patients with endometriosis. It has been validated in patients with endometriosis, in whom it appears to have good psychometric proprieties. The Fibromyalgia Survey Questionnaire (FSQ) has also been used, although it has not been specifically validated in endometriosis patients. The debate regarding these questionnaires' construct validity is still open and will be so until a gold standard diagnostic tool for CS is found. In fact, some authors argue these questionnaires are measuring psychological vulnerability and a hypervigilant state that is associated with pain, rather than CS itself. However, their use should not be discouraged as they are able to identify chronic pain patients which warrant further attention and who may benefit from broader treatment strategies.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giussy Barbara
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Obstetric and Gynecological Emergency Unit and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carlotta Caia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Giberson-Chen C, Liu C, Grisdela P, Liu D, Model Z, Steele A, Blazar P, Earp BE, Zhang D. Risk Factors for Rescue Opioid Prescription After Cubital Tunnel Surgery. Hand (N Y) 2024:15589447241232015. [PMID: 38357894 DOI: 10.1177/15589447241232015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Concerns regarding the ongoing opioid epidemic have led to heightened scrutiny of postoperative opioid prescribing patterns for common orthopedic surgical procedures. This study investigated patient- and procedure-specific risk factors for additional postoperative opioid rescue prescriptions following ambulatory cubital tunnel surgery. METHODS A retrospective review was performed of patients who underwent cubital tunnel surgery at 2 academic medical centers between June 1, 2015 and March 1, 2020. Patient demographics, comorbidities, prior opioid history, and surgical variables were recorded. The primary outcome was postoperative rescue opioid prescription. Univariate and bivariate statistical analyses were performed. RESULTS Two hundred seventy-four patients were included, of whom 171 (62%) underwent in situ ulnar nerve decompression and 103 (38%) underwent ulnar nerve decompression with anterior transposition. The median postoperative opioid prescription amount was 90 morphine equivalent units (MEU) for the total cohort, 77.5 MEU for in situ ulnar nerve decompression, and 112.5 MEU for ulnar nerve decompression with transposition. Twenty-two patients (8%) required additional rescue opioid prescriptions postoperatively. Female sex, fibromyalgia, chronic opioid use, chronic pain diagnosis, and recent opioid were associated with the need for additional postoperative rescue opioid prescriptions. CONCLUSIONS While most patients do not require additional rescue opioid prescriptions after cubital tunnel surgery, chronic pain patients and patients with pain sensitivity syndromes are at risk for requiring additional rescue opioid prescriptions. For these high-risk patients, preoperative collaboration of a multidisciplinary team may be beneficial for developing a perioperative pain management plan that is both safe and effective.
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Affiliation(s)
- Carew Giberson-Chen
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - Christina Liu
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - Phillip Grisdela
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - David Liu
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - Zina Model
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - Amy Steele
- Harvard Combined Orthopaedic Residency Program, Harvard Affiliated Hospitals, Boston, MA, USA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Brigham and Women's Hospital, Boston, MA, USA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Brigham and Women's Hospital, Boston, MA, USA
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Brigham and Women's Hospital, Boston, MA, USA
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Scott JR, Williams DA, Harte SE, Harris RE, Litinas E, Sisley S, Clauw DJ, Boehnke KF. Relationship Between Nociplastic Pain Involvement and Medication Use, Symptom Relief, and Adverse Effects Among People Using Medical Cannabis for Chronic Pain. Clin J Pain 2024; 40:1-9. [PMID: 37823303 DOI: 10.1097/ajp.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Cannabis is increasingly being used for chronic pain management, but cannabis' effects remain poorly characterized in chronic nociplastic pain (NPP), which is posited to be caused by disturbances in nervous system pain processing. In this cross-sectional study (n=1213), we used the 2011 Fibromyalgia (FM) Survey Criteria as a surrogate measure for degree of NPP among individuals using medical cannabis for chronic pain. METHODS Using a quartile-split, we investigated associations between the degree of NPP and medication use, cannabis use characteristics, and symptom relief. Continuous variables were assessed using one-way analysis of variance and categorical variables with Pearson χ 2 test and binomial logistic regression for calculation of odds ratios. RESULTS Participants were predominately female (59%), with a mean ± SD age of 49.4±13.6 years. Higher FM scores were associated with less self-reported improvement in pain and health since initiating medical cannabis use, as well as more cannabis-related side effects. Paradoxically, higher FM scores were also associated with higher usage of concomitant medication use (including opioids and benzodiazepines) but also with substituting cannabis for significantly more medication classes, including opioids and benzodiazepines. DISCUSSION This article presents evidence that individuals in higher NPP quartiles have higher analgesic intake, higher odds of substituting cannabis for medications, higher side effect burden, and lower therapeutic effect from cannabis. These seemingly contradictory findings may reflect higher symptom burden, polypharmacy at baseline, or that NPP may be challenging to treat with cannabis. Further research is necessary to further explain cannabinoid effects in NPP.
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Affiliation(s)
- J Ryan Scott
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan
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Liu R, Gutiérrez R, Mather RV, Stone TAD, Santa Cruz Mercado LA, Bharadwaj K, Johnson J, Das P, Balanza G, Uwanaka E, Sydloski J, Chen A, Hagood M, Bittner EA, Purdon PL. Development and prospective validation of postoperative pain prediction from preoperative EHR data using attention-based set embeddings. NPJ Digit Med 2023; 6:209. [PMID: 37973817 PMCID: PMC10654400 DOI: 10.1038/s41746-023-00947-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
Preoperative knowledge of expected postoperative pain can help guide perioperative pain management and focus interventions on patients with the greatest risk of acute pain. However, current methods for predicting postoperative pain require patient and clinician input or laborious manual chart review and often do not achieve sufficient performance. We use routinely collected electronic health record data from a multicenter dataset of 234,274 adult non-cardiac surgical patients to develop a machine learning method which predicts maximum pain scores on the day of surgery and four subsequent days and validate this method in a prospective cohort. Our method, POPS, is fully automated and relies only on data available prior to surgery, allowing application in all patients scheduled for or considering surgery. Here we report that POPS achieves state-of-the-art performance and outperforms clinician predictions on all postoperative days when predicting maximum pain on the 0-10 NRS in prospective validation, though with degraded calibration. POPS is interpretable, identifying comorbidities that significantly contribute to postoperative pain based on patient-specific context, which can assist clinicians in mitigating cases of acute pain.
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Affiliation(s)
- Ran Liu
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rodrigo Gutiérrez
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rory V Mather
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, US
| | - Tom A D Stone
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura A Santa Cruz Mercado
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kishore Bharadwaj
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jasmine Johnson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Proloy Das
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gustavo Balanza
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ekenedilichukwu Uwanaka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin Sydloski
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew Chen
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mackenzie Hagood
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patrick L Purdon
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Alsouhibani A, Speck P, Cole EF, Mustin DE, Li Y, Barron JR, Orenstein LAV, Harper DE. Quantitative Sensory Testing to Characterize Sensory Changes in Hidradenitis Suppurativa Skin Lesions. JAMA Dermatol 2023; 159:1102-1111. [PMID: 37702999 PMCID: PMC10500434 DOI: 10.1001/jamadermatol.2023.3243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/25/2023] [Indexed: 09/14/2023]
Abstract
Importance Pain is the most impactful symptom in patients with hidradenitis suppurativa (HS). Characterization of sensory profiles may improve understanding of pain mechanisms in HS and facilitate identification of effective pain management strategies. Objective To characterize somatosensory profiles in patients with HS at clinically affected and nonaffected sites compared with pain-free reference data. Design, Setting, and Participants This cross-sectional study was conducted at the Emory University Dermatology Clinic. It was hypothesized (1) that patients with HS would demonstrate hypersensitivity to pain in HS lesions and (2) that some patients would have sensory profiles consistent with complex pain mechanisms. Therefore, adults with dermatologist-diagnosed HS and at least 1 painful HS lesion at the time of testing were enrolled between September 10, 2020, and March 21, 2022. Patients with other diagnoses contributing to pain or neuropathy were excluded. Data analysis was conducted between March and April 2022. Exposure Quantitative sensory testing was performed on HS lesions and control skin according to a standardized protocol. Main Outcomes and Measures Quantitative sensory testing outcomes included innocuous thermal and mechanical sensitivity (cold, warmth, and light touch detection thresholds), noxious thermal and mechanical sensitivity (cold, heat, pinprick, and deep pressure pain thresholds and suprathreshold pinprick sensitivity), temporal summation of pinprick, paradoxical thermal sensations, and dynamic mechanical allodynia (pain upon light stroking of the skin). Sensitivity in HS lesions was compared with sensitivity in a control location (the hand) and in pain-free controls using t tests. Results This study included 20 participants with a median age of 35.5 (IQR, 30.0-46.5) years, the majority of whom were women (15 [75%]). In terms of race and ethnicity, 2 participants (10%) self-identified as Asian, 11 (55%) as Black, 6 (30%) as White, and 1 (5%) as more than 1 race or ethnicity. Compared with site-specific reference values from healthy, pain-free control participants, HS lesions were insensitive to innocuous cold and warmth, noxious heat, and light touch (t = -5.69, -10.20, -3.84, and 4.46, respectively; all P < .001). In contrast, HS lesions also demonstrated significant hypersensitivity to deep pressure pain (t = 8.36; P < .001) and cutaneous pinprick (t = 2.07; P = .046). Hypersensitivity to deep pressure pain was also observed in the control site (t = 5.85; P < .001). A subset of patients with HS displayed changes in pain processing that are often seen in neuropathic and nociplastic pain conditions, including hypersensitivity to repetitive pinprick (5 [26%]), paradoxical thermal sensations (3 [15%]), and pain upon light stroking of the skin (10 [50%]). Conclusions and Relevance The findings of this cross-sectional study suggest that HS involves local changes in the skin or its free nerve endings, possibly leading to peripheral neuropathy and alterations in the transduction of innocuous and noxious thermal and mechanical stimuli. For some patients, central nervous system changes in somatosensory processing may also occur, but confirmatory evidence is needed. Better understanding of neuropathic and nociplastic mechanisms in HS pain could lead to individually tailored treatments.
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Affiliation(s)
- Ali Alsouhibani
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Patrick Speck
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Emily F. Cole
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Danielle E. Mustin
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Yiwen Li
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Jason R. Barron
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Daniel E. Harper
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
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Hall OT, Teater J, Entrup P, Deaner M, Bryan C, Harte SE, Kaplan CM, Phan KL, Clauw DJ. Fibromyalgia predicts increased odds of pain-related addiction exacerbation among individuals with pain and opioid use disorder. Pain 2023; 164:1801-1809. [PMID: 36921216 PMCID: PMC10348630 DOI: 10.1097/j.pain.0000000000002878] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
ABSTRACT Fibromyalgia and opioid use disorder (OUD) are highly impactful chronic illnesses with substantially overlapping psychosocial, biological, and clinical features. Little previous research has examined interactions between fibromyalgia and OUD. Limiting such research has been the previous requirement of a clinical examination to diagnose fibromyalgia. The 2011 American College of Rheumatology Fibromyalgia Survey (ACR-FMS) is a validated self-report instrument with high sensitivity and specificity for fibromyalgia intended to enable fibromyalgia research in settings where a clinical examination is impractical. The present observational study uses the ACR-FMS to determine whether fibromyalgia affects odds of acknowledging pain-related OUD exacerbations among a sample of participants with pain and OUD. Participants with pain and OUD (n = 125) were recruited from an academic substance use treatment facility. The ACR-FMS, along with an original scale measuring pain-related OUD exacerbation-the Pain-related OUD Exacerbation Scale-was administered through an electronic survey. The factor structure, internal consistency, and construct validity of Pain-related OUD Exacerbation Scale were tested. In addition, descriptive analyses, multiple hierarchical linear regression, ordinal logistic regression, and multinomial logistic regression analyses were performed. Although all participants had pain, those with fibromyalgia demonstrated significantly greater odds of acknowledging pain-related OUD exacerbations. Pain-related OUD Exacerbation Scale was found to have a single-factor solution, strong internal consistency, and construct validity. This study provides first evidence of fibromyalgia as a risk factor for pain-related exacerbation of OUD and introduces a new scale with promising psychometric properties to measure pain-related OUD exacerbation.
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Affiliation(s)
- Orman Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Parker Entrup
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Megan Deaner
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Craig Bryan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Chelsea M. Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Kihn Luan Phan
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
- Departments of Anesthesiology, Internal Medicine (Rheumatology) and Psychiatry, University of Michigan, Ann Arbor, MI, United States
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11
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Till SR, Schrepf A, Clauw DJ, Harte SE, Williams DA, As-Sanie S. Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain. THE JOURNAL OF PAIN 2023; 24:1406-1414. [PMID: 36958459 PMCID: PMC10511662 DOI: 10.1016/j.jpain.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/25/2023]
Abstract
Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis. Multiple measures of pelvic pain, including pain severity, frequency, interference, pelvic myofascial pain, and high-impact pain were examined in General Linear Models with FM Survey Score as the primary predictor of interest in models controlling for endometriosis, surgical history, use of opioids, body mass index, and patient age. Higher level of nociplastic pain was associated with greater pelvic pain severity, frequency, interference, and pelvic myofascial pain (all P < .05). For all models, degree of nociplastic pain was more strongly associated with pain outcomes than the presence of endometriosis, and use of opioids was the only stronger predictor of worse pain outcomes. The likelihood of high impact pain increased 7% for each additional point on the FM Survey Score. Degree of nociplastic pain was robustly associated with severity, frequency, and impact of pelvic pain, and was independent of the presence of endometriosis, history of surgical procedures for pelvic pain, age, and BMI. Trial registration: not applicable PERSPECTIVE: This article evaluates the impact of nociplastic pain on symptoms and functional status in chronic pelvic pain. These findings raise the possibility that a simple screening tool for nociplastic pain might provide clinically actionable information without the need for deep neurobiological phenotyping and may inform development of personalized management strategies.
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Affiliation(s)
- Sara R Till
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan..
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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12
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Kuisell C, Ploutz-Snyder R, Williams DA, Voepel-Lewis T, Hutchinson R, Dudding KM, Bridges C, Smith EML. Adolescents and Young Adults With Sickle Cell Disease: Nociplastic Pain and Pain Catastrophizing as Predictors of Pain Interference and Opioid Consumption. Clin J Pain 2023; 39:326-333. [PMID: 37083638 PMCID: PMC10330104 DOI: 10.1097/ajp.0000000000001119] [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: 05/21/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Some patients with sickle cell disease (SCD) have features of nociplastic pain. While research suggests that many patients with nociplastic pain consume more opioids due to opioid nonresponsiveness, little is known about the impact of nociplastic pain and pain catastrophizing on opioid consumption and pain interference among adolescents and young adults (AYA) with SCD. The purpose of this study was to (1) characterize nociplastic pain and pain catastrophizing among AYA with SCD, and (2) determine whether these characterizations are associated with subsequent opioid consumption and pain interference 1 month after characterization. METHODS Participants completed surveys characterizing nociplastic pain and catastrophizing at a routine clinic visit (baseline). Thereafter, participants received weekly text messages that included pain interference and opioid consumption surveys. Multipredictor 2-part models were used to evaluate the predictive relationships between baseline characterizations and subsequent pain interference, and opioid consumption. RESULTS Forty-eight AYA aged 14 to 35 completed baseline measures. Twenty-five percent of participants had scores suggestive of nociplastic pain. Greater nociplastic pain features significantly increased the odds of consuming opioids (odds ratio=1.2) and having greater interference from pain (odds ratio=1.46). Regression analyses found that greater baseline nociplastic pain characteristics were significantly associated with opioid consumption (β=0.13) and pain interference (β=0.061); whereas higher pain catastrophizing scores predicted less opioid consumption (β=-0.03) and less pain interference (β=-0.0007). DISCUSSION In this sample of AYA with SCD, features of nociplastic pain predicted higher subsequent opioid consumption and pain interference. Being aware of nociplastic pain features in patients with SCD may better guide individualized pain management.
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Affiliation(s)
| | | | | | | | | | | | - Celia Bridges
- University of Alabama at Birmingham School of Nursing, Birmingham, AL
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13
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Dizner-Golab A, Lisowska B, Kosson D. Fibromyalgia - etiology, diagnosis and treatment including perioperative management in patients with fibromyalgia. Reumatologia 2023; 61:137-148. [PMID: 37223370 PMCID: PMC10201378 DOI: 10.5114/reum/163094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/06/2023] [Indexed: 05/25/2023] Open
Abstract
Fibromyalgia (FM) is considered a multifactorial disorder/syndrome with not fully understood etiology. Chronic generalized pain is the main symptom. A broad spectrum of factors is proposed to explain the etiology. Its multifactorial nature is inherently associated with challenges in diagnosis and therapy. Various evidence of etiology has been evaluated with the aim of establishing a novel therapeutic approach. The main issue in the diagnosis and management is to focus on the evaluation of strict diagnostic criteria to minimize under- and overdiagnosis. Fibromyalgia is a challenge for perioperative management because of the increased risk of possible complications and poorer outcomes, including postoperative pain chronification. The authors have proposed an up-to-date evaluation of perioperative management considering the current guidelines. Multimodal analgesia combined with tailored perioperative care is the most appropriate assessment. Interdisciplinary research with special interest in pain management, including perioperative medicine, seems to be the main theme for the future.
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Affiliation(s)
- Anna Dizner-Golab
- 1 Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Poland
| | - Barbara Lisowska
- Anaesthesiology Department, Carolina Medical Centre, Warsaw, Poland
| | - Dariusz Kosson
- Department of Anaesthesiology and Intensive Care, Division of Teaching, Medical University of Warsaw, Poland
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14
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Gorzewski AM, Heisler AC, Neogi T, Muhammad LN, Song J, Dunlop D, Bingham CO, Bolster MB, Clauw DJ, Marder W, Lee YC. Predicting Disease Activity in Rheumatoid Arthritis With the Fibromyalgia Survey Questionnaire: Does the Severity of Fibromyalgia Symptoms Matter? J Rheumatol 2023; 50:684-689. [PMID: 36521924 PMCID: PMC10159881 DOI: 10.3899/jrheum.220507] [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] [Accepted: 10/17/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine if the degree of baseline fibromyalgia (FM) symptoms in patients with rheumatoid arthritis (RA), as indicated by the Fibromyalgia Survey Questionnaire (FSQ) score, predicts RA disease activity after initiation or change of a disease-modifying antirheumatic drug (DMARD). METHODS One hundred ninety-two participants with active RA were followed for 12 weeks after initiation or change of DMARD therapy. Participants completed the FSQ at the initial visit. The Disease Activity Score in 28 joints using C-reactive protein (DAS28-CRP) was measured at baseline and follow-up to assess RA disease activity. We evaluated the association between baseline FSQ score and follow-up DAS28-CRP. As a secondary analysis, we examined the relationship between the 2 components of the FSQ, the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), with follow-up DAS28-CRP. Multiple linear regression analyses were performed, adjusting for clinical and demographic variables. RESULTS In multiple linear regression models, FSQ score was independently associated with elevated DAS28-CRP scores 12 weeks after DMARD initiation (B = 0.04, P = 0.01). In secondary analyses, the WPI was significantly associated with increased follow-up DAS28-CRP scores (B = 0.08, P = 0.001), whereas the SSS was not (B = -0.03, P = 0.43). CONCLUSION Higher levels of FM symptoms weakly predicted worse disease activity after treatment. The primary factor that informed the FSQ's prediction of disease activity was the spatial extent of pain, as measured by the WPI.
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Affiliation(s)
| | - Andrew C Heisler
- A.C. Heisler, MD, MSci, Rheumatology, Department of Medicine, Western Michigan University, Kalamazoo, Michigan
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Department of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Lutfiyya N Muhammad
- L.N. Muhammad, PhD, J. Song, MS, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Jing Song
- L.N. Muhammad, PhD, J. Song, MS, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Dorothy Dunlop
- D. Dunlop, PhD, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Clifton O Bingham
- C.O. Bingham III, MD, Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcy B Bolster
- M.B. Bolster, MD, Division of Rheumatology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel J Clauw
- D.J. Clauw, MD, Rheumatology, Department of Medicine and Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Wendy Marder
- W. Marder, MD, Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yvonne C Lee
- Y.C. Lee, MD, MMSc, Rheumatology, Department of Medicine, Northwestern University, Chicago, Illinois, USA.
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15
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Verspyck E, Attal N. Diagnosing nociplastic pain in cancer survivors: a major step forward. Br J Anaesth 2023; 130:515-518. [PMID: 36890060 DOI: 10.1016/j.bja.2023.02.006] [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: 01/27/2023] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Nociplastic pain syndromes include particular fibromyalgia, irritable bowel syndrome, headache, complex regional pain syndrome, and idiopathic orofacial pain. Several mechanisms have been proposed to account for nociplastic pain including central sensitisation, alterations of pain modulatory controls, epigenetic changes, and peripheral mechanisms. Importantly, nociplastic pain might also be present in patients with cancer pain, particularly those with pain related to complications of cancer treatment. Increased awareness of nociplastic pain associated with cancer should have important implications for monitoring and managing such patients.
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Affiliation(s)
| | - Nadine Attal
- CETD, Ambroise Pare Hospital, APHP, Boulogne-Billancourt, France; Inserm U987, UVSQ-Paris-Saclay University, Ambroise Pare Hospital, APHP, Boulogne-Billancourt, France.
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16
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Sun Y, Kang J, Brummett C, Li Y. Individualized risk assessment of preoperative opioid use by interpretable neural network regression. Ann Appl Stat 2023; 17:434-453. [PMID: 37006707 PMCID: PMC10065608 DOI: 10.1214/22-aoas1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preoperative opioid use has been reported to be associated with higher preoperative opioid demand, worse postoperative outcomes, and increased postoperative healthcare utilization and expenditures. Understanding the risk of preoperative opioid use helps establish patient-centered pain management. In the field of machine learning, deep neural network (DNN) has emerged as a powerful means for risk assessment because of its superb prediction power; however, the blackbox algorithms may make the results less interpretable than statistical models. Bridging the gap between the statistical and machine learning fields, we propose a novel Interpretable Neural Network Regression (INNER), which combines the strengths of statistical and DNN models. We use the proposed INNER to conduct individualized risk assessment of preoperative opioid use. Intensive simulations and an analysis of 34,186 patients expecting surgery in the Analgesic Outcomes Study (AOS) show that the proposed INNER not only can accurately predict the preoperative opioid use using preoperative characteristics as DNN, but also can estimate the patient-specific odds of opioid use without pain and the odds ratio of opioid use for a unit increase in the reported overall body pain, leading to more straight-forward interpretations of the tendency to use opioids than DNN. Our results identify the patient characteristics that are strongly associated with opioid use and is largely consistent with the previous findings, providing evidence that INNER is a useful tool for individualized risk assessment of preoperative opioid use.
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Affiliation(s)
- Yuming Sun
- Department of Biostatistics, University of Michigan
| | - Jian Kang
- Department of Biostatistics, University of Michigan
| | - Chad Brummett
- Department of Anesthesiology, University of Michigan
| | - Yi Li
- Department of Biostatistics, University of Michigan
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17
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Joyce E, Carr G, Wang S, Brummett CM, Kidwell KM, Henry NL. Association between nociplastic pain and premature endocrine therapy discontinuation in breast cancer patients. Breast Cancer Res Treat 2023; 197:397-404. [PMID: 36371776 PMCID: PMC9825644 DOI: 10.1007/s10549-022-06806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE At least 5 years of adjuvant endocrine therapy (ET) is recommended for patients with hormone receptor-positive invasive breast cancer to reduce cancer recurrence risk. Up to half of patients prematurely discontinue ET, often due to musculoskeletal pain. Nociplastic pain is abnormal central nervous system pain processing without evidence of tissue or neuronal damage. This study aimed to evaluate the relationship between baseline nociplastic pain and ET discontinuation. METHODS This was a retrospective, single center, cohort study. Included patients were female, had stage 0-III invasive breast cancer, did not receive neoadjuvant therapy, and completed quality of life questionnaires prior to breast surgery, including Fibromyalgia Survey for nociplastic pain. Clinical data including duration of ET were abstracted from the medical record. Patient characteristics were analyzed with t-tests and Chi-squared tests, as appropriate. Univariate and multivariable regressions were performed with Cox proportional hazard models. RESULTS Six hundred eighty-one patients diagnosed between 2012 and 2019 met inclusion criteria; 480 initiated ET and were included in the analysis. Of these 480 patients, 203 (42.3%) prematurely discontinued initial ET therapy. On univariate analysis, tamoxifen use (hazard ratio [HR] 0.70, p = 0.021) and premenopausal status (HR 0.73, p = 0.04) were inversely associated with ET discontinuation, while Fibromyalgia Score was positively associated (HR 1.04, p = 0.043). On multivariable analysis, baseline Fibromyalgia Score remained associated with ET discontinuation. CONCLUSION Nociplastic pain present prior to surgery was associated with premature ET discontinuation. Fibromyalgia Score screening may be useful for evaluating ET discontinuation risk. Treatments targeting nociplastic pain may be more effective for treating ET-emergent pain.
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Affiliation(s)
| | - Grant Carr
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sidi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Dr. Room 7322, Ann Arbor, MI, 48109, USA.
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18
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Lepping RJ, McMillan ML, Chadwick AL, Mansour ZM, Martin LE, Gustafson KM. Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:953118. [PMID: 36185772 PMCID: PMC9521378 DOI: 10.3389/fpain.2022.953118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 01/02/2023]
Abstract
Purpose To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.
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Affiliation(s)
- Rebecca J. Lepping
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,*Correspondence: Rebecca J. Lepping
| | - Miranda L. McMillan
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Andrea L. Chadwick
- Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Zaid M. Mansour
- Department of Physical and Occupational Therapy, The Hashemite University, Zarqa, Jordan
| | - Laura E. Martin
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States,Department for McMillan and Chadwick, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States
| | - Kathleen M. Gustafson
- Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States,Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
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Schrepf A, Gallop R, Naliboff B, Harte SE, Afari N, Lai HH, Pontari M, McKernan LC, Strachan E, Kreder KJ, As-Sanie SA, Rodriguez LV, Griffith JW, Williams DA. Clinical Phenotyping for Pain Mechanisms in Urologic Chronic Pelvic Pain Syndromes: A MAPP Research Network Study. THE JOURNAL OF PAIN 2022; 23:1594-1603. [PMID: 35472518 PMCID: PMC10547025 DOI: 10.1016/j.jpain.2022.03.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
Three categories of pain mechanisms are recognized as contributing to pain perception: nociceptive, neuropathic, and nociplastic (ie, central nervous system augmented pain processing). We use validated questionnaires to identify pain mechanisms in Urologic Chronic Pelvic Pain Syndrome (UCCPS) patients (n = 568, female = 378, male = 190) taking part in the Symptom Patterns Study of the Multidisciplinary Approach to the study of chronic Pelvic Pain Research Network. A cutoff score of 12 on the painDETECT questionnaire (-1 to 38) was used to classify patients into the neuropathic category while the median score of 7 on the fibromyalgia survey criteria (0-31) was used to classify patients into the nociplastic category. Categories were compared on demographic, clinical, psychosocial, psychophysical and medication variables. At baseline, 43% of UCPPS patients were classified as nociceptive-only, 8% as neuropathic only, 27% as nociceptive+nociplastic, and 22% as neuropathic+nociplastic. Across outcomes nociceptive-only patients had the least severe symptoms and neuropathic+nociplastic patients the most severe. Neuropathic pain was associated with genital pain and/or sensitivity on pelvic exam, while nociplastic pain was associated with comorbid pain conditions, psychosocial difficulties, and increased pressure pain sensitivity outside the pelvis. A self-report method classifying individuals on pain mechanisms reveals clinical differences that could inform clinical trials and novel targets for treatment. PERSPECTIVE: This article presents differences in clinical characteristics based on a simple self-report method of classifying pain mechanisms for Urologic Chronic Pelvic Pain Syndrome patients. This method can be easily applied to other chronic pain conditions and may be useful for exploring pathophysiology in pain subtypes.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Robert Gallop
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Niloofar Afari
- Department of Psychiatry, UC San Diego & VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - H Henry Lai
- Department of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, Missouri
| | - Michel Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Lindsey C McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Karl J Kreder
- Departments of Urology and Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa
| | - Sawsan A As-Sanie
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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20
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Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria. Pain Rep 2022; 7:e1016. [PMID: 35812839 PMCID: PMC9263499 DOI: 10.1097/pr9.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
Central sensitization may be an underlying mechanism linking chronic pain and opioid use disorder associated with opioid use disorder onset, maintenance, escalation, treatment delay, and relapse. Introduction: Central sensitization (CS) involves dysfunctional central nervous system pain modulation resulting in heightened pain perception. Central sensitization is not commonly assessed among patients with opioid use disorder (OUD), despite the fact that pain has been implicated in the development, maintenance, and relapse of OUD and chronic opioid use may produce opioid-induced hyperalgesia. Central sensitization is a plausibly important mechanism underlying the complex relationship between OUD and chronic pain. However, this premise is largely untested. Methods: Participants with OUD (n = 141) were recruited from an academic addiction treatment center in Columbus, Ohio. An established surrogate measure of CS, the American College of Rheumatology 2011 Fibromyalgia Survey Criteria, was administered using electronic survey. Participants also responded to questions about pain interference (Brief Pain Inventory), quality of life (RAND-36), and items regarding pain beliefs and expectations of pain and addiction treatment. Descriptive analyses, Spearman rho correlations, and Mann–Whitney U tests were performed. Results: Hypothesized relationships were confirmed between degree of CS, pain interference, and health-related quality of life. Degree of CS was also positively correlated with greater endorsement of pain as a reason for the onset, maintenance, and escalation of OUD; treatment delay; and OUD relapse. Participants with the American College of Rheumatology 2011 Fibromyalgia Survey Criteria ≥13 had significantly greater endorsement of pain as a reason for delaying OUD treatment, continuing and increasing opioid use, and precipitating OUD relapse. Conclusions: This study provides early evidence CS may underlie previously observed connections between clinically salient features of chronic pain and OUD, potentially informing future mechanistic research and precision treatment.
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Till SR, Nakamura R, Schrepf A, As-Sanie S. Approach to Diagnosis and Management of Chronic Pelvic Pain in Women. Obstet Gynecol Clin North Am 2022; 49:219-239. [DOI: 10.1016/j.ogc.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Cockrum R, Tu F. Hysterectomy for Chronic Pelvic Pain. Obstet Gynecol Clin North Am 2022; 49:257-271. [DOI: 10.1016/j.ogc.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Goebel A, Andersson D, Barker C, Basu N, Bullock C, Bevan S, Bashford-Rogers RJM, Choy E, Clauw D, Dulake D, Dulake R, Flor H, Glanvill M, Helyes Z, Irani S, Kosek E, Laird J, MacFarlane G, McCullough H, Marshall A, Moots R, Perrot S, Shenker N, Sher E, Sommer C, Svensson CI, Williams A, Wood G, Dorris ER. Research Recommendations Following the Discovery of Pain Sensitizing IgG Autoantibodies in Fibromyalgia Syndrome. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1084-1094. [PMID: 34850195 PMCID: PMC9157149 DOI: 10.1093/pm/pnab338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is the most common chronic widespread pain condition in rheumatology. Until recently, no clear pathophysiological mechanism for fibromyalgia had been established, resulting in management challenges. Recent research has indicated that serum immunoglobulin Gs (IgGs) may play a role in FMS. We undertook a research prioritisation exercise to identify the most pertinent research approaches that may lead to clinically implementable outputs. METHODS Research priority setting was conducted in five phases: situation analysis; design; expert group consultation; interim recommendations; consultation and revision. A dialogue model was used, and an international multi-stakeholder expert group was invited. Clinical, patient, industry, funder, and scientific expertise was represented throughout. Recommendation-consensus was determined via a voluntary closed eSurvey. Reporting guideline for priority setting of health research were employed to support implementation and maximise impact. RESULTS Arising from the expert group consultation (n = 29 participants), 39 interim recommendations were defined. A response rate of 81.5% was achieved in the consensus survey. Six recommendations were identified as high priority- and 15 as medium level priority. The recommendations range from aspects of fibromyalgia features that should be considered in future autoantibody research, to specific immunological investigations, suggestions for trial design in FMS, and therapeutic interventions that should be assessed in trials. CONCLUSIONS By applying the principles of strategic priority setting we directed research towards that which is implementable, thereby expediating the benefit to the FMS patient population. These recommendations are intended for patients, international professionals and grant-giving bodies concerned with research into causes and management of patients with fibromyalgia syndrome.
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Affiliation(s)
- Andreas Goebel
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - David Andersson
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | - Chris Barker
- Lancashire and South Cumbria NHS Foundation Trust, UK
| | - Neil Basu
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Craig Bullock
- Versus Arthritis, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, UK
| | - Stuart Bevan
- Institute of Psychiatry, Psychology and Neuroscience, Wolfson Centre for Age Related Disease, King’s College, London, UK
| | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, UK
| | - David Clauw
- Anesthesiology, Medicine (Rheumatology) and Psychiatry University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School & Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Laird
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | | | - Hayley McCullough
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Andrew Marshall
- Institute of Life Course and Medicine Sciences, Pain Research Institute, University of Liverpool, and Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Robert Moots
- Faculty of Health Social Care and Medicine, Edge Hill University, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Serge Perrot
- Pain Center, Cochin Hospital, Paris University, Paris, France
| | - Nick Shenker
- Rheumatology Research Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Emanuele Sher
- Eli Lilly and Company, Pain & Neurodegeneration Therapeutic Area, Lilly Research Centre, Windlesham, Surrey, UK
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Germany
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Williams
- Health Psychology, UCL Research Department of Clinical, Educational & Health Psychology, University College London, UK
| | - Geoff Wood
- Cambridge Institute for Medical Research, Cambridge, UK
| | - Emma R Dorris
- School of Medicine, University College Dublin, Ireland
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Coxon L, Wiech K, Vincent K. Is There a Neuropathic-Like Component to Endometriosis-Associated Pain? Results From a Large Cohort Questionnaire Study. FRONTIERS IN PAIN RESEARCH 2022; 2:743812. [PMID: 35295529 PMCID: PMC8915551 DOI: 10.3389/fpain.2021.743812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pain is one of the primary symptoms of endometriosis, a chronic inflammatory condition characterised by the presence of endometrial tissue outside the uterus. Endometriosis-associated pain is commonly considered as nociceptive in nature, but its clinical presentation suggests that it might have neuropathic-like properties in a subgroup of patients. Methods: This is a cross sectional study using an online survey. The survey was distributed by patient support websites. The survey was composed of validated questionnaires assessing pain symptoms, psychological measures and questions about number of surgeries. Main Results: We had 1,417 responses which met the inclusion criteria. Using standard painDETECT cut-off scores, we found that pain was classified as neuropathic in 40% of patients and as mixed neuropathic/nociceptive in a further 35%. In line with observations in other neuropathic conditions, the neuropathic subgroup reported higher pain intensities, greater psychological distress and cognitive impairment. Neuropathic pain was also more likely in those with more surgeries to the abdomen and a longer history of pain. As revealed by a cluster analysis, those with a neuropathic pain component could further be divided into two subgroups based on their sensory profile. Conclusions: The data presented here indicate that endometriosis-associated pain includes a neuropathic-like component in a substantial proportion of women. Although further investigation is required, our finding challenges the current conceptualisation of endometriosis-associated pain as nociceptive and advocates for a new perspective on this type of pain, which is so debilitating to a large number of women.
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Affiliation(s)
- Lydia Coxon
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Katja Wiech
- Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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25
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As-Sanie S, Till SR, Schrepf AD, Griffith KC, Tsodikov A, Missmer SA, Clauw DJ, Brummett CM. Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain. Am J Obstet Gynecol 2021; 225:568.e1-568.e11. [PMID: 34464585 DOI: 10.1016/j.ajog.2021.08.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized. OBJECTIVE To describe the incidence of persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-reported measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy. STUDY DESIGN We conducted a prospective, observational cohort study of women undergoing hysterectomy at an academic tertiary care center for a benign indication. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0 to 10 numeric rating scale for >3 months before hysterectomy, were included in this analysis. The patients completed validated assessments of pain, anxiety, depression, and centralized pain (using the 2011 Fibromyalgia Survey Criteria, 0-31 points) preoperatively and 6 months after hysterectomy. The demographic information, surgical history, intraoperative findings, and surgical pathology were abstracted from the electronic medical records. Multivariate logistic regression was used to identify the independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity. RESULTS Among 176 participants with pelvic pain before hysterectomy, 126 (71.6%) were retained at 6 months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P=.46), race (P=.55), average pain severity during menses (P=.68), average overall pelvic pain (P=.10), or pain duration (P=.80) in those with and without persistent pelvic pain. Whereas intraoperative findings of endometriosis (P=.05) and uterine fibroids (P=.03) were associated with a higher incidence of persistent pain on univariate analysis, the surgical route (P=.46), pelvic adhesions (0.51), uterine weight (P=.66), and adenomyosis on histopathology (P=.27) were not related to the risk of persistent pain. Higher preoperative centralized pain scores (P=.01) but not depression (P=.64) or anxiety (P=.45) were more common in women with persistent pelvic pain. Multivariate logistic regression adjusting for age, preoperative pain severity, anxiety, depression, and operative findings of endometriosis and fibroids indicated that every 1-point increase in centralized pain before hysterectomy was associated with a 27% increase in the odds of persistent pelvic pain (odds ratio, 1.27; 95% confidence interval, 1.03-1.57) 6 months after surgery. CONCLUSION Although the majority of women with chronic pelvic pain report considerable improvement in pain following hysterectomy, higher degrees of centralized pain before hysterectomy is a robust predictor of persistent pelvic pain.
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Affiliation(s)
- Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - Sara R Till
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Andrew D Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Kendall C Griffith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
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Kosek E, Clauw D, Nijs J, Baron R, Gilron I, Harris RE, Mico JA, Rice ASC, Sterling M. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain 2021; 162:2629-2634. [PMID: 33974577 DOI: 10.1097/j.pain.0000000000002324] [Citation(s) in RCA: 191] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, MI, United States
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Ixelles, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
- Department of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ralf Baron
- Division of Neurological Pain Research and -therapy, Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, MI, United States
| | - Juan-Antonio Mico
- Department of Neuroscience, Pharmacology & Psychiatry, Biomedical Research Center on Mental Health (CIBERSAM), University of Cádiz, Cádiz, Spain
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
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27
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Rivera Redondo J, Díaz Del Campo Fontecha P, Alegre de Miquel C, Almirall Bernabé M, Casanueva Fernández B, Castillo Ojeda C, Collado Cruz A, Montesó-Curto P, Palao Tarrero Á, Trillo Calvo E, Vallejo Pareja MÁ, Brito García N, Merino Argumánez C, Plana Farras MN. Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and treatment. REUMATOLOGIA CLINICA 2021; 18:131-140. [PMID: 34649820 DOI: 10.1016/j.reumae.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.
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Affiliation(s)
- Javier Rivera Redondo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | | | | | | | | | | | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain
| | - Miguel Ángel Vallejo Pareja
- Departamento de Psicología Clínica, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - M Nieves Plana Farras
- Hospital Príncipe de Asturias, CIBER de Epidemiología y Salud Pública, Meco, Madrid, Spain
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28
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Wilson SH, Hellman KM, James D, Adler AC, Chandrakantan A. Mechanisms, Diagnosis, and Medical Management of Hyperalgesia: an Educational Review. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clauw D. Time to Stop the Fibromyalgia Criteria Wars and Refocus on Identifying and Treating Individuals With This Type of Pain Earlier in Their Illness. Arthritis Care Res (Hoboken) 2021; 73:613-616. [PMID: 32248650 DOI: 10.1002/acr.24198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 01/11/2023]
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30
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Kratz AL, Whibley D, Alschuler KN, Ehde DM, Williams DA, Clauw DJ, Braley TJ. Characterizing chronic pain phenotypes in multiple sclerosis: a nationwide survey study. Pain 2021; 162:1426-1433. [PMID: 33196577 PMCID: PMC8054538 DOI: 10.1097/j.pain.0000000000002136] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
ABSTRACT Chronic pain is highly prevalent in multiple sclerosis (MS). Pain heterogeneity may contribute to poor treatment outcomes. The aim of this study was to characterize pain phenotypes distributions in persons with MS and compare pain phenotypes in terms of pain intensity, frequency of chronic overlapping pain conditions, and use and analgesic effects of different classes of pain medications. Data were collected through a national web-based survey with measures of neuropathic (painDETECT) and nociplastic pain (Fibromyalgia Survey Criteria), chronic overlapping pain conditions, and pain medication use and pain relief. In a sample of N = 842 adults with chronic pain and MS, the largest proportion (41%) showed evidence of nociceptive pain, 27% had mixed neuropathic/nociplastic pain, 23% had nociplastic pain, and 9% had neuropathic pain. Nociplastic pain was associated with significantly higher pain intensity and frequency of chronic overlapping pain conditions. Across all pain types, high frequency of pain medication use along with poor-modest pain relief was reported. Cannabis use for pain was more common, and pain relief ratings were higher among those with nociplastic pain, relative to nociceptive pain. Although NSAID use was highest among those with nociplastic pain (80%), pain relief ratings for NSAIDs were highest among those with nociceptive pain. These findings underscore the need for multidimensional assessment of pain in MS with greater emphasis on the identification of pain phenotype. An improved characterization of pain as a multifaceted condition in MS could inform therapeutic approaches.
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Affiliation(s)
- Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Kevin N. Alschuler
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Dawn M. Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J. Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany J. Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
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Rivera Redondo J, Díaz Del Campo Fontecha P, Alegre de Miquel C, Almirall Bernabé M, Casanueva Fernández B, Castillo Ojeda C, Collado Cruz A, Montesó-Curto P, Palao Tarrero Á, Trillo Calvo E, Vallejo Pareja MÁ, Brito García N, Merino Argumánez C, Plana Farras MN. Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00058-9. [PMID: 33931332 DOI: 10.1016/j.reuma.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.
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Affiliation(s)
- Javier Rivera Redondo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | | | | | | | | | | | | | | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, España
| | - Miguel Ángel Vallejo Pareja
- Departamento de Psicología Clínica, Facultad de Psicología. Universidad Nacional de Educación a Distancia (UNED), Madrid, España
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - M Nieves Plana Farras
- Hospital Príncipe de Asturias, CIBER de Epidemiología y Salud Pública, Meco, Madrida, España
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Harper DE, Sayre K, Schrepf A, Clauw DJ, Aronovich S. Impact of Fibromyalgia Phenotype in Temporomandibular Disorders. PAIN MEDICINE 2021; 22:2050-2056. [PMID: 33674851 DOI: 10.1093/pm/pnab077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Mounting evidence suggests that central nervous system amplification, similar to that seen in fibromyalgia (FM), contributes to the pain experience in a subset of patients with temporomandibular disorders (TMD). METHODS In this prospective observational study, patients with TMD completed the 2011 FM survey questionnaire, a surrogate measure of "centralized" pain. The influence of centralized pain on TMD pain, dysfunction, and disability was assessed dichotomously by determining the incidence of FM-positive cases in the sample and by using FM survey scores as a continuous measure of "fibromyalgia-ness" ("FM-ness"). RESULTS The patients meeting criteria for FM diagnosis (17 of 89) had significantly more disease burden on numerous measures. FM-ness was positively associated with pain at rest, negative mood, tenderness to palpation, perceived jaw functional limitation, and pain-related disability, and it was negatively associated with comfortable pain-free jaw opening. The impact of FM-ness on perceived jaw functional limitation and disability was mediated by levels of spontaneous, ongoing pain in the orofacial region. Importantly, this pattern of findings was still present even in those not meeting the criteria for FM diagnosis. CONCLUSION Together, these results imply that higher FM-ness increases TMD patient burden by amplifying spontaneous pain and further hampering painless jaw function, even in patients who do not meet criteria for FM diagnosis. These results are highly relevant for the clinical management of TMD, as they imply that targeting the central nervous system in the treatment of patients with TMD with evidence of pain centralization may help ameliorate both pain and jaw dysfunction.
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Affiliation(s)
- Daniel E Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology.,Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
| | - Kelly Sayre
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Ann Arbor, Michigan
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery and Hospital Dentistry, University of Michigan, Ann Arbor, Michigan
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Larach DB, Sahara MJ, As-Sanie S, Moser SE, Urquhart AG, Lin J, Hassett AL, Wakeford JA, Clauw DJ, Waljee JF, Brummett CM. Patient Factors Associated With Opioid Consumption in the Month Following Major Surgery. Ann Surg 2021; 273:507-515. [PMID: 31389832 PMCID: PMC7068729 DOI: 10.1097/sla.0000000000003509] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to determine preoperative patient characteristics associated with postoperative outpatient opioid use and assess the frequency of postoperative opioid overprescribing. SUMMARY BACKGROUND DATA Although characteristics associated with inpatient opioid use have been described, data regarding patient factors associated with opioid use after discharge are lacking. This hampers the development of individualized approaches to postoperative prescribing. METHODS We included opioid-naïve patients undergoing hysterectomy, thoracic surgery, and total knee and hip arthroplasty in a single-center prospective observational cohort study. Preoperative phenotyping included self-report measures to assess pain severity, fibromyalgia survey criteria score, pain catastrophizing, depression, anxiety, functional status, fatigue, and sleep disturbance. Our primary outcome measure was self-reported total opioid use in oral morphine equivalents. We constructed multivariable linear-regression models predicting opioids consumed in the first month following surgery. RESULTS We enrolled 1181 patients; 1001 had complete primary outcome data and 913 had complete phenotype data. Younger age, non-white race, lack of a college degree, higher anxiety, greater sleep disturbance, heavy alcohol use, current tobacco use, and larger initial opioid prescription size were significantly associated with increased opioid consumption. Median total oral morphine equivalents prescribed was 600 mg (equivalent to one hundred twenty 5-mg hydrocodone pills), whereas median opioid consumption was 188 mg (38 pills). CONCLUSIONS In this prospective cohort of opioid-naïve patients undergoing major surgery, we found a number of characteristics associated with greater opioid use in the first month after surgery. Future studies should address the use of non-opioid medications and behavioral therapies in the perioperative period for these higher risk patients.
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Affiliation(s)
- Daniel B. Larach
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | | | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Andrew G. Urquhart
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Jules Lin
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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Rabbitts JA, Palermo TM, Lang EA. A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents. J Pain Res 2020; 13:3071-3080. [PMID: 33262642 PMCID: PMC7699440 DOI: 10.2147/jpr.s239320] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsychosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain. This review aims to summarize existing research examining key factors underlying acute to chronic postsurgical pain transition in order to guide prevention and intervention efforts aimed at addressing this health issue in children. As pain transitions from acute nociceptive pain to chronic pain, changes in the peripheral and central nervous system contribute to the chronification of pain after surgery. These changes include alterations in sensory pain processing and psychosocial processes (psychological, behavioral, and social components), which promote the development of chronic pain. Patient-related premorbid factors (eg, demographic factors, genetic profile, and medical factors such as premorbid pain) may further modulate these changes. Factors related to acute injury and recovery (eg, surgical and treatment factors), as well as biological response to surgery (eg, epigenetic, inflammatory, and endocrine factors), may also influence this process. Overall, longitudinal studies examining temporal pathways of biopsychosocial processes including both risk and resiliency factors will be essential to identify the mechanisms involved in the transition from acute to chronic pain. Research is also needed to unravel connections between the acute pain experience, opioid exposure, and sensory pain processing during acute to chronic pain transition. Furthermore, future studies should include larger and more diverse samples to more fully explore risk factors in a broader range of pediatric surgeries. The use of conceptual models to guide intervention approaches targeting mechanisms of transition from acute to chronic pain will significantly advance this field and improve outcomes for children and adolescents undergoing surgery.
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Affiliation(s)
- Jennifer A Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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McEntee KM, Crawford KD, Wilson MD, Ponzini MD, Wu BT, Nejad BM, Waetjen LE. Postoperative Opioid Prescribing and Consumption after Hysterectomy: A Prospective Cohort Study. J Minim Invasive Gynecol 2020; 28:1013-1021. [PMID: 33152533 DOI: 10.1016/j.jmig.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To examine opioid prescribing and consumption patterns after hysterectomy and identify factors associated with postoperative opioid consumption. DESIGN Prospective cohort study. SETTING Single university medical center. PATIENTS Women undergoing hysterectomy for benign, nonobstetric indications. INTERVENTIONS Participant preoperative and surgical characteristics were obtained through chart review and patient report of baseline pain score. During the third postoperative week, participants completed a telephone interview, including a direct count of remaining opioid pills and assessment of satisfaction with pain management. We assessed factors associated with opioid consumption in oral morphine equivalents (OME) using a linear regression model. MEASUREMENTS AND MAIN RESULTS Of the 129 participants, 113 (88%) completed the postoperative survey after hysterectomy: 16 vaginal, 43 robotic-assisted, 42 conventional laparoscopic, and 12 abdominal hysterectomies. The median amount of opioid prescribed was 150 OME (interquartile range [IQR] 113-200), while the median amount consumed was 75 (IQR 10-135), reflecting an average consumption of about 50% of the prescription. Opioid prescription size was associated with consumption; for every additional oral morphine equivalent prescribed, on average, an additional 0.5 was consumed (p <.001). If the indication for hysterectomy was related to pain, participants consumed 25.3 additional OME (p = .04). The amount of opioid prescribed was inversely correlated with pain management satisfaction; every additional point on a 1 through 5 Likert scale of increasing satisfaction was associated with 44 fewer OME prescribed (standard error 9 OME, p <.001). For the 1464 total unused pills among the 104 participants with leftover opioids, only 20% reported an Food and Drug Administration -compliant opioid disposal plan. CONCLUSION Gynecologic surgeons can respond to the opioid epidemic by reducing excess opioid pills after hysterectomy by providing both the smallest effective prescription size and concrete resources for safe opioid disposal. These actions may contribute to a reduction in opioid use disorder cases or overdose deaths.
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Affiliation(s)
- Kelli M McEntee
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento (Drs. McEntee, Crawford, Wu, Nejad, and Waetjen).
| | - Kaitlin D Crawford
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento (Drs. McEntee, Crawford, Wu, Nejad, and Waetjen)
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis Health, Davis (Dr. Wilson and Mr. Ponzini), California
| | - Matthew D Ponzini
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis Health, Davis (Dr. Wilson and Mr. Ponzini), California
| | - Brenda T Wu
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento (Drs. McEntee, Crawford, Wu, Nejad, and Waetjen)
| | - Bahareh M Nejad
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento (Drs. McEntee, Crawford, Wu, Nejad, and Waetjen)
| | - L Elaine Waetjen
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, Sacramento (Drs. McEntee, Crawford, Wu, Nejad, and Waetjen)
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Hassett AL, Whibley D, Kratz A, Williams DA. Measures for the Assessment of Pain in Adults. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:342-357. [PMID: 33091243 DOI: 10.1002/acr.24222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | - Daniel Whibley
- University of Michigan, Ann Arbor, and University of Aberdeen, Aberdeen, Scotland
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Curatolo M. Common Biological Modulators of Acute Pain: An Overview Within the AAAPT Project (ACTTION-APS-AAPM Acute Pain Taxonomy). PAIN MEDICINE 2020; 21:2394-2400. [PMID: 32747929 DOI: 10.1093/pm/pnaa207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The ACTTION-APS-AAPM Acute Pain Taxonomy (AAAPT) project relies on the identification of modulators to improve characterization and classification of acute pain conditions. In the frame of the AAAPT effort, this paper presents an overview of common biological modulators of acute pain. METHODS Nonsystematic overview. RESULTS Females may experience more acute pain than males, but the clinical significance may be modest. Increasing age is associated with decreasing analgesic requirement and decreasing pain intensity after surgery and with higher risk of acute low back pain. Racial and ethnic minorities have worse pain, function, and perceived well-being. Patients with preexisting chronic pain and opioid use are at higher risk of severe acute pain and high opioid consumption. The OPRM1 gene A118G polymorphism is associated with pain severity and opioid consumption, with modest quantitative impact. Most studies have found positive associations between pain sensitivity and intensity of acute clinical pain. However, the strength of the association is unclear. Surgical techniques, approaches, and complications influence postoperative pain. CONCLUSIONS Sex, age, race, ethnicity, preexisting chronic pain and opioid use, surgical approaches, genetic factors, and pain sensitivity are biological modulators of acute pain. Large studies with multisite replication will quantify accurately the association between modulators and acute pain and establish the value of modulators for characterization and classification of acute pain conditions, as well as their ability to identify patients at risk of uncontrolled pain. The development and validation of quick, bed-side pain sensitivity tests would allow their implementation as clinical screening tools. Acute nonsurgical pain requires more investigation.
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Affiliation(s)
- Michele Curatolo
- Department of Anesthesiology & Pain Medicine, Harborview Injury Preventions and Research Center (HIPRC), University of Washington, Seattle, Washington, USA
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Stone R, Carey E, Fader AN, Fitzgerald J, Hammons L, Nensi A, Park AJ, Ricci S, Rosenfield R, Scheib S, Weston E. Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper. J Minim Invasive Gynecol 2020; 28:179-203. [PMID: 32827721 DOI: 10.1016/j.jmig.2020.08.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.
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Affiliation(s)
- Rebecca Stone
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston).
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina (Dr. Carey)
| | - Amanda N Fader
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston)
| | - Jocelyn Fitzgerald
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr. Fitzgerald)
| | - Lee Hammons
- Allegheny Women's Health, Pittsburgh, Pennsylvania (Dr. Hammons)
| | - Alysha Nensi
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada (Dr. Nensi)
| | - Amy J Park
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio (Drs. Park and Ricci)
| | - Stephanie Ricci
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio (Drs. Park and Ricci)
| | | | - Stacey Scheib
- Department of Obstetrics and Gynecology, Tulane University, New Orleans, Louisiana (Dr. Scheib)
| | - Erica Weston
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston)
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Billig JI, Sears ED, Gunaseelan V, Santosa KB, Iwashyna TJ, Englesbe MJ, Brummett CM, Waljee JF. Inappropriate Preoperative Gabapentinoid Use Among Patients With Carpal Tunnel Syndrome. J Hand Surg Am 2020; 45:677-689.e5. [PMID: 32487365 PMCID: PMC7453721 DOI: 10.1016/j.jhsa.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/18/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Gabapentinoids are commonly prescribed for the treatment of neuropathic pain but are not recommended for the primary treatment of carpal tunnel syndrome (CTS). We sought (1) to investigate the preoperative use of gabapentinoids for the treatment of CTS and (2) to determine whether preoperative exposure is associated with persistent gabapentinoid and opioid use after carpal tunnel release. METHODS We performed a retrospective cohort study using IBM MarketScan Research Databases (2010-2017) of patients who did not fill a gabapentinoid or opioid prescription within 3 months of a new CTS diagnosis undergoing surgical release. Our primary outcomes included preoperative gabapentinoid prescription fills associated with CTS and persistent prescription fills of gabapentinoids and opioids at 91 to 180 days after surgery. Multivariable logistic regression models were used to evaluate the association between patient-level factors and persistent gabapentinoid and opioid use. RESULTS Of the 56,593 patients without a previous gabapentinoid or opioid prescription prior to diagnosis of CTS, 3,474 patients (6%) filled a gabapentinoid prescription before carpal tunnel release. Overall, 835 patients (24% of the preoperative users) continued to fill gabapentinoid prescriptions at 91 to 180 days after surgery. Of the preoperative gabapentinoid users, 20% (702 patients) continued to fill opioid prescriptions at 91 to 80 days after release. After adjusting for patient characteristics, preoperative gabapentinoid use was associated with increased odds of persistent postoperative gabapentinoid use (preoperative gabapentinoid, 22% adjusted probability; 95% confidence interval [95% CI], 20.3%-23.0%, no preoperative gabapentinoid use, 1%; 95% CI, 1.2%-1.4%) and persistent postoperative opioid use (preoperative gabapentinoid, 18% adjusted probability; 95% CI, 17%-20%), no preoperative gabapentinoid, 9%; 95% CI, 8.6%-9.1%). CONCLUSIONS Despite a lack of evidence to support the use of gabapentinoids for CTS, 6% of patients are prescribed a gabapentinoid prior to surgery, and prolonged use is common. Given the effectiveness of surgical release and the risks associated with gabapentinoids, greater attention is needed to ensure that gabapentinoids are prescribed appropriately, avoided when possible, and stopped after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Jessica I Billig
- VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI
| | - Erika D Sears
- Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | | | | | | | - Chad M Brummett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
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Brown LM, Kratz A, Verba S, Tancredi D, Clauw DJ, Palmieri T, Williams D. Pain and Opioid Use After Thoracic Surgery: Where We Are and Where We Need To Go. Ann Thorac Surg 2020; 109:1638-1645. [DOI: 10.1016/j.athoracsur.2020.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
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Sturgeon JA, Sullivan MD, Parker-Shames S, Tauben D, Coelho P. Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrospective Clinical Data Analysis. PAIN MEDICINE 2020; 21:3635-3644. [DOI: 10.1093/pm/pnaa029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
There are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use.
Methods
The current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores.
Results
One hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical School, Seattle, Washington
| | - Mark D Sullivan
- Department of Anesthesiology and Pain Medicine, University of Washington Medical School, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Washington
| | | | - David Tauben
- Department of Anesthesiology and Pain Medicine, University of Washington Medical School, Seattle, Washington
| | - Paul Coelho
- Department of Physical Medicine and Rehabilitation/Pain Medicine, Salem Health Pain Clinic, Salem, Oregon, USA
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Nalliah RP, Sloss KR, Kenney BC, Bettag SK, Thomas S, Dubois K, Waljee JF, Brummett CM. Association of Opioid Use With Pain and Satisfaction After Dental Extraction. JAMA Netw Open 2020; 3:e200901. [PMID: 32167567 PMCID: PMC7070233 DOI: 10.1001/jamanetworkopen.2020.0901] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Dentists commonly prescribe opioids to relieve pain after tooth extraction. Understanding the differences in patient-reported outcomes between opioid users and nonusers could encourage the adoption of more conservative and appropriate prescribing practices in dental medicine. OBJECTIVE To evaluate whether pain and satisfaction scores reported by patients who used opioids after tooth extraction were similar to the levels reported by patients with no opioid use. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted in the 14 dental clinics of the University of Michigan School of Dentistry. Eligible adult patients of these clinics who underwent routine or surgical extractions between June 1, 2017, and December 31, 2017, were contacted by telephone within 6 months of the procedure. Patients were surveyed about the type of extraction, use of prescription opioid (if given), use of nonopioid analgesics, pain levels, and satisfaction with care after the procedure. Data analysis was conducted from February 1, 2018, to July 31, 2018. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported pain as assessed by the question, "Thinking back, how would you rate your pain in the first week after your dental procedure?" with a 4-point pain scale of no pain, minimal pain, moderate pain, or severe pain. Secondary outcomes included self-reported satisfaction with care as assessed by a Likert scale ranging from 1 to 10, in which 1 was extremely dissatisfied and 10 was extremely satisfied. RESULTS The final cohort comprised 329 patients, of whom 155 (47.1%) underwent surgical extraction (mean [SD] age, 41.8 [18.1] years; 80 [51.6%] were men) and 174 (52.9%) underwent routine extraction (mean [SD] age, 52.4 [17.9] years; 79 [45.4%] were men). Eighty patients (51.6%) with surgical extraction and 68 (39.1%) with routine extraction used opioids after their procedure. In both extraction groups, patients who used opioids reported higher levels of pain compared with those who did not use opioids (surgical extraction group: 51 [63.8%] vs 34 [45.3%], P < .001; routine extraction group: 44 [64.7%] vs 35 [33.0%], P < .001). No statistically significant difference in satisfaction was found between groups after surgical extraction (median [interquartile range] scores: 9 [7-10] for nonopioid group vs 9 [8-10] for opioid group) and routine extraction (median [interquartile range] scores: 10 [8-10] for nonopioid group vs 9 [7-10] for opioid group). CONCLUSIONS AND RELEVANCE This study found that patients who used opioids after tooth extraction reported significantly higher levels of pain compared with nonusers, but no difference in satisfaction was observed.
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Affiliation(s)
- Romesh P. Nalliah
- University of Michigan School of Dentistry, Ann Arbor
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
| | - Kenneth R. Sloss
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
| | - Brooke C. Kenney
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
| | | | | | - Kendall Dubois
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
| | - Jennifer F. Waljee
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Chad M. Brummett
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
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Schrepf A, Moser S, Harte SE, Basu N, Kaplan C, Kolarik E, Tsodikov A, Brummett CM, Clauw DJ. Top down or bottom up? An observational investigation of improvement in fibromyalgia symptoms following hip and knee replacement. Rheumatology (Oxford) 2020; 59:594-602. [PMID: 31411333 PMCID: PMC7998337 DOI: 10.1093/rheumatology/kez303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/05/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Many patients with osteoarthritis have comorbid symptoms of FM, but it is unknown how these symptoms respond to surgical procedures that address nociceptive input in the periphery, such as total joint replacement. Here we explore differences in clinical characteristics between patients whose FM symptoms do and do not improve following total hip or knee replacement. METHODS Participants were 150 patients undergoing knee or hip replacement who had a minimum FM survey score of 4 or greater prior to surgery. The top tertile of patients experiencing the most improvement in FM symptoms at month 6 were categorized as 'Improve' (n = 48) while the bottom two tertiles were categorized as 'Worsen/Same' (n = 102). Baseline symptom characteristics were compared between groups, as well as improvement in overall pain severity, surgical pain severity and physical function at 6 months. RESULTS The Worsen/Same group had higher levels of fatigue, depression and surgical site pain at baseline (all P < 0.05). Additionally, they improved less on overall pain severity and physical functioning 6 months after surgery (both P < 0.05). CONCLUSION Most patients derive significant benefit in improvement of comorbid FM symptoms following total joint replacement, but a substantial proportion do not. Understanding the neurobiological basis for these different trajectories may help inform clinical judgment and improve patient care.
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Affiliation(s)
- Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Neil Basu
- Department of Rheumatology, Institute of Infection, Immunity & Inflammation, University of Glasgow, UK
| | - Chelsea Kaplan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Ellen Kolarik
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Tsodikov
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Khazi ZM, Lu Y, Patel BH, Cancienne JM, Werner B, Forsythe B. Risk factors for opioid use after total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:235-243. [PMID: 31495704 DOI: 10.1016/j.jse.2019.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/09/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose was to assess opioid use before and after anatomic and reverse total shoulder arthroplasty (TSA) and determine patient factors associated with prolonged postoperative opioid use. METHODS Patients undergoing primary TSA (anatomic or reverse) were identified within the Humana database from 2007 to 2015. Patients were categorized as opioid-naive patients who did not fill a prescription prior to surgery or those who filled opioid prescriptions within 3 months preoperatively (OU); the OU cohort was subdivided into those filling opioid prescriptions within 1 month preoperatively and those filling opioid prescriptions between 1 and 3 months preoperatively. The incidence of opioid use was evaluated preoperatively and longitudinally tracked for each cohort. Multivariate analysis was used to identify factors associated with opioid use at 12 months after surgery, with statistical significance defined as P < .05. RESULTS Overall, 12,038 patients (5180 in OU cohort, 43%) underwent primary TSA during the study period. Opioid use declined after the first postoperative month; however, the incidence of opioid use was significantly higher in the OU cohort than in the opioid-naive cohort at 1 year (31.4% vs. 3.1%, P < .0001). Subgroup analysis revealed a similar decline in postoperative opioid use for anatomic and reverse TSA (P < .0001 for both). Multivariate analysis identified chronic preoperative opioid use (ie, filling an opioid prescription between 1 and 3 months prior to surgery) as the strongest risk factor for opioid use at 12 months after anatomic and reverse TSA (P < .0001). CONCLUSION More than 40% of patients undergoing TSA received opioid medications within 3 months before surgery. Preoperative opioid use, age younger than 65 years, and fibromyalgia were independent risk factors for opioid use 1 year following anatomic and reverse TSA. Chronic preoperative opioid use conferred the highest risk of prolonged postoperative opioid use.
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Affiliation(s)
- Zain M Khazi
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yining Lu
- Division of Sports Medicine, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jourdan M Cancienne
- Division of Sports Medicine, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Werner
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Hassett AL, Pierce J, Goesling J, Fritsch L, Bakshi RR, Kohns DJ, Brummett CM. Initial validation of the electronic form of the Michigan Body Map. Reg Anesth Pain Med 2019; 45:rapm-2019-101084. [PMID: 31857372 DOI: 10.1136/rapm-2019-101084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Michigan Body Map (MBM) was developed to assess pain location in a reliable and valid manner; however, electronic formats have not been validated. This study had two aims: (1) initial validation of the electronic form of the MBM (eMBM) and (2) preliminary test of assessing pain severity within body zones. METHODS For the first aim, 68 participants with chronic pain completed paper and electronic forms of the MBM, then underwent scripted interviews to assess preferences among body maps and verbal confirmation of pain locations. For the second aim, a subset of the participants (n=40) completed the Brief Pain Inventory (BPI) pain severity subscale, as well as the eMBM again and endorsed pain severity using additional screens showing body zones that contained areas in which pain was endorsed. RESULTS There were few discrepancies between MBM, eMBM and verbal report (1.9% and 1.6%, respectively), and no difference between forms in perceived ability to indicate areas of pain or ease of completion. Patients accurately indicated their bodily pain on both maps, with 84% and 87% reporting one or no errors on MBM and eMBM, respectively. Participants also reported no preference for which version best-depicted areas of pain or best distinguished left from right. Lastly, the most preferred measure was eMBM with pain severity zones, followed by eMBM without zones, followed by the BPI pain severity subscale. CONCLUSIONS These data support the validity of the eMBM for patients with chronic pain. Further, an expanded form of the eMBM that assesses pain severity was preferred by most participants.
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Affiliation(s)
- Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Fritsch
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rishi R Bakshi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - David J Kohns
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 2019; 34:909-917. [PMID: 29642237 DOI: 10.1097/ajp.0000000000000619] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). MATERIALS AND METHODS Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. RESULTS A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. DISCUSSION We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.
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47
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Hilliard PE, Waljee J, Moser S, Metz L, Mathis M, Goesling J, Cron D, Clauw DJ, Englesbe M, Abecasis G, Brummett CM. Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery. JAMA Surg 2019; 153:929-937. [PMID: 29998303 DOI: 10.1001/jamasurg.2018.2102] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect. Objectives To assess the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort. Design, Setting, and Participants Cross-sectional, observational study of patients undergoing surgery at a tertiary care academic medical center. Data were collected as a part of large prospective institutional research registries from March 1, 2010, through April 30, 2016. Exposures Preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures. Main Outcomes and Measures Patient-reported opioid use before surgery. Results Of the total 34 186 patients recruited (54.2% women; mean [SD] age, 53.1 [16.1] years), preoperative opioid use was reported in 7894 (23.1%). The most common opioids used were hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]). Age of 31 to 40 years (adjusted odds ratio [aOR], 1.26; 95% CI, 1.10-1.45), tobacco use (former use aOR, 1.32 [95% CI, 1.22-1.42]; current use aOR, 1.62 [95% CI, 1.48-1.78]), illicit drug use (aOR, 1.74; 95% CI, 1.16-2.60), higher pain severity (aOR, 1.33; 95% CI, 1.31-1.35), depression (aOR, 1.22; 95% CI, 1.12-1.33), higher Fibromyalgia Survey scores (aOR, 1.06, 95% CI, 1.05-1.07), lower life satisfaction (aOR, 0.95, 95% CI, 0.93-0.96), and more medical comorbidities (American Society of Anesthesiology score aOR, 1.47 [95% CI, 1.37-1.58]; Charlson Comorbidity Index aOR, 1.29 [95% CI, 1.18-1.41]) were all independently associated with preoperative opioid use. Preoperative opioid use was most commonly reported by patients undergoing orthopedic (226 [65.1%]) and neurosurgical spinal (596 [55.1%]) procedures and least common among patients undergoing thoracic procedures (244 [15.7%]). After adjusting for patient characteristics, the patients undergoing lower extremity procedures were most likely to report preoperative opioid use (aOR, 3.61; 95% CI, 2.81-4.64), as well as those undergoing pelvic (excluding hip) (aOR, 3.09; 95% CI, 1.88-5.08), upper extremity (aOR, 3.07; 95% CI, 2.12-4.45), and spinal or spinal cord (aOR, 2.68; 95% CI, 2.15-3.32) procedures, with the group undergoing intrathoracic surgery as the reference group. Conclusions and Relevance In this large study of preoperative opioid use that includes patient-reported outcome measures, more than 1 in 4 patients presenting for surgery reported opioid use. These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.
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Affiliation(s)
- Paul E Hilliard
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
| | - Jennifer Waljee
- Department of Surgery, University of Michigan Health System, Ann Arbor.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Stephanie Moser
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
| | - Lynn Metz
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
| | - Michael Mathis
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
| | - Jenna Goesling
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor
| | - David Cron
- currently a medical student at University of Michigan Health System Medical School, Ann Arbor
| | - Daniel J Clauw
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor.,Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Domino's Farms, Ann Arbor, Michigan.,Division of Rheumatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor
| | - Michael Englesbe
- Department of Surgery, University of Michigan Health System, Ann Arbor.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Goncalo Abecasis
- School of Public Health, University of Michigan Health System, Ann Arbor
| | - Chad M Brummett
- Division of Pain Medicine, Department of Anesthesiology, University of Michigan Health System, Ann Arbor.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Khor S, Lavallee D, Cizik AM, Bellabarba C, Chapman JR, Howe CR, Lu D, Mohit AA, Oskouian RJ, Roh JR, Shonnard N, Dagal A, Flum DR. Development and Validation of a Prediction Model for Pain and Functional Outcomes After Lumbar Spine Surgery. JAMA Surg 2019. [PMID: 29516096 DOI: 10.1001/jamasurg.2018.0072] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Functional impairment and pain are common indications for the initiation of lumbar spine surgery, but information about expected improvement in these patient-reported outcome (PRO) domains is not readily available to most patients and clinicians considering this type of surgery. Objective To assess population-level PRO response after lumbar spine surgery, and develop/validate a prediction tool for PRO improvement. Design, Setting, and Participants This statewide multicenter cohort was based at 15 Washington state hospitals representing approximately 75% of the state's spine fusion procedures. The Spine Surgical Care and Outcomes Assessment Program and the survey center at the Comparative Effectiveness Translational Network prospectively collected clinical and PRO data from adult candidates for lumbar surgery, preoperatively and postoperatively, between 2012 and 2016. Prediction models were derived for PRO improvement 1 year after lumbar fusion surgeries on a random sample of 85% of the data and were validated in the remaining 15%. Surgical candidates from 2012 through 2015 were included; follow-up surveying continued until December 31, 2016, and data analysis was completed from July 2016 to April 2017. Main Outcomes and Measures Functional improvement, defined as a reduction in Oswestry Disability Index score of 15 points or more; and back pain and leg pain improvement, defined a reduction in Numeric Rating Scale score of 2 points or more. Results A total of 1965 adult lumbar surgical candidates (mean [SD] age, 61.3 [12.5] years; 944 [59.6%] female) completed baseline surveys before surgery and at least 1 postoperative follow-up survey within 3 years. Of these, 1583 (80.6%) underwent elective lumbar fusion procedures; 1223 (77.3%) had stenosis, and 1033 (65.3%) had spondylolisthesis. Twelve-month follow-up participation rates for each outcome were between 66% and 70%. Improvements were reported in function, back pain, and leg pain at 12 months by 306 of 528 surgical patients (58.0%), 616 of 899 patients (68.5%), and 355 of 464 patients (76.5%), respectively, whose baseline scores indicated moderate to severe symptoms. Among nonoperative patients, 35 (43.8%), 47 (53.4%), and 53 (63.9%) reported improvements in function, back pain, and leg pain, respectively. Demographic and clinical characteristics included in the final prediction models were age, sex, race, insurance status, American Society of Anesthesiologists score, smoking status, diagnoses, prior surgery, prescription opioid use, asthma, and baseline PRO scores. The models had good predictive performance in the validation cohort (concordance statistic, 0.66-0.79) and were incorporated into a patient-facing, web-based interactive tool (https://becertain.shinyapps.io/lumbar_fusion_calculator). Conclusions and Relevance The PRO response prediction tool, informed by population-level data, explained most of the variability in pain reduction and functional improvement after surgery. Giving patients accurate information about their likelihood of outcomes may be a helpful component in surgery decision making.
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Affiliation(s)
- Sara Khor
- Surgical Outcomes Research Center, University of Washington, Seattle
| | - Danielle Lavallee
- Surgical Outcomes Research Center, University of Washington, Seattle
| | - Amy M Cizik
- Department of Orthopaedic and Sports Medicine, University of Washington, Seattle
| | - Carlo Bellabarba
- Department of Orthopaedic and Sports Medicine, University of Washington, Seattle
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | | | - Dawei Lu
- Skagit Northwest Orthopedics, Proliance Surgeons, Inc, Mount Vernon, Washington
| | - A Alex Mohit
- Franciscan Neurosurgery Associates at St Joseph, CHI Franciscan Health, Tacoma, Washington
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Jeffrey R Roh
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Neal Shonnard
- Rainier Orthopedic Institute, Proliance Surgeons, Inc, Puyallup, Washington
| | - Armagan Dagal
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - David R Flum
- Surgical Outcomes Research Center, University of Washington, Seattle.,Department of Surgery, University of Washington, Seattle
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Compagnoni R, Gualtierotti R, Luceri F, Sciancalepore F, Randelli PS. Fibromyalgia and Shoulder Surgery: A Systematic Review and a Critical Appraisal of the Literature. J Clin Med 2019; 8:jcm8101518. [PMID: 31546598 PMCID: PMC6832346 DOI: 10.3390/jcm8101518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
Fibromyalgia is a common musculoskeletal syndrome characterized by chronic widespread pain and other systemic manifestations, which has demonstrated a contribution to higher postoperative analgesic consumption to other surgeries such as hysterectomies and knee and hip replacements. The aim of this review is to search current literature for studies considering the impact of fibromyalgia on clinical outcomes of patients undergoing shoulder surgery. A systematic literature review was conducted in PubMed/Medline, Embase, and ClinicalTrials.gov in February 2019. Studies were selected based on the following participants, interventions, comparisons, outcomes, and study design criteria: adult patients undergoing surgery for shoulder pain (P); diagnosis of fibromyalgia (I); patients without fibromyalgia (C); outcome of surgery in terms of pain or analgesic or non-steroidal anti-inflammatory drugs consumption (O); case series, retrospective studies, observational studies, open-label studies, randomized clinical trials, systematic reviews and meta-analyses were included (S). Authors found 678 articles, of which four were found eligible. One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery. The scarce and low-quality evidence available does not allow confirming that fibromyalgia has an impact on postoperative outcomes in shoulder surgery. Future studies specifically focusing on shoulder surgery outcomes may help improvement and personalization of the management of patients with fibromyalgia syndrome (PROSPERO 2019, CRD42019121180).
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Affiliation(s)
- Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
| | - Roberta Gualtierotti
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20090 Milano, Italy.
| | - Francesco Luceri
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
| | - Fabio Sciancalepore
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
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50
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Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter? Ann Surg 2019; 268:271-276. [PMID: 28594744 DOI: 10.1097/sla.0000000000002308] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to determine the correlation between the probability of postoperative opioid prescription refills and the amount of opioid prescribed, hypothesizing that a greater initial prescription yields a lower probability of refill. BACKGROUND Although current guidelines regarding opioid prescribing largely address chronic opioid use, little is known regarding best practices and postoperative care. METHODS We analyzed Optum Insight claims data from 2013 to 2014 for opioid-naïve patients aged 18 to 64 years who underwent major or minor surgical procedures (N = 26,520). Our primary outcome was the occurrence of an opioid refill within 30 postoperative days. Our primary explanatory variable was the total oral morphine equivalents provided in the initial postoperative prescription. We used logistic regression to examine the probability of an additional refill by initial prescription strength, adjusting for patient factors. RESULTS We observed that 8.67% of opioid-naïve patients refilled their prescriptions. Across procedures, the probability of a single postoperative refill did not change with an increase with initial oral morphine equivalents prescribed. Instead, patient factors were correlated with the probability of refill, including tobacco use [odds ratio (OR) 1.42, 95% confidence interval (CI) 1.23-1.57], anxiety (OR 1.30, 95% CI 1.15-1.47), mood disorders (OR 1.28. 95% CI 1.13-1.44), alcohol or substance abuse disorders (OR 1.43, 95% CI 1.12-1.84), and arthritis (OR 1.21, 95% CI 1.10-1.34). CONCLUSIONS The probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests. Future research that examines the interplay between pain, substance abuse, and mental health could inform strategies to tailor opioid prescribing for patients.
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