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Coaccioli S, Sarzi-Puttini P, Fornasari DMM, Schweiger V, Zis P, Viswanath O, Varrassi G. Immune Competence and Pain: A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01282-y. [PMID: 38935243 DOI: 10.1007/s11916-024-01282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize current knowledge on the pathophysiology of pain and the role of neuro-immune crosstalk in the development of acute and chronic pain (CP). Specifically, the review focuses on the role of immune cells involved in the innate and acquired immune response, emphasizing their bidirectional interactions with the nervous systems and discussing the implications of this crosstalk on acute and CP management. RECENT FINDINGS In the last two decades, multiple studies have uncovered the important role of the immune system in initiating, maintaining, and resolving pain stimuli. Furthermore, researchers discovered that the immune system interacts tightly with the nervous system, creating a bidirectional crosstalk in which immune cells influence the response of peripheral and central nerve fibers while neurotransmitters and neuropeptides released by nociceptors directly and indirectly modulate the immune response. The neuro-immune crosstalk in acute and CP is a complex and not fully understood process that comprise the interactions of multiple diverse molecules, bidirectional interferences, and numerous redundant processes. Despite the complexity, important steps have been taken in recent years toward explaining the specific roles of each immune cell type and molecule in the initiation, maintenance and resolution of pain. These findings may set the basis for innovative therapeutic options that target the immune system, overcoming the limitations of current treatments in providing pain relief and the disadvantages associated with opioid therapy.
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Affiliation(s)
| | | | - Diego M M Fornasari
- Dept. of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Vittorio Schweiger
- Dept. of Anesthesia, Intensive Care and Pain Therapy, Verona University Hospital, Verona, Italy
| | - Panagiotis Zis
- Medical School University of Cyprus, Nicosia, Cyprus
- 2nd Dept. of Neurology, Attikon University Hospital, University of Athens, Athens, Greece
| | - Omar Viswanath
- Clinical Professor of Anesthesiology, Creighton University School of Medicine, Phoenix, AZ, USA
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Reed DE, Fischer IC, Williams RM, Na PJ, Pietrzak RH. Co-occurring Chronic Pain and PTSD Among US Military Veterans: Prevalence, Correlates, and Functioning. J Gen Intern Med 2024:10.1007/s11606-024-08803-w. [PMID: 38780882 DOI: 10.1007/s11606-024-08803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The prevalence of co-occurring chronic pain and posttraumatic stress disorder (PTSD) has yet to be established in a nationally representative sample of US veterans, and little is known about the individual contributing roles of these disorders to the psychiatric and functional burden of this comorbidity. OBJECTIVE To determine the prevalence of chronic pain, PTSD, and co-occurring chronic pain and PTSD, and psychiatric comorbidities and psychosocial functioning in these groups. DESIGN Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans. PARTICIPANTS Veterans (n=4069) were classified into four groups: control (i.e., no PTSD or chronic pain), chronic pain only, PTSD only, and co-occurring chronic pain and PTSD. MAIN MEASURES A probable PTSD diagnosis was established using the PTSD Checklist for DSM-5, and a chronic pain diagnosis using a self-report item that queried health care professional diagnoses. Psychiatric and functional status were assessed using the Patient Health Questionnaire-4, Alcohol Use Disorders Identification Test, Screen of Drug Use, Suicide Behaviors Questionnaire-Revised, Short Form Health Survey-8, Brief Inventory of Psychosocial Functioning, and Medical Outcomes Study Cognitive Functioning Scale. KEY RESULTS A total of 3.8% of veterans reported both probable PTSD and a diagnosis of chronic pain. Relative to veterans with chronic pain alone, those with co-occurring chronic pain and probable PTSD were more likely to screen positive for psychiatric disorders (odds ratios [ORs]=2.59-9.88) and scored lower on measures of psychosocial functioning (Cohen's ds=0.38-1.43). Relative to veterans with probable PTSD only, those with co-occurring chronic pain and probable PTSD were more likely to have attempted suicide (OR=4.79; 95%CI, 1.81-12.69). CONCLUSIONS Results underscore the importance of whole health care that considers a broad range of health and functional domains in the assessment and treatment of co-occurring chronic pain and PTSD in veterans.
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Affiliation(s)
- David E Reed
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA.
| | - Ian C Fischer
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Rhonda M Williams
- Rehabilitation Care Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Peter J Na
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Visoiu M, Chelly J, Sadhasivam S. Gaining Insight into Teenagers' Experiences of Pain after Laparoscopic Surgeries: A Prospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:493. [PMID: 38671710 PMCID: PMC11049025 DOI: 10.3390/children11040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
There is an anecdotal impression that teenage patients report exaggerated postoperative pain scores that do not correlate with their actual level of pain. Nurse and parental perception of teenagers' pain can be complemented by knowledge of patient pain behavior, catastrophizing thoughts about pain, anxiety, and mood level. Two hundred and two patients completed the study-56.4% were female, 89.6% White, 5.4% Black, and 5% were of other races. Patient ages ranged from 11 to 17 years (mean = 13.8; SD = 1.9). The patient, the parent, and the nurse completed multiple questionnaires on day one after laparoscopic surgery to assess patient pain. Teenagers and parents (r = 0.56) have a high level of agreement, and teenagers and nurses (r = 0.47) have a moderate level of agreement on pain scores (p < 0.05). The correlation between patient APBQ (adolescent pain behavior questionnaire) and teenager VAS (visual analog scale) and between nurse APBQ and teenager VAS, while statistically significant (p < 0.05), is weaker (r range = 0.14-0.17). There is a moderate correlation between teenagers' pain scores and their psychological assessments of anxiety, catastrophic thoughts, and mood (r range = 0.26-0.39; p < 0.05). A multi-modal evaluation of postoperative pain can be more informative than only assessing self-reported pain scores.
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Affiliation(s)
- Mihaela Visoiu
- UPMC Children’s Hospital of Pittsburgh, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, USA;
| | - Jacques Chelly
- UPMC Shadyside Hospital, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center 5230 Center Ave, Pittsburgh, PA 15232, USA;
| | - Senthilkumar Sadhasivam
- UPMC Children’s Hospital of Pittsburgh, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, PA 15224, USA;
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Moore RA, Clephas PRD, Straube S, Wertli MM, Ireson-Paige J, Heesen M. Comparing pain intensity rating scales in acute postoperative pain: boundary values and category disagreements. Anaesthesia 2024; 79:139-146. [PMID: 38058028 DOI: 10.1111/anae.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
Pain intensity assessment scales are important in evaluating postoperative pain and guiding management. Different scales can be used for patients to self-report their pain, but research determining cut points between mild, moderate and severe pain has been limited to studies with < 1500 patients. We examined 13,017 simultaneous acute postoperative pain ratings from 913 patients taken at rest and on activity, between 4 h and 48 h following surgery using both a verbal rating scale (no, mild, moderate or severe pain) and 0-100 mm visual analogue scale. We determined the best cut points on the visual analogue scale between mild and moderate pain as 35 mm, and moderate and severe pain as 80 mm. These remained consistent for pain at rest and on activity, and over time. We also explored the presence of category disagreements, defined as patients verbally describing no or mild pain scored above the mild/moderate cut point on the visual analogue scale, and patients verbally describing moderate or severe pain scored below the mild/moderate cut point on the visual analogue scale. Using 30 and 60 mm cut points, 1533 observations (12%) showed a category disagreement and using 35 and 80 mm cut points, 1632 (13%) showed a category disagreement. Around 1 in 8 simultaneous pain scores implausibly disagreed, possibly resulting in incorrect pain reporting. The reasons are not known but low rates of literacy and numeracy may be contributing factors. Understanding these disagreements between pain scales is important for pain research and medical practice.
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Affiliation(s)
| | - P R D Clephas
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Alberta, Canada
- School of Public Health, University of Alberta, Alberta, Canada
| | - M M Wertli
- Department of Internal Medicine, Kantonsspital Baden, Baden, Switzerland
- Division of General Internal Medicine, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - M Heesen
- Department of Anaesthesia, Bethanien Hospital, Zurich, Switzerland
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Lévesque-Lacasse A, Desjardins MC, Fiset D, Charbonneau C, Cormier S, Blais C. The Relationship Between the Ability to Infer Another's Pain and the Expectations Regarding the Appearance of Pain Facial Expressions: Investigation of the Role of Visual Perception. THE JOURNAL OF PAIN 2024; 25:250-264. [PMID: 37604362 DOI: 10.1016/j.jpain.2023.08.007] [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: 12/23/2022] [Revised: 08/01/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
Although pain is a commonly experienced and observed affective state, it is frequently misinterpreted, which leads to inadequate caregiving. Studies show the ability at estimating pain in others (estimation bias) and detecting its subtle variations (sensitivity) could emerge from independent mechanisms. While estimation bias is modulated by variables such as empathy level, pain catastrophizing tendency, and overexposure to pain, sensitivity remains unimpacted. The present study verifies if these 2 types of inaccuracies are partly explained by perceptual factors. Using reverse correlation, we measured their association with participants' mental representation of pain, or more simply put, with their expectations of what the face of a person in pain should look like. Experiment 1 shows that both parameters are associated with variations in expectations of this expression. More specifically, the estimation bias is linked with expectations characterized by salient changes in the middle face region, whereas sensitivity is associated with salient changes in the eyebrow region. Experiment 2 reveals that bias and sensitivity yield differences in emotional representations. Expectations of individuals with a lower underestimation tendency are qualitatively rated as expressing more pain and sadness, and those of individuals with a higher level of sensitivity as expressing more pain, anger, and disgust. Together, these results provide evidence for a perceptual contribution in pain inferencing that is independent of other psychosocial variables and its link to observers' expectations. PERSPECTIVE: This article reinforces the contribution of perceptual mechanisms in pain assessment. Moreover, strategies aimed to improve the reliability of individuals' expectations regarding the appearance of facial expressions of pain could potentially be developed, and contribute to decrease inaccuracies found in pain assessment and the confusion between pain and other affective states.
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Affiliation(s)
- Alexandra Lévesque-Lacasse
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Marie-Claude Desjardins
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Daniel Fiset
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Carine Charbonneau
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Stéphanie Cormier
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Caroline Blais
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, Québec, Canada
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6
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Bidonde J, Fisher E, Perrot S, Moore RA, Bell RF, Makri S, Häuser W. Effectiveness of non-pharmacological interventions for fibromyalgia and quality of review methods: an overview of Cochrane Reviews. Semin Arthritis Rheum 2023; 63:152248. [PMID: 37598586 DOI: 10.1016/j.semarthrit.2023.152248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is defined as chronic widespread pain associated with sleep disorders, cognitive dysfunction, and somatic symptoms present for at least three months and cannot be better explained by another diagnosis. OBJECTIVES To examine efficacy and safety of non-pharmacological interventions for FMS in adults reported in Cochrane Reviews, and reporting quality of reviews. METHODS Systematic reviews of randomised controlled trials (RCTs) of non-pharmacological interventions for FMS were identified from the Cochrane Database of Systematic Reviews (CDSR 2022, Issue 3 and CDSR 2023 Issue 6). Methodological quality was assessed using the AMSTAR-2 tool and a set of methodological criteria critical for analgesic effects. The primary efficacy outcomes of interest were clinically relevant pain relief, improvement in health-related quality of life (HRQoL), acceptability, safety, and reduction of mobility difficulties as reported by study participants. No pooled analyses were planned. We assumed a clinically relevant improvement was a minimal clinically important difference (MCID) between interventions and controls of 15%, or a SMD of more than 0.2, or a MD of more than 0.5, on a 0 to 10 scale. RESULTS Ten Cochrane reviews were eligible, reporting 181 randomized or quasi- randomized trials (11,917 participants, average trial size 66 participants). The reviews examined exercise training, acupuncture, transcutaneous electrical nerve stimulation, and psychological therapies. One review was rated moderate according to AMSTAR 2, seven were rated low and two were rated critically low. All reviews met most of the additional methodological quality criteria. All reviews included studies with patient-reported outcomes for pain. We found low certainty evidence of clinically relevant positive effects of aerobic and mixed exercise training and for cognitive behavioural therapies (CBTs) at reducing mobility difficulties and for mixed exercise training and CBTs for improving HRQoL at the end of the intervention. Number needed to treat for an additional beneficial outcome (NNTB) values for a MCID of 15% ranged between 4 and 9. We found low certainty evidence that was clinically relevant for mixed exercise and CBTs for reducing mobility difficulties at an average follow up of 24 weeks. We found low certainty evidence of clinically relevant positive effects of mixed exercise on HRQoL at an average follow up of 24 weeks. NNTB values for a MCID of 15% ranged from 5 to 11. The certainty of evidence of the acceptability (measured by dropouts) of the different non-pharmacological interventions ranged from very low to moderate and the dropout rate for any reason did not differ across the interventions or the controls, except for biofeedback and movement therapies. All the systematic reviews stated that the reporting of adverse events was inconsistent in the studies analysed (very low certainty evidence). AUTHORS' CONCLUSIONS There is low certainty evidence of clinically relevant reduction of mobility difficulties and of improvement of HRQoL among individuals with FMS by aerobic and mixed exercise training and by CBTs at the end of the intervention. There is low certainty evidence that CBTs and mixed exercise training reduces mobility difficulties post-treatment and that mixed exercise training improves HRQoL at follow-up by clinically meaningful scores.
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Affiliation(s)
- Julia Bidonde
- Norwegian Institute of Public Health, Oslo, Norway; School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Emma Fisher
- Centre for Pain Research, University of Bath, UK
| | - Serge Perrot
- Centre de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France
| | | | - Rae Frances Bell
- Regional Centre of Excellence in Palliative Care Haukeland University Hospital, Bergen, Norway
| | - Souzi Makri
- Cyprus League for People with Rheumatism, Nicosia, Cyprus
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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7
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de C Williams AC. Pain: Behavioural expression and response in an evolutionary framework. Evol Med Public Health 2023; 11:429-437. [PMID: 38022798 PMCID: PMC10656790 DOI: 10.1093/emph/eoad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
An evolutionary perspective offers insights into the major public health problem of chronic (persistent) pain; behaviours associated with it perpetuate both pain and disability. Pain is motivating, and pain-related behaviours promote recovery by immediate active or passive defence; subsequent protection of wounds; suppression of competing responses; energy conservation; vigilance to threat; and learned avoidance of associated cues. When these persist beyond healing, as in chronic pain, they are disabling. In mammals, facial and bodily expression of pain is visible and identifiable by others, while social context, including conspecifics' responses, modulate pain. Studies of responses to pain emphasize onlooker empathy, but people with chronic pain report feeling disbelieved and stigmatized. Observers frequently discount others' pain, best understood in terms of cheater detection-alertness to free riders that underpins the capacity for prosocial behaviours. These dynamics occur both in everyday life and in clinical encounters, providing an account of the adaptiveness of pain-related behaviours.
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Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, Gower St, London WC1E 6BT, UK
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Ghomrawi HMK, O'Brien MK, Carter M, Macaluso R, Khazanchi R, Fanton M, DeBoer C, Linton SC, Zeineddin S, Pitt JB, Bouchard M, Figueroa A, Kwon S, Holl JL, Jayaraman A, Abdullah F. Applying machine learning to consumer wearable data for the early detection of complications after pediatric appendectomy. NPJ Digit Med 2023; 6:148. [PMID: 37587211 PMCID: PMC10432429 DOI: 10.1038/s41746-023-00890-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
When children are discharged from the hospital after surgery, their caregivers often rely on subjective assessments (e.g., appetite, fatigue) to monitor postoperative recovery as objective assessment tools are scarce at home. Such imprecise and one-dimensional evaluations can result in unwarranted emergency department visits or delayed care. To address this gap in postoperative monitoring, we evaluated the ability of a consumer-grade wearable device, Fitbit, which records multimodal data about daily physical activity, heart rate, and sleep, in detecting abnormal recovery early in children recovering after appendectomy. One hundred and sixty-two children, ages 3-17 years old, who underwent an appendectomy (86 complicated and 76 simple cases of appendicitis) wore a Fitbit device on their wrist for 21 days postoperatively. Abnormal recovery events (i.e., abnormal symptoms or confirmed postoperative complications) that arose during this period were gathered from medical records and patient reports. Fitbit-derived measures, as well as demographic and clinical characteristics, were used to train machine learning models to retrospectively detect abnormal recovery in the two days leading up to the event for patients with complicated and simple appendicitis. A balanced random forest classifier accurately detected 83% of these abnormal recovery days in complicated appendicitis and 70% of abnormal recovery days in simple appendicitis prior to the true report of a symptom/complication. These results support the development of machine learning algorithms to predict onset of abnormal symptoms and complications in children undergoing surgery, and the use of consumer wearables as monitoring tools for early detection of postoperative events.
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Affiliation(s)
- Hassan M K Ghomrawi
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Global Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine (Rheumatology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Michela Carter
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Rushmin Khazanchi
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher DeBoer
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Samuel C Linton
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Suhail Zeineddin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J Benjamin Pitt
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Megan Bouchard
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Angie Figueroa
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Soyang Kwon
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jane L Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fizan Abdullah
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Global Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 63, Chicago, IL, 60611, USA.
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9
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Erlenwein J, Lauff S, Plohmann J, Dreiling J, Meißner W, Feltgen N. [Identifying patients with risk for severe pain after ophthalmological surgery]. DIE OPHTHALMOLOGIE 2023; 120:692-700. [PMID: 37368014 DOI: 10.1007/s00347-023-01890-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
Modern ophthalmology includes a wide range of surgical options and, accordingly, also requires appropriate pain management. There are established risk factors for severe postoperative pain that should be identified and considered in the perioperative management. The main risk factors and existing recommendations are presented in this article. Patients at risk should be identified before surgery. It is important that perioperative pain management is implemented in the treatment plan as part of an interdisciplinary cooperation to identify and address the risks as early as possible.
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Affiliation(s)
- Joachim Erlenwein
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Sören Lauff
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Juliane Plohmann
- Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Johannes Dreiling
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Schmerztherapie und Klinik für Innere Medizin II, Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Winfried Meißner
- Klinik für Anästhesiologie und Intensivmedizin, Sektion Schmerztherapie und Klinik für Innere Medizin II, Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Nicolas Feltgen
- Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Whitley GA, Wijegoonewardene N, Nelson D, Curtis F, Ortega M, Siriwardena AN. Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta-synthesis. J Am Coll Emerg Physicians Open 2023; 4:e12940. [PMID: 37056718 PMCID: PMC10086522 DOI: 10.1002/emp2.12940] [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] [Indexed: 04/15/2023] Open
Abstract
Background We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. Methods A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Results Twenty-five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient-clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Conclusion Interventions and guidelines that strengthen the patient-clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.
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Affiliation(s)
- Gregory Adam Whitley
- Community and Health Research UnitUniversity of LincolnLincolnUK
- Clinical Audit and Research UnitEast Midlands Ambulance Service NHS TrustLincolnUK
| | - Nimali Wijegoonewardene
- Community and Health Research UnitUniversity of LincolnLincolnUK
- Healthcare Quality and SafetyMinistry of HealthColomboSri Lanka
| | - David Nelson
- Lincoln International Institute for Rural HealthUniversity of LincolnLincolnUK
| | - Ffion Curtis
- Centre for Ethnic Health ResearchEast Midlands Applied Research CollaborationUniversity of LeicesterLeicesterUK
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11
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Pearson NA, Tutton E, Gwilym SE, Joeris A, Grant R, Keene DJ, Haywood KL. Understanding patient experience of distal tibia or ankle fracture: a qualitative systematic review. Bone Jt Open 2023; 4:188-197. [PMID: 37051834 PMCID: PMC10031546 DOI: 10.1302/2633-1462.43.bjo-2022-0115.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery. We undertook a systematic review of qualitative studies. Five databases were searched from inception to 1 February 2022. All titles and abstracts were screened, and a subset were independently assessed. Methodological quality was appraised using the Critical Appraisal Skills Programme (CASP) checklist. The GRADE-CERQual checklist was used to assign confidence ratings. Thematic synthesis was used to analyze data with the identification of codes which were drawn together to form subthemes and then themes. From 2,682 records, 15 studies were reviewed in full and four included in the review. A total of 72 patients were included across the four studies (47 female; mean age 50 years (17 to 80)). Methodological quality was high for all studies, and the GRADE-CERQual checklist provided confidence that the findings were an adequate representation of patient experience of distal tibia or ankle fracture. A central concept of 'being the same but different' conveyed the substantial disruption to patients' self-identity caused by their injury. Patient experience of 'being the same but different' was expressed through three interrelated themes, with seven subthemes: i) being proactive where persistence, doing things differently and keeping busy prevailed; ii) living with change including symptoms, and living differently due to challenges at work and leisure; and iii) striving for normality, adapting while lacking in confidence, and feeling fearful and concerned about the future. Ankle injuries were disruptive, draining, and impacted on patients' wellbeing. Substantial short- and longer-term challenges were experienced during recovery. Rehabilitation and psychosocial treatment strategies may help to ameliorate these challenges. Patients may benefit from clinicians being cognisant of patient experience when assessing, treating, and discussing expectations and outcomes with patients.
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Affiliation(s)
- Nathan A Pearson
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen E Gwilym
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Joeris
- AO ITC, Clinical Science, AO Foundation, Strettbacherstrausse 6, 8600, Dubendorf, Switzerland
| | - Richard Grant
- National Institute for Health Research, Applied Research Collaboration, West Midlands; Warwick Medical School, User Teaching and Research Action Partnership; Fragility Fracture Network; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David J Keene
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Kirstie L Haywood
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Munday I, Newton-John T, Kneebone I. Clinician experience of metaphor in chronic pain communication. Scand J Pain 2023; 23:88-96. [PMID: 35920187 DOI: 10.1515/sjpain-2022-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study investigated clinician experience of patient use of metaphors in chronic pain communication. METHODS Interviews were conducted with eighteen Australian clinicians working with chronic pain patients, age range 26-64 years (M=46.6), 50% female, experience working in chronic pain ranging from 2 to 27 years (M=11.16). RESULTS Thematic Analysis yielded four key themes: Metaphor as communicative tool, Metaphor as clue, Metaphor as obstacle, and Metaphor use in treatment. Clinicians identified metaphor as an important tool for patients to communicate their pain experience, whilst acknowledging that it could at times be unhelpful to patients. Metaphor was seen to contain useful information for clinicians and possess utility in assessment and treatment. CONCLUSIONS Metaphors play a significant role in chronic pain consultations, enabling clinician insight into pain type, psychopathology, and patient pain understanding. Metaphor in treatment phases may be underutilised. Clinicians should encourage patient metaphor use in chronic pain communication.
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Affiliation(s)
- Imogene Munday
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Ian Kneebone
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Shipton E, Steketee C, Visser E. The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1057114. [PMID: 36700142 PMCID: PMC9869177 DOI: 10.3389/fpain.2022.1057114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023]
Abstract
Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.
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Affiliation(s)
- Elspeth Shipton
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia,Correspondence: Elspeth Shipton
| | - Carole Steketee
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Eric Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
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14
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Yoo H, Cho Y, Cho S. Does past/current pain change pain experience? Comparing self-reports and pupillary responses. Front Psychol 2023; 14:1094903. [PMID: 36874838 PMCID: PMC9982106 DOI: 10.3389/fpsyg.2023.1094903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction For decades, a substantial body of research has confirmed the subjective nature of pain. Subjectivity seems to be integrated into the concept of pain but is often confined to self-reported pain. Although it seems likely that past and current pain experiences would interact and influence subjective pain reports, the influence of these factors has not been investigated in the context of physiological pain. The current study focused on exploring the influence of past/current pain on self-reporting and pupillary responses to pain. Methods Overall, 47 participants were divided into two groups, a 4°C-10°C group (experiencing major pain first) and a 10°C-4°C group (experiencing minor pain first), and performed cold pressor tasks (CPT) twice for 30 s each. During the two rounds of CPT, participants reported their pain intensity, and their pupillary responses were measured. Subsequently, they reappraised their pain ratings in the first CPT session. Results Self-reported pain showed a significant difference (4°C-10°C: p = 0.045; 10°C-4°C: p < 0.001) in the rating of cold pain stimuli in both groups, and this gap was higher in the 10°C-4°C group than in the 4°C-10°C group. In terms of pupillary response, the 4°C-10°C group exhibited a significant difference in pupil diameter, whereas this was marginally significant in the 10°C-4°C group (4°C-10°C: p < 0.001; 10°C-4°C: p = 0.062). There were no significant changes in self-reported pain after reappraisal in either group. Discussion The findings of the current study confirmed that subjective and physiological responses to pain can be altered by previous experiences of pain.
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Affiliation(s)
- Hyunkyung Yoo
- Department of Psychology, Chungnam National University, Daejeon, Republic of Korea
| | - Younhee Cho
- Department of Psychology, Chungnam National University, Daejeon, Republic of Korea
| | - Sungkun Cho
- Department of Psychology, Chungnam National University, Daejeon, Republic of Korea
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15
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Out of the mouth of babes: a lot about pain has nothing to do with pain. Pain 2022; 163:S117-S125. [DOI: 10.1097/j.pain.0000000000002761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022]
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16
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Andre G, Petitjean P, Haas V, Geraud E, Fantini ML, Creac'h C, Perez C, Bonnefoi M, Gadea E. Screening and management of sleep disorders in patients with fibromyalgia syndrome: a French multicentred, prospective, observational study protocol (FIBOBS). BMJ Open 2022; 12:e062549. [PMID: 36180114 PMCID: PMC9528680 DOI: 10.1136/bmjopen-2022-062549] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Sleep disorders are still often underestimated in patient care management even though they are present in the criteria of the American College of Rheumatology for the diagnosis of fibromyalgia syndrome (FMS). The objective of this study will be to assess the current situation of sleep disorders in patients with FMS in France and to estimate its prevalence. METHODS AND ANALYSIS The FIBOBS study is a multicentred, prospective, observational trial performed by 46 specialised chronic pain structures in France. Patients with FMS visiting for a first consultation or follow-up (if they have already been followed up for less than a year with a pain management service) will be included after giving their informed consent. Data will be collected through the physician questionnaire filled during the inclusion visit. Patient self-questionnaires will be completed from home. The primary outcome of the study will be to estimate the prevalence of sleep disorders classified into three categories: (a) poor sleep quality in general, (b) sleep apnoea syndrome and (c) restless legs syndrome, using self-administered questionnaires. ETHICS AND DISSEMINATION This protocol is approved by the ethics committee Comité de Protection des Personnes 'Ile de France II' in accordance with French regulations. The results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT04775368.
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Affiliation(s)
- Gilbert Andre
- Consultation douleur, Centre Hospitalier Emile Roux, Le Puy en Velay, France
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Pauline Petitjean
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Victoria Haas
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Eva Geraud
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Maria Livia Fantini
- NPsy-Sydo, Service de Neurologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Christelle Creac'h
- INSERM U1208, Laboratoire Intégration Centrale de la Douleur chez l'Homme (NeuroPain), Centre de Recherche en Neurosciences de Lyon, Centre Stéphanois de la douleur, Service de Neurochirurgie, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Christèle Perez
- Consultation douleur, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Marlène Bonnefoi
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Emilie Gadea
- Unité de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
- U1059, Inserm, Université de Lyon, Mines Saint-Etienne, Université Jean Monnet Saint-Étienne, Saint-Etienne, France
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Kelly I, Fields K, Sarin P, Pang A, Sigurdsson MI, Shernan SK, Fox AA, Body SC, Muehlschlegel JD. Identifying Patients Vulnerable to Inadequate Pain Resolution After Cardiac Surgery. Semin Thorac Cardiovasc Surg 2022; 36:182-194. [PMID: 36084862 DOI: 10.1053/j.semtcvs.2022.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Acute postoperative pain (APOP) is often evaluated through granular parameters, though monitoring postoperative pain using trends may better describe pain state. We investigated acute postoperative pain trajectories in cardiac surgical patients to identify subpopulations of pain resolution and elucidate predictors of problematic pain courses. We examined retrospective data from 2810 cardiac surgical patients at a single center. The k-means algorithm for longitudinal data was used to generate clusters of pain trajectories over the first 5 postoperative days. Patient characteristics were examined for association with cluster membership using ordinal and multinomial logistic regression. We identified 3 subgroups of pain resolution after cardiac surgery: 37.7% with good resolution, 44.2% with moderate resolution, and 18.2% exhibiting poor resolution. Type I diabetes (2.04 [1.00-4.16], p = 0.05), preoperative opioid use (1.65 [1.23-2.22], p = 0.001), and illicit drug use (1.89 [1.26-2.83], p = 0.002) elevated risk of membership into worse pain trajectory clusters. Female gender (1.72 [1.30-2.27], p < 0.001), depression (1.60 [1.03-2.50], p = 0.04) and chronic pain (3.28 [1.79-5.99], p < 0.001) increased risk of membership in the worst pain resolution cluster. This study defined 3 APOP resolution subgroups based on pain score trend after cardiac surgery and identified factors that predisposed patients to worse resolution. Patients with moderate or poor pain trajectory consumed more opioids and received them for longer before discharge. Future studies are warranted to determine if altering postoperative pain monitoring and management improve postoperative course of patients at risk of moderate or poor pain resolution.
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Affiliation(s)
- Ian Kelly
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pankaj Sarin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amanda Pang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin I Sigurdsson
- Department of Anesthesiology and Critical Care Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amanda A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, University of Texas Southwestern, Dallas, Texas
| | - Simon C Body
- Department of Anesthesiology, Boston University School of Medicine, Boston, Massachusetts
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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18
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Vitou V, Gély-Nargeot MC, Jeandel C, Bayard S. The influence of Alzheimer's disease stigma on pain assessment in older persons. DEMENTIA 2022; 21:2418-2441. [PMID: 35976758 DOI: 10.1177/14713012221117907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pain of nursing homes residents with Alzheimer's disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored. RESEARCH QUESTION The objective of this research was to analyze whether a diagnosis label of Alzheimer's disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes. METHODS Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer's disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer's disease (mild stage vs severe stage). RESULTS Alzheimer's disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions. CONCLUSION These results confirm that the Alzheimer's disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer's disease and to enhance the pain management of this frail population.
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Affiliation(s)
- Valérie Vitou
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France.,Fondation Partage et Vie, Montrouge, France
| | | | - Claude Jeandel
- Fondation Partage et Vie, Montrouge, France.,Département de Gériatrie, Université De Montpellier, 26905CHU de Montpellier, Montpellier, France
| | - Sophie Bayard
- 27038EPSYLON, EA4556, Univ Paul Valéry Montpellier 3, F34000, Montpellier, France
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Dorris ER, Maccarthy J, Simpson K, McCarthy GM. Sensory Perception Quotient Reveals Visual, Scent and Touch Sensory Hypersensitivity in People With Fibromyalgia Syndrome. FRONTIERS IN PAIN RESEARCH 2022; 3:926331. [PMID: 35866137 PMCID: PMC9294149 DOI: 10.3389/fpain.2022.926331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEnvironmental sensitivity is commonly reported by people with fibromyalgia syndrome. People living with fibromyalgia syndrome frequently report hypersensitivity to noxious and non-noxious sensations. To date, there has been little empirical validation of sensory disturbance to non-noxious triggers. Environmental sensitivity is used as a diagnostic feature only in Bennet's alternative criteria for diagnosis of fibromyalgia, where it was ranked the second most important of the components for diagnosis, after number of pain sites. The aim of this study was to use a validated sensory measure to determine if people with fibromyalgia have greater sensory disturbances compared to people with other chronic pain conditions.MethodsThis study used the Sensory Perception Quotient (SPQ) 92 question survey in adults with chronic pain conditions. A fibromyalgia group (n = 135) and a non-fibromyalgia chronic pain control group (n = 45) were recruited. All participants completed the SPQ as a self-report measure of sensory processing. In addition to the original SPQ scoring method, the Revised Scoring of the Sensory Perception Quotient (SPQ-RS) method was used to investigate self-reported hypersensitivity and hyposensitivity and the vision, hearing, taste, touch, and smell subscales. Chi-squared tests were used for categorical variables and Mann Whitney U, or Kruskal-Wallis H test were used to compare groups.ResultsThe fibromyalgia group reported significantly more sensitivity compared to the control group (p = 0.030). The fibromyalgia group reported significantly greater hypersensitivity (p = 0.038), but not more hyposensitivity (p = 0.723) compared to controls. The average fibromyalgia SPQ score (92.64 ± 23.33) was similar to that previously reported for adults with autism (92.95 ± 26.61). However, whereas adults with autism had broad range hypersensitivity, the fibromyalgia group reported significantly more hypersensitivity compared to the control group, but the range was restricted to vision (p = 0.033), smell (p = 0.049) and touch (0.040).ConclusionsThese findings demonstrate greater sensory hypersensitivity in people with fibromyalgia compared to people with other chronic pain disorders. Greater hypersensitivity was restricted to touch, vision, and smell, all of which have previously been demonstrated to crosstalk with nociception.
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Affiliation(s)
- Emma R. Dorris
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
- *Correspondence: Emma R. Dorris
| | - James Maccarthy
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
| | - Ken Simpson
- Northeast Fibromyalgia Support Group, Duleek, Ireland
| | - Geraldine M. McCarthy
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
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20
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Wilford KF, Mena-Iturriaga MJ, Vugrin M, Wainer M, Sizer PS, Seeber GH. International perspective on healthcare provider gender bias in musculoskeletal pain management: a scoping review protocol. BMJ Open 2022; 12:e059233. [PMID: 35715190 PMCID: PMC9207904 DOI: 10.1136/bmjopen-2021-059233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Chronic pain affects millions of individuals worldwide. Healthcare provider gender bias in the management of these individuals has societal and individual ramifications. Yet, a thorough and comprehensive literature summary on this topic is lacking. Therefore, this study aims to systematically: (1) identify and map the available scientific and grey literature as it relates to healthcare provider gender bias in the assessment, diagnosis and management of (chronic) musculoskeletal pain and (2) identify current gaps that necessitate further research. METHODS AND ANALYSIS This scoping review will be conducted in accordance with recent guidelines, and the results will be reported via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The following databases will be searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (Ebscohost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022. Additionally, relevant grey literature will be identified. All screening will be done by two independent reviewers during two stages: first title/abstract screening followed by full-text screening. Data will be extracted from the bibliometric, study characteristics, and pain science families of variables. Results will be descriptively mapped, and the frequency of concepts, population, characteristics and other details will be narratively reported. Additionally, results will be presented in tabular and graphical form. ETHICS AND DISSEMINATION As this study will neither involve human subject participation nor utilisation of protected data, ethical approval is not required. This study's methodological approach follows current recommendations. Study findings will be disseminated through conference presentations and international peer-review journal publication. In addition, infographics available in English, Spanish and German will be disseminated. REGISTRATION DETAILS This project will be registered in Open Science Framework prior to data collection.
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Affiliation(s)
- Katherine Fisher Wilford
- College of Rehabilitative Sciences Physical Therapy, University of Saint Augustine - Austin Campus, Austin, Texas, USA
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Maria Jesus Mena-Iturriaga
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Margaret Vugrin
- Preston Smith Library, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Macarena Wainer
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Phillip S Sizer
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Gesine Hendrijke Seeber
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
- University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Gilron I, Xiao MZX, Balanaser M, Carley M, Ghasemlou N, Salter MW, Hutchinson MR, Moulin DE, Moore RA, Ross-White A. Glial-modulating agents for the treatment of pain: protocol for a systematic review. BMJ Open 2022; 12:e055713. [PMID: 35387818 PMCID: PMC8987758 DOI: 10.1136/bmjopen-2021-055713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Evidence suggests a role for Central nervous system glia in pain transmission and in augmenting maladaptive opioid effects. Identification of drugs that modulate glia has guided the evaluation of glial suppression as a pain management strategy. This planned systematic review will describe evidence of the efficacy and adverse effects of glial-modulating drugs in pain management. METHODS AND ANALYSIS A detailed search will be conducted on the Cochrane Central Register of Controlled Trials, Medline, and Embase from their inception until the date the final searches are run to identify relevant randomised controlled trials. The reference lists of retrieved studies, as well as online trial registries, will also be searched. English language, randomised, double-blind trials comparing various glial-modulating drugs with placebo and/or other comparators, with participant-reported pain assessment, will be included. Two reviewers will independently evaluate studies for eligibility, extract data and assess trial quality and potential bias. Risk of bias will be assessed using criteria outlined in the Cochrane Handbook for Systematic Review of Interventions. Primary outcomes for this review will include any validated measure of pain intensity and/or pain relief. Dichotomous data will be used to calculate risk ratio and number needed to treat or harm. The quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This systematic review does not require formal ethics approval. The findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021262074.
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Affiliation(s)
- Ian Gilron
- Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Maggie Z X Xiao
- Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Marielle Balanaser
- Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Meg Carley
- Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nader Ghasemlou
- Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael W Salter
- The Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Mark R Hutchinson
- Centre of Excellence for Nanoscale BioPhotonics, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dwight E Moulin
- Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada
| | - R Andrew Moore
- Department of Anaesthetics, Oxford University, Plymouth, UK
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen's University, Kingston, Ontario, Canada
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22
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Kim S, Kang J, Choi J, Kong E. The effects of ketamine on pain control in stage IV cancer patients receiving palliative care. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.21.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hanna M, Montero Matamala A, Perrot S, Varrassi G. Delivery of Multimodal Analgesia to Effectively Treat Acute Pain: A Review From Roma Pain Days. Cureus 2022; 14:e22465. [PMID: 35345718 PMCID: PMC8942173 DOI: 10.7759/cureus.22465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/19/2022] [Indexed: 12/03/2022] Open
Abstract
It is crucial that acute pain be promptly and adequately treated in order to prevent it from transitioning to chronic pain, a devastating and sometimes permanent condition that is challenging to treat and associated with disability, reduced quality of life, and depression. Guidelines for the treatment of acute low-back pain (LBP) are predicated on assumptions that all acute LBP is benign, temporary, and traditionally treated with a “wait and see” approach. LBP is far from a monolithic condition: etiology, the presence of underlying conditions, mental health status, social situation, patient’s age and occupation, and comorbidities all present different risk factors for chronic LBP that should be considered in treating acute LBP or other forms of acute pain. A multimodal approach to acute pain has been shown to be safe and effective. In particular, the combination product of oral dexketoprofen and tramadol has been shown effective in controlling acute pain, which spares the use of opioids and is well tolerated. Chronic pain must be viewed as a global health crisis, and the timely and adequate control of acute painful conditions is a good strategy to reduce its prevalence. Experts at Roma Pain Days discussed this important topic which is the foundation of this review.
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Häuser W, Fisher E, Perrot S, Moore RA, Makri S, Bidonde J. Non-pharmacological interventions for fibromyalgia (fibromyalgia syndrome) in adults: an overview of Cochrane Reviews. Hippokratia 2022. [DOI: 10.1002/14651858.cd015074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | | | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
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Cousins M, Lane-Krebs K, Matthews J, Johnston-Devin C. Student nurses' pain knowledge and attitudes towards pain management over the last 20 years: A systematic review. NURSE EDUCATION TODAY 2022; 108:105169. [PMID: 34653890 DOI: 10.1016/j.nedt.2021.105169] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/16/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To discover if nursing students have improved their level of pain knowledge and their attitudes towards pain management over the last 20 years. DESIGN Systematic review utilising the Kable, Pich, and Maslin-Prothero 12 step approach to document a search strategy. DATA SOURCES A search was conducted from 2000 to 2020 using CINAHL, PubMed, Embase and ProQuest. REVIEW METHODS Studies exploring the level of pain management knowledge and attitudes of nursing students were included. The Critical Review Form - Quantitative Studies provided the appraisal framework (Law et al., 1998). A narrative synthesis of eligible studies was undertaken. RESULTS Six studies with a total of 1454 participants were included. The studies demonstrated that nursing students have not improved their level of pain knowledge and attitudes towards pain management in the last 20 years. Whilst many nursing students thought they possessed adequate pain knowledge, the studies all demonstrated that their pain knowledge is lacking and that they do not have appropriate attitudes towards pain. Students did not recognise the patient who was not grimacing as being in pain despite the patient report of pain. CONCLUSIONS These findings support the notion that nursing education does not include sufficient focus on pain identification and management. Alignment of nursing pain education with the curriculum developed in 1993 by the International Association for the Study of Pain is needed to ensure nurses have appropriate knowledge so that patients can receive effective pain management.
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Affiliation(s)
- Marina Cousins
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, 554-700 Yaamba Rd, Norman Gardens, QLD 4701, Australia.
| | - Katrina Lane-Krebs
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, 554-700 Yaamba Rd, Norman Gardens, QLD 4701, Australia
| | - Joy Matthews
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, 554-700 Yaamba Rd, Norman Gardens, QLD 4701, Australia
| | - Colleen Johnston-Devin
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, 554-700 Yaamba Rd, Norman Gardens, QLD 4701, Australia
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Huang L, Xu G, He J, Tian H, Zhou Z, Huang F, Liu Y, Sun M, Liang F. Bibliometric Analysis of Functional Magnetic Resonance Imaging Studies on Acupuncture Analgesia Over the Past 20 Years. J Pain Res 2021; 14:3773-3789. [PMID: 34916843 PMCID: PMC8670890 DOI: 10.2147/jpr.s340961] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Researches on the central mechanisms of acupuncture analgesia have been widely conducted worldwide. However, there is no bibliometric analysis of functional magnetic resonance imaging (fMRI) studies on acupuncture analgesia. This study visualized the current status, hot spots and frontiers of fMRI studies on acupuncture analgesia in the past 20 years to provide a theoretical basis for its clinical application. Methods All publications were obtained from Science Citation Index-Expanded (SCI-E) of Web of Science (WOS). We used CiteSpace to analyze publications, journals, cited journals, authors, cited authors, institutions, countries, references, and keywords. We also analyzed collaborative network maps and co-occurrence network maps. Results We retrieved a total of 797 articles. Regarding the volume of publications, the total number of annual publications showed a fluctuating but overall increasing trend. Evidence-based Complementary and Alternative Medicine (21 articles) was the most productive journal, and Pain (225 articles) was the most cited journal. The most productive author was Qin W (16 articles), and the most co-cited author was Hui KKS (111). The most prolific institution and country were Massachusetts General Hospital (34 articles) and USA (212 articles). “Pain” was the top-ranked for keyword frequency and centrality. “Functional connectivity” was the frontier hotspot for 2018–2021. Conclusion First, fMRI researches on acupuncture analgesia involved several countries (regions) and institutions, mainly located in the USA, China and Korea, and most of them were universities. In addition, the USA was a major contributor in this field. Second, in terms of disciplinary distribution, the literatures were mainly from clinical neurology, neuroscience, and radiology nuclear medicine medical imaging. Third, the keyword co-occurrence analysis showed that the hot keywords included pain, fMRI, and lower back pain. Fourth, through keyword clustering analysis, the hot disease was found to be lower back pain, and the hot contents were acupuncture specificity and frequency specificity. Fifth, a timeline analysis of the references identified that chronic low back pain and specificity will remain a hot topic for future research.
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Affiliation(s)
- Liuyang Huang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Guixing Xu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jiamei He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Hao Tian
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Zhuo Zhou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Fengyuan Huang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Yilin Liu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Mingsheng Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Fanrong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine/Clinical Research Center for Acupuncture and Moxibustion in Sichuan Province, Chengdu, Sichuan, People's Republic of China
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Bi T, Xie Q, Gao J, Zhang T, Kou H. The Effect of Empathy on the Attentional Processing of Painful and Emotional Stimuli. Psychol Res Behav Manag 2021; 14:1223-1234. [PMID: 34408507 PMCID: PMC8364384 DOI: 10.2147/prbm.s318657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Empathy is shown to affect the attentional processing of painful stimuli and emotional stimuli. However, whether the attentional effects on emotional stimuli depend on emotional valence and the nature of the relationship between the attentional effects on different stimuli are still unknown. Methods In the present study, 25 high-empathy (HE) participants and 25 low-empathy (LE) participants were recruited to perform dot-probe tasks on painful stimuli and emotional stimuli. Results The results showed that HE individuals had weak attentional disengagement to painful pictures. More importantly, regarding emotional pictures, HE individuals showed attentional avoidance to negative emotion pictures, while LE individuals showed attentional bias to positive emotion pictures. Correlation analysis showed that the attentional bias score and attentional disengagement score were only associated with each other within the same category of stimuli (painful, positive or negative stimuli). Conclusion These results revealed that HE individuals mainly showed attentional avoidance to negative stimuli, while LE individuals mainly showed attentional bias to positive stimuli.
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Affiliation(s)
- Taiyong Bi
- Center for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Qinhong Xie
- Center for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, People's Republic of China.,School of Criminal Justice, China University of Political Science and Law, Beijing, People's Republic of China
| | - Jianhui Gao
- Center for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Tao Zhang
- Center for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, People's Republic of China
| | - Hui Kou
- Center for Mental Health Research in School of Management, Zunyi Medical University, Zunyi, People's Republic of China
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Moore RA, Fisher E, Häuser W, Bell RF, Perrot S, Bidonde J, Makri S, Straube S. Pharmacological therapies for fibromyalgia (fibromyalgia syndrome) in adults - an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd013151.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group; Pain Research Unit, Churchill Hospital; Oxford UK
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy; Technische Universität München; München Germany
| | - Rae Frances Bell
- Emerita, Regional Centre of Excellence in Palliative Care; Haukeland University Hospital; Bergen Norway
| | - Serge Perrot
- Service de Médecine Interne et Thérapeutique; Hôtel Dieu, Université Paris Descartes, INSERM U 987; Paris France
| | - Julia Bidonde
- School of Rehabilitation Science, College of Medicine; University of Saskatchewan; Saskatoon Canada
| | - Souzi Makri
- Cyprus League Against Rheumatism; Nicosia Cyprus
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine; University of Alberta; Edmonton Canada
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29
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Goldman RE, Broderick JE, Junghaenel DU, Bolton A, May M, Schneider S, Stone AA. Beyond Average: Providers' Assessments of Indices for Measuring Pain Intensity in Patients With Chronic Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:692567. [PMID: 35295477 PMCID: PMC8915753 DOI: 10.3389/fpain.2021.692567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Effective clinical care for chronic pain requires accurate, comprehensive, meaningful pain assessment. This study investigated healthcare providers' perspectives on seven pain measurement indices for capturing pain intensity. Methods: Semi-structured telephone interviews were conducted with a purposeful sample from four US regions of 20 healthcare providers who treat patients with chronic pain. The qualitative interview guide included open-ended questions to address perspectives on pain measurement, and included quantitative ratings of the importance of seven indices [average pain, worst pain, least pain, time in no/low pain, time in high pain, fluctuating pain, unpredictable pain]. Qualitative interview data were read, coded and analyzed for themes and final interpretation. Standard quantitative methods were used to analyze index importance ratings. Results: Despite concerns regarding 10-point visual analog and numeric rating scales, almost all providers used them. Providers most commonly asked about average pain, although they expressed misgivings about patient reporting and the index's informational value. Some supplemented average with worst and least pain, and most believed pain intensity is best understood within the context of patient functioning. Worst pain received the highest mean importance rating (7.60), average pain the second lowest rating (5.65), and unpredictable pain the lowest rating (5.20). Discussion: Assessing average pain intensity obviates obtaining clinical insight into daily contextual factors relating to pain and functioning. Pain index use, together with timing, functionality and disability, may be most effective for understanding the meaning to patients of high pain, how pain affects their life, how life affects their pain, and how pain changes and responds to treatment.
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Affiliation(s)
- Roberta E. Goldman
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
- *Correspondence: Roberta E. Goldman
| | - Joan E. Broderick
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Doerte U. Junghaenel
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Alicia Bolton
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Marcella May
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Stefan Schneider
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Arthur A. Stone
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
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Moore RA, Fisher E, Finn DP, Finnerup NB, Gilron I, Haroutounian S, Krane E, Rice ASC, Rowbotham M, Wallace M, Eccleston C. Cannabinoids, cannabis, and cannabis-based medicines for pain management: an overview of systematic reviews. Pain 2021; 162:S67-S79. [PMID: 32804833 DOI: 10.1097/j.pain.0000000000001941] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
ABSTRACT Cannabinoids, cannabis, and cannabis-based medicines (CBM) are increasingly used to manage pain, with limited understanding of their efficacy and safety. We assessed methodological quality, scope, and results of systematic reviews of randomised controlled trials of these treatments. Several search strategies sought self-declared systematic reviews. Methodological quality was assessed using both AMSTAR-2 and techniques important for bias reduction in pain studies. Of the 106 articles read, 57 were self-declared systematic reviews, most published since 2010. They included any type of cannabinoid, cannabis, or CBM, at any dose, however administered, in a broad range of pain conditions. No review examined the effects of a particular cannabinoid, at a particular dose, using a particular route of administration, for a particular pain condition, reporting a particular analgesic outcome. Confidence in the results in the systematic reviews using AMSTAR-2 definitions was critically low (41), low (8), moderate (6), or high (2). Few used criteria important for bias reduction in pain. Cochrane reviews typically provided higher confidence; all industry-conflicted reviews provided critically low confidence. Meta-analyses typically pooled widely disparate studies, and, where assessable, were subject to potential publication bias. Systematic reviews with positive or negative recommendation for use of cannabinoids, cannabis, or CBM in pain typically rated critically low or low (24/25 [96%] positive; 10/12 [83%] negative). Current reviews are mostly lacking in quality and cannot provide a basis for decision-making. A new high-quality systematic review of randomised controlled trials is needed to critically assess the clinical evidence for cannabinoids, cannabis, or CBM in pain.
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Affiliation(s)
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, NCBES, National University of Ireland Galway, Galway, Ireland
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital and Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Washington University Pain Center, St. Louis, MO, United States
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Elliot Krane
- Department of Anesthesiology, Perioperative and Pain Medicine, and Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Michael Rowbotham
- Department of Anesthesia, Pain Management Center, University of California San Francisco, San Francisco, CA, United Kingdom
- Sutter Health, CPMC Research Institute, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Boerlage AA, Sneep L, van Rosmalen J, van Dijk M. Validity of the Rotterdam Elderly Pain Observation Scale for institutionalised cognitively impaired Dutch adults. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:675-687. [PMID: 33955082 PMCID: PMC8252534 DOI: 10.1111/jir.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Rotterdam Elderly Pain Observation Scale (REPOS) has not yet been validated for institutionalised cognitively impaired adults. To fill this gap of knowledge, we tested psychometric properties of the REPOS when used for pain assessment in this population. METHODS In this multicentre observational study, residents were filmed during a possibly painful moment and at rest. Healthcare professionals were asked to rate residents' pain by means of a Numeric Rating Scale (NRS)-proxy. Two researchers assessed pain with the REPOS and the Chronic Pain Scale for Non Verbal Adults with Intellectual Disabilities (CPS-NAID) from video-recordings. RESULTS In total, 168 observations from 84 residents were assessed. Inter-observer reliability between the two researchers was good, with Cohen's kappa 0.72 [95% confidence interval (CI) 0.64 to 0.79]. Correlation between the REPOS and CPS-NAID for a possibly painful moment was 0.73 (95% CI 0.65 to 0.79). Sensitivity (85%) and specificity (61%) for the detection of pain were calculated with REPOS ≥ 3 and NRS ≥ 4 as a reference value. Item response theory analysis shows that the item grimace displayed perfect discrimination between residents with and without pain. CONCLUSION The REPOS is a reliable and valid instrument to assess pain in cognitively impaired individuals.
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Affiliation(s)
- A. A. Boerlage
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
- Department of AnesthesiologyErasmus MCRotterdamThe Netherlands
| | - L. Sneep
- Department of PhysiotherapyIpse de BruggenNootdorpThe Netherlands
| | - J. van Rosmalen
- Department of BiostatisticsErasmus MCRotterdamThe Netherlands
| | - M. van Dijk
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children's HospitalRotterdamThe Netherlands
- Department of Internal Medicine, Section of Nursing ScienceErasmus MCRotterdamThe Netherlands
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Eccleston C, Aldington D, Moore A, de C Williams AC. Pragmatic but flawed: the NICE guideline on chronic pain. Lancet 2021; 397:2029-2031. [PMID: 34062133 DOI: 10.1016/s0140-6736(21)01058-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022]
Affiliation(s)
| | - Dominic Aldington
- Department of Anaesthesia, Royal Hampshire County Hospital, Winchester, UK
| | | | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Tutton E, Saletti-Cuesta L, Langstaff D, Wright J, Grant R, Willett K. Patient and informal carer experience of hip fracture: a qualitative study using interviews and observation in acute orthopaedic trauma. BMJ Open 2021; 11:e042040. [PMID: 33542042 PMCID: PMC7925874 DOI: 10.1136/bmjopen-2020-042040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The time taken for older people to recover from hip fracture can be extensive. The aim of this study was to gain an understanding of patient and informal carer experience of recovery in the early stage, while in acute care. DESIGN A phenomenological (lived experience) approach was used to guide the design of the study. Interviews and observation took place between March 2016 and December 2016 in acute care. SETTING Trauma wards in a National Health Service Foundation Trust in the South West of England. PARTICIPANTS A purposive sample of 25 patients were interviewed and observation taking 52 hours was undertaken with 13 patients and 12 staff. 11 patients had memory loss, 2 patients chose to take part in an interview and observation. The age range was 63-91 years (median 83), 10 were men. A purposive sample of 25 informal carers were also interviewed, the age range was 42-95 years (mean 64), 11 were men. RESULTS The results identified how participants moved forward together after injury by sharing the journey. This was conveyed through three themes: (1) sustaining relationships while experiencing strong emotions and actively helping, (2) becoming aware of uncertainty about the future and working through possible outcomes, (3) being changed, visibly looking different, not being able to walk, and enduring indignity and pain. CONCLUSION This study identified the experience of patients and informal carers as they shared the journey during a challenging life transition. Strategies that support well-being and enable successful negotiation of the emotional and practical challenges of acute care may help with longer term recovery. Research should focus on developing interventions that promote well-being during this transition to help provide the foundation for patients and carers to live fulfilled lives.
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Affiliation(s)
- Elizabeth Tutton
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Lorena Saletti-Cuesta
- Culture and Society Research and Study Centre, National Scientific and Technical Research Council, Cordoba, Argentina
| | - Debbie Langstaff
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Julie Wright
- Trauma and Major Trauma Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Richard Grant
- Patient and Public Involvement Partner, Kadoorie, Oxford Trauma and Emergency Care, University of Oxford, Oxford, UK
| | - Keith Willett
- Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abstract
Pain is a highly personal experience that can be challenging to define. In addition, evidence has indicated that the assessment of pain by healthcare professionals is often suboptimal and its severity often underestimated. In clinical practice, the use of language can be a significant influencing factor in the effective management of pain, with terms such as pain, discomfort and comfort used interchangeably. This article explores how language can both act as a barrier to, and assist, nurses to understand the patient's pain experience.
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Vitou V, Gély-Nargeot MC, Bayard S. Interrater Variability in Pain Assessment of Long-term Care Residents with Dementia. Pain Manag Nurs 2021; 22:377-385. [PMID: 33446451 DOI: 10.1016/j.pmn.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE People with dementia are at great risk of their pain being undetected. In long-term care facilities, certified nursing assistants are on the front-line to detect whether a resident with dementia is experiencing pain, but research on certified nursing assistants' abilities to accurately assess pain are scarce. This study aims to examine certified nursing assistants' pain assessment skills using a simulated standardized video context. DESIGN A cross-sectional study was conducted. METHODS Fifty certified nursing assistants and 40 individuals with no professional experience in the field of care (controls) watched the same video of an older adult woman with dementia experiencing pain. Afterwards, they completed visual analog scales (pain intensity, affective distress), an observational pain assessment scale (Algoplus), and a set of questionnaires. RESULTS In both groups, pain intensity assessment and empathic reaction scores showed important interrater variability. Moreover, certified nursing assistants and controls did not differ in detecting the presence of pain or assessing its intensity. But certified nursing assistants displayed lower empathic reactions and dispositions. Certified nursing assistants pain assessment scores decreased with experience and expertise. CONCLUSIONS The practice of pain assessment is challenging for certified nursing assistants in long-term care facilities. Their professional status does not prevent inter-personal inconsistency and tends to lower their empathic dispositions. Personal determinants may interfere with their assessment behaviors and must be considered to enhance pain management for residents with dementia.
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Affiliation(s)
- Valérie Vitou
- University Paul Valéry Montpellier 3, University Montpellier, Montpellier, France; Fondation Partage et Vie, Montrouge, France.
| | | | - Sophie Bayard
- University Paul Valéry Montpellier 3, University Montpellier, Montpellier, France
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36
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White SJ, Butlin M, Brown A, White R. Correlation of patient- and clinician-assessment of pain: comparing physiotherapy and general practice. Aust J Prim Health 2021; 27:291-296. [PMID: 33773606 DOI: 10.1071/py20214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022]
Abstract
The clinical work of GPs and physiotherapists frequently involves the assessment of patient pain. In this study, we aimed to determine the correlation of patient- and clinician-assessment of severity of pain through quantitative analysis of patient- and clinician-assessed pain scores collected at metropolitan general practice and physiotherapy clinics. Prior to a consultation, 30 patients were asked to complete a short general health survey within which they answered questions regarding current pain and, if in pain, the severity of that pain on the visual analogue scale. Following the consultation, their clinicians were asked questions on their observation of the patients, including whether they observed that their patients were in pain and, if so, how severe on the visual analogue scale. Statistical analysis of these data showed that although there was a correlation between the physiotherapist- and patient-assessed pain scores, there was no correlation between the GP- and patient-assessed pain scores. Accurately establishing the severity of patient pain can be difficult. These results suggest that GPs routinely underestimate the severity of patient pain. If the severity of patient pain is clinically relevant, GPs could improve the accuracy of assessment by asking patients directly about that aspect of pain.
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Affiliation(s)
- Sarah J White
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia; and Corresponding author.
| | - Mark Butlin
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
| | - Alicia Brown
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
| | - Ross White
- Faculty of Medicine, Health and Human Sciences, Level 3, Talavera Road, Macquarie University, NSW 2109, Australia
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Karos K, Meulders A, Leyssen T, Vlaeyen JW. Freeze-like responses to pain in humans and its modulation by social context. PeerJ 2020; 8:e10094. [PMID: 33240593 PMCID: PMC7680627 DOI: 10.7717/peerj.10094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
Background Maladaptive defensive responses such as excessive avoidance behavior have received increasing attention as a main mechanism for the development and maintenance of chronic pain complaints. However, another defensive response which is commonly studied in animals as a proxy for fear is freezing behavior. No research to date has investigated human freezing behavior in the context of pain. In addition, there is an increasing realization that social context can affect pain-relevant processes such as pain experience and pain behavior but less is known about the effects of social context on defensive responses to pain. Hence, this study investigated freezing behavior and facial pain expression in the context of pain, and their modulation by social context. Methods Healthy, pain-free participants (N = 39) stood on a stabilometric force platform in a threatening or safe social context, which was manipulated using angry or happy facial stimuli. In some trials, an auditory cue (conditioned stimulus; CS) predicted the occurrence of painful electrocutaneous stimulus (unconditioned stimulus; pain-US). We assessed body sway (an index of freezing), heart rate, facial pain expression, self-reported pain intensity, unpleasantness, and pain-US expectancy during the CS and the context alone (no CS). Results The results were mixed. Neither the anticipation of pain, nor social context affected body sway. Heart rate and painful facial expression were reduced in the threatening social context at high anxiety levels. A threatening social context also elicited higher pain-US expectancy ratings. In sum, a threatening social context increases the expectation of pain, but reduces the facial expression of pain and lowers heart rate in highly anxious individuals.
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Affiliation(s)
- Kai Karos
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium.,Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands
| | - Ann Meulders
- Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands.,Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
| | - Tine Leyssen
- Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
| | - Johan W Vlaeyen
- Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, Netherlands.,Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Vlanders, Belgium
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De Sola H, Dueñas M, Salazar A, Ortega-Jiménez P, Failde I. Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:564412. [PMID: 33364942 PMCID: PMC7750787 DOI: 10.3389/fphar.2020.564412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/16/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives: To determine the prevalence and factors associated with the use of opioids among patients with chronic non-cancer pain (CNCP). Methods: A systematic review and meta-analysis. Comprehensive literature searches in Medline-PubMed, Embase and SCOPUS databases. Original studies published between 2009 and 2019 with a cross-sectional design were included. The quality of the studies was assessed with Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute. Protocol registered in the International Prospective Register of Systematic Reviews with reference number: CRD42019137990. Results: Out of the 1,310 potential studies found, 25 studies fulfilled the inclusion criteria. Most of the studies were of high quality. High levels of heterogeneity were found in the studies included. In the general population, the prevalence of long-term opioid use was 2.3% (95% CI: 1.5–3.6%), the prevalence of short-term opioid use was 8.1% (95% CI: 5.6–11.6%), and among people with chronic low back pain it was 5.8% (95% CI: 0.5–45.5%). The prevalence of opioid use among patients from the health records or medical surveys was 41% (95% CI: 23.3–61.3%). Finally, in patients with musculoskeletal pain, the prevalence was 20.5% (95% CI: 12.9–30.9%) and in patients with fibromyalgia, 24.5% (95% CI: 22.9–26.2%). A higher prevalence of opioid use was observed among men, younger people, patients receiving prescriptions of different types of drugs, smokers and patients without insurance or with noncommercial insurance. In addition, non-white and Asian patients were less likely to receive opioids than non-Hispanic white patients. Conclusions: The prevalence of opioid use among patients with CNCP was higher in subjects with short or occasional use compared to those with long-term use. Men, younger people, more chronic pain conditions, and patients without insurance or with noncommercial insurance were most related to opioid use. However, non-white and Asian patients, and those treated by a physician trained in complementary medicine were less likely to use opioids.
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Affiliation(s)
- Helena De Sola
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - María Dueñas
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Alejandro Salazar
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Patricia Ortega-Jiménez
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
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Klukowska AM, Schröder ML, Stienen MN, Staartjes VE. Objective functional impairment in lumbar degenerative disease: concurrent validity of the baseline severity stratification for the five-repetition sit-to-stand test. J Neurosurg Spine 2020; 33:4-11. [PMID: 32084632 DOI: 10.3171/2019.12.spine191124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The five-repetition sit-to-stand (5R-STS) test provides a new dimension of clinical assessment by capturing objective functional impairment (OFI). Through the utilization of data from two prospective studies, the authors sought to evaluate the concurrent validity of the proposed 5R-STS baseline severity stratification (BSS) for OFI with the following levels based on time to completion in seconds: none, ≤ 10.4; mild, 10.5-15.2; moderate, 15.3-22.0; and severe, > 22.0 seconds. METHODS Patients with degenerative diseases of the spine performed the 5R-STS test and completed visual analog scales (VASs) for back and leg pain, the Oswestry Disability Index (ODI), the Roland-Morris Disability Questionnaire (RMDQ), and EQ-5D questionnaires. The degree of OFI severity was assessed based on the previously proposed BSS, and its association with patient-reported scales was evaluated using ANOVA as well as crude and adjusted linear regression models. RESULTS Our sample included 240 patients, of whom 101 exhibited no OFI, whereas 80, 34, and 25 were judged to have mild, moderate, and severe OFI, respectively. A higher baseline severity was strongly associated with loss of working ability (p < 0.001), as well as results of all patient-reported scales (p ≤ 0.001), with the exception of the VAS for leg pain (p = 0.556). Crude and adjusted regression analyses corroborated these findings, although only patients with moderate and severe OFI as judged by using the 5R-STS BSS demonstrated clinically relevant differences compared with patients without OFI. CONCLUSIONS The degree of OFI-based on the 5R-STS BSS-is strongly associated with measures of back pain, subjective functional impairment, and health-related quality of life. However, leg pain severity is not reflected within the dimension of OFI measured by the 5R-STS. The proposed BSS appears to be a concurrently valid and clinically relevant measure of OFI in patients with degenerative spinal pathologies.
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Affiliation(s)
- Anita M Klukowska
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- 2School of Medicine, University of Nottingham, United Kingdom
| | - Marc L Schröder
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
| | - Martin N Stienen
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
| | - Victor E Staartjes
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam, The Netherlands
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
- 4Amsterdam UMC, Vrije Universiteit Amsterdam; and Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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40
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Jerant A, Agnoli A, Franks P. Poorer Physical and Mental Health Status Are Associated with Subsequent Opioid Prescriptions: a U.S. National Study. J Gen Intern Med 2020; 35:554-560. [PMID: 31637645 PMCID: PMC7018871 DOI: 10.1007/s11606-019-05401-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/24/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND How physical and mental health status relate to receipt of opioid prescription remains unclear, creating uncertainty in minimizing opioid harms while avoiding pain under-treatment. OBJECTIVE To examine the associations of physical and mental health status with subsequent opioid prescriptions. DESIGN Observational study of 2005-2015 United States (U.S.) Medical Expenditure Panel Survey data. PARTICIPANTS Adult respondents (N = 78,563) participating for 2 years. The analyses focused on respondents reporting no opioid prescriptions in year 1 (N = 65,249). MAIN MEASURES In the primary analysis, a negative binomial regression yielding adjusted incidence rate ratios (IRRs), the dependent variable was the number of opioid prescriptions in year 2. In two secondary analyses, both logistic regressions yielding adjusted odds ratios (ORs), the dependent variables were receipt of any opioid prescription (versus none) and receipt of ≥ 6 opioid prescriptions (versus 0-5) in year 2. The key independent variables in all analyses were the SF-12 Physical and Mental Component Summary scores (PCS-12 and MCS-12, respectively; higher scores = better health status). All models adjusted for socio-demographics, health-related variables, and year. KEY RESULTS Primary analysis. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were more opioid prescriptions received in year 2 (adjusted IRRs [95% CIs] 1.45 [1.39-1.52] and 1.22 [1.16-1.27], respectively). Secondary analyses. With each 10-point decrement in year 1 PCS-12 or MCS-12 score, there were higher odds in year 2 both of receiving any opioid prescription (adjusted ORs 1.23 [1.19-1.28] and 1.11 [1.08-1.15], respectively) and of receiving ≥ 6 opioid prescriptions (adjusted ORs 1.96 [1.75-2.17] and 1.37 [1.23-1.54], respectively). CONCLUSIONS In a nationally representative U.S. sample, both poorer physical and mental health status independently predicted receiving more opioid prescriptions received in a subsequent year, as well as receiving ≥ 6 prescriptions during the year. Our findings may contribute to a more nuanced picture of the drivers of opioid prescription.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Alicia Agnoli
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Peter Franks
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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41
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Jones B, Williams ACDC. Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'. J Psychosom Res 2020; 131:109937. [PMID: 32044519 DOI: 10.1016/j.jpsychores.2020.109937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinical judgments of pain are influenced by patient and observer factors, and affect their treatment decisions. This study investigated the factors of a lack of a medical explanation for pain, 'medically unexplained' comorbid conditions, and ethnicity, on CBT therapists' judgments of pain and treatment. METHOD An online experimental study was conducted in which participants viewed computer-generated faces expressing pain with a brief written patient history, then estimated the severity and likely exaggeration of pain, and likelihood of pain being caused by a mental or physical health problem. Participants ranked a number of treatment options for priority. RESULTS 107 CBT therapists were recruited as participants. Estimates of pain were lower, and of likely exaggeration higher, for patients with pain presented without a medical explanation or with a comorbid 'medically unexplained' condition. They were also more likely to be recommended CBT for depression over referral to a specialist service or psychological treatment for pain. Contrary to expectations, ethnicity produced no effect on pain judgments, only on treatment decisions. Participants' training also affected their treatment decisions. CONCLUSIONS Lack of medical explanation for pain and other long-term conditions biases assessment and treatment decisions by CBT therapists. As CBT therapists are increasingly referred people with 'medically unexplained' symptoms in primary care, these biases need to be addressed for better treatment.
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Affiliation(s)
- Brittni Jones
- Millfields Personality Disorder Unit, John Howard Centre, London, 12 Kenworthy Road, Homerton, London E9 5TD, United Kingdom.
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London WC1E 6BT, United Kingdom
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Developing Improved Translational Models of Pain: A Role for the Behavioral Scientist. Perspect Behav Sci 2020; 43:39-55. [PMID: 32440644 DOI: 10.1007/s40614-019-00239-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The effective management of pain is a longstanding public health concern. Although opioids have been frontline analgesics for decades, they also have well-known undesirable effects that limit their clinical utility, such as abuse liability and respiratory depression. The failure to develop better analgesics has, in some ways, contributed to the escalating opioid epidemic that has claimed tens of thousands of lives and has cost hundreds of billions of dollars in health-care expenses. A paradigm shift is needed in the pharmacotherapy of pain management that will require extensive efforts throughout biomedical science. The purpose of the present review is to highlight the critical role of the behavioral scientist to devise improved translational models of pain for drug development. Despite high heterogeneity of painful conditions that involve cortical-dependent pain processing, current models often feature an overreliance on simple reflex-based measures and an emphasis on the absence, rather than presence, of behavior as evidence of analgesic efficacy. Novel approaches should focus on the restoration of operant and other CNS-mediated behavior under painful conditions.
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43
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Chen YJ, Cheng SF, Lee PC, Lai CH, Hou IC, Chen CW. Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial. J Clin Nurs 2019; 29:503-510. [PMID: 31715039 DOI: 10.1111/jocn.15088] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 01/13/2023]
Abstract
AIM AND OBJECTIVES To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. BACKGROUND An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. DESIGN A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. METHODS One hundred and thirty-six children aged 7-12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). RESULTS Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. CONCLUSION Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.
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Affiliation(s)
- Yen-Ju Chen
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan.,School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hsiu Lai
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan
| | - I-Ching Hou
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Visoiu M. Erector spinae plane continuous blocks for pediatric liver transplantation. Reg Anesth Pain Med 2019; 45:321. [PMID: 31630132 DOI: 10.1136/rapm-2019-100857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/18/2019] [Accepted: 09/18/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Mihaela Visoiu
- Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Fisher E, Eccleston C, Degenhardt L, Finn DP, Finnerup NB, Gilron I, Haroutounian S, Krane E, Rice AS, Rowbotham M, Wallace M, Moore RA. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a protocol for an overview of systematic reviews and a systematic review of randomised controlled trials. Pain Rep 2019; 4:e741. [PMID: 31583356 PMCID: PMC6749927 DOI: 10.1097/pr9.0000000000000741] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 01/08/2023] Open
Abstract
Pain is an experience that affects many people worldwide and is associated with higher mortality and lower quality of life. Cannabinoid, cannabis, and cannabis-based medicines (CBMs) are thought to reduce pain, but a proliferation of different products has led to variability in trials, creating a challenge when determining the assessment of efficacy in systematic reviews. We will conduct 2 systematic reviews commissioned by the International Association for the Study of Pain Task Force on the use of cannabinoids, cannabis, and CBMs for pain management: first, an overview review of systematic reviews to summarise the evidence base and second, a systematic review of randomised controlled trials of cannabinoids, cannabis, and CBMs. In these reviews we will determine the harm and benefit of CBM from the current literature and will interpret the findings in light of the quality of evidence and reviews included. We will search online databases and registries in any language for systematic reviews and randomised controlled trials. We will include studies that evaluate any cannabinoid or CBM vs any control for people with acute and chronic pain. Our primary outcomes for both reviews are the number of participants achieving (1) a 30% and (2) 50% reduction in pain intensity, (3) moderate improvement, and (4) substantial improvement. A number of secondary outcome measures will also be included. We will assess risk of bias and quality of evidence. We will analyse data using fixed and random effect models, with separate comparators for cannabis and CBMs. Prospero ID (CRD42019124710; CRD42019124714).
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Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - David P. Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, NCBES, National University of Ireland Galway, Galway, Ireland
| | - Nanna B. Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Ian Gilron
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University Pain Center, Washington University School of Medicine, St Louis, MO
| | - Elliot Krane
- Department of Anesthesiology, Perioperative, and Pain Medicine, and Pediatrics, Stanford University School of Medicine, Stanford, Palo Alto, CA
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Department of Anesthesia, University of California, San Francisco, CA
- Sutter Health, CPMC Research Institute, California Pacific Medical Center Research Institute, San Francisco, CA
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA
| | - R. Andrew Moore
- Pain Research, Nuffield Department of Clinical Neurosciences, The Churchill, University of Oxford, Oxford, United Kingdom
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Acute Pain in the African Prehospital Setting: A Scoping Review. Pain Res Manag 2019; 2019:2304507. [PMID: 31149317 PMCID: PMC6501243 DOI: 10.1155/2019/2304507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/02/2019] [Indexed: 01/21/2023]
Abstract
Background Acute pain is a common reason for seeking prehospital emergency care. Regrettably, acute pain is often underestimated and poorly managed in this setting. The scoping review was conducted to gain insight into existing research on the topic and to make recommendations for future work. Objectives To identify all available evidence related to acute pain assessment and management in the African prehospital setting, describe the extent of the evidence, encapsulate findings, and identify research gaps. Methods The scoping review considered primary and secondary research related to acute pain assessment and management of both medical and traumatic origins in all age groups in the African prehospital setting. The search strategy aimed to identify published, unpublished, and ongoing research which met the inclusion criteria. Potentially eligible studies were identified by a comprehensive search of electronic databases, trial registers, dissertation/thesis databases, grey literature databases, and conference proceedings. Screening and data extraction were conducted independently and in duplicate. Results The comprehensive search identified 3823 potential studies, duplicate titles were removed, and 3358 titles/abstracts were screened. Full text of 66 potentially eligible titles was screened, 60 were excluded, and six publications met the inclusion criteria. Despite recommendations for pain assessment during general patient care, most studies reported no/limited pain assessment. In general, pain management was concluded to be insufficient and not conforming to best practice. Conclusions Only six publications addressing prehospital acute pain care in Africa could be identified, possibly indicative of a knowledge gap. Future research is indicated to enable a better understanding of the epidemiology of acute pain and barriers and enablers of acute pain care and to develop evidence-based clinical practice guidelines (CPGs) catering for all EMS systems in Africa. Additionally, educational initiatives should be implemented to improve the quality of acute pain care and to monitor quality through continuous quality improvement (CQI) programs.
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Was That Painful or Nonpainful? The Sensation and Pain Rating Scale Performs Well in the Experimental Context. THE JOURNAL OF PAIN 2019; 20:472.e1-472.e12. [DOI: 10.1016/j.jpain.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022]
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48
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Rash JA, Prkachin KM, Solomon PE, Campbell TS. Assessing the efficacy of a manual-based intervention for improving the detection of facial pain expression. Eur J Pain 2019; 23:1006-1019. [PMID: 30697949 DOI: 10.1002/ejp.1369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/19/2019] [Accepted: 01/20/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND This article presents the results of a parallel-group, non-randomized, controlled study that evaluated the feasibility of an online training program for improving observer detection of facial pain expression. METHOD Fifty-four undergraduate students attended two laboratory sessions interspersed by an intervention period where they were assigned to complete the Index of Facial Pain Expression (IFPE)-an online training environment designed to teach observers to code facial muscle movements associated with pain-or a no-contact control. Participants completed questionnaires during the first session and watched parallel versions of the Sensitivity to Expression of Pain (STEP) test during laboratory sessions. STEP tests contained excerpts of facial expressions taken from patients with shoulder pain. Reliability of coding following the IFPE was measured. Signal detection methods were applied to pain ratings to the STEP tests to calculate measures of sensitivity and response bias to facial pain expression. RESULTS Participants took 3.5 hr to complete the IFPE. Training resulted in reliable coding of facial muscle movements associated with pain and improvements in sensitivity (from 0.75 to 0.87 in experimental relative to 0.75 to 0.80 in control), but not response bias, to facial expressions of clinical pain. Training was influenced by observer traits, including empathy, emotional intelligence (EI), and prior experience with individuals who experience chronic pain. CONCLUSIONS The IFPE represents a brief measurement system for facial pain expression with research applicability and potential clinical utility. The IFPE could help clinicians be more sensitive to expressions of clinical pain. SIGNIFICANCE The index of facial pain expression (IFPE) is an online training program that can improve an observer's ability to reliably detect expressions of clinical pain after as few as 3.5-hr of training.
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Affiliation(s)
- Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kenneth M Prkachin
- Department of Psychology, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Patricia E Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Abstract
BACKGROUND This review updates part of an earlier Cochrane Review titled "Pregabalin for acute and chronic pain in adults", and considers only neuropathic pain (pain from damage to nervous tissue). Antiepileptic drugs have long been used in pain management. Pregabalin is an antiepileptic drug used in management of chronic pain conditions. OBJECTIVES To assess the analgesic efficacy and adverse effects of pregabalin for chronic neuropathic pain in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, and Embase for randomised controlled trials from January 2009 to April 2018, online clinical trials registries, and reference lists. SELECTION CRITERIA We included randomised, double-blind trials of two weeks' duration or longer, comparing pregabalin (any route of administration) with placebo or another active treatment for neuropathic pain, with participant-reported pain assessment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality and biases. Primary outcomes were: at least 30% pain intensity reduction over baseline; much or very much improved on the Patient Global Impression of Change (PGIC) Scale (moderate benefit); at least 50% pain intensity reduction; or very much improved on PGIC (substantial benefit). We calculated risk ratio (RR) and number needed to treat for an additional beneficial (NNTB) or harmful outcome (NNTH). We assessed the quality of the evidence using GRADE. MAIN RESULTS We included 45 studies lasting 2 to 16 weeks, with 11,906 participants - 68% from 31 new studies. Oral pregabalin doses of 150 mg, 300 mg, and 600 mg daily were compared with placebo. Postherpetic neuralgia, painful diabetic neuropathy, and mixed neuropathic pain predominated (85% of participants). High risk of bias was due mainly to small study size (nine studies), but many studies had unclear risk of bias, mainly due to incomplete outcome data, size, and allocation concealment.Postherpetic neuralgia: More participants had at least 30% pain intensity reduction with pregabalin 300 mg than with placebo (50% vs 25%; RR 2.1 (95% confidence interval (CI) 1.6 to 2.6); NNTB 3.9 (3.0 to 5.6); 3 studies, 589 participants, moderate-quality evidence), and more had at least 50% pain intensity reduction (32% vs 13%; RR 2.5 (95% CI 1.9 to 3.4); NNTB 5.3 (3.9 to 8.1); 4 studies, 713 participants, moderate-quality evidence). More participants had at least 30% pain intensity reduction with pregabalin 600 mg than with placebo (62% vs 24%; RR 2.5 (95% CI 2.0 to 3.2); NNTB 2.7 (2.2 to 3.7); 3 studies, 537 participants, moderate-quality evidence), and more had at least 50% pain intensity reduction (41% vs 15%; RR 2.7 (95% CI 2.0 to 3.5); NNTB 3.9 (3.1 to 5.5); 4 studies, 732 participants, moderate-quality evidence). Somnolence and dizziness were more common with pregabalin than with placebo (moderate-quality evidence): somnolence 300 mg 16% versus 5.5%, 600 mg 25% versus 5.8%; dizziness 300 mg 29% versus 8.1%, 600 mg 35% versus 8.8%.Painful diabetic neuropathy: More participants had at least 30% pain intensity reduction with pregabalin 300 mg than with placebo (47% vs 42%; RR 1.1 (95% CI 1.01 to 1.2); NNTB 22 (12 to 200); 8 studies, 2320 participants, moderate-quality evidence), more had at least 50% pain intensity reduction (31% vs 24%; RR 1.3 (95% CI 1.2 to 1.5); NNTB 22 (12 to 200); 11 studies, 2931 participants, moderate-quality evidence), and more had PGIC much or very much improved (51% vs 30%; RR 1.8 (95% CI 1.5 to 2.0); NNTB 4.9 (3.8 to 6.9); 5 studies, 1050 participants, moderate-quality evidence). More participants had at least 30% pain intensity reduction with pregabalin 600 mg than with placebo (63% vs 52%; RR 1.2 (95% CI 1.04 to 1.4); NNTB 9.6 (5.5 to 41); 2 studies, 611 participants, low-quality evidence), and more had at least 50% pain intensity reduction (41% vs 28%; RR 1.4 (95% CI 1.2 to 1.7); NNTB 7.8 (5.4 to 14); 5 studies, 1015 participants, low-quality evidence). Somnolence and dizziness were more common with pregabalin than with placebo (moderate-quality evidence): somnolence 300 mg 11% versus 3.1%, 600 mg 15% versus 4.5%; dizziness 300 mg 13% versus 3.8%, 600 mg 22% versus 4.4%.Mixed or unclassified post-traumatic neuropathic pain: More participants had at least 30% pain intensity reduction with pregabalin 600 mg than with placebo (48% vs 36%; RR 1.2 (1.1 to 1.4); NNTB 8.2 (5.7 to 15); 4 studies, 1367 participants, low-quality evidence), and more had at least 50% pain intensity reduction (34% vs 20%; RR 1.5 (1.2 to 1.9); NNTB 7.2 (5.4 to 11); 4 studies, 1367 participants, moderate-quality evidence). Somnolence (12% vs 3.9%) and dizziness (23% vs 6.2%) were more common with pregabalin.Central neuropathic pain: More participants had at least 30% pain intensity reduction with pregabalin 600 mg than with placebo (44% vs 28%; RR 1.6 (1.3 to 2.0); NNTB 5.9 (4.1 to 11); 3 studies, 562 participants, low-quality evidence) and at least 50% pain intensity reduction (26% vs 15%; RR 1.7 (1.2 to 2.3); NNTB 9.8 (6.0 to 28); 3 studies, 562 participants, low-quality evidence). Somnolence (32% vs 11%) and dizziness (23% vs 8.6%) were more common with pregabalin.Other neuropathic pain conditions: Studies show no evidence of benefit for 600 mg pregabalin in HIV neuropathy (2 studies, 674 participants, moderate-quality evidence) and limited evidence of benefit in neuropathic back pain or sciatica, neuropathic cancer pain, or polyneuropathy.Serious adverse events, all conditions: Serious adverse events were no more common with placebo than with pregabalin 300 mg (3.1% vs 2.6%; RR 1.2 (95% CI 0.8 to 1.7); 17 studies, 4112 participants, high-quality evidence) or pregabalin 600 mg (3.4% vs 3.4%; RR 1.1 (95% CI 0.8 to 1.5); 16 studies, 3995 participants, high-quality evidence). AUTHORS' CONCLUSIONS Evidence shows efficacy of pregabalin in postherpetic neuralgia, painful diabetic neuralgia, and mixed or unclassified post-traumatic neuropathic pain, and absence of efficacy in HIV neuropathy; evidence of efficacy in central neuropathic pain is inadequate. Some people will derive substantial benefit with pregabalin; more will have moderate benefit, but many will have no benefit or will discontinue treatment. There were no substantial changes since the 2009 review.
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Affiliation(s)
| | - Rae Frances Bell
- Haukeland University HospitalRegional Centre of Excellence in Palliative CareBergenNorway
| | - Sebastian Straube
- University of AlbertaDepartment of Medicine, Division of Preventive Medicine5‐30 University Terrace8303‐112 StreetEdmontonCanadaT6G 2T4
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Boerlage AA, van Rosmalen J, Cheuk-Alam-Balrak JM, Goudzwaard JA, Tibboel D, van Dijk M. Validation of the Rotterdam Elderly Pain Observation Scale in the Hospital Setting. Pain Pract 2019; 19:407-417. [PMID: 30554464 DOI: 10.1111/papr.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Rotterdam Elderly Pain Observation Scale (REPOS) has been proven useful to assess pain in noncommunicative and cognitively impaired nursing home residents. We evaluated whether the REPOS is also reliable and valid for pain assessment in the hospital setting. METHODS In this prospective multicenter observational study, surgical patients were observed perioperatively at bedside and internal medicine patients were filmed during a possible painful moment and at rest. Pain behavior was assessed from the video recordings with the REPOS and the Pain Assessment Checklist for seniors with Severe Dementia-Dutch language (PACSLAC-D). Longitudinal associations between REPOS score and numeric rating scale pain ratings from observers and nurses (NRSobs and NRSproxy ) corrected for patients' gender were assessed with linear mixed models. RESULTS In total, 72 patients were included; 118 observations of surgical and 68 observations of internal medicine patients were analyzed. Interobserver reliability between the researcher and 2 other observers was good, with Cohen's kappa values of 0.71 (confidence interval [CI] 0.59 to 0.83) and 0.84 (CI 0.74 to 0.94), respectively. The intraobserver reliability of the principal investigator was good, with Cohen's kappa 0.82 (CI 0.67 to 0.91). Linear mixed modeling revealed correlation values between the REPOS and NRSobs of 0.67 and the REPOS and NRSproxy of 0.73. Optimal sensitivity (78%) and specificity (90%) for the detection of pain were found with a REPOS cutoff score of ≥3, using an NRS score of ≥4 as the reference value. CONCLUSIONS The REPOS is reliable and valid for the assessment of postoperative and chronic pain in hospital patients who cannot self-report pain.
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Affiliation(s)
- Anneke A Boerlage
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Jeannette A Goudzwaard
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Monique van Dijk
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Section of Nursing Science, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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