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Gupta A, Vejapi M, Knezevic NN. The role of nitric oxide and neuroendocrine system in pain generation. Mol Cell Endocrinol 2024; 591:112270. [PMID: 38750811 DOI: 10.1016/j.mce.2024.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Previous studies have indicated a complex interplay between the nitric oxide (NO) pain signaling pathways and hormonal signaling pathways in the body. This article delineates the role of nitric oxide signaling in neuropathic and inflammatory pain generation and subsequently discusses how the neuroendocrine system is involved in pain generation. Hormonal systems including the hypothalamic-pituitary axis (HPA) generation of cortisol, the renin-angiotensin-aldosterone system, calcitonin, melatonin, and sex hormones could potentially contribute to the generation of nitric oxide involved in the sensation of pain. Further research is necessary to clarify this relationship and may reveal therapeutic targets involving NO signaling that alleviate neuropathic and inflammatory pain.
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Affiliation(s)
- Aayush Gupta
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Rosalind Franklin University of Medicine and Science, USA
| | - Maja Vejapi
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
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Agulló L, Escorial M, Orutño S, Muriel J, Sandoval J, Margarit C, Peiró AM. Epigenetic and sex differences in opioid use disorder in chronic pain: A real-world study linked with OPRM1 DNA methylation. Addict Biol 2024; 29:e13422. [PMID: 38949208 PMCID: PMC11215788 DOI: 10.1111/adb.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Opioid use disorder (OUD) is a multifaceted condition influenced by sex, genetic and environmental factors that could be linked with epigenetic changes. Understanding how these factors interact is crucial to understand and address the development and progression of this disorder. Our aim was to elucidate different potential epigenetic and genetic mechanisms between women and men that correlate with OUD under real-world pain unit conditions. Associations between analgesic response and the DNA methylation level of the opioid mu receptor (OPRM1) gene (CpG sites 1-5 selected in the promoter region) were evaluated in 345 long opioid-treated chronic non cancer pain: cases with OUD (n = 67) and controls (without OUD, n = 278). Cases showed younger ages, low employment status and quality of life, but higher morphine equivalent daily dose and psychotropic use, compared to the controls. The patients with OUD showed a significant decrease in OPRM1 DNA methylation, which correlated with clinical outcomes like pain relief, depression and different adverse events. Significant differences were found at the five CpG sites studied for men, and exclusively in women for CpG site 3, in relation to OUD diagnosis. These findings support the importance of epigenetics and sex as biological variables to be considered toward efficient OUD understanding and therapy development.
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Affiliation(s)
- Laura Agulló
- Pharmacogenetic Unit, Clinical Pharmacology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)AlicanteSpain
- Bioengineering Institute, Department of Pharmacology, Paediatrics and Organic ChemistryMiguel Hernández University (UMH)ElcheSpain
| | - Mónica Escorial
- Pharmacogenetic Unit, Clinical Pharmacology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)AlicanteSpain
- Bioengineering Institute, Department of Pharmacology, Paediatrics and Organic ChemistryMiguel Hernández University (UMH)ElcheSpain
| | - Samantha Orutño
- Alicante Institute for Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Javier Muriel
- Pharmacogenetic Unit, Clinical Pharmacology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Juan Sandoval
- Epigenomics UnitLa Fe Health Research InstituteValenciaSpain
| | - César Margarit
- Pain Unit, Department of Health of AlicanteDr. Balmis General HospitalAlicanteSpain
| | - Ana M. Peiró
- Pharmacogenetic Unit, Clinical Pharmacology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)AlicanteSpain
- Bioengineering Institute, Department of Pharmacology, Paediatrics and Organic ChemistryMiguel Hernández University (UMH)ElcheSpain
- Pain Unit, Department of Health of AlicanteDr. Balmis General HospitalAlicanteSpain
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Le LHL, Brown VAV, Mol S, Azijli K, Kuijper MM, Becker L, Koopman SSHA. Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain. BMC Anesthesiol 2024; 24:127. [PMID: 38566044 PMCID: PMC10985981 DOI: 10.1186/s12871-024-02496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND IMPORTANCE Differences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification. OBJECTIVES The aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain. DESIGN, SETTINGS AND PARTICIPANTS Adults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain. OUTCOMES MEASURE AND ANALYSIS The outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes. MAIN RESULTS In total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes. CONCLUSIONS This study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.
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Affiliation(s)
- Linh H L Le
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vanessa A V Brown
- Department of Emergency Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Sander Mol
- Department of Emergency Medicine, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Kaoutar Azijli
- Department of Emergency Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Leonie Becker
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Seppe S H A Koopman
- Department of Anaesthesiology, Maasstad Hospital, Maasstadweg 21 3079 DZ Rotterdam, Rotterdam, The Netherlands.
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Baagil H, Baagil H, Gerbershagen MU. Preoperative Anxiety Impact on Anesthetic and Analgesic Use. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2069. [PMID: 38138172 PMCID: PMC10744982 DOI: 10.3390/medicina59122069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.
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Affiliation(s)
- Hanaa Baagil
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
| | - Hamzah Baagil
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany;
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Research Center Jülich, RWTH Aachen University, 52074 Aachen, Germany
| | - Mark Ulrich Gerbershagen
- Department of Anaesthesiology, Hospital Cologne Holweide, Teaching Hospital of the University Cologne, Neufelder Str. 32, 51067 Cologne, Germany
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Emrich NLA, Tascón Padrón L, Komann M, Arnold C, Dreiling J, Meißner W, Strizek B, Gembruch U, Jiménez Cruz J. Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section-A Prospective Multi-Center Study of 11,932 Patients. J Clin Med 2023; 12:6999. [PMID: 38002614 PMCID: PMC10672043 DOI: 10.3390/jcm12226999] [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: 09/25/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry "quality improvement in postoperative pain treatment" (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p < 0.001). Distraction, relaxation, mobilization, having conversations, patient-controlled analgesia (PCA) and pain monitoring were shown to be protective for severe pain (p < 0.001). Maximal pain in PCS and UCS was similar, but UCS obtained more analgesics (p < 0.001), and experienced more impairment of ambulation (p < 0.001) and deep breathing (p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS.
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Affiliation(s)
- Norah L. A. Emrich
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Laura Tascón Padrón
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Marcus Komann
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Christin Arnold
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Johannes Dreiling
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Winfried Meißner
- Department for Anesthesiology and Intensive Care Medicine, University Hospital of Jena, Am Klinikum 1, 07740 Jena, Germany; (M.K.); (C.A.); (J.D.); (W.M.)
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
| | - Jorge Jiménez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (L.T.P.); (B.S.); (U.G.); (J.J.C.)
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Ayano WA, Fentie AM, Tileku M, Jiru T, Hussen SU. Assessment of adequacy and appropriateness of pain management practice among trauma patients at the Ethiopian Aabet Hospital: A prospective observational study. BMC Emerg Med 2023; 23:92. [PMID: 37592216 PMCID: PMC10433567 DOI: 10.1186/s12873-023-00869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Pain is unpleasant sensory and emotional experiences associated with actual and/or potential tissue damage. It is the most common and prevalent reason for emergency departments (ED) visits with prevalence over 70% in the world. AIM OF THE STUDY The study aimed to assess the adequacy and appropriateness of pain management at Aabet Hospital, Addis Ababa, Ethiopia. METHODS A hospital-based prospective cross-sectional study was conducted at Aabet hospital from December 1, 2020 to March 30, 2021. Adult trauma patients having pain (at least score 1 on Numeric Rating Scale) with Glasgow Coma Scale score > 13 were eligible to participate in the study. The pain intensity was evaluated at the time of admission (o minute) and then at 60, 120, 180, and 240 minutes. The time of the first analgesics was registered. The adequacy and the appropriateness of the pain management were calculated through pain management index (PMI). RESULTS Two hundred thirty-two (232) participants were included in this study of which 126 (54.3%) were admitted due to road traffic accident followed by fall 44(19%). Only 21 (9.1%) study participants received the first analgesic treatment within 30 minutes while 27(11.6%) participants had no treatment at all within 240 minutes. The mean pain intensity score at admission was 5.55 ± 2.32 and reduced to 4.09 ± 2.69. Nearly half 110 (47.4%) of the study participants were treated inadequately (PMI (-) score). There was a weak and negative correlation between PMI and time to analgesia (r = - .159, p = 0.0001). The type of analgesia used, the time to analgesia, and the degree of pain may predict 65% of the variance in PMI score (R2 = 0.65, P = .001). CONCLUSION From the results of this study, it can be concluded that acute pain in trauma patients was under and inappropriately treated.
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Affiliation(s)
- Wondwossen Alemu Ayano
- Department of Pharmacy, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melaku Tileku
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tilahun Jiru
- Department of Emergency Medicine and Critical Care, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shemsu Umer Hussen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Duff IT, Krolick KN, Mahmoud HM, Chidambaran V. Current Evidence for Biological Biomarkers and Mechanisms Underlying Acute to Chronic Pain Transition across the Pediatric Age Spectrum. J Clin Med 2023; 12:5176. [PMID: 37629218 PMCID: PMC10455285 DOI: 10.3390/jcm12165176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic pain is highly prevalent in the pediatric population. Many factors are involved in the transition from acute to chronic pain. Currently, there are conceptual models proposed, but they lack a mechanistically sound integrated theory considering the stages of child development. Objective biomarkers are critically needed for the diagnosis, risk stratification, and prognosis of the pathological stages of pain chronification. In this article, we summarize the current evidence on mechanisms and biomarkers of acute to chronic pain transitions in infants and children through the developmental lens. The goal is to identify gaps and outline future directions for basic and clinical research toward a developmentally informed theory of pain chronification in the pediatric population. At the outset, the importance of objective biomarkers for chronification of pain in children is outlined, followed by a summary of the current evidence on the mechanisms of acute to chronic pain transition in adults, in order to contrast with the developmental mechanisms of pain chronification in the pediatric population. Evidence is presented to show that chronic pain may have its origin from insults early in life, which prime the child for the development of chronic pain in later life. Furthermore, available genetic, epigenetic, psychophysical, electrophysiological, neuroimaging, neuroimmune, and sex mechanisms are described in infants and older children. In conclusion, future directions are discussed with a focus on research gaps, translational and clinical implications. Utilization of developmental mechanisms framework to inform clinical decision-making and strategies for prevention and management of acute to chronic pain transitions in children, is highlighted.
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Affiliation(s)
- Irina T. Duff
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Kristen N. Krolick
- Department of Anesthesia, Cincinnati Children’s Hospital, Cincinnati, OH 45242, USA; (K.N.K.); (H.M.M.)
| | - Hana Mohamed Mahmoud
- Department of Anesthesia, Cincinnati Children’s Hospital, Cincinnati, OH 45242, USA; (K.N.K.); (H.M.M.)
| | - Vidya Chidambaran
- Department of Anesthesia, Cincinnati Children’s Hospital, Cincinnati, OH 45242, USA; (K.N.K.); (H.M.M.)
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Abd-Elsayed A, Gyorfi M, Fischman M, Odonkor C, Siff B, Cyr K. Reduced Pain and Improved Function Following Short-Term Use of Noninvasive BioWave High Frequency Peripheral Nerve Stimulation for Pain Management. Pain Ther 2023; 12:553-562. [PMID: 36807084 PMCID: PMC10036714 DOI: 10.1007/s40122-023-00480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The peripheral nervous system is an increasingly popular target for chronic pain treatment modalities. Noninvasive neuromodulation has shown promise at providing significant chronic pain relief with a much safer side effect profile. This retrospective pilot study is shaped around a noninvasive neuromodulation system over a 2-week treatment timeline. METHODS Open-label survey of chronic pain patients recruited from Veteran Affairs, orthopedic, and pain health systems. If a noninvasive neuromodulation system was prescribed the patients were then offered a 2-week follow-up survey. This voluntary survey did not affect their therapy duration or quality. This survey was designed to address similar metrics as smaller noninvasive neuromodulation studies to allow a quality comparison while giving more power with a large population size of 1511 patients. Overall pain scores (including before and after scores), satisfaction level, desire to continue therapy, medication use, effect on functional metrics (mood, sleep, sit, stand, walk, and lift), and activities of daily living (ADL) scores were assessed. RESULTS The results demonstrated an overall pain reduction of 46%. All functional metrics were improved throughout with the largest improvements reported in mood and sleep at over 47%. Medication use was reported as decreased or eliminated in 42% of patients. There were no adverse reactions or complications reported over the 1511 patients. CONCLUSION This survey is amongst the largest population sizes every studied for noninvasive neuromodulation. Within just 2 weeks patients can see a reduction in overall pain and medication needs. Although survey studies have inherent limitations such as duration and compliance biases with such an overwhelming benefit in every category we believe that noninvasive neuromodulation therapy is a promising, safe, and cost-effective therapy. Future studies should focus on long-term follow-ups and post-therapy pain scores with a placebo group.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
| | - Michael Gyorfi
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | | | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Interventional Pain Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Kevin Cyr
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Crilly J, Huang Y, Krahe M, Wilhelms D, Ekelund U, Hörlin E, Hayes J, Keijzers G. Research priority setting in emergency care: A scoping review. J Am Coll Emerg Physicians Open 2022; 3:e12852. [PMCID: PMC9742830 DOI: 10.1002/emp2.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Objective Priority areas for emergency care research are emerging and becoming ever more important. The objectives of this scoping review were to (1) provide a comprehensive overview of published emergency care priority‐setting studies by collating and comparing priority‐setting methodology and (2) describe the resulting research priorities identified. Methods The Joanna Briggs Institute methodological framework was used. Inclusion criteria were peer‐review articles available in English, published between January 1, 2008 and March 31, 2019 and used 2 or more search terms. Five databases (Scopus, AustHealth, EMBASE, CINAHL, and Ovid MEDLINE) were searched. REporting guideline for PRIority SEtting of health research (REPRISE) criteria were used to assess the quality of evidence of included articles. Results Forty‐five studies were included. Fourteen themes for emergency care research were considered within 3 overarching research domains: emergency populations (pediatrics, geriatrics), emergency care workforce and processes (nursing, shared decision making, general workforce, and process), and emergency care clinical areas (imaging, falls, pain management, trauma care, substance misuse, infectious diseases, mental health, cardiology, general clinical care). Variation in the reporting of research priority areas was evident. Priority areas to drive the global agenda for emergency care research are limited given the country and professional group‐specific context of existing studies. Conclusion This comprehensive summary of generated research priorities across emergency care provides insight into current and future research agendas. With the nature of emergency care being inherently broad, future priorities may warrant population (eg, children, geriatrics) or subspecialty (eg, trauma, toxicology, mental health) focus and be derived using a rigorous framework and patient engagement.
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Affiliation(s)
- Julia Crilly
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ya‐Ling Huang
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Faculty of Health (Nursing)Southern Cross UniversityQueenslandGold CoastAustralia
| | - Michelle Krahe
- Office of the Pro Vice Chancellor (Indigenous)Griffith UniversityMeadowbrookQueenslandAustralia
| | - Daniel Wilhelms
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden,Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Ulf Ekelund
- Department of Clinical SciencesFaculty of MedicineLund UniversityLundSweden
| | - Erika Hörlin
- Department of Emergency MedicineLocal Health Care ServicesCentral ÖstergötlandLinköpingSweden,Department of Biomedical and Clinical SciencesLinköping UniversitySweden
| | - Jessica Hayes
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Gerben Keijzers
- Department of Emergency MedicineGold Coast Hospital and Health ServiceQueenslandGold CoastAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia,School of MedicineGriffith UniversityGold CoastQueenslandAustralia
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Petrie KA, Chen JN, Miears H, Grimes JS, Zumwalt M. Gender Differences in Seeking Health Care and Postintervention Pain Outcomes in Foot and Ankle Orthopedic Patients. WOMEN'S HEALTH REPORTS 2022; 3:500-507. [PMID: 35652003 PMCID: PMC9148655 DOI: 10.1089/whr.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/13/2022]
Abstract
Background: Materials and Methods: Results: Conclusions:
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Affiliation(s)
- Kyla A. Petrie
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jason N. Chen
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hunter Miears
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jerry Speight Grimes
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Mimi Zumwalt
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Connelly M, Glynn EF, Hoffman MA, Bickel J. Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults. Pediatr Emerg Care 2021; 37:e981-e987. [PMID: 31246788 DOI: 10.1097/pec.0000000000001851] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings. METHODS Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status). RESULTS The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (mean, 26.4% ± 20.1%; range, 0-100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients. CONCLUSIONS Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.
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Affiliation(s)
- Mark Connelly
- From the Children's Mercy Kansas City, Kansas City, MO
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Jiménez Cruz J, Kather A, Nicolaus K, Rengsberger M, Mothes AR, Schleussner E, Meissner W, Runnebaum IB. Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient. Sci Rep 2021; 11:22148. [PMID: 34773057 PMCID: PMC8590005 DOI: 10.1038/s41598-021-01597-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/21/2021] [Indexed: 12/04/2022] Open
Abstract
Effective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensity was measured by means of a 11-point numeric rating scale (NRS) and related to procedure, perioperative care as well as patient characteristics. The interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts (NRS of 6.41 ± 2.12) and caesarean section (NRS of 6.98 ± 2.08). Factors associated with higher pain intensity were younger age (OR 1.75, 95% CI 1.65-1.99), chronic pain (OR 2.08, 95% CI 1.65-2.64) and surgery performed outside the regular day shift (OR 1.67, 95% CI 1.09-2.36). Shorter duration of surgery, peridural or local analgesic and preoperative sedation reduced postoperative pain. Patients reporting high pain scores (NRS ≥ 5) showed relevant impairment of daily activities and reduced satisfaction. Caesarean section and minimal invasive procedures were associated with the highest pain scores in the present ranking. Pain management of these procedures has to be reconsidered. Younger age, receiving surgery outside of the regular shifts, chronic pain and the surgical approach itself have a relevant influence on postoperative pain intensity. When reporting pain scores of 5 or more, patients were more likely to have perioperative complications like nausea or vomiting and to be impaired in mobilisation. Registry-based data are useful to identify patients, procedures and critical situations in daily clinical routine, which increase the risk for elevated post-intervention pain. Furthermore, it provides a database for evaluation of new pain management strategies.
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Affiliation(s)
- Jorge Jiménez Cruz
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Department of Obstetrics and Perinatal Medicine, Bonn University Hospital, Sigmund Freud Street 25, 53127, Bonn, Germany
| | - Angela Kather
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Kristin Nicolaus
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Rengsberger
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- SRH Wald-Klinikum Gera, Gera, Germany
| | - Anke R Mothes
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Department of Gynaecology, St. Georg Hospital Eisenach, Academic Teaching Hospital of University of Jena, Mühlhäuser Straße 94, 99817, Eisenach, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Betelman Mahalo Y, Avital G, Radomislensky I, Vysokovsky M, Avital-Cohen R, Gelikas S, Tsur AM, Nadler R, Bodas M, Chen J, Glassberg E, Benov A. Pain management for casualties receiving lifesaving interventions in the prehospital scenario: Raising awareness of our human nature. J Trauma Acute Care Surg 2021; 91:S201-S205. [PMID: 34039916 DOI: 10.1097/ta.0000000000003295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lifesaving interventions (LSIs) are the hallmark of medical care in trauma casualties, reducing mortality and morbidity. Analgesia is another essential treatment, which has been shown to improve outcomes and decrease long-term complications. However, oligoanalgesia is common, and information regarding its relation to the performance of LSIs is scarce. The purpose of this study was to assess the relation between the performance of LSIs and analgesia administration in the prehospital environment. METHODS A retrospective database-based study was performed, including all trauma casualties treated by Israeli Defense Forces physicians and paramedics during 2006 to 2017 and admitted to hospitals participating in the Israeli National Trauma Registry. Included LSIs were tourniquet application, administration of tranexamic acid and freeze-dried plasma, and administration of chest decompression. Casualties treated with endotracheal intubation or cricothyroidotomy were excluded. RESULTS In the multivariable logistic regression analysis, LSIs were associated with prehospital analgesia administration (odds ratio [OR], 3.59; confidence interval [CI], 2.56-5.08; p < 0.001). When assessing for the different LSIs, tourniquet application (OR, 2.83; CI, 1.89-4.27; p < 0.001) and tranexamic acid administration (OR, 4.307; CI, 2.42-8.04; p < 0.001) were associated with prehospital analgesia administration. CONCLUSION A positive association exists between performance of LSIs and administration of analgesia in the prehospital environment. Possible explanations may include cognitive and emotional biases affecting casualty care providers. LEVEL OF EVIDENCE Retrospective study, level IV.
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Affiliation(s)
- Yaar Betelman Mahalo
- From the Trauma and Combat Medicine Branch (Y.B.M., G.A., M.V., S.G., A.M.T., R.N., A.B.), Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan; Division of Anesthesia (G.A.), Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv; National Center for Trauma and Emergency Medicine Research (I.R., M.B.), Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan; Department of Psychology and Cognitive Science Studies (R.A.-C.), Open University of Israel, Raanana; Department of Medicine 'B' (A.M.T.), Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; Department of General Surgery and Transplantation-Surgery B (R.N.), Chaim Sheba Medical Center, Ramat Gan; Department of Emergency Management and Disaster Medicine (M.B.), School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv; Meir Medical Center (J.C.), Kfar Saba; Sackler Faculty of Medicine (J.C.), Tel-Aviv University, Tel-Aviv; Azrieli Faculty of Medicine (E.G., A.B.), Bar-Ilan University, Safed, Israel; Uniformed Services University of the Health Sciences (E.G.), Bethesda, Maryland; and Surgeon General's Headquarters (E.G.), Israel Defense Forces, Ramat Gan, Israel
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Hansen M, Bosson N, Gausche-Hill M, Shah MI, VanBuren JM, Wendelberger B, Wang H. Critical Factors in Planning a Pediatric Prehospital Airway Trial. PREHOSP EMERG CARE 2021; 26:476-483. [PMID: 33886422 DOI: 10.1080/10903127.2021.1918808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: The objective of this study was to assess factors influencing the design of a pediatric prehospital airway management trial, including minimum clinically significant differences for three clinical subgroups. Methods: We conducted a virtual consensus-conference among U.S. emergency medical services (EMS) agency medical directors and researchers in the Fall of 2020. This included (1) a preconference survey, (2) an interactive live videoconference, and (3) a postconference survey. Participants were identified through co-investigator relationships and by surveying "The Eagles," a consortium of medical directors from large urban EMS systems and, subsequently, through follow up email contact based on survey responses. Results: Twenty-seven of the 34 (80%) EMS agencies we invited responded to the prewebinar survey. Of the 27 agencies, 27 (100%) use BMV, 19 (70%) use endotracheal intubation (ETI), 21 (78%) use supraglottic airways (SGA). SGA use included 14 (52%) who use the iGel, 8 (30%) who use the King laryngeal tube (LT), and 2 (7%) who use a laryngeal mask airway (LMA). Three agencies use more than one of the available SGAs. Twenty (74%) of the EMS agencies indicated they had access to an SGA suitable for pediatric patients, and 9 (33%) agencies have access to pediatric video laryngoscopy. The majority of agencies indicated that the minimum clinically significant difference for survival to change practice was 1% for cardiac arrest patients with a baseline survival assumption of 7%, 4% for respiratory failure with a baseline survival assumption of 73%, and 3% for trauma with a baseline survival assumption of 42%. Overall, these agencies responded that BVM vs. SGA is the most important comparison that would change their practice. Conclusions: This virtual consensus conference provided a new perspective on current airway management practice and identified specific factors likely to drive change in pediatric prehospital airway management. This information will be leveraged in future trial design to ensure impactful clinical trials.
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Chiu V, Chan G, Hall W, Hides L, Lim C, Leung J. Personal Correlates of Support for Medical and Recreational Cannabis Legalization in Australia. Front Psychiatry 2021; 12:551661. [PMID: 33716801 PMCID: PMC7947688 DOI: 10.3389/fpsyt.2021.551661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 02/05/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction and Aims: Increasingly more Australians are in favor of legalizing medical and recreational cannabis use. This paper explored the personal characteristics of those who supported each of these policies in Australia. Design: Cross-sectional national survey. Methods: This study included 21,729 participants aged 18 years and above who responded to the 2016 National Drug Strategy Household Survey. Participants were provided the assurance of confidentiality for their participations. Logistic regression models were used to examine the relationships between personal characteristics and support for the legalization of medical and recreational cannabis. Results: Overall, 77 and 40% of participants supported the legalization of medical and recreational cannabis respectively. People of older age were more likely to support medical cannabis legalization while those who supported legalization of recreational cannabis use were more likely to be younger. Medical cannabis supporters were more likely to report chronic pain (OR = 1.44, 95% CI: 1.04, 2.00) while recreational cannabis supporters were more likely to suffer high level of psychological distress (OR = 1.28, 95% CI: 1.14, 1.43). Experience with cannabis use was strongly associated with supportive attitudes, with recent cannabis users almost 14 times (OR = 14.13, 95% CI: 5.37, 37.20) and 34 times (OR = 33.74, 95% CI: 24.22, 47.01) more likely to support the legalization of medical and recreational cannabis use, respectively. Discussion and Conclusions: The majority of Australians approve the legalization of cannabis for medicinal purposes but most remain cautious about legalizing recreational cannabis use. The sociodemographic and clinical profile of supporters of medical and recreational legalization suggests a potential interaction of self-interests and beliefs about the harms of cannabis use.
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Affiliation(s)
- Vivian Chiu
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia.,National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia
| | - Leanne Hides
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia
| | - Carmen Lim
- National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia
| | - Janni Leung
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,National Centre for Youth Substance Use Research, University of Queensland, Brisbane, QLD, Australia.,National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, NSW, Australia
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16
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Archibald J, MacMillan EL, Graf C, Kozlowski P, Laule C, Kramer JLK. Metabolite activity in the anterior cingulate cortex during a painful stimulus using functional MRS. Sci Rep 2020; 10:19218. [PMID: 33154474 PMCID: PMC7645766 DOI: 10.1038/s41598-020-76263-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
To understand neurochemical brain responses to pain, proton magnetic resonance spectroscopy (1H-MRS) is used in humans in vivo to examine various metabolites. Recent MRS investigations have adopted a functional approach, where acquisitions of MRS are performed over time to track task-related changes. Previous studies suggest glutamate is of primary interest, as it may play a role during cortical processing of noxious stimuli. The objective of this study was to examine the metabolic effect (i.e., glutamate) in the anterior cingulate cortex during noxious stimulation using fMRS. The analysis addressed changes in glutamate and glutamate + glutamine (Glx) associated with the onset of pain, and the degree by which fluctuations in metabolites corresponded with continuous pain outcomes. Results suggest healthy participants undergoing tonic noxious stimulation demonstrated increased concentrations of glutamate and Glx at the onset of pain. Subsequent reports of pain were not accompanied by corresponding changes in glutamate of Glx concentrations. An exploratory analysis on sex revealed large effect size changes in glutamate at pain onset in female participants, compared with medium-sized effects in male participants. We propose a role for glutamate in the ACC related to the detection of a noxious stimulus.
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Affiliation(s)
- J Archibald
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.
- Department of Experimental Medicine, University of British Columbia, Vancouver, Canada.
| | - E L MacMillan
- Department of Radiology, University of British Columbia, Vancouver, Canada
- ImageTech Lab, Simon Fraser University, Surrey, Canada
- Philips Healthcare Canada, Markham, Canada
| | - C Graf
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - P Kozlowski
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Hughill Center, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - C Laule
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Hughill Center, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
- UBC MRI Research Centre, University of British Columbia, Vancouver, Canada
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - J L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Center for Brain Health (DMCH), Vancouver, Canada
- Hughill Center, Vancouver, Canada
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Orhurhu V, Khan F, Salisu Orhurhu M, Agudile E, Urits I, Hasoon J, Owais K, Chu R, Ogunsola D, Viswanath O, Yazdi C, Karri J, Hirji S, Gill J, Simopoulos T. Obesity Trends Amongst Hospitalized Patients with Spinal Cord Stimulator Implants. Adv Ther 2020; 37:4614-4626. [PMID: 32935285 DOI: 10.1007/s12325-020-01487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic pain remains an important public health problem as it continues to increase healthcare-related cost. Comorbidities like obesity have been associated with efficacy of spinal cord stimulator (SCS) therapy and worse outcomes. The goal of this study is to investigate the trends of obesity amongst hospitalized patients with SCS therapy as well as healthcare utilization outcomes. METHODS Using the International Classification of Diseases (ICD) ninth and tenth procedure and diagnosis code, we investigated the National Inpatient Sample (NIS) for patients with SCS implants between 2011 and 2015. Patients received a diagnosis of obesity based on the following categories: class I, II and III obesity. Age, gender, and comorbid conditions of patients with obesity were matched 1:1 on propensity score to those without obesity diagnosis. Our primary outcome was defined as trend of obesity diagnosis. Our secondary outcome, healthcare utilization, included in-hospital cost, length of stay, and discharge location. RESULTS Between 2011 and 2015, a total of 3893 patients with SCS implants were identified (average age 56 ± 15 years, 58% female, 0.70 ± 1.1 Charlson Comorbidity Index, CCI). Of this cohort, 640 patients were identified as obese. The proportion of patients with obesity diagnosis increased significantly from 13.75% in 2011 to 19.36% in 2015 (p < 0.001). After 1:1 matching on propensity score, 597 patients with obesity were successfully matched to 597 patients without obesity. The total hospital cost for SCS patients with obesity (median $104,845, IQR $74,648-144,292) was not significantly different from patients without obesity diagnosis (median $111,092, IQR $68,990-145,459) (p = 0.161). CONCLUSIONS The data from our study suggests that there is an increasing rate of obesity diagnosis amongst patients with SCS therapy. However, there was no difference in healthcare utilization between patients with and without obesity. Additional studies may provide more insight into our findings.
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Affiliation(s)
- Vwaire Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Division of Pain, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Faizan Khan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Division of Pain, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emeka Agudile
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ivan Urits
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Khurram Owais
- Department of Anesthesiology, Critical Care and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Chu
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Dotun Ogunsola
- Department of Epidemiology and Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Cyrus Yazdi
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Samir Hirji
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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An exploration of the use of visually appealing contexts in a pain management program. Eur Geriatr Med 2020; 11:821-827. [PMID: 32564342 DOI: 10.1007/s41999-020-00339-6] [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] [Received: 02/23/2020] [Accepted: 05/21/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Pleasant pictures can help to reduce stress, promote positive feelings, and even facilitate recovery from diseases. Visual stimulation is an approach of distraction that can effectively reduce pain thresholds and increase pain tolerances. The number of older adults who suffer from pain has increased due to age-related diseases. Technology is increasingly being applied to the management of acute pain. The pain situation among older people was explored in this study, and a visually appealing pain management program was designed with the participants' experiences in mind. METHODS This was a descriptive observational study. Participants were recruited from local nursing homes. RESULTS A total of 165 older adults joined the study. The mean age of the participants was 85.6. More female than male participants experienced pain and the intensity of their pain was significantly greater. The results showed no significant differences in pain interferences between males and females. The participants stated that photographs of family members, homes, and natural scenery made them feel relaxed and happy, and reminded them of past happy times. They preferred to view those visually appealing pictures using digital devices (iPad/iPhone) to seeing hard copy versions. CONCLUSION A digital-based pain management program using visually appealing contexts for older adults can be implemented. The patients' experiences were collected and will be considered when developing a future program.
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D’Ippolito M, Purgato A, Buzzi MG. Pain and Evil: From Local Nociception to Misery Following Social Harm. J Pain Res 2020; 13:1139-1154. [PMID: 32547177 PMCID: PMC7250527 DOI: 10.2147/jpr.s236507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/07/2020] [Indexed: 01/03/2023] Open
Abstract
Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.
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Affiliation(s)
| | - Adriano Purgato
- National Health System, Azienda USL Roma 2, Rome00157, Italy
| | - Maria Gabriella Buzzi
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome00179, Italy
- Headache Centre, IRCCS Fondazione Santa Lucia, Rome00179, Italy
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Pro G, Utter J, Haberstroh S, Baldwin JA. Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year. Drug Alcohol Depend 2020; 209:107952. [PMID: 32172130 PMCID: PMC7537819 DOI: 10.1016/j.drugalcdep.2020.107952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. METHODS MAT treatment discharges were identified using the Treatment Episodes Dataset-Discharges (TEDS-D; 2014-2017) (n = 1,400,808). We used multivariate logistic regression to model MAT receipt using interactions and adjusted for several potential confounders. RESULTS Nearly one-third of OUD treatment discharges received MAT. Dual MHDs in both expansion and non-expansion states were positively associated with MAT uptake over time. Dual MHDs were negatively associated with MAT receipt only among American Indian/Alaska Native women residing in Medicaid expansion states (aOR = 0.58, 95 % CI = 0.52-0.66, p < 0.0001). CONCLUSION Disparities in MAT utilization are nuanced and vary widely depending on dual MHD status, Medicaid expansion, and race/ethnicity/gender. Medicaid is beneficial but not a universal treatment panacea. Clinical decisions to initiate MAT are dependent on multiple factors and should be tailored to meet the needs of high-risk, historically disadvantaged clients.
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Affiliation(s)
- George Pro
- Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA.
| | - Jeff Utter
- University of Colorado, Department of Family Medicine, Colorado University Anschutz, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Shane Haberstroh
- Northern Arizona University, Department of Educational Psychology, 801 South Knoles Drive, Flagstaff, AZ, 86011, USA.
| | - Julie A Baldwin
- Northern Arizona University, Center for Health Equity Research, 1395 South Knoles Drive, Flagstaff, AZ, 86011, USA.
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Earp BD, Monrad JT, LaFrance M, Bargh JA, Cohen LL, Richeson JA. Featured Article: Gender Bias in Pediatric Pain Assessment. J Pediatr Psychol 2020; 44:403-414. [PMID: 30615163 DOI: 10.1093/jpepsy/jsy104] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Accurate assessment of pain is central to diagnosis and treatment in healthcare, especially in pediatrics. However, few studies have examined potential biases in adult observer ratings of children's pain. Cohen, Cobb, & Martin (2014. Gender biases in adult ratings of pediatric pain. Children's Health Care, 43, 87-95) reported that adult participants rated a child undergoing a medical procedure as feeling more pain when the child was described as a boy as compared to a girl, suggesting a possible gender bias. To confirm, clarify, and extend this finding, we conducted a replication experiment and follow-up study examining the role of explicit gender stereotypes in shaping such asymmetric judgments. METHODS In an independent, pre-registered, direct replication and extension study with open data and materials (https://osf.io/t73c4/), we showed participants the same video from Cohen et al. (2014), with the child described as a boy or a girl depending on condition. We then asked adults to rate how much pain the child experienced and displayed, how typical the child was in these respects, and how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls. RESULTS Similar to Cohen et al. (2014), but with a larger and more demographically diverse sample, we found that the "boy" was rated as experiencing more pain than the "girl" despite identical clinical circumstances and identical pain behavior across conditions. Controlling for explicit gender stereotypes eliminated the effect. CONCLUSIONS Explicit gender stereotypes-for example, that boys are more stoic or girls are more emotive-may bias adult assessment of children's pain.
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Kiavialaitis GE, Müller S, Braun J, Rössler J, Spahn DR, Stein P, Kaserer A. Clinical practice of pre-hospital analgesia: An observational study of 20,978 missions in Switzerland. Am J Emerg Med 2019; 38:2318-2323. [PMID: 31785972 DOI: 10.1016/j.ajem.2019.10.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pain is a frequent problem faced by emergency medical services (EMS) in pre-hospital settings. This large observational study aims to assess the prevalence of sufficiently provided analgesia and to analyze the efficacy of different analgesics. Moreover, we evaluated if quality of analgesia changed with an emergency physician on scene or depended on paramedics' gender. METHODS This is a retrospective analysis of all pre-hospital medical charts from adults and adolescents treated by the municipal EMS Schutz & Rettung Zürich over a period of 4 years from 2013 to 2016. Inclusion criteria were age ≥16 years, initial GCS > 13, NACA score ≥I and ≤V, an initial numeric rating scale (NRS) ≥ I and a documented NRS at hospital admission. 20,978 out of 142,484 missions fulfilled the inclusion criteria and therefore underwent further investigation. Descriptive, univariate and multivariate analyses were applied. RESULTS Initial NRS on scene was on average 5.2 ± 3.0. Mean NRS reduction after treatment was 2.2 ± 2.5 leading to a NRS at hospital admission of 3.0 ± 1.9. This resulted in sufficient analgesia for 77% of included patients. Among analgesics, the highest odds ratio for sufficient analgesia was observed for ketamine (OR 4.7, 95%CI 2.2-10.4, p < 0.001) followed by fentanyl (OR 1.4, 95%CI 1.1-1.7, p = 0.004). Female paramedics provided better analgesia (OR 1.2, 95%CI 1.1-1.2; p < 0.001). Patient's sex had no influence on analgesia. In patients with a NACA score > 2, the presence of an emergency physician on scene improved the quality of analgesia significantly. CONCLUSIONS Pre-hospital analgesia is mostly adequate, especially when done with ketamine or fentanyl. Female paramedics provided better analgesia and in selected patients, an emergency physician on scene improved quality of analgesia in critical patients.
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Affiliation(s)
| | - Stefan Müller
- Schutz & Rettung Zürich, Zurich, Switzerland; Institute of Anesthesiology and Intensive Care Medicine, Stadtspital Triemli, Zurich, Switzerland
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Julian Rössler
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland; Institute of Anesthesiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
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Kobayashi Y, Ogura Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yasuda A, Shinozaki Y, Ogawa J. Gender Differences in Pre- and Postoperative Health-Related Quality of Life Measures in Patients Who Have Had Decompression Surgery for Lumbar Spinal Stenosis. Asian Spine J 2019; 14:238-244. [PMID: 31679323 PMCID: PMC7113473 DOI: 10.31616/asj.2019.0067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/20/2019] [Indexed: 01/02/2023] Open
Abstract
Study Design Retrospective chart audit. Purpose This study aimed to investigate the gender difference in pre- and postoperative health-related quality of life (HRQOL) in patients who have had decompression surgery for lumbar spinal stenosis (LSS). Overview of Literature Gender differences may contribute to variations in disease presentations and health outcomes. The influence of gender on pre- and postoperative HRQOL in spinal disorders remains unclear. Methods We reviewed 125 patients (79 men and 46 women) who had lumbar spinous process splitting laminectomy (LSPSL) for LSS. We assessed the following clinical information: Japanese Orthopedic Association (JOA) score; numerical rating scale (NRS) for low back pain (LBP), leg pain, and leg numbness; Zurich Claudication Questionnaire; JOA Back Pain Evaluation Questionnaire; Roland- Morris Disability Questionnaire (RMDQ); and Short Form 8 (SF-8) as HRQOL. We compared the HRQOLs of men and women pre- and postoperatively. Results Although the preoperative NRS results for LBP were significantly higher in women (p <0.05), there were no significant differences in clinical outcomes between men and women postoperatively. For HRQOL, the RMDQ scores were significantly worse in women preoperatively (p <0.05), but no significant differences were found postoperatively between men and women. Similarly, the SF-8 mental health score was also significantly lower in women preoperatively (p <0.05), but no significant differences were noted between the two groups postoperatively. Conclusions LSPSL greatly reduced LBP, leg pain, and leg numbness in both genders. There were limited differences in pain and several HRQOL questionnaire responses between men and women after surgery. We found that women had greater sensitivity to and/or lower tolerance for pain than men, which led to lower HRQOL mental health scores preoperatively.
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Affiliation(s)
| | - Yoji Ogura
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | | | - Yoshiro Yonezawa
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yohei Takahashi
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Nagoya, Japan
| | - Akimasa Yasuda
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Yoshio Shinozaki
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Jun Ogawa
- Spine Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
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Luna MJ, Ameli R, Sinaii N, Cheringal J, Panahi S, Berger A. Gender Differences in Psycho-Social-Spiritual Healing. J Womens Health (Larchmt) 2019; 28:1513-1521. [PMID: 31502927 PMCID: PMC6862956 DOI: 10.1089/jwh.2019.7837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Many individuals exhibit significant distress in response to serious and/or life-limiting illness. However, there are others who make life-transforming changes, which involve healing experiences in the psychological, social, and spiritual domains of life regardless of illness outcome. The aim of the present study is to determine if there are any differences in psycho-social-spiritual healing between genders. Materials and Methods: The NIH Healing Experiences in All Life Stressors (NIH-HEALS), a 35-item measure of psycho-social-spiritual healing, is composed of three factors: Connection, Reflection & Introspection, and Trust & Acceptance. NIH-HEALS and a demographic questionnaire were administered to 193 patients with serious and/or life-limiting illness at the National Institutes of Health Clinical Center. Results: In response to NIH-HEALS, men and women significantly differed on the Reflection & Introspection factor. Women reported increased enjoyment of mind–body practices (p < 0.001), compassion (p = 0.005), gratitude (p = 0.014), and a desire to be more positive (p = 0.044) compared to men. Men rated their pain levels (p = 0.035) and severity of illness (p = 0.016) higher and their overall level of health (p = 0.010) poorer compared to women. Women's responses to items regarding compassion (rs = 0.37, p < 0.001) and gratitude (rs = 0.24, p = 0.015) correlated positively with better overall health ratings. Conclusion: Men and women show some differences in their self-reported psycho-social-spiritual healing, which may have implications when designing interventions aimed at promoting a healing experience in the context of serious and life-limiting illness.
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Affiliation(s)
- María José Luna
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rezvan Ameli
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ninet Sinaii
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Julia Cheringal
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Samin Panahi
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Ann Berger
- Clinical Center, National Institutes of Health, Bethesda, Maryland
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Shoqirat N, Mahasneh D, Singh C, Al-Sagarat AY, Habashneh S. Barriers to nursing pain management in the emergency department: A qualitative study. Int J Nurs Pract 2019; 25:e12760. [PMID: 31297927 DOI: 10.1111/ijn.12760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/04/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management. PURPOSE The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective. METHODS Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016. RESULTS Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management. CONCLUSIONS The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.
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Affiliation(s)
| | | | - Charleen Singh
- Betty Irene Moore School of Nursing, UC Davis, Sacramento, California
| | - Ahmad Yahya Al-Sagarat
- Community and Mental Health Nursing Department, Faculty of Nursing, Mutah University, AL-Karak, Jordan
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Kim DE, Pruskowski KA, Ainsworth CR, Linsenbardt HR, Rizzo JA, Cancio LC. A Review of Adjunctive Therapies for Burn Injury Pain During the Opioid Crisis. J Burn Care Res 2019; 40:983-995. [DOI: 10.1093/jbcr/irz111] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Opioids are the mainstay of pain management after burn injury. The United States currently faces an epidemic of opioid overuse and abuse, while simultaneously experiencing a nationwide shortage of intravenous narcotics. Adjunctive pain management therapies must be sought and utilized to reduce the use of opioids in burn care to prevent the long-term negative effects of these medications and to minimize the dependence on opioids for analgesia. The purpose of this review was to identify literature on adjunctive pain management therapies that have been demonstrated to reduce pain severity or opioid consumption in adult burn patients. Three databases were searched for prospective studies, randomized controlled trials, and systematic reviews that evaluated adjunctive pain management strategies published between 2008 and 2019 in adult burn patients. Forty-six studies were analyzed, including 24 randomized controlled trials, six crossover trials, and 10 systematic reviews. Various adjunctive pain management therapies showed statistically significant reduction in pain severity. Only one randomized controlled trial on music therapy for acute background pain showed a reduction in opioid use. One cohort study on hypnosis demonstrated reduced opioid use compared with historical controls. We recommend the development of individualized analgesic regimens with the incorporation of adjunctive therapies in order to improve burn pain management in the midst of an abuse crisis and concomitant national opioid shortage.
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Affiliation(s)
- Daniel E Kim
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kaitlin A Pruskowski
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Craig R Ainsworth
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Leopoldo C Cancio
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Eerdekens M, Beuter C, Lefeber C, van den Anker J. The challenge of developing pain medications for children: therapeutic needs and future perspectives. J Pain Res 2019; 12:1649-1664. [PMID: 31213880 PMCID: PMC6536714 DOI: 10.2147/jpr.s195788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
It is broadly accepted that children of all age groups including (preterm) neonates and young infants can perceive pain and that there is an absolute need to treat their pain safely and effectively. The approved treatment options for children, particularly (preterm) neonates and young infants, are very limited with only a few medications specifically labelled for this population. This article presents the challenges of developing pain medications for children. A short overview gives information on pain in children, including pain perception, prevalence of pain and the long-term consequences of leaving pain untreated in this vulnerable population. Current pain management practices are briefly discussed. The challenges of conducting pediatric clinical trials in general and trials involving analgesic medications in particular within the regulatory framework available to develop these medications for children are presented. Emphasis is given to the operational hurdles faced in conducting a pediatric clinical trial program. Some suggestions to overcome these hurdles are provided based on our experience during the pediatric trial program for the strong analgesic tapentadol used for the treatment of moderate to severe acute pain.
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Affiliation(s)
| | | | | | - John van den Anker
- Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
- Division of Clinical Pharmacology, Children’s National Medical Center, Washington, DC, USA
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Designing and conducting proof-of-concept chronic pain analgesic clinical trials. Pain Rep 2019; 4:e697. [PMID: 31583338 PMCID: PMC6749910 DOI: 10.1097/pr9.0000000000000697] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction: The evolution of pain treatment is dependent on successful development and testing of interventions. Proof-of-concept (POC) studies bridge the gap between identification of a novel target and evaluation of the candidate intervention's efficacy within a pain model or the intended clinical pain population. Methods: This narrative review describes and evaluates clinical trial phases, specific POC pain trials, and approaches to patient profiling. Results: We describe common POC trial designs and their value and challenges, a mechanism-based approach, and statistical issues for consideration. Conclusion: Proof-of-concept trials provide initial evidence for target use in a specific population, the most appropriate dosing strategy, and duration of treatment. A significant goal in designing an informative and efficient POC study is to ensure that the study is safe and sufficiently sensitive to detect a preliminary efficacy signal (ie, a potentially valuable therapy). Proof-of-concept studies help avoid resources wasted on targets/molecules that are not likely to succeed. As such, the design of a successful POC trial requires careful consideration of the research objective, patient population, the particular intervention, and outcome(s) of interest. These trials provide the basis for future, larger-scale studies confirming efficacy, tolerability, side effects, and other associated risks.
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Becker JB, Mazure CM. The federal plan for health science and technology's response to the opioid crisis: understanding sex and gender differences as part of the solution is overlooked. Biol Sex Differ 2019; 10:3. [PMID: 30616693 PMCID: PMC6322277 DOI: 10.1186/s13293-018-0215-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 01/22/2023] Open
Abstract
The Fast-Track Action Committee on (the) Health Science and Technology Response to the Opioid Crisis recently released their draft report for public comment. This report provides the "roadmap" for a coordinated federal research and development response to the opioid crisis. Other than noting the important concerns regarding maternal and neonatal exposure to opioids, the report overlooks the laboratory, clinical, and epidemiological data that inform the need for further research on sex and gender differences in opioid addiction that have critical gender-based treatment and prevention implications. As we embark on research and development, investigations into the neurobiology of pain, opioid use, and addiction must include both females and males in model systems and, similarly, psychological and sociocultural investigations must study women and men. All data should be reported by sex and gender so that gender-specific treatment and prevention strategies derived from this research are provided to practitioners and the public. We encourage biomedical researchers and clinical care providers, as well as the public, to insist that a successful response to the opioid crisis should highlight the importance of understanding sex and gender differences in the current opioid epidemic.
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Affiliation(s)
- Jill B Becker
- Department of Psychology and the Molecular & Behavioral Neuroscience Institute, University of Michigan, 205 Zina Pitcher Place, Ann Arbor, MI, 48109, USA.
| | - Carolyn M Mazure
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine, 135 College Street, Suite, New Haven, CT, 220, USA
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Nurses' Knowledge, Attitudes, and Barriers Toward Pain Management Among Postoperative Patients in Jordan. J Perianesth Nurs 2018; 34:359-367. [PMID: 30293792 DOI: 10.1016/j.jopan.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to measure nurses' knowledge, attitudes, and barriers regarding pain management (PM) of postoperative patients in Jordan. DESIGN A descriptive survey research design was used. METHODS This descriptive study adopted a modified version of the "Knowledge and Attitudes Survey Regarding Pain" tool, administered to 120 nurses working in surgical wards. FINDINGS Nurses had inadequate knowledge of PM, with a mean knowledge score of 63.9%. Knowledge of PM and attitudes toward PM were associated positively with the age of the participant (P = .001), years of experience in the surgical area (P = .026), and academic degree of participants (P = .026). CONCLUSIONS Surgical nurses in this study had low knowledge levels and poor attitudes regarding PM in postoperative patients. Unless identified barriers to PM are seriously addressed, this vital aspect of holistic care will continue to be marginalized.
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Archey M, Goldey K, Crockett E, Boyette-Davis J. An Investigation of the Effects of Testosterone and Behavioral Expressions of Pain on Sex/Gender Differences in Pain Perception. Psychol Rep 2018; 122:826-840. [DOI: 10.1177/0033294118781320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Research indicates that women are more susceptible to pain than men, but the reason for this difference is unclear. While estrogen and progesterone have been implicated, testosterone has not received adequate consideration in the literature. Additionally, incorporating behavioral expressions, or exaggerations, of pain as an important aspect of pain perception is receiving increasing attention. The current study examined the role of testosterone in female pain expression and perception via the cold pressor test. Following all participant exclusions, 46 healthy participants (32 women) provided saliva samples for testosterone analysis using enzyme-linked immunosorbent assay before and after rating their pain during the cold pressor test. Participants used a visual analog scale to indicate how the 2℃ water was perceived, ranging from “worst pain imaginable” to “no pain.” The researcher also noted whether a participant displayed overt behavioral expressions of pain such as jumping and cursing. The results revealed that men reported lower visual analog scale scores than women, indicating less perceived pain. A subgroup of women who displayed overt behavioral responses to pain seemed to be driving this sex/gender difference. It was expected that this subgroup of females would have corresponding changes in testosterone that would further explain the observed sex/gender differences, but this was not supported. Collectively, these data add to the previous literature investigating sex/gender differences in pain perception and highlight the importance of studying overt behavioral expressions of pain. Testosterone may alter this behavior and subsequent pain perception, but the contributions of testosterone are likely subtle and were not detected in this study.
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Affiliation(s)
- Meggan Archey
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Katherine Goldey
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
| | - Erin Crockett
- Department of Psychology, Southwestern University, Georgetown, TX, USA
| | - Jessica Boyette-Davis
- Department of Psychology and Behavioral Neuroscience, St. Edward’s University, Austin, TX, USA
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Madsen TE, McLean S, Zhai W, Linnstaedt S, Kurz MC, Swor R, Hendry P, Peak D, Lewandowski C, Pearson C, O'Neil B, Datner E, Lee D, Beaudoin F. Gender Differences in Pain Experience and Treatment after Motor Vehicle Collisions: A Secondary Analysis of the CRASH Injury Study. Clin Ther 2018; 40:204-213.e2. [PMID: 29371004 DOI: 10.1016/j.clinthera.2017.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Little is known about gender differences in the treatment of pain after motor vehicle collisions (MVCs) in an emergency department (ED). We aimed to describe gender differences in pain experiences and treatment, specifically the use of opioids and benzodiazepines after ED discharge, for MVC-related pain. METHODS This was a secondary analysis of previously collected data from the CRASH Injury studies. We included patients who were seen and discharged from an ED after an MVC and who were enrolled in 1 of 2 multicenter longitudinal prospective cohort studies (1 black/non-Hispanic and 1 white/non-Hispanic). First, we compared the experience of pain as defined by self-reported moderate-to-severe axial pain, widespread pain, number of somatic symptoms, pain catastrophizing, and peritraumatic distress between women and men using bivariate analyses. We then determined whether there were gender differences in the receipt of prescription medications for post-MVC pain symptoms (opioids and benzodiazepines) using multivariate logistic regression adjusting for demographic characteristics, pain, and collision characteristics. FINDINGS In total, 1878 patients were included: 61.4% were women. More women reported severe symptoms on the pain catastrophizing scale (36.8% vs 31.0%; P = 0.032) and peritraumatic distress following the MVC (59.7% vs 42.5%; P < 0.001), and women reported more somatic symptoms than men (median, 3.9; interquartile range, 3.7-4.0 vs median, 3.3; interquartile range, 3.1-3.5; P < 0.001). Unadjusted, similar proportions of women and men were given opioids (29.2% vs 29.7%; P = 0.84). After adjusting for covariates, women and men remained equally likely to receive a prescription for opioids (relative risk = 0.83; 95% confidence interval, 0.58-1.19). Women were less likely than men to receive a benzodiazepine at discharge from an ED (relative risk = 0.53; 95% confidence interval, 0.32-0.88). IMPLICATIONS In a large, multicenter study of ED patients treated for MVC, there were gender differences in the acute psychological response to MVC with women reporting more psychological and somatic symptoms. Women and men were equally likely to receive opioid prescriptions at discharge. Future research should investigate potential gender-specific interventions to reduce both posttraumatic distress and the risk of developing negative long-term outcomes like chronic pain.
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Affiliation(s)
- Tracy E Madsen
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Samuel McLean
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina; Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Wanting Zhai
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Sarah Linnstaedt
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael C Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
| | - David Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Brian O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Elizabeth Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - David Lee
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Francesca Beaudoin
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
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Abstract
This article examines the symbolic work of gender as it intersects with race and class in popular media and in local community discourses surrounding the “suburban opioid epidemic,” in which national drug policies, and White futures, are thought to be at stake. The study starts with an analysis of the White, middle-class, female “new face of addiction” that has been cultivated by national press coverage of prescription opioid-cum-heroin overdoses in the U.S. and then turns to interviews with community physicians in the front line of a clinical response to the “epidemic” in Staten Island, a White suburban enclave within New York City that is experiencing 3–4 times the opioid overdose rate of any other City borough. Physicians use the language of family membership to indicate identification with their opioid addiction patients, and many go to lengths to provide holistic care and to incorporate family support for their patients despite lack of insurance reimbursement. White, educated patients describe buprenorphine as a way to maintain their professional identities, while low-income Black and Latino patients describe pharmaceutical maintenance as a socially alienating arm of the criminal justice system. Together, media and clinical responses make up strategies of White racial rescue from threatened social reproduction in an era of substance-induced White downward mobility.
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Affiliation(s)
- Helena Hansen
- Departments of Psychiatry and Anthropology, New York University, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service. Anesth Analg 2017; 125:200-209. [PMID: 28489643 DOI: 10.1213/ane.0000000000002016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. METHODS For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score < VI. Univariate and multivariable logistic regression analyses were performed to evaluate patient and mission characteristics of helicopter emergency service associated with insufficient pain management. RESULTS A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). CONCLUSIONS In the studied specific Swiss cohort, nontrauma patients, patients on secondary missions, patients treated only for a short time at the scene before transport, patients who receive no analgesic, and treatment by a female physician may be risk factors for insufficient pain management. Patients suffering pain at the scene (NRS > 3) should receive an analgesic whenever possible. Patients with severe pain at the scene (NRS ≥ 8) may benefit from the combination of ketamine with an opioid. The finding about sex differences concerning analgesic administration is intriguing and possibly worthy of further study.
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Siddiqui A, Belland L, Rivera-Reyes L, Handel D, Yadav K, Heard K, Eisenberg A, Khelemsky Y, Hwang U. A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures. PAIN MEDICINE 2017; 18:41-48. [PMID: 27245631 DOI: 10.1093/pm/pnw072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients. Design Secondary analysis of retrospective cohort study. Setting Five EDs (four academic, one community) in the United States. Participants Patients (1,664) who presented in January, March, July, and October 2009 with a final diagnosis of fracture (774 long bone [LBF], 890 shorter bone [SBF]). Measurements Primary-predictor was type of fracture (LBF vs. SBF). Pain-care process outcomes included likelihood of analgesic administration, opioid-dose, and time to first analgesic. General estimating equations were used to control for age, gender, race, baseline pain score, triage acuity, comorbidities and ED crowding. Subgroup analyses were conducted to analyze age-based differences in pain care by fracture type. Results A larger proportion of patients with LBF (30%) were older (>65 years old) compared to SBF (13%). Compared with SBF, patients with LBF were associated with greater likelihood of analgesic-administration (OR = 2.03; 95 CI = 1.58 to 2.62; P < 0.001) and higher opioid-doses (parameter estimate = 0.268; 95 CI = 0.239 to 0.297; P < 0.001). When LBF were examined separately, older-patients had a trend to longer analgesic wait-times (99 [55-163] vs. 76 [35-149] minutes, P = 0.057), but no other differences in process outcomes were found. Conclusion Long bone fractures were associated with more aggressive pain care than SBF. When fracture types were examined separately, older patients did not appear to receive more aggressive pain care. This difference should be accounted for in further research.
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Affiliation(s)
- Ammar Siddiqui
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Belland
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Rivera-Reyes
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Daniel Handel
- Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kennon Heard
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Eisenberg
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Yury Khelemsky
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ula Hwang
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Treating without Seeing: Pain Management Practice in a Thai Context. Pain Res Manag 2016; 2016:9580626. [PMID: 28044071 PMCID: PMC5156806 DOI: 10.1155/2016/9580626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 01/07/2023]
Abstract
Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley's ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfort.
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Abstract
Musculoskeletal pain (MSP) is a common sequela of traumatic stress exposure. While biological factors contributing to chronic MSP after motor vehicle collision (MVC) have traditionally focused on tissue injury, increasing evidence suggests that neuro/stress/immune processes mediated by stress system activation may play a more dominant role. In a previous study, we found that genetic variants in the hypothalamic-pituitary-adrenal (HPA) axis-related gene FKBP5 influence vulnerability to persistent MSP 6 weeks after MVC. In the present cohort study (n = 855), we evaluated whether genetic variants in several other important HPA axis-related genes, including the glucocorticoid receptor (NR3C1), corticotropin-releasing hormone receptor R1 (CRHR1), and corticotropin-releasing hormone-binding protein (CRHBP), influence risk of chronic MSP over time after MVC. Genetic polymorphism rs7718461 in the CRHBP gene showed significant association (P = 0.0012) with overall pain severity during the year after MVC in regression models controlling for multiple comparisons. Two additional CRHBP alleles in high linkage disequilibrium with rs7718461 also showed trend-level significance. In secondary analyses, a significant interaction between this CRHBP locus (minor allele frequency = 0.33) and time was observed (P = 0.015), with increasing effect observed over time following trauma. A significant CRHBP × FKBP5 interaction was also observed, with substantially increased MSP after MVC in those with a risk allele in both genes compared with either gene alone. The results of this study indicate that genetic variants in 2 different HPA axis genes predict chronic MSP severity following MVC and support the hypothesis that the HPA axis is involved in chronic post-MVC MSP pathogenesis.
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Innes GD, Scheuermeyer FX, Law MR, McRae AD, Weber BA, Boyda HN, Lonergan K, Andruchow JE. Sex-related Differences in Emergency Department Renal Colic Management: Females Have Fewer Computed Tomography Scans but Similar Outcomes. Acad Emerg Med 2016; 23:1153-1160. [PMID: 27357754 DOI: 10.1111/acem.13041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/12/2016] [Accepted: 06/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sex-related differences occur in many areas of medicine. Emergency department (ED) studies have suggested differences in access to care, diagnostic imaging use, pain management, and intervention. We investigated sex-based differences in the care and outcomes for ED patients with acute renal colic. METHODS This was a multicenter population-based retrospective observational cohort study using administrative data and supplemented by structured chart review. All patients seen in Calgary Health Region EDs between January 1 and December 31, 2014, with an ED diagnosis of renal colic based on the following ICD-10 codes were eligible for inclusion: calculus of kidney (N200), calculus of ureter (N201), calculus of kidney with calculus of ureter (N202), hydronephrosis with renal and ureteral calculous obstruction (N132), unspecified renal colic (N23), and unspecified urinary calculus (N209). ED visit data and test results were accessed in the regional ED clinical database. Stone characteristics were captured from diagnostic imaging reports. Regional hospital databases were used to identify subsequent ED encounters, hospital admissions, and surgical procedures within 60 days. Outcomes were stratified by sex. The primary outcome, intended as a marker of overall effectiveness of ED care, was the unscheduled 7-day ED revisit rate among patients who were discharged home after their index ED visit. Secondary outcomes included ED pain management as reflected by administration of narcotics or intravenous nonsteroidals, the performance of advanced imaging-either ultrasound (US) or computed tomography (CT), and the proportion of patients who required hospitalization or surgical intervention within 60 days. RESULTS From January 1 to December 31, 2014, a total of 3,104 eligible patients were studied: 1,111 women (35.8%) and 1,993 men (64.2%). Baseline characteristics, access times, analgesic use, and admission rates were similar in both groups. Men were more likely to have CT (68.9% vs. 58.5%, difference = 10.4%, 95% confidence interval [CI] = 6.8 to 14.0) while women were more likely to have US (20.8% vs. 9.6%, difference = 11.2%, 95% CI = 8.4 to 13.9). At 7 days, 17.9% of women and 19.0% of men who were discharged after their index ED visit required an ED revisit (difference = 1.1%, 95% CI = -2.8 to 4.9). Men were more likely to be hospitalized at 7 days (9.8% vs. 6.5%, difference = 3.3%, 95% CI = 0.6 to 6.0). CONCLUSION This study shows greater reliance on US in females but no other sex-specific differences in the management of ED patients with acute renal colic. Higher CT use in men was not associated with improved outcomes, and we found no important differences in access to care, diagnostic or treatment intensity, or revisit rates as a marker of care effectiveness.
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Affiliation(s)
- Grant D. Innes
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Rockyview General Hospital Calgary Alberta Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine St. Paul's Hospital Vancouver British Columbia Canada
| | - Michael R. Law
- School for Population and Public Health and the Centre for Health Services and Policy Research University of British Columbia Vancouver British Columbia Canada
| | - Andrew D. McRae
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Rockyview General Hospital Calgary Alberta Canada
| | - Bryce A. Weber
- Rockyview General Hospital Calgary Alberta Canada
- Division of Urological Sciences Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Heidi N. Boyda
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | | | - James E. Andruchow
- Department of Emergency Medicine Cumming School of Medicine University of Calgary Calgary Alberta Canada
- Rockyview General Hospital Calgary Alberta Canada
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Van Woerden G, Van Den Brand CL, Den Hartog CF, Idenburg FJ, Grootendorst DC, Van Der Linden MC. Increased analgesia administration in emergency medicine after implementation of revised guidelines. Int J Emerg Med 2016; 9:4. [PMID: 26860533 PMCID: PMC4749514 DOI: 10.1186/s12245-016-0102-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/03/2016] [Indexed: 01/25/2023] Open
Abstract
Background The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management. Methods We conducted a prospective pre-post intervention cohort study with implementation of a revised guideline for pain management at our ED, in which nurses are allowed to administer analgesia (including low-dosage piritramid (opioid) intravenous) without doctor intervention. Numeric Rating Scales (NRS) were measured, and administration of medication (main outcome) was documented. We included every adult patient presenting with pain (NRS 4–10) at the ED. Results A total of 2107 patients (1089 pre-implementation phase and 1018 post-implementation phase) were included in our study. During pre-implementation, 25.4 % of the patients with NRS between 4 and 10 received analgesia. After implementation, 32.0 % of these patients received analgesia (p < 0.001). Conclusions After implementation of the revised guidelines in pain management at the ED, the administration of pain medication increased significantly. Nevertheless, the percentage of patients in pain receiving analgesia remain low (32 % after implementation).
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Affiliation(s)
- Geesje Van Woerden
- Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Crispijn L Van Den Brand
- Emergency Department, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Cornelis F Den Hartog
- Department of Anaesthesiology, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Floris J Idenburg
- Department of Surgery, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Diana C Grootendorst
- Landsteiner Institute, Medical Centre Haaglanden, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
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Abstract
BACKGROUND Previous studies examining sex-based disparities in emergency department (ED) pain care have been limited to a single pain condition, a single study site, and lack rigorous control for confounders. OBJECTIVE A multicenter evaluation of the effect of sex on abdominal pain (AP) and fracture pain (FP) care outcomes. RESEARCH DESIGN A retrospective cohort review of ED visits at 5 US hospitals in January, April, July, and October 2009. SUBJECTS A total of 6931 patients with a final ED diagnosis of FP (n=1682) or AP (n=5249) were included. MEASURES The primary predictor was sex. The primary outcome was time to analgesic administration. Secondary outcomes included time to medication order, and the likelihood of receiving an analgesic and change in pain scores 360 minutes after triage: Multivariable models, clustered by study site, were conducted to adjust for race, age, comorbidities, initial pain score, ED crowding, and triage acuity. RESULTS On adjusted analyses, compared with men, women with AP waited longer for analgesic administration [AP women: 112 (65-187) minutes, men: 96 (52-167) minutes, P<0.001] and ordering [women: 84 (41-160) minutes, men: 71 (32-137) minutes, P<0.001], whereas women with FP did not (Administration: P=0.360; Order: P=0.133). Compared with men, women with AP were less likely to receive analgesics in the first 90 minutes (OR=0.766; 95% CI, 0.670-0.875; P<0.001), whereas women with FP were not (P=0.357). DISCUSSION In this multicenter study, we found that women experienced delays in analgesic administration for AP, but not for FP. Future research and interventions to decrease sex disparities in pain care should take type of pain into account.
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Greenberg MR, Safdar B, Choo EK, McGregor AJ, Becker LB, Cone DC. Future directions in sex- and Gender-specific Emergency Medicine. Acad Emerg Med 2014; 21:1339-42. [PMID: 25421874 DOI: 10.1111/acem.12520] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022]
Abstract
The 2014 Academic Emergency Medicine (AEM) consensus conference "Gender-Specific Research in Emergency Medicine: Investigate, Understand, and Translate How Gender Affects Patient Outcomes" convened a diverse group of stakeholders to target gaps in emergency medicine (EM) sex- and gender-specific research and identify research priorities. At the close of the conference, the executive committee sought feedback from group leaders and conference attendees about the next critical steps in EM sex- and gender-specific research, goals for their own future research, and anticipated barriers in pursuing this research. This article summarizes this feedback on the future directions in sex- and gender-specific research in emergency care and strategies to overcome barriers.
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Affiliation(s)
- Marna R. Greenberg
- Department of Emergency Medicine; Lehigh Valley Health Network/USF Morsani College of Medicine; Allentown PA
| | - Basmah Safdar
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Esther K. Choo
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Alyson J. McGregor
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Lance B. Becker
- Department of Emergency Medicine; Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - David C. Cone
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Choo EK, Beauchamp G, Beaudoin FL, Bernstein E, Bernstein J, Bernstein SL, Broderick KB, Cannon RD, D'Onofrio G, Greenberg MR, Hawk K, Hayes RB, Jacquet GA, Lippmann MJ, Rhodes KV, Watts SH, Boudreaux ED. A research agenda for gender and substance use disorders in the emergency department. Acad Emerg Med 2014; 21:1438-46. [PMID: 25444022 DOI: 10.1111/acem.12534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
Abstract
For many years, gender differences have been recognized as important factors in the etiology, pathophysiology, comorbidities, and treatment needs and outcomes associated with the use of alcohol, drugs, and tobacco. However, little is known about how these gender-specific differences affect ED utilization; responses to ED-based interventions; needs for substance use treatment and barriers to accessing care among patients in the ED; or outcomes after an alcohol-, drug-, or tobacco-related visit. As part of the 2014 Academic Emergency Medicine consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions related to substance use disorders.
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Affiliation(s)
- Esther K. Choo
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Gillian Beauchamp
- Department of Emergency Medicine; Oregon Health & Sciences University; Portland OR
| | - Francesca L. Beaudoin
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Edward Bernstein
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- Department of Community Health Sciences; Boston University School of Public Health; Boston MA
| | - Judith Bernstein
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- Department of Community Health Sciences; Boston University School of Public Health; Boston MA
| | | | - Kerryann B. Broderick
- Department of Emergency Medicine; Denver Health; University of Colorado School of Medicine; Denver CO
| | - Robert D. Cannon
- Department of Emergency Medicine; Lehigh Valley Hospital; University of South Florida Morsani College of Medicine; Allentown PA
| | - Gail D'Onofrio
- Department of Emergency Medicine; Yale School of Medicine; New Haven CT
| | - Marna R. Greenberg
- Department of Emergency Medicine; Lehigh Valley Hospital; University of South Florida Morsani College of Medicine; Allentown PA
| | - Kathryn Hawk
- Department of Emergency Medicine; Yale School of Medicine; New Haven CT
| | - Rashelle B. Hayes
- Department of Medicine; University of Massachusetts Medical School; Worcester MA
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
| | - Melanie J. Lippmann
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Karin V. Rhodes
- Department of Emergency Medicine; University of Pennsylvania School of Medicine; Philadelphia PA
| | - Susan H. Watts
- Department of Emergency Medicine; Texas Tech University Health Sciences Center; El Paso TX
| | - Edwin D. Boudreaux
- Department of Emergency Medicine; University of Massachusetts Medical School; Worcester MA
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