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Son J, Kim ES, Lee YJ, Lee NW, Ha IH. Minimum clinically important difference and substantial clinical benefit in patients with chronic temporomandibular disorders. J Oral Rehabil 2024. [PMID: 38706163 DOI: 10.1111/joor.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 12/07/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Research on temporomandibular disorder (TMD) responsiveness is scarce and limited regarding patients' representativeness. OBJECTIVE(S) This study aimed to estimate minimum clinically important difference (MCID) and substantial clinical benefit (SCB) among a large and diverse patient population regarding sex and age. METHODS In this study, 162 patients participated from five hospitals. MCID and SCB in pain, functional disability and quality of life were examined with anchor-based methods. Patients' global impression of change was used as the anchor. Area under the curve (AUC) values were determined for testing accuracy. Changes from baseline and coefficient of variation by responsiveness status were calculated to explain the results of accuracy. RESULTS SCB was estimated to be 2.18 for the numeric rating scale (NRS) for pain (AUC: 0.80 [95% CI: 0.72-0.88]) in all patients and 2.50 in women (AUC: 0.81 [95% CI: 0.71-0.89]). The estimated SCB of NRS for discomfort (1.50) and Jaw Functional Limitation Scale for mastication (1.35) had wide CIs for AUCs. Likewise, the estimated MCIDs of NRS for pain (0.80) and NRS for discomfort (1.50) had wide CIs for AUCs. Among non-responders who did not achieve the MCID of NRS for pain, the coefficient of variation was very high for all outcomes other than the NRS for pain. CONCLUSION This study investigated the responsiveness of patients with TMD using a large and diverse patient sample. SCB in pain decrease can be used to assess the responsiveness of patients with TMD. Composite outcomes should be developed to estimate MCID.
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Affiliation(s)
- Jaemin Son
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Nam-Woo Lee
- Department of Korean Rehabilitation Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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Risch N, Dubois J, Etain B, Aouizerate B, Bellivier F, Belzeaux R, Dubertret C, Haffen E, Januel D, Leboyer M, Lefrere A, Samalin L, Polosan M, Rey R, Roux P, Schwan R, Walter M, Courtet P, Olié E. Subjects suffering from bipolar disorder taking lithium are less likely to report physical pain: a FACE-BD study. Eur Psychiatry 2023; 67:e8. [PMID: 38086540 DOI: 10.1192/j.eurpsy.2023.2476] [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] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Physical pain is a common issue in people with bipolar disorder (BD). It worsens mental health and quality of life, negatively impacts treatment response, and increases the risk of suicide. Lithium, which is prescribed in BD as a mood stabilizer, has shown promising effects on pain. METHODS This naturalistic study included 760 subjects with BD ( FACE-BD cohort) divided in two groups: with and without self-reported pain (evaluated with the EQ-5D-5L questionnaire). In this sample, 176 subjects were treated with lithium salts. The objectives of the study were to determine whether patients receiving lithium reported less pain, and whether this effect was associated with the recommended mood-stabilizing blood concentration of lithium. RESULTS Subjects with lithium intake were less likely to report pain (odds ratio [OR] = 0.59, 95% confidence interval [CI], 0.35-0.95; p = 0.036) after controlling for sociodemographic variables, BD type, lifetime history of psychiatric disorders, suicide attempt, personality traits, current depression and anxiety levels, sleep quality, and psychomotor activity. Subjects taking lithium were even less likely to report pain when lithium concentration in blood was ≥0.5 mmol/l (OR = 0.45, 95% CI, 0.24-0.79; p = 0.008). CONCLUSIONS This is the first naturalistic study to show lithium's promising effect on pain in subjects suffering from BD after controlling for many confounding variables. This analgesic effect seems independent of BD severity and comorbid conditions. Randomized controlled trials are needed to confirm the analgesic effect of lithium salts and to determine whether lithium decreases pain in other vulnerable populations.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Clinique de la Lironde, Clinea Psychiatrie, Saint-Clément-de-Rivière, France
| | - Jonathan Dubois
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, INSERM UMR-S 1144, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Charles Perrens, Bordeaux, France
- Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Paris, France
- Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Université Paris Cité, INSERM UMR-S 1144, Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France
- Pôle Universitaire de Psychiatrie, CHU de Montpellier, Montpellier, France /INT-UMR7289, CNRS Aix-Marseille Université, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
- Université de Paris, Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France
- Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, UFC, UBFC, Besançon, France
| | - Dominique Januel
- Fondation FondaMental, Créteil, France
- Pôle universitaire 93G03 EPS ville Evrard, Neuilly-sur- Marne, France
- Université Sorbonne Paris Nord, Bobigny, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France
- Translational NeuroPsychiatry Laboratory, Univ Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Antoine Lefrere
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôpitaux de Marseille, Pôle de Psychiatrie, Marseille, France
- Institut de neurosciences de la Timone UMR 7289, Aix-Marseille Université & CNRS, Marseille, France
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France
- University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, CHU Clermont-Ferrand, Department of Psychiatry, Clermont-Ferrand, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France
- Centre Hospitalier Le Vinatier, INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Pole Est, 95 bd Pinel, BP 30039, Bron Cedex, France
| | - Paul Roux
- Fondation FondaMental, Créteil, France
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, Université Paris-Saclay; Université de Versailles Saint-Quentin-En-Yvelines; DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France
- Centre Psychothérapique de Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Michel Walter
- Fondation FondaMental, Créteil, France
- Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
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Taimeh D, Ni Riordain R, Fedele S, Leeson R. Patient-Reported Outcome Measures Used in Temporomandibular Disorders: A Review of the Literature. J Oral Facial Pain Headache 2023; 37:113-129. [PMID: 37389838 PMCID: PMC10642334 DOI: 10.11607/ofph.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIMS To identify the range of patient-reported outcome measures (PROMs) used in TMD studies, summarize the available evidence for their psychometric properties, and provide guidance for the selection of such measures. METHODS A comprehensive search was conducted to retrieve articles published between 2009 and 2018 containing a patient-reported measure of the effects of TMDs. Three databases were searched: MEDLINE, Embase, and Web of Science. RESULTS A total of 517 articles containing at least one PROM were included in the review, and 57 additional studies were also located describing the psychometric properties of some tools in a TMD population. A total of 106 PROMs were identified and fell into the following categories: PROMs describing the severity of symptoms; PROMs describing psychologic status; and PROMs describing quality of life and general health. The most commonly used PROM was the visual analog scale. However, a wide range of verbal descriptors was employed. The Oral Health Impact Profile-14 and Beck Depression Inventory were the most commonly used PROMs describing the effect of TMDs on quality of life and psychologic status, respectively. Additionally, the Oral Health Impact Profile (various versions) and the Research Diagnostic Criteria Axis ll questionnaires were the instruments most repeatedly tested in a TMD population, and these instruments have undergone cross-cultural validation in several languages. CONCLUSION A wide range of PROMs have been used to describe the impact of TMDs on patients. Such variability may limit the ability of researchers and clinicians to evaluate the efficacy of different treatments and make meaningful comparisons.
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Engel L, Whitehurst DGT, Haagsma J, Janssen MF, Mulhern B. What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis. Qual Life Res 2022; 32:1175-1186. [PMID: 36469212 DOI: 10.1007/s11136-022-03312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study examines the EQ-5D-5L pain/discomfort dimension by drawing comparisons with five other pain and discomfort items (pain severity, discomfort severity, pain frequency, discomfort frequency and pain interference) collected in the Australian psychometric study for the EQ Health and Wellbeing instrument. METHODS Participants, recruited via a market research company, completed an online survey. Methods of analyses included the assessment of descriptive statistics, variation in reporting patterns using chi-square tests and cross-tabulations, correlation analyses, ordered univariate logistic regression, and discriminatory power analyses (Shannon index (H') and Shannon Evenness index (J')). RESULTS Survey data from 514 participants were used. Compared with EQ-5D-5L pain/discomfort, there was a higher proportion of respondents reporting some level of impairment on at least one of the pain severity and discomfort severity items (74% versus 81%). Correlation with EQ-5D-5L pain/discomfort was strongest for pain severity (r = 0.83) and weakest for discomfort frequency (r = 0.41); the same inferences were drawn for predictive ability. Adding any additional pain or discomfort items to the EQ-5D-5L increased the absolute informativity (H') but not the relative informativity (J'). When replacing EQ-5D-5L pain/discomfort with separate pain and/or discomfort items - i.e., adding items to a modified 'EQ-4D-5L'-absolute informativity increased, while relative informativity increased only when pain interference and frequency-related items (independently or in combination) were added. CONCLUSION The EQ-5D-5L pain/discomfort dimension captures aspects of pain more than aspects of discomfort. Potential reasons include the absence of descriptors or because pain is mentioned first in the composite item.
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Affiliation(s)
- Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia.
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
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Wang A, Shulman M, Choo T, Pavlicova M, Langleben DD, Nunes EV, Rotrosen J. Baseline- and treatment-associated pain in the X:BOT comparative effectiveness study of extended-release naltrexone versus buprenorphine-naloxone for OUD. Addict Biol 2022; 27:e13112. [PMID: 34877769 DOI: 10.1111/adb.13112] [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: 04/16/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
Chronic pain is highly prevalent among patients with opioid use disorder (OUD). However, little is known about how pharmacological treatments for OUD, for example, extended-release naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX), affect pain. To begin addressing this question, we performed a secondary analysis of pain data on a large prospective 24-week, open-label, randomized-controlled comparative effectiveness trial of XR-NTX versus BUP-NX (X:BOT trial). Participants' pain status was measured by the EuroQol (EQ-5D). Based on their responses to the pain question at baseline, participants were dichotomized into "Pain" versus "No Pain" categories. Participant's pain status was evaluated every 4 weeks. A mixed effects longitudinal logistic regression model was fitted to examine the differential effect of XR-NTX versus BUP-NX on pain, modelling pain at all available follow-up assessments, adjusted for age, sex, and baseline pain. A total of 474 individuals who were successfully inducted onto their assigned medications were included in this analysis. Among participants endorsing pain at baseline, substantial reductions in pain were observed over the course of the study in both treatment groups. Howecver reduction in pain was slightly greater in the group treated with XR-NTX than the one treated with BUP-NX (OR = 1.60 [95% CI: 1.07-2.40], P = 0.023). Future research using instruments and design specifically focused on pain could extend the present observations and evaluate their clinical significance.
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Affiliation(s)
- An‐Li Wang
- Addiction Institute of Mount Sinai, Department of Psychiatry Icahn School of Medicine at Mount Sinai New York New York USA
| | - Matisyahu Shulman
- Department of Psychiatry Columbia University Irving Medical Center and New York State Psychiatric Institute New York New York USA
| | - Tse‐Hwei Choo
- Department of Psychiatry Columbia University Irving Medical Center and New York State Psychiatric Institute New York New York USA
| | - Martina Pavlicova
- Department of Biostatistics Columbia University Mailman School of Public Health New York New York USA
| | - Daniel D. Langleben
- Department of Psychiatry University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA
| | - Edward V. Nunes
- Department of Psychiatry Columbia University Irving Medical Center and New York State Psychiatric Institute New York New York USA
| | - John Rotrosen
- Department of Psychiatry NYU Grossman School of Medicine New York New York USA
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Risch N, Dubois J, M’bailara K, Cussac I, Etain B, Belzeaux R, Dubertret C, Haffen E, Schwan R, Samalin L, Roux P, Polosan M, Leboyer M, Courtet P, Olié E. Self-Reported Pain and Emotional Reactivity in Bipolar Disorder: A Prospective FACE-BD Study. J Clin Med 2022; 11:jcm11030893. [PMID: 35160345 PMCID: PMC8836480 DOI: 10.3390/jcm11030893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
In patients with bipolar disorder (BD), pain prevalence is close to 30%. It is important to determine whether pain influences BD course and to identify factors associated with pain in BD in order to guide BD management. This naturalistic, prospective study used data on 880 patients with BD from the French FACE-BD cohort who were divided into two groups according to the presence or absence of pain. Multivariate models were used to test whether pain was associated with affective states and personality traits while controlling for confounders. Then, multivariate models were used to test whether pain at baseline predicted global life functioning and depressive symptomatology at one year. At baseline, 22% of patients self-reported pain. The pain was associated with depressive symptomatology, levels of emotional reactivity in a quadratic relationship, and a composite variable of personality traits (affective lability, affective intensity, hostility/anger, and impulsivity). At one year, the pain was predictive of depression and lower global life functioning. Pain worsens mental health and well-being in patients with BD. The role of emotions, depression, and personality traits in pain has to be elucidated to better understand the high prevalence of pain in BD and to promote specific therapeutic strategies for patients experiencing pain.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Clinique de la Lironde, Clinea Psychiatrie, 34980 Saint-Clément-de-Rivière, France
- Correspondence: ; Tel.: +33-46-733-8581
| | - Jonathan Dubois
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
| | - Katia M’bailara
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- LabPsy, University of Bordeaux, EA 4139, F-33000 Bordeaux, France
- Department of Clinical and Academic Psychiatry, Charles-Perrens Hospital, 33076 Bordeaux, France
| | - Irena Cussac
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Psychiatric Center, Hospital Princesse Grace, 1 Ave. Pasteur, 98000 Monaco, Monaco
| | - Bruno Etain
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Fernand Widal, 75010 Paris, France
- INSERM UMRS 1144-Université de Paris, 75006 Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France
- INT-UMR 7289, CNRS Aix-Marseille Université, 13385 Marseille, France
| | - Caroline Dubertret
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Department of Psychiatry, University of Paris, AP-HP, Louis Mourier Hospital, INSERM UMR 1266 Paris, 92700 Colombes, France
| | - Emmanuel Haffen
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Service de Psychiatrie de l’Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université de Franche-Comté, UBFC, 25000 Besançon, France
| | - Raymund Schwan
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université de Lorraine, Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, INSERM U1254, 54000 Nancy, France
| | - Ludovic Samalin
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, UMR 6602 Institut Pascal (IP), 63178 Clermont-Ferrand, France
| | - Paul Roux
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Centre Hospitalier de Versailles, Service de Psychiatrie et D’addictologie Adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France and Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe “PsyDev”, 94807 Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université Grenoble Alpes, Inserm U1216, Grenoble Institut de Neurosciences, CHU de Grenoble, F-38000 Grenoble, France
| | - Marion Leboyer
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
- Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires «H. Mondor», DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 34094 Montpellier, France; (J.D.); (P.C.); (E.O.)
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, 34295 Montpellier, France
- Fondation FondaMental, 94000 Créteil, France; (K.M.); (I.C.); (B.E.); (R.B.); (C.D.); (E.H.); (R.S.); (L.S.); (P.R.); (M.P.); (M.L.)
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Durham J, Breckons M, Vale L, Shen J. DEEP Study: Modeling Outcomes and Costs of Persistent Orofacial Pain. JDR Clin Trans Res 2021; 8:23800844211063870. [PMID: 34915751 PMCID: PMC9773005 DOI: 10.1177/23800844211063870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
KNOWLEDGE OF TRANSFER STATEMENT Despite a substantial number of consultations, individuals experiencing the care pathways in this study continued to have far from perfect health over their life course. The modeling suggests they would only experience 18 y in "perfect health." There is considerable scope to improve current care/outcomes and patient experience.
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Affiliation(s)
- J. Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
- Newcastle Dental Hospital, Newcastle-Upon-Tyne Hospitals’ NHS Foundation Trust, Newcastle, UK
| | - M. Breckons
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
| | - L. Vale
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
| | - J. Shen
- Health Economics Group, Newcastle University Population Health Sciences Institute, Newcastle, UK
- Current affiliation: GSK Belgium, Wavre, Belgium
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Chana P, Smith JG, Karamat A, Simpson A, Renton T. Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome. J Oral Rehabil 2021; 48:458-468. [PMID: 33368621 DOI: 10.1111/joor.13136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/13/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders. OBJECTIVES To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL. METHODS A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL. RESULTS Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity. CONCLUSIONS A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.
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Affiliation(s)
- Pavneet Chana
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Jared G Smith
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK.,Population Health Research Institute, St George's, University of London, London, UK
| | - Aalia Karamat
- Community Oral Health Unit, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Anna Simpson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tara Renton
- Department of Oral Surgery, King's College London, Dental Hospital, King's College Hospital NHS Foundation Trust, London, UK
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Riley P, Glenny AM, Worthington HV, Jacobsen E, Robertson C, Durham J, Davies S, Petersen H, Boyers D. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-224. [PMID: 32065109 PMCID: PMC7049908 DOI: 10.3310/hta24070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). REVIEW METHODS Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. RESULTS Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. LIMITATIONS There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. CONCLUSIONS The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. FUTURE WORK There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068512. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Davies
- TMD Unit, University Dental Hospital of Manchester, Manchester, UK
| | - Helen Petersen
- University Dental Hospital of Manchester, Manchester, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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10
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Forssell H, Sipilä K, Teerijoki-Oksa T, Vartiainen P, Kautiainen H, Sintonen H, Kalso E. The impact of chronic orofacial pain on health-related quality of life. Scand J Pain 2019; 20:329-338. [DOI: 10.1515/sjpain-2019-0131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/17/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Health-related quality of life (HRQoL) assessments have been widely used in pain medicine as they are able to reflect the subjective and multidimensional nature of chronic pain. Studies have shown a consistent impairment in HRQoL in different chronic pain conditions. However, it is not known whether HRQoL is impaired in chronic orofacial pain (OFP). The generic 15D HRQoL instrument has been shown to fare as well as or better than other generic HRQoL instruments in the study of chronic pain. The aim was to investigate HRQoL in patients with chronic OFP using the generic 15D HRQoL instrument. The validity of the instrument was tested by studying the association of the 15D data with pain interference.
Methods
One hundred fifty-one patients (mean age 50 years, SD 15 years, 119 females) were recruited from three tertiary facial pain clinics. HRQoL data of the participants were contrasted with that of an age- and gender- standardized sample of general population by comparing the mean 15D scores and profiles. The data for the general population came from the National Health 2011 Survey representing Finnish population aged 18 years and older. Pain interference was assessed using Brief Pain Inventory. Based on pain interference distribution the participants were divided into tertiles. Statistical comparison between patient and population HRQoL values were performed using Monte-Carlo-type simulations. Statistical significance for the hypothesis of linearity was evaluated by using generalized linear models.
Results
The mean 15D score of OFP patients (0.824, SD 0.113) was statistically significantly lower than that of the age- and gender-standardized general population (0.929, SD 0.019) (p < 0.001). The difference between the patients and the general population was also clinically important, i.e. over the minimum clinically important difference in the 15D score. All mean 15D dimension values were significantly lower compared with the general population values (p < 0.001 for all dimensions). The largest differences were seen in the dimensions of discomfort and symptoms (0.418, SD 0.222 vs. 0.816, SD 0.027), sleeping (0.693, SD 0.258 vs. 0.838, SD 0.029), and vitality (0.702, SD 0.221 vs. 0.884 SD 0.026). There was a statistically significant linear decrease in the 15D dimension values (p < 0.001) with increasing pain interference. The greatest differences were found on the dimensions of discomfort and symptoms, sleeping and vitality.
Conclusions
HRQoL is significantly impaired in patients with chronic OFP. A decrease in the 15D dimension values with increasing pain interference indicated convergent validity between 15D and pain interference.
Implications
The findings suggest that 15D is an appropriate instrument for use in the assessment of HRQoL in OFP patients. By showing the usefulness of the 15D, the present study may encourage further use of generic HRQoL assessments in the study of chronic OFP, and contribute e.g. to the implementation of HRQoL as one of the core outcome measures in future treatment studies on chronic OFP.
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Affiliation(s)
- Heli Forssell
- Institute of Dentistry, University of Turku , Lemminkäisenkatu 2 , FIN-21520 Turku , Finland , Phone: +358 405392030
| | - Kirsi Sipilä
- Research Unit of Oral Health Sciences, University of Oulu , Box 5000 , FIN-90014, University of Oulu , Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu , Oulu University Hospital , Box 5000 , FIN-90014, University of Oulu , Finland
| | - Tuija Teerijoki-Oksa
- Department of Oral and Maxillofacial Diseases , Turku University Hospital , Lemminkäisenkatu 2 , FIN-20520 Turku , Finland
| | - Pekka Vartiainen
- Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology , Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki , Haartmaninkatu 2A , FIN-00029 HUS , Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center , Helsinki , Finland
- Primary Health Care Unit, Kuopio University Hospital , Kuopio , Finland
| | - Harri Sintonen
- Department of Public Health , University of Helsinki , PO Box 20 (Tukholmankatu 8 B) , FIN-00014 University of Helsinki , Finland
| | - Eija Kalso
- Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology , Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki , Haartmaninkatu 2A , FIN-00029 HUS , Finland
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Jongen PJ, Ruimschotel RP, Museler-Kreijns YM, Dragstra T, Duyverman L, Valkenburg-Vissers J, Cornelissen J, Lagrand R, Donders R, Hartog A. Improved health-related quality of life, participation, and autonomy in patients with treatment-resistant chronic pain after an intensive social cognitive intervention with the participation of support partners. J Pain Res 2017; 10:2725-2738. [PMID: 29238216 PMCID: PMC5716312 DOI: 10.2147/jpr.s137609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Despite the availability of various specific treatments, most patients with chronic pain (CP) consider their pain problem as undertreated. Recently, multiple sclerosis (MS) patients who were given an intensive 3-day social cognitive treatment with the participation of support partners experienced lasting improvements in health-related quality of life (HRQoL) and self-efficacy. In this study, a similar intervention was given to treatment-resistant CP patients with stressors, relational problems with support partner, and distress, anxiety or depression. Before and 1, 3, and 6 months after the intervention, patients completed the Euro-Qol 5 Dimensions 5 Levels (EQ-5D-5L) and Impact on Participation and Autonomy (IPA) questionnaires (primary outcomes), and the Survey Of Pain Attitudes (SOPA), the Four-Dimensional Symptom Questionnaire (4DSQ) (distress, depression, anxiety, and somatization), and Visual Analog Scale for pain intensity, whereas the support partners completed the Caregiver Strain Index (CSI) questionnaire. Differences between baseline and post-treatment were tested via paired t-tests (significance level 0.05). Of the 39 patients who were included, 34 (87.2%) completed the 3-day treatment. At 1, 3, and 6 months, improvements were seen in EQ-5D-5L-Index (+40.6%; +22.4%; +31.7%), Health Today (+61.8%; +36.3%; +46.8%), Control attitude (+45.8%; not significant [NS]; +55.0%) and decreases in IPA-Problems (−14.8%; NS; −20.4%), Harm attitude (−18.9%; −15.0%; −17.7%), Distress (−17.7%; −31.8%; −37.1%), and Depression (−37.4%; −31.4%; −35.7%) scores. The CSI score had decreased by −29.0%, −21.4%, and −25.9%, respectively. In conclusion, after an intensive 3-day social cognitive intervention, treatment-resistant CP patients experienced substantial and lasting improvements in HRQoL and in problematic limitations to participation and autonomy, in association with improvements in pain attitudes, depression, and distress. To assess whether this innovative approach may be an effective treatment for this subgroup of CP patients, future randomized controlled studies are needed.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Centre Groningen, Groningen.,MS4 Research Institute, Nijmegen
| | | | | | | | | | | | | | - R Lagrand
- Fysio- en Manuele Therapie R. & Y.M. Lagrand, Rotterdam
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A Hartog
- DC Klinieken Rotterdam, Rotterdam
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12
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Breckons M, Bissett SM, Exley C, Araujo-Soares V, Durham J. Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study. JDR Clin Trans Res 2016; 2:48-57. [PMID: 28879244 DOI: 10.1177/2380084416679648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Affiliation(s)
- M Breckons
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S M Bissett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | - C Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J Durham
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
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