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Suri P, Heagerty PJ, Timmons A, Jensen MP. Description and initial validation of a novel measure of pain intensity: the Numeric Rating Scale of Underlying Pain without concurrent Analgesic use. Pain 2024; 165:1482-1492. [PMID: 38189184 PMCID: PMC11189761 DOI: 10.1097/j.pain.0000000000003150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/23/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT Although many individuals with chronic pain use analgesics, the methods used in many randomized controlled trials (RCTs) do not sufficiently account for confounding by differential post-randomization analgesic use. This may lead to underestimation of average treatment effects and diminished power. We introduce (1) a new measure-the Numeric Rating Scale of Underlying Pain without concurrent Analgesic use (NRS-UP (A) )-which can shift the estimand of interest in an RCT to target effects of a treatment on pain intensity in the hypothetical situation where analgesic use was not occurring at the time of outcome assessment; and (2) a new pain construct-an individuals' perceived effect of analgesic use on pain intensity (E A ). The NRS-UP (A) may be used as a secondary outcome in RCTs of point treatments or nonpharmacologic treatments. Among 662 adults with back pain in primary care, participants' mean value of the NRS-UP (A) among those using analgesics was 1.2 NRS points higher than their value on the conventional pain intensity NRS, reflecting a mean E A value of -1.2 NRS points and a perceived beneficial effect of analgesics. More negative values of E A (ie, greater perceived benefit) were associated with a greater number of analgesics used but not with pain intensity, analgesic type, or opioid dose. The NRS-UP (A) and E A were significantly associated with future analgesic use 6 months later, but the conventional pain NRS was not. Future research is needed to determine whether the NRS-UP (A), used as a secondary outcome may allow pain RCTs to target alternative estimands with clinical relevance.
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, USA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Patrick J. Heagerty
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Andrew Timmons
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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2
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Lytras D, Iakovidis P, Sykaras E, Kottaras A, Kasimis K, Myrogiannis I, Barouxakis A, Tarfali G. Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial. Aging Clin Exp Res 2023; 35:3059-3071. [PMID: 37934400 DOI: 10.1007/s40520-023-02604-7] [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: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied. AIM To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP. METHODS Sixty-three women (≥ 65 years) with chronic NSLBP were randomly assigned to intervention (IG) or control (CG) groups. IG received individualized mat-Pilates sessions (45 min, twice weekly), while CG followed a home-based general exercise program. Primary outcomes included visual analog scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), timed up-and-go (TUG), and Berg Balance Scale (BBS) at baseline, 10 weeks, and 6 months post-intervention. Repeated measures multivariate analysis of covariance (MANCOVA) was used, adjusted for exercise adherence and analgesic use. RESULTS IG significantly improved in VAS and RMDQ scores at 10 weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up. CONCLUSIONS A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION NCT04752579/February 12, 2021.
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Affiliation(s)
- Dimitrios Lytras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thermi, 57001, Thessaloniki, Greece.
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece.
| | - Paris Iakovidis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Evaggelos Sykaras
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thermi, 57001, Thessaloniki, Greece
| | - Anastasios Kottaras
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Konstantinos Kasimis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Ioannis Myrogiannis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Aristeidis Barouxakis
- Laboratory of Biomechanics and Ergonomics, Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University - Alexander Campus, Sindos, P.O. Box 141, 57 400, Thessaloniki, Greece
| | - Georgia Tarfali
- Biomedical Engineering Department, Faculty of Engineering, Strathclyde University, Glasgow, UK
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3
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Suri P, Heagerty PJ, Korpak A, Jensen MP, Gold LS, Chan KCG, Timmons A, Friedly J, Jarvik JG, Baraff A. Improving Power and Accuracy in Randomized Controlled Trials of Pain Treatments by Accounting for Concurrent Analgesic Use. THE JOURNAL OF PAIN 2023; 24:332-344. [PMID: 36220482 PMCID: PMC9898095 DOI: 10.1016/j.jpain.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/08/2022]
Abstract
The 0 to 10 numeric rating scale of pain intensity is a standard outcome in randomized controlled trials (RCTs) of pain treatments. For individuals taking analgesics, there may be a disparity between "observed" pain intensity (pain intensity with concurrent analgesic use) and pain intensity without concurrent analgesic use (what the numeric rating scale would be had analgesics not been taken). Using a contemporary causal inference framework, we compare analytic methods that can potentially account for concurrent analgesic use, first in statistical simulations, and second in analyses of real (non-simulated) data from an RCT of lumbar epidural steroid injections. The default analytic method was ignoring analgesic use, which is the most common approach in pain RCTs. Compared to ignoring analgesic use and other analytic methods, simulations showed that a quantitative pain and analgesia composite outcome based on adding 1.5 points to pain intensity for those who were taking an analgesic (the QPAC1.5) optimized power and minimized bias. Analyses of real RCT data supported the results of the simulations, showing greater power with analysis of the QPAC1.5 as compared to ignoring analgesic use and most other methods examined. We propose alternative methods that should be considered in the analysis of pain RCTs. PERSPECTIVE: This article presents the conceptual framework behind a new quantitative pain and analgesia composite outcome, the QPAC1.5, and the results of statistical simulations and analyses of trial data supporting improvements in power and bias using the QPAC1.5. Methods of this type should be considered in the analysis of pain RCTs.
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Affiliation(s)
- Pradeep Suri
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington; Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
| | - Patrick J Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Anna Korpak
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Laura S Gold
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington; Departments of Radiology and Neurological Surgery, University of Washington, Seattle, Washington
| | - Kwun C G Chan
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Andrew Timmons
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
| | - Janna Friedly
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Jeffrey G Jarvik
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington; Departments of Radiology and Neurological Surgery, University of Washington, Seattle, Washington
| | - Aaron Baraff
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington; Department of Statistics, University of Washington, Seattle, Washington
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Patterson T, Turner J, Gnjidic D, Mintzes B, Bennett C, Bywaters L, Clavisi O, Baysari M, Ferreira M, Beckenkamp P, Ferreira P. (C)onsumer focused (E)ducation on p(A)racetamol (S)ide (E)ffects, i(N)adequate (O)utcomes and (W)eaning (CEASE NOW) for individuals with low back pain: results of a feasibility study. BMJ Open 2022; 12:e068164. [PMID: 36424116 PMCID: PMC9693669 DOI: 10.1136/bmjopen-2022-068164] [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: 09/10/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine the feasibility of a patient-education booklet to support patients with low back pain (LBP) to reduce paracetamol intake. DESIGN Single group, repeated measures feasibility study. SETTING Community. PARTICIPANTS Adults experiencing LBP of any kind and self-reporting consumption of paracetamol for LBP weekly for at least 1 month were invited to participate. INTERVENTION Participants received a patient-education booklet 1 week after the baseline measures were collected. The intervention was designed to change beliefs, increase knowledge and self-efficacy to deprescribe paracetamol for their LBP and create discussion with a health professional through the mechanisms of motivation, capacity and opportunity. PRIMARY OUTCOME MEASURES Feasibility of recruitment procedures, data collection and acceptability of the intervention. SECONDARY OUTCOME MEASURES Changes in motivation, self-efficacy, opportunity to deprescribe paracetamol for their LBP, paracetamol usage and LBP clinical outcomes at baseline, 1-week and 1-month follow-up. RESULTS A total of 24 participants were recruited into the study within the timeframe of 3 months from study advertisement and all completed the study follow-up. There were no missing data for any outcome measure across all follow-up points, 22 (91.6%) participants were willing to participate in a future randomised control trial (RCT) and over 60% of participants responded positively to questions regarding acceptability of the patient-educational booklet. Overall, at the 1-month follow-up, approximately two thirds (15/24) of participants had an increase in motivation and self-efficacy scores and had discussed or intended to discuss their paracetamol use for LBP with a health professional. CONCLUSIONS The results of this study demonstrate that the patient-education booklet is feasible to implement, and both the intervention and study design were well-received by participants. This study supports the undertaking an RCT to assess the effects of the patient-education booklet on deprescribing paracetamol in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Justin Turner
- School of Pharmacy, University of Montreal, Montreal, Québec, Canada
| | - Danijela Gnjidic
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Barbara Mintzes
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carol Bennett
- painaustralia, Deakin, Australian Capital Territory, Australia
| | - Lisa Bywaters
- Musculoskeletal Australia, Elsternwick, Victoria, Australia
| | | | - Melissa Baysari
- The University of Sydney, Discipline of Biomedical Informatics and Digital Health, Medicine and Health, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - Manuela Ferreira
- The University of Sydney, Institute of Bone and Joint, Kolling Institute, Faculty of Medicine and Health, St Leonards, New South Wales, Australia
| | - Paula Beckenkamp
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Paulo Ferreira
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
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5
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Bjelkarøy MT, Cheng S, Siddiqui TG, Benth JŠ, Grambaite R, Kristoffersen ES, Lundqvist C. The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults. Scand J Pain 2022; 22:483-493. [PMID: 34913326 DOI: 10.1515/sjpain-2021-0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Central nervous system depressant medications (CNSD) including benzodiazepines, z-hypnotics and opioids are regularly prescribed for the older patient. These medications are linked to dependence and associated with severe side effects in some older patients. Consensus recommendations for this group suggest limiting their use. We have recently described a high proportion of long-term CNSD use and dependence among older in-hospital patients. In this study, we aim to investigate factors associated with pain intensity and presentation of pain among older adults with long-term use of CNSDs compared to non-users. METHODS Two hundred and forty six elderly hospitalised patients were recruited consecutively in a cross-sectional study. Data was collected from patients and electronic health records (EHR). Independent variables were sex, age, education, emotional symptoms (hospital anxiety and depression scale [HADS]), cognitive function (Mini-mental State Examination test [MMSE]), comorbidity (cumulative illness rating score - geriatrics [CIRS-G]), loneliness (the six-item De Jong Gierveld Loneliness Scale) and prolonged (≥4 weeks) use of any CNSDs or prolonged use of opioids (≥4 weeks). All variables, including pain intensity, were collected at one time point consistent with the cross-sectional study design. Statistical analyses included descriptive statistics and linear regression models using the above mentioned variables and pain intensity (visual analogue scale for pain intensity [VAS] pain 0-100) as outcome. Additional information regarding pain presentation was extracted from the patients' EHR. RESULTS Mean pain intensity VAS (SD) was 35.2 (30.4) and 18.1 (24.2) respectively, for patients with vs. without prolonged use of CNSDs. In the multivariable linear regression analysis, prolonged use of CNSDs and opioids were positively associated with pain intensity (VAS) (regression coefficient (95% CI) 20.7 (11.0; 30.3), p<0.001, and 19.8 (5.7; 33.8), p=0.006, respectively), while sex, age, education, MMSE, HADS, CIRS-G and loneliness scores were not. Pain related to back (23.2%) and lower extremities (23.2%) were most common pain sites, and those with one or more pain sites reported overall higher pain intensity compared to those with no reported pain sites (p<0.006). CONCLUSIONS Prolonged use of CNSD medications as well as prolonged use of opioids are both positively associated with pain intensity. The results may have implications for treatment and long-term pain management for older patients.
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Affiliation(s)
- Maria Torheim Bjelkarøy
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Socheat Cheng
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Tahreem Ghazal Siddiqui
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
| | - Ramune Grambaite
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Espen Saxhaug Kristoffersen
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, Faculty of Medicine, University of Oslo, Lorenskog, Norway
- Department of Neurology, Akershus Univeristy Hospital, Lorenskog, Norway
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6
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Lehti TE, Rinkinen MO, Aalto U, Roitto HM, Knuutila M, Öhman H, Kautiainen H, Karppinen H, Tilvis R, Strandberg T, Pitkälä KH. Prevalence of Musculoskeletal Pain and Analgesic Treatment Among Community-Dwelling Older Adults: Changes from 1999 to 2019. Drugs Aging 2021; 38:931-937. [PMID: 34386937 PMCID: PMC8484214 DOI: 10.1007/s40266-021-00888-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
Background Pain is undertreated in older populations. At the same time, increased use of opioids is of concern in the Western world. Aims We sought to analyze temporal trends in musculoskeletal pain and prescribed analgesic treatment among community-dwelling people aged 75–95 years using cross-sectional cohort data spanning 20 years. Methods The Helsinki Aging Study recruited random samples of people aged 75, 80, 85, 90, and 95 years in 1999, 2009, and 2019. In total, 5707 community-dwelling persons participated in the study. The participants reported their medical diagnoses, regular prescription medications, and the presence of back pain or joint pain within the last 2 weeks (never, sometimes, or daily). We compared analgesic use among participants reporting and not reporting musculoskeletal pain in 1999, 2009, and 2019. Results Of the participants, 57–61% reported intermittent or daily musculoskeletal pain. The percentage receiving a prescribed daily analgesic increased from 9% in 1999 to 16% in 2019. The use of non-steroidal anti-inflammatory drugs (NSAIDs) decreased from 1999 to 2019, while the use of paracetamol increased from 2 to 11%. Opioids were taken by 2% in 1999 and 3% in 2019. Of those reporting daily musculoskeletal pain, 20%, 35%, and 32% received regular pain medication in 1999, 2009, and 2019, respectively. Conclusions Pain remains undertreated in the community-dwelling older population, although the use of regular prescribed analgesics increased between 1999 and 2019. The use of NSAIDs has decreased, while the use of paracetamol has increased. Daily opioid use has remained modest.
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Affiliation(s)
- Tuuli Elina Lehti
- Primary Health Care Unit, Helsinki University Hospital, Ilkantie 10 B 22, 00400, Helsinki, Finland. .,Social Services and Health Care Division, City of Helsinki, Helsinki, Finland. .,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
| | - M-O Rinkinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - U Aalto
- Social Services and Health Care Division, City of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H M Roitto
- Social Services and Health Care Division, City of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - M Knuutila
- Social Services and Health Care Division, City of Helsinki, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Öhman
- Geriatric Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - H Karppinen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - R Tilvis
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - T Strandberg
- Geriatric Unit, Department of Internal Medicine, University of Helsinki, Helsinki, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - K H Pitkälä
- Primary Health Care Unit, Helsinki University Hospital, Ilkantie 10 B 22, 00400, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Ozturk O, Sunter AT, Unal M, Selçuk MY, Oruç MA. Evaluation of painkillers according to the principles of rational drug use in patients registered to a family medicine unit. Int J Clin Pract 2021; 75:e14018. [PMID: 33428818 DOI: 10.1111/ijcp.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS We aimed to evaluate knowledge, attitudes and usage of the painkillers within the framework of rational drug use. METHODS This study was conducted in a family medicine unit with a questionnaire consists of 27 questions. RESULTS Total of 506 patients participated in the study. The number of people who used pain medication every day was 29 (5.7%) and paracetamol was the most common analgesic (51.1%). The use of painkillers was more common in women and amongst the patients over 65 years of age. The rate of those who preferred painkillers in the form of pills was higher in married patients and the singles preferred injectables (P = .004). Inappropriate use of painkillers was much more prominent in nonsteroidal antiinflammatory drug users (P < .05). CONCLUSION Demographic features and disease characteristics were the notable factors that affected painkillers selection and the level of knowledge about them.
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Affiliation(s)
- Onur Ozturk
- Clinic of Family Medicine, Samsun Education and Research Hospital, Samsun, Turkey
| | - Ahmet Tevfik Sunter
- Department of Public Health, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Unal
- Department of Family Medicine, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Yasin Selçuk
- Department of Family Medicine, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Muhammet Ali Oruç
- Department of Family Medicine, Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
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8
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Prescribing Patterns of Pain Medications in Unspecific Low Back Pain in Primary Care: A Retrospective Analysis. J Clin Med 2021; 10:jcm10071366. [PMID: 33810469 PMCID: PMC8036853 DOI: 10.3390/jcm10071366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Acute low back pain (LBP) is one of the most prevalent diseases worldwide. Since there is evidence of excessive prescriptions of analgesics, i.e., opioids, the aim of this study was to describe the use of pain medications in patients with LBP in the Swiss primary care setting. A retrospective, observational study was performed using medical prescriptions of 180 general practitioners (GP) during years 2009–2020. Patterns of pain medications (nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, and opioids) as well as co-medications were analyzed in patients with a LBP diagnosis. Univariable and multivariable regression analyses assessed GP and patient characteristics associated with the prescription of pain medication. Patients included were 10,331 (mean age 51.7 years, 51.2% female); 6449 (62.4%) received at least one pain medication and of these 86% receive NSAIDs and 22% opioids. GP characteristics (i.e., self-employment status) and patient characteristics (male gender and number of consultations) were associated with significantly higher odds of receiving any pain medication in multivariable analysis. 3719 patients (36%) received co-medications. Proton-pump-inhibitors and muscle relaxants were the most commonly used co-medications. In conclusion, two-thirds of LBP patients were treated with pain medications. Prescribing patterns were conservative, with little use of strong opioids and co-medications.
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9
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Marttinen MK, Kautiainen H, Haanpää M, Pohjankoski H, Hintikka J, Kauppi MJ. Analgesic purchases among older adults - a population-based study. BMC Public Health 2021; 21:256. [PMID: 33517898 PMCID: PMC7849135 DOI: 10.1186/s12889-021-10272-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.
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Affiliation(s)
- Maiju K Marttinen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland. .,Department of Anesthesiology, Intensive Care and Pain Medication, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, 00290, Helsinki, Finland.
| | - Hannu Kautiainen
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Puijonlaaksontie 2, 70200, Kuopio, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Porkkalankatu 1, 00180, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00270, Helsinki, Finland
| | - Heini Pohjankoski
- Department of Paediatrics, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Jukka Hintikka
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Psychiatry, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
| | - Markku J Kauppi
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.,Department of Rheumatology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland
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Koes B, Schreijenberg M, Tkachev A. Paracetamol for low back pain: the state of the research field. Expert Rev Clin Pharmacol 2020; 13:1059-1066. [PMID: 32878493 DOI: 10.1080/17512433.2020.1817738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Paracetamol is one of the most frequently used analgesics for people with low back pain, but despite its frequent use there is still debate regarding its efficacy and safety for this indication. AREAS COVERED We describe the origin of paracetamol and its proposed mechanisms of action. We focus in on low back pain and describe the evidence it has on the efficacy of paracetamol (taken by patients orally) and current insights on its side-effects. When searching for relevant publications we focused mainly on recent Cochrane reviews and published RCTs. We found that there is increasing evidence that shows paracetamol is not more effective than placebo in patients with acute low back pain. Concerning patients with subacute and chronic back pain, the evidence for or against the efficacy of paracetamol vs placebo is lacking and would need more research. EXPERT OPINION We argue that we still need better evidence on the efficacy of paracetamol for acute and chronic back pain. Until that evidence becomes available paracetamol should still be considered as an option for patients with back pain. However, we suggest that a strategy focusing on non-pharmacological management as the first treatment option in low back pain may be equally effective with less side effects.
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Affiliation(s)
- Bart Koes
- Department of General Practice, Erasmus University Medical Center Rotterdam , Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark , Odense, Denmark
| | - Marco Schreijenberg
- Department of General Practice, Erasmus University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Alexander Tkachev
- Neurology Department, Sechenov University , Moscow, Russia.,Neurology Department, Tkachev Clinic , Volgograd, Russia
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Musich S, Wang SS, Slindee LB, Keown K, Hawkins K, Yeh CS. Using Pain Medication Intensity to Stratify Back Pain Among Older Adults. PAIN MEDICINE 2020; 20:252-266. [PMID: 29394401 PMCID: PMC6374135 DOI: 10.1093/pm/pny007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To examine the prevalence of musculoskeletal back pain among older adults stratified by pain medication intensity to 1) review treatment patterns and 2) consider targeted back pain prevention interventions. Methods A random sample of older adults age 64 years and older was utilized to identify new and recurring back pain. Prescription pain medications from drug claims were used to stratify to five unique intensity levels. The characteristics of each level were determined using regression models. Results About 10% had musculoskeletal back pain. Of these, 54% (N = 20,645) had new back pain and 46% (N = 17,252) had recurring back pain. Overall, about 35% received physical therapy. Pain medication intensity levels included no prescription pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, low-dose opioids, and high-dose opioids (new back pain: 39%, 10%, 6%, 23%, and 23%, respectively; recurring back pain 32%, 9%, 4%, 17%, and 38%, respectively). NSAID and muscle relaxant users were younger, healthier, and received physical therapy. Opioid users were younger, in poorer health, used sleep medications, received physical therapy, and had more falls and higher health care utilization and expenditures. Conclusions New and recurring back pain patients can be stratified by pain medication intensity to review treatment patterns and target back pain prevention programs. Those with back pain but taking no prescription pain medications may benefit from back pain prevention programs. More research on guidelines for treatment options for those on high levels of pain medications is warranted.
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Affiliation(s)
| | | | - Luke B Slindee
- Informatics and Data Science, Optum, Minnetonka, Minnesota
| | - Karen Keown
- UnitedHealthcare Alliances, Optum, Minneapolis, Minnesota
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Abstract
Objective: To characterize the literature describing the therapeutic use of opioids in the elderly. Data Sources: Two electronic databases, EMBASE and MEDLINE, were searched from years 1990 to September 5, 2018. Relevant reference lists were reviewed. Searches were restricted to English language. Study Selection and Data Extraction: Two reviewers independently screened 827 citations to identify observational studies, population-based cohort studies, retrospective analyses, and control trials looking at the management of persistent pain in patients aged ≥65 years and/or frail patients. Data Synthesis: Thirty-nine articles were included in the systematic review. More specifically, 17 observational studies, 7 population-based cohort studies, 10 retrospective analyses, and 4 controlled trials. The most common etiology of persistent pain was musculoskeletal (50%), and the most often adverse effects reported were central nervous system related (41%) and falls/fractures (39%). Relevance to Patient Care and Clinical Practice: As there is a lack of strong evidence-based recommendations for opioid use in the elderly, this review aims to evaluate opioid use in the elderly and compare their efficacy and safety among this population. Conclusions: Overall, central nervous system adverse effects were most commonly seen in the elderly. However, higher quality evidence is required to further appreciate the dose-related effects on efficacy and safety of opioids in the elderly.
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Affiliation(s)
- Melissa Jassal
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Greg Egan
- Vernon Jubilee Hospital, Vernon, British Columbia, Canada
| | - Karen Dahri
- Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Predictors of gastrointestinal bleeding in older persons taking nonsteroidal anti-inflammatory drugs: Results from the FDA adverse events reporting system. J Am Assoc Nurse Pract 2019; 31:206-213. [PMID: 30589757 DOI: 10.1097/jxx.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Older adults continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) to manage chronic pain. The study's purpose was to identify predictors of gastrointestinal (GI) bleeding in older adults taking NSAIDs. METHODS A secondary analysis of the 2016 Food and Drug Administration's Adverse Events Reporting System data was conducted with 1,347 cases aged 65 years and older with an NSAID as the primary suspect for an adverse drug event (ADE). Data included age, sex, NSAID, multiple NSAID use, rivaroxaban, warfarin, clopidogrel, cardiovascular drug (proxy for cardiovascular disease), diabetes drug (proxy for diabetes mellitus), and primary adverse drug response. CONCLUSIONS Aspirin was the primary suspect NSAID in 72.5% of cases. Rivaroxaban was taken in 67.9% of cases. Logistic regression was conducted to predict GI bleed versus other NSAID-related ADEs with age, sex, cardiovascular medication, diabetes medication, warfarin, clopidogrel, concurrent NSAID use, aspirin, and rivaroxaban as predictors. Aspirin, rivaroxaban, and concurrent NSAID were significant predictors of GI bleed. Gastrointestinal bleed risk versus other ADE risk increased by 39.77 times when taking aspirin, rivaroxaban, and another NSAIDs concurrently. IMPLICATIONS FOR PRACTICE Results support reduced NSAID use by older adults, especially aspirin, and avoidance of rivaroxaban in older persons taking NSAIDs.
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Schreijenberg M, Koes BW, Lin CWC. Guideline recommendations on the pharmacological management of non-specific low back pain in primary care - is there a need to change? Expert Rev Clin Pharmacol 2019; 12:145-157. [PMID: 30618319 DOI: 10.1080/17512433.2019.1565992] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Analgesic drugs are often prescribed to patients with non-specific low back pain (NSLBP). Recommendations for non-invasive pharmacological management of NSLBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy. Areas covered: Recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacological treatment, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized. Expert opinion: Although differences exist between guidelines, publications are universally moving away from pharmacotherapy due to the limited efficacy and the risk of adverse effects. NSAIDs have replaced paracetamol as the first choice analgesics for NSLBP in many guidelines. Opioids are generally considered to be a last resort, but opioid prescriptions have been increasing over recent years. Upcoming guideline updates should explicitly shift their focus from pain to function and from pharmacotherapy to non-pharmacological treatments; patient education is important to make sure NSLBP patients accept these changes. To improve the quality of NSLBP care, the evidence-practice gap should be closed through guideline implementation strategies.
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Affiliation(s)
- Marco Schreijenberg
- a Department of General Practice , Erasmus MC, University Medical Center , Rotterdam , The Netherlands
| | - Bart W Koes
- a Department of General Practice , Erasmus MC, University Medical Center , Rotterdam , The Netherlands.,b Center for Muscle and Joint Health , University of Southern Denmark , Odense , Denmark
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Koes BW, Backes D, Bindels PJE. Pharmacotherapy for chronic non-specific low back pain: current and future options. Expert Opin Pharmacother 2018; 19:537-545. [PMID: 29578822 DOI: 10.1080/14656566.2018.1454430] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Low back pain is associated with a large burden-of-illness. It is responsible for the most years lived with disability as compared with any other medical condition. A comprehensive overview of the evidence on pharmacological treatment options for chronic low back pain is lacking. This review evaluates the evidence for the benefits and risks of currently available pharmacological treatments for chronic low back pain. AREAS COVERED The authors focus on the recent (Cochrane) systematic reviews and meta-analyses of randomized clinical trials covering paracetamol (acetaminophen), NSAIDs, muscle relaxants, antidepressants, anticonvulsants, opioids, and other (new) drugs. EXPERT OPINION The overall impression of the efficacy of pharmacological treatments for patients with chronic low back pain is rather sobering. The effects on pain reduction and improvement of function are commonly small to moderate and short lasting when compared to placebo. At the same time, the various types of drugs are not without side-effects. This holds especially true for serious side-effects associated with (prolonged) use of strong opioids. Future studies on patients with chronic back pain should aim to identify subgroups of patients with good response to specific pharmacological treatment to facilitate personalized care.
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Affiliation(s)
- Bart W Koes
- a Department of General Practice , Erasmus MC , Rotterdam , The Netherlands
| | - Daan Backes
- a Department of General Practice , Erasmus MC , Rotterdam , The Netherlands
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Serinken M, Eken C, Karcıoğlu Ö. Intravenous Dexketoprofen versus Intravenous Paracetamol for Dysmenorrhea: A Randomized Controlled Trial. Balkan Med J 2018. [PMID: 29526831 PMCID: PMC6060974 DOI: 10.4274/balkanmedj.2016.0536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dysmenorrhea is one of the most common acute pain disorders among women of reproductive age. AIMS To compare the effects of IV paracetamol with dexketoprofen in patients presenting with primary dysmenorrhea to the emergency department. STUDY DESIGN Randomized controlled trial. METHODS Patients over 18 years old presenting with pelvic pain related to menstruation were eligible for the study. Study patients received 1 g paracetamol or 50 mg dexketoprofen in 100 mL normal saline with a 4-5 minute infusion via the intravenous route. Pain intensity was measured by a visual analog scale at 15 and 30 minutes. Patients were randomized and assigned to either of two study arms via sealed envelopes. Study drugs were identical in color, and thus both personnel and patients were blinded to the study drug. The dexketoprofen group comprised 49 patients, and the paracetamol group had 50 patients in the final analysis. RESULTS The mean age of the study subjects was 20.9±2.5 and the mean duration of the pain was 1.9±1.7 (median: 1, interquartile range: 1 to 2) hours. Both dexketoprofen (median change: 33, 95% CI: 24 to 38) and paracetamol (median change: 21, 95% CI: 12 to 32) effectively reduced the pain at 15 minutes, which was repeated at 30 minutes (median change: 63, 95% CI: 57 to 65 vs 55.5, 95% CI: 50 to 59, respectively). Pain improvement in the dexketoprofen group was better than in the paracetamol group at 15 (median difference: 8, 95% CI: 0 to 16, p=0.048) and 30 (median difference: 6, 95% CI: 1 to 12, p=0.028) minutes, which was statistically significant but not clinically significant. CONCLUSION Dexketotoprofen has a better visual analogue scale score that is not clinically relevant compared to paracetamol.
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Affiliation(s)
- Mustafa Serinken
- Department of Emergency Medicine, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cenker Eken
- Department of Emergency Medicine, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özgür Karcıoğlu
- Clinic of Emergency Medicine, İstanbul Training and Research Hospital, İstanbul, Turkey
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Kikuchi S. The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain. Spine Surg Relat Res 2017; 1:1-6. [PMID: 31440605 PMCID: PMC6698534 DOI: 10.22603/ssrr.1.2016-0022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/13/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Development of evidence-based medicine has made a big change in diagnosis and treatment of chronic low back pain. The recent trend is assessed through a review of literature. METHODS The articles published in these 10 years are reviewed, and important points are examined. RESULTS In diagnosis, challenges for history taking and limit of imaging or clinical guidelines are revealed. In treatment, cognitive behavioral treatment and exercises are proved effective. Sleep disturbance has recently attracted attention as a factor associated with low back pain. Cost-effectiveness of diagnosis and treatment modalities has come to be emphasized. CONCLUSIONS Diagnosis and treatment of chronic low back pain have been significantly changing. Multidisciplinary and multidimensional approach is essential. Chronic low back pain should be treated as a total pain, not a local pain.
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Affiliation(s)
- Shinichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
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Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study. Aging Clin Exp Res 2017; 29:1139-1147. [PMID: 28224474 DOI: 10.1007/s40520-016-0700-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. METHODS The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI <2), mild (BPI 2-3.99), and moderate to severe (BPI 4-10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview. RESULTS Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49 versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR 7.19, 95% CI 4.02-12.9). Nearly one third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication. CONCLUSION Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.
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Teut M, Knilli J, Daus D, Roll S, Witt CM. Qigong or Yoga Versus No Intervention in Older Adults With Chronic Low Back Pain-A Randomized Controlled Trial. THE JOURNAL OF PAIN 2016; 17:796-805. [PMID: 27046802 DOI: 10.1016/j.jpain.2016.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/29/2016] [Accepted: 03/16/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED The aim of this study was to assess the effectiveness of the reduction of chronic lower back pain in older adults using either yoga classes or qigong classes compared with no intervention. Older adults (65 years of age and older) with chronic low back pain were enrolled in and randomly allocated to: 1) yoga (24 classes, 45 minutes each, during 3 months), 2) qigong (12 classes, 90 minutes each, during 3 months), or 3) a control group who received no additional intervention. The pain intensity item of the Functional Rating Index after 3 months was used as primary outcome parameter. A total of 176 patients were randomized (n = 61 yoga, n = 58 qigong, n = 57 control; mean age 73 ± 5.6 years, 89% female). The mean adjusted pain intensity after 3 months was 1.71 for the yoga group (95% confidence interval [CI], 1.54-1.89), 1.67 for the qigong group (95% CI, 1.45-1.89), and 1.89 for no intervention (95% CI, 1.67-2.11). No statistically significant group differences were observed. Possible explanations for this lack of pain relief might include the ineffectiveness of interventions, inappropriate outcomes, or differences in pain perception and processing in older adults. PERSPECTIVE The aim of this study was to assess the effectiveness of the reduction of chronic lower back pain in older adults using either yoga classes or qigong classes compared with no intervention. This 3-armed randomized trial with 176 older adults showed that yoga and qigong were not superior to no treatment in reducing pain and increasing quality of life.
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Affiliation(s)
- Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Judith Knilli
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothea Daus
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zürich, Zürich, Switzerland
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