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Lakshman R, Tomlinson E, Bucknall T. A Systematic Review of Chronic Pain Management Interventions Among Veterans of Recent Wars and Armed Conflicts. Pain Manag Nurs 2024; 25:285-293. [PMID: 38604820 DOI: 10.1016/j.pmn.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To identify chronic pain management strategies aimed to reduce pain intensity and enhance functional outcomes in veterans of wars and armed conflict. DESIGN Systematic review without meta-analysis. DATA SOURCES Key words "chronic pain," "veterans," and "injuries" were used to search for articles in the MEDLINE, CINAHL, APA PsycInfo, and Embase databases. Articles published in English between 2000 and 2023 were included. REVIEW/ANALYSIS METHODS A systematic literature search was conducted in June 2020, updated in April 2023, and managed using Covidence review software. Inclusion criteria focused on combat-injured veterans with chronic pain, excluding nonveterans and civilians treated for acute or chronic pain. Data from included studies were extracted, summarized, and critically appraised using the 2018 Mixed Methods Appraisal Tool. This review is registered with PROSPERO (CRD42020207435). RESULTS Fourteen studies met the inclusion criteria, with 10 of them supporting nonpharmacological approaches for managing chronic pain among veterans of armed conflicts and wars. Interventions included psychological/behavioral therapies, peer support, biofeedback training via telephone-based therapy, manual therapy, yoga, cognitive processing therapy, cognitive-behavioral therapy, and social and community integration to reduce pain intensity and enhance functional outcomes. CONCLUSION Nonpharmacological treatments for chronic pain have increased in recent years, a shift from earlier reliance on pharmacological treatments. More evidence from randomized controlled trials on the benefits of combined pain interventions could improve pain management of veterans with complex care needs.
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Affiliation(s)
- Rital Lakshman
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
| | - Emily Tomlinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia. https://twitter.com/emjane88
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Alfred Health Partnership, Melbourne, Victoria, Australia. https://twitter.com/nursedecisions
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Rodgers-Melnick SN, Trager RJ, Love TE, Dusek JA. Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain: Analysis of the 2019 National Health Interview Survey. J Pain Res 2024; 17:253-264. [PMID: 38260001 PMCID: PMC10800282 DOI: 10.2147/jpr.s439682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Objective To examine variables associated with engagement in (1) integrative health and medicine (IHM) and (2) nonpharmacologic modalities rather than opioids among United States adults with chronic pain. Methods Using the 2019 National Health Interview Survey, we examined sociodemographic, pain, and mental health predictors of (1) the sum of IHM modalities (ie, chiropractic care, yoga/Tai Chi, massage, or meditation/guided imagery) used to manage pain and (2) exclusive engagement in nonpharmacologic pain management modalities (ie, IHM, a chronic pain self-management program, support groups, or physical, rehabilitative, occupational, or talk therapy) or opioids in the past 3 months. Results Metropolitan residency, higher family income, higher education levels, increased number of pain locations, and increased frequency of pain limiting life/work activities were associated with increased odds of IHM engagement. Older age, male sex, non-Hispanic Black/African American race/ethnicity, and daily opioid use were associated with decreased odds of IHM engagement. Older age, male sex, and increased depressive symptoms were associated with decreases in the count of IHM modalities used to manage pain. Metropolitan residency, higher family income, and higher education levels were associated with increased odds of exclusive nonpharmacologic modality engagement. Older age and increasing frequency of pain limiting life/work activities were associated with decreased odds of exclusive nonpharmacologic modality engagement. Conclusions We identified several contrasts between factors prevalent among individuals with chronic pain and factors associated with engagement in nonpharmacologic and IHM modalities. These results support efforts to address barriers to accessing these modalities among subpopulations of adults with chronic pain (eg, older adults, individuals identifying as Black/African American, rural residents, and those with lower levels of education and income).
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Affiliation(s)
- Samuel N Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Robert J Trager
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Thomas E Love
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Crouch TB, Donovan E, Smith WR, Barth K, Becker WC, Svikis D. Patient Motivation to Reduce or Discontinue Opioids for Chronic Pain: Self-efficacy, Barriers, and Readiness to Change. Clin J Pain 2024; 40:18-25. [PMID: 37855333 PMCID: PMC10841444 DOI: 10.1097/ajp.0000000000001167] [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: 06/01/2023] [Accepted: 09/17/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES This study aimed to assess levels and predictors of self-efficacy and motivation to change opioid use among a community sample of patients using opioids for chronic pain, as well as patient-reported barriers to pursuing opioid discontinuation. METHODS Participants with a variety of chronic pain conditions, recruited from ResearchMatch.org , completed a battery of electronic, self-report questionnaires assessing demographic and medical characteristics, pain treatment history, and levels of readiness, self-efficacy, and other attitudes toward reducing or discontinuing opioid use. Multiple regression analyses and analyses of variance were conducted to examine predictors of readiness and self-efficacy to change opioid use. A modified version of rapid qualitative analysis was utilized to analyze themes in participant responses to an open-ended item about "what it would take" to consider opioid discontinuation. RESULTS The final sample included N=119 participants, the majority of whom were female (78.2%), Caucasian (77.3%), and well-educated. Readiness and self-efficacy to decrease or stop opioid use were fairly low on a 0 to 10 Visual Analog Scale (2.6 to 3.8) and significantly higher to decrease than stop ( P <0.01). Higher readiness to change was predicted by lower pain severity and higher concern about opioids, whereas higher self-efficacy was predicted by shorter pain duration. Results from the qualitative analyses revealed that the availability of an alternative treatment option was the most commonly cited requirement to consider opioid discontinuation. DISCUSSION Patients with lower pain severity, shorter duration of pain, and higher concerns about opioids may be a prime target from a motivation standpoint for interventions addressing opioid tapering and discontinuation.
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Affiliation(s)
| | - Emily Donovan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Wally R Smith
- Department of Internal Medicine, Division of General Internal Medicine, Virginia Commonwealth University School of Medicine
| | - Kelly Barth
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - William C Becker
- Department of Internal Medicine, Yale School of Medicine
- VA Connecticut Healthcare System, New Haven, CT
| | - Dace Svikis
- Obstetrics and Gynecology
- Institute for Women's Health
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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Nakase-Richardson R, Cotner BA, Martin AM, Agtarap SD, Tweed A, Esterov D, O'Connor DR, Ching D, Haun JN, Hanks RA, Bergquist TF, Hammond FM, Zafonte RD, Hoffman JM. Provider Perspectives of Facilitators and Barriers to Reaching and Utilizing Chronic Pain Healthcare for Persons With Traumatic Brain Injury: A Qualitative NIDILRR and VA TBI Model Systems Collaborative Project. J Head Trauma Rehabil 2024; 39:E15-E28. [PMID: 38167719 PMCID: PMC10768799 DOI: 10.1097/htr.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To identify facilitators and barriers to reaching and utilizing chronic pain treatments for persons with traumatic brain injury (TBI) organized around an Access to Care framework, which includes dimensions of access to healthcare as a function of supply (ie, provider/system) and demand (ie, patient) factors for a specified patient population. SETTING Community. PARTICIPANTS Clinicians (n = 63) with experience treating persons with TBI were interviewed between October 2020 and November 2021. DESIGN Descriptive, qualitative study. MAIN MEASURES Semistructured open-ended interview of chronic pain management for persons with TBI. Informed by the Access to Care framework, responses were coded by and categorized within the core domains (reaching care, utilizing care) and relevant subdimensions from the supply (affordability of providing care, quality, coordination/continuity, adequacy) and demand (ability to pay, adherence, empowerment, caregiver support) perspective. RESULTS Themes from provider interviews focused on healthcare reaching and healthcare utilization resulted in 19 facilitators and 9 barriers reaching saturation. The most themes fell under the utilization core domain, with themes identified that impact the technical and interpersonal quality of care and care coordination/continuity. Accessibility and availability of specialty care and use of interdisciplinary team that permitted matching patients to treatments were leading thematic facilitators. The leading thematic barrier identified primarily by medical providers was cognitive disability, which is likely directly linked with other leading barriers including high rates of noncompliance and poor follow-up in health care. Medical and behavioral health complexity was also a leading barrier to care and potentially interrelated to other themes identified. CONCLUSION This is the first evidence-based study to inform policy and planning for this complex population to improve access to high-quality chronic pain treatment. Further research is needed to gain a better understanding of the perspectives of individuals with TBI/caregivers to inform interventions to improve access to chronic pain treatment for persons with TBI.
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Affiliation(s)
- Risa Nakase-Richardson
- Mental Health and Behavioral Sciences/Polytrauma (Drs Nakase-Richardson and Martin), Research Service/Polytrauma (Dr Cotner and Ms O'Connor), and Research Service (Dr Haun), James A. Haley Veterans Hospital, Tampa, Florida; Sleep and Pulmonary Division (Dr Nakase-Richardson), Department of Internal Medicine (Dr Cotner), and Department of Child and Family Studies, College of Behavioral Health and Community Sciences (Dr Ching), University of South Florida, Tampa; Defense Health Agency Traumatic Brain Injury Center of Excellence, Tampa, Florida (Dr Nakase-Richardson and Ms Tweed); Craig Hospital Research Department, Englewood, Colorado (Dr Agtarap); 9Line, LLC, Tampa, Florida (Ms Tweed); Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Drs Esterov and Bergquist); Tampa Veterans Research and Education Foundation, Tampa, Florida (Dr Ching); Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan (Dr Hanks); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr Zafonte); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman)
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Nakase-Richardson R, Cotner BA, Agtarap SD, Martin AM, Ching D, O'Connor DR, Tweed A, Haun JN, Hanks RA, Bergquist TF, Hammond FM, Zafonte RD, Hoffman JM. Provider Perceived Facilitators and Barriers to Identifying, Perceiving, and Seeking Healthcare for Chronic Pain After TBI: A Qualitative NIDILRR and VA TBI Model Systems Collaborative Project. J Head Trauma Rehabil 2024; 39:E1-E14. [PMID: 38167718 PMCID: PMC10768806 DOI: 10.1097/htr.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Identify determinants to chronic pain healthcare for persons with traumatic brain injury (TBI) informed by an Access to Care Framework. Findings related to the Access Framework's core domains of identifying a need, perceptions of the need, and seeking healthcare are reported. SETTING Community. PARTICIPANTS Healthcare providers (n = 63) with 2 or more years of experience treating persons with TBI interviewed between October 2020 and November 2021. DESIGN Descriptive, qualitative study. MAIN MEASURES Semi-structured interviews with open-ended questions of chronic pain management for persons with TBI. Informed by the Access Framework, responses were coded by and categorized within the domains of identifying healthcare needs, perceptions of needs, and factors related to healthcare seeking from the supply and demand perspective. RESULTS For the overall sample, 14 facilitators and 6 barriers were endorsed by more than 20% of the provider cohort. Top facilitators included on-site availability of needed resources and treatments (94%), adequate time and provider capability to ensure patient comprehension of diagnosis and treatment plans (83%), and establishing patient motivation and buy-in with the treatment plan (75%). Barriers most endorsed included policies impacting access (46%), wait times for services (41%), and patient uncertainty regarding telehealth commonly due to cognitive and physical challenges (37%). Unique determinants are reported across civilian versus Department of Veterans Affairs (VA) healthcare systems and different provider types. CONCLUSION This is the first evidence-based study to inform policy and planning to improve access to high-quality chronic pain treatments for persons with TBI. Results will inform future interventions at the systems, patient, and policy levels of healthcare that can be tailored to healthcare settings (VA, Civilian) and types of providers (rehabilitation therapists, psychologists, and medical). Evidence-informed interventions may help minimize healthcare disparities experienced by persons with TBI and facilitate access to high-quality, evidence-informed chronic pain care.
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Affiliation(s)
- Risa Nakase-Richardson
- James A. Haley Veterans' Hospital, Tampa, Florida (Dr Nakase-Richardson); Sleep and Pulmonary Division, Department of Internal Medicine, University of South Florida, Tampa (Drs Nakase-Richardson and Cotner); Traumatic Brain Injury Center of Excellence, Defense Health Agency, Tampa, Florida (Dr Nakase-Richardson and Ms Tweed); Research Service/Polytrauma, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Cotner and Haun and Ms O'Connor); Research Department, Craig Hospital, Englewood, Colorado (Dr Agtarap); Mental Health and Behavioral Sciences/Polytrauma, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Martin); Tampa Veterans Research and Education Foundation, Tampa, Florida (Dr Ching); Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa (Dr Ching); 9Line, LLC, Tampa, Florida (Ms Tweed); Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan (Dr Hanks); Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Dr Bergquist); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine & Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston (Dr Zafonte); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman)
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Haun JN, Nakase-Richardson R, Cotner BA, Agtarap SD, Martin AM, Tweed A, Hanks RA, Wittine L, Bergquist TF, Hoffman JM. Stakeholder Engagement to Identify Implementation Strategies to Overcome Barriers to Delivering Chronic Pain Treatments: A NIDILRR and VA TBI Model Systems Collaborative Project. J Head Trauma Rehabil 2024; 39:E29-E40. [PMID: 38167720 PMCID: PMC10768800 DOI: 10.1097/htr.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The purpose of this article is to illustrate the process of stakeholder-engaged intervention mapping approach to identify implementation strategies to overcome data-driven prioritized barriers to receiving chronic pain services for persons with traumatic brain injury (TBI). SETTING Community. PARTICIPANTS Healthcare providers (n = 63) with 2 or more years' experience treating persons with TBI, interviewed between October 2020 and November 2021 provided data for identification of barriers. TBI, chronic pain, and qualitative research subject matter experts (SMEs) participated in the mapping approach. DESIGN Participatory-based research design, using descriptive and intervention mapping approaches. RESULTS Four barriers to accessing chronic pain treatment by persons with TBI which emerged from provider interviews were prioritized for intervention mapping: cognitive deficits of patients (67%); patient comorbidities (63%); mental health and/or substance abuse issues (59%); and patient participation (62%). SMEs used prioritized barriers to develop 4 primary objectives and implementation strategies designed to: (1) engage consumers to validate and identify strategies; (2) tailor pain treatment and delivery to overcome barriers; (3) develop and disseminate guidelines and best practices when delivering care to persons with TBI to support spread; and (4) increase awareness, skills, and readiness of workforce to deliver pain treatment to persons with TBI. SMEs used an evidence-based approach to develop a mapping matrix of the prioritized barriers, implementation objectives, and aligned implementation strategies to impact change. CONCLUSION Implementation science is needed to facilitate knowledge translation into practice for this complex population to overcome barriers to care. Implementation strategies to address barriers to accessing chronic pain care for individuals with TBI were chosen through a participatory approach to engaging SMEs to support these rehabilitation implementation efforts. Future work includes gathering input from individuals with TBI and chronic pain and to move the intervention (implementation) mapping matrix forward to inform future implementation research, policy, and practice.
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Affiliation(s)
- Jolie N Haun
- Research Service/Polytrauma (Drs Haun and Cotner) and Mental Health and Behavioral Sciences/Polytrauma (Drs Nakase-Richardson and Martin), James A. Haley Veterans' Hospital, Tampa, Florida; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City (Dr Haun); Sleep and Pulmonary Division, Department of Internal Medicine, University of South Florida, Tampa (Dr Nakase-Richardson); Traumatic Brain Injury Center of Excellence, Defense Health Agency, Tampa, Florida (Dr Nakase-Richardson and Ms Tweed); Department of Internal Medicine, University of South Florida, Tampa (Dr Cotner); Research Department, Craig Hospital, Englewood, Colorado (Dr Agtarap); 9Line, LLC, Tampa, Florida (Ms Tweed); Department of Physical Medicine and Rehabilitation, School of Medicine, Wayne State University, Detroit, Michigan (Dr Hanks); Medicine, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Wittine); Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Dr Bergquist); and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman)
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Schmiesing A, Liang Y, Turner BJ. Association of nonpharmacologic chronic pain management with function in a low-income population: Evidence from a survey of a sample of Latinos from five states. PM R 2022; 14:1343-1350. [PMID: 34464031 DOI: 10.1002/pmrj.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Low-income minority populations often confront barriers to professional nonpharmacologic management of chronic pain and, without this care, may have poorer daily function. OBJECTIVE To examine the association of professional nonpharmacologic chronic pain management in the past year categorized as physical interventions or mind-body interventions with current functional status. DESIGN Online, population-based survey. SETTING Community-dwelling Latinos from five southwestern states (California, Texas, Arizona, Nevada, and New Mexico). PARTICIPANTS The survey was offered to all Latino online panel members aged 35 to 75 years in 5 states (N = 1007). With weights, this sample represented 11,016,135 persons. Of 516 respondents (51%), 486 (94%) had valid surveys and, of these, 102 members (21%) had chronic noncancer pain. With weights, they represented 1,140,170 persons with chronic pain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Daily impairment in mobility and in activities of daily living (ADLs). RESULTS Of the weighted sample, 37.2% reported daily impairment in mobility and 29.4% in ADLs. Professional physical interventions for chronic pain were received by 41.2% and mind-body interventions received by 33.4% but usually with physical interventions. Adjusted odds ratios (AOR) of daily mobility impairment for respondents who used physical interventions with mind-body interventions or alone were both less than 0.10 (p < .01) versus none. Only professional physical intervention was associated with decreased odds for daily impairment in ADLs (AOR = 0.07; 95% confidence interval = 0.01 to 0.94; p = .045). CONCLUSIONS In a weighted sample of Latinos with chronic pain, professional physical interventions reduced the likelihood of daily impairment in mobility and ADLs.
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Affiliation(s)
- Allie Schmiesing
- Department of Rehabilitation, Stanford Healthcare, Stanford, California, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, California, USA
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Balbale SN, Iroz CB, Schäfer WLA, Johnson JK, Stulberg JJ. A Missing Piece of the Puzzle: Patient and Provider Perspectives on Pain Management Needs and Opioid Prescribing in Inflammatory Bowel Disease Care. CROHN'S & COLITIS 360 2022; 4:otac033. [PMID: 36777413 PMCID: PMC9802220 DOI: 10.1093/crocol/otac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Recent data have shown high rates of opioid misuse among inflammatory bowel disease (IBD) patients. We conducted a qualitative study to explore IBD patient and provider perceptions and experiences with pain management and opioid prescribing. Methods We conducted a focus group with IBD patients and semistructured interviews with IBD-focused physicians and nurses. We used an inductive approach for analysis and the constant comparison method to develop and refine codes and identify prominent themes. We analyzed interview and focus group data concurrently to triangulate themes. Results Nine patients and 10 providers participated. We grouped themes into 3 categories: (1) current practices to manage pain; (2) perceived pain management challenges; and (3) suggestions to optimize pain management. In the first category (current practices), both patients and providers reported building long-term patient-provider relationships and the importance of exploring nonpharmacologic pain management strategies. Patients reported proactively trying remedies infrequently recommended by IBD providers. In the second category (pain management challenges), patients and providers reported concerns about opioid use and having limited options to treat pain safely. Patients discussed chronic pain and having few solutions to manage it. In the third category, providers shared suggestions for improvement such as increasing use of nonpharmacologic pain management strategies and enhancing care coordination. Conclusions Despite some common themes between the 2 groups, we identified some pain management needs (eg, addressing chronic pain) that matter to patients but were seldom discussed by IBD providers. Addressing these areas of potential disconnect is essential to optimize pain management safety in IBD care.
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Affiliation(s)
- Salva N Balbale
- Address correspondence to: Salva N. Balbale, PhD, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 1400, Chicago, IL 60611, USA ()
| | - Cassandra B Iroz
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Willemijn L A Schäfer
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie K Johnson
- Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonah J Stulberg
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
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People with Arthritis-Disability and Provider Experiences With Chronic Opioid Therapy: A Qualitative Inquiry. Disabil Health J 2022; 15:101294. [DOI: 10.1016/j.dhjo.2022.101294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 01/01/2023]
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Subramaniam S, Stryczek KC, Ball S, Stevenson L, Ho PM, Aron DC. Workforce Development to Improve Access to Pain Care for Veterans: A Qualitative Analysis of VA-ECHO Participant Experiences. Health Serv Res Manag Epidemiol 2022; 9:23333928221124806. [PMID: 36093259 PMCID: PMC9452798 DOI: 10.1177/23333928221124806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Objective The prevalence of chronic pain and its links to the opioid epidemic have given way to widespread aims to improve pain management care and reduce opioid use, especially in rural areas. Pain Management Specialty Care Access Network-Extension for Community Health Outcomes (VA-ECHO) promotes increased pain care access to rural Veterans through knowledge sharing from specialists to primary care providers (PCPs). We explored PCP participants’ experiences in VA-ECHO and pain management care. Methods This qualitative study is based on a descriptive secondary analysis of semi-structured interviews (n = 10) and 3 focus groups with PCPs participating in VA-ECHO from 2017–2019. A rapid matrix analysis approach was used to analyze participants’ responses. Results VA-ECHO was an effective workforce development strategy for meeting PCPs’ training needs by providing pain management knowledge and skills training (eg alternative care approaches and communicating treatment options). Having protected time to participate in VA-ECHO was a challenge for many PCPs, mitigated by leadership and administrative support. Participants who volunteer to participate had more positive experiences than those required to attend. Conclusions VA-ECHO could be used for meeting the workforce development needs of PCPs. Respondents were satisfied with the program citing improvement in their practice and increased confidence in providing pain management care to Veterans despite some challenges to participation. These findings offer insight into using VA-ECHO to meet the VHA’s workforce development to improve Veterans’ access to pain management care. The ECHO model presents opportunities for workforce development in large complex healthcare systems and garnering ongoing support for this training model is necessary for promoting workforce development for PCPs.
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Affiliation(s)
| | | | - Sherry Ball
- VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | | | - P. Michael Ho
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - David C. Aron
- VA Northeast Ohio Healthcare System, Cleveland, OH, USA
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Farr M, Brant H, Patel R, Linton MJ, Ambler N, Vyas S, Wedge H, Watkins S, Horwood J. Experiences of patient-led chronic pain peer support groups after pain management programmes: A qualitative study. PAIN MEDICINE 2021; 22:2884-2895. [PMID: 34180996 PMCID: PMC8665998 DOI: 10.1093/pm/pnab189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE A qualitative study of patients' experiences and the impacts of peer support groups that patients maintained after UK NHS group pain management programmes (PMPs). DESIGN Long-term impacts of group PMPs remain unclear, with indications that positive effects can fade. We evaluated a model of continued peer support, co-produced by patients and clinicians, to maintain the therapeutic impact of PMP groups. A protocol was implemented that encouraged patients to continue to meet in their established PMP group for patient-led peer support (without clinical input) after PMPs finished. Peer support aimed to consolidate self-management, and advance social life recovery. We examined the impacts that groups had on attendees, and why some dropped out. METHODS Semi-structured interviews with 38 patients and 7 clinicians, analysed thematically. RESULTS Friendship bonds and mutual understandings of effective ways of coping with pain encouraged participants to maintain recovery following PMPs. After PMP professional involvement has ended, these meetings enabled patients to develop greater agency from the shared sense of helping bring about new achievements or averting setbacks. Peer support extended the understanding of what is possible when living with pain. However, continuing meetings were not right for all. Reasons for not attending included lack of connection with peers. CONCLUSIONS Co-produced peer support groups after PMPs can be a low-cost, effective social intervention, providing emotional, practical and social benefits, with improved self-management skills, stronger social connections and some reduced use of health services. Project resources for developing peer support meetings after PMPs are freely available online.
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Affiliation(s)
- Michelle Farr
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Heather Brant
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rita Patel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Myles-Jay Linton
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nick Ambler
- Pain Management Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Sareeta Vyas
- Pain Management Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Trainee Clinical Psychologist, Clinical Psychology Unit, University of Sheffield, Cathedral Court, Floor F, 1 Vicar Lane, Sheffield, S1 2LT
| | - Hannah Wedge
- Pain Management Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.,Trainee Clinical Psychologist, Clinical Psychology, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff, CF10 3AT
| | - Sue Watkins
- Pain Management Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jeremy Horwood
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Leonard C, Ayele R, Ladebue A, McCreight M, Nolan C, Sandbrink F, Frank JW. Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. PAIN MEDICINE 2021; 22:1167-1173. [PMID: 32974662 DOI: 10.1093/pm/pnaa312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers' and administrators' perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. METHODS We conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments. Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis. RESULTS We interviewed 49 participants from 25 facilities from April through September of 2017. We identified three themes. First, the Veterans Health Administration's integrated health care system is both an asset and a challenge for multimodal chronic pain care. Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment. Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients. Early- and late-adopting sites differed in perceived resource availability. CONCLUSIONS Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources.
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Affiliation(s)
- Chelsea Leonard
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Roman Ayele
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado.,Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado
| | - Amy Ladebue
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Marina McCreight
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Charlotte Nolan
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado
| | - Friedhelm Sandbrink
- Department of Neurology, Washington DC VA Medical Center, Washington, DC.,Department of Neurology, George Washington University, Washington, DC
| | - Joseph W Frank
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
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13
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Turner BJ, Rodriguez N, Bobadilla R, Hernandez AE, Yin Z. Chronic Pain Self-Management Program for Low-Income Patients: Themes from a Qualitative Inquiry. PAIN MEDICINE 2021; 21:e1-e8. [PMID: 30312459 DOI: 10.1093/pm/pny192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine factors influencing initial engagement, ongoing participation, learned behaviors, and subjective functional outcomes after a trial of the Living Better Beyond Pain (LBBP) chronic pain self-management program. DESIGN Qualitative study using the Grounded Theory approach. SETTING Two 60-minute focus groups and phone interviews in May 2017. SUBJECTS Focus groups with 18 participants who completed LBBP and six-month measures; telephone interviews with 17 participants who stopped attending. METHODS Study coordinators randomly selected program completers for focus groups and conducted phone interviews with noncompleters. Inductive thematic analysis was used to identify patterns in semantic content with a recursive process applied to focus group transcripts and interview transcriptions to codify into themes. Themes were categorized according to the Theory of Planned Behavior. RESULTS Focus group and telephone interview participants were primarily Hispanic and unemployed. Attitudes fostering participation in LBBP included dissatisfaction with the status quo, need to reduce pain medication, and lack of training and knowledge about chronic pain. Positive social norms from meeting others with chronic pain and support from the LBBP team encouraged attendance and adoption of behaviors. Transportation, pain, and competing activities were barriers, whereas adapting activities for the disabled was a facilitator. Maintaining behaviors and activities at home was challenging but ultimately rewarding due to improvement in daily function with less pain medication. CONCLUSIONS This qualitative study complements quantitative results showing clinically significant improvements in function after the LBBP program by adding practical insights into ways to increase participation and outcomes. Participants strongly endorsed the need for chronic pain self-management training.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio (UT Health San Antonio), San Antonio, Texas.,Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Natalia Rodriguez
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Raudel Bobadilla
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Arthur E Hernandez
- Dreeben School of Education, University of the Incarnate Word, San Antonio, Texas
| | - Zenong Yin
- Center for Research to Advance Community Health (ReACH), Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas.,Department of Kinesiology, Health and Nutrition, College of Education and Human Development, University of Texas at San Antonio, San Antonio, Texas, USA
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14
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Mannes ZL, Dunne EM, Ferguson EG, Cottler LB, Ennis N. History of opioid use as a risk factor for current use and mental health consequences among retired National Football League athletes: A 9-year follow-up investigation. Drug Alcohol Depend 2020; 215:108251. [PMID: 32916451 PMCID: PMC7590231 DOI: 10.1016/j.drugalcdep.2020.108251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many retired National Football League (NFL) athletes manage pain with opioids during their playing careers and in retirement, though the longitudinal association between opioid use and health outcomes pertinent to an NFL career are not yet known. This study aimed to assess the relationship between opioid use in 2010 and current use, depressive symptoms, and health related quality of life (HRQoL) among NFL retirees. METHODS Former NFL athletes from the Retired NFL Players Association initially recruited in 2010 for a study examining risk factors of opioid use and misuse were re-contacted (N = 89) from 2018 to 2019 and administered measures of pain, opioid use, depressive symptoms, and HRQoL. Binomial regression examined the association between 2010 opioid use with current use, moderate-severe depressive symptoms, and average and above HRQoL (physical and mental) while controlling for covariates. RESULTS Nearly 50 % of retirees using opioids in 2010 currently used. Compared to non-users, retirees who used opioids in 2010 had greater odds of current use (AOR: 3.71, 95 % CI: 1.02-13.56, p = 0.046) and experiencing moderate-severe depressive symptoms (AOR: 5.93, 95 % CI: 1.15-30.54, p = 0.033). Retirees reporting use in 2010 also evidenced lower odds of reporting average or above mental HRQoL (AOR: 0.13, 95 % CI: 0.03-0.67, p = 0.015) compared to non-users. CONCLUSIONS This study showed that among NFL retirees, early retirement opioid use predicted current use and deleterious effects on mental health, including moderate-severe depressive symptoms approximately nine years later. This investigation further supports the importance of early intervention of pain and opioid use among this population.
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Affiliation(s)
- Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States.
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building West, Suite 309, 164 Summit Ave, Providence, RI, 02906, United States; Alpert Medical School, Brown University, Providence, RI, 02906, United States
| | - Erin G Ferguson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, 1225 Center Drive, Room 3146 Gainesville, FL, 32610-0165, United States
| | - Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida P.O. Box 100231, 2004 Mowry Road, Gainesville, FL, 32610, United States
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, 32310, United States
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15
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Carrignan JA, Simmet RT, Coddington M, Gill NW, Greenlee TA, McCafferty R, Rhon DI. Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery? Arch Phys Med Rehabil 2020; 101:1389-1395. [DOI: 10.1016/j.apmr.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/29/2022]
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16
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Finley EP, Schneegans S, Curtis ME, Bebarta VS, Maddry JK, Penney L, McGeary D, Potter JS. Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts. PLoS One 2020; 15:e0234425. [PMID: 32542028 PMCID: PMC7295233 DOI: 10.1371/journal.pone.0234425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 05/26/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.
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Affiliation(s)
- Erin P. Finley
- UT Health San Antonio, San Antonio, Texas, United States of America
- South Texas Veterans Health Care System, San Antonio, Texas, United States of America
| | - Suyen Schneegans
- UT Health San Antonio, San Antonio, Texas, United States of America
| | - Megan E. Curtis
- UT Health San Antonio, San Antonio, Texas, United States of America
| | - Vikhyat S. Bebarta
- University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Joseph K. Maddry
- Emergency Department, Brooke Army Medical Center, San Antonio, Texas, United States of America
- 59th Medical Wing Science and Technology Cell, San Antonio, Texas, United States of America
- San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, United States of America
| | - Lauren Penney
- UT Health San Antonio, San Antonio, Texas, United States of America
- South Texas Veterans Health Care System, San Antonio, Texas, United States of America
| | - Don McGeary
- UT Health San Antonio, San Antonio, Texas, United States of America
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17
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Frank JW, Carey E, Nolan C, Kerns RD, Sandbrink F, Gallagher R, Ho PM. Increased Nonopioid Chronic Pain Treatment in the Veterans Health Administration, 2010-2016. PAIN MEDICINE 2020; 20:869-877. [PMID: 30137520 DOI: 10.1093/pm/pny149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joseph W Frank
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Evan Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Charlotte Nolan
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Departments of Psychiatry, Neurology and Psychology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Friedhelm Sandbrink
- Department of Neurology, Washington DC VA Medical Center, Washington, DC, USA.,Department of Neurology, George Washington University, Washington, DC, USA
| | - Rollin Gallagher
- Center for Health Equity Research and Promotion (CHERP), Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA.,Departments of Psychiatry and Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - P Michael Ho
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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18
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Nichols VP, Toye F, Eldabe S, Sandhu HK, Underwood M, Seers K. Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography. BMJ Open 2020; 10:e032988. [PMID: 32075828 PMCID: PMC7044883 DOI: 10.1136/bmjopen-2019-032988] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them. DESIGN This is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography. DATA SOURCES AND ELIGIBILITY CRITERIA We searched selected databases-Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)-for qualitative studies which provide patients' views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018). DATA EXTRACTION AND SYNTHESIS Papers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument. RESULTS We screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of 'constantly balancing' emerged from the data. CONCLUSIONS People taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always 'on the same page' as their healthcare professional and felt changes in opioid use were often challenging. TRIAL REGISTRATION NUMBER 49470934; Pre-results.
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Affiliation(s)
- Vivien P Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Francine Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Harbinder Kaur Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Kate Seers
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
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19
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Andrews-Cooper IN, Kozachik SL. How Patient Education Influences Utilization of Nonpharmacological Modalities for Persistent Pain Management: An Integrative Review. Pain Manag Nurs 2019; 21:157-164. [PMID: 31521522 DOI: 10.1016/j.pmn.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Opioid analgesic misuse and abuse has given rise to an epidemic that has added to an increase in opioid-related overdoses and deaths. Adults with persistent noncancer pain (PNCP) are primarily treated with opioid analgesics. Many remain on these medications long term. Most of these patients are unaware of other effective measures for managing PNCP, such as nonpharmacologic modalities (NPMs). This lack of familiarity with NPMs presents a key contributor to the problem of NPM underuse among adult PNCP patients. This integrative review sought to identify key factors that contribute to NPMs underuse and the effect of education on patients' adoption or use for PNCP management. DESIGN Integrative review. DATA SOURCES A literature search was conducted using PubMed, CINAHL, Embase, Cochrane, and hand-searching of the literature published between 2002 and November 2017. REVIEW/ANALYSIS METHODS Systematic screening using the Johns Hopkins Nursing evidence appraisal tools yielded articles that were analyzed and synthesized to identify themes, and patterns. RESULTS Nineteen research articles were identified with these main themes: NPMs are effective in PNCP management, lack of familiarity with NPMs influences patients' willingness to try them, and access to local NPMs must be addressed to facilitate use. CONCLUSIONS Findings suggest that patient education about NPMs has the potential to motivate patients to try these modalities, which may increase overall use of NPMs for PCNP. Nurses could play a vital role in ensuring evidence-based NPMs are introduced to PNCP patients, which could increase patients' use of these measures and improve outcomes.
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Affiliation(s)
- Iquo N Andrews-Cooper
- Johns Hopkins School of Nursing, NOVA Interventional Pain Management, Edgewood, Maryland.
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20
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Enhancing Motivation for Change in the Management of Chronic Painful Conditions: a Review of Recent Literature. Curr Pain Headache Rep 2019; 23:75. [PMID: 31388839 DOI: 10.1007/s11916-019-0813-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate and summarize recent empirical research investigating motivational factors for management of chronic pain and headache disorders. RECENT FINDINGS Research on motivation for non-pharmacological treatment of chronic pain and headache disorders has identified factors that influence initiation of and adherence to treatment. To address common factors that inhibit initiation of treatment (i.e., cost, time commitment), several electronic treatments have been developed. Self-efficacy is the most commonly studied psychosocial influence on treatment adherence, with evidence that it is positively correlated with adherence. Other studies have sought to improve adherence to treatment using motivational interviewing interventions. There is currently limited research on how to enhance motivation for initial adherence to non-pharmacological treatment for chronic pain and headache disorders. Instead of enhancing motivation, researchers have looked to reduce barriers to treatment with electronic health treatments; however, many of these studies have focused on intervention feasibility, rather than efficacy or effectiveness. Numerous studies have identified a relationship between self-efficacy and treatment adherence. Although motivational interviewing interventions have been shown to improve adherence to treatment, there is little evidence that they improve treatment outcomes. Recommendations for further investigation include improving interventions to enhance accessibility and adherence to treatment with the goal of improving outcomes, as well as identifying ways to improve treatment initiation and adherence in patients who are currently engaged in long-term opioid therapy.
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21
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Carlin L, Zhao J, Dubin R, Taenzer P, Sidrak H, Furlan A. Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study. PAIN MEDICINE 2019; 19:1140-1146. [PMID: 29036381 DOI: 10.1093/pm/pnx233] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Family physicians in Canada receive little training in chronic pain management; concomitantly, they face increasing pressure to reduce their prescribing of opioids. Project ECHO Ontario Chronic Pain/Opioid Stewardship (ECHO) is a telementoring intervention for primary care practitioners that enhances their pain management skills. This qualitative study reports participants' experiences and assessment of ECHO. Design An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions. Setting University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada. Subjects Seventeen physicians and 20 allied health professionals. Methods Six focus group discussions were conducted at three different sites during 2014 and 2015. Transcripts were analyzed using a qualitative-descriptive approach involving analytic immersion in the data, reflection, and achieving consensus around themes discerned from transcribed discussions. Results Findings resolved into five main themes: 1) challenges of managing chronic pain in primary care; 2) ECHO participation and improvement in patient-provider interaction and participant knowledge; 3) the diffusion of knowledge gained through ECHO to participants' colleagues and patients; 4) ECHO participation generating a sense of community; and 5) disadvantages associated with participating in ECHO. Conclusions Managing patients with chronic pain in primary care can be difficult, particularly in remote or underserved practices. Project ECHO offers guidance to primary care practitioners for their most challenging patients, promotes knowledge acquisition and diffusion, and stimulates the development of a "community of practice."
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Affiliation(s)
- Leslie Carlin
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jane Zhao
- Outpatient Services -Project ECHO, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Ruth Dubin
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul Taenzer
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Hannah Sidrak
- The Tweed Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Furlan
- Department of Medicine, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract
Pain and pain management are a major focus for an orthopedic nurse. However, reliance upon opioid monotherapy creates adverse effects for patients and has contributed to the opioid epidemic across the United States. There have been strategies developed locally and nationally to address the epidemic. Nurses, too, have an ethical and moral obligation to balance the management of pain therapies to alleviate the suffering of their patients, all while being good stewards of opioid medications. Nurses must also take the time to properly educate their patients on good stewardship techniques including proper use and disposal of their opioid medications.
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23
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Polenick CA, Cotton BP, Bryson WC, Birditt KS. Loneliness and Illicit Opioid Use Among Methadone Maintenance Treatment Patients. Subst Use Misuse 2019; 54:2089-2098. [PMID: 31232142 PMCID: PMC6803066 DOI: 10.1080/10826084.2019.1628276] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Loneliness has been linked to greater substance use, especially among women. Yet little is known about how loneliness is associated with treatment outcomes for patients with opioid use disorder (OUD). Objectives: We evaluated how patient reports of using illicit opioids (i.e. heroin or non-prescription pain medications) are linked to perceptions of loneliness in a sample of adults receiving methadone maintenance treatment (MMT), and whether this link varies by gender. Methods: Participants for this cross-sectional observational study included 371 MMT patients aged 18 and older drawn from four opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a self-administered survey assessing sociodemographic and health information, loneliness, illicit opioid use, and MMT characteristics. Logistic regressions were estimated to examine the link between patient odds of illicit opioid use in the past month and perceived loneliness. Results: Patient gender moderated the association between illicit opioid use and loneliness such that severe loneliness was associated with higher odds of using illicit opioids among women (OR = 3.00, 95% CI [1.19, 7.57], p=.020) but lower odds of using illicit opioids among men (OR = 0.35, 95% CI [0.14, 0.87], p=.024), accounting for age, marital status, work status, depressive symptoms, and MMT characteristics (treatment episode, treatment duration, and methadone dose). Conclusions/importance: This study underscores the importance of considering loneliness in the management of OUD. Routine clinical care and treatment may benefit from strategies to build and sustain social connections that support long-term recovery among MMT patients.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan , Ann Arbor , Michigan , USA.,Program for Positive Aging, University of Michigan , Ann Arbor , Michigan , USA.,Institute for Social Research, University of Michigan , Ann Arbor , Michigan , USA.,Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , Michigan , USA
| | | | - William C Bryson
- Department of Psychiatry, Oregon Health and Sciences University , Portland , Oregon , USA
| | - Kira S Birditt
- Institute for Social Research, University of Michigan , Ann Arbor , Michigan , USA
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24
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Baria AM, Pangarkar S, Abrams G, Miaskowski C. Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans. PAIN MEDICINE 2019; 20:14-27. [PMID: 29727005 DOI: 10.1093/pm/pny058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Population Veterans with chronic noncancer pain (CNCP) are a vulnerable population whose care remains a challenge for clinicians, policy-makers, and researchers. As a result of military experience, veterans are exposed to high rates of musculoskeletal injuries, trauma, psychological stressors (e.g., post-traumatic stress disorder, depression, anxiety, substance abuse), and social factors (e.g., homelessness, social isolation, disability, decreased access to medical care) that contribute to the magnitude and impact of CNCP. In the veteran population, sound theoretical models are needed to understand the specific physiological, psychological, and social factors that influence this unique experience. Objective This paper describes an adaption of Gatchel and colleagues' biopsychosocial model of CNCP to veterans and summarizes research findings that support each component of the revised model. The paper concludes with a discussion of important implications for the use of this revised model in clinical practice and future directions for research. Conclusions The adaption of the biopsychosocial model of CNCP for veterans provides a useful and relevant conceptual framework that can be used to guide future research and improve clinical care in this vulnerable population.
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Affiliation(s)
- Ariel M Baria
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,School of Nursing
| | - Sanjog Pangarkar
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
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Lee J, Lin J, Suter LG, Fraenkel L. Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 71:1410-1418. [PMID: 30295422 DOI: 10.1002/acr.23777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/02/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In order to identify opportunities to improve outpatient care, we evaluated patients with systemic lupus erythematosus (SLE) who persistently frequent the emergency department (ED). METHODS We conducted a retrospective study of patients with SLE who frequented the ED for ≥3 visits in a calendar year, from 2013 to 2016. Persistent users were those who met criteria for persistent use for at least 2 of the 4 years, and limited users for 1 of the 4 years. Each ED encounter was categorized as SLE-related, infection-related, pain-related, or other. We compared ED use between persistent and limited users, and analyzed factors associated with pain-related encounters among persistent users through multivariate logistic regression. RESULTS We identified 77 participants who had 1,143 encounters as persistent users, and 52 participants who had 335 encounters as limited users. Persistent users accounted for 77% of ED use by patients with SLE who frequented the ED. Pain-related ED visits were more common among persistent users (32%) than limited users (18%). Among persistent users, most pain-related encounters were discharged from the ED (69%) or within 48 hours of admission (20%). Persistent users with pain-related encounters accounting for >10% of ED use were more likely to be obese, have fewer comorbid conditions, and be on long-term opioid therapy. CONCLUSION Pain is a major cause of ED use. Patients with SLE who persistently utilize the ED for pain are likely to be noncritically ill, as evidenced by frequent discharges from the ED and short-stay admissions. Patients with SLE who persistently frequent the ED for pain represent a viable target for interventions to improve outpatient quality of care.
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Affiliation(s)
- Jiha Lee
- Yale University School of Medicine, New Haven, Connecticut, and University of Michigan, Ann Arbor
| | - Judith Lin
- Yale University School of Medicine, New Haven, Connecticut
| | - Lisa Gale Suter
- Yale University School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut
| | - Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut
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Evans EA, Herman PM, Washington DL, Lorenz KA, Yuan A, Upchurch DM, Marshall N, Hamilton AB, Taylor SL. Gender Differences in Use of Complementary and Integrative Health by U.S. Military Veterans with Chronic Musculoskeletal Pain. Womens Health Issues 2018; 28:379-386. [PMID: 30174254 PMCID: PMC6699154 DOI: 10.1016/j.whi.2018.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/16/2022]
Abstract
AIMS The Veterans Health Administration promotes evidence-based complementary and integrative health (CIH) therapies as nonpharmacologic approaches for chronic pain. We aimed to examine CIH use by gender among veterans with chronic musculoskeletal pain, and variations in gender differences by race/ethnicity and age. METHODS We conducted a secondary analysis of electronic health records provided by all women (n = 79,537) and men (n = 389,269) veterans age 18 to 54 years with chronic musculoskeletal pain who received Veterans Health Administration-provided care between 2010 and 2013. Using gender-stratified multivariate binary logistic regression, we examined predictors of CIH use, tested a race/ethnicity-by-age interaction term, and conducted pairwise comparisons of predicted probabilities. RESULTS Among veterans with chronic musculoskeletal pain, more women than men use CIH (36% vs. 26%), with rates ranging from 25% to 42% among women and 15% to 29% among men, depending on race/ethnicity and age. Among women, patients under age 44 who were Hispanic, White, or patients of other race/ethnicities are similarly likely to use CIH; in contrast, Black women, regardless of age, are least likely to use CIH. Among men, White and Black patients, and especially Black men under age 44, are less likely to use CIH than men of Hispanic or other racial/ethnic identities. CONCLUSIONS Women veteran patients with chronic musculoskeletal pain are more likely than men to use CIH therapies, with variations in CIH use rates by race/ethnicity and age. Tailoring CIH therapy engagement efforts to be sensitive to gender, race/ethnicity, and age could reduce differential CIH use and thereby help to diminish existing health disparities among veterans.
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Affiliation(s)
- Elizabeth A Evans
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
| | | | - Donna L Washington
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Karl A Lorenz
- RAND Corporation, Santa Monica, California; Center for Innovation to Implementation (ci2i), VA Palo Alto Health Care System, Palo Alto, California; Stanford School of Medicine, Stanford, California
| | - Anita Yuan
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
| | - Nell Marshall
- Center for Innovation to Implementation (ci2i), VA Palo Alto Health Care System, Palo Alto, California
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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27
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Lusk SL, Stipp A. Opioid use disorders as an emerging disability. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Outcalt SD, Nicolaidis C, Bair MJ, Myers LJ, Miech EJ, Matthias MS. A Qualitative Examination of Pain Centrality Among Veterans of Iraq and Afghanistan Conflicts. PAIN MEDICINE 2018; 18:211-219. [PMID: 28204704 DOI: 10.1093/pm/pnw137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Centrality of pain refers to the degree to which a patient views chronic pain as integral to his or her life or identity. The purpose of this study was to gain a richer understanding of pain centrality from the perspective of patients who live with chronic pain. Methods Face-to-face interviews were conducted with 26 Veterans with chronic and disabling musculoskeletal pain after completing a stepped care intervention within a randomized controlled trial. Qualitative data were analyzed using an immersion/crystallization approach. We evaluated the role centrality plays in Veterans’ lives and examined whether and how their narratives differ when centrality either significantly decreases or increases after participation in a stepped care intervention for chronic pain. Results Our data identified three emergent themes that characterized pain centrality: 1) control, 2) acceptance, and 3) preoccupation. We identified five characteristics that distinguished patients’ changes in centrality from baseline: 1) biopsychosocial viewpoint, 2) activity level, 3) pain communication, 4) participation in managing own pain, and 5) social support. Conclusions This study highlights centrality of pain as an important construct to consider within the overall patient experience of chronic pain.
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Affiliation(s)
- Samantha D Outcalt
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute Inc, Indianapolis, IN, USA
| | - Christina Nicolaidis
- Regional Research Institute, School of Social Work, Portland State University, Portland, Oregon.,Departments of Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Matthew J Bair
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.,Regenstrief Institute Inc, Indianapolis, IN, USA
| | - Laura J Myers
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA
| | - Edward J Miech
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.,Regenstrief Institute Inc, Indianapolis, IN, USA.,Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marianne S Matthias
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN, Indianapolis, Indiana, USA.,Regenstrief Institute Inc, Indianapolis, IN, USA.,Department of Communication Studies, IUPUI, Indianapolis, Indiana USA
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Carey EP, Nolan C, Kerns RD, Ho PM, Frank JW. Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy. J Gen Intern Med 2018; 33:38-45. [PMID: 29633137 PMCID: PMC5902343 DOI: 10.1007/s11606-018-4324-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Expert guidelines recommend non-pharmacologic treatments and non-opioid medications for chronic pain and recommend against initiating long-term opioid therapy (LTOT). OBJECTIVE We examined whether veterans with incident chronic pain receiving care at facilities with greater utilization of non-pharmacologic treatments and non-opioid medications are less likely to initiate LTOT. DESIGN Retrospective cohort study PARTICIPANTS: Veterans receiving primary care from a Veterans Health Administration facility with incident chronic pain between 1/1/2010 and 12/31/2015 based on either of 2 criteria: (1) persistent moderate-to-severe patient-reported pain and (2) diagnoses "likely to represent" chronic pain. MAIN MEASURES The independent variable was facility-level utilization of pain-related treatment modalities (non-pharmacologic, non-opioid medications, LTOT) in the prior calendar year. The dependent variable was patient-level initiation of LTOT (≥ 90 days within 365 days) in the subsequent year, adjusting for patient characteristics. KEY RESULTS Among 1,094,569 veterans with incident chronic pain from 2010 to 2015, there was wide facility-level variation in utilization of 10 pain-related treatment modalities, including initiation of LTOT (median, 16%; range, 5-32%). Veterans receiving care at facilities with greater utilization of non-pharmacologic treatments were less likely to initiate LTOT in the year following incident chronic pain. Conversely, veterans receiving care at facilities with greater non-opioid and opioid medication utilization were more likely to initiate LTOT; this association was strongest for past year facility-level LTOT initiation (adjusted rate ratio, 2.10; 95% confidence interval, 2.06-2.15, top vs. bottom quartile of facility-level LTOT initiation in prior calendar year). CONCLUSIONS Facility-level utilization patterns of non-pharmacologic, non-opioid, and opioid treatments for chronic pain are associated with subsequent patient-level initiation of LTOT among veterans with incident chronic pain. Further studies should seek to understand facility-level variation in chronic pain care and to identify facility-level utilization patterns that are associated with improved patient outcomes.
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Affiliation(s)
- Evan P Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Charlotte Nolan
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, USA.,Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, USA
| | - P Michael Ho
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph W Frank
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA. .,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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Bachhuber MA, Arnsten JH, Starrels JL, Cunningham CO. Willingness to Participate in Longitudinal Research Among People with Chronic Pain Who Take Medical Cannabis: A Cross-Sectional Survey. Cannabis Cannabinoid Res 2018; 3:45-53. [PMID: 29607410 PMCID: PMC5870058 DOI: 10.1089/can.2017.0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Regulatory barriers limit clinical trials of medical cannabis in the United States. Longitudinal cohort studies may be one feasible alternative that could yield clinically relevant information. Willingness to participate in such studies is not known. Materials and Methods: In October 2016, we surveyed a convenience sample of patients with chronic pain from two New York registered organizations (responsible for growing, processing, distributing, and retailing medical cannabis products). After a vignette describing a longitudinal cohort study involving weekly patient-reported outcomes and quarterly assessments of physical functioning and urine and blood tests, we asked about respondents' willingness to participate. We examined willingness to participate, duration of participation, and frequency of data collections overall and by subgroups, using multivariable logistic regression models. Results: Of 405 respondents (estimated response rate: 30%), 54% were women and 81% were white non-Hispanic. Neuropathy was the most common pain condition (67%) followed by inflammatory bowel disease (19%). Of respondents, 94% (95% CI 92–97%) thought that the study should be done, 85% (95% CI 81–88%) would definitely or probably enroll if asked, 76% (95% CI 72–81%) would participate for ≥1 year, and 59% (95% CI 54–64%) would respond to questions at least daily. Older age was the only factor associated with lower willingness to participate, lower willingness to participate for ≥1 year, and lower willingness to respond to questions at least daily. Conclusions: Nearly all respondents were supportive of the proposed study and most reported that they would enroll if asked. Enhanced engagement with older individuals may be needed to promote equal enrollment. Recruitment for longitudinal cohort studies with frequent data collection appears feasible in this patient population.
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Affiliation(s)
- Marcus A Bachhuber
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Julia H Arnsten
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Joanna L Starrels
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Hulen E, Saha S, Morasco BJ, Zeigler C, Mackey K, Edwards ST. Sources of Distress in Primary Care Opioid Management and the Role of a Controlled Substance Review Group: A Qualitative Study. PAIN MEDICINE 2017; 19:1570-1577. [DOI: 10.1093/pm/pnx259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC)
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University,Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care (CIVIC)
- Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health and Science University,Portland, Oregon, USA
| | - Claire Zeigler
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University,Portland, Oregon
| | - Katherine Mackey
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University,Portland, Oregon
| | - Samuel T Edwards
- Center to Improve Veteran Involvement in Care (CIVIC)
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University,Portland, Oregon
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Slomp FJ, Mayan MJ, Lasiuk GC, Dick BD. The determinants of meaning of pain following an acute traumatic injury. Scand J Caring Sci 2017; 32:672-680. [PMID: 28851066 DOI: 10.1111/scs.12493] [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: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 12/01/2022]
Abstract
RATIONALE AND AIMS Meaning is an integral aspect of life that drives behaviours, actions and emotions. Perception of pain is believed to be affected by the meaning of pain. Our primary aim was to investigate and discuss the determinants of meaning in acute pain following a traumatic injury. METHODOLOGICAL DESIGN Using the Interpretive Description approach, a method of qualitative inquiry, 13 adults hospitalised due to their accidental injuries were recruited. Semi-structured interviews that were digitally recorded were used to collect the data. Ethical approval was received by our local Health Research Ethics Board, and all relevant ethical standards were followed as outlined in the approved ethics proposal. FINDINGS The three primary determinants of meaning during an acute pain event, or the experience of acute pain include permanence of injuries, incongruence of care quality, and personal responses to the injury and care received. Although the permanence of an injury is lasting, we did not find any emotional response to this fact while the participants were hospitalised. The emotion characterising the personal response to the perceived poor quality of hospital care received was anxiety. CONCLUSION Both the technical and personal components of healthcare quality have the potential to increase the perception of pain. Meanings in an acute pain event are primarily related to the determinants of incongruent care and the personal response to that determinant: anxiety.
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Affiliation(s)
- Florence J Slomp
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maria J Mayan
- Faculty of Extension, University of Alberta, Edmonton, AB, Canada
| | - Gerri C Lasiuk
- College of Nursing Simulation Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bruce D Dick
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Edmonton, AB, Canada
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Lim YS, Lee-Won RJ. When retweets persuade: The persuasive effects of dialogic retweeting and the role of social presence in organizations’ Twitter-based communication. TELEMATICS AND INFORMATICS 2017. [DOI: 10.1016/j.tele.2016.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Penney LS, Ritenbaugh C, DeBar LL, Elder C, Deyo RA. Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. BMC FAMILY PRACTICE 2017; 17:164. [PMID: 28403822 PMCID: PMC5390355 DOI: 10.1186/s12875-016-0566-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. METHODS Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. RESULTS We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants' perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. CONCLUSIONS These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers. TRIAL REGISTRATION ClinicalTrials.gov NCT01345409 , date of registration 28/4/2011.
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Affiliation(s)
- Lauren S. Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA
| | - Cheryl Ritenbaugh
- The University of Arizona, Department of Family and Community Medicine, 1450N. Cherry Ave, Tucson, AZ 85719 USA
| | - Lynn L. DeBar
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Charles Elder
- Kaiser Permanente Center for Health Research Northwest Region, 3800N. Interstate Ave, Portland, OR 97227 USA
| | - Richard A. Deyo
- Oregon Health & Science University, 3181S.W. Sam Jackson Park Rd, Portland, OR 97239 USA
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Becker WC, Dorflinger L, Edmond SN, Islam L, Heapy AA, Fraenkel L. Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC FAMILY PRACTICE 2017; 18:41. [PMID: 28320337 PMCID: PMC5359906 DOI: 10.1186/s12875-017-0608-2] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/01/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs). METHODS We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus. RESULTS Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs. CONCLUSIONS In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development.
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Affiliation(s)
- William C. Becker
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | | | - Sara N. Edmond
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | - Leila Islam
- University of Maryland School of Medicine, Baltimore, MD USA
| | - Alicia A. Heapy
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
| | - Liana Fraenkel
- West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT 06516 USA
- Yale University School of Medicine, New Haven, CT USA
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Turner BJ, Liang Y, Rodriguez N, Valerio MA, Rochat A, Potter JS, Winkler P. Gaps in the Public's Knowledge About Chronic Pain: Representative Sample of Hispanic Residents From 5 States. THE JOURNAL OF PAIN 2017; 18:628-636. [PMID: 28088505 PMCID: PMC6023619 DOI: 10.1016/j.jpain.2016.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/07/2016] [Accepted: 12/31/2016] [Indexed: 01/30/2023]
Abstract
Educating the general public about chronic pain and its care is a national health priority. We evaluated knowledge, attitudes, and beliefs (KAB) of a 5-state, population-based sample of Hispanic individuals aged 35 to 75 years without chronic pain, representing more than 8.8 million persons. A Web-based survey assessed KAB using an adapted version of the Survey of Pain Attitudes-Brief and self-reported knowledge about chronic pain (nothing, a little, a lot). In unweighted analyses of participants (N = 349), the mean age was 52.0 (±10.6) years, 54% were women, 53% preferred Spanish, and 39% did not graduate from high school. More participants reported knowing nothing about chronic pain (24%) than a lot (12%). In weighted logistic models with knowing nothing as the reference, knowing a lot was associated with greater KAB for chronic pain-related emotions, functioning, and cure (all P < .01) but poorer KAB about pain medications (P < .001). Associations were similar for those knowing a little. Men and women preferring Spanish had poorer KAB about pain medications than men preferring English (both P < .001). In view of Hispanic individuals' disparities in chronic pain care, these data underscore the need for effective public educational campaigns about chronic pain. PERSPECTIVE In this 5-state representative sample of Hispanic individuals without chronic pain, one-quarter reported knowing nothing about chronic pain and had poorer KAB about multiple aspects of this disease. This study reinforces the need to evaluate and address gaps in the general public's knowledge about chronic pain.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas; Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas.
| | - Yuanyuan Liang
- Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas; Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas
| | - Natalia Rodriguez
- Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas
| | - Melissa A Valerio
- Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas; Department of Health Promotion and Behavioral Science, University of Texas School of Public Health in San Antonio, San Antonio, Texas
| | - Andrea Rochat
- Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas
| | - Jennifer S Potter
- Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Texas
| | - Paula Winkler
- Center for Research to Advance Community Health (ReACH), University of Texas Health San Antonio, San Antonio, Texas; South Central Area Health Education Center, University of Texas Health San Antonio, San Antonio, Texas
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Valerio MA, Rodriguez N, Winkler P, Lopez J, Dennison M, Liang Y, Turner BJ. Comparing two sampling methods to engage hard-to-reach communities in research priority setting. BMC Med Res Methodol 2016; 16:146. [PMID: 27793191 PMCID: PMC5084459 DOI: 10.1186/s12874-016-0242-z] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/08/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Effective community-partnered and patient-centered outcomes research needs to address community priorities. However, optimal sampling methods to engage stakeholders from hard-to-reach, vulnerable communities to generate research priorities have not been identified. METHODS In two similar rural, largely Hispanic communities, a community advisory board guided recruitment of stakeholders affected by chronic pain using a different method in each community: 1) snowball sampling, a chain- referral method or 2) purposive sampling to recruit diverse stakeholders. In both communities, three groups of stakeholders attended a series of three facilitated meetings to orient, brainstorm, and prioritize ideas (9 meetings/community). Using mixed methods analysis, we compared stakeholder recruitment and retention as well as priorities from both communities' stakeholders on mean ratings of their ideas based on importance and feasibility for implementation in their community. RESULTS Of 65 eligible stakeholders in one community recruited by snowball sampling, 55 (85 %) consented, 52 (95 %) attended the first meeting, and 36 (65 %) attended all 3 meetings. In the second community, the purposive sampling method was supplemented by convenience sampling to increase recruitment. Of 69 stakeholders recruited by this combined strategy, 62 (90 %) consented, 36 (58 %) attended the first meeting, and 26 (42 %) attended all 3 meetings. Snowball sampling recruited more Hispanics and disabled persons (all P < 0.05). Despite differing recruitment strategies, stakeholders from the two communities identified largely similar ideas for research, focusing on non-pharmacologic interventions for management of chronic pain. Ratings on importance and feasibility for community implementation differed only on the importance of massage services (P = 0.045) which was higher for the purposive/convenience sampling group and for city improvements/transportation services (P = 0.004) which was higher for the snowball sampling group. CONCLUSIONS In each of the two similar hard-to-reach communities, a community advisory board partnered with researchers to implement a different sampling method to recruit stakeholders. The snowball sampling method achieved greater participation with more Hispanics but also more individuals with disabilities than a purposive-convenience sampling method. However, priorities for research on chronic pain from both stakeholder groups were similar. Although utilizing a snowball sampling method appears to be superior, further research is needed on implementation costs and resources.
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Affiliation(s)
- Melissa A. Valerio
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health in San Antonio, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 USA
| | - Natalia Rodriguez
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio (UTHSCSA), 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229 USA
| | - Paula Winkler
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio (UTHSCSA), 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229 USA
- South Central Area Health Education Center (AHEC), UTHSCSA, 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229 USA
| | - Jaime Lopez
- Frio County AgriLife Extension, 400 S. Pecan Street, Pearsall, TX 78061 USA
| | - Meagen Dennison
- Karnes County AgriLife Extension, 115 N. Market Street, Karnes City, TX 78118 USA
| | - Yuanyuan Liang
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio (UTHSCSA), 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229 USA
- Department of Epidemiology and Biostatistics, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
| | - Barbara J. Turner
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio (UTHSCSA), 7411 John Smith Drive, Suite 1050, San Antonio, TX 78229 USA
- Department of Medicine, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA
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Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016; 65:1-49. [PMID: 26987082 DOI: 10.15585/mmwr.rr6501e1] [Citation(s) in RCA: 1991] [Impact Index Per Article: 248.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.
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Affiliation(s)
- Deborah Dowell
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
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Nielsen S, Campbell G, Peacock A, Smith K, Bruno R, Hall W, Cohen M, Degenhardt L. Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. AUST HEALTH REV 2015; 40:490-499. [PMID: 26599263 DOI: 10.1071/ah15047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/26/2015] [Indexed: 12/13/2022]
Abstract
Objective The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments. Methods The study was performed on a cohort (n=1514) of people prescribed pharmaceutical opioids for chronic non-cancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services. Results Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs; 41%), physiotherapy (16%) and medical and/or pain specialists (15%). Higher opioid dose was associated with increased financial and access barriers to non-opioid treatment. Multivariate analyses indicated being younger, female and having private health insurance were the factors most commonly associated with accessing non-opioid treatments. Conclusions Patients on long-term opioid therapy report using multiple types of pain treatments. High rates of CAM use are concerning given limited evidence of efficacy for some therapies and the low-income status of most people with CNCP. Financial and insurance barriers highlight the importance of considering how different types of treatments are paid for and subsidised. What is known about the topic? Given concerns regarding long-term efficacy, adverse side-effects and risk of misuse and dependence, prescribing guidelines recommend caution in prescribing pharmaceutical opioids in cases of CNCP, typically advising a multidisciplinary approach to treatment. There is a range of evidence supporting different (non-drug) treatment approaches for CNCP to reduce pain severity and increase functioning. However, little is known about the non-opioid treatments used among those with CNCP and the demographic and clinical characteristics that may be associated with the use of different types of treatments. Understanding the use of non-drug therapy among people with CNCP is crucial given the potential to improve pain control for these patients. What does this paper add? The present study found that a wide range of non-opioid treatments was accessed by the study sample, both before and after commencing opioids, indicating that in this sample opioids were not the sole strategy used for pain management. The most common treatment (other than opioids) was CAM, reported by two-fifths of the sample. Having private health insurance was associated with increased use of non-opioid treatments for pain, highlighting the importance of considering how treatments are paid for and potential financial barriers to effective treatments. What are the implications for practitioners? Patients' beliefs and financial barriers may affect the uptake of different treatments. Many patients may be using complementary and alternative approaches with limited evidence to support their use, highlighting the need for clinicians to discuss with patients the range of prescribed and non-prescribed treatments they are accessing and to help them understand the benefits and risks of treatments that have not been tested sufficiently, or have inconsistent evidence, as to their efficacy in improving pain outcomes.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Amy Peacock
- School of Medicine, University of Tasmania, Private Bag 30, Hobart, Tas. 7001, Australia.
| | - Kimberly Smith
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Australia. Email
| | - Milton Cohen
- St Vincent's Clinical School, UNSW Medicine, Level 5 deLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia. Email
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW 2031, Australia.
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Gautam S, Franzini L, Mikhail OI, Chan W, Turner BJ. Longitudinal Analysis of Opioid Analgesic Dose and Diabetes Quality of Care Measures. PAIN MEDICINE 2015; 16:2134-41. [DOI: 10.1111/pme.12835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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