1
|
Morgner C, Dening KH, Dening T, Gibson B. An alternative theoretical approach to develop a new conception about pain in people with dementia. MEDICAL HUMANITIES 2024; 50:545-554. [PMID: 38802249 DOI: 10.1136/medhum-2023-012718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/29/2024]
Abstract
The theoretical approach presented in this paper describes a novel experimental-theoretical methodology to conceptualise pain in people with dementia. Existing procedures for assessment of pain rely on subjective self-report using pain questionnaires and rating scales that have proven to be highly problematic where a person has dementia. Consequently, pain in people with dementia can be undetected and/or undertreated. To address that, we have developed an alternative experimental approach that builds on theoretical and methodological precedents from the arts, humanities and social sciences, for instance, visual thinking strategies, creative thinking or two-step flow of communication. Based on this approach, we designed an experimental workshop setting to ingrate these methodologies to explore pain and its expression in people with dementia. This had led to a new definition of pain as an interruption of the socially mediated process of bodily meaning-making. Furthermore, our experimental methodology could equally well be applied as a training method, where professional staff can intervene into existing implicit meanings and understandings of medical issues. These results emphasise that the future of pain research needs to consider the relational aspects of pain more seriously.
Collapse
Affiliation(s)
| | | | - Tom Dening
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Barry Gibson
- School of Clinical Dentistry & The Healthy Lifespan Institute, The University of Sheffield, Sheffield, UK
| |
Collapse
|
2
|
Sora B, Nieto R, Vall-Roqué H, Conesa J, Pérez-Navarro A, Saigí-Rubió F. Chronic neck and low back pain from personal experiences: a written narrative approach. Pain Manag 2024; 14:183-194. [PMID: 38717373 PMCID: PMC11229442 DOI: 10.1080/17581869.2024.2343648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/12/2024] [Indexed: 06/29/2024] Open
Abstract
Background: Chronic neck and low back pain are very common and have detrimental effects for people and society. In this study, we explore the experiences of individuals with neck and/or back pain using a written narrative methodology. Materials & methods: A total of 92 individuals explained their pain experience using written narratives. Narratives were analyzed through thematic analysis and text data mining. Results: Participants wrote about their experience in terms of pain characteristics, diagnosis process, pain consequences, coping strategies, pain triggers, well-being and future expectations. Text data mining allowed us to identify concurrent networks that were basically related with pain characteristics, management and triggers. Conclusion: Written narratives are useful to understand individuals' experiences from their point of view.
Collapse
Affiliation(s)
- Beatriz Sora
- Faculty of Education Sciences & Psychology, Universitat Rovira i Virgili, Tarragona, Spain
| | - Rubén Nieto
- eHealth Lab, Faculty of Psychology & Education, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Helena Vall-Roqué
- Department of Clinical Psychology & Psychobiology, Faculty of Psychology, Universitat de Barcelona
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
| | - Jordi Conesa
- Faculty of Computer Science, Multimedia & Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Antoni Pérez-Navarro
- Faculty of Computer Science, Multimedia & Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Epi4Health research group, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona,Spain
| |
Collapse
|
3
|
Reezigt R, Beetsma A, Köke A, Hobbelen H, Reneman M. Toward consensus on pain-related content in the pre-registration, undergraduate physical therapy curriculum: a Delphi-study. Physiother Theory Pract 2024; 40:1040-1053. [PMID: 36412979 DOI: 10.1080/09593985.2022.2144562] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Access to pain education for healthcare professionals is an International Association for the Study of Pain's key recommendation to improve pain care. The content of preregistration and undergraduate physical therapy pain curricula, however, is highly variable. OBJECTIVE This study aimed to develop a list, by consensus, of essential pain-related topics for the undergraduate physical therapy curriculum. METHODS A modified Delphi study was conducted in four rounds, including a Delphi Panel (N = 22) consisting of in pain experienced lecturers of preregistration undergraduate physical therapy of Universities of Applied Sciences in the Netherlands, and five Validation Panels. Round 1: topics were provided by the Delphi Panel, postgraduate pain educators, and a literature search. Rounds 2-4: the Delphi Panel rated the topics and commented. All topics were analyzed in terms of importance and degree of consensus. Validation Panels rated the outcome of Round 2. RESULTS The Delphi Panel rated 257, 146, and 90 topics in Rounds 2, 3, and 4, respectively. This resulted in 71 topics judged as "not important," 97 as "important," and 89 as "highly important." In total, 63 topics were rated as "highly important" by the Delphi Panel and Validation Panels. CONCLUSION A list was developed and can serve as a foundation for the development of comprehensive physical therapy pain curricula.
Collapse
Affiliation(s)
- Roland Reezigt
- Department of Physiotherapy, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Anneke Beetsma
- Department of Physiotherapy, Hanze University of Applied Sciences, Groningen, Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- FAITH Research, Groningen, Netherlands
| | - Albere Köke
- Department of Rehabilitation Medicine, Faculty of Health, Life Sciences and Medicine, Care and Public Health Research Institute (Caphri),Maastricht University, Maastricht, Netherlands
- Centre of Expertise in Pain and Rehabilitation, Hoensbroek, Netherlands
- Department of Physiotherapy, Zuyd University of Applied Sciences, Heerlen, Netherlands
- Pain in Motion International Research Group, Brussel, Belgium
| | - Hans Hobbelen
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- FAITH Research, Groningen, Netherlands
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michiel Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
4
|
Shipton E, Steketee C, Visser E. The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum. FRONTIERS IN PAIN RESEARCH 2023; 3:1057114. [PMID: 36700142 PMCID: PMC9869177 DOI: 10.3389/fpain.2022.1057114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Abstract
Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.
Collapse
Affiliation(s)
- Elspeth Shipton
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Carole Steketee
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Eric Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| |
Collapse
|
5
|
Al-Sharaee Y, Al-Moraissi EA, Christidis N, Galvão EL, Falci SGM. Top 100 Cited Publications in the Field of Temporomandibular Disorders: A Bibliometric Analysis. FRONTIERS IN ORAL HEALTH 2022; 3:864519. [PMID: 35571979 PMCID: PMC9091811 DOI: 10.3389/froh.2022.864519] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe aim of this bibliometric research was to identify and analyze the top 100 cited publications in the field of temporomandibular disorders (TMD) in order to guide any professional level with interest in this topic by mapping the current trends in the field of TMD.Materials and MethodsThe Clarivate Analytics' Web of Science database was used to find the top 100 most cited papers in the field of TMD, published from the year 2000 to November 18, 2021, with MeSH terms in the search strategy. Data extracted were ranking, title, main author, institution, publication year, a total of citations, citation average per year, the journal the study was published, journal impact factor, and the number of studies that each journal published. Further, also the percentage of the different study designs, the number of studies regarding a specific area within the field of TMD, and the number of studies per country were also calculated. A ranking of authors was also performed.ResultsThe top cited paper was a study on diagnostic criteria for TMD, with 1,287 citations published in 2014 in the Journal of Oral and Facial Pain and Headache which also had most of the top 100 cited publications. Eighty-one percent of the most cited studies were from the USA and Europe and 33% of the included studies were review articles.ConclusionTaken together, since all papers were considered classic, one can draw the conclusion that researchers in 2000 onward in the field of TMD are interested in (a) diagnostic criteria, (b) TMD symptoms and mainly pain-related symptoms, (c) etiology and risk factors of TMD and mainly bruxism, and (d) treatment of TMD. However, topics such as imaging, occlusion, tissue engineering, and disk displacements are presently not as popular.
Collapse
Affiliation(s)
- Yaser Al-Sharaee
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Dhamar, Yemen
- *Correspondence: Essam Ahmed Al-Moraissi ;
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Endi Lanza Galvão
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales Do Jequitinhonha e Mucuri, São Paulo, Brazil
| | - Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales Do Jequitinhonha e Mucuri, São Paulo, Brazil
| |
Collapse
|
6
|
Fitzgerald K, Vaughan B, Devonshire E, Schneider C, Denham R. No gain without pain education: Improving knowledge and biopsychosocial attitudes and beliefs in a predominantly non-health-related undergraduate target audience. Musculoskeletal Care 2022; 20:660-665. [PMID: 35278023 DOI: 10.1002/msc.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Chronic pain (CP) impacts individuals and society and is the leading cause of disability globally. Pain education interventions are often evaluated in patients and health professional students, but not in non-health student groups. Increasing knowledge of pain may facilitate shifts in attitudes and beliefs towards sufferers. We report on changes in pain knowledge, attitudes and beliefs of predominantly non-health-related tertiary degree students participating in online education. METHODS Quantitative cohort study design. Students reported demographics and completed the Chronic Pain Myth Scale and 12-item Neurophysiology of Pain Questionnaire (NPQ) before (T1) and after (T2) the 7-week online module at The University of Sydney in 2020. RESULTS Twenty-two students undertaking predominantly non-health-related bachelor's degrees (16.5% response rate, 90.9% female, mean = 19.5 years) participated. NPQ scores increased from 47.3% to 62.9%. Attitudes and beliefs towards biopsychosocial impact improved (p < 0.027) but not towards individuals suffering from CP or treatment of CP. A negative correlation was found between age and people suffering from CP (ρ = -0.437, p < 0.042) and age and towards treatment of CP; ρ = -0.556, p < 0.007) at T2. CONCLUSION Completing the elective online module resulted in improved knowledge and biopsychosocial attitudes towards CP in this predominantly non-health cohort, as reported in health and patient cohorts.
Collapse
Affiliation(s)
- Kylie Fitzgerald
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Brett Vaughan
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Devonshire
- Pain Education Unit, Sydney Medical School - Northern, The University of Sydney, Sydney, New South Wales, Australia
| | - Carl Schneider
- School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Denham
- Educational Innovation, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Rop S, Matheri JM, Tawa N. Knowledge, attitudes and practice of clinicians managing chronic pain in a tertiary care facility. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1597. [PMID: 35169653 PMCID: PMC8831966 DOI: 10.4102/sajp.v78i1.1597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/13/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Solomon Rop
- Department of Rehabilitation Science, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Joseph M. Matheri
- Department of Rehabilitation Science, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nassib Tawa
- Department of Rehabilitation Science, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
8
|
de Oliveira Lima L, Saragiotto BT, Costa LOP, Nogueira LC, Meziat-Filho N, Reis FJJ. Self-Guided Web-Based Pain Education for People With Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6309587. [PMID: 34174081 DOI: 10.1093/ptj/pzab167] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/09/2021] [Accepted: 05/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of web-based pain education programs without clinical support in patients with musculoskeletal pain. METHODS PubMed, Scopus, CINAHL, Web of Science, Cochrane Library, and PsycINFO were searched from inception to February 2020. Included studies were randomized clinical trials in which people with musculoskeletal pain were allocated to an experimental group that received web-based pain education as a standalone approach. Three review authors performed data extraction. The PEDro (Physiotherapy Evidence Database) scale was used to assess the methodological quality of the studies. The primary outcomes were pain intensity and disability. RESULTS Six trials with a total of 1664 participants were included. There is moderate-quality evidence with a small effect size that web-based pain education programs, as a standalone approach, are better than minimal intervention (no intervention or booklets) for pain intensity (standardized mean difference [SMD] = -0.23; 95% CI = -0.43 to -0.04) in the short term and intermediate term (SMD = -0.26; 95% CI = -0.42 to -0.10). Regarding disability, there is low-quality evidence that web-based pain education programs are better than minimal intervention (SMD = -0.36; 95% CI = -0.64 to -0.07) in the short term. Web-based pain education added to usual care was no better than usual care alone in the intermediate or long term for primary outcomes. CONCLUSIONS Web-based pain education for adults with musculoskeletal pain, as a standalone approach, was better than minimal intervention for pain intensity and disability in the short term, and for pain intensity in the intermediate term. Web-based pain education added to usual care did not provide additional benefits for primary outcomes in the intermediate or long term. IMPACT Web-based pain education as a standalone intervention provided small improvements in pain intensity and disability in patients with chronic musculoskeletal pain. Poorly resourced settings and overburdened health systems should consider this delivery method in the management of chronic musculoskeletal pain. LAY SUMMARY If you have chronic musculoskeletal pain, your physical therapist might recommend web-based pain education as treatment to help you reduce pain intensity and disability.
Collapse
Affiliation(s)
- Lívia de Oliveira Lima
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Bruno T Saragiotto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Leandro Calazans Nogueira
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.,Postgraduation Progam in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Postgraduation Progam in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil.,Postgraduation Progam in Clinical Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
9
|
Therapeutic Effects of Traditional Chinese Exercises on Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Pain Res Manag 2021; 2021:5584997. [PMID: 34055119 PMCID: PMC8131159 DOI: 10.1155/2021/5584997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023]
Abstract
Background The number of patients with musculoskeletal pain, which seriously affects people's quality of life, has increased. Traditional Chinese exercises are accepted and practiced to strengthen the body. Objective This study aims to explore the efficacy of traditional Chinese exercises for the treatment of musculoskeletal pain. Methods A comprehensive search of randomized controlled trials (RCTs) related to traditional Chinese exercises on patients with musculoskeletal pain was completed using PubMed, SinoMed, CNKI, VIP, and Wanfang Med Online databases. All RCTs published until February 2021 were considered. Two researchers independently screened the literature according to the predesigned inclusion and exclusion criteria, and data was extracted and assessed for their risk of bias via the Cochrane collaboration tool. Meta-analysis was performed using RevMan5.2 and Rx64 4.0.2 software. Results A total of 45 RCT studies with 3178 patients were included. Traditional Chinese exercises were able to effectively alleviate patients with musculoskeletal pain (MD = −1.54, 95% confidence interval (−1.88, −1.19), P < 0.01). Among them, the Yi Jin Jing exercise was superior to other exercises, while Wu Qin Xi showed no significant effects. Besides, traditional Chinese exercises had significant positive effects on the dysfunction and stiffness of the waist and knee joints. Traditional Chinese exercises could effectively relieve the clinical symptoms of patients with musculoskeletal pain. Particularly, the Yi Jin Jing exercise presented the most significant positive effect on pain reduction.
Collapse
|
10
|
Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
Collapse
Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
| |
Collapse
|
11
|
Al Sayegh S, Vasilatou I, Kumar A, Al Barwari C, Fredriksson L, Grigoriadis A, Christidis N. Experimental pain and fatigue induced by excessive chewing. BMC Oral Health 2020; 20:179. [PMID: 32600327 PMCID: PMC7322929 DOI: 10.1186/s12903-020-01161-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background The study was aiming to optimize excessive gum chewing as an experimental model to induce jaw muscle pain and fatigue similar to those in painful TMDs with durations that would allow immediate investigations of jaw-motor function. Further, if any sex differences would be detected in the expression of pain. Methods This randomized, double blinded study included 31 healthy participants of both sexes. A standardized chewing protocol of either 40- or 60-min of chewing was used with a wash-out period of 1 week. Subjective fatigue, pain characteristics and functional measures were assessed. For statistical analyses, Wilcoxon Signed Rank test, Mann–Whitney Rank Sum test and Friedman’s ANOVA with Tukey post-hoc test were used. Results High subjective fatigue scores that lasted up to 20 min after the end of the trial were significantly induced both in the 40- and 60-min chewing trials (P < 0.001*). Significant but mild pain was induced only in the 60-min trial (P = 0.004*) and only in men (P = 0.04*). Also, the induced pain area was significantly bigger in the 60-min trial (P = 0.009*). However, this increase in pain and pain area did not last to the first 10-min follow-up. There were no significant differences neither between the 40- and 60-min chewing trials, except regarding the pain area (P = 0.008*), nor between the sexes. Conclusion Taken together, excessive chewing in its current form does not seem to be a proper pain experimental model. The model needs further adjustments in order to mimic TMD-pain especially in women and to prolong the pain duration.
Collapse
Affiliation(s)
- Samaa Al Sayegh
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden. .,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.
| | - Ioanna Vasilatou
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden
| | - Abhishek Kumar
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Ceva Al Barwari
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden
| | - Lars Fredriksson
- Department of Clinical Oral Physiology at the Eastman Institute, Folktandvården Stockholms län AB, SE-113 24, Stockholm, Sweden
| | - Anastasios Grigoriadis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4046, SE-141 04, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| |
Collapse
|
12
|
Al‐Moraissi EA, Alradom J, Aladashi O, Goddard G, Christidis N. Needling therapies in the management of myofascial pain of the masticatory muscles: A network meta‐analysis of randomised clinical trials. J Oral Rehabil 2020; 47:910-922. [DOI: 10.1111/joor.12960] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/31/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Jabr Alradom
- Department of Oral and Maxillofacial Surgery Thamar University Thamar Yemen
| | - Omar Aladashi
- Department of Oral and Maxilofacial Surgery Cairo University Cairo Egypt
| | - Greg Goddard
- Center for Orofacial Pain University of California at San Francisco San Francisco CA USA
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Scandinavian Center for Orofacial Neuroscience Huddinge Sweden
| |
Collapse
|
13
|
Deslauriers S, Déry J, Proulx K, Laliberté M, Desmeules F, Feldman DE, Perreault K. Effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders: a systematic review. Disabil Rehabil 2019; 43:611-620. [PMID: 31304824 DOI: 10.1080/09638288.2019.1639222] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This systematic review aimed to assess the scientific evidence on the effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders. METHODS A literature search was conducted in three databases (Medline, CINAHL, and Embase) for articles assessing the effects of waiting for outpatient physiotherapy services in persons with musculoskeletal disorders. Clinical and health system outcomes were analyzed. RESULTS Sixteen studies met the inclusion criteria for this review. The studies varied in designs, settings, and populations. The definition of waiting also varied between studies. The studies were of low to high methodological quality. Waiting for outpatient physiotherapy services was shown to have mixed results on clinical and health system outcomes. Results from included studies suggest the possible detrimental effects of waiting on pain, disability, quality of life, and psychological symptoms in persons with musculoskeletal disorders. There was also evidence of higher healthcare utilization and costs for patients who wait longer before physiotherapy services. CONCLUSIONS This review provides mixed evidence that suggest potential detrimental effects on the health of individuals with MSDs and at the health system level. Further high-quality studies are needed, such as longitudinal studies specifically addressing the effects of waiting due to lack of access to physiotherapy services.IMPLICATIONS FOR REHABILITATIONThe findings from this review suggest potential detrimental effects on health outcomes when patients wait longer before receiving physiotherapy services.The findings also suggest higher healthcare utilization and costs for patients with longer wait times compared to those who receive physiotherapy services more rapidly.This review suggests the need to assess and implement strategies and policies to ensure timely access to physiotherapy.
Collapse
Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Julien Déry
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ketsia Proulx
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Maude Laliberté
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Maisonneuve-Rosemont Hospital Research Centre (CRHMR), Montreal, Canada
| | - Debbie E Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Public Health Research Institute of Université de Montréal, Montréal, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada
| |
Collapse
|
14
|
Mailis A, Lakha SF. From (Ontario Ministry of Health and Long-Term Care) policy to implementation: A retrospective look at a community-based patient-centered model of care for chronic pain. Can J Pain 2019; 3:114-125. [PMID: 35005400 PMCID: PMC8730640 DOI: 10.1080/24740527.2019.1614880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Chronic pain is one of the most widely recognized, disabling, and expensive health problems in Canada. Interdisciplinary multimodal pain management is effective in helping chronic pain patients lessen symptoms and reclaim functionality, but most patients lack access to such treatments. Aim: The aim of this study was to describe the development and implementation of a publicly funded and patient-centered model of care in the community. Methods: The study was set in the Pain & Wellness Centre (PWC) in Vaughan, the only community-based chronic pain clinic in Ontario funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) as a demonstration project of a template for similar future community clinics. The study is descriptive, including a brief review of the Ontario comprehensive pain strategy framework and an overview of the PWC and the process involved in the development of an interdisciplinary pain program (IDP), based on the biopsychosocial model of chronic pain management. Results: During a 2.5-year period, the PWC has offered 1055 new patient medical consultations and 1921 follow-up visits and admitted 242 patients in the IDP program (demonstrating significant success in patient outcomes at the 3-month exit from the program). It established robust outcomes research, organized educational programs for pain trainees, and cultivated a collaborative relationship with the Toronto Academic Pain Medicine (TAPMI) network and the community at large. Conclusions: This demonstration program has shown the feasibility and applicability of the principles of the MOHLTC comprehensive pain strategy, providing an effective, evidence-based, and accountable approach to chronic pain diagnosis and management in the community.
Collapse
Affiliation(s)
- Angela Mailis
- Pain & Wellness Center, Vaughan, Ontario, Canada.,University of Toronto, Ontario, Canada
| | - S Fatima Lakha
- Pain & Wellness Center, Vaughan, Ontario, Canada.,University of Toronto, Ontario, Canada
| |
Collapse
|
15
|
Odenigbo C, Julien N, Benyamina Douma N, Lacasse A. The importance of chronic pain education and awareness amongst occupational safety and health professionals. J Pain Res 2019; 12:1385-1392. [PMID: 31118756 PMCID: PMC6507068 DOI: 10.2147/jpr.s202041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: Occupational safety and health (OSH) professionals are often the point of contact for health and safety policies derived in the workplace, and the handling of incidents in their aftermath. As chronic pain affects 20% of people, many pain-awareness campaigns and educational activities target healthcare professionals. However, initiatives directed toward OSH professionals are also important to aid in prevention and rehabilitation efforts. The objective of this study was to describe knowledge and attitudes of OSH students with regard to chronic pain. Methods: A web-based cross-sectional study was conducted amongst a convenience sample of 88 students enrolled in the distance learning OSH undergraduate certificate program at the Université du Québec en Abitibi-Témiscamingue (Quebec, Canada). Results: Although 30% of students were already employed within OSH or human resources and 40% reported intervening in cases involving chronic pain in their line of work, 56% of respondents had received no training on chronic pain and its treatment in the past five years. Only 14% chose to take the optional 45 hr course dedicated to pain within the program. OSH students also exhibited poorer knowledge and more negative attitudes toward people suffering from chronic pain when compared to other groups assessed in the province of Quebec, including healthcare professionals, chronic pain patients, and people not suffering from chronic pain (p≤0.0002). Half of the respondents (51.9%) were not aware that chronic pain affects 1 in 5 adults. Conclusion: Our study demonstrates a need for pain education within OSH training programs and through continuing education.
Collapse
Affiliation(s)
- Chúk Odenigbo
- Department of Environmental and Occupational Health, School of Public Health, Montreal University, Montreal, Quebec, Canada
| | - Nancy Julien
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Nabiha Benyamina Douma
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
| |
Collapse
|
16
|
Whitsel BL, Vierck CJ, Waters RS, Tommerdahl M, Favorov OV. Contributions of Nociresponsive Area 3a to Normal and Abnormal Somatosensory Perception. THE JOURNAL OF PAIN 2019; 20:405-419. [PMID: 30227224 PMCID: PMC6420406 DOI: 10.1016/j.jpain.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/12/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022]
Abstract
Traditionally, cytoarchitectonic area 3a of primary somatosensory cortex (SI) has been regarded as a proprioceptive relay to motor cortex. However, neuronal spike-train recordings and optical intrinsic signal imaging, obtained from nonhuman sensorimotor cortex, show that neuronal activity in some of the cortical columns in area 3a can be readily triggered by a C-nociceptor afferent drive. These findings indicate that area 3a is a critical link in cerebral cortical encoding of secondary/slow pain. Also, area 3a contributes to abnormal pain processing in the presence of activity-dependent reversal of gamma-aminobutyric acid A receptor-mediated inhibition. Accordingly, abnormal processing within area 3a may contribute mechanistically to generation of clinical pain conditions. PERSPECTIVE: Optical imaging and neurophysiological mapping of area 3a of SI has revealed substantial driving from unmyelinated cutaneous nociceptors, complementing input to areas 3b and 1 of SI from myelinated nociceptors and non-nociceptors. These and related findings force a reconsideration of mechanisms for SI processing of pain.
Collapse
Affiliation(s)
- Barry L Whitsel
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - Charles J Vierck
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida
| | - Robert S Waters
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina
| | - Oleg V Favorov
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
17
|
Martorella G, Kostic M, Lacasse A, Schluck G, Abbott L. Knowledge, Beliefs, and Attitudes of Emergency Nurses Toward People With Chronic Pain. SAGE Open Nurs 2019; 5:2377960819871805. [PMID: 33415252 PMCID: PMC7774372 DOI: 10.1177/2377960819871805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022] Open
Abstract
More and more people suffering from chronic pain (CP) utilize the emergency department (ED). However, their needs are not properly addressed. Stigmatization toward people with CP can partially explain this gap. Most studies in the ED have been focused on measuring nurses' pain management knowledge in general, not negative attitudes toward CP. Hence, understanding of the determinants of the stigma related to CP is needed. The objectives of this study were to (a) describe the knowledge, beliefs, and attitudes of ED nurses toward people suffering from CP and (b) identify nurses' characteristics associated with these perceptions. A cross-sectional web-based survey design was conducted using the KnowPain-12 questionnaire and the Chronic Pain Myth Scale. A total of 571 participants from 20 different states across the United States were recruited among whom 482 completed the entire survey. The sample included about one third of the ED nurses suffering from CP. Negative beliefs and attitudes toward people with CP were present in a considerable proportion of participants (up to 64%), even in nurses suffering from CP (up to 47.5%). Nevertheless, our results suggest that higher levels of education and suffering from CP were associated with better beliefs and attitudes toward people with CP. The ED presents an increased risk of stigmatization of people with CP as compared with the general population. Identifying determinants of the stigma associated with CP is crucial, as it will help tailoring awareness and educational campaigns. In addition, CP patients utilizing the ED often have complex needs which are difficult to address in this clinical environment. This situation can contribute to negative beliefs and attitudes. Given the scarcity of specialized care clinics for this population, health-care stakeholders should devise solutions to improve continuity of care in primary care settings and between the latter and ED.
Collapse
Affiliation(s)
- Geraldine Martorella
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Michelle Kostic
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Anaïs Lacasse
- Laboratoire de recherche en épidémiologie de la douleur chronique, Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Glenna Schluck
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Laurie Abbott
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
18
|
Shipton EE, Bate F, Garrick R, Steketee C, Shipton EA, Visser EJ. Systematic Review of Pain Medicine Content, Teaching, and Assessment in Medical School Curricula Internationally. Pain Ther 2018; 7:139-161. [PMID: 30058045 PMCID: PMC6251835 DOI: 10.1007/s40122-018-0103-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction Pain management is a major health care challenge in terms of the significant prevalence of pain and the negative consequences of poor management. Consequently, there have been international calls to improve pain medicine education for medical students. This systematic review examines the literature on pain medicine education at medical schools internationally, with a particular interest in studies that make reference to: a defined pain medicine curriculum, specific pain medicine learning objectives, dedicated pain education modules, core pain topics, medical specialties that teach pain medicine, elective study opportunities, hours allocated to teaching pain medicine during the curriculum, the status of pain medicine in the curriculum (compulsory or optional), as well as teaching, learning, and assessment methods. Methods A systematic review was undertaken of relevant studies on pain medicine education for medical students published between January 1987 and May 2018 using PubMed, Medline, Excerpta Medica database (EMBASE), Education Resources Information Center (ERIC), and Google Scholar, and Best Evidence Medical Education (BEME) data bases. Results Fourteen studies met the inclusion criteria. Evaluation of pain medicine curricula has been undertaken at 383 medical schools in Australia, New Zealand, the United States of America (USA), Canada, the United Kingdom (UK), and Europe. Pain medicine was mostly incorporated into medical courses such as anaesthesia or pharmacology, rather than presented as a dedicated pain medicine module. Ninety-six percent of medical schools in the UK and USA, and nearly 80% of medical schools in Europe had no compulsory dedicated teaching in pain medicine. On average, the median number of hours of pain content in the entire curriculum was 20 in Canada (2009), 20 in Australia and New Zealand (2018), 13 in the UK (2011), 12 in Europe (2012/2013), and 11 in the USA (2009). Neurophysiology and pharmacology pain topics were given priority by medical schools in all countries. Lectures, seminars, and case-based instruction were the teaching methods most commonly employed. When it was undertaken, medical schools mostly assessed student competency in pain medicine using written examinations rather than clinical assessments. Conclusions This systematic review has revealed that pain medicine education at medical schools internationally does not adequately respond to societal needs in terms of the prevalence and public health impact of inadequately managed pain. Electronic supplementary material The online version of this article (10.1007/s40122-018-0103-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elspeth E Shipton
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| | - Frank Bate
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| | - Raymond Garrick
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| | - Carole Steketee
- The Learning and Teaching Office, University of Notre Dame Australia, Fremantle, Australia
| | - Edward A Shipton
- Department of Anaesthesia, University of Otago Christchurch, Christchurch, New Zealand.
| | - Eric J Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia
| |
Collapse
|
19
|
May C, Brcic V, Lau B. Characteristics and complexity of chronic pain patients referred to a community-based multidisciplinary chronic pain clinic. Can J Pain 2018; 2:125-134. [PMID: 35005372 PMCID: PMC8730665 DOI: 10.1080/24740527.2018.1453751] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community-based care fills an important service gap for patients living with chronic pain. Better understanding of unmet patient needs in the community may inform improved policy and resource allocation. AIMS The aim of this study was to describe patients presenting to a community-based, multidisciplinary chronic pain clinic in Vancouver, British Columbia. METHODS This is a retrospective cross-sectional study of 935 unique consecutive patients who completed an intake questionnaire between January 2016 and March 2017. All data were patient reported. RESULTS Nine hundred thirty-five patient records were analyzed for descriptive characteristics. The mean age of the population was 49.5 (SD = 14.9) years; 70% were female. Approximately 50% of patients lived below the poverty line in Vancouver; 30% were not working due to disability, 51% had pain for more than 5 years, and 63% reported severe functional impairment. CONCLUSIONS Substantial unmet need is demonstrated in this patient population accessing a community-based chronic pain clinic. The population described is mainly of working age with significant functional impairment, reflecting a high level of need due to severity and duration of symptoms, poverty, and other characteristics described.
Collapse
Affiliation(s)
- C. May
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - V. Brcic
- Family Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B. Lau
- Department of Anesthesiology, Pharmacology, & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW Opioid use and abuse has led to a worldwide opioid epidemic. And while opioids are clinically useful when appropriately indicated, they are associated with a wide range of dangerous side effects and whether they are effective at treating or eliminating chronic pain is controversial. There has long been a need for the development of nonopioid alternative treatments for patients that live in pain, and until recently, only a few effective treatments were available. Today, there are a wide range of nonopioid treatments available including NSAIDs, acetaminophen, corticosteroids, nerve blocks, SSRIs, neurostimulators, and anticonvulsants. However, these treatments are still not entirely effective at treating pain, which has sparked a new exploration of novel nonopioid pharmacotherapies. RECENT FINDINGS This manuscript will outline the most recent trends in novel nonopioid pharmacotherapy development including tramadol/dexketoprofen, TrkA inhibitors, tapentadol, opioid agonists, Nektar 181, TRV 130, ßarrestin2, bisphosphonates, antibodies, sodium channel blockers, NMDA antagonists, TRP receptors, transdermal vitamin D, AAK1 kinase inhibition, calcitonin gene-related peptide (CGRP), TRPV4 antagonists, cholecystokinin, delta opioid receptor, neurokinin, and gene therapy. The pharmacotherapies discussed in this manuscript outline promising opioid alternatives which can change the future of chronic pain treatment.
Collapse
|
21
|
Bjørnnes AK, Parry M, Lie I, Falk R, Leegaard M, Rustøen T. The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. BMC WOMENS HEALTH 2018; 18:2. [PMID: 29291728 PMCID: PMC5749023 DOI: 10.1186/s12905-017-0501-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
Background Cardiac surgery is a major life event, and outcomes after surgery are associated with men’s and women’s ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. Methods We did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure. Results For the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3 ± 5.1 at 3 months to 38.7 ± 5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3) I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period. Conclusion Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. Trial registration Clinical Trials gov Identifier: NCT01976403. Date of registration: November 28, 2011.
Collapse
Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Irene Lie
- Center for patient centered heart- and lung research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Marit Leegaard
- Faculty of Health Sciences, Institute of Nursing, Oslo and Akershus University College of Applied Sciences, P.O Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway.,Institute of Health and Society, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| |
Collapse
|
22
|
Lacasse A, Choinière M, Connelly JA. Knowledge, beliefs, and attitudes of the Quebec population toward chronic pain: Where are we now? Can J Pain 2017; 1:151-160. [PMID: 35005351 PMCID: PMC8730576 DOI: 10.1080/24740527.2017.1369849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 01/07/2023]
Abstract
Background: Many chronic pain (CP) awareness and educational initiatives have been achieved, but it is time to take stock of where we are today. Aims: The aim of this study was to describe and identify determinants of knowledge, beliefs, and attitudes of different subgroups of the Quebec population regarding CP and especially toward people suffering from this condition. Methods: A web-based, cross-sectional study was conducted between May and June 2014. Results: A total of 1958 participants responded, among whom 70.9% reported suffering from CP and 14.4% reported being a health care professional (HCP). Almost half of the participants were not aware that the risk of developing CP is increased after undergoing surgery or that CP affects approximately one in five adults. A minority (10.30%) agreed that HCP are well trained in CP treatment. The two most frequent negative beliefs were that people suffering from CP become dependent on their medications as do drug addicts (16.7%) and that consulting a psychologist is useless unless the person with CP is depressed (16.9%). Multiple regression analysis showed that being a woman, being born in Canada, being unemployed, suffering from CP, and being an HCP were predictors of better knowledge and more positive attitudes toward people suffering from CP (all P values < 0.05). Older age and residing in a remote region were associated with poorer knowledge and more negative attitudes. Conclusions: Our results underline the importance of continuing the efforts and the need for more education programs, awareness campaigns, and stigma reduction activities about CP for HCP, patients, and the general public.
Collapse
Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
- Quebec Pain Research Network (QPRN), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Manon Choinière
- Quebec Pain Research Network (QPRN), Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Tour Saint-Antoine, Montréal, QC, Canada
- Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | - Judy-Ann Connelly
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| |
Collapse
|
23
|
Alford DP, Zisblatt L, Ng P, Hayes SM, Peloquin S, Hardesty I, White JL. SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program. PAIN MEDICINE 2016; 17:52-63. [PMID: 26304703 PMCID: PMC4718419 DOI: 10.1111/pme.12878] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. METHOD Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. SUBJECTS The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. RESULTS Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. CONCLUSIONS The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain.
Collapse
Affiliation(s)
- Daniel P. Alford
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Lara Zisblatt
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Pamela Ng
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sean M. Hayes
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Sophie Peloquin
- Performance Improvement Division, AXDEV Group Inc., Brossard, Quebec, Canada
| | - Ilana Hardesty
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Julie L. White
- *The Barry M. Manuel Office of Continuing Medical Education, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Lacasse A, Connelly JA, Choinière M. The Chronic Pain Myth Scale: Development and Validation of a French-Canadian Instrument Measuring Knowledge, Beliefs, and Attitudes of People in the Community towards Chronic Pain. Pain Res Manag 2016; 2016:5940206. [PMID: 27746680 PMCID: PMC5055985 DOI: 10.1155/2016/5940206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 07/20/2016] [Indexed: 12/02/2022]
Abstract
Background. In order to better design awareness programs on chronic pain (CP), measurement of knowledge, beliefs, and attitudes of people in the community towards this condition is most useful. Objectives. To develop and validate a French-Canadian scale that could be used for this purpose. Methods. Items of the Chronic Pain Myth Scale (CPMS) were developed based on different information sources, reviewed by pain experts, and pretested. The CPMS was administered to 1555 participants among the general Quebec population. Results. The final CPMS contained 26 items allowing the calculation of three subscales scores (knowledge, beliefs, and attitudes towards people suffering from CP, biopsychosocial impacts of CP, and treatment of CP) which showed adequate internal consistency (α = 0.72-0.82). There were statistically significant differences in subscales scores between participants who reported suffering versus not suffering from CP, reported knowing versus not knowing someone who suffers from CP, and reported being versus not being a healthcare professional, which supports the construct validity of the scale. Conclusions. Our results provide preliminary evidence supporting the psychometric qualities of the use of the CPMS for the measurement of knowledge, beliefs, and attitudes towards CP among French-speaking individuals of the Quebec general population.
Collapse
Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Judy-Ann Connelly
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Manon Choinière
- Département d'Anesthésiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| |
Collapse
|
25
|
Lacasse A, Bourgault P, Choinière M. Fibromyalgia-related costs and loss of productivity: a substantial societal burden. BMC Musculoskelet Disord 2016; 17:168. [PMID: 27084363 PMCID: PMC4833946 DOI: 10.1186/s12891-016-1027-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/08/2016] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND This study aimed at describing pain-related health care resource use, direct costs, and productivity loss among patients suffering from fibromyalgia syndrome (FMS). METHODS A cost-of-illness study with a sample of 57 adults having a diagnosis of FMS was conducted in the province of Quebec (Canada). Data regarding FMS-related direct costs and productivity loss from paid and unpaid work over a three-month period were collected using a standardized structured telephone interview protocol. Direct costs were valued in 2009 Canadian dollars using a societal perspective. RESULTS Results showed that average direct costs over a three-month period added up to $951 per patient (SD: $710), which could be translated in a mean annual cost of $3804. The purchase of prescribed medications led to the highest costs (mean: $329, SD: $321), followed by consultations to health care professionals other than physicians (mean: $129, SD: $222) and physicians consultations (mean: $98, SD: $116). Results further showed a high economic burden for patients themselves, aside from costs covered by public or private insurers. Among the subsample of participants who had a paid job (45.6%), an average of 5.6 days (SD: 13.2) were lost due to pain during the past three months. Among those who were not employed (54.4%), an average of 25.1 days in household productivity (SD: 24.8) were lost. CONCLUSIONS FMS is associated with a substantial socioeconomic burden. Further research is clearly needed to improve the management of this type of disorder and make better decisions regarding resource allocation.
Collapse
Affiliation(s)
- Anaïs Lacasse
- />Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec Canada
| | - Patricia Bourgault
- />Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec Canada
- />École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - Manon Choinière
- />Département d’anesthésiologie, Faculté de médecine, Université de Montréal, Montréal, Québec Canada
- />Centre de recherche du Centre hospitalier de l’Université de Montréal, Tour Saint-Antoine 850, rue Saint-Denis, Bureau S03-428, Montréal, Québec Canada
| |
Collapse
|
26
|
Zidarov D, Visca R, Gogovor A, Ahmed S. Performance and quality indicators for the management of non-cancer chronic pain: a scoping review protocol. BMJ Open 2016; 6:e010487. [PMID: 26895987 PMCID: PMC4762093 DOI: 10.1136/bmjopen-2015-010487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Chronic pain is a public health problem of epidemic proportion in most countries with important physical, psychological, social and economic consequences. The management of chronic pain is complex and requires an integrated network approach between all levels of the healthcare system and the involvement of several health professionals from different disciplines. Measuring the performance of organisations that provide care to individuals with chronic pain is essential to improve quality of care and requires the use of relevant performance and quality indicators. A scoping review methodology will be used to synthesise the evidence on performance and quality indicators developed for non-cancer chronic pain management across the continuum of care. METHODS AND ANALYSIS The following electronic databases will be searched from 2000 onwards: Cochrane Effective Practice and Organisation of Care (EPOC) Review Group Specialised Register; Cochrane Library; EMBASE; PubMed; CINAHL; PsycINFO; ProQuest Dissertations and Theses. All types of studies will be included if these are concerned with performance or quality indicators in adults with chronic non-cancer pain. In addition, searches will be conducted on provincial, national and international health organisations as well as health professional and scientific associations' websites. A qualitative descriptive approach will be used to describe characteristics of each indicator. All identified indicators will be classified according to dimensions covered by Donabedian and the Triple Aim frameworks. ETHICS AND DISSEMINATION The scoping review findings will inform the development of a performance measurement system comprising a list of performance indicators with their level of evidence which can be used by stakeholders to evaluate the quality of care for individuals with chronic non-cancer pain at the patient, institutional and system level. The results will be disseminated via several knowledge translation strategies, including 2 stakeholder meetings, publication and presentation at conferences.
Collapse
Affiliation(s)
- Diana Zidarov
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, Quebec, Canada
| | - Regina Visca
- Centre of Expertise in Chronic Pain, Réseau Universitaire Intégré de Santé (RUIS) McGill, Montreal, Quebec, Canada
| | - Amédé Gogovor
- Faculty of Medicine, School of Physical and Occupational Therapy, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sara Ahmed
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, Quebec, Canada
- Centre of Expertise in Chronic Pain, Réseau Universitaire Intégré de Santé (RUIS) McGill, Montreal, Quebec, Canada
- Faculty of Medicine, School of Physical and Occupational Therapy, Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Clinical Epidemiology, McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
27
|
Abstract
Self-efficacy can be defined as the belief in one’s capability to acheive certain goals. In the context of chronic pain, self-efficacy may reflect an individual’s performance with regard to self-management strategies to improve their chronic pain. The authors of this article aimed to generate a translation of the Chronic Pain Self-efficacy Scale, a validated scale used to measure self-efficacy, for use in French-Canadian populations. The internal consistency, convergent construct validity and sensitivity to change of the translated document were assessed. BACKGROUND: Perceived self-efficacy is a non-negligible outcome when measuring the impact of self-management interventions for chronic pain patients. However, no validated, chronic pain-specific self-efficacy scales exist for studies conducted with French-speaking populations. OBJECTIVES: To establish the validity of the use of the French-Canadian Chronic Pain Self-efficacy Scale (FC-CPSES) among chronic pain patients. METHODS: The Chronic Disease Self-Efficacy Scale is a validated 33-item self-administered questionnaire that measures perceived self-efficacy to perform self-management behaviours, manage chronic disease in general and achieve outcomes (a six-item version is also available). This scale was adapted to the context of chronic pain patients following cross-cultural adaptation guidelines. The FC-CPSES was administered to 109 fibromyalgia and 34 chronic low back pain patients (n=143) who participated in an evidence-based self-management intervention (the PASSAGE program) offered in 10 health care centres across the province of Quebec. Cronbach’s alpha coefficients (α) were calculated to determine the internal consistency of the 33- and six-item versions of the FC-CPSES. With regard to convergent construct validity, the association between the FC-CPSES baseline scores and related clinical outcomes was examined. With regard to the scale’s sensitivity to change, pre- and postintervention FC-CPSES scores were compared. RESULTS: Internal consistency was high for both versions of the FC-CPSES (α=0.86 to α=0.96). Higher self-efficacy was significantly associated with higher mental health-related quality of life and lower pain intensity and catastrophizing (P<0.05), supporting convergent validity of the scale. There was a statistically significant increase in FC-CPSES scores between pre- and postintervention measures for both versions of the FC-CPSES (P<0.003), which supports their sensitivity to clinical change during an intervention. CONCLUSIONS: These data suggest that both versions of the FC-CPSES are reliable and valid for the measurement of pain management self-efficacy among chronic pain patients.
Collapse
|
28
|
Abstract
Chronic pain is common and strongly impacts the individual and society as a whole. Although there are effective multidisciplinary treatments available, they are often not easily accessible and designed for people with severe long-lasting problems. The main aim of this paper is to propose and stimulate debate about how the internet can help to increase accessibility and promote a shift toward secondary prevention. Specifically, internet can help by providing access to educational websites containing information for professionals and the general population. Internet can also be useful for creating accessible interventions designed to reduce risk factors for the development of long-term disability. The involvement of society in general and the professionals working in the field is fundamental for advancing in this direction.
Collapse
|
29
|
Lacasse A, Ware MA, Dorais M, Lanctôt H, Choinière M. Is the Quebec provincial administrative database a valid source for research on chronic non-cancer pain? Pharmacoepidemiol Drug Saf 2015; 24:980-90. [DOI: 10.1002/pds.3820] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé; Université du Québec en Abitibi-Témiscamingue; Rouyn-Noranda Québec Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Mark A. Ware
- Alan Edwards Pain Management Unit; McGill University Health Centre; Montréal Québec Canada
| | - Marc Dorais
- StatSciences Inc.; Notre-Dame-de-l'Île-Perrot Québec Canada
| | - Hélène Lanctôt
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal; Montréal Québec Canada
- Département d'anesthésiologie, Faculté de médecine; Université de Montréal; Montréal Québec Canada
| |
Collapse
|
30
|
|
31
|
Stockbridge EL, Suzuki S, Pagán JA. Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey. Health Serv Res 2015; 50:847-70. [PMID: 25424348 PMCID: PMC4450933 DOI: 10.1111/1475-6773.12263] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. DATA SOURCE Medical Expenditure Panel Survey (MEPS) data (2008-2011; N = 26,671). STUDY DESIGN Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. PRINCIPAL FINDINGS "A little bit" of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (p < .0001) and a $1,008 increase over nonchronic pain interference (p = .0001). Moderate and severe chronic pain-related interference was associated with a $3,707 and $5,804 increase in expenditures over no pain interference and a $2,218 and $4,315 increase over nonchronic interference, respectively (p < .0001). Expenditure increases were most pronounced for inpatient and hospital outpatient expenditures compared to other types of health care expenditures. CONCLUSIONS Chronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.
Collapse
Affiliation(s)
- Erica L Stockbridge
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science CenterFort Worth, TX
| | - Sumihiro Suzuki
- Department of Behavioral Health Analytics, Magellan Health, Inc.Columbia, MD
| | - José A Pagán
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center Fort Worth, TX Center for Health Innovation, The New York Academy of Medicine New York, NY Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai New York, NY Leonard Davis Institute of Health Economics, University of PennsylvaniaPhiladelphia, PA
| |
Collapse
|
32
|
St-Amant H, Ware MA, Julien N, Lacasse A. Prevalence and determinants of cannabinoid prescription for the management of chronic noncancer pain: a postal survey of physicians in the Abitibi-Témiscamingue region of Quebec. CMAJ Open 2015; 3:E251-7. [PMID: 26389104 PMCID: PMC4565172 DOI: 10.9778/cmajo.20140095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few studies have been conducted to explore physicians' prescription practices and attitudes toward the use of cannabinoids in Canada.We measured the prevalence and identified determinants of cannabinoid prescription for the management of chronic noncancer pain among physicians in southwestern Quebec. METHODS In February 2013, we conducted a postal survey using a modified Dillman method that involved physicians practising in the Abitibi-Témiscamingue region of Quebec. We used multivariate logistic regression models to identify determinants of cannabinoid prescription. RESULTS A total of 166 physicians of 318 practising in the region participated in the survey (response rate 52.2%). The prevalence of cannabinoid prescription was 27.3% (45/165) for any indication and 23.0% (38/165) for the management of chronic noncancer pain; 91.1% (41/45) of the physicians prescribed cannabinoids to 5 or fewer patients. Of the 38 physicians who prescribed cannabinoids for chronic noncancer pain, 35 (92.1%) prescribed nabilone, 7 (18.4%) medical marijuana and 2 (5.3%) nabiximols. The principal determinant of cannabinoid prescription was the physician's level of comfort with prescribing cannabinoids (adjusted odds ratio 1.25, 95% confidence interval 1.01-1.55, per 1-point increase in comfort level measured on 10-point scale). Respondents reported that continuing medical education (CME) activities could increase their comfort level. They also indicated a need for guidelines or algorithms that included cannabinoid use as well as more studies about the efficacy and safety of cannabinoids for the management of chronic noncancer pain. INTERPRETATION We found that cannabinoids were not often prescribed for the management of chronic noncancer pain and that survey respondents were not comfortable with prescribing this drug class. This degree of discomfort could be addressed by CME activities, more effective dissemination of guidelines and more evidence regarding cannabinoid use for the management of chronic noncancer pain.
Collapse
Affiliation(s)
- Huguette St-Amant
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
| | - Mark A. Ware
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montréal, Que
| | - Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
| |
Collapse
|
33
|
Although unseen, chronic pain is real-A phenomenological study. Scand J Pain 2015; 6:33-40. [PMID: 29911591 DOI: 10.1016/j.sjpain.2014.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/28/2014] [Indexed: 11/22/2022]
Abstract
Background Research has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients' perspective. Methods Thirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi's four-phase phenomenological method. Results The participants' chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants. As a result from the interviews, subthemes such as "Being disbelieved", "Adolescents' pain is also disbelieved", "Denying pain", "Underrating symptoms", "The pain is in your head", "Second-class citizen", "Lazy pain patient", and "False beliefs demand passivity" were identified. Conclusions In health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice. Implications The Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.
Collapse
|
34
|
Hunter JP, Stinson J, Campbell F, Stevens B, Wagner SJ, Simmons B, White M, van Wyk M. A novel pain interprofessional education strategy for trainees: assessing impact on interprofessional competencies and pediatric pain knowledge. Pain Res Manag 2015; 20:e12-20. [PMID: 25144859 PMCID: PMC4325895 DOI: 10.1155/2015/159580] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health care trainees⁄students lack knowledge and skills for the comprehensive clinical assessment and management of pain. Moreover, most teaching has been limited to classroom settings within each profession. OBJECTIVES To develop and evaluate the feasibility and preliminary outcomes of the 'Pain-Interprofessional Education (IPE) Placement', a five-week pain IPE implemented in the clinical setting. The utility (content validity, readability, internal consistency and practical considerations) of the outcome measures was also evaluated. METHODS A convenience sample of 21 trainees from eight professions was recruited over three Pain-IPE Placement cycles. Pre- and postcurriculum assessment included: pain knowledge (Pediatric Pain Knowledge and Attitudes Survey), IPE attitudes (Interdisciplinary Education Perception Scale [IEPS]) and IPE competencies (Interprofessional Care Core Competencies Global Rating Scales [IPC-GRS]), and qualitative feedback on process⁄acceptability. RESULTS Recruitment and retention met expectations. Qualitative feedback was excellent. IPE measures (IEPS and IPC-GRS) exhibited satisfactory utility. Postcurriculum scores improved significantly: IEPS, P<0.05; IPC-GRS constructs, P<0.01; and competencies, P<0.001. However, the Pediatric Pain Knowledge and Attitudes Survey exhibited poor utility in professions without formal pharmacology training. Scores improved in the remaining professions (n=14; P<0.01). DISCUSSION There was significant improvement in educational outcomes. The IEPS and IPC-GRS are useful measures of IPE-related learning. At more advanced training levels, a single pain-knowledge questionnaire may not accurately reflect learning across diverse professions. CONCLUSION The Pain-IPE Placement is a successful collaborative learning model within a clinical context that successfully changed interprofessional competencies. The present study represents a first step at defining and assessing change in interprofessional competencies gained from Pain-IPE.
Collapse
Affiliation(s)
- Judith P Hunter
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Jennifer Stinson
- Center for Nursing, The Hospital for Sick Children, and Lawrence S Bloomberg Faculty of Nursing, University of Toronto
- Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Bonnie Stevens
- Center for Nursing, The Hospital for Sick Children, and Lawrence S Bloomberg Faculty of Nursing, University of Toronto
- Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Susan J Wagner
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Centre for Interprofessional Education, University of Toronto, Toronto, Ontario
| | - Brian Simmons
- Centre for Interprofessional Education, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Sunnybrook Health Science Centre, Toronto, Ontario
| | - Meghan White
- Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario
| | - Margaret van Wyk
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
- Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario
| |
Collapse
|