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Zerriouh M, De Clifford-Faugère G, Nguena Nguefack HL, Pagé MG, Guénette L, Blais L, Lacasse A. Pain relief and associated factors: a cross-sectional observational web-based study in a Quebec cohort of persons living with chronic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1306479. [PMID: 38560482 PMCID: PMC10978597 DOI: 10.3389/fpain.2024.1306479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Randomized clinical trials are used to evaluate the efficacy of various pain treatments individually, while a limited number of observational studies have portrayed the overall relief experienced by persons living with chronic pain. This study aimed to describe pain relief in real-world clinical settings and to identify associated factors. Methods This exploratory web-based cross-sectional study used data from 1,419 persons recruited in the community. Overall pain relief brought by treatments used by participants was assessed using a 0%-100% scale (10-unit increments). Results A total of 18.2% of participants reported minimal pain relief (0%-20%), 60.0% moderate to substantial pain relief (30%-60%), and 21.8% extensive pain relief (70%-100%). Multivariable multinomial regression analysis revealed factors significantly associated with greater pain relief, including reporting a stressful event as circumstances surrounding the onset of pain, living with pain for ≥10 years, milder pain intensity, less catastrophic thinking, use of prescribed pain medications, use of nonpharmacological pain treatments, access to a trusted healthcare professional, higher general health scores, and polypharmacy. Factors associated with lower pain relief included surgery as circumstances surrounding pain onset, use of over-the-counter pain medications, and severe psychological distress. Discussion In this community sample of persons living with chronic pain, 8 out of 10 persons reported experiencing at least moderate relief with their treatment. The analysis has enabled us to explore potential modifiable factors as opportunities for improving the well-being of persons living with chronic pain.
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Affiliation(s)
- Meriem Zerriouh
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Gwenaelle De Clifford-Faugère
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Centre de Recherche, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Département d’Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada
- Centre de Recherche, Centre Hospitalier Universitaire (CHU) de Québec—Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Quebec City, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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Audet C, Zerriouh M, Nguena Nguefack HL, Julien N, Pagé MG, Guénette L, Blais L, Lacasse A. Where we live matters: a comparison of chronic pain treatment between remote and non-remote regions of Quebec, Canada. FRONTIERS IN PAIN RESEARCH 2024; 5:1291101. [PMID: 38468692 PMCID: PMC10925759 DOI: 10.3389/fpain.2024.1291101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Where a person lives is a recognized socioeconomic determinant of health and influences healthcare access. This study aimed to compare the pain treatment profile of persons with chronic pain (CP) living in remote regions to those living in non-remote regions (near or in major urban centers). Methods A cross-sectional study was performed among persons living with CP across Quebec. In a web-based questionnaire, participants were asked to report in which of the 17 administrative regions they were living (six considered "remote"). Pain treatment profile was drawn up using seven variables: use of prescribed pain medications, over-the-counter pain medications, non-pharmacological pain treatments, multimodal approach, access to a trusted healthcare professional for pain management, excessive polypharmacy (≥10 medications), and use of cannabis for pain. Results 1,399 participants completed the questionnaire (women: 83.4%, mean age: 50 years, living in remote regions: 23.8%). As compared to persons living in remote regions, those living in non-remote regions were more likely to report using prescribed pain medications (83.8% vs. 67.4%), a multimodal approach (81.5% vs. 75.5%), experience excessive polypharmacy (28.1% vs. 19.1%), and report using cannabis for pain (33.1% vs. 20.7%) (bivariable p < 0.05). Only the use of prescribed medications as well as cannabis remained significantly associated with the region of residence in the multivariable models. Discussion There are differences in treatment profiles of persons with CP depending on the region they live. Our results highlight the importance of considering remoteness, and not only rurality, when it comes to better understanding the determinants of pain management.
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Affiliation(s)
- Claudie Audet
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Meriem Zerriouh
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Hermine Lore Nguena Nguefack
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Nancy Julien
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - M. Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Centre de Recherche Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département d’Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Axis, Centre de Recherche CHU de Québec—Université Laval, Québec, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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De Clifford-Faugère G, Nguena Nguefack HL, Godbout-Parent M, Diallo MA, Guénette L, Gabrielle Pagé M, Choinière M, Harden RN, Beaudoin S, Boulanger A, Pinard AM, Lussier D, De Grandpré P, Deslauriers S, Lacasse A. The Medication Quantification Scale 4.0: An Updated Index Based on Prescribers' Perceptions of the Risk Associated With Chronic Pain Medications. THE JOURNAL OF PAIN 2024; 25:508-521. [PMID: 37838346 DOI: 10.1016/j.jpain.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
To quantify risks associated with drug utilization in the real world for the treatment of chronic pain (CP), an index called the Medication Quantification Scale (MQS) was developed in 1992 in the United States and last updated in 2003. This study aimed to update, adapt to the contemporary Canadian context, and validate a revised version of the MQS (the MQS-4.0). Step 1: An expert committee adapted the MQS to the Canadian clinical practice context. Step 2: An update of risk weights given to medication subclasses was achieved using a prescriber survey (weights were derived from median 0-10 scores given to each subclass). Step 3: Construct validity of the MQS-4.0 was assessed after applying risk weights to the medication use profile of persons living with CP covered by public drug insurance plan. Thirty-six medication subclasses were included in the MQS-4.0. A total of 207 prescribers (physicians, pharmacists, and nurse practitioners) participated in the perception survey; 10.63% identified as pain specialists. When risk weights were applied to prescription claims (n = 9,122), the MQS-4.0 score was associated (P < .05) with the MQS-III score and variables associated with polypharmacy (eg, Charlson Comorbidity Index, number of prescribers or health care visits). This study provides an updated index intended for adult populations based on prescribers' perceptions of the risk associated with CP medications that can be useful for clinical practice and research among persons living with CP in Canada. It will, however, be relevant to verify whether similar risk weights are obtained in future pain specialist surveys. PERSPECTIVE: The MQS-4.0 is an update of the MQS used for quantifying the risk associated with the use of analgesics/coanalgesics. Adequate psychometrics properties were found.
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Affiliation(s)
| | | | - Marimée Godbout-Parent
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Mamadou Aliou Diallo
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Line Guénette
- Research Center, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
| | - M Gabrielle Pagé
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Norman Harden
- Department of Physical Medicine and Rehabilitation and Department of Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sylvie Beaudoin
- Person with lived experience, Chronic Pain Epidemiology Chair, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Aline Boulanger
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Pain Clinic, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Anne Marie Pinard
- Pain Clinic, CHU de Québec-Université Laval, Québec, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université Laval, Québec, Québec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré de Santé et de Services Sociaux de la Capitale-Nationale, Québec, Québec, Canada
| | - David Lussier
- Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Philippe De Grandpré
- Familiprix Chantale Gaboury & Marie-Ève Gélinas, Berthierville, Québec, Canada; Groupe de Médecine Familiale Clinique Familiale des Prairies, Notre-Dame-des-Prairies, Québec, Canada
| | - Simon Deslauriers
- VITAM - Centre de Recherche en Santé Durable, CIUSSS de la Capitale-Nationale, Québec, Québec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Angarita-Fonseca A, Lacasse A, Choinière M, Kaboré JL, Sylvestre MP, Dinkou GDT, Bruneau J, Martel MO, Hovey R, Motulsky A, Rahme E, Pagé MG. Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics. Pharmacoepidemiol Drug Saf 2024; 33:e5706. [PMID: 37800356 DOI: 10.1002/pds.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Manon Choinière
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Luc Kaboré
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Canada
| | - Marie-Pierre Sylvestre
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
| | | | - Julie Bruneau
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Marc O Martel
- Department of Anesthesia, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Elham Rahme
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - M Gabrielle Pagé
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Zahlan G, De Clifford-Faugère G, Nguena Nguefack HL, Guénette L, Pagé MG, Blais L, Lacasse A. Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors. J Pain Res 2023; 16:3085-3100. [PMID: 37719270 PMCID: PMC10505027 DOI: 10.2147/jpr.s411451] [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: 03/21/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polypharmacy. Patients and Methods This cross-sectional study used data from 1342 persons from the ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number of medications currently used by participants (regardless of whether they were prescribed or taken over-the-counter, or were used for treating pain or other health issues) was categorized to assess polypharmacy and excessive polypharmacy. Results Participants reported using an average of 6 medications (median: 5). The prevalence of polypharmacy was 71.4% (95% CI: 69.0-73.8) and excessive polypharmacy was 25.9% (95% CI: 23.6-28.3). No significant differences were found across gender identity groups. Multivariable logistic regression revealed that factors associated with greater chances of reporting excessive polypharmacy (vs <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0-10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, considering pain to be terrible/feeling like it will never get better, and being employed. Conclusion Polypharmacy is the rule rather than the exception among persons living with chronic pain. Close monitoring and evaluation of the different medications used are important for all persons, especially those with limited access to care.
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Affiliation(s)
- Ghita Zahlan
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | | | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Quebec, Quebec, Canada
- Centre de recherche, CHU de Québec - Université Laval, Quebec, Quebec, Canada
| | - M Gabrielle Pagé
- Centre de recherche, Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Patterns of patient outcomes following specialist pain management in Australasia: a latent class analysis using the ePPOC database. Pain 2022; 164:967-976. [PMID: 36448970 DOI: 10.1097/j.pain.0000000000002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022]
Abstract
ABSTRACT The increasing demand for pain management and limited resources available highlight the need to measure treatment effectiveness. We analysed data collected at 75 specialist persistent pain services located in Australia and New Zealand to calculate overall treatment outcome for patients receiving care during 2014-2020. Socio-demographic and clinical information was provided for 23,915 patients, along with patient-reported measures assessing pain, pain interference, depression, anxiety, stress, pain catastrophizing and pain self-efficacy. Latent Class Analysis identified four distinct outcomes based on patients' pattern of responses across the assessment tools at treatment end. Group 1 (n=8,369, 35%) reported low/mild severity across all clinical domains at the end of care, while Group 4 (n= 7,081, 30%) were more likely to report moderate/high severity on all domains. Group 2 (n=1,991, 8%) reported low/mild pain with moderate/high psychological distress at treatment end, and Group 3 (n=6,474, 27%) reported moderate/high pain with low/mild psychological distress. Multi-variable logistic regression identified those factors associated with the different groups. In particular, factors most predictive of a poor (Group 4) vs. good outcome (Group 1) were unemployment (due to pain or other reasons), requiring an interpreter, widespread pain, pain of longer duration and attributing the pain to an injury at work. The results may allow identification of those most likely to benefit from the services currently provided, and inform development of alternative or enhanced services for those at risk of a poor outcome.
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Laskawska MS, Hébert HL, Richardson C, Berlouis K, Cameron P, Colvin LA, Smith BH. The core minimum dataset for measuring pain outcomes in pain services across Scotland. Developing and testing a brief multi-dimensional questionnaire. Br J Pain 2022; 16:504-517. [PMID: 36389005 PMCID: PMC9644105 DOI: 10.1177/20494637221092907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background There is currently no agreed minimum dataset to inform specialist chronic pain service provision. We aimed to develop a Core Minimum Dataset (CMD) for pain services in Scotland and perform preliminary analysis to evaluate its psychometric properties in adults with chronic pain. Methods The questionnaire was developed following a review of existing relevant data collection instruments and national consultation. The CMD questionnaire was completed alongside a routine pre-clinic questionnaire by patients attending two pain services over 3 months. Concurrent validity was tested by comparing scores between the CMD and pre-existing questionnaires. Reliability was assessed by test-retest and discriminative validity via receiver operating characteristic (ROC) curves. Results The final CMD questionnaire consisted of five questions on four domains: pain severity (Chronic Pain Grade [CPG] Q1); pain interference (CPG Q5); emotional impact (Patient Health Questionnaire-2 [PHQ-2], two questions); and quality of life (Short Form Health Survey-36 [SF-36] Q1). 530 patients completed the questionnaire. Strong correlation was found with the Hospital Anxiety and Depression Scale (rs = 0.753, p < 0.001). Moderate correlations were found with the Brief Pain Inventory for pain interference (rs = 0.585, p < 0.001) and pain severity (rs = 0.644, p < 0.001). Moderate to good reliability was demonstrated (Intra-class Correlation Coefficient = 0.572-0.845). All items indicated good discrimination for relevant health states. Conclusions The findings represent initial steps towards developing an accurate questionnaire that is feasible for assessing chronic pain in adults attending specialist pain clinics and measuring service improvements in Scotland. Further validation testing, in clinical settings, is now required.
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Affiliation(s)
- Magdalena S Laskawska
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Harry L Hébert
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Cara Richardson
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Katherine Berlouis
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Paul Cameron
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
- Fife Health & Social Care
Partnership, Dunfermline, UK
| | - Lesley A Colvin
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Blair H Smith
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
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Magaway CL, Malanga G. Patient registries in orthopedics and orthobiologic procedures: a narrative review. BMC Musculoskelet Disord 2022; 23:543. [PMID: 35668394 PMCID: PMC9171990 DOI: 10.1186/s12891-022-05416-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 05/10/2022] [Indexed: 11/17/2022] Open
Abstract
There has been increasing evidence and growing popularity of orthobiologic treatments, such as platelet-rich plasma, bone marrow aspirate concentrate, and microfragmented adipose tissue. However, real-world data, including patient-reported pain and function outcomes, remains sparse for these procedures. Thus, collecting patient-reported outcome measures is important to evaluate the safety and efficacy of these treatments and hopefully improve patient care. Patient reported outcome measures can systematically be collected through patient registries. This narrative review serves to describe the data collection platforms and registries that obtain patient-reported outcome measures on orthobiologic procedures and provide a discussion on the benefits and limitations of registries. An internet search of the list of orthopedic registries available was conducted, and registries that collect patient-reported outcome measures for orthobiologic procedures were identified. Additional information regarding these various registries was collected by directly contacting these vendors. Publications from these registries, including case series, observational studies, and annual reports, were also reviewed. Providing this review will inform clinicians of a digital tool that can increase the efficiency of collecting outcome measures for orthobiologics and aid physicians in choosing a data collection platform.
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Affiliation(s)
- Cedric Lester Magaway
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ, 08901, USA.
| | - Gerard Malanga
- New Jersey Regenerative Institute, 197 Ridgedale Ave #210, Cedar Knolls, NJ, 07927, USA.,Clinical Professor Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07109, USA
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Godbout-Parent M, Nguena Nguefack HL, Angarita-Fonseca A, Audet C, Bernier A, Zahlan G, Julien N, Pagé MG, Guénette L, Blais L, Lacasse A. Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain. Can J Pain 2022; 6:65-77. [PMID: 35694144 PMCID: PMC9176231 DOI: 10.1080/24740527.2022.2051112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Medical cannabis has been legal in Canada since 2001, and recreational cannabis was legalized in October 2018, which has led to a widespread increase in the accessibility of cannabis products. Aims This study aimed to estimate the prevalence of cannabis use among adults living with chronic pain (CP) and investigate the relationship between age and cannabis use for CP management. Methods A cross-sectional analysis of the COPE Cohort data set, a large Quebec sample of 1935 adults living with CP, was conducted. Participants completed a web-based questionnaire in 2019 that contained three yes/no questions about past-year use of cannabis (i.e., for pain management, management of other health-related conditions, recreational purposes). Results Among the 1344 participants who completed the cannabis use section of the questionnaire, the overall prevalence of cannabis use for pain management was 30.1% (95% confidence interval 27.7-32.7). Differences were found between age groups, with the highest prevalence among participants aged ≤26 years (36.5%) and lowest for those aged ≥74 years (8.8%). A multivariable logistic model revealed that age, region of residence, generalized pain, use of medications or nonpharmacological approaches for pain management, alcohol/drug consumption, and smoking were associated with the likelihood of using cannabis for pain management. Conclusions Cannabis is a common treatment for the management of CP, especially in younger generations. The high prevalence of use emphasizes the importance of better knowledge translation for people living with CP, rapidly generating evidence regarding the safety and efficacy of cannabis, and clinicians' involvement in supporting people who use cannabis for pain management.
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Affiliation(s)
- Marimée Godbout-Parent
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Adriana Angarita-Fonseca
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada,Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Claudie Audet
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Andréanne Bernier
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Ghita Zahlan
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada,médecine, Université de MontréalDépartement d’anesthésiologie et de médecine de la douleur, Faculté de, Montréal, Québec, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Québec, Québec, Canada,Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada,CONTACT Anaïs Lacasse, PhD Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, 445, boul. de l’Université, Rouyn-Noranda, QCJ9X 5E4, Canada
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10
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Nguena Nguefack HL, Gabrielle Pagé M, Guénette L, Blais L, Diallo M, Godbout-Parent M, Angarita-Fonseca A, Lacasse A. Gender Differences in Medication Adverse Effects Experienced by People Living With Chronic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:830153. [PMID: 35620635 PMCID: PMC9128021 DOI: 10.3389/fpain.2022.830153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesUnderstanding gender differences in chronic pain (CP) outcome research is essential to optimal treatment delivery. This study explored the associations between gender identity, gender roles, and the number of non-life-threatening pain medication adverse effects reported as severe by people living with CP.MethodsThe analyses were conducted using the COPE Cohort, a dataset generated through a web-based recruitment of adults with CP. Participants were asked how they identified themselves (women, men, unknown, unspecified) and gender roles were measured using the Bem Sex-Role Inventory (subgroups were formed applying the median split method). Pain medication adverse effects were assessed using a standardized checklist (none/mild/moderate/severe). A zero-inflated Poisson model was used to assess gender identity, gender roles and their interaction as potential predictors of the number of pain medication adverse effects.ResultsA total of 1,343 participants reported using pain medications. Adjusting for potential confounders, both gender identity (men vs. women: ß = −0.32, p = 0.0024) and gender roles (androgynous vs. undifferentiated: ß = 0.26, p = 0.0030) were associated with the number of pain medication adverse effects reported as severe, and they interacted with each other. The stratified analysis by gender roles showed that women reported a greater number of severe adverse effects than men among those classified as masculine and androgynous.DiscussionAlthough we are unable to confirm whether the associations can be explained by differences in the experience or in the reporting of effects, gender identity and gender roles should both be explored when studying pain medication adverse effects.
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Affiliation(s)
| | - M. Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Département d'anesthésiologie et de Médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Québec City, QC, Canada
- Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec – Université Laval, Québec, QC, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada
| | - Mamadou Diallo
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marimée Godbout-Parent
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Adriana Angarita-Fonseca
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
- *Correspondence: Anaïs Lacasse
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11
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Moisset X, Pagé MG, Pereira B, Choinière M. Pharmacological treatments of neuropathic pain: real-life comparisons using propensity score matching. Pain 2022; 163:964-974. [PMID: 34985849 DOI: 10.1097/j.pain.0000000000002461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/18/2021] [Indexed: 01/20/2023]
Abstract
ABSTRACT Studies comparing different drug treatments for chronic neuropathic pain (NP) are very limited. We, therefore, examined 4 recommended treatments, namely, antidepressants (duloxetine, venlafaxine, and tricyclic antidepressants), antiepileptics (gabapentine and pregabalin), weak opioids, and strong opioids, among patients with NP evaluated before first visit in a tertiary pain treatment centre and 6 months later. Patients with both a clinical diagnosis of NP and a DN4 score ≥3/7 were selected from patients enrolled in the Quebec Pain Registry. Each participant was assigned an inverse weighting of the probability of receiving any NP treatment, taking into account their age, sex, baseline pain intensity, pain duration, pain catastrophizing tendency, education level, employment, and comedications at 6-month follow-up (M6). Patients were considered as improved if they presented at least a 30% reduction on average pain intensity at M6 compared with baseline. A total of 944 patients completed both baseline and M6 evaluations. Overall, 23.0% of patients were significantly improved for pain intensity at M6. There was no significant difference in proportions patients taking or not antidepressants, gabapentinoids, or weak opioids. Among patients taking strong opioids (N = 288), 13.9% (N = 40/288) were improved vs 27.0% (177/656) of those who were not on opioids (P < 0.004). Inverse probability of treatment weighting confirmed that the proportion of patients who improved was significantly lower among those taking strong opioids compared with those who did not (P < 0.001). In conclusion, long-term use of strong opioids is a treatment suited for a limited proportion of patients with chronic NP.
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Affiliation(s)
- Xavier Moisset
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - M Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, QC, Canada
| | - Bruno Pereira
- Université Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, Clermont-Ferrand, France
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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12
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Pagé MG, Tousignant-Laflamme Y, Dorais M, Beaudry H, Fernet M. Characteristics of Persons Seeking Care for Moderate to Severe Pain Due to Chronic Low Back Pain and Osteoarthritis: A Cross-Sectional Study. J Pain Res 2022; 15:1125-1139. [PMID: 35469249 PMCID: PMC9034864 DOI: 10.2147/jpr.s360314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/30/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose To assess the associations between pain severity or physical (pQoL) and mental (mQoL) health-related quality of life and disability status or health-care utilization among persons living with moderate/severe pain due to chronic low back pain (CLBP) or osteoarthritis (OA), who received treatments in Quebec’s tertiary care pain centers. Materials and Methods This retrospective study was carried out using the Quebec Pain Registry (Canada) from 2008 to 2014 and contains data on persons referred to tertiary pain management clinics. Participants were selected if they were diagnosed with CLBP (N = 2663) or OA (N = 139) of more than 3 months duration and of pain intensity ≥5 on the Numeric Rating Scale (0–10) and completed baseline questionnaires. Results Less than 5% of persons were hospitalized in the 6 months before their first visit at the pain clinic, and 11.9% and 18.9% of persons with OA and CLBP, respectively, had a pain-related emergency room (ER) visit. Less than 1/5 and more than 1/4 of persons with OA and CLBP were receiving disability benefits, respectively. Persons with CLBP who had visited the ER, those on disability and those receiving disability benefits, reported higher levels of pain severity, interference, and lower levels of mQoL (and pQoL for those on disability or receiving benefits) compared to those who did not consult the ER, those not on disability or not receiving disability benefits, respectively (all p < 0.05). For OA, disability status was the only variable associated with pain interference and QoL (all p < 0.05). Conclusion Pain severity, pain interference and mQoL were associated with health-care utilization and disability status in persons with CLBP. These results were globally not found among persons with OA, which might be due to smaller sample size or unique characteristics of this population.
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Affiliation(s)
- M Gabrielle Pagé
- Research Center, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada
- Correspondence: M Gabrielle Pagé, Research Center, Centre hospitalier de l’Université de Montréal, S01-122, St-Antoine Tower, 850 St-Denis, Montreal, QC, H2X 0A9, Canada, Tel +1 514-890-8000, ext. 31601, Email
| | | | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l’Ile-Perrot, QC, Canada
| | | | - Mireille Fernet
- Medical Affairs Division, Pfizer Canada, Montreal, QC, Canada
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13
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Grzelak S, Bérubé M, Gagnon MA, Côté C, Turcotte V, Pelet S, Belzile É. Pain Management Strategies After Orthopaedic Trauma: A Mixed-Methods Study with a View to Optimizing Practices. J Pain Res 2022; 15:385-402. [PMID: 35177930 PMCID: PMC8843780 DOI: 10.2147/jpr.s342627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To examine 1) pain management strategies within the care trajectory of orthopaedic trauma patients and patients' perception of their effectiveness, 2) adverse effects (AEs) associated with pharmacological treatments, particularly opioids and cannabis, and 3) patients' perceptions of strategies that should be applied after an orthopaedic trauma and support that they should obtain from health professionals for their use. PATIENTS AND METHODS This study was conducted with orthopaedic trauma patients in a level 1 trauma center. A convergent mixed-methods design was used. Data on pain experience, pain management strategies used and AEs were collected with self-administered questionnaires at hospital discharge (T1) and at 3 months after injury (T2). Patients' preferences about the pain management strategies used, the required support and AEs were further examined through semi-structured individual interviews at the same time measures. Descriptive statistics and thematic analyses were performed. RESULTS Seventy-one patients were recruited and 30 individual interviews were undertaken. Pharmacological pain management strategies used at T1 and T2 were mainly opioids (95.8%; 20.8%) and acetaminophen (91.5%; 37.5%). The most frequently applied non-pharmacological strategies were sleep (95.6%) and physical positioning (89.7%) at T1 and massage (46.3%) and relaxation (32.5%) at T2. Findings from quantitative and qualitative analyses highlighted that non-pharmacological strategies, such as comfort, massage, distraction, and physical therapy, were perceived as the most effective by participants. Most common AEs related to opioids were dry mouth (78.8%) and fatigue (66.1%) at T1 and insomnia (30.0%) and fatigue (20.0%) at T2. Dry mouth (28.6%) and drowsiness (14.3%) were the most reported AEs by patients using recreational cannabis. An important need for information at hospital discharge and for a personalized follow-up was identified by participants during interviews. CONCLUSION Despite its AEs, we found that opioids are still the leading pain management strategy after an orthopaedic trauma and that more efforts are needed to implement non-pharmacological strategies. Cannabis was taken for recreational purposes but patients also used it for pain relief. Support from health professionals is needed to promote the adequate use of these strategies.
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Affiliation(s)
- Sonia Grzelak
- Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Marc-Aurèle Gagnon
- Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
| | - Caroline Côté
- Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Valérie Turcotte
- Nursing Department, CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Stéphane Pelet
- Department of Orthopedic Surgery, CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
| | - Étienne Belzile
- Department of Orthopedic Surgery, CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada
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Lakha SF, Deshpande A, Assimakopoulos D, Mailis A. Demographics, Pain Characteristics and Diagnostic Classification Profile of Chronic Non-Cancer Pain Patients Attending a Canadian University-Affiliated Community Pain Clinic. Pain Ther 2021; 10:1413-1426. [PMID: 34410629 PMCID: PMC8586118 DOI: 10.1007/s40122-021-00301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Little information exists regarding the characteristics of patients with chronic non-cancer pain (CNCP) attending Canadian pain clinics. The study describes the demographics, pain characteristics and the diagnostic classification profile of such patients attending a university-affiliated community-based pain clinic in the Greater Toronto Area. METHODS Retrospective descriptive study based on 644 unique consecutive CNCP patients assessed between January 2016 and December 2017. RESULTS The female/male ratio was 1.6:1; 80% were younger than 65 years; 43% held some form of employment (full-time, part-time or self employment); median pain duration was 3 years; car accidents and medical conditions accounted for 28 and 27% of pain onset, respectively; 34% had four or more distinct areas of pain; and low back pain (LBP) was the most prevalent site (66%), but was the sole site of pain in less than a third of these patients. Age was positively associated with LBP prevalence. Self-reported health service utilization (visits to the emergency room, pain physician or psychologist) increased with patient psychopathology. Cannabis was used by 15% of the cohort and opioids by 34.5%, with only one in six opioid users exceeding 90 mg of morphine equivalent dose per day. Comparison of our data to three previously published studies from other Canadian pain clinics demonstrated both similarities and substantial differences between the populations. CONCLUSION Our study highlights regional differences between CNCP population phenotypes. Recognition of biomedical, psychological and socio-environmental factors affecting pain should be considered for patient stratification and rational approaches to treatment, as "one size treatment does not fit all".
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Affiliation(s)
- S. Fatima Lakha
- Pain and Wellness Centre, Vaughan, ON Canada
- 2301 Major Mackenzie Drive West Unit 101, Vaughan, ON L6A 3Z3 Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON Canada
| | - Amol Deshpande
- Department of Family and Community Medicine, Toronto Rehabilitation Institute, UHN, Quality and Innovation, University of Toronto, Toronto, ON Canada
| | - Demetry Assimakopoulos
- Pain and Wellness Centre, Vaughan, ON Canada
- Chiropractor, University Health Network, Comprehensive Integrated Pain Program Rehabilitation Pain Service, Toronto, ON Canada
| | - Angela Mailis
- Pain and Wellness Centre, Vaughan, ON Canada
- 2301 Major Mackenzie Drive West Unit 101, Vaughan, ON L6A 3Z3 Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON Canada
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Bisson EJ, Katz L, Vader K, Bossio JA, Wilson R, Duggan S. Pain-Related Fear in Adults Living With Chronic Pain: Development and Psychometric Validation of a Brief Form of the Tampa Scale of Kinesiophobia. Arch Phys Med Rehabil 2021; 103:875-881.e1. [PMID: 34610284 DOI: 10.1016/j.apmr.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/13/2021] [Accepted: 09/02/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To develop and validate a brief version of the Tampa Scale of Kinesiophobia (TSK) while preserving content validity in a mixed chronic pain population. DESIGN Cross-sectional study. SETTING Tertiary care interdisciplinary chronic pain clinic. PARTICIPANTS Adults with chronic pain (N=933; mean age, 53.5±15.7 years; 63% women). INTERVENTION Not applicable. MAIN OUTCOME MEASURE TSK-11 measured at intake. Self-reported data from a patient registry were extracted from November 2017 to October 2019. RESULTS An exploratory factor analysis identified a 2-factor structure from the TSK-11 and item reduction resulted in a 7-item TSK (TSK-7) with 61.2% explained variance and Cronbach's alphas of 0.76 and 0.70 for each of the 2 factors. To maximally reduce the number of items without affecting internal consistency, a 5-item TSK (TSK-5) with 72% explained variance was also explored. Strong correlations were found between the newly developed brief TSK versions and TSK-11 (r>0.93), suggesting good concurrent validity. TSK-11, TSK-7, and TSK-5 had similar convergent validity with moderate correlations for pain catastrophizing (r=0.57, 0.58, 0.54), depression (r=0.45, 0.46, 0.42), pain interference (r=0.43, 0.44, 0.40), and pain acceptance (r=-0.57, -0.59, -0.55). CONCLUSIONS These 2 brief versions of the TSK may help to simplify questionnaires across chronic pain centers where multiple outcome measures are used for a complete biopsychosocial assessment of patients.
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Affiliation(s)
- Etienne J Bisson
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, Canada.
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, McMaster University, Hamilton, Canada
| | - Kyle Vader
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Jennifer A Bossio
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; School of Medicine, Queen's University, Kingston, Canada
| | - Rosemary Wilson
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; School of Nursing, Queen's University, Kingston, Canada
| | - Scott Duggan
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Baradaran A, Rahimzadeh P, Gholamzadeh M, Shahmoradi L. Determining chronic pain data elements as a first step towards improving quality of care and research in chronic pain. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021272. [PMID: 34487107 PMCID: PMC8477077 DOI: 10.23750/abm.v92i4.9651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/03/2020] [Indexed: 11/23/2022]
Abstract
Background: Chronic pain is a significant clinical problem in the world. There is still no quite effective treatment for this pain due to its complex nature. Timely retrieval of accurate and comprehensive information through organized clinical and epidemiological studies is an essential prerequisite for providing high quality clinical care and more accurate health planning. We aimed to determine minimum set of data needed as a first step in design and development of a chronic pain registry system. Materials and Methods: This descriptive-applied study was carried out in three phases; identifying necessary minimum data, preparing a primary minimum dataset, and surveying expertsby questionnaire. Result: The literature review revealed that, theprimary minimum dataset consisted of 51 elements, which were reduced to 41 after applying the experts’ opinion. This dataset covered six areas:demographic information(8 elements), initial pain assessment(12 elements), medical history (8 elements), mental health and well-being(6 elements), diagnostic measures(3elements), and diagnosis and treatment plan (4 elements). Conclusion: Determining minimum set of chronic pain data will be an effective step towards integrating and improving information management of patients with chronic pain. It will also allow for proper storage and retrieval of information related to these patients.
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Affiliation(s)
- Arezo Baradaran
- School of Allied Medical Sciences, Tehran University of Medical Sciences.
| | - Poupak Rahimzadeh
- Professor of Anesthesiology, Pain Research Center, Iran University of Medical Sciences.
| | - Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences.
| | - Leila Shahmoradi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences.
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Interest of registries in neuropathic pain research. Rev Neurol (Paris) 2021; 177:843-848. [PMID: 34384628 DOI: 10.1016/j.neurol.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
Neuropathic pain is frequent in the general population, with 7 to 10% of adults presenting with chronic neuropathic pain. To date, the gold standard to evaluate treatments is based on randomized controlled trials. Nonetheless, such design is run on a limited sample and for a limited period. Moreover, many treatments will never be compared directly in sufficiently large and representative populations. A way to overcome several of these limitations is to use real-world data. Indeed, the International Association for the Study of Pain (IASP) includes a special interest group focusing on pain registries and promoting the use of such approaches. In this short narrative review, several of the main chronic pain registries are presented. The strengths and weaknesses of this approach are presented. Indication bias is frequent in observational studies because the choice of treatment is generally influenced by the patients' characteristics. However, a propensity score can be computed to adjust for these differences. The use of propensity score is briefly explained. Some data specific to neuropathic pain are discussed.
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18
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Lacasse A, Gagnon V, Nguena Nguefack HL, Gosselin M, Pagé MG, Blais L, Guénette L. Chronic pain patients' willingness to share personal identifiers on the web for the linkage of medico-administrative claims and patient-reported data: The chronic pain treatment cohort. Pharmacoepidemiol Drug Saf 2021; 30:1012-1026. [PMID: 33901339 PMCID: PMC8360172 DOI: 10.1002/pds.5255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The linkage between patient-reported data and medico-administrative claims is of great interest for epidemiologic research. The goal of this study was to assess the willingness of people living with chronic pain to share personal identifiers on the web for the linkage of medico-administrative and patient-reported data. METHODS This methodological investigation was achieved in the context of the implementation of the chronic pain treatment (COPE) cohort. A web-based recruitment initiative targeting adults living with chronic pain was conducted in the province of Quebec (Canada). RESULTS A total of 1935 participants completed the questionnaire (mean age: 49.86 ± 13.27; females: 83.69%), 921 (47.60%) of which agreed to data linkage and shared their personal identifiers (name, date of birth, health insurance number online). The most common reasons for refusal were: (1) concerns regarding data security/privacy (25.71%) and (2) the belief that the requested data were too personal/intrusive (13.52%). Some participants did not understand the relevance of data linkage (11.81%). Participants from the COPE cohort and those from the subsample who agreed to data linkage were comparable to other random samples of chronic pain individuals in terms of age and pain characteristics. CONCLUSIONS Although approximately half of the participants refused data linkage, our approach allowed for the implementation of a data platform that contains a diverse and substantial sample. This investigation has also led to the formulation of recommendations for web-based data linkage, including placing items designed to assess willingness to share personal identifiers at the end of the questionnaire, adding explanatory videos, and using a mixed-mode questionnaire.
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Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - Véronique Gagnon
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | | | - Mélissa Gosselin
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)MontréalQuébecCanada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecineUniversité de MontréalMontréalQuébecCanada
| | - Lucie Blais
- Faculté de pharmacieUniversité de MontréalMontréalCanada
| | - Line Guénette
- Faculté de pharmacieUniversité LavalQuébecQuébecCanada
- Centre de recherche du CHU de Québec – Université LavalQuébecQuébecCanada
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Kaboré JL, Choinière M, Dassieu L, Lacasse A, Pagé MG. Opioid Doctor Shopping: A Rare Phenomenon Among Patients with Chronic Non-Cancer Pain Followed in Tertiary Care Settings. J Pain Res 2021; 14:1855-1861. [PMID: 34188532 PMCID: PMC8232848 DOI: 10.2147/jpr.s310580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Opioid doctor shopping has not yet been investigated in patients followed in tertiary care settings. This study aimed at assessing the prevalence of opioid doctor shopping among patients with chronic non-cancer pain (CNCP) (ie, pain lasting ≥3 months) attending multidisciplinary pain clinics in Quebec, Canada. Patients and Methods This was a retrospective cohort study of patients with CNCP enrolled in the Quebec Pain Registry (QPR) between 2008 and 2014. QPR data were linked to the Quebec health insurance databases. The index date was the date of the first visit at the pain clinic. Prevalence of doctor shopping was assessed within the 12 months following the index date. Doctor shopping was defined as at least 1 day of overlapping opioid prescriptions from ≥2 prescribers and filled in ≥3 pharmacies. Results A total of 2191 patients with CNCP with at least one opioid dispensation within the 12 months following the index date were included. The mean age was 58.6±14.9 years and 41.3% were men. The median pain duration was 4 years, and 13.3% of patients were diagnosed with neuropathic pain. Regarding past year comorbidities, 15.0% presented anxiety, 16.8% depression and 6.4% substance use disorder. Among the included patients, 15 (0.7%) presented at least one episode of doctor shopping. Among these doctor-shoppers, 9 (60.0%) exhibited only 1 episode. Conclusion Opioid doctor shopping is a rare phenomenon among patients with CNCP treated in tertiary care settings. Opioids should remain a drug option for patients without substance use disorder, and who have persistent pain despite optimized nonopioid therapy.
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Affiliation(s)
- Jean-Luc Kaboré
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Quebec, Canada
| | - M Gabrielle Pagé
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, Quebec, Canada
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20
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Vadalouca A, Alexopoulou-Vrachnou E, Rekatsina M, Kouroukli I, Anisoglou S, Kremastinou F, Gabopoulou Z, Chloropoulou P, Micha G, Tsaroucha A, Siafaka I. The Greek Neuropathic Pain Registry: The structure and objectives of the sole NPR in Greece. Pain Pract 2021; 22:47-56. [PMID: 34145725 DOI: 10.1111/papr.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Neuropathic pain (NP) is a complex condition that impairs the patients' quality of life. Registries are useful tools, increasingly used as they provide high-quality data. This article aims to describe the Greek Neuropathic Pain Registry (Gr.NP.R.) design, the patients' baseline data, and real-world treatment outcomes. METHODS The Gr.NP.R. collects electronically, stores, and shares real-world clinical data from Pain and Palliative Care centers in Greece. It is a web-based application, which ensures security, simplicity, and transparency. VAS, DN4, and Pain Detect were used for pain and NP assessment. RESULTS From 2016 to 2020, 5980 patients with chronic pain, of cancer or non-cancer origin, were examined and 2334 fulfilled the NP inclusion criteria (VAS > 5, DN4 > 4, and Pain Detect ≥ 19). At the first visit, the mean age was 64.8 years, 65.5% were female patients, and 97.9% were Greek. The mean (SD) time from pain initiation to visiting the pain clinics was 1.5 (3.8) years. Most patients were undertreated. Following the patients' registration, the national guidelines were implemented. The majority of the prescribed medications were gabapentinoids (70.2%), especially pregabalin (62.6%), and opioids (tramadol, 55.3%). At visits 1 and 6, mean VAS was 7.1 and 5, and mean DN4 score was 5.6 and 3.5, respectively. CONCLUSIONS The Gr.NP.R. provides information on the demographics, clinical progress, treatment history, treatment responses, and the drugs of choice for patients with cancer and non-cancer NP. The collected data may help physicians plan the management of their patients.
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Affiliation(s)
- Athina Vadalouca
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Pain and Palliative Care Center, Athens Medical Center, Private Hospital, Athens, Greece
| | - Evnomia Alexopoulou-Vrachnou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Department and Pain Clinic and PC, Oncological Hospital "St. Savvas", Athens, Greece
| | - Martina Rekatsina
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Irene Kouroukli
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Private Anesthesiologist, Zografou, Athens, Greece
| | - Sousana Anisoglou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,ICU and Pain Medical Center, Theagenion Hospital, Thessaloniki, Greece
| | - Fani Kremastinou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Anaesthesiology and Pain & Palliative Care, Ippokration General Hospital, Athens, Greece
| | - Zoi Gabopoulou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,KAT Hospital Evaluation Pain Center, Athens, Greece
| | - Panagiota Chloropoulou
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,General Hospital of Kavala, Kavala, Greece
| | - Georgia Micha
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,Department and Pain Clinic and PC, Oncological Hospital "St. Savvas", Athens, Greece
| | - Athanasia Tsaroucha
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,First Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Siafaka
- Hellenic Society of Pain Management and Palliative Care (PARH.SY.A.), Athens, Greece.,First Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
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21
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Kroma RB, Giordano NA, Highland KB, Bedocs P, McDuffie M, Buckenmaier CC. Implementation of the Uniformed Services University Pain Registry Biobank: A Military and Veteran Population Focused Biobank and Registry. PAIN MEDICINE 2021; 22:2950-2963. [PMID: 33983447 DOI: 10.1093/pm/pnab166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this overview is to discuss the development, implementation, data content, and structure of the Uniformed Services University Pain Registry Biobank. Additionally, procedures and policies for accessing samples for pain-related research purposes are detailed. DESIGN Cross-sectional overview. SETTING Multiple military treatment facilities. SUBJECTS Adult beneficiaries seeking care within the Military Health System. METHODS Participants complete a baseline battery of biopsychosocial survey measures, including PROMIS® measures, provide biologic samples (e.g. blood and saliva), and relevant health history, including medications and surgical history, is extracted from medical records. During the course of the next year, enrolled participants complete surveys and provide biologic samples at 3-months, 6-months, and 12-months. Thereafter, participants are contacted once annually to complete self-reported assessments and provide biologic samples. RESULTS In the first year alone 86 subjects have participated in the Uniformed Services University Pain Registry Biobank and provided 390 observations (e.g. biological samples and biopsychosocial patient-reported outcomes). The Uniformed Services University Pain Registry Biobank's integration of biological samples, patient-reported outcomes, and health record data over a longitudinal period across a diverse sample recruited from multiple military facilities addresses many of the limitations faced by other pain-related registries or biorepositories. CONCLUSIONS The Uniformed Services University Pain Registry Biobank will serve as a platform for conducting research closely aligned with the Federal Pain Research Strategy. The inclusion of active duty service members, beneficiaries, and civilians living with and without acute or chronic pain provides a unique data repository for all investigators interested in advancing pain science.
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Affiliation(s)
- Raymond B Kroma
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
| | - Peter Bedocs
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
| | - Mary McDuffie
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
| | - Chester C Buckenmaier
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Rockville, Maryland, USA
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22
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Reyes Velez J, Thompson JM, Sweet J, Busse JW, VanTil L. Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:81-95. [PMID: 34189392 PMCID: PMC8210876 DOI: 10.1080/24740527.2021.1898278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study explored the heterogeneity of Canadian Armed Forces veterans living with chronic pain to inform service needs planning and research using cluster analysis. Design: We used a national cross-sectional Statistics Canada population survey. Participants: Participants included 2754 Canadian Armed Forces (CAF) Regular Force veterans released from service between 1998 and 2015 and surveyed in 2016. Methods: We used cluster analysis of veterans with chronic pain based on pain severity, mental health, and activity limitation characteristics. We compared clusters for sociodemographic, health, and service utilization characteristics. Results: Of 2754 veterans, 1126 (41%) reported chronic pain. Veterans in cluster I (47%) rarely had severe pain (2%) or severe mental health problems (8%), and none had severe activity limitations. Veterans in cluster II (26%) more often than veterans in cluster I but less often than veterans in cluster III endorsed severe pain (27%) and severe mental health problems (22%) and were most likely to report severe activity limitation (91%). Veterans in cluster III (27%) were most likely to report severe pain (36%) and severe mental health problems (96%), and a majority reported severe activity limitations (72%). There was evidence of considerable heterogeneity among individuals in terms of socioeconomic characteristics, pain characteristics, mental and physical health status, activity limitations, social integration, and service utilization indicators. Conclusions: About half of Canadian veterans living with chronic pain infrequently endorse severe pain or serious mental health issues without severe activity limitations. The other half had more complex characteristics. The heterogeneity of CAF veterans with chronic pain emphasizes the need for support systems that can address variability of needs.
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Affiliation(s)
| | - James M Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
| | - Jill Sweet
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
| | - Jason W Busse
- Michael DeGroote Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Linda VanTil
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
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23
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Deslauriers S, Roy JS, Bernatsky S, Feldman DE, Pinard AM, Desmeules F, Fitzcharles MA, Perreault K. The association between waiting time and multidisciplinary pain treatment outcomes in patients with rheumatic conditions. BMC Rheumatol 2020; 4:59. [PMID: 33111034 PMCID: PMC7583241 DOI: 10.1186/s41927-020-00157-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Access to multidisciplinary pain treatment facilities (MPTF) is limited by extensive waiting time in many countries. However, there is a lack of knowledge about the impact of waiting time on clinical outcomes, particularly for patients with rheumatic conditions. This study examined the association between waiting time for MPTF and clinical outcomes in patients with rheumatic conditions. METHODS Data were extracted from the Quebec Pain Registry, a large database of patients who received services in MPTF. The associations between waiting time (classified as < 2 months, 2-6 months and > 6 months) and change in pain interference, pain intensity and health-related quality of life, from the initial visit at the MPTF to the 6-month follow-up, were tested using generalized estimating equations. RESULTS A total of 3230 patients with rheumatic conditions (mean age: 55.8 ± 14.0 years; 66% were women) were included in the analysis. Small significant differences in improvement between waiting time groups were revealed, with patients waiting less than 2 months having a larger improvement in all clinical outcomes compared to patients who waited 2-6 months or over 6 months before their initial visit (adjusted time X group effect p ≤ 0.001). Only patients waiting less than 2 months reached a clinically important improvement in pain interference (1.12/10), pain intensity (1.3/10) and physical and mental quality of life (3.9 and 3.7/100). CONCLUSIONS Longer delays experienced by patients before receiving services in MPTF were associated with statistically significant smaller improvements in pain interference, pain intensity and health-related quality of life; these differences were, however, not clinically significant. Based on these results, we advise that strategies are developed not only to reduce waiting times and mitigate their impacts on patients with rheumatic conditions, but also to improve treatment effectiveness in MPTF.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
| | - Sasha Bernatsky
- McGill University Health Centre (MUHC), 1650 Cedar Ave, Montreal, QC H3G 1A4 Canada
- McGill University, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
| | - Debbie E. Feldman
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), CRIR, 6363, chemin Hudson (Pavillon Lindsay) bureau 061, Montréal, QC H3S 1M9 Canada
- Public Health Research Institute of Université de Montréal, Montréal, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
- Centre hospitalier universitaire (CHU) de Québec, Québec, Canada
| | - François Desmeules
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Maisonneuve-Rosemont Hospital (CRHMR) Research Center, CRHMR, 5415 Assomption boulevard, Montreal, QC H1T 2M4 Canada
| | - Mary-Ann Fitzcharles
- McGill University Health Centre (MUHC), 1650 Cedar Ave, Montreal, QC H3G 1A4 Canada
- McGill University, Montréal, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
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24
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Biopsychosocial Characteristics of Patients With Chronic Pain Expecting Different Levels of Pain Relief in the Context of Multidisciplinary Treatments. Clin J Pain 2020; 37:11-19. [PMID: 33060382 DOI: 10.1097/ajp.0000000000000885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Evidence suggests that patients' expectations predict chronic pain treatment outcomes. Although patients vary in terms of expected pain relief, little is known about individual factors related to such variations. This study aims to investigate how patients with various levels of pain relief expectations differ on the basis of biopsychosocial baseline characteristics in the context of multidisciplinary chronic pain treatment. MATERIALS AND METHODS Data from 3110 individuals with chronic pain attending one of 3 multidisciplinary pain treatment centers were considered. Participants completed a self-reported measure of pain relief expectations and provided information pertaining to biological, psychological, and social variables. RESULTS A backward stepwise regression helped identify biopsychosocial variables that significantly predicted expected pain relief. Subsequent analyses suggest that patients reporting low, moderate, high, and very high expectations of pain relief differed significantly in terms of pain duration and depressive symptoms. Significant between-group differences were also found with regard to overall physical health, age, sex, and ethnicity. DISCUSSION Identifying characteristics related to different levels of pain relief expectations is a fundamental step in generating a more comprehensive understanding of how expectations can be of use in the successful management of chronic pain conditions.
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25
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Fang L, Chen L, Sun H, Xu Y, Jin J. The Effectiveness of Using a Nurse-Led Pain Relief Model for Pain Management among Abdominal Surgical Patients: A Single-Center, Controlled before-after Study in China. Pain Manag Nurs 2020; 22:198-204. [PMID: 33039300 DOI: 10.1016/j.pmn.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/08/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Effective pain management is closely related to the prognosis of patients after surgery. Setting up acute pain service is among the effective strategies to control pain. The operation of acute pain service is mostly dominated by anesthesiologists; however, control of postsurgical pain is still unsatisfactory. Nurses are the main force for providing postoperative care of patients, and their role in acute pain service is crucial. Therefore, in the current study, we have developed a nurse-led pain relief model that emphasizes the central role of nurses during the entire surgical procedure. However, the effect of using this model for pain management among abdominal surgical patients remains unknown. AIMS The current study was conducted to investigate the effect of using a nurse-led pain relief model for pain management among abdominal surgical patients. DESIGN A single-center, propensity score-matched, controlled before-after study. METHODS The patients, hospitalized for abdominal surgery in a university-affiliated hospital from January 2015 to December 2017, were enrolled and divided into group A (hospitalized before nurse-led pain relief model implementation, from January, 2015 to October, 2016) and group B (hospitalized after nurse-led pain relief model implementation, from October, 2016, to December, 2017) using propensity score match assay. The researchers compared the quality of acute pain management, the main side effects of pain management, and nurses' pain knowledge and attitude between group A and group B. RESULTS A total of 2851 patients undergoing nonemergency abdominal surgery were enrolled in the current study and were propensity matched 1:1 into two groups with 1,127 subjects in each group. The quality of acute pain management postsurgery was better after implementation of the nurse-led pain relief model. More patients received higher numerical rating scales cores (≥4 points) at indicated time points after surgery in group A compared with group B (14.20% vs. 12.24% 6 hours postsurgery, p = .001; 12.33% vs. 8.52% 12 hours postsurgery, p = .004; 12.95% vs. 3.99% 24 hours postsurgery, p = .036; 16.06% vs. 7.19% 48 hours postsurgery, p = .001). Furthermore, the occurrence of nausea and vomiting during pain management were significantly decreased in patients from group B (nausea: X2 = 38.926, p < .05; vomit: X2 = 39.302, p < .05). Additionally, after using the nurse-led pain relief model, nurses were more open to improving their knowledge and attitudes to pain management (p < .05). CONCLUSION Our study demonstrated that a nurse-led pain relief model can enhance the quality of acute pain management among post-abdominal surgical patients, suggesting that such a model can be an effective intervention for providing a better pain control among postsurgical patients.
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Affiliation(s)
- Liangyu Fang
- Department of Anesthesiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Laijuan Chen
- Department of Anesthesiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Hongling Sun
- Department of Specialist Nursing, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yinchuan Xu
- Department of Cardiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jingfeng Jin
- Department of Nursing, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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26
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Kazemi-Arpanahi H, Moulaei K, Shanbehzadeh M. Design and development of a web-based registry for Coronavirus (COVID-19) disease. Med J Islam Repub Iran 2020; 34:68. [PMID: 32974234 PMCID: PMC7500427 DOI: 10.34171/mjiri.34.68] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background: The 2019 coronavirus (COVID-19) is a highly contagious disease associated with a high morbidity and mortality worldwide. The accumulation of data through a prospective clinical registry enables public health authorities to make informed decisions based on real evidence obtained from surveillance of COVID-19. This registry is also fundamental to providing robust infrastructure for future research surveys. The purpose of this study was to design a registry and its minimum data set (MDS), as a valid and reliable data source for reporting and benchmarking COVID-19. Methods: This cross sectional and descriptive study provides a template for the required MDS to be included in COVID-19 registry. This was done by an extensive literature review and 2 round Delphi survey to validate the content, which resulted in a web-based registry created by Visual Studio 2019 and a database designed by Structured Query Language (SQL). Results: The MDS of COVID-19 registry was categorized into the administrative part with 3 sections, including 30 data elements, and the clinical part with 4 sections, including 26 data elements. Furthermore, a web-based registry with modular and layered architecture was designed based on final data classes and elements. Conclusion: To the best of our knowledge, COVID-19 registry is the first designed instrument from information management perspectives in Iran and can become a homogenous and reliable infrastructure for collecting data on COVID-19. We hope this approach will facilitate epidemiological surveys and support policymakers to better plan for monitoring patients with COVID-19.
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Affiliation(s)
- Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan Faculty of Medical Sciences, Abadan, Iran
| | - Khadijeh Moulaei
- Department of Health Information Management, School of Health Management and Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
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27
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Vadalouca A, Rekatsina M. Neuropathic Pain Registries Improve Pain Management and Provide More Efficacious Planning of Healthcare Services. Pain Ther 2020; 9:1-6. [PMID: 32303978 PMCID: PMC7203239 DOI: 10.1007/s40122-020-00168-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/14/2022] Open
Abstract
The first official health registry dates back to the 19th century and was proven to be very useful for gathering important information regarding a specific disease. Since then, data collection through registries is gaining more popularity, as it can offer useful information not only to health providers but also to healthcare planning services. Health registries could come along with randomized controlled trials and support or reject their findings in the "real world". Pain registries and neuropathic pain registries have proven to be very potent weapons in the armory of the pain specialist and are growing rapidly, offering substantial information for this challenging pain entity.
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Affiliation(s)
- Athina Vadalouca
- Head of Pain and Palliative Care Center, Athens Medical Center Hospital, Athens, Greece
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28
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Kaboré J, Saïdi H, Dassieu L, Choinière M, Pagé MG. Predictors of Long‐Term Opioid Effectiveness in Patients With Chronic Non‐Cancer Pain Attending Multidisciplinary Pain Treatment Clinics: A Quebec Pain Registry Study. Pain Pract 2020; 20:588-599. [DOI: 10.1111/papr.12883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/17/2020] [Accepted: 03/07/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Jean‐Luc Kaboré
- Department of Pharmacology and Physiology Faculty of Medicine Université de Montréal Montreal Quebec Canada
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Hichem Saïdi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Lise Dassieu
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
- Department of Anesthesiology and Pain Medicine Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - M. Gabrielle Pagé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
- Department of Anesthesiology and Pain Medicine Faculty of Medicine Université de Montréal Montreal Quebec Canada
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29
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Granan LP, Reme SE, Jacobsen HB, Stubhaug A, Ljoså TM. The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scand J Pain 2020; 19:365-373. [PMID: 30699072 DOI: 10.1515/sjpain-2017-0160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/05/2019] [Indexed: 12/26/2022]
Abstract
Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0-10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient's perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients' self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.
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Affiliation(s)
- Lars-Petter Granan
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424 Oslo, Norway.,Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway, Phone: +47 91 85 95 05
| | - Silje Endresen Reme
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,National Advisory Unit for Neuropathic Pain, Oslo, Norway
| | - Audun Stubhaug
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Marte Ljoså
- Advisory Unit on Pain Management Health Region South-East, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Stedenfeldt M, Kvarstein G, Nilsen TIL, Schjødt B, Borchgrevink PC, Halsteinli V. Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway. Scand J Pain 2020; 20:363-373. [DOI: 10.1515/sjpain-2019-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/12/2019] [Indexed: 01/13/2023]
Abstract
Abstract
Background and aims
A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics.
Methods
Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center.
Results
Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS.
Conclusions
Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups.
Implications
The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.
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Affiliation(s)
- Mona Stedenfeldt
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UiT , The Arctic University of Norway , Tromsø , Norway
- Department of Pain Management , University Hospital of Northern Norway , Tromsø , Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Borrik Schjødt
- Centre for Pain Management and Palliative Care, Haukeland University Hospital , Bergen , Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Vidar Halsteinli
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
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Wei X, Liu B, He L, Yang X, Zhou J, Zhao H, Liu J. Acupuncture therapy for chronic low back pain: protocol of a prospective, multi-center, registry study. BMC Musculoskelet Disord 2019; 20:488. [PMID: 31656194 PMCID: PMC6815416 DOI: 10.1186/s12891-019-2894-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022] Open
Abstract
Objective Acupuncture therapy for chronic low back pain (CLBP) has received increasing attention. Nevertheless, the evidence of efficacy and safety of random controlled trials (RCTs) remains controversial. Acupuncture as a complex intervention influenced by many factors, its effectiveness in treating chronic low back pain in the real world is unknown. We will develop a network-based registry study to evaluate the effectiveness and safety of acupuncture for the treatment of chronic low back pain and explore key factors affecting efficacy in the real world. Methods A prospective, multi-center and dynamic registry study. All acupuncture related information will be collected through a high-quality structured network platform. Patients with CLBP included in the study met the following criteria: age from 16 to 80 years, using acupuncture as a main therapy and voluntarily signing the informed consent. At least 2000 patients, 27 acupuncturist, and 9 medical centers will be recruited under actual clinical settings at the first stage. Numeric rating scale (NRS), Oswestry Disability Index (ODI) and Effective rate will be measured in pain and functional disability assessment, respectively, as the primary outcome. Evaluation index will be collected at the baseline and follow-up in 1, 4, 12 weeks after the last visit. Hierarchical models and regression analysis will be used to explore the key factors affecting acupuncture effectiveness. Effects between propensity matching groups (Traditional Chinese acupuncture style vs Microacupuncture style, Local acupoint selection vs Non-local acupoint selection, Single Acupuncture vs Combined therapy) will be compared. Discussion This study will be conducted based on the characteristics of acupuncture therapy in the “Real World”. Fundamental factors affecting the clinical effectiveness of acupuncture and the preferred acupuncture regimen in the treatment of CLBP will be identified. Reliable acupuncture evidence for the treatment of CLBP through the registry will be a significant supplement to the RCTs. Trial registration Chinese Clinical Trial Registry, ChiCTR-OOC-17010751 and Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-OOO-17000045. Registered date on 3 December 2016.
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Affiliation(s)
- Xuqiang Wei
- College of Acupuncture and Orthopedic, Hubei University of Chinese Medicine, No.1 Huangjiahu West Road, Hongshan District, Wuhan, Hubei, 430065, People's Republic of China
| | - Baoyan Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 Dongzhimen inside south St. Dongchen District, Beijing, 100700, People's Republic of China
| | - Liyun He
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 Dongzhimen inside south St. Dongchen District, Beijing, 100700, People's Republic of China
| | - Xingyue Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11, North Third Ring Road, Chaoyang District, Beijing, 100045, People's Republic of China
| | - Jincao Zhou
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, No.16 Dongzhimen inside south St. Dongchen District, Beijing, 100700, People's Republic of China
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, No.16 Dongzhimen inside south St. Dongchen District, Beijing, 100700, People's Republic of China.
| | - Jia Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 Dongzhimen inside south St. Dongchen District, Beijing, 100700, People's Republic of China.
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Deslauriers S, Roy JS, Bernatsky S, Feldman DE, Pinard AM, Desmeules F, Fitzcharles MA, Perreault K. Factors associated with waiting times for persons with rheumatic conditions in multidisciplinary pain treatment facilities. J Pain Res 2019; 12:2379-2390. [PMID: 31534361 PMCID: PMC6681557 DOI: 10.2147/jpr.s206519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Access to multidisciplinary pain treatment facilities (MPTF) in Canada is limited by long waiting lists. However, little is known about the factors associated with access to MPTF specifically for persons with rheumatic conditions. This study aimed to 1) determine the waiting time for services in publicly funded MPTF for persons with rheumatic conditions in the province of Quebec, Canada, as well as 2) identify the factors associated with waiting time. METHODS This study was conducted using the Quebec Pain Registry, a large database of patients who received pain management services in MPTF. Sociodemographic and clinical variables were assessed for potential associations with waiting time. Descriptive, bivariate analyses and multiple linear regression analyses were conducted. RESULTS A total of 3,665 patients with rheumatic conditions were identified within the registry. Patients had a mean age of 55±14 years and the majority were women (65.7%). The average waiting time was 241.2±308.9 days (median=126), with 34.2% of the patients waiting longer than 6 months before having a first appointment. Results indicate that longer pain duration, lower household income, pain onset following a motor vehicle accident, having fibromyalgia, being on permanent disability or unemployed and being referred by a family physician (versus specialist) were significantly associated with longer waiting times. CONCLUSIONS Many patients with rheumatic conditions (especially fibromyalgia) face long delays before receiving services in Quebec's MPTF. This study identified several factors associated with waiting time and emphasizes the need to improve access to pain management services.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Sasha Bernatsky
- McGill University Health Centre (MUHC)
, Montréal, QC, Canada
- Faculty of Medicine, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC)
, Montréal, QC, Canada
| | - Debbie E Feldman
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)
, Montréal, QC, Canada
- Public Health Research Institute of Université de Montréal
, Montréal, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre Hospitalier Universitaire (CHU) de Québec
, Québec, QC, Canada
| | - François Desmeules
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Maisonneuve-Rosemont Hospital (CRHMR) Research Center
, Montréal, QC, Canada
| | - Mary-Ann Fitzcharles
- McGill University Health Centre (MUHC)
, Montréal, QC, Canada
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
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Jenio FZ, Scholes C, Marenah M, Li J, Cowley M, Ebrahimi M, Harrison-Brown M, Murrell WD. Quality in practice: implementation of a clinical outcomes registry in regenerative medicine. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:130. [PMID: 31157251 DOI: 10.21037/atm.2019.02.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this didactic article is to describe the implementation of a clinical outcomes registry within a clinical setting for musculoskeletal regenerative medicine. A patient-centred clinical registry, designed and implemented into the practice of a musculoskeletal clinic specializing in regenerative medicine. Methods A focus on patient outcomes at all levels of the patient journey was established to monitor and continually improve care. The registry was designed to monitor the diagnosis, treatment and outcomes of musculoskeletal pathologies of the shoulder, elbow, hip, knee, foot and spine presenting to the clinic. Specifically, the registry was designed for surveillance, tracking, and reporting of efficacy and adverse events of cellular-based therapies. Results The registry has completed its implementation phase and is now in a pilot period to confirm data collection processes and user feedback. Initial findings indicate suboptimal data entry compliance in key areas that were rectified by refining data fields, reimaging within existing operating systems, and linkage to external supporting documents. Conclusions The key impacts of the registry implementation have been to (I) redefine criteria for treatment success and failure within the area of biologic treatments in musculoskeletal practice; (II) instigate discussion, and document standardized treatment pathways, clinical handover processes and shared decision-making with patients; and (III) act as a catalyst to target deficiencies in staff knowledge and skills in the areas of patient management and interaction, clinical documentation and administration processes. A practice registry provides a platform for monitoring treatment safety and efficacy in the context of biologic therapies in musculoskeletal medicine. Registries of this kind will contribute to ongoing discourse regarding best value treatments in the musculoskeletal context.
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Affiliation(s)
| | | | - Maimuna Marenah
- Emirates Integra Medical & Surgery Centre, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Jinjie Li
- Emirates Integra Medical & Surgery Centre, Dubai Healthcare City, Dubai, United Arab Emirates
| | | | | | | | - William D Murrell
- Emirates Integra Medical & Surgery Centre, Dubai Healthcare City, Dubai, United Arab Emirates.,Emirates Healthcare, Dubai, United Arab Emirates.,Landsthul Regional Medical Center, Landsthul, Germany.,7th Medical Support Unit, Kaiserslautern, Germany
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Price CM, C de C Williams A, Smith BH, Bottle A. Implementation of Patient-Reported Outcomes (PROMs) from specialist pain clinics in England and Wales: Experience from a nationwide study. Eur J Pain 2019; 23:1368-1377. [PMID: 31025797 DOI: 10.1002/ejp.1406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Evaluating outcomes in routine clinical practice is a significant challenge for specialist pain clinics due to the complexity of interventions provided and the subjective nature of pain. This study reports findings from implementation of Patient Reported Outcomes (PROMs) in pain clinics in England and Wales between 2011 and 2013. METHODS A paper-based questionnaire was administered at a first appointment in participating centres. This assessed quality of life, experience of health care and health care usage with postal follow-up at 6 and 12 months by the research team. Feasibility was assessed in terms of response rates, completion rates and outcomes. RESULTS Ninety-one (56%) clinics participated, entering 9,588 patients (19% of those eligible). For responders, there was a 92% item completion rate. The dropout rate was high, 46% and 19% returned questions at 6 and 12 months, respectively. Quality of life at baseline was low, with a mean EQ5D-3L Time Trade Off value of 0.32. Amongst responders at 12 months, 92% continued to experience significant pain. For those with planned discharges 30% achieved the Minimal Important Change for quality of life. Nonetheless, 70% reported positive experiences of care. CONCLUSIONS Patients attending UK pain clinics report an extraordinarily poor quality of life and difficulty with understanding their condition. Problems with PROMs implementation included initial recruitment, follow-up response rates, classification systems and benchmarking. Successful implementation should include use of electronic data capture, feedback and focus on gradual improvement. To achieve this would require extended periods of funding. SIGNIFICANCE No nationwide evaluation of the effectiveness of specialist pain clinics had previously been attempted. Comparison of patient outcomes from services enables improvement. This work provides a platform to improve methods of routine PROMs capture in pain clinics, measure clinical effectiveness and identify areas for potential research.
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Affiliation(s)
| | | | - Blair H Smith
- Department of Population Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alex Bottle
- Dr Foster Unit, Imperial College London, London, UK
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Pagé MG, Boyd K, Ware MA. Examination of the Course of Low Back Pain Intensity Based on Baseline Predictors and Health Care Utilization Among Patients Treated in Multidisciplinary Pain Clinics: A Quebec Pain Registry Study. PAIN MEDICINE 2019; 20:564-573. [DOI: 10.1093/pm/pny205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Gabrielle Pagé
- Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anethesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Kelly Boyd
- Division of Experimental Medicine, Department of Medicine
| | - Mark A Ware
- Department of Family Medicine
- Department of Anesthesia, Faculty of Medicine
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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Guertin JR, Pagé MG, Tarride JÉ, Talbot D, Watt-Watson J, Choinière M. Just how much does it cost? A cost study of chronic pain following cardiac surgery. J Pain Res 2018; 11:2741-2759. [PMID: 30519078 PMCID: PMC6235323 DOI: 10.2147/jpr.s175090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The study objective was to determine use of pain-related health care resources and associated direct and indirect costs over a two-year period in cardiac surgery patients who developed chronic post-surgical pain (CPSP). METHODS This multicentric observational prospective study recruited patients prior to cardiac surgery; these patients completed research assistant-administered questionnaires on pain and psychological characteristics at 6, 12 and 24 months post-operatively. Patients reporting CPSP also completed a one-month pain care record (PCR) (self-report diary) at each follow-up. Data were analyzed using descriptive statistics, multivariable logistic regression models, and generalized linear models with log link and gamma family adjusting for sociodemographic and pain intensity. RESULTS Out of 1,247 patients, 18%, 13%, and 9% reported experiencing CPSP at 6, 12, and 24 months, respectively. Between 16% and 28% of CPSP patients reported utilizing health care resources for their pain over the follow-up period. Among all CPSP patients, mean monthly pain-related costs were CAN$207 at 6 months and significantly decreased thereafter. More severe pain and greater levels of pain catastrophizing were the most consistent predictors of health care utilization and costs. DISCUSSION Health care costs associated with early management of CPSP after cardiac surgery seem attributable to a minority of patients and decrease over time for most of them. Results are novel in that they document for the first time the economic burden of CPSP in this population of patients. Longer follow-up time that would capture severe cases of CPSP as well as examination of costs associated with other surgical populations are warranted. SUMMARY Economic burden of chronic post-surgical pain may be substantial but few patients utilize resources. Health utilization and costs are associated with pain and psychological characteristics.
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Affiliation(s)
- Jason Robert Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - M Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada,
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Judy Watt-Watson
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada,
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,
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Saïdi H, Pagé MG, Boulanger A, Ware MA, Choinière M. Effectiveness of long-term opioid therapy among chronic non-cancer pain patients attending multidisciplinary pain treatment clinics: A Quebec Pain Registry study. Can J Pain 2018; 2:113-124. [PMID: 35005371 PMCID: PMC8730575 DOI: 10.1080/24740527.2018.1451252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to investigate in a real-life context the effectiveness of long-term opioid therapy for reducing pain intensity and interference and improving health-related quality of life (QOL) in patients with chronic noncancer pain. METHODS Participants were 893 patients (age = 52.4 ± 14.1, female = 62.4%) enrolled in the Quebec Pain Registry (2008-2011) who completed questionnaires before their first visit at one of three multidisciplinary pain management clinics and 6 and 12 months thereafter. Based on their opioid use profile (OUP), patients were categorized as nonusers, non-lasting users, or lasting users. Data were analyzed using generalized estimating equations. RESULTS More than 60% of patients newly initiated on opioid therapy stopped their medication mainly because of adverse effects and/or lack of pain relief. OUP significantly predicted pain intensity and interference and physical QOL (pQOL; P values < 0.001). Lasting users of opioids reported higher levels of pain intensity and interference and poorer pQOL than nonusers and/or non-lasting users over the 12-month follow-up (P values < 0.001). However, all effect sizes were small, thus questioning the clinical significance of these group differences. Among lasting users, more than 20% of patients experienced a meaningful amelioration in pain intensity and interference as well as mental QOL (mQOL), whereas only 8% exhibited improved pQOL. DISCUSSION A significant subgroup of patients may benefit from long-term opioid therapy in terms of pain severity and mQOL but the majority do not. The challenge facing clinicians is how to identify who the responders will be.
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Affiliation(s)
- Hichem Saïdi
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Aline Boulanger
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre d’expertise en gestion de la douleur du Réseau universitaire intégré en santé de l’Université de Montréal, Montreal, Quebec, Canada
- Québec Pain Research Network
| | - Mark A. Ware
- Québec Pain Research Network
- Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Québec Pain Research Network
- Alan Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada
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Pagé MG, Fortier M, Ware MA, Choinière M. As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes. J Pain Res 2018; 11:237-254. [PMID: 29416373 PMCID: PMC5790081 DOI: 10.2147/jpr.s149262] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The presence of multiple coexisting chronic pain (CP) conditions (eg, low-back pain and migraines) within patients has received little attention in literature. The goals of this observational longitudinal study were to determine the prevalence of coexisting CP conditions, identify the most frequent ones and patterns of coexistence, investigate the relationships among patients' biopsychosocial characteristics and number of CP conditions, and determine the impact of coexisting CP conditions on treatment response. PATIENTS AND METHODS A total of 3,966 patients attending multidisciplinary pain-treatment centers who were enrolled in the Quebec Pain Registry were included. Patients completed self-report and nurse-administered questionnaires before their first visit and 6 months later. Results were analyzed using descriptive statistics, factor and cluster analyses, negative binomials with log-link generalized linear models, and linear mixed-effect models. RESULTS A third of patients reported coexisting CP conditions. No specific patterns of comorbidities emerged. The presence of coexisting CP conditions was associated with longer pain duration, older age, being female, and poorer quality of life. The presence of more than one CP condition did not have a clinically significant impact on treatment responses. DISCUSSION The novelty of the study results relate to the heterogeneity that was found in the patterns of coexistence of CP conditions and the fact that having multiple CP conditions did not clinically impact treatment response. These results highlight the need for future research that examines causes of coexistence among CP conditions across the spectrum of CP, as opposed to focusing on specific conditions, and to examine whether multiple CP conditions impact on additional domains, such as treatment satisfaction. These results highlight the importance of studying the pathophysiological mechanisms underlying the development of coexisting CP conditions, in order eventually to prevent/minimize their occurrence and/or develop optimal treatment and management approaches.
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Affiliation(s)
- M Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal
| | - Maude Fortier
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
| | - Mark A Ware
- Department of Family Medicine
- Department of Anesthesia, Faculty of Medicine
- Alan Edwards Centre for Research on Pain, McGill University
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM)
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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