An observational study of pain self-management strategies and outcomes: does type of pain, age, or gender, matter?

Predicting Chronic Pain and Treatment Outcomes Using Machine Learning Models Based on High-dimensional Clinical Data From a Large Retrospective Cohort

PURPOSE

To identify factors and indicators that affect chronic pain and pain relief, and to develop predictive models using machine learning.

METHODS

We analyzed the data of 67,028 outpatient cases and 11,310 valid samples with pain from a large retrospective cohort. We used decision tree, random forest, AdaBoost, neural network, and logistic regression to discover significant indicators and to predict pain and treatment relief.

FINDINGS

The random forest model had the highest accuracy, F1 value, precision, and recall rates for predicting pain relief. The main factors affecting pain and treatment relief included body mass index, blood pressure, age, body temperature, heart rate, pulse, and neutrophil/lymphocyte × platelet ratio. The logistic regression model had high sensitivity and specificity for predicting pain occurrence.

IMPLICATIONS

Machine learning models can be used to analyze the risk factors and predictors of chronic pain and pain relief, and to provide personalized and evidence-based pain management.

Exploring the Experiences of Co-morbid Pain and Depression in Older African American Women and Their Preferred Management Strategies

The intersection of race, gender, and age places older African American women at an increased risk for untreated physical pain and depression that can significantly diminish their quality of life. The objectives of this study were to (1) explore older African American women's perceptions of pain and depressive symptoms and how these symptoms influence each other, and (2) explore effective pain and depression alleviation strategies used by the women. We conducted five focus groups with older African American women (N = 18). We used deductive coding to analyze focus group transcripts and qualitative description to summarize themes. We identified five major themes: (1) Spiritual Suffering from Linked Pain and Depression, (2) Lack of Understanding from Healthcare Providers, (3) Push Through and Live Through, (4) Medications Not Worth the Risk and, (5) Strategies for Pain and Depression. This study offers insight into the experiences of pain and depression in older African American women, and alleviation strategies they perceive as effective. These qualitative findings may be used to inform interventions for older African American women who experience pain and depressive symptoms.

Chronic cadmium exposure and cardiovascular disease in adults

Chronic cadmium exposure and its effect on cardiovascular-related markers were explored in the cross-sectional study of U.S. adults using the National Health and Nutrition Examination Survey (NHANES) 2007-2010 data. Cardiovascular-related markers, such as LDL cholesterol mg/dL (LDL-C), non-HDL cholesterol mg/dL (non-HDL-C), triglycerides mg/dL (TG), c-reactive protein mg/dL (CRP), and gamma-glutamyl transferase U/L (GGT) were explored in relation to urine cadmium level µg/L (UCL). The variables and their relation to UCL µg/L were explored both as continuous and categorical variables using linear and logistic regression models and basic descriptive statistics. Geometric Mean values of the markers of interest were statistically significantly more elevated in middle-aged adults (45-65 years) as compared to younger adults (18-44 years). In linear regression analysis, CRP mg/dL, LDL-C mg/dL, non-HDL-C mg/dL, and GGT U/L levels were significantly associated with UCLs mg/dL after adjusting for confounding variables. In binary logistic regression models, young and middle-aged adults chronically exposed to cadmium were significantly more likely to have elevated CRP mg/dL levels. This study suggests that chronic exposure to cadmium alters cardiovascular-related markers in middle-aged adults more so than younger adults, which calls for early public health intervention to limit cadmium exposure in the U.S.

A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol

Aims

Pain is underestimated and insufficiently treated in Emergency Departments (ED). The primary objective of this multicenter, prospective, observational, and interventional study is to analyze the clinical impact of a simulation-based training for Emergency Nurses on pain assessment and management. Secondary objectives are to measure instructed staff's satisfaction with the simulation training and to evaluate the progress of participants as well as studying the clinical impact of this course: level of correlation between accuracy of analgesia and level of pain, assessment of patient and caregiver satisfaction.

Design

this study will be undertaken in EDs at two university hospitals (Paris, France: Bichat and Beaujon) with randomly selected experimental and control groups.

Methods

During the first phase, inventories in the EDs of current professional practice will be realized. Then, the control group will have theoretical classes and the experimental group will have both the theoretical class and simulation courses for all the nurses (with simulated patients in trauma pain scenarios). Post course assessment will be established of triage nurses' and other nurses’ practice changes concerning trauma pain management in EDs. Moreover, this study will include an assessment of the impact on patient and caregiver satisfaction. All patients over 18 years old who are admitted to the ED for a non-vital trauma are included. Exclusion criteria are patients who are admitted by an EMS ambulance.

Clinical implication

this study seeks to demonstrate that the implementation of a theoretical course combined with a simulation session will improve pain management in EDs by Emergency Nurses.

Xm2 Scores for Estimating Total Exposure to Multimodal Strategies Identified by Pharmacists for Managing Pain: Validity Testing and Clinical Relevance

Objective

To assess the validity of an exposure score obtained from the Xm² tool for all pharmacological and nonpharmacological strategies used by individuals to manage chronic pain.

Methods

Using data from individuals with chronic pain, eXposure multimodal (Xm²) scores were calculated by assigning one point for every 100 mg of morphine equivalent used (opioid medications); 25% of the maximum recommended exposure used (nonopioid medications); and any use of another strategy then summed. Content, criterion, construct, and convergent validity were assessed.

Results

The sample of 149 individuals used a mean of 12.6 (SD = 4.6) strategies to manage pain and had a mean Xm² score of 16.8 (SD = 9.1). Content validity was established by demonstrating that the pain management strategies identified were also reported in the literature. Criterion validity was established by the positive association of exposure scores with the following: interference with work (odds ratio (OR) = 2.23, 95% confidence interval (CI) = 1.14–4.36), daily activities (OR = 2.10, CI = 1.07–4.13), relationships (OR = 1.98, CI = 1.01–3.88), and leisure activities (OR = 2.31, CI = 1.18–4.50); workdays missed (OR = 5.10, CI = 1.92–13.58); emergency department visits (OR = 3.40, CI = 1.17–9.91); hospitalizations (OR = 4.18, CI = 0.86–20.37); and by a negative association with satisfaction (OR = 0.40, CI = 0.18–0.88). Construct validity was established by the positive association of exposure with baseline pain intensity (p < 0.01) and odds of experiencing an adverse event (OR = 2.31, CI = 1.18–4.52). Convergent validity was established through correlations of pain intensity from the Xm² score and existing quantitative analgesic questionnaire (QAQ) score.

Discussion

Xm² scores represent a valid estimate of total exposure to multimodal strategies used and provide clinically relevant information for deciding what strategies to use at what level.