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Hooten WM, Backonja M, Williams KA, Sturgeon JA, Gross JB, Borodianski S, Wang V, Tuan WJ, Zgierska AE, Moeller-Bertram T, Kriegel ML. Integrated pain care models and the importance of aligning stakeholder values. Pain Rep 2024; 9:e1160. [PMID: 38646660 PMCID: PMC11029933 DOI: 10.1097/pr9.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 04/23/2024] Open
Abstract
Sustained widespread deployment of clinically and cost-effective models of integrated pain care could be bolstered by optimally aligning shared stakeholder values.
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Affiliation(s)
- W. Michael Hooten
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miroslav Backonja
- Division of Intramural Research, National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, USA
| | - Kayode A. Williams
- Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jacob B. Gross
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Wen-Jan Tuan
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Aleksandra E. Zgierska
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA, USA
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Donovan LM, McDowell JA, Pannick AP, Pai J, Bais AF, Plumley R, Wai TH, Grunwald GK, Josey K, Sayre GG, Helfrich CD, Zeliadt SB, Hoerster KD, Ma J, Au DH. Protocol for a pragmatic trial testing a self-directed lifestyle program targeting weight loss among patients with obstructive sleep apnea (POWER Trial). Contemp Clin Trials 2023; 135:107378. [PMID: 37935303 DOI: 10.1016/j.cct.2023.107378] [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: 07/18/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Obesity comprises the single greatest reversible risk factor for obstructive sleep apnea (OSA). Despite the potential of lifestyle-based weight loss services to improve OSA severity and symptoms, these programs have limited reach. POWER is a pragmatic trial of a remote self-directed weight loss care among patients with OSA. METHODS POWER randomizes 696 patients with obesity (BMI 30-45 kg/m2) and recent diagnosis or re-confirmation of OSA 1:1 to either a self-directed weight loss intervention or usual care. POWER tests whether such an intervention improves co-primary outcomes of weight and sleep-related quality of life at 12 months. Secondary outcomes include sleep symptoms, global ratings of change, and cardiovascular risk scores. Finally, consistent with a hybrid type 1 approach, the trial embeds an implementation process evaluation. We will use quantitative and qualitative methods including budget impact analyses and qualitative interviews to assess barriers to implementation. CONCLUSIONS The results of POWER will inform population health approaches to the delivery of weight loss care. A remote self-directed program has the potential to be disseminated widely with limited health system resources and likely low-cost.
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Affiliation(s)
- Lucas M Donovan
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
| | - Jennifer A McDowell
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anna P Pannick
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - James Pai
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Tulane University, New Orleans, LA, USA
| | - Anthony F Bais
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | | | | | - George G Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Katherine D Hoerster
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Jun Ma
- University of Illinois Chicago, Chicago, IL, USA
| | - David H Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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Laksono RM, Siswagama TA, Asmoro AA, Sjahrir H, Musba AM, Halim W, der Weegen WV, Vissers K. Identifying pain problems, healthcare professional perceptions, expectations and challenges in multidisciplinary pain center establishment. Pain Manag 2023; 13:385-395. [PMID: 37458192 DOI: 10.2217/pmt-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Aim: Before establishing a multidisciplinary pain center (MPC), the pain problem, healthcare professionals (HCP) perceptions, expectations and the potential challenges of MPC establishment need to be identified. Methods: A quantitative survey study of 1058 Indonesian HCPs. The study uses a national inquiry sent by the International Association for the Study of Pain (IASP) chapter for pain. Results: 99.0% of respondents had met patients with pain as the primary complaint and acute pain as the most common complaint. Insufficient pain management in Indonesian healthcare, insufficient pain epidemiological data and unaware HCP about MPC become problems of pain management in Indonesia. However, most HCP agreed that health facilities should have MPC. Financial issues (insufficient patient insurance) were considered the most important barrier for referring patients to MPC. Conclusion: The identified core problem, HCP perceptions, expectations and challenges of MPC establishment should become a consideration in the strategic planning of MPC establishment.
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Affiliation(s)
- Ristiawan M Laksono
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Taufiq A Siswagama
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Aswoco A Asmoro
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Hasan Sjahrir
- Department of Neurology, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
| | - Andi Mt Musba
- Department of Anesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Willy Halim
- Department of Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | | | - Kris Vissers
- Department of Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, The Netherlands
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4
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Marttinen M, Oura P, Huttunen M, Vartiainen P, Paananen M. Determinants of responsiveness to multidisciplinary chronic pain management interventions: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057481. [PMID: 36123091 PMCID: PMC9486225 DOI: 10.1136/bmjopen-2021-057481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The current manuscript presents a protocol for a systematic review and meta-analysis of the evidence regarding the determinants of responsiveness to multidisciplinary management of chronic pain, with pain intensity, pain-related interference, physical functioning and health-related quality of life as the main outcomes, with consideration to multiple secondary outcomes. METHODS AND ANALYSIS To identify relevant studies, the Ovid MEDLINE, PubMed, Ovid PsycINFO, EBSCO CINAHL and Scopus databases will be searched for all studies exploring factors associated with responsiveness to multidisciplinary pain management from study inception to the present. Cohorts, case-control studies and randomised controlled trials will be included. Independent screening for eligible studies will be completed by a total of four researchers using defined criteria. Data extraction will be executed by two researchers. Study heterogeneity will be estimated using the I2 index. A meta-analysis will be performed using random effects models. Publication bias will be evaluated by means of funnel plots and Egger's test. ETHICS AND DISSEMINATION The proposed study does not involve collection of primary data. Therefore, no ethical approval is required. The results of the systematic review and meta-analysis will be presented in a peer-reviewed journal and at conferences. PROSPERO REGISTRATION NUMBER CRD42021236424.
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Affiliation(s)
- Maiju Marttinen
- The Finnish Center for Pediatric and Adolescent Pain Management and Research, New Children's Hospital, Helsinki University Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Merja Huttunen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Vartiainen
- Department of Paediatrics, Päijät-Häme Central Hospital, Lahti, Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- City of Espoo Health Services, Espoo, Finland
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Primary care management of patients with pain complaints and the influence of physician training in mechanical diagnosis and therapy. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pilitsis JG, Khazen O, Wenzel NG. Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:781433. [PMID: 35295487 PMCID: PMC8915644 DOI: 10.3389/fpain.2021.781433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022] Open
Abstract
Sixteen million people suffer with chronic low back pain and related healthcare expenditures can be as high as $USD 635 billion. Current pain treatments help a significant number of acute pain patients, allowing them to obtain various treatments and then “exit the market for pain services” quickly. However, chronic patients remain in pain and need multiple, varying treatments over time. Often, a single pain provider does not oversee their care. Here, we analyze the current pain market and suggest ways to establish a new treatment paradigm. We posit that more cost effective treatment and better pain relief can be achieved with multi-disciplinary care with a provider team overseeing care.
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Affiliation(s)
- Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, United States.,Department of Neuroscience and Experimental Therapeutics, Albany, NY, United States
| | - Olga Khazen
- Department of Neuroscience and Experimental Therapeutics, Albany, NY, United States
| | - Nikolai G Wenzel
- Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, NC, United States
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Comment on "Patient Factors Associated With Opioid Consumption in the Month Following Major Surgery". Ann Surg 2021; 274:e198-e199. [PMID: 31804391 DOI: 10.1097/sla.0000000000003716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This study evaluated both randomized and nonrandomized trials of battlefield acupuncture for the treatment of both acute and chronic pain. Studies published between May 2016 and November 2019 were found through PubMed, the Cochrane Library, or Scopus, concerned with the treatment of pain using auricular acupuncture in accordance with battlefield acupuncture protocol. Search terms were battlefield acupuncture AND pain or auricular acupuncture AND pain. Case reports, literature reviews, meta-analyses, and expert opinions were not included. Bias risk was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We found 12 studies with a combined sample size of 12,326. All five of the included nonrandomized trials reported positive outcomes, while five of seven of the included randomized trials reached statistical significance in their primary outcome. Six of the randomized trials were considered to have a high risk of bias resulting from the lack of blinding. The one randomized trial with moderate bias risk was a positive study. No severe adverse events were reported. Clinicians may consider battlefield acupuncture as a safe treatment for pain while the evidence base grows; however, we conclude that widespread adoption of battlefield acupuncture will require further high-quality studies drawing from diverse settings and patient populations. In addition, future studies should attempt to achieve blinding.
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Affiliation(s)
- Frank J Salamone
- From the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven; the Department of Medicine, VA Connecticut Healthcare System, West Haven; and the Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Daniel G Federman
- From the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven; the Department of Medicine, VA Connecticut Healthcare System, West Haven; and the Department of Medicine, Yale University School of Medicine, New Haven, CT
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