Practical approach to a patient with chronic pain of uncertain etiology in primary care

Divine resilience: Unveiling the impact of religious coping mechanisms on pain endurance in arab older adults battling chronic pain

BACKGROUND

Chronic pain diminishes the quality of life for many Older Adults individuals. Identifying effective coping methods to enhance pain resilience is imperative as populations age. Older Adults commonly use religious faith and spiritual practices to endure pain, yet little research has explored their impact on pain tolerance.

METHODS

This cross-sectional study examined relationships between positive/negative religious coping styles and pain endurance in 200 Arab elders with chronic pain. Participants completed the Brief Arab Religious Coping Scale, Numeric Pain Rating Scale, WHOQOL-BREF, and demographic/medical history questionnaires.

RESULTS

Quantitative analysis demonstrated significant positive associations between positive religious reappraisal and active spiritual coping with higher self-reported pain endurance (p<.05). Negative religious coping styles lacked meaningful relationships with pain tolerance. Multiple regression confirmed the unique effects of reappraisal and spiritual practice on improving pain resilience, controlling for covariates.

CONCLUSIONS

Outcomes align with perspectives highlighting multidimensional neurocognitive, emotional, and psychosocial pain relief from religious coping. Findings underscore integrating positive faith-based resources in biopsychosocial paradigms for Older Adult's pain management. Additional research should investigate causal pathways and contextual factors influencing religious coping effects on diverse Older Adult subgroups.

Professional-Facing Digital Health Solutions for the Care of Patients With Chronic Pain: Protocol for a Systematic Scoping Review

BACKGROUND

Chronic pain is a highly prevalent condition and one of the most common reasons why people seek health care. As a result, chronic pain has a significant personal and economic burden. The COVID-19 pandemic has aggravated the situation for patients with chronic pain through increased risk factors (eg, anxiety or depression) as well as decreased access to health care. Digital health solutions to support people with chronic pain are becoming increasingly popular. Most of the research has focused on patient-facing digital health solutions, although it is clear that the involvement of health and care professionals is crucial in chronic pain care. Certainly, digital health solutions intended for the use of health and care professionals in the care of patients with chronic pain (ie, professional facing) exist, for example, for clinical decision support; however, no review has investigated the studies reporting these interventions.

OBJECTIVE

The overall aim of this scoping review is to identify the available professional-facing digital health solutions for the purpose of chronic pain management. The objectives of this review are to investigate the components, target populations, and user settings of the available professional-facing digital solutions; health and care professionals' perspectives on using digital health solutions (if reported); the methods in which the digital health solutions are developed; and the outcomes of using professional-facing digital health solutions.

METHODS

Databases including MEDLINE, Embase, CINAHL, PsycInfo, and Inspec will be searched for studies reporting professional-facing digital health solutions for chronic pain care, using a comprehensive search strategy developed for each of the specific databases. A total of 2 independent reviewers will screen the titles and abstracts for review inclusion and then conduct full-text screening. Any conflicts in study inclusion will be resolved by a third reviewer at each stage of the screening process. Following data extraction and quality assessment, a qualitative content analysis of the results will be conducted. This review will identify the available professional-facing digital health solutions for chronic pain management. The results of this review are likely to be heterogeneous in terms of content (ie, the digital solutions will serve a variety of purposes, settings, target populations, etc) and methods (ie, experimental and nonexperimental designs).

RESULTS

The review is expected to finish in March 2024 and published in the summer of 2024.

CONCLUSIONS

This protocol outlines the need for a scoping review to identify professional-facing digital health solutions for the management of chronic pain. Results from this review will contribute to the growing field of research into the utility of digital health for chronic pain management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51311.

Trends of opioid prescription in cancer patients utilizing telemedicine: a retrospective study

Aim: Prescribing patterns among healthcare practitioners remain a recurring theme of interest in the opioid crisis. This study aims to provide insight on opioid prescribing patterns for cancer pain in telemedicine and in-person encounters during COVID-19. Materials & methods: A retrospective chart review of 1000 encounters (500 telemedicine and 500 in-person) at an academic tertiary care comprehensive cancer center. Results: On average, overall, significantly higher narcotics (in morphine milligram equivalents [MME]) prescribed for patients receiving telemedicine services. In-person encounters had a significantly higher proportion of narcotic (in MME) increases in subsequent visits. Conclusion: Our institution continues to adapt telehealth services as an additional care venue and deeper insight helps mitigate development of maladaptive opioid prescribing patterns.

The Additive Antinociceptive Effect of Resveratrol and Ketorolac in the Formalin Test in Mice

Pain represents one of the leading causes of suffering and disability worldwide. Currently available drugs cannot treat all types of pain and may have adverse effects. Hence, the use of pharmacological combinations is an alternative treatment strategy. Therefore, this study aimed to evaluate the combination of resveratrol and ketorolac through isobolographic analysis. CD1 mice were used to study the antinociceptive effect of this combination using the formalin test and the study was divided into two phases. In the first phase, four individual doses of each drug were evaluated, totaling eight testing groups. From these data, the median effective doses (ED50) of each drug were calculated. In the second phase, four testing groups were used to evaluate the combination of sub-doses of both drugs and obtain the experimental ED50. To evaluate gastric damage, five groups were employed, including indomethacin, vehicle, resveratrol, ketorolac, and combined resveratrol and ketorolac groups. Stomach samples from the mice were taken after 5 h of treatment, and the area of the ulcers was determined. Resveratrol plus ketorolac elicited a reduction in nociceptive behavior during both phases of the formalin test, and isobologram analysis revealed that the theoretical and experimental ED50 values of resveratrol and ketorolac did not differ significantly, implying an additive interaction between the drugs. Additionally, the drug combination did not generate gastric ulcers, thus enhancing the desired effects without increasing the adverse effects. Consequently, these findings substantiate the efficacy of the resveratrol and ketorolac combination in the formalin test, thereby highlighting its potential as a viable alternative for alleviating pain.

Contemporary management of pain in cirrhosis: Toward precision therapy for pain

Chronic pain is highly prevalent in patients with cirrhosis and is associated with poor health-related quality of life and poor functional status. However, there is limited guidance on appropriate pain management in this population, and pharmacologic treatment can be harmful, leading to adverse outcomes, such as gastrointestinal bleeding, renal injury, falls, and hepatic encephalopathy. Chronic pain can be categorized mechanistically into three pain types: nociceptive, neuropathic, and nociplastic, each responsive to different therapies. By discussing the identification, etiology, and treatment of these three mechanistic pain descriptors with a focus on specific challenges in patients with cirrhosis, we provide a framework for better tailoring treatments, including nonpharmacologic therapies, to patients' needs.

[Modern principles of primary headaches prevention in children and adolescents]

Headaches in children and adolescents are an actual problem of modern medicine. In most cases, headaches are regarded as a manifestation of vertebrogenic or cerebrovascular pathology, or as a manifestation of autonomic dystonia syndrome which leads to an erroneous diagnosis and treatment. The review considers the factors of occurrence and chronicity of primary headaches (hypodynamia, postural disorders, magnesium and vitamin D deficiency, anxiety and depression, central sensitization, alexithymia), methods for their diagnosis and treatment.

Relational uncertainty, interdependence and psychological distress during COVID‐19: A longitudinal study

Drawing on the relational turbulence theory, this study explored the associations of self, partner and relationship uncertainty, and partner interference and facilitation with psychological distress symptoms during the COVID-19 stay-at-home orders. A longitudinal study of 313 individuals was conducted in Israel at three time points, spanning from the first lockdown (April 2020) and through the alleviation of the severe restrictions (June 2020). Multilevel modelling indicated divergent associations between the different sources of relational uncertainty and interdependence and somatization, depression and anxiety. Further analyses pointed to divergent findings regarding how change in self, partner and relationship uncertainty predicted change in somatization, depression and anxiety over the course of the study, depending on whether the three sources of relational uncertainty were analysed separately or simultaneously in the same model. Change in interference from a partner did not predict changes in psychological distress. Theoretical and practical implications of the findings are discussed.

Multidisciplinary Firms and the Treatment of Chronic Pain: A Case Study of Low Back Pain

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.

Can a Brief Online Interdisciplinary Program Enhance the Understanding of Musculoskeletal Pain amongst Primary Care Staff? A Prospective Study

Background

Primary care staff do not provide consistent education on musculoskeletal pain management to patients in accordance with the recommendations of clinical practice guidelines. We have developed a concise online learning program to bridge this gap.

Objectives

To investigate (1) the effectiveness of 1-hour musculoskeletal pain neurophysiology education program conducted by a physiotherapist on primary care staff; (2) the correlation between demographic factors of staff and the interdisciplinary learning performances.

Methods

We piloted a multicenter single-blind prospective study on sixty-four staff from the pharmacy department in eight public primary care clinics. Participants in the intervention group attended the 1-hour online program compared to a control group. The Neurophysiology of Pain Questionnaire (NPQ) to assess learning and the 10-point Likert scale program evaluation form to assess learning reaction of participants after the program were used.

Results

The participants reacted positively to the online learning program. The intervention group significantly improved in their musculoskeletal pain knowledge by a greater mean NPQ score difference 2.39 ( p < 0.001) compared with the control group. There were poor correlations between the demographic factors and their learning.

Conclusion

The pilot study shows that primary care staff may still utilize a biomedical approach in managing musculoskeletal pain. The improvement in knowledge demonstrates that short online programs could be a valuable part of interdisciplinary education in primary care because it is easily accessible by healthcare professionals and can benefit other healthcare staff regardless of their background.

Community Perspectives on Patient Credibility and Provider Burden in the Treatment of Chronic Pain

OBJECTIVE

This study examined factors influencing lay perceptions of a provider's clinical burden in providing care to a person with chronic pain.

DESIGN

In a between-subjects design that varied three levels of pain severity (4-6-8/10) with two levels of medical evidence (low/high), participants rated the credibility of pain reported by a hypothetical patient and psychosocial factors expected to mediate the effects of evidence and severity on a provider's burden of care.

SETTING

A randomized vignette study in which community participants were recruited via Amazon Mechanical Turk.

SUBJECTS

337 community participants.

METHODS

Using a Qualtrics platform, participants read one of six vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity, and then rated perceived pain severity, pain credibility, psychosocial variables, and burden.

RESULTS

Serial mediation models accounted for all effects of medical evidence and pain severity on burden. Low medical evidence was associated with increased burden, as mediated through lower pain credibility and greater concerns about patient depression, opioid abuse, and learning pain management. Higher levels of reported pain severity were associated with increased burden, as mediated through greater pain discounting and concerns about opioid abuse.

CONCLUSIONS

The lay public is skeptical of chronic pain that is not supported by medical evidence or is reported at high levels of severity, raising concerns about psychosocial complications and drug seeking and expectations of higher burden of care. Such negative stereotypes can pose obstacles to people seeking necessary care if they or others develop a chronic pain condition.

Portuguese Version of the Intentional Non-Adherence Scale: Validation in a Population of Chronic Pain Patients

Objective: Despite the effectiveness of pain medicines, nonadherence to prescribed medication remains a major problem faced by healthcare systems. The aim of present study was to perform the translation, cultural adaptation, and validation of the Intentional Non-Adherence Scale (INAS) for the European Portuguese language in a sample of chronic pain patients.

Methods: A Portuguese version of the INAS scale was constructed through a process of translation, back translation, and expert’s panel evaluation. A total of 133 chronic pain patients were selected from two chronic pain clinics from tertiary hospitals in Porto, Portugal. The protocol interview included the assessment of pain beliefs (PBPI), beliefs about medicine (BMQ), medication adherence (MARS-P9), and two direct questions about adherence previously validated.

Results: The internal consistency in all subscales was α = 0.902 for testing treatment; α = 0.930 for mistrust treatment; α = 0.917 for resisting treatment; and α = 0.889 for resisting illness. Exploratory and confirmatory factor analysis revealed a four-factor structure that explained 74% of the variance. The construct validity of the INAS was shown to be adequate, with the majority of the previously defined hypotheses regarding intercorrelations with other measures confirmed.

Conclusion: The Portuguese version of INAS could be a valuable and available instrument for Portuguese researchers and clinicians to assess the intentional nonadherence determinants during the management of chronic pain.

Satellite Glial Cells in Pain Research: A Targeted Viewpoint of Potential and Future Directions

Chronic pain is known to be caused by sensitization within the pain circuits. An imbalance occurs between excitatory and inhibitory transmission that enables this sensitization to form. In addition to neurons, the contribution of central glia, especially astrocytes and microglia, to the pathogenesis of pain induction and maintenance has been identified. This has led to the targeting of astrogliosis and microgliosis to restore the normal functions of astrocytes and microglia to help reverse chronic pain. Gliosis is broadly defined as a reactive response of glial cells in response to insults to the central nervous system (CNS). The role of glia in the peripheral nervous system (PNS) has been less investigated. Accumulating evidence, however, points to the contribution of satellite glial cells (SGCs) to chronic pain. Hence, understanding the potential role of these cells and their interaction with sensory neurons has become important for identifying the mechanisms underlying pain signaling. This would, in turn, provide future therapeutic options to target pain. Here, a viewpoint will be presented regarding potential future directions in pain research, with a focus on SGCs to trigger further research. Promising avenues and new directions include the potential use of cell lines, cell live imaging, computational analysis, 3D tissue prints and new markers, investigation of glia–glia and macrophage–glia interactions, the time course of glial activation under acute and chronic pathological pain compared with spontaneous pain, pharmacological and non-pharmacological responses of glia, and potential restoration of normal function of glia considering sex-related differences.

[Central Sensitization Inventory - a Russian version]

OBJECTIVE

To develop and validate a Russian version of The Central Sensitization Inventory (CSI-R).

MATERIAL AND METHODS

The study included 3 stages: 1) direct and reverse translation, linguistic validation of the questionnaire; 2) assessment of internal consistency, reliability and sensitivity (n=50); 3) psychometric validation in the samples of patients with fibromyalgia syndrome (n=40), chronic widespread pain (n=40), regional chronic low back pain without other specific pain complaints (n=40), and in the control sample of informants with no pain complaints (n=40).

RESULTS AND CONCLUSION

The Russian version of CSI-R is valid, reliable and can be used in clinical practice as a diagnostic tool for revealing central sensitization. The study of the sensitivity of the questionnaire in patients during drug therapy proved its effectiveness in assessing the dynamics of the disease and the effect of therapy.