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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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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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Nim CG, Ravn SL, Andersen TE, Engelsholm E, Hestbech F, Hvidkær IS, Traidl AN, O'Neill S. No effect of social interaction on experimental pain sensitivity: a randomized experimental study. Pain 2023; 164:2112-2121. [PMID: 37058414 DOI: 10.1097/j.pain.0000000000002913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/15/2023] [Indexed: 04/15/2023]
Abstract
ABSTRACT Quantitative sensory testing (QST) is a commonly applied paradigm to investigate pain, which is a subjective experience influenced by a myriad of social and contextual factors. Therefore, it is important to consider the potential sensitivity of QST to the test setting and the social interaction that naturally is a part of it. This may particularly be the case in clinical settings where patients have something at stake. Therefore, we investigated differences in pain responses using QST in different test setups with varying degrees of human interaction. In a parallel three-armed randomized experimental study, we included 92 participants with low back pain and 87 healthy volunteers allocated to 1 of the 3 QST setups: 1 setup with manual tests performed by a human tester, 1 setup with automated tests performed by a robot and orally guided by a human tester, and 1 setup with automated tests performed solely by a robot without social interaction with a human tester. All 3 setups consisted of the same pain tests in the same order, including pressure pain threshold and cold pressor tests. We found no statistically significant differences between setups on the primary outcome of conditioned pain modulation nor any secondary QST outcomes. While this study is not without limitations, the results indicate that QST procedures are robust enough not to be influenced by social interaction to an appreciable degree.
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Affiliation(s)
- Casper Glissmann Nim
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Departments of Regional Health Research
- Sport Science and Clinical Biomechanics and
| | - Sophie Lykkegaard Ravn
- Psychology, University of Southern Denmark, Odense, Denmark
- Specialized Hospital for Polio and Accident Victims, Ròdovre, Denmark
| | | | | | | | | | | | - Søren O'Neill
- Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Departments of Regional Health Research
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De Clifford-Faugère G, Nguena Nguefack HL, Godbout-Parent M, Diallo MA, Guénette L, Pagé MG, Choinière M, Beaudoin S, Boulanger A, Pinard AM, Lussier D, De Grandpré P, Deslauriers S, Lacasse A. Pain Medications Used by Persons Living With Fibromyalgia: A Comparison Between the Profile of a Quebec Sample and Clinical Practice Guidelines. Can J Pain 2023; 7:2252037. [PMID: 38025837 PMCID: PMC10653640 DOI: 10.1080/24740527.2023.2252037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
Background Pharmacological management of fibromyalgia is complex. Chronic pain management is characterized by off-label prescribing and use, multimorbidity, and polypharmacy. Aims This study aimed to describe pain medications use and perceived risk among people living with fibromyalgia and compare this use to evidence-based recommendations. Methods Directive telephone interviews were conducted with 63 individuals self-reporting a diagnosis of fibromyalgia (Quebec, Canada). The questionnaire addressed specific questions about their pain and pharmacological treatments currently used for pain management (prescribed and over-the-counter). Collected data were compared to the Canadian Fibromyalgia Clinical Practice Guidelines and to evidence reports published by recognized organizations. Results Despite a lack of robust scientific evidence to support opioids use to manage pain in fibromyalgia, 33% of our sample reported using them. Nonsteroidal anti-inflammatory drugs were used by 54.0% of participants, although this medication is not recommended due to lack of efficacy. Tramadol, which is recommended, was used by 23.8% of participants. Among the medications strongly recommended, anticonvulsants were used by 36.5%, serotonin norepinephrine reuptake inhibitor antidepressants by 55.6%, and tricyclic antidepressants by 22.2%. Cannabinoids (17.5%) and medical cannabis (34.9%) use were also reported. For all of these medication subclasses, no differences were found between participants not reporting (n = 35) or reporting (n = 28) more than one pain diagnosis (P < 0.05). Medication subclasses considered most at risk of adverse effects by participants were the least used. Conclusions Results reveal discordance between evidence-based recommendations and medications use, which highlights the complexity of pharmacological treatment of fibromyalgia.
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Affiliation(s)
- Gwenaelle De Clifford-Faugère
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), RouynNoranda, Québec, Canada
| | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), RouynNoranda, Québec, Canada
| | - Marimée Godbout-Parent
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), RouynNoranda, Québec, Canada
| | - Mamadou Aliou Diallo
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), RouynNoranda, Québec, Canada
| | - Line Guénette
- Centre de recherche du Centre hospitalier universitaire de Québec–Université Laval, Quebec City, Québec, Canada
- Faculté de pharmacie, Université Laval, Quebec City, Québec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Beaudoin
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- Patiente Partenaire, Laboratoire de recherche en épidémiologie de la douleur chronique, UQAT, RouynNoranda, Québec, Canada
- Centre d’expertise en gestion de la douleur chronique, Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Aline Boulanger
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
- Centre d’expertise en gestion de la douleur chronique, Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Anne Marie Pinard
- Centre d’expertise en gestion de la douleur chronique, Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Département d’anesthésiologie et de soins intensifs, Université Laval, Quebec City, Québec, Canada
- Centre intégré de recherche en réadaptation et intégration sociale, Centre intégré de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Québec, Canada
| | - David Lussier
- Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Philippe De Grandpré
- Familiprix Chantale Gaboury & Marie-Ève Gélinas, Québec, Canada
- Groupe de médecine familiale Clinique Familiale des prairies, Québec, Canada
| | - Simon Deslauriers
- VITAM–Centre de recherche en santé durable, CIUSSS de la CapitaleNationale, Quebec City, Québec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), RouynNoranda, Québec, Canada
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Lacasse A, Nguena Nguefack HL, Page G, Choinière M, Samb OM, Katz J, Ménard N, Vissandjée B, Zerriouh M. Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain. BMJ Open 2023; 13:e070509. [PMID: 37518085 PMCID: PMC10387645 DOI: 10.1136/bmjopen-2022-070509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. DESIGN Retrospective cohort study. PARTICIPANTS This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. OUTCOME Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). RESULTS Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). CONCLUSIONS Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
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Affiliation(s)
- Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Hermine Lore Nguena Nguefack
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - G Page
- 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
| | - Oumar Mallé Samb
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Nancy Ménard
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing and Public Health Research Institute (CReSP), Université de Montréal, Montreal, Quebec, Canada
- SHERPA Research Centre, Montreal, Quebec, Canada
| | - Meriem Zerriouh
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Wreyford L, Gururajan R, Zhou X. When can cancer patient treatment nonadherence be considered intentional or unintentional? A scoping review. PLoS One 2023; 18:e0282180. [PMID: 37134109 PMCID: PMC10155980 DOI: 10.1371/journal.pone.0282180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/10/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Treatment nonadherence in cancer patients remains high with most interventions having had limited success. Most studies omit the multi-factorial aspects of treatment adherence and refer to medication adherence. The behaviour is rarely defined as intentional or unintentional. AIM The aim of this Scoping Review is to increase understanding of modifiable factors in treatment nonadherence through the relationships that physicians have with their patients. This knowledge can help define when treatment nonadherence is intentional or unintentional and can assist in predicting cancer patients at risk of nonadherence and in intervention design. The scoping review provides the basis for method triangulation in two subsequent qualitative studies: 1. Sentiment analysis of online cancer support groups in relation to treatment nonadherence; 2. A qualitative validation survey to refute / or validate claims from this scoping review. Thereafter, framework development for a future (cancer patient) online peer support intervention. METHODS A Scoping Review was performed to identify peer reviewed studies that concern treatment / medication nonadherence in cancer patients-published between 2000 to 2021 (and partial 2022). The review was registered in the Prospero database CRD42020210340 and follows the PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Searches. The principles of meta-ethnography are used in a synthesis of qualitative findings that preserve the context of primary data. An aim of meta-ethnography is to identify common and refuted themes across studies. This is not a mixed methods study, but due to a limited qualitativevidence base and to broaden findings, the qualitative elements (author interpretations) found within relevant quantitative studies have been included. RESULTS Of 7510 articles identified, 240 full texts were reviewed with 35 included. These comprise 15 qualitative and 20 quantitative studies. One major theme, that embraces 6 sub themes has emerged: 'Physician factors can influence patient factors in treatment nonadherence'. The six (6) subthemes are: 1. Suboptimal Communication; 2. The concept of Information differs between Patient and Physician; 3.Inadequate time. 4. The need for Treatment Concordance is vague or missing from concepts; 5. The importance of Trust in the physician / patient relationship is understated in papers; 6. Treatment concordance as a concept is rarely defined and largely missing from studies. LINE OF ARGUMENT WAS DRAWN Treatment (or medication) nonadherence that is intentional or unintentional is often attributed to patient factors-with far less attention to the potential influence of physician communication factors. The differentation between intentional or unintentional nonadherence is missing from most qualitative and quantitative studies. The holistic inter-dimensional / multi-factorial concept of 'treatment adherence' receives scant attention. The main focus is on medication adherence / nonadherence in the singular context. Nonadherence that is unintentional is not necessarily passive behaviour and may overlap with intentional nonadherence. The absence of treatment concordance is a barrier to treatment adherence and is rarely articulated or defined in studies. CONCLUSION This review demonstrates how cancer patient treatment nonadherence is often a shared outcome. An equal focus on physican and patient factors can increase understanding of the two main types of nonadherence (intentional or unintentional). This differentation should help improve the fundamentals of intervention design.
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Affiliation(s)
- Leon Wreyford
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Raj Gururajan
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
| | - Xujuan Zhou
- University of Southern Queensland (USQ), Toowoomba, Qld, Australia
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Bryson-Campbell M, Shaw L, Cooper L, Chedore B. Developing guidelines to support injured workers who live and work with chronic pain. Work 2021; 66:383-404. [PMID: 32568155 DOI: 10.3233/wor-203180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Living and working with chronic pain requires persons to alter lifestyles and have the knowledge as well as support to manage unforeseen challenges. Knowledge for persons living with pain who want to participate in meaningful paid and unpaid work is not easily accessible. While there is literature on chronic pain management, work transitions and return to work, less emphasis has been placed on the complexity of living and working with chronic pain. The Creating a Way Forward Project was envisioned to address this gap and to identify the informational needs of workers with pain, health/helping professionals (workers' advisors, return to work specialists, legal representatives), and stakeholders. The overarching aim of the project was to use evidence and experiential knowledge to inform the development of a foundation for educational guides and toolkits to support workers with pain to achieve their outcomes for remaining at work. METHODS Phase one of the project involved a scoping review of chronic pain and work. Phase two involved stakeholder consultations, a focus group and knowledge integration of the literature and experiential insights. Knowledge synthesis drew on a Template Analysis of multiple sources of data. RESULTS Knowledge domains and key components were identified for persons with pain and for the health/helping professions. CONCLUSION These domains reflect a foundation for knowledge in practical training and the development of curriculum for education in self-management program and in inter professional health profession education. These knowledge domains provide a basis for future research in integrated approaches and knowledge use toward improving transitions for persons living with chronic pain who want to participate in productive paid and unpaid work. Ongoing research in knowledge domains that health providers and persons with pain need will expand the potential for improving health outcomes in living with and managing pain.
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Affiliation(s)
| | - Lynn Shaw
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Bill Chedore
- Canadian Injured Workers Alliance, Kitchener, Canada
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Karjalainen M, Kautiainen H, Saltevo J, Haanpää M, Mäntyselkä P, Tiihonen M. Use of pain relieving drugs in community-dwelling older people with and without type 2 diabetes. Prim Care Diabetes 2020; 14:736-740. [PMID: 32980280 DOI: 10.1016/j.pcd.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
AIMS To analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care. METHODS A total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain status was defined as no pain, nociceptive pain or neuropathic pain. Pain medication (paracetamol, NSAID, opioids, neuropathic pain medication) use was based on electronic patient records and checked by a physician during a health examination. RESULTS Some pain was present in 90 (51%) patients without and in 106 (57%) patients with diabetes (p = 0.55). Of the patients without diabetes, 109 (62%) and with diabetes 123 (66%) used some pain medication (p = 0.45). The respective proportions for the regular use were 13% and 11% and for the as needed use 56% and 61%. Diabetes was not associated with any of the pain medications used. The use of pain-relieving drugs was most common for neuropathic pain. CONCLUSIONS The present study indicated that community-dwelling people with and without diabetes used pain medication similarly. Pain medication was used mostly as needed instead of being regular.
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Affiliation(s)
- Merja Karjalainen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland; Inner Savo Health Center, Suonenjoki, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juha Saltevo
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Finland; Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
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Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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10
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LaChance J, Booth R, Befus D. Exploring unmet healthcare needs, healthcare access, and the use of practitioner based complementary and alternative medicine in adults with chronic pain. Contemp Nurse 2020; 56:105-119. [PMID: 32193985 DOI: 10.1080/10376178.2020.1743192] [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: 10/24/2022]
Abstract
Background: Chronic pain is a complex condition frequently encountered in nursing practice, resulting in negative multidimensional effects on the individual and healthcare system. Increasingly, people with chronic pain are turning to Complementary and Alternative Medicine (CAM) to manage their pain. Objectives: To explore the relationship between healthcare access, unmet healthcare needs, and practitioner-based Complementary and Alternative Medicine use in adults with chronic pain. Design: A secondary analysis of 1688 individuals ≥18 years old self-reporting chronic pain from Cycle 9 of the Canadian National Population Health Survey. Methods: Multivariate logistic regression and descriptive statistics. Results: When controlling for demographics and health status indicators, the presence of unmet healthcare needs was found to predict CAM use (p < 0.001; OR 2.02; CI [1.45, 2.81]), along with sex, education, income, employment, and restriction of activities. Conclusion: People may be using CAM due to shortcomings of the conventional healthcare system, with implications for policymakers and healthcare professions to develop more integrative strategies to improve chronic pain management. Impact statement: Having unmet healthcare needs is associated with two-fold increased odds of using Complementary and Alternative Medicine in Canadian adults with chronic pain.
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Affiliation(s)
- Jessica LaChance
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Canada.,Department of Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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11
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Carlin L, Zhao J, Dubin R, Taenzer P, Sidrak H, Furlan A. Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study. PAIN MEDICINE 2019; 19:1140-1146. [PMID: 29036381 DOI: 10.1093/pm/pnx233] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Family physicians in Canada receive little training in chronic pain management; concomitantly, they face increasing pressure to reduce their prescribing of opioids. Project ECHO Ontario Chronic Pain/Opioid Stewardship (ECHO) is a telementoring intervention for primary care practitioners that enhances their pain management skills. This qualitative study reports participants' experiences and assessment of ECHO. Design An opportunistic sample of multidisciplinary primary care providers attending one of three residential weekend workshops participated in focus group discussions. Setting University or hospital facilities in Toronto, Thunder Bay, and Kingston, Ontario, Canada. Subjects Seventeen physicians and 20 allied health professionals. Methods Six focus group discussions were conducted at three different sites during 2014 and 2015. Transcripts were analyzed using a qualitative-descriptive approach involving analytic immersion in the data, reflection, and achieving consensus around themes discerned from transcribed discussions. Results Findings resolved into five main themes: 1) challenges of managing chronic pain in primary care; 2) ECHO participation and improvement in patient-provider interaction and participant knowledge; 3) the diffusion of knowledge gained through ECHO to participants' colleagues and patients; 4) ECHO participation generating a sense of community; and 5) disadvantages associated with participating in ECHO. Conclusions Managing patients with chronic pain in primary care can be difficult, particularly in remote or underserved practices. Project ECHO offers guidance to primary care practitioners for their most challenging patients, promotes knowledge acquisition and diffusion, and stimulates the development of a "community of practice."
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Affiliation(s)
- Leslie Carlin
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jane Zhao
- Outpatient Services -Project ECHO, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Ruth Dubin
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul Taenzer
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Hannah Sidrak
- The Tweed Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrea Furlan
- Department of Medicine, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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12
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Mishriky J, Stupans I, Chan V. An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines. Pharm Pract (Granada) 2019; 17:1436. [PMID: 31275495 PMCID: PMC6594427 DOI: 10.18549/pharmpract.2019.2.1436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/09/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Fever and pain are common conditions in the Australian healthcare setting.
Whilst clinical guidelines provide important therapeutic recommendations,
evidence suggests they are not always followed. Given that community
pharmacy is one of the most frequently accessed primary healthcare services,
it is important to understand the views and practices of community
pharmacists in pain and fever. Objectives: To investigate the views and practices of Australian community pharmacists in
pain and fever management, and their views on relevant clinical
guidelines. Methods: A cross-sectional study of community pharmacists in Australia was conducted
using a customised, anonymous, self-administered, online questionnaire
between March and May 2018. To capture a broad range of demographics,
pharmacists were recruited via local industry contacts and the
Pharmaceutical Society newsletter, with further recruitment through snowball
sampling. The main outcomes measured were pharmacists’ views,
practices and treatment recommendation of choice in pain and fever
management, as well as views on clinical guidelines and training. Results: A total of 113 pharmacists completed the survey. In general, paracetamol
(72%) was preferred as a recommendation over ibuprofen, and was the
drug of choice for most mild to moderate pain and fever scenarios. Majority
of pharmacists reported good knowledge of pain and fever management,
however, only approximately half reported recent pain management training.
Greater than 87% of pharmacists believe that clinical guidelines are
useful in fever management, and 79% of pharmacists believe that
following clinical guidelines is important in pain management. Conclusions: While most pharmacists recognise the importance of guidelines and
demonstrated good pain and fever management, results suggests opportunities
to promote additional education, upskilling, and research in this space to
further optimise pain and fever management in the community.
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Affiliation(s)
- John Mishriky
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC, (Australia).
| | - Ieva Stupans
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC, (Australia).
| | - Vincent Chan
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC (Australia).
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13
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Odenigbo C, Julien N, Benyamina Douma N, Lacasse A. The importance of chronic pain education and awareness amongst occupational safety and health professionals. J Pain Res 2019; 12:1385-1392. [PMID: 31118756 PMCID: PMC6507068 DOI: 10.2147/jpr.s202041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: Occupational safety and health (OSH) professionals are often the point of contact for health and safety policies derived in the workplace, and the handling of incidents in their aftermath. As chronic pain affects 20% of people, many pain-awareness campaigns and educational activities target healthcare professionals. However, initiatives directed toward OSH professionals are also important to aid in prevention and rehabilitation efforts. The objective of this study was to describe knowledge and attitudes of OSH students with regard to chronic pain. Methods: A web-based cross-sectional study was conducted amongst a convenience sample of 88 students enrolled in the distance learning OSH undergraduate certificate program at the Université du Québec en Abitibi-Témiscamingue (Quebec, Canada). Results: Although 30% of students were already employed within OSH or human resources and 40% reported intervening in cases involving chronic pain in their line of work, 56% of respondents had received no training on chronic pain and its treatment in the past five years. Only 14% chose to take the optional 45 hr course dedicated to pain within the program. OSH students also exhibited poorer knowledge and more negative attitudes toward people suffering from chronic pain when compared to other groups assessed in the province of Quebec, including healthcare professionals, chronic pain patients, and people not suffering from chronic pain (p≤0.0002). Half of the respondents (51.9%) were not aware that chronic pain affects 1 in 5 adults. Conclusion: Our study demonstrates a need for pain education within OSH training programs and through continuing education.
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Affiliation(s)
- Chúk Odenigbo
- Department of Environmental and Occupational Health, School of Public Health, Montreal University, Montreal, Quebec, Canada
| | - Nancy Julien
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Nabiha Benyamina Douma
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, University of Quebec in Abitibi-Temiscamingue, Rouyn-Noranda, Quebec, Canada
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14
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Perspective of Pain Clinicians in Three Global Cities on Local Barriers to Providing Care for Chronic Noncancer Pain Patients. Pain Res Manag 2019; 2019:3091309. [PMID: 30863473 PMCID: PMC6377973 DOI: 10.1155/2019/3091309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 11/18/2022]
Abstract
An increasing proportion of the global chronic pain population is managed through services delivered by specialized pain clinics in global cities. This paper describes the results of a survey of pain clinic leaders in three global cities on barriers influencing chronic noncancer pain (CNCP) management provided by those clinics. It demonstrates a pragmatic qualitative approach for characterizing how the global city location of the clinic influences those results. A cross-sectional prospective survey design was used, and data were analyzed using quantitative and qualitative content analysis. Key informants were pain clinicians (n = 4 women and 8 men) responsible for outputs of specialized pain clinics in academic hospital settings in three global cities: Toronto, Kuwait, and Karachi. Krippendorff's thematic clustering technique was used to identify the repetitive themes in the data. All but one of the key informants had their primary pain training from Europe or North America. In Kuwait and Karachi, pain specialists were anesthesiologists and provided CNCP management services independently. In Toronto, pain clinic leaders were part of some form of the multidisciplinary team. Using the results of a question that asked informants to list their top three barriers, ten themes were identified. These themes were artificially organized in three thematic domains: infrastructure, clinical services, and education. In parallel, 31 predefined barriers identified from the literature were scored. The results showed variation in perception of barriers that not only depended on the clinic location but also demonstrated shared experiences across thematic domains. This study demonstrates a simple methodology for informing global and local efforts to improve access to and implementation of CNCP services globally.
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15
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Martorella G, Kostic M, Lacasse A, Schluck G, Abbott L. Knowledge, Beliefs, and Attitudes of Emergency Nurses Toward People With Chronic Pain. SAGE Open Nurs 2019; 5:2377960819871805. [PMID: 33415252 PMCID: PMC7774372 DOI: 10.1177/2377960819871805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022] Open
Abstract
More and more people suffering from chronic pain (CP) utilize the emergency department (ED). However, their needs are not properly addressed. Stigmatization toward people with CP can partially explain this gap. Most studies in the ED have been focused on measuring nurses' pain management knowledge in general, not negative attitudes toward CP. Hence, understanding of the determinants of the stigma related to CP is needed. The objectives of this study were to (a) describe the knowledge, beliefs, and attitudes of ED nurses toward people suffering from CP and (b) identify nurses' characteristics associated with these perceptions. A cross-sectional web-based survey design was conducted using the KnowPain-12 questionnaire and the Chronic Pain Myth Scale. A total of 571 participants from 20 different states across the United States were recruited among whom 482 completed the entire survey. The sample included about one third of the ED nurses suffering from CP. Negative beliefs and attitudes toward people with CP were present in a considerable proportion of participants (up to 64%), even in nurses suffering from CP (up to 47.5%). Nevertheless, our results suggest that higher levels of education and suffering from CP were associated with better beliefs and attitudes toward people with CP. The ED presents an increased risk of stigmatization of people with CP as compared with the general population. Identifying determinants of the stigma associated with CP is crucial, as it will help tailoring awareness and educational campaigns. In addition, CP patients utilizing the ED often have complex needs which are difficult to address in this clinical environment. This situation can contribute to negative beliefs and attitudes. Given the scarcity of specialized care clinics for this population, health-care stakeholders should devise solutions to improve continuity of care in primary care settings and between the latter and ED.
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Affiliation(s)
- Geraldine Martorella
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Michelle Kostic
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Anaïs Lacasse
- Laboratoire de recherche en épidémiologie de la douleur chronique, Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Glenna Schluck
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Laurie Abbott
- TMH Center for Research and Evidence-Based Practice, College of Nursing, Florida State University, Tallahassee, FL, USA
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16
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Janke EA, Cheatle M, Keefe FJ, Dhingra L. Society of Behavioral Medicine (SBM) position statement: improving access to psychosocial care for individuals with persistent pain: supporting the National Pain Strategy's call for interdisciplinary pain care. Transl Behav Med 2018; 8:305-308. [PMID: 29385551 DOI: 10.1093/tbm/ibx043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Policy makers have articulated a need for clear, evidence-based guidance to help inform pain policy. Persistent pain is common, expensive, and debilitating, and requires comprehensive assessment and treatment planning. Recently released opioid prescribing guidelines by the CDC (2016) emphasize the importance of using nonopioid therapies before considering opioid treatment for those without a malignant illness. The National Pain Strategy (2016) underscores the importance of comprehensive, interdisciplinary pain care. Unfortunately, despite persuasive evidence supporting the efficacy of psychosocial approaches, these interventions are inaccessible to the majority of Americans. Psychosocial approaches to pain management should be available for all individuals with persistent pain and in all health care settings and contexts as part of the comprehensive, interdisciplinary approach to pain care as outlined in the National Pain Strategy. To achieve this, we must prioritize reimbursement of evidence-based psychosocial approaches for pain assessment and management and improve provider training and competencies to implement these approaches.
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Affiliation(s)
- E Amy Janke
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
| | - Martin Cheatle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francis J Keefe
- Pain Prevention and Treatment Research Program, Duke University Medical Center, Durham, NC, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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17
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Wiznia DH, Zaki T, Leslie MP, Halaszynski TM. Complexities of Perioperative Pain Management in Orthopedic Trauma. Curr Pain Headache Rep 2018; 22:58. [PMID: 29987515 DOI: 10.1007/s11916-018-0713-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This review discusses both obvious and hidden barriers in trauma patient access to pain management specialists and provides some suggestions focusing on outcome optimization in the perioperative period. RECENT FINDINGS Orthopedic trauma surgeons strive to provide patients the best possible perioperative pain management, while balancing against potential risks of opioid abuse and addiction. Surgeons often find they are ill-prepared to effectively manage postoperative pain in patients returning several months following trauma surgery, many times still dependent on opioids for pain control. Some individuals from this trauma patient population may also require the care of pain management specialists and/or consultation with drug addiction specialists. As the US opioid epidemic continues to worsen, orthopedic trauma surgeons can find it difficult to obtain access to pain management specialists for those patients requiring complex pain medication management and substance abuse counseling. The current state of perioperative pain management for orthopedic trauma patients remains troubling due to reliance on only opioid analgesics, society-associated risks of opioid medication addiction, an "underground" prescription drug marketplace, and an uncertain legal atmosphere related to opioid pain medication management that can deter pain management physicians from accepting narcotic-addicted patients and discourage future physicians from pursuing advanced training in the specialty of pain management. Additionally, barriers continue to exist among Medicaid patients that deter this patient population from access to pain medicine subspecialty care, diminishing medication management reimbursement rates make it increasingly difficult for trauma patients to receive proper opioid analgesic pain medication management, and a lack of proper opioid analgesic medication management training among PCPs and orthopedic trauma surgeons further contributes to an environment ill-prepared to provide effective perioperative pain management for orthopedic trauma patients.
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Affiliation(s)
- Daniel H Wiznia
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA
| | - Theodore Zaki
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA
| | - Michael P Leslie
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA
| | - Thomas M Halaszynski
- Yale Anesthesiology, Yale-New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA. .,Department of Adult and Perioperative Anesthesiology, Yale University School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA.
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18
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Nøst TH, Steinsbekk A, Riseth L, Bratås O, Grønning K. Expectations towards participation in easily accessible pain management interventions: a qualitative study. BMC Health Serv Res 2017; 17:712. [PMID: 29126444 PMCID: PMC5681789 DOI: 10.1186/s12913-017-2668-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with chronic pain use a range of healthcare services, but they also report a high degree of dissatisfaction with treatments. One reason for dissatisfaction might be participants' expectations towards treatments. The aim of this study was to explore expectations of people with chronic pain towards participation in easily accessible pain management interventions delivered in public primary care. METHODS A qualitative study using semi-structured individual face-to-face interviews with 21 informants. The informants were recruited among participants enrolled in a randomised controlled trial on the effect of an easily accessible self-management course for people with chronic pain. The data were analysed thematically using Systematic Text Condensation. RESULTS Having experienced pain for a long time, there was no specific expectation of a cure or a significant alleviation of the pain. The informants' expectations mainly concerned a hope that participation could lead to a better everyday life. The informants said that hope was important as it motivated them to keep going and continue self-care activities. The hope acted as a driving force towards trying new interventions and maintaining motivation to do activities they experienced as beneficial. Both concrete aspects of the current intervention and an understanding of what interventions in general could offer contributed to the informants hope. The expectations centred about the interventions being something new, as they had not previously tried this service, an opportunity to gain and reinforce skills, to help them continue to grow as a person, to meet others in similar situations, and to access professional support in an easy manner. Participating in interventions provided by healthcare services was seen by some as an act of self-care, where they did something active to manage their health. CONCLUSIONS Expectations towards the interventions were related to a hope for participation leading to a better everyday life. The role of hope for peoples' motivation to self-care implies that service providers should be aware of and help to maintain hope for a better everyday life. The importance of social support as part of self-care should be acknowledged when developing interventions targeting chronic pain. TRIAL REGISTRATION ClinicalTrials.gov: NCT02531282 . Registered on August 21 2015.
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Affiliation(s)
- Torunn Hatlen Nøst
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway. .,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway
| | - Liv Riseth
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,3T- Fitness Center, Trondheim, Norway
| | - Ola Bratås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjersti Grønning
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Postbox 8905, 7491, Trondheim, Norway.,Centre for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway
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19
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Lacasse A, Choinière M, Connelly JA. Knowledge, beliefs, and attitudes of the Quebec population toward chronic pain: Where are we now? Can J Pain 2017; 1:151-160. [PMID: 35005351 PMCID: PMC8730576 DOI: 10.1080/24740527.2017.1369849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Many chronic pain (CP) awareness and educational initiatives have been achieved, but it is time to take stock of where we are today. Aims: The aim of this study was to describe and identify determinants of knowledge, beliefs, and attitudes of different subgroups of the Quebec population regarding CP and especially toward people suffering from this condition. Methods: A web-based, cross-sectional study was conducted between May and June 2014. Results: A total of 1958 participants responded, among whom 70.9% reported suffering from CP and 14.4% reported being a health care professional (HCP). Almost half of the participants were not aware that the risk of developing CP is increased after undergoing surgery or that CP affects approximately one in five adults. A minority (10.30%) agreed that HCP are well trained in CP treatment. The two most frequent negative beliefs were that people suffering from CP become dependent on their medications as do drug addicts (16.7%) and that consulting a psychologist is useless unless the person with CP is depressed (16.9%). Multiple regression analysis showed that being a woman, being born in Canada, being unemployed, suffering from CP, and being an HCP were predictors of better knowledge and more positive attitudes toward people suffering from CP (all P values < 0.05). Older age and residing in a remote region were associated with poorer knowledge and more negative attitudes. Conclusions: Our results underline the importance of continuing the efforts and the need for more education programs, awareness campaigns, and stigma reduction activities about CP for HCP, patients, and the general public.
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Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada.,Quebec Pain Research Network (QPRN), Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Manon Choinière
- Quebec Pain Research Network (QPRN), Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Montréal, QC, Canada.,Département d'anesthésiologie, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | - Judy-Ann Connelly
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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20
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Nøst TH, Steinsbekk A, Bratås O, Grønning K. Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study. Trials 2016; 17:325. [PMID: 27430319 PMCID: PMC4950079 DOI: 10.1186/s13063-016-1462-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND People struggling with chronic pain may benefit from different types of non-pharmacological interventions such as self-management courses. Self-management courses aim to increase participants' skills and knowledge in managing chronic conditions. Community health-care services in Norway have increasingly established Healthy Life Centres (HLCs) to offer easily accessible interventions to people in need of support to better handle a life with chronic illness. The aim of this trial is to investigate the expectations, effect and experience of an easily accessible, group-based self-management course delivered at a HLC for people with chronic pain. METHODS/DESIGN This is an open pragmatic two-armed randomised controlled trial with an embedded qualitative study. The intervention is a self-management course comprising education, discussions, exchange of experiences between the participants, and physical movement exercises. The control group is offered a drop-in outdoor physical activity. The intervention period is 6 weeks. The primary outcome is patient activation measured by the patient activation measure (PAM). The secondary outcomes include measures of self-efficacy, pain and quality of life. Data will be collected at baseline, and after 3, 6 and 12 months. Using a mixed linear model, the number needed in each arm to achieve a power of 80 % becomes 55. To allow for dropout, the aim is to include 120 participants. Analysis will be done using mixed linear models. In the embedded qualitative study, we will perform semi-structured face-to-face interviews with a sample from both trial arms before randomisation and after 3 and 12 months. The topics elaborated will be motivation for participation and experiences with the activity related to possible changes in managing and coping with chronic pain. DISCUSSION There is need for more knowledge on interventions delivering self-care support in an easily accessible way that aim to reach those in need of this kind of health service. This trial will produce important knowledge on the effect and the experiences of participants in such an easily accessible self-management course delivered in Norwegian public primary care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02531282 . Registered on 21 August 2015.
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Affiliation(s)
- Torunn Hatlen Nøst
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Aslak Steinsbekk
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Ola Bratås
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kjersti Grønning
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Abstract
Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral.
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Affiliation(s)
- Sarah Mills
- Division of Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, Scotland, UK.
| | - Nicola Torrance
- Division of Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF Scotland UK
| | - Blair H. Smith
- Division of Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF Scotland UK
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