1
|
Mathew A, McQuinn H, Flynn DM, Ransom JC, Doorenbos AZ. Tools, Time, Training, and Team-Military Primary Care Providers' Perspectives on Improving Chronic Pain Assessment and Management. Mil Med 2023; 188:e731-e738. [PMID: 34480481 DOI: 10.1093/milmed/usab367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Primary care providers are on the front lines of chronic pain management, with many reporting frustration, low confidence, and dissatisfaction in handling the complex issues associated with chronic pain care. Given the importance of their role and reported inadequacies and dissatisfaction in managing this challenging population, it is important to understand the perspectives of primary care providers when considering approaches to chronic pain management. This qualitative descriptive study aimed to comprehensively summarize the provider challenges and suggestions to improve chronic pain care in military primary care settings. MATERIALS AND METHODS Semi-structured interviews with 12 military primary care providers were conducted in a single U.S. Army medical center. All interviews were audio-recorded and lasted between 30 and 60 minutes. Interview transcripts were analyzed using ATLAS 9.0 software. Narratives were analyzed using a general inductive approach to content analysis. The Framework Method was used to organize the codes and emergent categories. All study procedures were approved by the Institutional Review Board of the University of Washington. RESULTS Four categories captured providers' challenges and suggestions for improving chronic pain care: (1) tools for comprehensive pain assessment and patient education, (2) time available for each chronic pain appointment, (3) provider training and education, and (4) team-based approach to chronic pain management. Providers suggested use of the Pain Assessment Screening Tool and Outcomes Registry, more time per visit, incorporation of chronic pain care in health sciences curriculum, consistent provider training across the board, insurance coverage for complementary and integrative therapies, patient education, and improved access to interdisciplinary chronic pain care. CONCLUSIONS Lack of standardized multifaceted tools, time constraints on chronic pain appointments, inadequate provider education, and limited access to complementary and integrative health therapies are significant provider challenges. Insurance coverage for complementary and integrative health therapies needs to be expanded. The Stepped Care Model of Pain Management is a positive and definite stride toward addressing many of these challenges. Future studies should examine the extent of improvement in guidelines-concordant chronic pain care, patient outcomes, and provider satisfaction following the implementation of the Stepped Care Model of Pain Management in military health settings.
Collapse
Affiliation(s)
- Asha Mathew
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois, Chicago, IL 60612, USA
- College of Nursing, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Honor McQuinn
- Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Diane M Flynn
- Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Jeffrey C Ransom
- Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA 98431, USA
| | - Ardith Z Doorenbos
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois, Chicago, IL 60612, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
2
|
Allen-Watts K, Sims AM, Buchanan TL, DeJesus DJB, Quinn TL, Buford TW, Goodin BR, Rumble DD. Sociodemographic Differences in Pain Medication Usage and Healthcare Provider Utilization Among Adults With Chronic Low Back Pain. FRONTIERS IN PAIN RESEARCH 2022; 2:806310. [PMID: 35295517 PMCID: PMC8915740 DOI: 10.3389/fpain.2021.806310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic low back pain (cLBP) is the most common reason for individual suffering and health care utilization in adults. Ample evidence suggests sociodemographic variables and socioeconomic status (SES) influence pain. However, a framework informing associations on race, SES, and the utilization of pharmacologic therapies and provider type are limited—particularly in cLBP. Thus, this study examined the extent to which sociodemographic (i.e., age, race, and gender) and socioeconomic factors (i.e., national area deprivation index, NADI) influence pain treatment (i.e., NSAIDs, opioids, antidepressants, and non-NSAIDs) and provider utilization for cLBP (i.e., no provider care, primary care, or tertiary care). Eligible participants with cLBP completed a series of questionnaires. Of the 174 participants, 58% were women, 59% were non-Hispanic Black (NHB), and the mean age was 46.10 (SD 13.58). Based on NADI distributions by race, NHB participants lived in more socioeconomically disadvantaged neighborhoods (p < 0.001) than non-Hispanic White (NHW) adults. Results suggested that the use of one or more pharmacologic therapies was associated with race (p = 0.021). Specifically, NHW adults were two times more likely to take one or more pharmacologic therapies than NHBs (p = 0.009). NHWs were also more likely to use NSAIDs (p = 0.041) and antidepressants (p < 0.001) than NHBs. Furthermore, provider utilization was significantly associated with gender (p = 0.037) and age (p = 0.018); which suggests older women were more likely to use primary or tertiary care. Findings from this study expand on the existing literature as it relates to associations between disparities in access to healthcare providers and access to medications. Future research should seek to understand differences in age and utilization of primary or tertiary care providers and continue to examine the influence of sociodemographic and SES factors to cLBP and compare with other types of chronic pain.
Collapse
Affiliation(s)
- Kristen Allen-Watts
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Kristen Allen-Watts
| | - Andrew M. Sims
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Taylor L. Buchanan
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Danica J. B. DeJesus
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tammie L. Quinn
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas W. Buford
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, AL, United States
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Deanna D. Rumble
- Department of Psychology and Counseling, University of Central Arkansas, Conway, AR, United States
| |
Collapse
|
3
|
Flynn DM, Mathew A, McQuinn H, Ransom JC, Steffen AD, Doorenbos AZ. Effectiveness of Telementoring in Improving Provider Knowledge, Attitudes, and Perceived Competence in Managing Chronic Pain: A Mixed Methods Study. Mil Med 2022; 188:1192-1198. [PMID: 35077533 DOI: 10.1093/milmed/usac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/14/2021] [Accepted: 01/08/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Telementoring is an evidence-based approach to meet the educational needs of primary care providers (PCPs) and to improve the quality of chronic pain care. This mixed methods study evaluated the effectiveness of pain management telementoring in improving provider knowledge, attitudes, and perceived competence. MATERIALS AND METHODS The study was conducted at Madigan Army Medical Center. Using a non-randomized quasi-experimental approach, 25 providers were assigned to intervention arm and control arm (14 intervention and 13 control). Providers in the intervention group attended telementoring sessions. Videoconference technology was used to deliver weekly 90-minute TelePain sessions to the PCPs in the intervention group. The first 25-30 minutes of each session consisted of a didactic presentation led by a panel of interdisciplinary pain management clinicians. During the remaining 60 minutes, all PCPs in the intervention group presented clinical histories and asked specific management questions regarding patients of their choosing. An interdisciplinary panel of pain management clinicians provided telementoring consultations. The panel included experts from pain medicine, primary care, psychology or psychiatry, chiropractic, clinical pharmacy, and nursing. Changes in provider knowledge, attitudes, and perceived competence were evaluated using the Knowledge and Attitudes Survey Regarding Pain, KnowPain-12, and the Perceived Competence Scale (n = 23; 12 intervention and 11 control). Qualitative interviews were conducted among a subset of providers (n = 12; 8 intervention and 4 control), and provider narratives were analyzed using content analysis. RESULTS Increased provider knowledge (Z = 2.0, P = .046 [KnowPain-12]) and perceived competence (Z = 2.1, P = .033) were observed among intervention group providers. Provider narratives supported more implementation of non-pharmacological pain management strategies, use of strategies to engage patients in reducing reliance on opioids, and perception of TelePain as a helpful resource especially in the context of inadequate preparation in chronic pain management during professional training. CONCLUSIONS Telementoring may hold significant potential to support providers in their efforts to decrease use of prescription opioids. Overall, this study provides further support for the value of telementoring in improving comprehensive chronic pain management in military settings.
Collapse
|
4
|
Giannitrapani KF, Haverfield MC, Lo NK, McCaa MD, Timko C, Dobscha SK, Kerns RD, Lorenz KA. "Asking Is Never Bad, I Would Venture on That": Patients' Perspectives on Routine Pain Screening in VA Primary Care. PAIN MEDICINE 2020; 21:2163-2171. [PMID: 32142132 DOI: 10.1093/pm/pnaa016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Screening for pain in routine care is one of the efforts that the Veterans Health Administration has adopted in its national pain management strategy. We aimed to understand patients' perspectives and preferences about the experience of being screened for pain in primary care. DESIGN Semistructured interviews captured patient perceptions and preferences of pain screening, assessment, and management. SUBJECTS We completed interviews with 36 patients: 29 males and seven females ranging in age from 28 to 94 years from three geographically distinct VA health care systems. METHODS We evaluated transcripts using constant comparison and identified emergent themes. RESULTS Theme 1: Pain screening can "determine the tone of the examination"; Theme 2: Screening can initiate communication about pain; Theme 3: Screening can facilitate patient recall and reflection; Theme 4: Screening for pain may help identify under-reported psychological pain, mental distress, and suicidality; Theme 5: Patient recommendations about how to improve screening for pain. CONCLUSION Our results indicate that patients perceive meaningful, positive impacts of routine pain screening that as yet have not been considered in the literature. Specifically, screening for pain may help capture mental health concerns that may otherwise not emerge.
Collapse
Affiliation(s)
- Karleen F Giannitrapani
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California.,Stanford University, Palo Alto, California
| | - Marie C Haverfield
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California.,Stanford University, Palo Alto, California
| | - Natalie K Lo
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California
| | - Matthew D McCaa
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California
| | - Christine Timko
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California.,Stanford University, Palo Alto, California
| | - Steven K Dobscha
- VA Portland Healthcare System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, Oregon.,Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation, West Haven, Connecticut.,Department of Psychiatry, Neurology and Psychology, Yale School of Medicine, New Haven, Connecticut
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California.,Stanford University, Palo Alto, California.,Department of Psychiatry, Neurology and Psychology, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
5
|
The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review. J Clin Med 2020; 9:jcm9082486. [PMID: 32756298 PMCID: PMC7464293 DOI: 10.3390/jcm9082486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pain conditions are among the leading causes of global disability, impacting on global healthcare utilization (HCU). Health seeking behavior might be influenced by cognitive and emotional factors (CEF), which can be tackled by specific therapies. The purpose of this study was to systematically review the evidence concerning associations between CEF and HCU in people experiencing pain. Three databases were consulted: PubMed, Web of Science and EconLit. Risk of bias was assessed using the Downs and Black Checklist (modified). A total of 90 publications (total sample n = 59,719) was included after double-blind screening. In people experiencing pain, positive associations between general anxiety symptoms, depressive symptoms and catastrophizing and pain medication use were found. Additionally, there appears to be a relationship between general anxiety and depressive symptoms and opioid use. Symptom-related anxiety and psychological distress were found to be positively related with consulting behavior. Last, a positive association between use of complementary and alternative medicine and level of perceived symptom control was confirmed in people with pain. For other relationships no evidence or inconsistent findings were found, or they were insufficiently studied to draw firm conclusions, indicating that more research on this topic is needed.
Collapse
|
6
|
Mutubuki EN, Luitjens MA, Maas ET, Huygen FJPM, Ostelo RWJG, van Tulder MW, van Dongen JM. Predictive factors of high societal costs among chronic low back pain patients. Eur J Pain 2019; 24:325-337. [PMID: 31566839 PMCID: PMC7003839 DOI: 10.1002/ejp.1488] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 01/30/2023]
Abstract
Background Societal costs of low back pain (LBP) are high, yet few studies have been performed to identify the predictive factors of high societal costs among chronic LBP patients. This study aimed to determine which factors predict high societal costs in patients with chronic LBP. Methods Data of 6,316 chronic LBP patients were used. In the main analysis, high societal costs were defined as patients in the top 10% of cost outcomes. Sensitivity analyses were conducted using patients in the top 5% and top 20% of societal costs. Potential predictive factors included patient expectations, demographic factors (e.g. age, gender, nationality), socio‐economic factors (e.g. employment, education level) and health‐related factors (e.g. body mass index [BMI], general health, mental health). The final prediction models were obtained using backward selection. The model's prognostic accuracy (Hosmer–Lemeshow X2, Nagelkerke's R2) and discriminative ability (area under the receiver operating curve [AUC]) were assessed, and the models were internally validated using bootstrapping. Results Poor physical health, high functional disability, low health‐related quality of life, high impact of pain experience, non‐Dutch nationality and decreasing pain were found to be predictive of high societal costs in all models, and were therefore considered robust. After internal validation, the models' fit was good, their explained variance was relatively low (≤14.1%) and their AUCs could be interpreted as moderate (≥0.71). Conclusion Future studies should focus on understanding the mechanisms associated with the identified predictors for high societal costs in order to design effective cost reduction initiatives. Significance Identifying low back pain patients who are at risk (risk stratification) of becoming high‐cost users and making appropriate initiatives could help in reducing high costs.
Collapse
Affiliation(s)
- Elizabeth N Mutubuki
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Mariette A Luitjens
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Child and Adolescent Health Service, Perth, Australia
| | - Esther T Maas
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Frank J P M Huygen
- Department of Anesthesiology, Centre of Pain Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Dorscht L, Schön C, Geiss C, Gräßel E, Donath C. Access to Pain Management Programs: A Multifactorial Analysis of the Pathways of Care for Chronic Pain Patients in the University Clinic Erlangen. DAS GESUNDHEITSWESEN 2019; 82:e94-e107. [PMID: 31185498 DOI: 10.1055/a-0832-2173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Different treatment options are offered for patients suffering from chronic pain, which differ in intensity and costs: 1) monodisciplinary treatment, mostly in outpatient care and 2) interdisciplinary treatment with the option of participating in pain management programs as outpatients or inpatients. The present work investigates how patients at the University Clinic Erlangen receiving monodisciplinary treatment differ from those receiving interdisciplinary treatment (research question I) as well as how patients participating in a pain management program differ from those who do not (research question II). The aim is to generate insights into whether the differences between the patient groups under various treatment modalities reflect the officially defined criteria for the indication of chronic pain management programs. METHODS Routine data of 1,833 patients treated from January 2008 to March 2013 at the University Clinic Erlangen were analyzed. After univariate preanalyses and checks for multicollinearity, the remaining variables were used for the final multivariate model (multiple binary logistic regression) for research question I and II. RESULTS Research question I: Patients getting interdisciplinary treatment were more often employed, had higher affective experience of pain, more often regarded their pain as treatable, had more often participated in at least one pain-associated rehabilitation treatment in the past, were younger and rarely had application for retirement in consideration. Research question II: Patients who participated in a pain management program were more often female, more often employed, described their pain as mainly located at the upper part of the body, had more concomitant symptoms, were more often diagnosed with musculoskeletal pain and rarely had a retirement request pending. CONCLUSIONS It could be shown that patients in the analyzed pathways of care mainly differed in demographic variables, and regarding pain management programs, also in the type of pain. Differences between patients in different treatment paths reflecting the officially defined indication criteria for chronic pain management programs were detectable only to a minor extent. Clearer and operational practical guidance should help support the clinical decision to assign patients to different treatment options and close the gap between theory and practice.
Collapse
Affiliation(s)
- Lisa Dorscht
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
| | - Christoph Schön
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Erlangen, Erlangen
| | - Christa Geiss
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Erlangen, Erlangen
| | - Elmar Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
| | - Carolin Donath
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische Universitätsklinik Erlangen, Erlangen
| |
Collapse
|
8
|
|
9
|
Tarraubella N, Sánchez-de-la-Torre M, Nadal N, De Batlle J, Benítez I, Cortijo A, Urgelés MC, Sanchez V, Lorente I, Lavega MM, Fuentes A, Clotet J, Llort L, Vilo L, Juni MC, Juarez A, Gracia M, Castro-Grattoni AL, Pascual L, Minguez O, Masa JF, Barbé F. Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial. Thorax 2018; 73:1152-1160. [DOI: 10.1136/thoraxjnl-2017-211237] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/13/2018] [Accepted: 06/25/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveTo assess the effectiveness and cost-effectiveness of primary care (PC) and sleep unit (SU) models for the management of subjects with suspected obstructive sleep apnoea (OSA).MethodsMulticentre, open-label, two-arm, parallel-group, non-inferiority randomised controlled trial. A total of 302 subjects with suspected OSA and/or resistant hypertension were consecutively enrolled, 149 were treated at 11 PC units and 153 patients at a SU. The primary outcomes were a 6-month change in the Epworth Sleepiness Scale (ESS) score and Health Utilities Index (HUI). The non-inferiority margin for the ESS score was −2.0.ResultsA total of 80.2% and 70.6% of the PC and SU patients were diagnosed with OSA, respectively, and 59.3% and 60.4% of those were treated with CPAP in PC and SU units, respectively. The Apnoea–Hypopnoea Index was similar between the groups (PC vs SU (median (IQR); 23.1 (26.8) events/h vs 21.8 (35.2) events/h), and the baseline ESS score was higher in the PC than in the SU group (10.3 (6.6) vs 9 (7.2)). After 6 months, the ESS score of the PC group decreased from a mean of 10.1 to 7.6 (−2.49; 95% CI −3.3 to −1.69), and that of the SU group decreased from 8.85 to 5.73 (−3.11; 95% CI −3.94 to 2.28). The adjusted difference between groups for the mean change in the ESS score was −1.25 (one-sided 95% CI −1.88; p=0.025), supporting the non-inferiority of PC management. We did not observe differences in the HUI between groups. The cost analysis showed a median savings of €558.14/patient for the PC setting compared with the SU setting.ConclusionsAmong patients with suspected OSA, the PC model did not result in a worse ESS score or HUI than the specialist model and generated savings in terms of management cost. Therefore, the PC model was more cost-efficient than the SU model.Trial registrationResults; >>NCT02234765, Clinical Trials.gov.
Collapse
|
10
|
Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin 2018. [PMID: 29513044 DOI: 10.1080/03007995.2018.1449738] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". METHODS This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. RESULTS Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." CONCLUSIONS Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.
Collapse
Affiliation(s)
- Bart Morlion
- a Leuven Centre for Algology & Pain Management , University Hospitals Leuven , KU Leuven , Belgium
| | - Flaminia Coluzzi
- b Department of Medical and Surgical Sciences and Biotechnologies Unit of Anaesthesia, Intensive Care and Pain Medicine , Sapienza University of Rome , Rome , Italy
| | | | - Magdalena Kocot-Kepska
- d Department of Pain Research and Treatment , Jagiellonian University Medical College , Kraków , Poland
| | - Joseph Pergolizzi
- e Global Pain Initiative, Golden, CO, USA and Naples Anesthesia and Pain Associates , Naples , FL , USA
| | | | | | - Eija Kalso
- h Pain Clinic, Departments of Anaesthesiology , Intensive Care, and Pain Medicine, Helsinki University Central Hospital , Helsinki , Finland
| |
Collapse
|
11
|
Kanzler KE, Robinson PJ, McGeary DD, Mintz J, Potter JS, Muñante M, Lopez EJ, Dougherty DM, Hale WJ, Velligan DI. Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic. Contemp Clin Trials 2018; 66:28-35. [PMID: 29414142 DOI: 10.1016/j.cct.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 01/01/2023]
Abstract
Most of the 100 million Americans with persistent pain are treated in primary care clinics, but evidence-based psychosocial approaches targeting pain-related disability are not usually provided in these settings. This manuscript describes the rationale and methods for a protocol to pilot test the feasibility and effectiveness of Acceptance and Commitment Therapy (ACT), an evidence-based psychological treatment for persistent pain, delivered by a Behavioral Health Consultant in primary care. Eligible patients are identified through electronic health record registries and invited to participate via secure messaging, letters and a follow-up phone call. Participants are also recruited with advertising and clinician referral. Patients agreeing to participate are consented and complete initial assessments, with a target of 60 participants. Randomization is stratified based on pain severity with participants assigned to either ACT or Enhanced Treatment as Usual (E-TAU). ACT participants receive one standardized Behavioral Health Consultation visit followed by three ACT-based group visits and one group booster visit. All patients attend six assessment visits, during which the E-TAU patients are provided with educational pain management handouts based on standard cognitive behavioral treatment of pain. The study aims to determine feasibility and effectiveness of brief ACT for persistent pain delivered by an integrated behavioral health clinician in primary care from pre- to post-treatment, and to examine mechanisms of change in ACT participants. This study, in a "real-world" setting, will lay groundwork for a larger trial. If effective, it could improve treatment methods and quality of life for patients with persistent pain using a scalable approach.
Collapse
Affiliation(s)
- Kathryn E Kanzler
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA; Department of Family & Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, USA.
| | - Patricia J Robinson
- Mountainview Consulting Group, 1327 SE Tacoma, #322, Portland, OR 97202, USA.
| | - Donald D McGeary
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA; Department of Family & Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, USA.
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA.
| | - Jennifer Sharpe Potter
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA.
| | - Mariana Muñante
- Department of Family & Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, USA.
| | - Eliot J Lopez
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA; Department of Family & Community Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7794, San Antonio, TX 78229, USA.
| | - Donald M Dougherty
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA.
| | - Willie J Hale
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Dawn I Velligan
- Department of Psychiatry, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, Mail Code 7792, San Antonio, TX 78229, USA.
| |
Collapse
|
12
|
Affiliation(s)
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences; Department of Medicine; Duke Clinical Research Institute, Duke University Medical Center; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA
| |
Collapse
|
13
|
Kavukcu E, Akdeniz M, Avci HH, Altuğ M, Öner M. Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse. Postgrad Med 2014; 127:22-6. [DOI: 10.1080/00325481.2015.993572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|