Multicenter survey of symptoms, work life, economic status, and quality of life of complex regional pain syndrome patients

Unraveling the Tapestry of Pain: A Comprehensive Review of Ethnic Variations, Cultural Influences, and Physiological Mechanisms in Pain Management and Perception

The medical management of pain is a nuanced challenge influenced by sociocultural, demographic, and ethical factors. This review explores the intricate interplay of these dimensions in shaping pain perception and treatment outcomes. Sociocultural elements, encompassing cultural beliefs, language, societal norms, and healing practices, significantly impact individuals' pain experiences across societies. Gender expectations further shape these experiences, influencing reporting and responses. Patient implications highlight age-related and socioeconomic disparities in pain experiences, particularly among the elderly, with challenges in managing chronic pain and socioeconomic factors affecting access to care. Healthcare provider attitudes and biases contribute to disparities in pain management across racial and ethnic groups. Ethical considerations, especially in opioid use, raise concerns about subjective judgments and potential misuse. The evolving landscape of placebo trials adds complexity, emphasizing the importance of understanding psychological and cultural factors. In conclusion, evidence-based guidelines, multidisciplinary approaches, and tailored interventions are crucial for effective pain management. By acknowledging diverse influences on pain experiences, clinicians can provide personalized care, dismantle systemic barriers, and contribute to closing knowledge gaps, impacting individual and public health, well-being, and overall quality of life.

The association of self-reported symptoms of central sensitization and sleep disturbances in neuropathic pain

Introduction

Patients with neuropathic pain (NP) report a higher impairment of quality of life and sleep than patients with chronic pain without neuropathic characteristics. These include somatosensory peculiarities like allodynia, a surrogate marker for central sensitization.

Objectives

This study aimed to investigate the relation between symptoms of central sensitization and sleep disturbances in patients with NP.

Methods

Within this cross-sectional study, data sets of 3339 patients with chronic NP syndromes (painful diabetic polyneuropathy, n = 543; postherpetic neuralgia, n = 1480) or complex regional pain syndromes (CRPS, n = 1316) were analyzed. Neuropathic pain symptoms were assessed with the painDETECT questionnaire (PD-Q), depression with the Patient Health Questionnaire-9, and sleep impairment with items of the Medical Outcomes Study Sleep Scale in 4 subscales. The association of demographic/clinical data, somatosensory phenotype, depression, and pain intensity with sleep impairment was assessed by unadjusted Spearman correlation analyses and multivariable regression analyses.

Results

Sleep impairment was observed in all pain aetiologies although with some significant differences in the single sleep items. The intensity of the individual PD-Q items differed to some extent between the 3 pain entities, whereas the PD-Q sum score was similar. Thermal hyperalgesia and burning assessed by the PD-Q were significantly associated with sleep disturbance, adequacy, and quantity but not with sleep somnolence. Only depression and self-reported allodynia had a significant relation to all 4 sleep elements.

Conclusion

Beside depression, allodynia as a surrogate marker hints to a possible impact of central sensitization on the sleep disruption of patients with NP.

Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study

BACKGROUND

The COVID-19 outbreak disrupted medical access for patients receiving chronic opioid therapy. This study investigated their prescription opioid dosages before and after the 2020 outbreak in Taiwan.

METHODS

A prospective questionnaire survey was conducted among registered outpatients receiving long-term opioids before July 2019 in Taiwan. The questionnaire included items from the Taiwanese Brief Pain Inventory and quality of life assessment. Follow-up surveys in outpatient departments through October 2020 were conducted to collect opioid prescription data.

RESULTS

After a mean of 531 days, the questionnaire responses of 103 of the initial 117 respondents were reviewed. Daily opioid doses decreased for 31 respondents (30.1%), remained roughly equivalent (defined as ±2.5%) for 27 (26.2%), and increased for 45 (43.7%) after the first wave of the pandemic. The use of strong opioids and nonopioid medications did not significantly differ among the three groups, but less fentanyl patch use was noted in the decreased-dose group after the outbreak. More than 70% of the patients received daily high-dose opioids (≥90 morphine milligram equivalents); moreover, 60% reported constipation. No deaths due to opioid overdose occurred during the study period.

CONCLUSIONS

The COVID-19 outbreak in 2020 did not interrupt access to long-term opioid prescriptions for most registered patients with chronic pain in Taiwan. Less fentanyl patch use was observed in participants whose opioid dose was tapering.

[Lived Experience of Middle-Aged Patients with Complex Regional Pain Syndrome]

PURPOSE

This qualitative study aimed to explore the lived and true meaning of experiences of middle-aged patients with complex regional pain syndrome.

METHODS

The participants were 10 men and women aged 40 to 60 years who received outpatient treatment at a university hospital, could communicate, and agreed to participate in the study. Data were collected through individual interviews using open and semi-structured questions from September 2019 to July 2021 and were analyzed using the content analysis method suggested by Hsieh and Shannon (2005).

RESULTS

As a result of this study, 42 summarized semantic units related to life experience, 15 subthemes, and seven themes were derived. The seven themes were "pressed by severe pain," "frustrated because I cannot be part of the community," "distressed because people do not recognize my disease," "sad about conflicts with family," "unmotivated because of desperate life," "appreciating for support," and "putting oneself together and living daily life."

CONCLUSION

The vivid experiences of the participants derived in this study are the basic data for developing treatment guidelines. In the future, we propose a study on life and family care experiences according to the developmental characteristics of the life cycle of patients with complex regional pain syndrome and develop and apply programs to support patients and their families.

Actual situation and prescribing patterns of opioids by pain physicians in South Korea

Background

Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients’ quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians’ experiences with opioid use in South Korea.

Methods

Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions.

Results

A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%).

Conclusions

The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

Impact of coronavirus disease 2019 on patients with chronic pain: multicenter study in Korea

Background

The coronavirus disease 2019 (COVID-19) pandemic has caused significant changes. This study aimed to investigate the impact of COVID-19 on patients with chronic pain.

Methods

Patients with chronic pain from 23 university hospitals in South Korea participated in this study. The anonymous survey questionnaire consisted of 25 questions regarding the following demographic data, diagnosis, hospital visit frequency, exercise duration, time outside, sleep duration, weight change, nervousness and anxiety, depression, interest or pleasure, fatigue, daily life difficulties, and self-harm thoughts. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was used to investigate the relationship between increased pain and patient factors.

Results

A total of 914 patients completed the survey, 35.9% of whom had decreased their number of visits to the hospital, mostly due to COVID-19. The pain level of 200 patients has worsened since the COVID-19 outbreak, which was more prominent in complex regional pain syndrome (CRPS). Noticeable post-COVID-19 changes such as exercise duration, time spent outside, sleep patterns, mood, and weight affected patients with chronic pain. Depression severity was more significant in patients with CRPS. The total PHQ-9 average score of patients with CRPS was 15.5, corresponding to major depressive orders. The patients’ decreased exercise duration, decreased sleep duration, and increased depression were significantly associated with increased pain.

Conclusions

COVID-19 has caused several changes in patients with chronic pain. During the pandemic, decreased exercise and sleep duration and increased depression were associated with patients’ increasing pain.

Symptomatic dermographism in Chinese population: an epidemiological study of hospital-based multicenter questionnaire survey

OBJECTIVE

There are few epidemiological studies on SD in China. This study aims to clarify the epidemic distribution characteristics of SD in China and provide ideas and clues for the prevention and treatment of the disease.

METHODS

The cross-sectional study was conducted in 2019 based on the hospital's epidemiological questionnaire. All enrolled patients completed a specific survey with 39 questions, related to demographic characteristics and the relative symptoms. Demographics, disease symptoms were characterized with descriptive statistics. The differences in the symptoms between different genders, disease courses, and regions were compared.

RESULTS

A total of 1800 patients were recruited, of which 615 patients were diagnosed with SD. Among 615 SD patients, the proportion of patients with chronic spontaneous urticaria was the highest, with 437 cases (71.1%). There is a female predominance (female/male ratio is 1.27:1), but there is no statistically significant difference between genders. The average disease course was 2.23 years. Among them, 429 patients had a course less than one year, accounting for about 2/3, and patients with a course more than one year accounted for less than 1/3. The clinical characteristics of patients with different course of disease were statistically different. The initial age is mainly concentrated in the 20-40 years old, accounting for 46.5% (286) of the total number. There are certain differences in incidence due to the different geographical conditions in north and south. Multiple types of urticaria may coexist in the same patient, and the number of patients with multiple urticaria is higher than the number of patients with simple SD. There are differences in the clinical manifestations of SD between north and south.

CONCLUSIONS

Environmental factors may affect the occurrence of SD, which may have a similar etiology to other types of urticaria and the cause of SD can be explored from more perspectives.

Analysis of the Effect of Cluster Nursing in Postoperative Hypertensive Cerebral Hemorrhage

Hypertensive intracerebral hemorrhage is a common condition in clinic. Due to the improvement of minimally invasive technology, its therapeutic effect is good, but there are still postoperative complications. The corresponding routine nursing intervention is not effective in the rehabilitation of postoperative patients with hypertensive intracerebral hemorrhage. In this paper, cluster nursing was applied to the treatment of postoperative patients with hypertensive intracerebral hemorrhage. For this purpose, a retrospective study or experiment was conducted on 150 patients with hypertensive intracerebral hemorrhage in the hospital specifically from January 2019 to December 2020. According to the nursing strategy, patients were divided into experimental (n = 75) and control groups (n = 75), respectively. The control group adopted routine nursing mode, whereas the experimental group adopted cluster nursing mode. The treatment compliance of patients in the experimental group was 86.67%, while that in the control group was 73.33% (P < 0.05). The total incidence of postoperative complications in the experimental group was 3.2%, which was lower than 25% in the control group (P < 0.05). The motor function score of the experimental group was better than that of the control group (P < 0.05). The application of cluster nursing in postoperative patients with hypertensive intracerebral hemorrhage is feasible, and its nursing effect is significant, which can not only reduce the incidence of postoperative complications but also improve patients' compliance and quality of life. It has good application value.