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Dudeney J, Scott AJ, Hathway T, Bisby MA, Harte N, Titov N, Dear BF. Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data. THE JOURNAL OF PAIN 2024; 25:104447. [PMID: 38122876 DOI: 10.1016/j.jpain.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
Young adults report chronic pain at rates of around 12% but lack access to clinical services. There is interest in learning how this emerging adult population engages with and responds to treatment. Using data from young adults aged 18 to 30 years (Mage = 25.8, SD = 3.2), taken from 4 previous randomised controlled trials, the current study investigated the feasibility, acceptability, and efficacy of an internet-delivered psychological pain-management intervention for young adults with chronic pain. We compared young adults in a treatment group (n = 104) with 1) a young-adult wait-list control group (n = 48), and 2) a treatment group reflecting the average-aged participant from the previous trials (39-63 years, n = 561). Feasibility was determined through treatment engagement, adherence and completion, and acceptability through a treatment satisfaction measure. Clinical outcomes were disability, pain intensity, anxiety, and depression; assessed at pre-treatment, post-treatment, and 3-month follow-up. Generalised estimation equation analyses were undertaken, using multiple imputations to account for missing data. Young adults had high engagement and acceptability ratings, though 34% did not complete the intervention. The treatment group significant improved across all outcomes, compared with control, with improvements maintained at follow-up. Post-treatment improvements were equivalent for young-adult and average-aged adult treatment groups, with no significant differences in feasibility or acceptability outcomes. Findings indicate young adults can engage with and show improvements following a psychological pain-management intervention designed for all adults with chronic pain. Future research is encouraged to examine outcomes related to role functioning of young adults, and moderators of treatment acceptability and efficacy for this population. PERSPECTIVE: Secondary analysis of data from 4 RCTs found an Internet-delivered psychological pain-management intervention acceptable and clinically efficacious for improving disability, anxiety, depression and pain intensity in young adults (18-30) with chronic pain.
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Affiliation(s)
- Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Taylor Hathway
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Nicole Harte
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
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MacIntyre E, Braithwaite FA, Stanton TR, Burke ALJ. Waiting in Pain II: An Updated Analysis of the Multidisciplinary Staffing Levels and Clinical Activity in Australian Specialist Persistent Pain Services. THE JOURNAL OF PAIN 2024; 25:104446. [PMID: 38101527 DOI: 10.1016/j.jpain.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
This study provides an update on multidisciplinary staffing and clinical activity in Australian specialist persistent pain services. Of the 109 services identified, 57 responded, met inclusion criteria and completed a study-specific questionnaire detailing service characteristics, staff resources, and clinical activities. Where possible, data were compared between the 'Waiting in Pain' (WIP) investigations (WIP-I: Dec'08-Jan'10, WIP-II: Jul'16-Feb'18). WIP-II found more pain services (Level 1 centres, rural services) and more full-time equivalent (FTE) staffing (overall, psychiatry, psychology, occupational therapy) than WIP-I. Although Level 1 centres employed more FTE staff (overall, medical) than Level 2 clinics, staffing was comparable when considered relative to clinical activity and this was stable over time for most disciplines. Clinical activity in metropolitan and rural services also remained stable, as did rural service staffing (type, FTE), suggesting that newer clinics replicated existing models. WIP-II highlighted greater diversity in group structures than WIP-I and an associated mean .02FTE allied health staff/patient seen (WIP-I = .03 FTE). Staffing (amounts, types) did not change significantly over time when considered relative to clinical activity, supporting the conclusion that these are workable clinical structures. However, changes in group format (duration, staffing) suggest a shift towards lower-intensity programmes that require less allied health staffing to deliver. PERSPECTIVE: This article presents updated data regarding multidisciplinary staffing profiles, clinical activity, and group programme structures within Australian specialist persistent pain services and examines changes since the original investigation. As the only published staffing profile for multidisciplinary pain services, this project provides critical information to inform service (re)design and care delivery.
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Affiliation(s)
- E MacIntyre
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - F A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - T R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - A L J Burke
- The Australian Pain Society, North Sydney, New South Wales, Australia; Psychology Department, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Maher CG, Han CS, Gilbert SE, Nicholas MK. A content analysis of the interventions for low back pain promoted on the websites of Australian pain clinics. Aust J Prim Health 2024; 30:PY23164. [PMID: 38373344 DOI: 10.1071/py23164] [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: 09/05/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The Internet is a widely used source of health information, yet the accuracy of online information can be low. This is the case for low back pain (LBP), where much of the information about LBP treatment is poor. METHODS This research conducted a content analysis to explore what pain treatments for LBP are presented to the public on websites of Australian pain clinics listed in the PainAustralia National Pain Services Directory. Websites providing information relevant to the treatment of LBP were included. Details of the treatments for LBP offered by each pain service were extracted. RESULTS In total, 173 pain services were included, with these services linking to 100 unique websites. Services were predominantly under private ownership and located in urban areas, with limited services in non-urban locations. Websites provided detail on a median of six (IQR 3-8) treatments, with detail on a higher number of treatments provided by services in the private sector. Physical, psychological and educational treatments were offered by the majority of pain services, whereas surgical and workplace-focused treatments were offered by relatively few services. Most services provided details on multidisciplinary care; however, interdisciplinary, coordinated care characterised by case-conferencing was infrequently mentioned. CONCLUSIONS Most websites provided details on treatments that were largely in-line with recommended care for LBP, but some were not, especially in private clinics. However, whether the information provided online is a true reflection of the services offered in clinics remains to be investigated.
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Affiliation(s)
- Chris G Maher
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Gadigal Country, Sydney, NSW, Australia
| | - Christopher S Han
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Gadigal Country, Sydney, NSW, Australia
| | - Stephen E Gilbert
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, Gadigal Country, Sydney, NSW, Australia
| | - Michael K Nicholas
- Pain Education Unit, Sydney Medical School-Northern, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Guringai and Dharug Country, Sydney, NSW, Australia
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Langford AV, Bero L, Lin CWC, Blyth FM, Doctor JN, Holliday S, Jeon YH, Moullin JC, Murnion B, Nielsen S, Penm J, Reeve E, Reid S, Wale J, Osman R, Gnjidic D, Schneider CR. Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care. J Clin Epidemiol 2024; 165:111204. [PMID: 37931823 DOI: 10.1016/j.jclinepi.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. STUDY DESIGN AND SETTING Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. RESULTS The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations. CONCLUSION The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
| | - Lisa Bero
- School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Chung-Wei Christine Lin
- Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia; Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Janet Wale
- Independent Consumer Representative, Melbourne, Victoria, Australia
| | - Rawa Osman
- NPS MedicineWise, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Simmich J, Ross MH, Andrews NE, Vaezipour A, Russell TG. Content and Quality of Mobile Apps for the Monitoring of Musculoskeletal or Neuropathic Pain in Australia: Systematic Evaluation. JMIR Mhealth Uhealth 2023; 11:e46881. [PMID: 37706480 PMCID: PMC10510453 DOI: 10.2196/46881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023] Open
Abstract
Background Mobile apps offer a potential mechanism for people with persistent pain to monitor pain levels conveniently within their own environment and for clinicians to remotely monitor their patients' pain. However, the quality of currently available apps and the usefulness of included features from a clinical perspective are not known. Objective The aim of this study was to examine the content and quality of currently available smartphone apps designed for monitoring the intensity or presence of musculoskeletal or neuropathic pain. Methods A systematic search was performed in the Australian Apple and Google Play stores. Apps were included if they were designed to monitor the intensity or presence of musculoskeletal or neuropathic pain and were available in the English language within the Australian app stores. Data pertaining to the intended use of the app and clinical population were extracted by using a custom-designed data extraction form, and app quality was assessed by using the 23-item Mobile App Rating Scale. Results Of the 2190 apps screened, 49 met the inclusion criteria. Apps were primarily designed for adult users (36/49, 73%) with nonspecific musculoskeletal or neuropathic pain conditions, arthritis, and joint pain. All apps monitored pain intensity, with almost half (23/49, 47%) also specifying pain location. Overall, the mean quality scores from the Mobile App Rating Scale ranged from 1.5 to 4.4 (out of 5.0). Between 20% (10/49) and 22% (11/49) of apps involved clinicians, consumers, or both in their development, and 20% (10/49) had published literature related to the development or use of the app in clinical scenarios. Although 71% (35/49) had data sharing features, only 5 apps enabled client-clinician communication through the app. Conclusions The overall quality of mobile apps that are currently available for monitoring pain intensity is acceptable. Presently, mobile apps for remote pain monitoring lack functionality for clinicians to view data between consults. Both users and clinicians should be aware of the limitations of these apps and make informed choices in using or recommending apps that best suit the clinical need.
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Affiliation(s)
- Joshua Simmich
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Megan Heather Ross
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nicole Emma Andrews
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Tess Cramond Pain and Research Centre, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane, Australia
- Occupational Therapy Department, Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Atiyeh Vaezipour
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Trevor Glen Russell
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Farrell SF, Edmunds D, Fletcher J, Martine H, Mohamed H, Liimatainen J, Sterling M. Effectiveness of psychological interventions delivered by physiotherapists in the management of neck pain: a systematic review with meta-analysis. Pain Rep 2023; 8:e1076. [PMID: 37731474 PMCID: PMC10508403 DOI: 10.1097/pr9.0000000000001076] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 09/22/2023] Open
Abstract
Physiotherapists are increasingly using psychological treatments for musculoskeletal conditions. We assessed the effects of physiotherapist-delivered psychological interventions on pain, disability, and quality of life in neck pain. We evaluated quality of intervention reporting. We searched databases for randomized controlled trials (RCTs) comprising individuals with acute or chronic whiplash-associated disorder (WAD) or nontraumatic neck pain (NTNP), comparing physiotherapist-delivered psychological interventions to standard care or no treatment. Data were extracted regarding study characteristics and outcomes. Standardised mean difference (SMD) was calculated by random-effects meta-analysis. We evaluated certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) and intervention reporting using TIDieR. Fourteen RCTs (18 articles-4 detail additional outcome/follow-up data) were included comprising 2028 patients, examining acute WAD (n = 4), subacute/mixed NTNP (n = 3), chronic WAD (n = 2), and chronic NTNP (n = 5). Treatment effects on pain favoured psychological interventions in chronic NTNP at short-term (SMD -0.40 [95% CI -0.73, -0.07]), medium-term (SMD -0.29 [95% CI -0.57, 0.00]), and long-term (SMD -0.32 [95% CI -0.60, -0.05]) follow-up. For disability, effects favoured psychological interventions in acute WAD at short-term follow-up (SMD -0.39 [95% CI -0.72, -0.07]) and chronic NTNP at short-term (SMD -0.53 [95% CI -0.91, -0.15]), medium-term (SMD -0.49 [95% CI -0.77, -0.21]), and long-term (SMD -0.60 [95% CI -0.94, -0.26]) follow-up. GRADE ratings were typically moderate, and intervention reporting often lacked provision of trial materials and procedural descriptions. Psychological interventions delivered by physiotherapists were more effective than standard physiotherapy for chronic NTNP (small-to-medium effects) and, in the short term, acute WAD.
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Affiliation(s)
- Scott F. Farrell
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Devon Edmunds
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - John Fletcher
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Harry Martine
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Hashem Mohamed
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Jenna Liimatainen
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre and NHMRC Centre for Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
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Redpath P, Searle A, Wall C, Venning A, Oswald T, Glover F, Herriot P. Guided Self-Help for People with Chronic Pain: Integrated Care in a Public Tertiary Pain Clinic-A Pilot Study. Pain Ther 2023; 12:449-460. [PMID: 36595182 PMCID: PMC10036713 DOI: 10.1007/s40122-022-00464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia. METHODS A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre-post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity - specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). RESULTS Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2-5 versus 6-12 sessions. CONCLUSION Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.
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Affiliation(s)
- Paula Redpath
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Amelia Searle
- Pain Management Unit, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Cindy Wall
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia, Darwin, Northern Territory, Australia
| | - Anthony Venning
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tassia Oswald
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Fiona Glover
- Discipline of Behavioural Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter Herriot
- Pain Management Unit, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
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8
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Briggs AM, Jordan JE, Sharma S, Young JJ, Chua J, Foster HE, Haq SA, Huckel Schneider C, Jain A, Joshipura M, Kalla AA, Kopansky-Giles D, March L, Reis FJJ, Reyes KAV, Soriano ER, Slater H. Context and priorities for health systems strengthening for pain and disability in low- and middle-income countries: a secondary qualitative study and content analysis of health policies. Health Policy Plan 2022; 38:129-149. [PMID: 35876078 PMCID: PMC9923377 DOI: 10.1093/heapol/czac061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/11/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
Musculoskeletal (MSK) health impairments contribute substantially to the pain and disability burden in low- and middle-income countries (LMICs), yet health systems strengthening (HSS) responses are nascent in these settings. We aimed to explore the contemporary context, framed as challenges and opportunities, for improving population-level prevention and management of MSK health in LMICs using secondary qualitative data from a previous study exploring HSS priorities for MSK health globally and (2) to contextualize these findings through a primary analysis of health policies for integrated management of non-communicable diseases (NCDs) in select LMICs. Part 1: 12 transcripts of interviews with LMIC-based key informants (KIs) were inductively analysed. Part 2: systematic content analysis of health policies for integrated care of NCDs where KIs were resident (Argentina, Bangladesh, Brazil, Ethiopia, India, Kenya, Malaysia, Philippines and South Africa). A thematic framework of LMIC-relevant challenges and opportunities was empirically derived and organized around five meta-themes: (1) MSK health is a low priority; (2) social determinants adversely affect MSK health; (3) healthcare system issues de-prioritize MSK health; (4) economic constraints restrict system capacity to direct and mobilize resources to MSK health; and (5) build research capacity. Twelve policy documents were included, describing explicit foci on cardiovascular disease (100%), diabetes (100%), respiratory conditions (100%) and cancer (89%); none explicitly focused on MSK health. Policy strategies were coded into three categories: (1) general principles for people-centred NCD care, (2) service delivery and (3) system strengthening. Four policies described strategies to address MSK health in some way, mostly related to injury care. Priorities and opportunities for HSS for MSK health identified by KIs aligned with broader strategies targeting NCDs identified in the policies. MSK health is not currently prioritized in NCD health policies among selected LMICs. However, opportunities to address the MSK-attributed disability burden exist through integrating MSK-specific HSS initiatives with initiatives targeting NCDs generally and injury and trauma care.
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Affiliation(s)
- Andrew M Briggs
- *Corresponding author. Curtin School of Allied Health and enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia. E-mail:
| | | | - Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal,School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, 18 High St Kensington, New South Wales 2052, Australia,Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, New South Wales 2031, Australia
| | | | - Jason Chua
- TBI Network, Faculty of Health and Environmental Sciences, Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland 1010, New Zealand
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom,Paediatric Global Musculoskeletal Task Force, Global Alliance for Musculoskeletal Health, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia
| | - Syed Atiqul Haq
- Rheumatology Department, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh,Asia Pacific League of Associations for Rheumatology (APLAR), 1 Scotts Road #24-10, Shaw Center Singapore 228208, Singapore
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, 17 John Hopkins Drive, Camperdown, New South Wales 2050, Australia
| | - Anil Jain
- Department of Physical Medicine & Rehabilitation, Santokba Durlabhji Memorial Hospital, Bhawani Singh Marg Road, Rambagh Circle 302015, Jaipur, India
| | - Manjul Joshipura
- AO Alliance Foundation, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Deborah Kopansky-Giles
- Global Alliance for Musculoskeletal Health (G-MUSC), Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia,Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, North York, Ontario M2H 3J1, Canada,Department of Family & Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
| | - Lyn March
- Global Alliance for Musculoskeletal Health (G-MUSC), Institute of Bone and Joint Research, Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia,Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Reserve Rd, St Leonards NSW 2065, Australia,Kolling Institute, University of Sydney, 10 Westbourne Street, St Leonards, New South Wales 2064, Australia
| | - Felipe J J Reis
- Physical Therapy Department, Instituto Federal do Rio de Janeiro (IFRJ), R. Sen. Furtado, 121/125 - Maracanã, Rio de Janeiro – RJ, 20270-021, Brazil,Clinical Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro – RJ, 21044-020, Brazil,Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Bd de la Plaine 2, Ixelles 1050, Brussels, Belgium
| | - Katherine Ann V Reyes
- Alliance for Improving Health Outcomes, Inc., West Ave, Quezon City 1104, Philippines,School of Public Health, Pamantasan ng Lungsod ng Maynila, Intramuros, Manila, 1002 Metro, Manila, Philippines
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Services and University Institute, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199 CABA, Buenos Aires, Argentina,Pan-American League of Associations for Rheumatology (PANLAR), Wells Fargo Plaza, 333 SE 2nd Avenue Suite 2000 Mia, Florida 33131, United States of America
| | - Helen Slater
- Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia
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9
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Elsharydah A, Wu J, Li FC. Decreasing waiting time for new patients at a community pain clinic. Proc AMIA Symp 2022; 35:315-318. [DOI: 10.1080/08998280.2022.2043715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas and Parkland Health, Dallas, Texas
| | - Jennifer Wu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas and Parkland Health, Dallas, Texas
| | - Frederick C. Li
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
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10
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Mayfield K, Nguyen H, Smith C, Morris T. The impact and value of a pharmacist within a persistent pain management service. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Karla Mayfield
- Sunshine Coast Hospital and Health Service Sunshine Coast Queensland Australia
| | - Huong Nguyen
- Persistent Pain Management Service Nambour Hospital Nambour Queensland Australia
| | - Cathy Smith
- Persistent Pain Management Service Nambour Hospital Nambour Queensland Australia
| | - Tania Morris
- Persistent Pain Management Service Nambour Hospital Nambour Queensland Australia
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11
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Areli E, Godfrey HK, Perry MA, Hempel D, Saipe B, Grainger R, Hale L, Devan H. 'I think there is nothing . . . that is really comprehensive': healthcare professionals' views on recommending online resources for pain self-management. Br J Pain 2021; 15:429-440. [PMID: 34840791 DOI: 10.1177/2049463720978264] [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: 11/16/2022] Open
Abstract
Objectives To explore healthcare professionals' views on, and attitudes, towards recommending online resources for persistent pain self-management. Methods This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach. Results The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption. Conclusion Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a 'blended model' where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed 'trustworthy online resources' that provide evidence-based, updated information that is personalised to clients' health literacy and cultural beliefs. Practice implications Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.
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Affiliation(s)
- E Areli
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - H K Godfrey
- Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand.,Centre for Science in Society, Victoria University of Wellington, Wellington, New Zealand
| | - M A Perry
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand
| | - D Hempel
- Pain Management Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - B Saipe
- Pain Management Service, Capital and Coast District Health Board, Wellington, New Zealand
| | - R Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - L Hale
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Dunedin, New Zealand
| | - H Devan
- School of Physiotherapy, Centre for Health, Activity and Rehabilitation Research (CHARR), University of Otago, Wellington, New Zealand
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12
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Giummarra MJ, Arnold CA, Beck BB. Evaluation of the Relationship Between Geographic Proximity and Treatment for People Referred to a Metropolitan Multidisciplinary Pain Clinic. PAIN MEDICINE 2021; 22:1993-2006. [PMID: 33502515 DOI: 10.1093/pm/pnab011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study examined which patient characteristics are associated with traveling further to attend a metropolitan, publicly funded pain management service, and whether travel distance was associated with differences in treatment profile, duration, and percentage of appointments attended. DESIGN Cross-sectional observational cohort study. METHOD Patients ≤70 years of age with a single referral between January 2014 and June 2018 who had not died within 12 months of their first appointment and who had a usual place of residence were included (N = 1,684; mean age = 47.2 years; 55.5% female). Travel distance was calculated with the HERE Routing API on the basis of historical travel times for each scheduled appointment. RESULTS Median travel time was 27.5 minutes (Q1, Q3: 12.5, 46.2). Ordinal regression showed that women had 20% lower odds of traveling further, but people who were overweight or obese (odds ratio [OR] = 1.4-2.3), unemployed (OR = 1.27), or taking higher opioid dosages (OR = 1.79-2.82) had higher odds of traveling further. People traveling >60 minutes had fewer treatment minutes (median = 143 minutes) than people living within 15 minutes of the pain clinic (median = 440 minutes), and a smaller proportion of those traveling >60 minutes attended group programs vs. medical appointments only (n = 35, 17.0%) relative to those living within 15 minutes of their destination (n = 184, 32.6%). People living 16-30 minutes from the clinic missed the highest proportion of appointments. CONCLUSIONS Although people traveling further for treatment may be seeking predominantly medical treatment, particularly opioid medications, the present findings highlight the need to further explore patient triage and program models of care to ensure that people living with persistent disabling pain can access the same level of care, regardless of where they live.
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Affiliation(s)
- Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia
| | - Carolyn A Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia.,Academic Board of Anaesthesia and Perioperative Medicine, School of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ben Ben Beck
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Vandermost M, Bagraith KS, Kennedy H, Doherty D, Kilner S, Sterling M, Henry D, Jones M. Improvement in pain interference and function by an allied health pain management program: Results of a randomized trial. Eur J Pain 2021; 25:2226-2241. [PMID: 34242463 DOI: 10.1002/ejp.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic pain is a significant health problem worldwide and requires a biopsychosocial treatment approach. Access to traditional pain medicine specialist services is limited and innovative treatment models are required to support patients in tertiary care. The study evaluated the clinical effectiveness and safety of the Treatment Access Pathway (TAP), an allied health expanded scope model of care which included innovative group assessment and collaboration with patients to create individualized treatment plans. METHODS One hundred and eighty-one patients referred to a tertiary level chronic pain service were randomly allocated to either the TAP or the waitlist study groups. Primary (pain interference) and secondary outcome measures were collected at recruitment and again at 6 months. Per-protocol analyses were utilized due to high participant attrition (46% across groups). RESULTS The TAP group reported greater reductions in pain interference at 6 months than waitlist group (0.9, 95% CI: 0.2-1.6), with more than half of the TAP group (52%) reporting clinically significant improvement. In addition, statistically significant differences between the TAP and waitlist groups were observed for objective measurements of walking endurance (5.4 m, 95% CI: 1.7-9.1); and global impressions of change (1.4 unit decrease, 95% CI: 1-1.9). Nil adverse events were recorded. CONCLUSIONS The study suggests that an expanded scope allied health model of care prioritizing patient choice and group-based interventions provides modest benefits for tertiary-referral chronic pain patients. TAP warrants further investigation as a potentially viable alternative for tertiary healthcare where traditional pain services are unavailable or have long waiting lists. SIGNIFICANCE The study tests effectiveness and safety of an expanded scope allied health-led chronic pain program. Despite a high attrition rate, the study showed reduced pain interference and increased physical function in those who completed the protocol. The results are promising and support introduction of this model as an adjunct to existing traditional chronic pain models of care, with a particular focus on improving participant retention in the program. Additionally, the model of care can be used as a standalone chronic pain model of care where no other pain management resources are available. The study was registered on ANZCTR (Trial ID: ACTRN12617001284358).
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Affiliation(s)
- Margaret Vandermost
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Karl S Bagraith
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Hannah Kennedy
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Darren Doherty
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Simon Kilner
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David Henry
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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14
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Tan C, Searle A, Wall C, Herriot P. Brief introductory group education programs for chronic disease patients in chronic disease management: a scoping review protocol. JBI Evid Synth 2021; 20:214-221. [PMID: 34171893 DOI: 10.11124/jbies-20-00464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To scope the literature available and map the range of features of brief introductory group education programs implemented in chronic disease management. INTRODUCTION Brief introductory group education programs are resource-efficient interventions used in chronic disease management to educate patients on basic disease concepts, self-management strategies, and to introduce specialist services. There is a lack of published research that synthesizes the characteristics, guiding principles, and outcomes reported in brief group education programs in chronic disease management. This scoping review will seek to identify brief introductory group education programs and describe the i) scope of literature available on brief introductory group education programs, ii) characteristics of programs, iii) guiding self-management principles used and the extent to which programs follow such principles, and iv) types of outcomes reported. INCLUSION CRITERIA Studies describing an introductory or brief group patient education program (one to four sessions, no more than eight hours) for the management of chronic disease in adults with ongoing chronic disease. METHODS MEDLINE, Scopus, CINAHL, Emcare, Web of Science, JBI Evidence Synthesis, and PsycINFO will be searched for English-language articles published from 2001 to the present. Titles and abstracts will be screened against inclusion/exclusion criteria, followed by full-text review, independently assessed by two reviewers. Eligible articles will be extracted and charted using a standardized data extraction form. A descriptive review to summarize and contextualize the extracted data will be conducted.
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Affiliation(s)
- Celia Tan
- School of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Pain Management Unit, Flinders Medical Centre, Adelaide, SA, Australia
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15
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Hogg MN, Kavanagh A, Farrell MJ, Burke ALJ. Waiting in Pain II: An Updated Review of the Provision of Persistent Pain Services in Australia. PAIN MEDICINE 2021; 22:1367-1375. [PMID: 33106875 PMCID: PMC7665701 DOI: 10.1093/pm/pnaa374] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To provide an update on Australian persistent pain services (number, structure, funding, wait times, activity). METHODS An updated national search was conducted. Of those identified, 74 persistent pain services provided detailed responses between July 2016 and February 2018 (64 adult, seven pediatric, two pelvic pain, and one cancer pain). A similar structure to the original Waiting in Pain (WIP) survey was used, and participants chose online or telephone completion. RESULTS Pediatric pain services had more than doubled but remained limited. Adult services had also increased, with a concurrent decrease in median wait times and an increase in the number of new referrals seen each year. Despite this, some lengthy wait times (≥3 years) persisted. Wait times were longest at clinics using public or combined funding models and offering pain management group programs (PMGPs). Although clinical activity had increased, medical staffing had not, suggesting that clinics were operating differently. Privately funded clinics performed more procedures than publicly funded services. Use of PMGPs had increased, but program structure remained diverse. CONCLUSIONS Specialist pain services have expanded since the original WIP survey, facilitating treatment access for many. However, wait time range suggested that the most disadvantaged individuals still experienced the longest wait times, often far exceeding the recommended 6-month maximum wait. More needs to be done. Numerous developments (e.g., National Strategic Action Plan for Pain Management, health system changes as a result of the COVID-19 pandemic) will continue to influence the delivery of pain services in Australia, and repeated analysis of service structures and wait times will optimize our health system response to the management of this condition.
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Affiliation(s)
- Malcolm N Hogg
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anthony Kavanagh
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael J Farrell
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Anne L J Burke
- The Australian Pain Society, North Sydney, New South Wales, Australia.,Psychology Department, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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16
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Sonneborn O, Miller C. The Pain Nurse Practitioner and Pain Nurse's Role and Views on Opioid Management in Australia: A National Questionnaire Survey. Pain Manag Nurs 2021; 22:740-746. [PMID: 34108101 DOI: 10.1016/j.pmn.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The demand for access to Australian pain management services is growing. The dual crisis of opioid misuse and chronic pain, means pain nurses and nurse practitioners (NPs) have a unique opportunity to meet clinical demands and advance their scope of practice. AIMS To understand the role of pain nurses and pain NPs across Australia and explore their perceptions of current opioid management. DESIGN This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. METHODS This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. Survey respondents were contacted via the eight nursing Pain Interest Groups in Australia. RESULTS Acute pain management (92.7%) and chronic pain management (80.5%) were the primary services provided, with pain specialty nurses providing nurse education (100.0%), patient support, clinician education, and policy development. Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation. CONCLUSIONS Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.
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Affiliation(s)
- Olivia Sonneborn
- Faculty of Nursing, Latrobe University, The Alfred Centre, Melbourne, Australia; Department of Perioperative Medicine, Alfred Health, Melbourne, Australia.
| | - Charne Miller
- Faculty of Nursing, Latrobe University, The Alfred Centre, Melbourne, Australia
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17
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Catalá P, Blanco S, Perez-Calvo S, Luque-Reca O, Bedmar D, Peñacoba C. Does the Rural Environment Influence Symptomatology and Optimize the Effectiveness of Disease Acceptance? A Study Among Women With Fibromyalgia. Front Psychol 2021; 12:658974. [PMID: 33995219 PMCID: PMC8116886 DOI: 10.3389/fpsyg.2021.658974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
The present study aims to explore whether the symptoms associated with fibromyalgia are contextually influenced by the area of residence (rural/urban). Furthermore, it is analyzed whether the effect of the acceptance of the disease on the emotional, cognitive and physical symptoms is moderated by the patients' place of residence. Using a cross-sectional design, a total of 234 women with fibromyalgia (mean age = 56.91 years; SD = 8.94) were surveyed, of which 55.13% resided in rural areas and 44.87% in urban areas. Self-reported questionnaires were used to assess pain severity, anxiety and depression, functional limitation, physical and mental fatigue and acceptance of the disease. The results show significant differences in acceptance (p = 0.040), pain (p < 0.001), and physical and mental fatigue (p = 0.003 and p = 0.004, respectively) between patients from rural and urban areas. The rural area patients presented higher levels of acceptance and pain and lesser levels of physical and mental fatigue compared to the urban area. The moderation analysis add that, only in patients from the rural area, the variables of physical symptoms (pain, functional limitation, and physical fatigue) were significantly and negatively associated with acceptance. This study addresses for the first time the role of the place of residence in suffering from fibromyalgia, suggesting that the rural or urban environment plays a relevant role in the severity and/or management of symptoms in fibromyalgia women. Limitations and practical implications are also discussed.
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Affiliation(s)
- Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Sheila Blanco
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | | | | | - Dolores Bedmar
- Pain Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
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18
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Elphinston RA, Sterling M, Leung J, Gray PD, Scotti Requena S, Connor JP. Brief Psychological Interventions for Reducing Prescription Opioid Use, Related Harm, and Pain Intensity in Patients With Chronic Pain: A Systematic Review and Assessment of Patient Interest. Clin J Pain 2021; 37:270-280. [PMID: 33323791 DOI: 10.1097/ajp.0000000000000908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Brief psychological interventions (BPIs) have demonstrated effectiveness in reducing substance use and related harm. No systematic review has examined their potential to reduce or prevent prescription opioid use or related harm, and/or pain intensity in opioid-using patients with chronic noncancer pain (CNCP). Recognizing the importance of patient preferences in evidence-based practice, we also sought to assess patient interest in BPIs. MATERIALS AND METHODS A systematic review of studies published between 1980 and 2020 was conducted using 5 databases. Eligible treatment studies included patients ≥18 years old, with CNCP, and who were using prescription opioids. An adjunctive study independent of our review was also undertaken in 188 prescription opioid-using patients (77% female; Mage=49 y) diagnosed with CNCP. Patients completed pain-related questionnaires online and indicated if they would consider BPI treatment options. RESULTS The review identified 6 studies. Given the heterogeneity across studies, a meta-analysis was not conducted. A narrative review found that all of the 6 studies demonstrated some evidence for BPI effectiveness for reducing opioid use or related harms; these were assessed as having mostly low methodological quality. Mixed support for the effect on pain intensity was found in 1 study. Despite the inconclusive findings and heterogenous studies identified in the review, 92% of patients in our survey reported interest in receiving a BPI. DISCUSSION In combination, these findings highlight the inconsistency between patient demand and the availability of evidence for BPIs targeting opioid use, related harm, and pain intensity. Future work should examine the effectiveness of BPIs in higher quality studies.
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Affiliation(s)
- Rachel A Elphinston
- Recover Injury Research Centre
- School of Psychology
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery
- Addiction and Mental Health Service, Metro South Hospital and Health Service
| | - Michele Sterling
- Recover Injury Research Centre
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery
| | - Janni Leung
- School of Psychology
- National Centre for Youth Substance Use Research
| | - Paul D Gray
- Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane
- School of Medicine, The University of Queensland, Herston, Qld, Australia
| | | | - Jason P Connor
- Discipline of Psychiatry
- National Centre for Youth Substance Use Research
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Gentili C, Zetterqvist V, Rickardsson J, Holmström L, Simons LE, Wicksell RK. ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain-A Pilot Trial. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:315-328. [PMID: 33200214 PMCID: PMC7901852 DOI: 10.1093/pm/pnaa360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients' everyday lives. OBJECTIVE ACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain. METHODS The study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models. RESULTS The sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = -1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up. CONCLUSION The results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.
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Affiliation(s)
- Charlotte Gentili
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Functional Unit Behavioral Medicine, Function Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Vendela Zetterqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Functional Unit Behavioral Medicine, Function Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jenny Rickardsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Functional Unit Behavioral Medicine, Function Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Holmström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Functional Unit Behavioral Medicine, Function Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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20
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Deslauriers S, Roy JS, Bernatsky S, Blanchard N, Feldman DE, Pinard AM, Fitzcharles MA, Desmeules F, Perreault K. The burden of waiting to access pain clinic services: perceptions and experiences of patients with rheumatic conditions. BMC Health Serv Res 2021; 21:160. [PMID: 33602224 PMCID: PMC7891805 DOI: 10.1186/s12913-021-06114-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Extensive waiting times before receiving services is a major barrier to adequate pain management. Waiting times may have a detrimental impact on patients' conditions and quality of life. However, there remains a lack of knowledge on the actual experiences of patients waiting to receive services, especially for those with rheumatic conditions. The present study aimed to gain an in-depth understanding of perceptions and experiences of patients with rheumatic conditions regarding access to pain clinic services. The secondary objective was to identify possible solutions to improve this access according to patients' perspectives. METHODS This qualitative study based on semi-structured interviews was conducted with adults with rheumatic conditions waiting to access pain clinics in the province of Quebec, Canada. Interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS Twenty-six participants were interviewed (22 women and 4 men; mean age 54 ± 10 years). Four main themes were identified: 1) the perception that waiting time is unacceptably long; 2) how the lack of information affects patients' experiences of waiting; 3) patients' various expectations towards the pain clinic, from high hopes to disillusionment and 4) carrying an emotional, physical and financial burden resulting from the wait. Participants reported several solutions to improve the experience of waiting, including providing information to patients, increasing resources, improving prioritization processes and care coordination, and providing alternative interventions to patients during the wait. CONCLUSIONS For patients with rheumatic conditions, access to pain clinic services is challenging due to extensive waiting times. The burden it imposes on them adds to the existing challenge of living with a chronic rheumatic condition. The solutions identified by participants could serve as building blocks to develop and implement measures to improve patients' experience of accessing pain-related services.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire De Santé Et De Services Sociaux De La Capitale-Nationale, 525, boulevard W.-Hamel, Quebec (QC), G1M 2S8 Canada
- Faculty of Medicine, Université Laval, Québec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire De Santé Et De Services Sociaux De La Capitale-Nationale, 525, boulevard W.-Hamel, Quebec (QC), G1M 2S8 Canada
- Faculty of Medicine, Université Laval, Québec, Canada
| | - Sasha Bernatsky
- McGill University Health Centre (MUHC), Montreal, Canada
- McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada
| | - Nathan Blanchard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire De Santé Et De Services Sociaux De La Capitale-Nationale, 525, boulevard W.-Hamel, Quebec (QC), G1M 2S8 Canada
- Faculty of Medicine, Université Laval, Québec, Canada
| | - Debbie E. Feldman
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), CRIR, Montréal, Canada
- Public Health Research Institute of Université de Montréal, Montréal, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire De Santé Et De Services Sociaux De La Capitale-Nationale, 525, boulevard W.-Hamel, Quebec (QC), G1M 2S8 Canada
- Faculty of Medicine, Université Laval, Québec, Canada
- Centre hospitalier universitaire (CHU) de Québec, CHUL, Quebec, Canada
| | - Mary-Ann Fitzcharles
- McGill University Health Centre (MUHC), Montreal, Canada
- McGill University, Montreal, Canada
| | - François Desmeules
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Maisonneuve-Rosemont Hospital (CRHMR) Research Center, CRHMR, Montreal, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire De Santé Et De Services Sociaux De La Capitale-Nationale, 525, boulevard W.-Hamel, Quebec (QC), G1M 2S8 Canada
- Faculty of Medicine, Université Laval, Québec, Canada
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21
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Hale L, Devan H, Davies C, Dean SG, Dowell A, Grainger R, Gray AR, Hempel D, Ingham T, Jones B, Leung W, Mills J, Saipe B, Shipton E, Perry M. Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain-protocol for a non-inferiority randomised controlled trial (iSelf-help trial). BMJ Open 2021; 11:e046376. [PMID: 33542046 PMCID: PMC7868244 DOI: 10.1136/bmjopen-2020-046376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Persistent non-cancer pain affects one in five adults and is more common in Māori-the Indigenous population of New Zealand (NZ), adults over 65 years, and people living in areas of high deprivation. Despite the evidence supporting multidisciplinary pain management programmes (PMPs), access to PMPs is poor due to long waiting lists. Although online-delivered PMPs enhance access, none have been codesigned with patients or compared with group-based, in-person PMPs. This non-inferiority trial aims to evaluate the clinical and cost-effectiveness of a cocreated, culturally appropriate, online-delivered PMP (iSelf-help) compared with in-person PMP in reducing pain-related disability. METHODS AND ANALYSIS Mixed-methods, using a modified participatory action research (PAR) framework, involving three phases. Phase I involved cocreation and cultural appropriateness of iSelf-help by PAR team members. Phase II: The proposed iSelf-help trial is a pragmatic, multicentred, assessor-blinded, two-arm, parallel group, non-inferiority randomised controlled trial. Adults (n=180, age ≥18 years) with persistent non-cancer pain eligible for a PMP will be recruited and block randomised (with equal probabilities) to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help participants will participate in two 60-minute video-conferencing sessions weekly for 12 weeks with access to cocreated resources via smartphone application and a password-protected website. The control participants will receive group-based, in-person delivered PMP. Primary outcome is pain-related disability assessed via modified Roland Morris Disability Questionnaire at 6 months post intervention. Secondary outcomes include anxiety, depression, stress, pain severity, quality of life, acceptance, self-efficacy, catastrophising and fear avoidance. Data will be collected at baseline, after the 12-week intervention, and at 3 and 6 months post intervention. We will conduct economic analyses and mixed-method process evaluations (Phase IIA). ETHICS AND DISSEMINATION The Health and Disability Ethics Committee approved the study protocol (HDEC18/CEN/162). Phase III involves dissemination of findings guided by the PAR team as outcomes become apparent. TRIAL REGISTRATION NUMBER ACTRN 12619000771156.
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Affiliation(s)
- Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Dunedin, New Zealand
| | - Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
| | - Cheryl Davies
- Tu Kotahi Māori Asthma and Research Trust, Wellington, New Zealand
| | - Sarah Gerard Dean
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Andrew R Gray
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Tristram Ingham
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Bernadette Jones
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jessica Mills
- Burwood Pain Management Service, Canterbury District Health Board (CDHB), Christchurch, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Edward Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Meredith Perry
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, Wellington, New Zealand
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22
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Rickardsson J, Gentili C, Holmström L, Zetterqvist V, Andersson E, Persson J, Lekander M, Ljótsson B, Wicksell RK. Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up. Eur J Pain 2021; 25:1012-1030. [PMID: 33460240 DOI: 10.1002/ejp.1723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/08/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies of Internet-delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT - a novel format of Internet-ACT using daily microlearning exercises - was examined for efficacy compared to a waitlist condition. METHODS Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self-referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post-assessments were completed by 88% (n = 100) of participants. Twelve-month follow-up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention-to-treat-approach. RESULTS Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between-group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between-group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1-year follow-up. CONCLUSIONS Internet-ACT as microlearning may improve a broad range of outcomes in chronic pain. SIGNIFICANCE The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.
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Affiliation(s)
- Jenny Rickardsson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Gentili
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linda Holmström
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Persson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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23
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Mesa-Castrillon CI, Simic M, Ferreira ML, Hatswell K, Luscombe G, de Gregorio AM, Davis PR, Bauman A, Bunker S, Clavisi O, Knox G, Bennell KL, Ferreira PH. EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol. BMC Musculoskelet Disord 2021; 22:11. [PMID: 33402161 PMCID: PMC7783996 DOI: 10.1186/s12891-020-03866-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. METHODS/DESIGN We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants' opinions and any barriers encountered throughout the trial. DISCUSSION The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. TRIAL REGISTRATION This study was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12618001494224 ) registered 09.05.2018.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Milena Simic
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, The Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - Kristy Hatswell
- Physiotherapy department, Dubbo Health Service, Western NSW Local Health District, Dubbo, NSW, Australia
| | - Georgina Luscombe
- School of Rural Health, The University of Sydney, Orange Campus, Orange, NSW, Australia
| | - Antonio Michell de Gregorio
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Phillip R Davis
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Ornella Clavisi
- Musculoskeletal Australia, Muscle Bone & Joint Health Ltd, Melbourne, Australia
| | - Grahame Knox
- Physiotherapy department, Orange Health Service, Western NSW Local Health District, Orange, NSW, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Paulo H Ferreira
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
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24
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Deslauriers S, Roy JS, Bernatsky S, Feldman DE, Pinard AM, Desmeules F, Fitzcharles MA, Perreault K. The association between waiting time and multidisciplinary pain treatment outcomes in patients with rheumatic conditions. BMC Rheumatol 2020; 4:59. [PMID: 33111034 PMCID: PMC7583241 DOI: 10.1186/s41927-020-00157-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Access to multidisciplinary pain treatment facilities (MPTF) is limited by extensive waiting time in many countries. However, there is a lack of knowledge about the impact of waiting time on clinical outcomes, particularly for patients with rheumatic conditions. This study examined the association between waiting time for MPTF and clinical outcomes in patients with rheumatic conditions. METHODS Data were extracted from the Quebec Pain Registry, a large database of patients who received services in MPTF. The associations between waiting time (classified as < 2 months, 2-6 months and > 6 months) and change in pain interference, pain intensity and health-related quality of life, from the initial visit at the MPTF to the 6-month follow-up, were tested using generalized estimating equations. RESULTS A total of 3230 patients with rheumatic conditions (mean age: 55.8 ± 14.0 years; 66% were women) were included in the analysis. Small significant differences in improvement between waiting time groups were revealed, with patients waiting less than 2 months having a larger improvement in all clinical outcomes compared to patients who waited 2-6 months or over 6 months before their initial visit (adjusted time X group effect p ≤ 0.001). Only patients waiting less than 2 months reached a clinically important improvement in pain interference (1.12/10), pain intensity (1.3/10) and physical and mental quality of life (3.9 and 3.7/100). CONCLUSIONS Longer delays experienced by patients before receiving services in MPTF were associated with statistically significant smaller improvements in pain interference, pain intensity and health-related quality of life; these differences were, however, not clinically significant. Based on these results, we advise that strategies are developed not only to reduce waiting times and mitigate their impacts on patients with rheumatic conditions, but also to improve treatment effectiveness in MPTF.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
| | - Sasha Bernatsky
- McGill University Health Centre (MUHC), 1650 Cedar Ave, Montreal, QC H3G 1A4 Canada
- McGill University, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
| | - Debbie E. Feldman
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), CRIR, 6363, chemin Hudson (Pavillon Lindsay) bureau 061, Montréal, QC H3S 1M9 Canada
- Public Health Research Institute of Université de Montréal, Montréal, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
- Centre hospitalier universitaire (CHU) de Québec, Québec, Canada
| | - François Desmeules
- Faculty of medicine, Université de Montréal, Montreal, Canada
- Maisonneuve-Rosemont Hospital (CRHMR) Research Center, CRHMR, 5415 Assomption boulevard, Montreal, QC H1T 2M4 Canada
| | - Mary-Ann Fitzcharles
- McGill University Health Centre (MUHC), 1650 Cedar Ave, Montreal, QC H3G 1A4 Canada
- McGill University, Montréal, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, boulevard W.-Hamel, Quebec, QC G1M 2S8 Canada
- Faculty of medicine, Université Laval, CHUL, 2705, boulevard Laurier, #3412, Quebec, QC G1V 4G2 Canada
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25
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Campbell G, Darke S, Degenhardt L, Townsend H, Carter G, Draper B, Farrell M, Duflou J, Lappin J. Prevalence and Characteristics Associated with Chronic Noncancer Pain in Suicide Decedents: A National Study. Suicide Life Threat Behav 2020; 50:778-791. [PMID: 32162732 DOI: 10.1111/sltb.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims were to estimate the prevalence of CNCP in suicide decedents, and compare sociodemographic and clinical characteristics of people who die by suicide (i) with and without a history of CNCP and (ii) among decedents with CNCP who are younger (<65 years) and older (65 + years). METHOD We examined all closed cases of intentional deaths in Australia in 2014, utilizing the National Coronial Information System. RESULTS We identified 2,590 closed cases of intentional deaths in Australia in 2014 in decedents over 18 years of age. CNCP was identified in 14.6% of cases. Decedents with CNCP were more likely to be older, have more mental health and physical health problems, and fewer relationship problems, and were more likely to die by poisoning from drugs, compared with decedents without CNCP. Comparisons of older and younger decedents with CNCP found that compared to younger (<65 years) decedents with CNCP, older decedents (65 + years) were less likely to have mental health problems. CONCLUSIONS This is the first national study to examine the characteristics of suicide deaths with a focus on people with CNCP. Primary care physicians should be aware of the increased risk for suicide in people living with CNCP, and it may be useful for clinicians to screen for CNCP among those presenting with suicidal behaviors.
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Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Harriet Townsend
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Edith St Waratah, NSW, Australia
| | - Brian Draper
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - Johan Duflou
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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26
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Walker P, De Morgan S, Sanders D, Nicholas M, Blyth FM. Primary care initiatives focused on the secondary prevention and management of chronic pain: a scoping review of the Australian literature. Aust J Prim Health 2020; 26:273-280. [PMID: 32669195 DOI: 10.1071/py20092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
The aim of this scoping review was to identify initiatives focused on the secondary prevention and management of chronic pain in Australian primary care to understand options available to Primary Health Networks and to identify evidence gaps. The Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature and Cochrane databases, as well as relevant websites, were searched for eligible records published from 2007 to 2018. Initiative characteristics and outcomes evaluated were extracted and synthesised. In all, 84 initiatives from 167 published and grey literature records were identified, including: (1) consumer initiatives that aimed to improve access to multidisciplinary care, health literacy and care navigation (n=56); (2) health professional capacity building initiatives that aimed to ensure health professionals are skilled and provide best-practice evidence-based care (n=21); and (3) quality improvement and health system support initiatives (n=7). Evidence gaps were found relating to initiatives addressing the secondary prevention of chronic pain, those targeting vulnerable and regional populations, health professional capacity building initiatives for all primary health care providers and quality improvement and system support initiatives. Addressing evidence gaps related to effectiveness, cost-effectiveness and implementation should be the focus for future chronic pain initiatives in primary care settings.
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Affiliation(s)
- Pippy Walker
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia; and Corresponding author.
| | - Simone De Morgan
- The Australian Prevention Partnership Centre and Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia
| | - Duncan Sanders
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Sydney Medical School - Northern, Faculty of Medicine and Health, University of Sydney, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, Camperdown, NSW 2006, Australia
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27
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Borg DN, Foster MM, Legg M, Jones R, Kendall E, Fleming J, Geraghty TJ. The Effect of Health Service Use, Unmet Need, and Service Obstacles on Quality of Life and Psychological Well-Being in the First Year After Discharge From Spinal Cord Injury Rehabilitation. Arch Phys Med Rehabil 2020; 101:1162-1169. [DOI: 10.1016/j.apmr.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023]
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28
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Slater H, Stinson JN, Jordan JE, Chua J, Low B, Lalloo C, Pham Q, Cafazzo JA, Briggs AM. Evaluation of Digital Technologies Tailored to Support Young People's Self-Management of Musculoskeletal Pain: Mixed Methods Study. J Med Internet Res 2020; 22:e18315. [PMID: 32442143 PMCID: PMC7305555 DOI: 10.2196/18315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Digital technologies connect young people with health services and resources that support their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain is a significant gap in the health services in Australia. Recognizing the intense resourcing required to develop and implement effective electronic health (eHealth) interventions, the adaptation of extant, proven digital technologies may improve access to pain care with cost and time efficiencies. OBJECTIVE This study aimed to test the acceptability and need for adaptation of extant digital technologies, the painHEALTH website and the iCanCope with Pain app, for use by young Australians with musculoskeletal pain. METHODS A 3-phased, mixed methods evaluation was undertaken from May 2019 to August 2019 in Australia. Young people aged 15 to 25 years with musculoskeletal pain for >3 months were recruited. Phases were sequential: (1) phase 1, participant testing (3 groups, each of n=5) of co-designed website prototypes compared with a control website (painHEALTH), with user tasks mapped to eHealth quality and engagement criteria; (2) phase 2, participants' week-long use of the iCanCope with Pain app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity, and energy levels; goal setting; and accessing resources); and (3) phase 3, semistructured interviews were conducted to gain insights into participants' experiences of using these digital technologies. RESULTS Fifteen young people (12/15, 80% female; mean age 20.5 [SD 3.3] years; range 15-25 years) participated in all 3 phases. The phase 1 aggregated group data informed the recommendations used to guide 3 rapid cycles of prototype iteration. Adaptations included optimizing navigation, improving usability (functionality), and enhancing content to promote user engagement and acceptability. In phase 2, all participants checked in, with the highest frequency of full check-ins attributed to pain intensity (183/183, 100.0%), pain interference (175/183, 95.6%), and mood (152/183, 83.1%), respectively. Individual variability was evident for monitoring progress with the highest frequency of history views for pain intensity (51/183, 32.3%), followed by pain interference (24/183, 15.2%). For the goals set feature, 87% (13/15) of participants set a total of 42 goals covering 5 areas, most frequently for activity (35/42, 83%). For phase 3, metasynthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. A total of 4 metathemes emerged: (1) importance of user-centered design to leverage user engagement; (2) website design (features) promoting user acceptability and engagement; (3) app functionality supporting self-management; and (4) the role of wider promotion, health professional digital prescriptions, and strategies to ensure longer-term engagement. CONCLUSIONS Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people's self-management of musculoskeletal pain.
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Affiliation(s)
- Helen Slater
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Jennifer N Stinson
- Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Chua
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ben Low
- Squawk Designs, Perth, Australia
| | - Chitra Lalloo
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quynh Pham
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON, Canada
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
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Hilyard A, Kingsley J, Sommerfield D, Taylor S, Bear N, Gibson N. Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth. J Pain Res 2020; 13:897-908. [PMID: 32431538 PMCID: PMC7200248 DOI: 10.2147/jpr.s217022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care. Patients and Methods Parent-adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11-17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention. Results Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5-9 and Hybrid-PIPP median 8.5, range 5-10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported. Conclusion The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications. Registration ANZTR(ACTRN2614000489695).
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Affiliation(s)
- Anna Hilyard
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Julia Kingsley
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David Sommerfield
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Susan Taylor
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Child Research, Child Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Joypaul S, Kelly FS, King MA. Turning Pain into Gain: Evaluation of a Multidisciplinary Chronic Pain Management Program in Primary Care. PAIN MEDICINE 2020; 20:925-933. [PMID: 30541054 PMCID: PMC6497132 DOI: 10.1093/pm/pny241] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To measure the impact of the multidisciplinary Turning Pain Into Gain program in people experiencing chronic pain of any etiology. Methods A mixed-methods observational study of 252 participants was used to explore the impact of Turning Pain Into Gain on medication use; quality of life and functioning, as measured by the Pain Self-Efficacy Questionnaire; and self-reported hospitalizations between 2015 and 2016. Results Responses from 178 participants showed an increased alignment with Australian pain medication guidelines (e.g., a 7.3% reduction in paracetamol duplication was reported with a concurrent 5.1% rise in the administration of sustained-release paracetamol formulations); improved Pain Self-Efficacy Questionnaire scores from 23.1 (out of a possible score of 60) preprogram to 35.3 postprogram; and a reduction in self-reported hospitalizations from 50 cases in the 12 months preprogram to 11 cases in the 12 months postprogram. Conclusions Positive medication, Pain Self-Efficacy Questionnaire, and hospitalization changes provide evidence for the broader implementation of similar patient-centered programs to promote more holistic management of diverse types of chronic pain in primary care. Reduced hospitalization reflects potential for this intervention to be cost-effective, which could be investigated further.
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Affiliation(s)
- Shirdhya Joypaul
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Queensland 4222, Australia and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Queensland, Australia
| | - Fiona S Kelly
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Queensland 4222, Australia and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Queensland, Australia
| | - Michelle A King
- School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University, Queensland 4222, Australia and Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Queensland, Australia
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31
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Berkovic D, Ayton D, Briggs AM, Ackerman IN. "The Financial Impact Is Depressing and Anxiety Inducing": A Qualitative Exploration of the Personal Financial Toll of Arthritis. Arthritis Care Res (Hoboken) 2020; 73:671-679. [PMID: 32100969 DOI: 10.1002/acr.24172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The financial experience faced by working-age people with arthritis includes living below the poverty line for many. Financial distress among people with arthritis is known to contribute to poorer health outcomes, including high psychological distress and more severe pain. Despite the demonstrated societal cost of arthritis care and management, the personal costs borne by the individual are not well understood. The aim of this study was to explore the perceived financial impacts of living with arthritis among younger adults (defined as those ages 18-50 years). METHODS A qualitative descriptive study design was used. Participants with inflammatory arthritis or osteoarthritis were recruited from the community, including urban and rural settings. An interview schedule was developed, informed by existing literature, which was piloted prior to data collection. Deductive and inductive coding techniques were used to identify financial-related themes arising from the data. RESULTS Semistructured interviews were conducted with 21 adults (90% female) with a mix of arthritis conditions, including rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Four themes were identified: direct arthritis-attributable medical costs, indirect arthritis-attributable costs, insurance and pension costs, and broader financial impacts on the family. Nonsubsidized costs were frequently referenced by participants as burdensome and existed even within the publicly funded Australian health care system. CONCLUSION Adults with arthritis experience significant arthritis-attributable financial burden and related distress. Financial concerns should be actively identified and considered within shared clinical decision-making to provide more patient-centered care for these individuals.
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Miller J, MacDermid JC, Walton DM, Richardson J. Chronic Pain Self-Management Support With Pain Science Education and Exercise (COMMENCE) for People With Chronic Pain and Multiple Comorbidities: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:750-761. [PMID: 32004517 DOI: 10.1016/j.apmr.2019.12.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 11/29/2019] [Accepted: 12/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the effectiveness of chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared with usual care. DESIGN Parallel group randomized controlled trial with 1- and 12-week follow-ups. SETTING Community health center. PARTICIPANTS Adults (N=102) with chronic noncancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. INTERVENTIONS Participants were randomized to COMMENCE or usual care. MAIN OUTCOME MEASURES Primary: Function measured using the Short Musculoskeletal Function Assessment-Dysfunction Index. Secondary: Short Musculoskeletal Function Assessment-Bother Index, Patient Reported Outcomes Measurement Information System pain interference, work status, numeric pain, and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of health care visits, satisfaction, and global rating of change. RESULTS COMMENCE resulted in greater improvements in function (mean difference [MD] at 12-wk follow-up=-8.0; 95% CI, -14.7 to -1.3), bother with functional difficulties (MD, -12.0; 95% CI, -20.8 to -3.2), pain intensity (MD, -1.0; 95% CI, -2.1 to -0.1), catastrophizing (MD , -8.2; 95% CI, -14.5 to -2.0), self-efficacy (MD, 7.0; 95% CI, 0.8-13.2), knowledge (MD, 2.8; 95% CI, 1.6-3.9), satisfaction (MD, 1.2; 95% CI, 0.7-1.8), and perceived change (MD, 1.4; 95% CI, 0.8-2.1). There were no significant between-group differences in pain interference, work, fatigue, depressive symptoms, or health care visits. CONCLUSION COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change but not pain interference, work status, fatigue, depressive symptoms, or health care visits.
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Affiliation(s)
- Jordan Miller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes. Pain Rep 2019; 4:e780. [PMID: 31875185 PMCID: PMC6882570 DOI: 10.1097/pr9.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Objective: To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain. Design: Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set. Setting: An Australian tertiary multidisciplinary pain service. Subjects: Patients with chronic noncancer pain actively participating in the group pathway in 2016. Methods: Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set. Results: In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose. Conclusion: Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
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The Promotion of Policy Changes Restricting Access to Codeine Medicines on Twitter: What do National Pain Organizations Say? THE JOURNAL OF PAIN 2019; 21:881-891. [PMID: 31857206 DOI: 10.1016/j.jpain.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/17/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Codeine is one of the most common opioid medicines for treating pain. Australia introduced policy changes in February 2018 to up-schedule codeine to prescription-only medicine due to concerns of adverse effects, opioid dependency, and overdose-related mortality. This study investigated the frequency and content of messages promoted on Twitter by 4 Australian peak pain organizations, pre- and postpolicy implementation. A time series analysis examined frequency of Twitter posts over a 48-week period. Text analysis via Leximancer examined message content. Results showed that promotion and education of the pending policy change dominated the Twitter feed prior to up-scheduling. However, immediately following policy change, there was a shift in content towards promoting conferences and research, and a significant decrease in the frequency of codeine-related posts, compared to opioid-related non-codeine posts. The findings suggest that pain organizations can provide timely and educational policy dissemination in the online environment. They have implications for individuals with chronic pain who use the Internet for health information and the degree to which they can trust these sources, as well as health professionals. Further research is required to determine if public health campaigns can be targeted to prevent opioid-related harm and improve pain care via this increasingly used medium. PERSPECTIVE: This study presents a first look at what information is being communicated by influential pain organizations that have an online Twitter presence and how messages were delivered during a major policy change restricting access to codeine medicines. Insights could drive targeted future online health campaigns for improved pain management.
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Veillette J, Martel ME, Dionne F. A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy-based bibliotherapy intervention among adults living with chronic pain. Can J Pain 2019; 3:209-225. [PMID: 35005411 PMCID: PMC8730660 DOI: 10.1080/24740527.2019.1678113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims: The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods: This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results: Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46–0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion: These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain.
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Affiliation(s)
- Josée Veillette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
| | - Marie-Eve Martel
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
| | - Frédérick Dionne
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Quebec and Pain Research Network (QPRN), Montreal, Quebec, Canada
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A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clin J Pain 2019; 34:838-857. [PMID: 29554030 DOI: 10.1097/ajp.0000000000000601] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis examined the effectiveness of physiotherapist delivered psychological interventions combined with physiotherapy on pain, disability, and psychological outcomes for patients with musculoskeletal pain conditions. METHODS The review was conducted in accordance with the (PRISMA) guidelines. Five databases were systematically searched for randomized controlled trials from inception to May 2016. Studies were required to compare a psychological intervention delivered by physiotherapists combined with physiotherapy to physiotherapy alone or usual care. Physiotherapists delivering the interventions must have undergone training by a psychologist or a health professional trained in the delivery of psychological interventions. RESULTS A total of 34 articles met the eligibility criteria, of those, 30 were suitable for meta-analysis. There was low to high quality evidence that physiotherapist delivered psychological intervention combined with physiotherapy decreased pain in the short (26 studies, mean difference=-0.37; 95% confidence interval [CI], -0.65 to -0.09) and long term (22 studies, mean difference=-0.38; 95% CI, -0.67 to -0.10) and decreased disability in the short term (29 studies, standardized mean difference =-0.14; 95% CI, -0.26 to -0.01). Effect sizes were small. Low to high quality evidence demonstrated small to medium effects for some psychological outcomes at short-term and long-term follow-ups. DISCUSSION The results indicate that psychological interventions delivered by physiotherapist show promise to improve health outcomes, particularly psychological outcomes, in musculoskeletal pain conditions.
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Devan H, Perry MA, van Hattem A, Thurlow G, Shepherd S, Muchemwa C, Grainger R. Do pain management websites foster self-management support for people with persistent pain? A scoping review. PATIENT EDUCATION AND COUNSELING 2019; 102:1590-1601. [PMID: 30981410 DOI: 10.1016/j.pec.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/10/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate if the contents of pain management websites include the current best practice self-management support strategies for people with persistent pain, are cultural tailored and to determine the website quality. METHODS Websites were searched from three major search engines (Google, Bing, and Yahoo). Websites providing information on self-management strategies and websites that were freely available to the public were included. The website contents were evaluated using a 14-item self-management support (SMS-14) checklist. Website quality was assessed using the Health On the Net code (HONcode) certification. RESULTS Of the twenty-seven websites evaluated, the websites scored a median of nine items (range 1-13) from the SMS-14 checklist. The websites LivePlanBe, ACI Pain Management Network and MyJointPain top-scored (13/14) from the SMS-14 checklist. One website (ACI Pain Management Network) provided culturally tailored information and HONcode certification was present in six websites. CONCLUSIONS The review identified 27 contemporary pain management websites that could be used for self-management skills training. PRACTICE IMPLICATIONS Clinicians could refer people with persistent pain to top ranked websites - LivePlanBe, ACI Pain Management Network, and MyJointPain for enabling self-management skills, with the caveats that most websites lacked cultural tailoring, and have limited or no evidence of clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | | | - Greg Thurlow
- School of Physiotherapy, University of Otago, New Zealand
| | - Sam Shepherd
- School of Physiotherapy, University of Otago, New Zealand
| | - Carol Muchemwa
- School of Physiotherapy, University of Otago, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Cole LJ, Bennell KL, Ahamed Y, Bryant C, Keefe F, Moseley GL, Hodges P, Farrell MJ. Determining Brain Mechanisms that Underpin Analgesia Induced by the Use of Pain Coping Skills. PAIN MEDICINE 2019; 19:2177-2190. [PMID: 29462464 DOI: 10.1093/pm/pnx301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Cognitive behavioral therapies decrease pain and improve mood and function in people with osteoarthritis. This study assessed the effects of coping strategies on the central processing of knee pain in people with osteoarthritis of the knees. Methods Mechanical pressure was applied to exacerbate knee pain in 28 people with osteoarthritis of the knee. Reports of pain intensity and functional magnetic resonance imaging measures of pain-related brain activity were recorded with and without the concurrent use of pain coping skills. Results Coping skills led to a significant reduction in pain report (Coping = 2.64 ± 0.17, Not Coping = 3.28 ± 0.15, P < 0.001). These strategies were associated with increased activation in pain modulatory regions of the brain (medial prefrontal and rostral anterior cingulate cortices, Pcorrected < 0.05) and decreased pain-related activation in regions that process noxious input (midcingulate cortex, supplementary motor area, secondary somatosensory cortex, and anterior parietal lobule, Pcorrected < 0.05). The magnitude of the decrease in pain report during the use of pain coping strategies was found to be proportional to the decrease in pain-related activation in brain regions that code the aversive/emotional dimension of pain (anterior insula, inferior frontal gyrus, orbitofrontal cortex, Pcorrected < 0.05) but did not differ between groups with and without training in coping skills. However, training in coping skills reduced the extent to which brain responses to noxious input were influenced by anxiety. Conclusions The results of this study support previous reports of pain modulation by cognitive pain coping strategies and contribute to the current understanding of how analgesia associated with the use of pain coping strategies is represented in the brain.
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Affiliation(s)
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville, Australia
| | - Yasmin Ahamed
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences.,Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Francis Keefe
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, North Carolina, USA
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia and Neuroscience Research, Adelaide, Australia
| | - Paul Hodges
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Queensland, Australia
| | - Michael J Farrell
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
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Devan H, Godfrey HK, Perry MA, Hempel D, Saipe B, Hale L, Grainger R. Current practices of health care providers in recommending online resources for chronic pain self-management. J Pain Res 2019; 12:2457-2472. [PMID: 31496788 PMCID: PMC6698079 DOI: 10.2147/jpr.s206539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/25/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose Online health resources (websites, apps and social media) may be an adjunct to provide self-management support for people with persistent or chronic pain. Endorsement of online health resources by health care providers is crucial for uptake by end-users. The aim of this study was to investigate the current practices of New Zealand (NZ) health care providers in recommending online resources for persistent pain management, and to identify what factors predict health care providers’ recommendations and to explore the common concerns. Methods An online survey of NZ health care providers (ie, chiropractors, general practitioners, nurses, occupational therapists, osteopaths, physiotherapists, psychologists, specialist consultants, and social workers) involved in the management of persistent pain was conducted. The recruitment strategy was tailored to each occupation via occupation-specific professional organizations, and by approaching multidisciplinary professional organizations. Results Data from 213 health care providers were used in the final analysis. Most of the health care providers were physiotherapists (n=71), followed by chiropractors (n=39) and general practitioners (n=31). Fifty three percent (111/210) of health care providers reported currently recommending online resources. A multivariate logistic regression model showed that specialist interest in treating pain (OR=3.84; 95% CI: 1.66, 8.87; P=0.002), and level of confidence in recommending online resources (OR=1.05; CI: 1.04, 1.07; P<0.001), positively influenced recommending online resources. The majority of the health care providers (65%, 138/213) were concerned about the safety issues related to the risk of patients misinterpreting online information and to the lack of evidence-based information. Conclusion Half of the health care providers surveyed reported recommending online resources, which may suggest limited confidence in recommending, or knowledge of, existing online resources for persistent pain management. Ongoing education for health care providers on evidence-based online resources is required to recommend online resources as a self-management support tool for people with persistent pain.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Hazel K Godfrey
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand.,School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Meredith A Perry
- Centre for Health, Activity, and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Dagmar Hempel
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Barbara Saipe
- Pain Management Service, Capital and Coast District Health Board (CCDHB), Wellington, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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The Pain Course: Exploring the Feasibility of an Internet-delivered Pain Management Program When Offered by a Tertiary Pain Management Service. Clin J Pain 2019; 34:505-514. [PMID: 29077622 DOI: 10.1097/ajp.0000000000000565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study examined the acceptability and preliminary outcomes of an internet-delivered pain management program, the Pain Course, when offered by a specialist pain management clinic in a large public hospital. METHODS A single-group feasibility open-trial design was used and 39 patients participated in the program, which ran for 8 weeks. Participants were supported through the program with weekly contact from a Clinical Psychologist at the clinic. RESULTS All participants provided data at posttreatment and >90% of participants completed all 5 lessons of the course. High levels of satisfaction were observed and relatively little clinician time (M=71.99 min/participant; SD=32.82 min) was required to support patients through the program. Preliminary evidence of clinical improvements in depression symptoms (avg. improvement=38%; Cohen d=0.74), but not disability levels or anxiety symptoms, was observed in the overall sample. However, evidence of improvements was observed across all the primary outcomes among patients who had clinical levels of difficulties with disability (n=20; avg. improvement=11%; Cohen d=0.64), depression (n=17; avg. improvement=35%; Cohen d=1.24) and anxiety (n=8; avg. improvement=29%; Cohen d=0.57). CONCLUSIONS These findings highlight the potential value of internet-delivered programs when provided by specialist pain management clinics as a part of their services and the value of larger scale studies in this area.
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Deslauriers S, Roy JS, Bernatsky S, Feldman DE, Pinard AM, Desmeules F, Fitzcharles MA, Perreault K. Factors associated with waiting times for persons with rheumatic conditions in multidisciplinary pain treatment facilities. J Pain Res 2019; 12:2379-2390. [PMID: 31534361 PMCID: PMC6681557 DOI: 10.2147/jpr.s206519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Access to multidisciplinary pain treatment facilities (MPTF) in Canada is limited by long waiting lists. However, little is known about the factors associated with access to MPTF specifically for persons with rheumatic conditions. This study aimed to 1) determine the waiting time for services in publicly funded MPTF for persons with rheumatic conditions in the province of Quebec, Canada, as well as 2) identify the factors associated with waiting time. METHODS This study was conducted using the Quebec Pain Registry, a large database of patients who received pain management services in MPTF. Sociodemographic and clinical variables were assessed for potential associations with waiting time. Descriptive, bivariate analyses and multiple linear regression analyses were conducted. RESULTS A total of 3,665 patients with rheumatic conditions were identified within the registry. Patients had a mean age of 55±14 years and the majority were women (65.7%). The average waiting time was 241.2±308.9 days (median=126), with 34.2% of the patients waiting longer than 6 months before having a first appointment. Results indicate that longer pain duration, lower household income, pain onset following a motor vehicle accident, having fibromyalgia, being on permanent disability or unemployed and being referred by a family physician (versus specialist) were significantly associated with longer waiting times. CONCLUSIONS Many patients with rheumatic conditions (especially fibromyalgia) face long delays before receiving services in Quebec's MPTF. This study identified several factors associated with waiting time and emphasizes the need to improve access to pain management services.
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Affiliation(s)
- Simon Deslauriers
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Sasha Bernatsky
- McGill University Health Centre (MUHC)
, Montréal, QC, Canada
- Faculty of Medicine, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC)
, Montréal, QC, Canada
| | - Debbie E Feldman
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)
, Montréal, QC, Canada
- Public Health Research Institute of Université de Montréal
, Montréal, QC, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
- Centre Hospitalier Universitaire (CHU) de Québec
, Québec, QC, Canada
| | - François Desmeules
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Maisonneuve-Rosemont Hospital (CRHMR) Research Center
, Montréal, QC, Canada
| | - Mary-Ann Fitzcharles
- McGill University Health Centre (MUHC)
, Montréal, QC, Canada
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
, Québec, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
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The Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC): establishment of a binational system for benchmarking children's persistent pain services. Pain 2019; 160:1572-1585. [DOI: 10.1097/j.pain.0000000000001548] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Mishriky J, Stupans I, Chan V. Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review. Pharm Pract (Granada) 2019; 17:1410. [PMID: 31015881 PMCID: PMC6463420 DOI: 10.18549/pharmpract.2019.1.1410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/03/2019] [Indexed: 01/12/2023] Open
Abstract
Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers.
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Affiliation(s)
- John Mishriky
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- Professor and Discipline Head of Pharmacy. 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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Devan H, Farmery D, Peebles L, Grainger R. Evaluation of Self-Management Support Functions in Apps for People With Persistent Pain: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e13080. [PMID: 30747715 PMCID: PMC6390192 DOI: 10.2196/13080] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Background Smartphone apps are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best-practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective The aim of the study was to evaluate the contents of smartphone apps providing information on pain management strategies for people with persistent pain facilitating self-management support and to appraise the app quality. Methods A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies, and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results Of the 939 apps screened, 19 apps met the inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. A total of 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, whereas a few apps had features facilitating social support and enabling communicating with clinicians. No apps provided information tailored to the cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). Although use of 2 apps (Headspace and SuperBetter) has been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions Of the 3 apps (Curable, PainScale-Pain Diary and Coach, and SuperBetter) that met the largest number of items to support skills in self-management of pain, 2 apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally tailored information. Although 2 apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians, and people with persistent pain in developing apps and evaluating for clinical efficacy.
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Affiliation(s)
- Hemakumar Devan
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Devin Farmery
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
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Campbell G, Lintzeris N, Gisev N, Larance B, Pearson S, Degenhardt L. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2018; 210:6-8.e1. [PMID: 30636303 DOI: 10.5694/mja2.12047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.,University of Wollongong, Wollongong, NSW
| | - Sallie Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW.,Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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Price C, de C Williams AC, Smith BH, Bottle A. The National Pain Audit for specialist pain services in England and Wales 2010-2014. Br J Pain 2018; 13:185-193. [PMID: 31308943 DOI: 10.1177/2049463718814277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction Numerous reports highlight variations in pain clinic provision between services, particularly in the provision of multidisciplinary services and length of waiting times. A National Audit aims to identify and quantify these variations, to facilitate raising standards of care in identified areas of need. This article describes a Quality Improvement Programme cycle covering England and Wales that used such an approach to remedy the paucity of data on the current state of UK pain clinics. Methods Clinics were audited over a 4-year period using standards developed by the Faculty of Pain Medicine of The Royal College of Anaesthetists. Reporting was according to guidance from a recent systematic review of national surveys of pain clinics. A range of quality improvement measures was introduced via a series of roadshows led by the British Pain Society. Results 94% of clinics responded to the first audit and 83% responded to the second. Per annum, 0.4% of the total national population was estimated to attend a specialist pain service. A significant improvement in multidisciplinary staffing was found (35-56%, p < 0.001) over the 4-year audit programme, although this still requires improvement. Very few clinics achieved recommended evidence-based waiting times, although only 2.5% fell outside government targets; this did not improve. Safety standards were generally met. Clinicians often failed to code diagnoses. Conclusion A National Audit found that while generally safe many specialist pain services in England and Wales fell below recommended standards of care. Waiting times and staffing require improvement if patients are to get effective and timely care. Diagnostic coding also requires improvement.
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Affiliation(s)
| | - Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Blair H Smith
- Department of Population Health Sciences, University of Dundee, Dundee, UK
| | - Alex Bottle
- Dr Foster Unit, Imperial College London, London, UK
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The Pain Course: 12- and 24-Month Outcomes From a Randomized Controlled Trial of an Internet-Delivered Pain Management Program Provided With Different Levels of Clinician Support. THE JOURNAL OF PAIN 2018; 19:1491-1503. [PMID: 30099209 DOI: 10.1016/j.jpain.2018.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023]
Abstract
Little is known about the long-term outcomes of emerging Internet-delivered pain management programs. The current study reports the 12- and 24-month follow-up data from a randomized controlled trial (n = 490) of an Internet-delivered pain management program, the Pain Course. The initial results of the trial to the 3-month follow-up have been reported elsewhere. There were significant improvements in disability, depression, anxiety, and pain levels across 3 treatment groups receiving different levels of clinician support compared with a treatment as the usual control. No marked or significant differences were found between the treatment groups either after treatment or at the 3-month follow-up. The current study obtained long-term follow-up data from 78% and 79% of participants (n = 397) at the 12-month and 24-month follow-up marks, respectively. Clinically significant decreases (average percent reduction; Cohen's d effect sizes) were maintained at the 12- and 24-month follow-ups for disability (average reduction ≥27%; d ≥ .67), depression (average reduction ≥36%; d ≥ .80), anxiety (average reduction ≥38%; d ≥ .66), and average pain levels (average reduction ≥21%; d ≥ .67). No marked or consistent differences were found among the 3 treatment groups. These findings suggest that the outcomes of Internet-delivered programs may be maintained over the long term. PERSPECTIVE: This article presents the long-term outcome data of an established Internet-delivered pain management program for adults with chronic pain. The clinical improvements observed during the program were found to be maintained at the 12- and 24-month follow-up marks. This finding indicates that these programs can have lasting clinical effects.
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Dear BF, Nicholson Perry K, Siddall P, Middleton JW, Johnson J, Katte L, Monypenny F, Karin E, Gandy M, Titov N. The Pain Course: exploring the feasibility of an internet-delivered pain management programme for adults with spinal cord injury. Spinal Cord 2018; 56:931-939. [DOI: 10.1038/s41393-018-0146-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 01/07/2023]
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49
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Slater H, Briggs A, Stinson J, Campbell JM. End user and implementer experiences of mHealth technologies for noncommunicable chronic disease management in young adults: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2018; 15:2047-2054. [PMID: 28800054 DOI: 10.11124/jbisrir-2016-003299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
REVIEW OBJECTIVE The objective of this review is to systematically identify, review and synthesize relevant qualitative research on end user and implementer experiences of mobile health (mHealth) technologies developed for noncommunicable chronic disease management in young adults. "End users" are defined as young people aged 15-24 years, and "implementers" are defined as health service providers, clinicians, policy makers and administrators.The two key questions we wish to systematically explore from identified relevant qualitative studies or studies with qualitative components are.
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Affiliation(s)
- Helen Slater
- 1School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia 2Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada 3Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada 4Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Shipton EE, Bate F, Garrick R, Steketee C, Visser EJ. Pain medicine content, teaching and assessment in medical school curricula in Australia and New Zealand. BMC MEDICAL EDUCATION 2018; 18:110. [PMID: 29751806 PMCID: PMC5948674 DOI: 10.1186/s12909-018-1204-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/20/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND The objective of pain medicine education is to provide medical students with opportunities to develop their knowledge, skills and professional attitudes that will lead to their becoming safe, capable, and compassionate medical practitioners who are able to meet the healthcare needs of persons in pain. This study was undertaken to identify and describe the delivery of pain medicine education at medical schools in Australia and New Zealand. METHOD All 23 medical schools in Australia and New Zealand in 2016 were included in this study. A structured curriculum audit tool was used to obtain information on pain medicine curricula including content, delivery, teaching and assessment methods. RESULTS Nineteen medical schools (83%) completed the curriculum audit. Neurophysiology, clinical assessment, analgesia use and multidimensional aspects of pain medicine were covered by most medical schools. Specific learning objectives for pain medicine were not identified by 42% of medical schools. One medical school offered a dedicated pain medicine module delivered over 1 week. Pain medicine teaching was delivered at all schools by a number of different departments throughout the curriculum. Interprofessional learning (IPL) in the context of pain medicine education was not specified by any of the medical schools. The mean time allocated for pain medicine teaching over the entire medical course was just under 20 h. The objective structured clinical examination (OSCE) was used by 32% of schools to assess knowledge and skills in pain medicine. 16% of schools were unsure of whether any assessment of pain medicine education took place. CONCLUSION This descriptive study provides important baseline information for pain medicine education at medical schools in Australia and New Zealand. Medical schools do not have well-documented or comprehensive pain curricula that are delivered and assessed using pedagogically-sound approaches considering the complexity of the topic, the prevalence and public health burden of pain.
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Affiliation(s)
- Elspeth Erica Shipton
- School of Medicine, University of Notre Dame Australia, UNDA, P O Box 1225, Fremantle, WA 6160 Australia
| | - Frank Bate
- School of Medicine, University of Notre Dame Australia, UNDA, P O Box 1225, Fremantle, WA 6160 Australia
| | - Raymond Garrick
- School of Medicine, University of Notre Dame Australia, UNDA, Sydney, Darlinghurst Campus, Darlinghurst, NSW 2000 Australia
| | - Carole Steketee
- The Learning and Teaching Office, University of Notre Dame Australia, UNDA, P O Box 1225, Fremantle, WA 6160 Australia
| | - Eric John Visser
- School of Medicine, University of Notre Dame Australia, UNDA, P O Box 1225, Fremantle, WA 6160 Australia
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