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Gan Z, Sima S, Lapkin S, Diwan AD. Low back pain classifications and their associations with disability, quality-of-life, and sociodemographic factors: a comprehensive examination using the PainDETECT questionnaire. Curr Med Res Opin 2024; 40:1379-1387. [PMID: 38980135 DOI: 10.1080/03007995.2024.2378177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Low back pain (LBP) is a debilitating phenomenon that significantly impacts quality-of-life (QoL). The PainDETECT questionnaire (PD-Q) is a screening tool aimed at distinguishing nociceptive pain (NoP) and neuropathic pain (NeP) classifications. Associations between these classifications and patient-reported outcome measures (PROMs) and sociodemographic parameters are yet to be established. OBJECTIVE The study aimed to determine the relationship between NeP as assessed by the PD-Q and pain, disability, QoL, and sociodemographic factors. METHODS A retrospective analysis of an ongoing prospectively collected database was conducted involving 512 patients aged >18 years who presented to a tertiary spine clinic for LBP having completed the PainDETECT questionnaire, Oswestry Disability Index (ODI), EuroQol Five-Dimensional (EQ-5D) questionnaire, or answered questions regarding sociodemographic status. RESULTS The NeP group had a higher mean numerical rating scale (NRS) score (7.96± 1.54 vs. 5.76± 2.27, p <.001) and lower age (55± 15.6 vs. 59± 17.8, p <.05) compared to the NoP group. When confounded for NRS, analysis of covariance demonstrated an 89.5% higher total ODI score (p <.001) and 50.5% lower EQ-5D utility score (p <.001) in the NeP compared to NoP group. Smokers and individuals with a no partner marital status were 2.373 (OR = 2.373, 95% CI = 1.319-4.266, p <.01) and 2.384 times (OR = 2.384, 95% CI = 1.390-4.092, p <.01) more likely to have NeP compared to NoP, respectively. Patients with NeP were also of lower income class compared to patients with NoP (Z = -2.45, p <.05). CONCLUSION NeP was associated with higher levels of disability and lower QoL. Smokers, individuals with a no partner marital status, and individuals with a lower income class were more likely to suffer NeP rather than NoP. These findings have illuminated a crucial notion: in patients with elevated NRS, the detrimental impact of NeP on patient wellbeing underscores the fundamental need to represent pain on a nociceptive-neuropathic continuum, permitting more accurate differentiation of pain components.
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Affiliation(s)
- Zachary Gan
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Stone Sima
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Samuel Lapkin
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Ashish D Diwan
- Spine Labs, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
- Spine Service, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
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Belay GM, Mak YW, Wong FKY, Lam KKW, Liu Q, Yang F, Mao T, Wu CST, Ho KY. Psychosocial treatment options for adolescents and young adults with alcohol use disorder: systematic review and meta-analysis. Front Public Health 2024; 12:1371497. [PMID: 39114525 PMCID: PMC11303970 DOI: 10.3389/fpubh.2024.1371497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/22/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Psychosocial intervention is imperative for treating alcohol use disorder (AUD), but there is no comprehensive evidence regarding its effectiveness. Therefore, this study aimed to determine the effectiveness of psychosocial interventions in treating AUD amongadolescents and young adults. Methods In this systematic review and meta-analysis, articles were searched from EMBASE, PubMed, Medline, CINAHL, Web of Science, PsycINFO, and Scopus. Also, articles were retrieved from gray literature. The quality of articles has been assessed using the Cochrane risk of bias assessment. Results A total of 12 randomized controlled trials were included. Integrated family and CBT, CBT, guided self-change, and ecologically based family therapy had a mild effect in reducing alcohol use frequency. On the other hand, integrated motivational enhancement therapy and CBT (-0.71 [95% CI: -0.97, -0.45]) and common elements treatment approaches (4.5 [95% CI: 6.9, 2.2]) had the highest effect size for reducing alcohol use frequency and amount, respectively. In conclusion, most of the interventions had no significant effect on different drinking outcomes. Nonetheless, the effectiveness of combined interventions surpassed that of the single interventions. The effect of psychosocial interventions on abstinence was inconclusive. Therefore, future studies will explore alternative, newly emerged third-wave therapeutic approaches. Systematic review registration PROSPERO, CRD42023435011, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=435011.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, HKSAR, Kowloon, Hong Kong SAR, China
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Logge W, Baillie A, Haber P, Towers E, Riordan BC, Morley K. Sex differences in the interrelations between stress, craving and alcohol consumption across individuals and time during baclofen treatment for alcohol dependence. Addict Behav 2023; 136:107462. [PMID: 36084413 DOI: 10.1016/j.addbeh.2022.107462] [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: 03/16/2022] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 02/03/2023]
Abstract
AIMS Recent studies have suggested that females respond more favourably to baclofen treatment for alcohol use disorder. Females are generally more likely to drink to regulate stress reactivity and negative affect. This study thus aimed to evaluate the role of sex on the effect of baclofen on the relationship between daily alcohol consumption, stress and craving. METHODS A network analysis of fluctuations using vectorized autoregressive modelling was used to explore the relationship between daily surveys of alcohol consumption, stress and craving from daily diary data over 84 days from a randomised controlled trial of baclofen (30 mg or 75 mg per day) versus placebo in 104 participants with alcohol dependence (1, 2). Symptom interrelations across patients and across time were examined including temporal networks (time lagged), contemporaneous and between-subjects networks, and were examined for placebo and baclofen stratified by sex. RESULTS Overall, between persons, there was a significant relationship between stress and drinking in placebo treated individuals in females (r = -0.70, p < 0.001) but not males (r = 0.32, p = 0.054) that was not observed in baclofen treated individuals. No relationship was observed between stress and drinking in the baclofen group for either sex (p's < 0.45). DISCUSSION There appears to be some sex-specific differences whereby baclofen abolishes an overall association between stress and drinking in females, but this is not observed in males. Network analyses may assist in elucidating the mechanism of action of alcohol pharmacotherapies such as baclofen and understanding which symptoms and mechanisms are key for effective interventions.
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Affiliation(s)
- Warren Logge
- Clinical School, Sydney Medical School, University of Sydney, NSW, Australia; Edith Collins Centre for Translational Research, Sydney Local Health District NSW, Australia
| | - Andrew Baillie
- Sydney School of Health Sciences, the University of Sydney, Australia
| | - Paul Haber
- Clinical School, Sydney Medical School, University of Sydney, NSW, Australia; Edith Collins Centre for Translational Research, Sydney Local Health District NSW, Australia
| | - Ellen Towers
- Clinical School, Sydney Medical School, University of Sydney, NSW, Australia
| | - Benjamin C Riordan
- Clinical School, Sydney Medical School, University of Sydney, NSW, Australia; Centre for Alcohol Policy Research (CAPR), La Trobe University, VIC, Australia
| | - Kirsten Morley
- Clinical School, Sydney Medical School, University of Sydney, NSW, Australia; Edith Collins Centre for Translational Research, Sydney Local Health District NSW, Australia.
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Grunze H, Soyka M. The pharmacotherapeutic management of comorbid bipolar disorder and alcohol use disorder. Expert Opin Pharmacother 2022; 23:1181-1193. [PMID: 35640575 DOI: 10.1080/14656566.2022.2083500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Comorbidity of bipolar disorder (BD) and alcohol use disorder (AUD) is very frequent resulting in detrimental outcomes, including increased mortality. Diagnosis of AUD in BD and vice versa is often delayed as symptoms of one disorder mimic and obscure the other one. Evidence for pharmacotherapies for people with comorbid BD and AUD remains limited, and further proof-of-concept studies are urgently needed. AREAS COVERED This paper explores the currently available pharmacotherapies for AUD, BD and their usefulness for comorbid BD and AUD. It also covers to some degree the epidemiology, diagnosis, and potential common neurobiological traits of comorbid BD and AUD. EXPERT OPINION The authors conclude that more controlled studies are needed before evidence-based guidance can be drawn up for clinician's use. Since there are no relevant pharmacological interactions, approved medications for AUD can also be used safely in BD. For mood stabilization, lithium should be considered first in adherent persons with BD and comorbid AUD. Alternatives include valproate, lamotrigine, and some atypical antipsychotics, with partial D2/D3 receptor agonism possibly being beneficial in AUD, too.
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Affiliation(s)
- Heinz Grunze
- Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.,Paracelsus Medical University, Nuremberg, Germany
| | - Michael Soyka
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians- University Munich, Munich, Germany
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Conigrave JH, Lee KSK, Haber PS, Vnuk J, Doyle MF, Conigrave KM. More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments. Addict Sci Clin Pract 2022; 17:23. [PMID: 35382880 PMCID: PMC8981780 DOI: 10.1186/s13722-022-00306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander (‘Indigenous’) Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments. Methods We performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score. Results The primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients. Conclusions Evidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00306-5.
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Affiliation(s)
- James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia. .,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,La Trobe University, Centre for Alcohol Policy Research, Bundoora, Victoria, Australia.,Burnet Institute, Melbourne, Victoria, Australia
| | - Paul S Haber
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, SA, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael F Doyle
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, Central Clinical School, Discipline of Addiction Medicine, Level 6, King George V Building, Drug Health Services, 83-117 Missenden Road, Camperdown, NSW, 2050, Australia.,The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
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