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Zheng DKY, Kawchuk GN, Bussières AE, Al Zoubi FM, Hartvigsen J, Fu SN, de Luca K, Weiner DK, Karppinen J, Samartzis D, Ferreira ML, Wu J, Dennett L, Wong AYL. Trends of Low Back Pain Research in Older and Working-Age Adults from 1993 to 2023: A Bibliometric Analysis. J Pain Res 2023; 16:3325-3341. [PMID: 37808461 PMCID: PMC10557964 DOI: 10.2147/jpr.s425672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p<0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal "Spine". Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.
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Affiliation(s)
- Daniel K Y Zheng
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - André E Bussières
- Université McGill, Montreal, Canada
- Université du Québec à Trois-Rivières, Trois‑Rivières, Canada
| | - Fadi M Al Zoubi
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - Siu Ngor Fu
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
| | | | - Debra K Weiner
- University of Pittsburgh, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jaro Karppinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | | | | | - Jinlong Wu
- Southwest University, Chongqing, People’s Republic of China
| | | | - Arnold Y L Wong
- Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China
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Tighe CA, Bachrach RL, Perera S, Weiner DK. Insomnia symptoms and postoperative healthcare utilization in veterans undergoing decompressive laminectomy for lumbar spinal stenosis. Sleep Adv 2023; 4:zpad005. [PMID: 37193289 PMCID: PMC10108638 DOI: 10.1093/sleepadvances/zpad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/01/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives Lumbar spinal stenosis is an age-related spine condition that contributes to pain and disability. Decompressive laminectomy (DL) is regularly performed to alleviate symptoms. Insomnia symptoms are common among people living with chronic pain and may affect key DL outcomes, such as healthcare utilization. We examined associations of insomnia symptom severity with post-DL healthcare utilization in veterans with lumbar spinal stenosis. Methods Veterans (N = 200) with lumbar spinal stenosis undergoing DL were recruited into a prospective cohort study and self-reported insomnia symptom severity on the Insomnia Severity Index prior to DL. Post-DL, veterans reported on pain and non-pain-related monthly healthcare office visits, emergency room visits, hospitalizations, and mental health visits for 1 year. Incident rate ratios (IRRs) obtained via negative binomial regression evaluated associations of insomnia symptom severity with healthcare utilization rates. Results Approximately 51% of participants endorsed insomnia symptoms of at least mild severity. Participants who reported at least mild insomnia symptoms had more healthcare office visits (IRR = 1.23, p = .04), general mental health visits (IRR = 3.98, p < .0001), and pain-related mental health visits (IRR = 9.55, p = .01) than those without insomnia symptoms. Adjusting for covariates, rates of mental health visits, overall (IRR = 3.13, p = .001) and pain-related (IRR = 6.93, p = .02), remained statistically significantly higher. Conclusions Insomnia symptoms are associated with postoperative healthcare utilization lending support for future work to examine the value of assessing and intervening on insomnia symptoms prelaminectomy.
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Affiliation(s)
- Caitlan A Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rachel L Bachrach
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Porter LS, Weiner DK, Ramos K, Barnes DE, Schmader KE, Gwyther L, Ritchie CS, Keefe FJ. Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia. Palliat Support Care 2022; 20:785-793. [PMID: 36942584 PMCID: PMC10032330 DOI: 10.1017/s1478951521001747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability. METHOD In Phase I, we conducted interviews with 10 patient-caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability. RESULTS Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use. SIGNIFICANCE OF RESULTS These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.
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Affiliation(s)
- Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Katherine Ramos
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Deborah E Barnes
- University of San Francisco, UCSF Weill Institute for Neurosciences, San Francisco, CA
| | - Kenneth E Schmader
- Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Medical Center, Durham, NC
| | - Lisa Gwyther
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Christine S Ritchie
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Francis J Keefe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
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Pugliese JM, Coyle PC, Knox PJ, Sions JM, Patterson CG, Pohlig RT, Simon CB, Weiner DK, George SZ, Piva S, Hicks GE. The Manual Therapy and Strengthening for the Hip (MASH) Trial: Protocol for a Multisite Randomized Trial of a Subgroup of Older Adults With Chronic Back and Hip Pain. Phys Ther 2021; 102:6420898. [PMID: 34751784 PMCID: PMC8831280 DOI: 10.1093/ptj/pzab255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/14/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is a disabling and costly condition for older adults that is difficult to properly classify and treat. In a cohort study, a subgroup of older adults with CLBP who had elevated hip pain and hip muscle weakness was identified; this subgroup differentiated itself by being at higher risk for future mobility decline. The primary purpose of this clinical trial is to evaluate whether a hip-focused low back pain (LBP) treatment provides better disability and physical performance outcomes for this at-risk group compared with a spine-focused LBP treatment. METHODS This study is a multisite, single-blinded, randomized controlled, parallel arm, Phase II trial conducted across 3 clinical research sites. A total of 180 people aged between 60 and 85 years with CLBP and hip pain are being recruited. Participants undergo a comprehensive baseline assessment and are randomized into 1 of 2 intervention arms: hip-focused or spine-focused. They are treated twice weekly by a licensed physical therapist for 8 weeks and undergo follow-up assessments at 8 weeks and 6 months after randomization. Primary outcome measures include the Quebec Low Back Disability Scale and the 10-Meter Walk Test, which are measures of self-report and performance-based physical function, respectively. IMPACT This multicenter, randomized clinical trial will determine whether a hip-focused or spine-focused physical therapist intervention results in improved disability and physical performance for a subgroup of older adults with CLBP and hip pain who are at increased risk of mobility decline. This trial will help further the development of effective interventions for this subgroup of older adults with CLBP.
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Affiliation(s)
- Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Charity G Patterson
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware, USA
| | - Corey B Simon
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Steven Z George
- Department of Orthopedic Surgery, Duke School of Medicine, Durham, North Carolina, USA
| | - Sara Piva
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hicks GE, Pohlig RT, Coyle PC, Sions JM, Weiner DK, Pugliese JM, Velasco TO, O’Brien VA. Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies. Phys Ther 2021; 101:6374826. [PMID: 34636887 PMCID: PMC8801002 DOI: 10.1093/ptj/pzab227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/03/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time. METHODS Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models. RESULTS Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 "weak" subgroups. CONCLUSION These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes. IMPACT Among older adults with chronic low back pain, there are 3 hip subgroups: "strong and nonsymptomatic," "weak and nonsymptomatic," and "weak and symptomatic." People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.
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Affiliation(s)
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware, USA,Biostatistics Core, University of Delaware, Newark, Delaware, USA
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Debra K Weiner
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Moehl K, Newman D, Perera S, Toto PE, Weiner DK. Validating Goal Attainment in Veterans Undergoing Decompressive Laminectomy: A Preliminary Study. Pain Med 2021; 22:829-835. [PMID: 33211875 DOI: 10.1093/pm/pnaa406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although decompressive laminectomy (DL) for lumbar spinal stenosis (LSS) is a common procedure among older adults, it is unclear whether surgical definitions of success translate into patient-defined success. Using goal attainment scaling (GAS) to compare goal achievement between individuals, we investigated the relationship between surgical-defined functional recovery and achievement of personalized goals in patients who underwent DL for LSS. PARTICIPANTS Twenty-eight community-dwelling veterans scheduled to undergo DL. METHODS Participants were interviewed over the phone to set 1-year post-DL goals within 30 days before undergoing DL. Brigham Spinal Stenosis (BSS) score, comorbidities, cognitive function, and psychological factors also were assessed. GAS and BSS were repeated 1 year after DL. GAS scores were transformed into GAS-T scores (T-score transformation) to standardize achievement between patients and GAS-T change scores to compare study variables. RESULTS Seventeen of 28 participants had successful DL outcomes by BSS standards, though none of the participants achieved all of their GAS goals, with follow-up GAS-T scores averaging 44.5 ± 16.8. All three BSS scales positively correlated with GAS-T change scores: severity change r = 0.52, P = 0.005; physical function change r = 0.51, P = 0.006; and satisfaction r = 0.70, P < 0.001. Covariate analysis revealed a negative correlation between GAS-T change score and fear-avoidance beliefs: r = -0.41, P = -0.029. CONCLUSION There was congruent validity between GAS and the BSS in older veterans undergoing DL for LSS. Given the need for patient-centered care in older adults, future investigations exploring GAS in larger studies that target additional pain conditions and include participants with greater demographic diversity are warranted.
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Affiliation(s)
| | - Dave Newman
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Department of Medicine (Geriatric Medicine).,Department of Biostatistics
| | | | - Debra K Weiner
- Department of Medicine (Geriatric Medicine).,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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8
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Tighe CA, Youk A, Ibrahim SA, Weiner DK, Vina ER, Kwoh CK, Gallagher RM, Bramoweth AD, Hausmann LRM. Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity. Pain Med 2021; 21:501-510. [PMID: 31504838 DOI: 10.1093/pm/pnz187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA. METHODS We analyzed cross-sectional baseline data collected from Veterans Affairs (VA) patients enrolled in a clinical trial examining the effectiveness of a positive psychology intervention in managing pain from knee OA. Participants indicated how often in the past two weeks they were bothered by trouble falling asleep, staying asleep, or sleeping too much. We used validated scales to assess the primary outcome (OA symptom severity) and potential mediators (arthritis self-efficacy and pain catastrophizing). To test the proposed mediation model, we used parallel multiple mediation analyses with bootstrapping, controlling for sociodemographic and clinical characteristics with bivariate associations with OA symptom severity. RESULTS The sample included 517 patients (Mage = 64 years, 72.9% male, 52.2% African American). On average, participants reported experiencing sleep disturbance at least several days in the past two weeks (M = 1.41, SD = 1.18) and reported moderate OA symptom severity (M = 48.22, SD = 16.36). More frequent sleep disturbance was associated with higher OA symptom severity directly (b = 3.08, P <0.001) and indirectly, through higher pain catastrophizing (b = 0.60, 95% confidence interval [CI] = 0.20 to 1.11) and lower arthritis self-efficacy (b = 0.84, 95% CI = 0.42 to 1.42). CONCLUSIONS Pain catastrophizing and arthritis self-efficacy partially mediated the association between sleep disturbance and OA symptom severity. Behavioral interventions that address pain catastrophizing and/or self-efficacy may buffer the association between sleep disturbance and OA symptom severity.
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Affiliation(s)
- Caitlan A Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ada Youk
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest R Vina
- College of Medicine and University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona
| | - C Kent Kwoh
- College of Medicine and University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona
| | - Rollin M Gallagher
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam D Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatric Research, Education & Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Moehl K, Wright RM, Shega J, Malec M, Kelley Fitzgerald G, Robbins-Welty G, Zoberi K, Tait R, Perera S, Deverts D, Horvath Z, Weiner DK. How to Teach Medical Students About Pain and Dementia: E-Learning, Experiential Learning, or Both? Pain Med 2020; 21:2117-2122. [PMID: 32770186 PMCID: PMC7820358 DOI: 10.1093/pm/pnaa187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Pain management in persons with mild to moderate dementia poses unique challenges because of altered pain modulation and the tendency of some individuals to perseverate. We aimed to test the impact of an e-learning module about pain in communicative people with dementia on third-year medical students who had or had not completed an experiential geriatrics course. DESIGN Analysis of pre- to postlearning changes and comparison of the same across the student group. SETTING University of Pittsburgh School of Medicine and Saint Louis University School of Medicine. SUBJECTS One hundred four University of Pittsburgh and 57 Saint Louis University medical students. METHODS University of Pittsburgh students were randomized to view either the pain and dementia module or a control module on pain during a five-day geriatrics course. Saint Louis University students were asked to complete either of the two modules without the context of a geriatrics course. A 10-item multiple choice knowledge test and three-item attitudes and confidence questionnaires were administered before viewing the module and up to seven days later. RESULTS Knowledge increase was significantly greater among students who viewed the dementia module while participating in the geriatrics course than among students who viewed the module without engaging in the course (P < 0.001). The modules did not improve attitudes in any group, while student confidence improved in all groups. CONCLUSIONS Medical students exposed to e-learning or experiential learning demonstrated improved confidence in evaluating and managing pain in patients with dementia. Those exposed to both educational methods also significantly improved their knowledge.
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Affiliation(s)
- Keelin Moehl
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rollin M Wright
- Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Shega
- VITAS Healthcare and University of Central Florida, Orlando, Florida
| | - Monica Malec
- Department of Medicine (Geriatric and Palliative Medicine), University of Chicago, Chicago, Illinois
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania
| | | | - Kimberly Zoberi
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Raymond Tait
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Subashan Perera
- VITAS Healthcare and University of Central Florida, Orlando, Florida
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Denise Deverts
- Office of Research, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Zsuzsa Horvath
- Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Debra K Weiner
- Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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10
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Stahl ST, Jung C, Weiner DK, Peciña M, Karp JF. Opioid Exposure Negatively Affects Antidepressant Response to Venlafaxine in Older Adults with Chronic Low Back Pain and Depression. Pain Med 2020; 21:1538-1545. [PMID: 31633789 PMCID: PMC7530569 DOI: 10.1093/pm/pnz279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly co-prescribed with opioids for chronic pain. The purpose of this study was to describe pain and mood response to venlafaxine among older adults with chronic low back pain (CLBP) and depression relative to opioid exposure. DESIGN Secondary analyses were collected from a randomized clinical trial testing a stepped-care approach to comorbid pain and depression in older patients: the Addressing Depression and Pain Together study (ADAPT: 2010-2016). SETTING University-based late-life mental health research clinic. SUBJECTS Two hundred twenty-seven adults aged 65+ years with CLBP and depression. METHODS Participants received six weeks of lower-dose venlafaxine (≤150 mg/d). Pain and depression were measured each week. Response for both pain and depression at the end of six weeks was defined by a ≥30% improvement on a 0-20 numeric rating scale for low back pain and a Patient Health Questionnaire-9 score ≤5. Opioid exposure was analyzed as prescribed (yes or no) and by morphine equivalent dosing (MED). RESULTS Patients co-prescribed an opioid were less likely to report a pain response to venlafaxine. MED was negatively correlated with pain response. Depression response was not impacted. CONCLUSIONS Opioids are negatively associated with older adults' early analgesic response to lower-dose venlafaxine. These findings suggest that clinicians may wish to consider either nonopioid or alternative antidepressant approaches to pain management in these complex patients. It is reassuring that opioids do not prevent depression response. Future research should examine both longer duration of treatment and a wider range of doses.
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Affiliation(s)
| | - Changgi Jung
- Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Debra K Weiner
- Departments of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Departments of Geriatric Research, Education and Clinic Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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11
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Weiner DK, Gentili A, Rossi M, Coffey-Vega K, Rodriguez KL, Hruska KL, Hausmann L, Perera S. Aging Back Clinics-a Geriatric Syndrome Approach to Treating Chronic Low Back Pain in Older Adults: Results of a Preliminary Randomized Controlled Trial. Pain Med 2020; 21:274-290. [PMID: 31503275 DOI: 10.1093/pm/pnz179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Treating chronic low back pain (CLBP) with spine-focused interventions is common, potentially dangerous, and often ineffective. This preliminary trial tests the feasibility and efficacy of caring for CLBP in older adults as a geriatric syndrome in Aging Back Clinics (ABC). DESIGN Randomized controlled trial. SETTING Outpatient clinics of two VA Medical Centers. SUBJECTS Fifty-five English-speaking veterans aged 60-89 with CLBP and no red flags for serious underlying illness, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness. METHODS Participants were randomized to ABC care or usual care (UC) and followed for six months. ABC care included 1) a structured history and physical examination to identify pain contributors, 2) structured participant education, 3) collaborative decision-making, and 4) care guided by condition-specific algorithms. Primary outcomes were low back pain severity (0-10 current and seven-day average/worst pain) and pain-related disability (Roland Morris). Secondary outcomes included the SF-12 and health care utilization. RESULTS ABC participants experienced significantly greater reduction in seven-day average (-1.22 points, P = 0.023) and worst pain (-1.70 points, P = 0.003) and SF-12 interference with social activities (50.0 vs 11.5%, P = 0.0030) at six months. ABC participants were less likely to take muscle relaxants (16.7 vs 42.3%, P = 0.0481). Descriptively, UC participants were more likely to experience pain-related emergency room visits (45.8% vs 30.8%) and to be exposed to non-COX2 nonsteroidal anti-inflammatory drugs (73.1% vs 54.2%). CONCLUSIONS These preliminary data suggest that ABC care for older veterans with CLBP is feasible and may reduce pain and exposure to other potential morbidity.
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Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Pennsylvania.,Department of Medicine (Geriatric Medicine), Virginia Commonwealth University, Richmond, Virginia
| | - Michelle Rossi
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katherine Coffey-Vega
- Department of Medicine (Geriatric Medicine), University of Virginia, Charlottesville, Virginia
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristina L Hruska
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Leslie Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Department of Medicine (Geriatric Medicine), University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Pruskowski J, Childers J, Moore PA, Zemaitis MA, Bauer RE, Deverts DJ, Elnicki DM, Levine SC, Kaufman R, Dziabiak MP, Spallek H, Weiner DK, Horvath Z. Managing Acute Pain and Opioid Risks Following Wisdom Teeth Extraction: An Illustrative Case. MedEdPORTAL 2019; 15:10855. [PMID: 31934617 PMCID: PMC6953741 DOI: 10.15766/mep_2374-8265.10855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/24/2019] [Indexed: 05/09/2023]
Abstract
Introduction The opioid epidemic has awakened educators to the insufficiency of training in the areas of pain management and substance use disorders within the curricula of health sciences schools. The University of Pittsburgh Center of Excellence in Pain Education created an online educational module focusing on factors contributing to the opioid epidemic and the role of robust interprofessional communication in avoiding common practitioner errors. Methods The 1-hour module created by an interprofessional team comprised a pretest, video presentation featuring case vignettes, posttest, and learner satisfaction survey. The content of the module focused on four core concepts: (1) managing acute perioperative pain, (2) maximizing opioid safety, and (3) identifying and (4) managing suspected opioid abuse and diversion. Results Data were obtained from 250 dental, pharmacy, and nursing students from the University of Pittsburgh who completed the module as part of their respective profession-specific curricula. Results collapsed across the three school-specific implementations indicated an average increase in knowledge test scores from pre- to posttest (Z = -8.82, p < .001). In addition, the learner satisfaction data revealed an overall positive response to the module, with students commenting that they enjoyed the module and felt it provided them with a valuable learning experience. Discussion Learner outcomes and feedback suggest that our interprofessional team was successful in creating an effective learning module applicable to several health care professions, namely, pharmacy, dentistry, and nursing. Future studies might address the application of the knowledge gained to actual patient care.
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Affiliation(s)
- Jennifer Pruskowski
- Assistant Professor, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | - Julie Childers
- Translational Research Facilitator, University of Pittsburgh School of Dental Medicine
| | - Paul A. Moore
- Associate Professor, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Michael A. Zemaitis
- Professor, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine
| | - Richard E. Bauer
- Professor, Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
| | - Denise J. Deverts
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
| | - D. Michael Elnicki
- Professor, Division of General Internal Medicine, University of Pittsburgh School of Medicine
- Director of International Medical Education Programs, Division of General Internal Medicine, University of Pittsburgh School of Medicine
| | - Steven C. Levine
- Professor, Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing
| | - Robert Kaufman
- Assistant Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine
| | - Michael P. Dziabiak
- Instructional Technologist, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine
| | - Heiko Spallek
- Dean, Faculty of Medicine and Health, University of Sydney School of Dentistry
| | - Debra K. Weiner
- Professor, Psychiatry, Anesthesiology, and Clinical & Translational Science, University of Pittsburgh School of Medicine
- Acting Associate Director of Education and Evaluation, VA Pittsburgh Healthcare System
| | - Zsuzsa Horvath
- Assistant Professor, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine
- Director of Faculty Development, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine
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13
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Madill ES, Samuels R, Newman DP, Boudreaux-Kelley M, Weiner DK. Development of an Evaluative, Educational, and Communication-Facilitating App for Older Adults with Chronic Low Back Pain: Patient Perceptions of Usability and Utility. Pain Med 2019; 20:2120-2128. [PMID: 31329964 DOI: 10.1093/pm/pnz088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study is to examine the usability and utility of an office-based iPad app that we developed for older adults with chronic low back pain (CLBP). The app screens for conditions that contribute to back pain and pain interference and provides personalized education based on patient responses. It also facilitates patient-provider communication regarding treatment targets and expectations. METHODS Forty-six older adults (age ≥60 years) with CLBP were recruited from the Veterans Affairs and from the Pittsburgh community. Testing was split into two phases. Alpha testing (N = 15) was used to drive design changes to the app. Beta testing (N = 30, after one participant withdrew) used a structured questionnaire to evaluate the app's usability and utility. RESULTS The application was rated highly for usability and utility (9.6 and 8.9 out of 10, respectively). The majority of participants (82.1%) agreed that the app would help them communicate with their doctor and that it gave them useful information about potentially harmful or unnecessary interventions such as opioids and imaging (79.2% and 75.0%). Participants (age ≥60 years, mean age = 75.5 years) were able to successfully use the application without assistance and would be willing to do so in their primary care office. CONCLUSIONS We present the development of a CLBP app that screens for pain contributors and provides personalized education based on patient responses. Such an app could be employed in a variety of clinical settings to help educate patients about their CLBP and to curtail unnecessary interventions. Patient outcomes are being tested in an ongoing clinical trial.
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Affiliation(s)
- Evan S Madill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachel Samuels
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - David P Newman
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of Geriatric Medicine, Department of Medicine.,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Karp JF, Zhang J, Wahed AS, Anderson S, Dew MA, Fitzgerald K, Weiner DK, Albert S, Gildengers A, Butters M, Reynolds CF. Improving Patient Reported Outcomes and Preventing Depression and Anxiety in Older Adults With Knee Osteoarthritis: Results of a Sequenced Multiple Assignment Randomized Trial (SMART) Study. Am J Geriatr Psychiatry 2019; 27:1035-1045. [PMID: 31047790 PMCID: PMC6739151 DOI: 10.1016/j.jagp.2019.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Older adults with knee osteoarthritis (OA) and comorbid subsyndromal depressive symptoms are at elevated risk for incidental major depression or anxiety disorders. Using an indicated prevention paradigm, the authors conducted a sequenced multiple assignment randomized trial (SMART) to: 1) evaluate the effect of cognitive behavioral therapy (CBT) and physical therapy (PT), together with the temporal ordering of these interventions, on patient-reported global impression of change (P-GIC), mood, anxiety, and pain; and 2) compare the strategies' impact on incidence of common psychiatric disorders over 12-months. METHODS This intervention development trial compared four adaptive strategies delivered in two stages (each up to 8 weeks), contrasted with enhanced usual care (EUC). The strategies were CBT followed by an increased dose of CBT (CBT-CBT), CBT followed by PT (CBT-PT), PT followed by an increased dose of PT (PT-PT), and PT followed by CBT (PT-CBT). Participants (n = 99) were aged 60 years and older and met clinical criteria for knee OA and subthreshold depression. Response was defined as at least "much better" on the P-GIC. Participants were assessed quarterly for 12 months for incidence of psychiatric disorders. RESULTS Stage 1 response was higher for PT (47.5%) compared to CBT (20.5%). Non-responders receiving an additional dose of the same intervention experienced a response rate of 73%, higher than for switching to a different intervention. All strategies were superior to EUC (5%). Although not powered to detect effects on disorders, neither intervention strategy nor response status affected 12-month incidence of depression and anxiety disorders. CONCLUSION As response rates were similar for PT-PT and CBT-CBT, it may be dose and not type of these interventions that are necessary for clinical benefit. For non-responders, this finding may guide providers to stay the clinical course for up to 12 weeks before switching. These results support future trials of SMART designs in late-life depression prevention.
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Affiliation(s)
- Jordan F. Karp
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Jun Zhang
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Abdus S. Wahed
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Stewart Anderson
- Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine,Department of Biostatistics, Graduate School of Public Health,University of Pittsburgh and University of Pittsburgh School of Medicine,Epidemiology,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Kelley Fitzgerald
- School of Health and Rehabilitation Sciences,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine,Department of Medicine,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Steve Albert
- Behavioral and Community Health Sciences,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Ari Gildengers
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Meryl Butters
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
| | - Charles F. Reynolds
- Department of Psychiatry,University of Pittsburgh and University of Pittsburgh School of Medicine
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15
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Jacobs ZG, Elnicki DM, Perera S, Weiner DK. An E-learning Module on Chronic Low Back Pain in Older Adults: Effect on Medical Resident Attitudes, Confidence, Knowledge, and Clinical Skills. Pain Med 2019; 19:1112-1120. [PMID: 29315426 DOI: 10.1093/pm/pnx333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To determine 1) the feasibility of implementing an e-learning module on chronic low back pain (CLBP) in an older adult into an existing internal medicine residency curriculum and 2) the impact of this module on resident attitudes, confidence, knowledge, and clinical skills relating to CLBP. Methods Participants were assigned to complete either the online module (N = 73) or the Yale Office-based curriculum on CLBP (N = 70). Attitudes, confidence, and knowledge were evaluated pre- and postintervention via survey. A retrospective blinded chart review of resident clinic encounters was conducted, wherein diagnosis codes and physical exam documentation were rated as basic or advanced. Results There was no improvement in overall knowledge scores in either group (60% average on both metrics). There were tendencies for greater improvements in the intervention group compared with controls for confidence in managing fibromyalgia (2.4 to 2.9 vs 2.5 to 2.5, P = 0.06) and leg length discrepancy (1.8 to 2.5 vs 1.5 to 1.9, P = 0.05). Those exposed to the online module also showed an increase in the percentage of physical exam documentation rated as advanced following the intervention (13% to 32%, P = 0.006), whereas the control group showed no change (14% to 12%, P = 0.68). Conclusions An online module on CLBP in the older adult was a feasible addition to an existing curriculum for internal medicine residents. The module positively and substantively impacted resident clinical behaviors, as evidenced by enhanced sophistication in physical exam documentation; it also was associated with improved confidence in certain aspects of chronic pain management.
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Affiliation(s)
| | | | | | - Debra K Weiner
- Division of Geriatric Medicine.,Department of Medicine.,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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16
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Abstract
Objective Mindfulness is a nonpharmacologic mind-body therapy that has been shown to be effective in older adults with chronic low back pain (cLBP). There are few first-person accounts in the literature that describe the older adult experience and perspective while learning mindfulness and meditation to treat pain. The objective of this study was to investigate dominant themes present in the experiences of older adults applying mindfulness and meditation to cope with cLBP. Design Qualitative analysis of four focus groups. Subject Twenty-five adults age 65 years or older who had completed an eight-week mindfulness program. Methods The focus groups met for a comprehensive discussion session about their experience with mindfulness and meditation. The audio for each session was recorded, and the discussions were transcribed. Codebook development, qualitative coding, and thematic analysis were performed. The coders each coded all four transcripts, following which they met to adjudicate all coding differences until they were in complete agreement on coding. Results Several key themes were brought up by older adults utilizing mindfulness as a means of coping with pain, which included overcoming fear of pain ("Before [learning mindfulness], I used to dread pain"), pain awareness ("You're focusing more on being aware than the pain; now that's what helps me"), and pain significance ("It becomes insignificant"). Conclusions The themes identify several ways mindfulness impacts older adults with cLBP, including decreased negative emotions related to chronic pain such as fear of pain, a different perspective or change in awareness about pain, and reducing the significance of pain.
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Affiliation(s)
| | - Jean Woo
- General Internal Medicine Residency, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Megan Hamm
- Division of General Internal Medicine, Center for Research on Health Care
| | | | - Debra K Weiner
- Department of Psychiatry
- Department of Anesthesiology
- Department of Medicine
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Natalia E Morone
- Division of General Internal Medicine, Center for Research on Health Care
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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17
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Hausmann LRM, Youk A, Kwoh CK, Gallagher RM, Weiner DK, Vina ER, Obrosky DS, Mauro GT, McInnes S, Ibrahim SA. Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e182533. [PMID: 30646170 PMCID: PMC6324470 DOI: 10.1001/jamanetworkopen.2018.2533] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Positive psychological interventions for improving health have received increasing attention recently. Evidence on the impact of such interventions on pain, and racial disparities in pain, is limited. OBJECTIVE To assess the effects of a positive psychological intervention on pain and functional difficulty in veterans with knee osteoarthritis. DESIGN, SETTING, AND PARTICIPANTS The Staying Positive With Arthritis Study is a large, double-blinded randomized clinical trial powered to detect race differences in self-reported pain in response to a positive psychological intervention compared with a neutral control intervention. Data were collected from 2 urban Veterans Affairs medical centers. Participants included non-Hispanic white and non-Hispanic African American patients aged 50 years or older with a diagnosis of osteoarthritis. Mailings were sent to 5111 patients meeting these criteria, of whom 839 were fully screened, 488 were eligible, and 360 were randomized. Enrollment lasted from July 8, 2015, to February 1, 2017, with follow-up through September 6, 2017. INTERVENTIONS The intervention comprised a 6-week series of evidence-based activities to build positive psychological skills (eg, gratitude and kindness). The control program comprised similarly structured neutral activities. Programs were delivered via workbook and weekly telephone calls with interventionists. MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported pain and functional difficulty measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range 0-100). Secondary outcomes included affect balance and life satisfaction. RESULTS The sample included 180 non-Hispanic white patients and 180 non-Hispanic African American patients (mean [SD] age, 64.2 [8.8] years; 76.4% were male). Mean (SD) baseline scores for WOMAC pain and functional difficulty were 48.8 (17.6) and 46.8 (18.1), respectively. Although both decreased significantly over time (pain: χ23 = 49.50, P < .001; functional difficulty: χ23 = 22.11, P < .001), differences were small and did not vary by treatment group or race. Exploratory analyses suggested that the intervention had counterintuitive effects on secondary outcomes. CONCLUSIONS AND RELEVANCE The results of this randomized clinical trial do not support the use of positive psychological interventions as a stand-alone treatment for pain among white or African American veterans with knee osteoarthritis. Adaptations are needed to identify intervention components that resonate with this population, and the additive effect of incorporating positive psychological interventions into more comprehensive pain treatment regimens should be considered. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02223858.
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Affiliation(s)
- Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ada Youk
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - C. Kent Kwoh
- University of Arizona Arthritis Center, University of Arizona, Tucson
- College of Medicine, University of Arizona, Tucson
| | - Rollin M. Gallagher
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- School of Medicine, University of Pennsylvania, Philadelphia
| | - Debra K. Weiner
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Ernest R. Vina
- University of Arizona Arthritis Center, University of Arizona, Tucson
- College of Medicine, University of Arizona, Tucson
| | - D. Scott Obrosky
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Genna T. Mauro
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Shauna McInnes
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Said A. Ibrahim
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- School of Medicine, University of Pennsylvania, Philadelphia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
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18
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Weiner DK, Marcum Z, Rodriguez E. Deconstructing Chronic Low Back Pain in Older Adults: Summary Recommendations. Pain Med 2018; 17:2238-2246. [PMID: 28025358 DOI: 10.1093/pm/pnw267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania .,Division of Geriatric Medicine, Department of Medicine.,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zachary Marcum
- School of Pharmacy, University of Washington, Seattle, Washington, USA
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19
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Weiner DK, Gentili A, Coffey-Vega K, Morone N, Rossi M, Perera S. Biopsychosocial Profiles and Functional Correlates in Older Adults with Chronic Low Back Pain: A Preliminary Study. Pain Medicine 2018; 20:1300-1310. [DOI: 10.1093/pm/pny065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Objective
To describe key peripheral and central nervous system (CNS) conditions in a group of older adults with chronic low back pain (CLBP) and their association with pain severity and self-reported and performance-based physical function.
Design
Cross-sectional.
Setting
Outpatient VA clinics.
Subjects
Forty-seven community-dwelling veterans with CLBP (age 68.0 ± 6.5 years, range = 60–88 years, 12.8% female, 66% white) participated.
Methods
Data were collected on peripheral pain generators—body mass index, American College of Rheumatology hip osteoarthritis criteria, neurogenic claudication (i.e., spinal stenosis), sacroiliac joint (SIJ) pain, myofascial pain, leg length discrepancy (LLD), and iliotibial band pain; and CNS pain generators—anxiety (GAD-7), depression (PHQ-9), insomnia (Insomnia Severity Index), maladaptive coping (Fear Avoidance Beliefs Questionnaire, Cognitive Strategies Questionnaire), and fibromyalgia (fibromyalgia survey). Outcomes were pain severity (0 to 10 scale, seven-day average and worst), self-reported pain interference (Roland Morris [RM] questionnaire), and gait speed.
Results
Approximately 96% had at least one peripheral CLBP contributor, 83% had at least one CNS contributor, and 80.9% had both peripheral and CNS contributors. Of the peripheral conditions, only SIJ pain and LLD were associated with outcomes. All of the CNS conditions and SIJ pain were related to RM score. Only depression/anxiety and LLD were associated with gait speed.
Conclusions
In this sample of older veterans, CLBP was a multifaceted condition. Both CNS and peripheral conditions were associated with self-reported and performance-based function. Additional investigation is required to determine the impact of treating these conditions on patient outcomes and health care utilization.
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Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine
- Department of Psychiatry
- Department of Anesthesiology
- Clinical and Translational Sciences Institute
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | | | - Natalia Morone
- Department of Medicine
- Clinical and Translational Sciences Institute
| | - Michelle Rossi
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine
| | - Subashan Perera
- Department of Medicine
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Hausmann LRM, Youk A, Kwoh CK, Ibrahim SA, Hannon MJ, Weiner DK, Gallagher RM, Parks A. Testing a Positive Psychological Intervention for Osteoarthritis. Pain Med 2017; 18:1908-1920. [PMID: 29044408 PMCID: PMC5914366 DOI: 10.1093/pm/pnx141] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Osteoarthritis is a leading cause of disability for which there is no cure. Psychosocial-oriented treatments are underexplored. We developed and tested an intervention to build positive psychological skills (e.g., gratitude) to reduce osteoarthritis symptom severity, including pain and functioning, and to improve psychosocial well-being in patients with knee or hip osteoarthritis. DESIGN Two-arm randomized design with six-month follow-up. SETTING An academic Veterans Affairs Medical Center. SUBJECTS Patients aged 50 years or older with knee or hip osteoarthritis and pain ratings of 4 or higher. METHODS Patients (N = 42) were randomized to a six-week program containing positive skill-building activities or neutral control activities tailored to the patient population. Adherence was assessed by telephone each week. We assessed osteoarthritis symptom severity (WOMAC Osteoarthritis Index) and measures of well-being (positive affect, negative affect, and life satisfaction) at baseline and by telephone one, three, and six months after the program ended. We used linear mixed models to examine changes over time. RESULTS The majority (64%) of patients completed more than 80% of their weekly activities. Patients in the positive (vs neutral) program reported significantly more improvement over time in osteoarthritis symptom severity (P = 0.02, Cohen's d = 0.86), negative affect (P = 0.03, Cohen's d = 0.50), and life satisfaction (P = 0.02, Cohen's d = 0.36). CONCLUSIONS The study successfully engaged patients with knee or hip osteoarthritis in a six-week intervention to build positive psychological skills. Improving osteoarthritis symptom severity and measures of psychosocial well-being, the intervention shows promise as a tool for chronic pain management.
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Affiliation(s)
| | - Ada Youk
- Center for Health Equity Research and Promotion
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - C. Kent Kwoh
- College of Medicine and University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona
| | - Said A. Ibrahim
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Debra K. Weiner
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- School of Medicine
| | - Rollin M. Gallagher
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Acacia Parks
- Department of Psychology, Hiram College, Hiram, Ohio
- Happify, New York, New York, USA
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Polsunas PJ, Sowa G, Fritz JM, Gentili A, Morone NE, Raja SN, Rodriguez E, Schmader K, Scholten JD, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part X: Sacroiliac Joint Syndrome. Pain Med 2017; 17:1638-47. [PMID: 27605679 DOI: 10.1093/pm/pnw151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To present an algorithm of sequential treatment options for managing sacroiliac joint (SIJ) pain in the setting of chronic low back pain (CLBP) in the older adult. This is the tenth part in a series, and includes an illustrative clinical case. METHODS The stepped care drug table and evaluation and treatment algorithm were created following a thorough literature review of approaches and subsequent analysis through a modified Delphi process. The principal investigator developed the initial draft, which was refined for content by an interdisciplinary panel of five experts. The refined materials were then assessed for the feasibility of implementation and validity of recommendations for older adults in a primary care setting by a panel of nine primary care providers. While not exclusive to Veteran's Health Administration (VHA) facilities, an emphasis was made to include resources and medications available to providers in the VHA. RESULTS The algorithm and drug table developed to systematically identify and address SIJ pain in the older adult is presented here. The process should begin with recognizing the presenting symptoms of CLBP stemming from the SI region, and supporting physical exam testing using the compression test and thigh thrust maneuver. Identification of the SIJ as a pain generator is followed by assessment and treatment of contributory factors. SIJ pain treatment should begin with education and self-management including exercise, and may escalate to include interventional procedures and/or referral to a pain rehabilitation program. CONCLUSIONS Pain originating from the SIJ is often under-recognized, but a structured and consistent approach can help identify older patients who would benefit from treatment of this contributor to CLBP. KEY WORDS Chronic Low Back Pain; Sacroiliac Joint Pain; Older Adults.
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Affiliation(s)
| | - Gwendolyn Sowa
- Departments of Physical Medicine and Rehabilitation Orthopaedic Surgery Bioengineering-University of Pittsburgh, Pittsburgh, PA
| | - Julie M Fritz
- Department of Physical Therapy, College of Health, University of Utah, Salt Lake City
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, VA Virginia Commonwealth University Health System, Richmond, VA
| | - Natalia E Morone
- **Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Srinivasa Naga Raja
- Department of Anesthesiology Critical Care Medicine Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric Rodriguez
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kenneth Schmader
- ***Durham VA Medical Center, GRECC, Durham, NC Duke University Medical Center, Division of Geriatrics, Department of Medicine, Durham, NC
| | - Joel D Scholten
- Washington DC VA Medical Center, Washington, DC Rehabilitation and Prosthetics Services, Veterans Health Administration, Washington, DC
| | - Debra K Weiner
- **Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA Department of Psychiatry Department of Departments of Medicine, Division of Geriatric Medicine
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22
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Walco GA, Krane EJ, Schmader KE, Weiner DK. Applying a Lifespan Developmental Perspective to Chronic Pain: Pediatrics to Geriatrics. J Pain 2017; 17:T108-17. [PMID: 27586828 DOI: 10.1016/j.jpain.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/23/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED An ideal taxonomy of chronic pain would be applicable to people of all ages. Developmental sciences focus on lifespan developmental approaches, and view the trajectory of processes in the life course from birth to death. In this article we provide a review of lifespan developmental models, describe normal developmental processes that affect pain processing, and identify deviations from those processes that lead to stable individual differences of clinical interest, specifically the development of chronic pain syndromes. The goals of this review were 1) to unify what are currently separate purviews of "pediatric pain," "adult pain," and "geriatric pain," and 2) to generate models so that specific elements of the chronic pain taxonomy might include important developmental considerations. PERSPECTIVE A lifespan developmental model is applied to the forthcoming Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy to ascertain the degree to which general "adult" descriptions apply to pediatric and geriatric populations, or if age- or development-related considerations need to be invoked.
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Affiliation(s)
- Gary A Walco
- Departments of Anesthesiology and Pain Medicine, Pediatrics, and Psychiatry, University of Washington School of Medicine, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington.
| | - Elliot J Krane
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California; Stanford Children's Health, Palo Alto, California
| | - Kenneth E Schmader
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; GRECC, Durham VA Medical Center, Durham, North Carolina
| | - Debra K Weiner
- VA Pittsburgh Geriatric Research, Education and Clinical Center, Pittsburgh, Pennsylvania; Departments of Medicine, Psychiatry, and Anesthesiology, Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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23
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Hausmann LRM, Ibrahim SA, Kwoh CK, Youk A, Obrosky DS, Weiner DK, Vina E, Gallagher RM, Mauro GT, Parks A. Rationale and design of the Staying Positive with Arthritis (SPA) Study: A randomized controlled trial testing the impact of a positive psychology intervention on racial disparities in pain. Contemp Clin Trials 2017; 64:243-253. [PMID: 28893676 DOI: 10.1016/j.cct.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/31/2017] [Accepted: 09/07/2017] [Indexed: 12/18/2022]
Abstract
Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
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Affiliation(s)
- Leslie R M Hausmann
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
| | - Said A Ibrahim
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, United States; University of Pennsylvania, School of Medicine, Philadelphia, PA, United States
| | - C Kent Kwoh
- University of Arizona, College of Medicine and University of Arizona Arthritis Center, Tucson, AZ, United States
| | - Ada Youk
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, United States
| | - D Scott Obrosky
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States
| | - Debra K Weiner
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Veterans Affairs Pittsburgh Healthcare System, Geriatric Research, Education & Clinical Center, Pittsburgh, PA, United States
| | - Ernest Vina
- University of Arizona, College of Medicine and University of Arizona Arthritis Center, Tucson, AZ, United States
| | - Rollin M Gallagher
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, United States; University of Pennsylvania, School of Medicine, Philadelphia, PA, United States
| | - Genna T Mauro
- Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States
| | - Acacia Parks
- Hiram College, Department of Psychology, Hiram, OH, United States; Happify, New York, NY, United States
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24
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Fritz JM, Rundell SD, Dougherty P, Gentili A, Kochersberger G, Morone NE, Naga Raja S, Rodriguez E, Rossi MI, Shega J, Sowa G, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis. ACTA ACUST UNITED AC 2017; 17:501-10. [PMID: 26962233 DOI: 10.1093/pm/pnw011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE . To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. METHODS . The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR). RESULTS . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care. CONCLUSIONS . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability.
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Affiliation(s)
- Julie M Fritz
- *Department of Physical Therapy and College of Health, University of Utah, Salt Lake City, Utah
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Paul Dougherty
- Canandaigua VA Medical Center, Canandaigua, New York Department of Research, New York Chiropractic College, Seneca Falls, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia **Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gary Kochersberger
- Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Natalia E Morone
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and
| | - Srinivasa Naga Raja
- Department of Anesthesiology, Critical Care Medicines, and Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Rodriguez
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and
| | - Michelle I Rossi
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and
| | - Joseph Shega
- VITAS Healthcare, Miami, Florida; Departments of
| | - Gwendolyn Sowa
- Physical Medicine and Rehabilitation, Orthopedic Surgery, Bioengineering
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Psychiatry, and ****Anesthesiolgoy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Havran M, Scholten JD, Breuer P, Lundberg J, Kochersberger G, Newman D, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult—Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy. Pain Med 2016; 17:2230-2237. [DOI: 10.1093/pm/pnw270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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DiNapoli EA, Craine M, Dougherty P, Gentili A, Kochersberger G, Morone NE, Murphy JL, Rodakowski J, Rodriguez E, Thielke S, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping. Pain Med 2016; 17:64-73. [PMID: 26768183 DOI: 10.1093/pm/pnv055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. METHODS A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice. RESULTS We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management. CONCLUSIONS To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
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Affiliation(s)
- Elizabeth A DiNapoli
- *Mental Illness Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Michael Craine
- VA Eastern Colorado Healthcare System, Denver, Colorado Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado
| | - Paul Dougherty
- Canandaigua VA Medical Center, Canandaigua, New York New York Chiropractic College, Seneca Falls, New York
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Virginia Commonwealth University Health System, Richmond, Virginia
| | - Gary Kochersberger
- Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, University of Rochester, Rochester, New York
| | - Natalia E Morone
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Murphy
- James A. Haley Veterans' Hospital, Tampa, Florida University of South Florida, Tampa, Florida
| | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric Rodriguez
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Maree RD, Marcum ZA, Saghafi E, Weiner DK, Karp JF. A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults. Am J Geriatr Psychiatry 2016; 24:949-963. [PMID: 27567185 PMCID: PMC5069126 DOI: 10.1016/j.jagp.2016.06.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/28/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The authors assessed the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions. METHODS Following PRISMA guidelines, a literature search of PubMed, PsycINFO, and EMBASE for peer-reviewed journal articles in English through April 2014 with updates through November 2015 was conducted for reports on misuse of prescription benzodiazepines and opioids in older adults. Relevant publications were reviewed that included participants age ≥65 years. Reference lists were manually searched for key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article. RESULTS Of 4,932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and nonprescription use of pain relievers, and health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse, and one study described the effects of provider education and an electronic support tool as an intervention. CONCLUSION There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. The need for further research specific to prescription drug misuse among older adults is discussed.
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Affiliation(s)
- RD Maree
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - ZA Marcum
- School of Pharmacy, University of Washington
| | - E Saghafi
- Department of Information Science, University of Pittsburgh School of Medicine
| | - DK Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Department of Medicine, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
| | - JF Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Anesthesiology, University of Pittsburgh School of Medicine,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System
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Wright R, Malec M, Shega JW, Rodriguez E, Kulas J, Morrow L, Rodakowski J, Semla T, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XI: Dementia. Pain Med 2016; 17:1993-2002. [PMID: 27880650 PMCID: PMC6388877 DOI: 10.1093/pm/pnw247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE : To present the 11th in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributions to pain and disability in older adults with CLBP. This article focuses on dementia. METHODS A modified Delphi technique was used to develop an algorithm for an approach to treatment for older adults living with CLBP and dementia. A panel of content experts on pain and cognition in older adults developed the algorithm through an iterative process. Though developed using resources available within Veterans Health Administration (VHA) facilities, the algorithm is applicable across all health care settings. A case taken from the clinical practice of one of the contributors demonstrates application of the algorithm. RESULTS We present an evidence-based algorithm and biopsychosocial rationale to guide providers evaluating CLBP in older adults who may have dementia. The algorithm considers both subtle and overt signs of dementia, dementia screening tools to use in practice, referrals to appropriate providers for a complete a workup for dementia, and clinical considerations for persons with dementia who report pain and/or exhibit pain behaviors. A case of an older adult with CLBP and dementia is presented that highlights how an approach that considers the impact of dementia on verbal and nonverbal pain behaviors may lead to more appropriate and successful pain management. CONCLUSIONS Comprehensive pain evaluation for older adults in general and for those with CLBP in particular requires both a medical and a biopsychosocial approach that includes assessment of cognitive function. A positive screen for dementia may help explain why reported pain severity does not improve with usual or standard-of-care pain management interventions. Pain reporting in a person with dementia does not always necessitate pain treatment. Pain reporting in a person with dementia who also displays signs of pain-associated suffering requires concerted pain management efforts targeted to improving function while avoiding harm in these vulnerable patients.Key Words. Dementia; Chronic Pain; Low Back Pain; Lumbar; Primary Care.
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Affiliation(s)
| | - Monica Malec
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Joseph W Shega
- VITAS Healthcare, Miami, Florida
- University of Central Florida, Orlando, Florida
| | | | - Joseph Kulas
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Medicine New Haven, Connecticut
| | | | - Juleen Rodakowski
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences
| | - Todd Semla
- US Department of Veterans Affairs, National Pharmacy Benefits Management Services, Hines, Illinois
- Departments of Psychiatry
- Behavioral Sciences, Northwestern University, Chicago, Illinois
| | - Debra K Weiner
- Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of Geriatric Medicine
- Yale School of Medicine New Haven, Connecticut
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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29
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Karp JF, DiNapoli EA, Wetherell J, Bolon C, Rodriguez E, Shega J, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult—Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IX: Anxiety. Pain Med 2016; 17:1423-35. [DOI: 10.1093/pm/pnw135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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30
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Rho M, Camacho-Soto A, Cheng A, Havran M, Morone NE, Rodriguez E, Shega J, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VIII: Lateral Hip and Thigh Pain. ACTA ACUST UNITED AC 2016; 17:1249-1260. [PMID: 27330155 PMCID: PMC7289330 DOI: 10.1093/pm/pnw111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective. This article presents an evidence-based algorithm to assist primary care providers with the diagnosis and management of lateral hip and thigh pain in older adults. It is part of a series that focuses on coexisting pain patterns and contributors to chronic low back pain (CLBP) in the aging population. The objective of the series is to encourage clinicians to take a holistic approach when evaluating and treating CLBP in older adults. Methods. A content expert panel and a primary care panel collaboratively used the modified Delphi approach to iteratively develop an evidence-based diagnostic and treatment algorithm. The panelists included physiatrists, geriatricians, internists, and physical therapists who treat both civilians and Veterans, and the algorithm was developed so that all required resources are available within the Veterans Health Administration system. An illustrative patient case was chosen from one of the author’s clinical practices to demonstrate the reasoning behind principles presented in the algorithm. Results. An algorithm was developed which logically outlines evidence-based diagnostic and therapeutic recommendations for lateral hip and thigh pain in older adults. A case is presented which highlights the potential complexities of identifying the true pain generator and the importance of implementing proper treatment. Conclusions. Lateral hip and thigh pain in older adults can contribute to and coexist with CLBP. Distinguishing the true cause(s) of pain from potentially a myriad of asymptomatic degenerative changes can be challenging, but a systematic approach can assist in identifying and treating some of the most common causes.
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Affiliation(s)
- Monica Rho
- *Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, Chicago, Illinois
| | | | - Abby Cheng
- *Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago/McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Mark Havran
- Extended Care & Rehab, VA Central Iowa Health Care Systems, Des Moines, Iowa.,Des Moines University, Des Moines, Iowa
| | - Natalia E Morone
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.,Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric Rodriguez
- **Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Debra K Weiner
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,**Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Psychiatry.,Department of Anesthesiology, Pittsburgh, Pennsylvania, USA
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31
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Karp JF, Dew MA, Wahed AS, Fitzgerald K, Bolon CA, Weiner DK, Morse JQ, Albert S, Butters M, Gildengers A, Reynolds CF. Challenges and Solutions for Depression Prevention Research: Methodology for a Depression Prevention Trial for Older Adults with Knee Arthritis and Emotional Distress. Am J Geriatr Psychiatry 2016; 24:433-43. [PMID: 26809601 PMCID: PMC4870147 DOI: 10.1016/j.jagp.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 10/19/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." METHODS A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. RESULTS At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. CONCLUSION A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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32
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Bramoweth AD, Renqvist JG, Germain A, Buysse DJ, Gentili A, Kochersberger G, Rodriguez E, Rossi MI, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult—Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part VII: Insomnia. Pain Medicine 2016; 17:851-63. [DOI: 10.1093/pm/pnw063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adam D Bramoweth
- Mental Illness Research, Education & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jenna G Renqvist
- Mental Illness Research, Education & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Gary Kochersberger
- VA Medical Center, Canandaigua, New York, USA
- Division of Geriatrics, University of Rochester, Rochester, New York, USA
| | - Eric Rodriguez
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle I Rossi
- Geriatric Research, Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Debra K Weiner
- Geriatric Research, Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Clinical and Translational Science Institute—University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA, USA
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Karp JF, McGovern J, Marron MM, Gerszten P, Weiner DK, Okonkwo D, Kanter AS. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study. Pain Manag 2016; 6:543-552. [PMID: 27102978 DOI: 10.2217/pmt.16.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. MATERIALS & METHODS Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. RESULTS Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. CONCLUSION Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.
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Affiliation(s)
- Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Geriatric Research Education & Clinical Center (GRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jonathan McGovern
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan M Marron
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Peter Gerszten
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Debra K Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Geriatric Research Education & Clinical Center (GRECC) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Morone NE, Greco CM, Moore CG, Rollman BL, Lane B, Morrow LA, Glynn NW, Weiner DK. A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:329-37. [PMID: 26903081 PMCID: PMC6361386 DOI: 10.1001/jamainternmed.2015.8033] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed. OBJECTIVE To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP. DESIGN, SETTING, AND PARTICIPANTS This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015. INTERVENTIONS The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the "10 Keys" to Healthy Aging. MAIN OUTCOMES AND MEASURES Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted. RESULTS Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional -1.1 (mean, 12.1 vs 13.1) points at 8 weeks and -0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, -0.23 and -0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional -1.8 points (95% CI, -3.1 to -0.05 points; effect size, -0.33) and -1.0 points (95% CI, -2.1 to 0.2 points; effect size, -0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (-0.1 [95% CI, -1.1 to 1.0] at 8 weeks and -1.1 [95% CI, -2.2 to -0.01] at 6 months; effect size, -0.01 and -0.22, respectively). CONCLUSIONS AND RELEVANCE A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01405716.
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Affiliation(s)
- Natalia E Morone
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsy
| | - Carol M Greco
- Department of Psychiatry, Center for Integrative Medicine at University of Pittsburgh Medical Center (UPMC), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Charity G Moore
- Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsy
| | - Bridget Lane
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa A Morrow
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Debra K Weiner
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania3Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania6Department of Ps
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Carley JA, Karp JF, Gentili A, Marcum ZA, Reid MC, Rodriguez E, Rossi MI, Shega J, Thielke S, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult: Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IV: Depression. Pain Med 2015; 16:2098-108. [PMID: 26539754 DOI: 10.1111/pme.12935] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression. METHODS The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice. RESULTS We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP. CONCLUSIONS Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented.
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Affiliation(s)
- Joseph A Carley
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.,Virginia Commonwealth University Health System, Richmond, VA, USA
| | | | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Eric Rodriguez
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michelle I Rossi
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,VA Pittsburgh Healthcare System, GRECC, Pittsburgh, PA, USA.,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Debra K Weiner
- Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.,Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on Research Standards for Chronic Low Back Pain. Int J Ther Massage Bodywork 2015; 8:16-33. [PMID: 26388962 PMCID: PMC4560531 DOI: 10.3822/ijtmb.v8i3.295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE A Task Force was convened by the NIH Pain Consortium, with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimal dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
| | | | | | | | | | | | | | - Roger Chou
- Oregon Health and Sciences University, Portland, OR
| | | | - Anthony DeLitto
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA
| | | | - Partap Khalsa
- National Center for Complementary and Alternative Medicine, Bethesda, MD
| | | | | | - James Panagis
- National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, MD
| | | | | | | | | | - Debra K. Weiner
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA
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Fatemi G, Fang MA, Breuer P, Cherniak PE, Gentili A, Hanlon JT, Karp JF, Morone NE, Rodriguez E, Rossi MI, Schmader K, Weiner DK. Deconstructing chronic low back pain in the older adult--Step by step evidence and expert-based recommendations for evaluation and treatment part III: Fibromyalgia syndrome. Pain Med 2015; 16:1709-19. [PMID: 26272644 DOI: 10.1111/pme.12863] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS). METHODS A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator. RESULTS Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS. CONCLUSIONS Recognition of FMS as a common contributor to CLBP in older adults and initiating treatment targeting both FMS and CLBP may lead to improved outcomes in pain and disability.
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Affiliation(s)
- Gita Fatemi
- VA Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine University of California Los Angeles, Los Angeles, California
| | - Meika A Fang
- VA Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine University of California Los Angeles, Los Angeles, California
| | - Paula Breuer
- University of Pittsburgh Medical Center, Centers for Rehab Services, Pittsburgh, Pennsylvania
| | - Paul E Cherniak
- Division of Geriatrics and Palliative Medicine, University of Miami Miller School of Medicine, Miami, Florida.,Bruce W. Carter Miami VA Medical Center, Miami, Florida
| | - Angela Gentili
- Virginia Commonwealth University Health System, Richmond, Virginia.,Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Joseph T Hanlon
- Departments of Geriatric Medicine.,Pharmacy and Therapeutics, School of Pharmacy.,Epidemiology, School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion at the VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natalia E Morone
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric Rodriguez
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michelle I Rossi
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kenneth Schmader
- GRECC, Durham VA Medical Center, Durham, North Carolina.,Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina
| | - Debra K Weiner
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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38
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Lisi AJ, Breuer P, Gallagher RM, Rodriguez E, Rossi MI, Schmader K, Scholten JD, Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part II: Myofascial Pain. Pain Med 2015; 16:1282-9. [DOI: 10.1111/pme.12821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/22/2015] [Accepted: 05/02/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Anthony J. Lisi
- VA Connecticut Healthcare System
- Rehabilitation and Prosthetics Services; Veterans Health Administration
- University of Bridgeport College of Chiropractic
| | - Paula Breuer
- University of Pittsburgh Medical Center Centers for Rehab Services
| | - Rollin M. Gallagher
- Departments of Psychiatry
- Department of Anesthesiology; University of Pennsylvania
- Pain Service; Philadelphia VA Medical Center
| | - Eric Rodriguez
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
| | - Michelle I. Rossi
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
- Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System
| | - Kenneth Schmader
- Durham VA Medical Center; GRECC
- Department of Medicine; Duke University Medical Center, Division of Geriatrics
| | - Joel D. Scholten
- Washington DC VA Medical Center
- Rehabilitation and Prosthetics Services; Veterans Health Administration
| | - Debra K. Weiner
- Division of Geriatric Medicine; Department of Medicine; University of Pittsburgh School of Medicine
- Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System
- Department of Psychiatry
- Anesthesiology
- Clinical and Translational Science Institute, University of Pittsburgh; Pittsburgh PA
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. Pain Med 2015; 15:1249-67. [PMID: 25132307 DOI: 10.1111/pme.12538] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific, and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. DESIGN Expert panel and preliminary evaluation of key recommendations. METHODS The NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. RESULTS The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSION The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document, and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- Oregon Health and Sciences University, Portland, Oregon, USA
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Weiner DK. Deconstructing Chronic Low Back Pain in the Older Adult: Shifting the Paradigm from the Spine to the Person. Pain Med 2015; 16:881-5. [DOI: 10.1111/pme.12759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weiner DK, Fang M, Gentili A, Kochersberger G, Marcum ZA, Rossi MI, Semla TP, Shega J. Deconstructing Chronic Low Back Pain in the Older Adult—Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part I: Hip Osteoarthritis. Pain Med 2015; 16:886-97. [DOI: 10.1111/pme.12757] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Malec M, Weiner DK, Shega JW. Optimal Pharmacologic Pain Management in the Older Adult: An Ongoing Quagmire. Pain Med 2015; 16:217-8. [DOI: 10.1111/pme.12653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, Delitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. Phys Ther 2015; 95:e1-e18. [PMID: 25639530 PMCID: PMC5396149 DOI: 10.2522/ptj.2015.95.2.e1] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- R.A. Deyo, MD, MPH, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Mail Code FM, Portland, Oregon.
| | | | | | | | | | | | - John Carrino
- J. Carrino, Johns Hopkins University, Baltimore, Maryland
| | - Roger Chou
- R. Chou, Oregon Health and Sciences University
| | - Karon Cook
- K. Cook, Northwestern University, Evanston, Illinois
| | - Anthony Delitto
- A. Delitto, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Partap Khalsa
- P. Khalsa, National Center for Complementary and Alternative Medicine, Bethesda, Maryland
| | | | | | - James Panagis
- J. Panagis, National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - James Rainville
- J. Rainville, New England Baptist Hospital, Roxbury Crossing, Massachusetts
| | - Tor Tosteson
- T. Tosteson, Dartmouth University, Hanover, New Hampshire
| | | | | | - Debra K Weiner
- D.K. Weiner, VA Pittsburgh Healthcare System and University of Pittsburgh
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Toto PE, Skidmore ER, Terhorst L, Rosen J, Weiner DK. Goal Attainment Scaling (GAS) in geriatric primary care: a feasibility study. Arch Gerontol Geriatr 2014; 60:16-21. [PMID: 25465505 DOI: 10.1016/j.archger.2014.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Evaluate the feasibility of generating patient-centered goals using GAS with older adults who have multiple chronic conditions, recruited through primary care. METHOD Adults age 65+ (N=27) were recruited from a geriatric primary care center. Participants were asked to identify 2-4 activity-based goals and set attainment levels using GAS. At 8 weeks, participants were asked to rate current level of their goal performance. Physician surveys were used to evaluate if goals were realistic and feasible, and patient surveys were implemented to evaluate satisfaction. GAS T-scores were used to quantify change in goal achievement. RESULTS Ninety-three percent (n=25) of participants were able to establish a minimum of two goals using GAS. 100% of participants were able to rate goal performance at follow-up. Physician survey results identified 100% of goals realistic and 93% achievable and 100% of participants were either neutral or satisfied with the process. Significant improvement was reported in GAS change scores (t(24)=6.54, p<0.001). CONCLUSION Findings support the feasibility of GAS for older adults with multiple chronic conditions in geriatric primary care as a strategy to facilitate patient-centered care and suggest that the process of personalized goal-setting itself may facilitate goal attainment.
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Affiliation(s)
- Pamela E Toto
- Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA.
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Jules Rosen
- School of Medicine, University of Pittsburgh M240 Scaife Hall 3550 Terrace Street Pittsburgh, PA 15261, USA
| | - Debra K Weiner
- Geriatric Research, Education and Clinical Center - VA Pittsburgh Healthcare System, 3950 Allequippa Street, Pittsburgh, PA 15261, USA; School of Medicine and Clinical & Translational Science Institute, University of Pittsburgh, USA
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Morone NE, Abebe KZ, Morrow LA, Weiner DK. Pain and Decreased Cognitive Function Negatively Impact Physical Functioning in Older Adults with Knee Osteoarthritis. Pain Med 2014; 15:1481-7. [DOI: 10.1111/pme.12483] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the National Institutes of Health task force on research standards for chronic low back pain. J Manipulative Physiol Ther 2014; 37:449-67. [PMID: 25127996 DOI: 10.1016/j.jmpt.2014.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed nonspecific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. The purpose of this article is to disseminate the report of the National Institutes of Health (NIH) task force on research standards for cLBP. METHODS The NIH Pain Consortium charged a research task force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting. RESULTS The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimal data set to describe research subjects (drawing heavily on the Patient Reported Outcomes Measurement Information System methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved these recommendations, which investigators should incorporate into NIH grant proposals. CONCLUSIONS The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of cLBP. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect the RTF recommendations will become a dynamic document and undergo continual improvement.
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Affiliation(s)
- Richard A Deyo
- Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Medicine, Oregon Health & Science University, Portland, OR; Professor, Department of Public Health & Community Medicine, Oregon Health & Science University, Portland, OR.
| | - Samuel F Dworkin
- Professor, Department of Oral Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Dagmar Amtmann
- Research Associate Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Gunnar Andersson
- Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - David Borenstein
- Clinical Professor, Department of Medicine, George Washington University Medical Center, Washington, DC
| | - Eugene Carragee
- Professor, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - John Carrino
- Associate Professor, Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Roger Chou
- Professor, Department of Medicine, Oregon Health and Science University, Portland, OR; Professor, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| | - Karon Cook
- Research Associate Professor, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony DeLitto
- Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Christine Goertz
- Vice Chancellor of Research & Health Policy, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA
| | - Partap Khalsa
- Deputy Director, National Institutes of Health, Division of Extramural Research, National Center for Complementary and Alternative Medicine, Bethesda, MD
| | - John Loeser
- Professor Emeritus, Department of Neurological Surgery, University of Washington, Seattle, WA; Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Sean Mackey
- Professor, Department of Anesthesia and Pain Management, Stanford University, Stanford, CA
| | - James Panagis
- Program Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Orthopaedics Research Program, Bethesda, MD
| | - James Rainville
- Chief, Department of Physical Medicine and Rehabilitation, New England Baptist Hospital, Roxbury Crossing, MA
| | - Tor Tosteson
- Professor, Department of Community and Family Medicine and The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Dennis Turk
- Professor Emeritus, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | | | - Debra K Weiner
- Professor, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Professor, Department of Anesthesiology; University of Pittsburgh, Pittsburgh, PA. Geriatric Research, Educational and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Marcum ZA, Zhan HL, Perera S, Moore CG, Fitzgerald GK, Weiner DK. Correlates of Gait Speed in Advanced Knee Osteoarthritis. Pain Med 2014; 15:1334-42. [DOI: 10.1111/pme.12478] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D, Carragee E, Carrino J, Chou R, Cook K, DeLitto A, Goertz C, Khalsa P, Loeser J, Mackey S, Panagis J, Rainville J, Tosteson T, Turk D, Von Korff M, Weiner DK. Report of the NIH Task Force on research standards for chronic low back pain. J Pain 2014; 15:569-85. [PMID: 24787228 PMCID: PMC4128347 DOI: 10.1016/j.jpain.2014.03.005] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/24/2014] [Accepted: 03/12/2014] [Indexed: 12/18/2022]
Abstract
UNLABELLED Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement. PERSPECTIVE A task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.
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Affiliation(s)
- Richard A Deyo
- Oregon Health and Sciences University, Portland, Oregon.
| | | | | | | | | | | | | | - Roger Chou
- Oregon Health and Sciences University, Portland, Oregon
| | - Karon Cook
- Northwestern University, Evanston, Illinois
| | - Anthony DeLitto
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Partap Khalsa
- National Center for Complementary and Alternative Medicine, Bethesda, Maryland
| | - John Loeser
- University of Washington, Seattle, Washington
| | | | - James Panagis
- National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - James Rainville
- New England Baptist Hospital, Roxbury Crossing, Massachusetts
| | | | - Dennis Turk
- University of Washington, Seattle, Washington
| | | | - Debra K Weiner
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania
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Weiner DK, Morone NE, Spallek H, Karp JF, Schneider M, Washburn C, Dziabiak MP, Hennon JG, Elnicki DM. E-learning module on chronic low back pain in older adults: evidence of effect on medical student objective structured clinical examination performance. J Am Geriatr Soc 2014; 62:1161-7. [PMID: 24833496 DOI: 10.1111/jgs.12871] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e-learning case-based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health-designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty-eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P < .001). Using an OSCE pass-fail cutoff score of 60%, 17 of 28 Group 1 students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between-group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e-learning modules on more-advanced learners and on improving the care of older adults with CLBP.
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Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Shega JW, Andrew M, Kotwal A, Lau DT, Herr K, Ersek M, Weiner DK, Chin MH, Dale W. Relationship between persistent pain and 5-year mortality: a population-based prospective cohort study. J Am Geriatr Soc 2013; 61:2135-2141. [PMID: 24320761 PMCID: PMC4140782 DOI: 10.1111/jgs.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the association between self-reported noncancer pain and 5-year mortality. DESIGN Cohort. SETTING Community-dwelling older adults. PARTICIPANTS Canadian Study of Health and Aging 1996 wave. MEASUREMENTS Registrar of Vital Statistics-established 5-year mortality. Noncancer pain was assessed using the 5-point verbal descriptor scale, dichotomized into no or very mild versus moderate, severe, or very severe pain. Frailty was the accumulation of health deficits. Cognitive status (Modified Mini-Mental State Examination) and depressed mood (five-item mental health screening questionnaire) were also assessed. Multivariable logistic regression and Cox proportional hazards were used to analyze the relationship between pain and 5-year mortality. RESULTS Of 5,703 participants, 4,694 (82.3%) had complete data for analysis; 1,663 of these (35.4%) reported moderate, severe, or very severe pain, and 1,343 (28.6%) had died at 5-year follow-up. Four hundred ninety-six of those who died (29.8%) reported moderate, severe, or very severe pain and 847 (27.9%) no or very mild pain. Multivariate logistic analysis found that individuals with moderate, severe, or very severe pain had lower odds of 5-year mortality than those with no or very mild pain (odds ratio=0.78, 95% confidence interval (CI)=0.66-0.92; P<.001). The risk of death was lower in persons reporting moderate or greater pain than in those with no or very mild pain (HR=0.85, 95% CI=0.75-0.96; P=.01). An interaction between pain and sex explained this effect. Men with pain were not significantly more likely than men without pain to die (HR=1.00, 95% CI=0.84-1.19; P=.99), whereas women without pain (HR=0.54, 95% CI=0.47-0.63; P<0.01) and women with pain (HR=0.40; CI=0.33-0.47; P<.01) had less risk of death than men without and with pain, respectively. CONCLUSION Older women with pain were less likely to die within 5 years than older women without pain, men in pain, or men without pain.
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Affiliation(s)
- Joseph W. Shega
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashwin Kotwal
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Denys T. Lau
- Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Mary Ersek
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Debra K. Weiner
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennslvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennslvania
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennslvania
| | - Marshall H. Chin
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
- Section of Hematology and Oncology, University of Chicago, Chicago, Illinois
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