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McConnell R, Lane E, Webb G, LaPeze D, Grillo H, Fritz J. A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain. Ann Med 2024; 56:2311846. [PMID: 38354690 PMCID: PMC10868420 DOI: 10.1080/07853890.2024.2311846] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a highly prevalent condition among adults and is correlated to high levels of pain, high disability, and lower quality of life. Pain neuroscience education (PNE) helps to explain the pain experience and can affect psychosocial factors, such as fear of movement, anxiety, socioeconomic status, work life satisfaction, etc. More recently, virtual reality (VR) programs have emerged allowing for immersive PNE experiences. OBJECTIVE The purpose of this randomized clinical trial is to determine the feasibility of using a VR application for the delivery of immersive PNE (VR-PNE) and other activity training for patients with CLBP presenting to outpatient physical therapy (PT) clinics. METHODS A two-arm, parallel group, randomized controlled feasibility trial of patients was conducted at 12 outpatient PT clinics from March 9, 2022, through September 9, 2022. The intervention group received PT as usual and VR-PNE while the control group received PT as usual. Between group feasibility, acceptability outcomes and other patient-reported outcomes were assessed at six weeks. RESULTS A total of 595 individuals were evaluated for low back pain during the recruitment period. Seventy individuals were eligible and met definition for CLBP, 52 enrolled and 32 completed the trial. Participant adherence was 63.6% for VR-PNE and 63.2% for PT as usual. Participants found VR-PNE acceptable and reported satisfaction scores (0-100) of 87.37 ± 11.05 compared to 81.17 ± 23.72 in the PT as usual group. There were no significant differences between groups for the BBQ, BRS, FABQ-PA, FABQ-W, GROC, NPRS, NPQ, PCS, and PSEQ at 6 weeks. CONCLUSION The results of the trial suggest that VR-PNE may be acceptable and feasible for patients with CLBP. Study procedures and PT delivery modifications should be considered for the next iteration of this study to improve follow-up assessment rates.
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Affiliation(s)
- Ryan McConnell
- Department of Physical Therapy, Belmont University, Nashville, TN, USA
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | | | - Grace Webb
- Benchmark Physical Therapy, Chattanooga, TN, USA
| | - Dana LaPeze
- Benchmark Physical Therapy, Chattanooga, TN, USA
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2
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Qiu X, Yang Y, Da X, Wang Y, Chen Z, Xu C. Satellite glial cells in sensory ganglia play a wider role in chronic pain via multiple mechanisms. Neural Regen Res 2024; 19:1056-1063. [PMID: 37862208 PMCID: PMC10749601 DOI: 10.4103/1673-5374.382986] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/26/2023] [Accepted: 07/10/2023] [Indexed: 10/22/2023] Open
Abstract
Satellite glial cells are unique glial cells that surround the cell body of primary sensory neurons. An increasing body of evidence suggests that in the presence of inflammation and nerve damage, a significant number of satellite glial cells become activated, thus triggering a series of functional changes. This suggests that satellite glial cells are closely related to the occurrence of chronic pain. In this review, we first summarize the morphological structure, molecular markers, and physiological functions of satellite glial cells. Then, we clarify the multiple key roles of satellite glial cells in chronic pain, including gap junction hemichannel Cx43, membrane channel Pannexin1, K channel subunit 4.1, ATP, purinergic P2 receptors, and a series of additional factors and their receptors, including tumor necrosis factor, glutamate, endothelin, and bradykinin. Finally, we propose that future research should focus on the specific sorting of satellite glial cells, and identify genomic differences between physiological and pathological conditions. This review provides an important perspective for clarifying mechanisms underlying the peripheral regulation of chronic pain and will facilitate the formulation of new treatment plans for chronic pain.
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Affiliation(s)
- Xiaoyun Qiu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yuanzhi Yang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Xiaoli Da
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
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Hoffman KL, Milazzo F, Williams NT, Samples H, Olfson M, Diaz I, Doan L, Cerda M, Crystal S, Rudolph KE. Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients. Psychol Med 2024; 54:1419-1430. [PMID: 37974483 PMCID: PMC10994776 DOI: 10.1017/s003329172300332x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain. METHODS Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019). RESULTS We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk. CONCLUSIONS These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.
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Affiliation(s)
- Katherine L. Hoffman
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Floriana Milazzo
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Nicholas T. Williams
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | | | - Mark Olfson
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Ivan Diaz
- New York University Grossman School of Medicine
| | - Lisa Doan
- New York University Grossman School of Medicine
| | | | | | - Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University
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Kitschen A, Wahidie D, Meyer D, Rau LM, Ruhe AK, Wager J, Zernikow B, Sauerland D. Cost-of-illness and Economic Evaluation of Interventions in Children and Adolescents With Chronic Pain: A Systematic Review. Clin J Pain 2024; 40:306-319. [PMID: 38268231 PMCID: PMC11005676 DOI: 10.1097/ajp.0000000000001199] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES Chronic pain in children and adolescents (CPCA) is widespread with an increasing prevalence. It is associated with a decreased quality of life and an increased parental work loss. Accordingly, CPCA may pose a substantial economic burden for patients, health care payers, and society. Therefore, this systematic review aimed to synthesize (1) the results of existing cost-of-illness studies (COIs) for CPCA and (2) the evidence of economic evaluations (EEs) of interventions for CPCA. METHODS The systematic literature search was conducted in EMBASE, MEDLINE, PsycINFO, NHS EED, and HTA Database until February 2023. Title, abstract, and full-text screening were conducted by 2 researchers. Original articles reporting costs related to CPCA published in English or German were included. Study characteristics, cost components, and costs were extracted. The quality of studies was assessed using standardized tools. All costs were adjusted to 2020 purchasing power parity US dollars (PPP-USD). RESULTS Fifteen COIs and 10 EEs were included. The mean annual direct costs of CPCA ranged from PPP-USD 603 to PPP-USD 16,271, with outpatient services accounting for the largest share. The mean annual indirect costs ranged from PPP-USD 92 to PPP-USD 12,721. All EEs reported a decrease in overall costs in treated patients. DISCUSSION The methodology across studies was heterogeneous limiting the comparability. However, it is concluded that CPCA is associated with high overall costs, which were reduced in all EEs. From a health-economic perspective, efforts should address the prevention and early detection of CPCA followed by specialized pain treatment.
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Affiliation(s)
- Anne Kitschen
- Chair for Institutional Economics and Health Policy, Department of Philosophy, Politics and Economics
| | - Diana Wahidie
- Department for Human Medicine, Health Services Research, Faculty of Health
| | - Dorothee Meyer
- Department of Children´s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute
| | - Lisa-Marie Rau
- Department of Children´s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
| | - Ann-Kristin Ruhe
- Department of Children´s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
| | - Julia Wager
- Department of Children´s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
| | - Boris Zernikow
- Department of Children´s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
| | - Dirk Sauerland
- Chair for Institutional Economics and Health Policy, Department of Philosophy, Politics and Economics
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Bergmans RS, Clauw DJ, Flint C, Harris H, Lederman S, Schrepf A. Chronic overlapping pain conditions increase the risk of long COVID features, regardless of acute COVID status. Pain 2024; 165:1112-1120. [PMID: 38112577 PMCID: PMC11017744 DOI: 10.1097/j.pain.0000000000003110] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Chronic overlapping pain conditions (COPCs) refer to conditions that have similar central nervous system pathophysiologic mechanisms driving widespread pain as well as common comorbid symptoms such as fatigue and problems with sleep, memory, and mood. If COPCs predict the onset of long COVID, this could offer a valuable orientation for long COVID-related research and clinical care. This retrospective cohort study aimed to determine whether having a COPC predicts the onset of long COVID features using US electronic health records and 1:1 propensity score matching without replacement. The study cohorts included (1) people with acute COVID (n = 1,038,402), (2) people with acute influenza (n = 262,092), and (3) a noninfected cohort comprising people with a routine healthcare encounter (n = 1,081,593). Having a COPC increased the risk of long COVID features in all 3 study cohorts. Among those with COVID, having a pre-existing COPC increased the risk by 1.47 (95% CI = 1.46, 1.47). In the influenza cohort, COPCs increased the risk by 1.39 (95% CI = 1.38, 1.40). In the noninfected cohort, COPCs increased the risk by 1.57 (95% CI = 1.56, 1.59). These findings reinforce the likelihood that nociplastic mechanisms play a prominent role in long COVID. Recognizing that this ubiquitous nonspecific syndrome occurs frequently in the population can inform precision medicine therapies that avoid the pitfalls of viewing long COVID exclusively in the framework of postinfectious disease.
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Affiliation(s)
- Rachel S. Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Herb Harris
- Tonix Pharmaceuticals, Chatham, NJ, United States
| | | | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
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Rogers AH, Smit T, Bakhshaie J, Zvolensky MJ. Momentary Emotion Regulation Strategies and Pain Experience Among Adults With Chronic Pain: An Ecological Momentary Assessment Study. Clin J Pain 2024; 40:269-277. [PMID: 38345471 PMCID: PMC11015978 DOI: 10.1097/ajp.0000000000001206] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES The intention of this study was to characterize the real-time momentary relationship between emotion regulation strategies and the pain experience (ie intensity, interference, and negative affect) among adults with chronic pain. Chronic pain is a significant public health concern. Psychological treatments are effective for treating chronic pain, but long-term follow-up studies are limited, and treatment effect sizes are small. Identifying modifiable treatment targets, such as emotion regulation (ER), is critical to improve interventions. ER (ie, cognitive and attentional strategies to modulate or maintain emotional experience) has been linked to psychopathology and pain experience in adults. Yet, the existing work is limited and has largely focused on the relationship between emotional experience, not ER, and pain. MATERIALS AND METHODS The current study utilized ecological momentary assessment 53 adults with chronic pain. Participants completed ecological momentary assessments of pain experience and ER strategies 5 times a day for 7 days. Associations by specific strategy type were also examined, highlighting the importance of worry, experiential avoidance, rumination, and expressive suppression in pain experience. RESULTS Results of the current study provide evidence for the association between within-person maladaptive ER strategies and pain intensity ( b = 2.11, SE = 0.37, P < 0.001), pain interference ( b = 1.25, SE = 0.40, P = 0.002), and pain-related negative affect ( b = 2.20, SE = 0.41, P < 0.001). (77.4% females; M age = 27.10 y, SD = 5.16 y). DISCUSSION Given that ER is readily targeted in psychological treatments for chronic pain, the results from the current study provide initial evidence to target these ER strategies in treatment.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA
| | | | - Jafar Bakhshaie
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Michael J Zvolensky
- Department of Psychology
- HEALTH Institute, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Alomari A, Bhatia A. An update on radiofrequency denervation for arthritis-related knee joint pain: a synthesis of the current evidence. BJA Educ 2024; 24:164-172. [PMID: 38646452 PMCID: PMC11026924 DOI: 10.1016/j.bjae.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
- Abeer Alomari
- Toronto Western Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Anuj Bhatia
- Toronto Western Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, Toronto, ON, Canada
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Su TF, Hamilton JD, Guo Y, Potas JR, Shivdasani MN, Moalem-Taylor G, Fridman GY, Aplin FP. Peripheral direct current reduces naturally evoked nociceptive activity at the spinal cord in rodent models of pain. J Neural Eng 2024; 21:026044. [PMID: 38579742 DOI: 10.1088/1741-2552/ad3b6c] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 04/05/2024] [Indexed: 04/07/2024]
Abstract
Objective.Electrical neuromodulation is an established non-pharmacological treatment for chronic pain. However, existing devices using pulsatile stimulation typically inhibit pain pathways indirectly and are not suitable for all types of chronic pain. Direct current (DC) stimulation is a recently developed technology which affects small-diameter fibres more strongly than pulsatile stimulation. Since nociceptors are predominantly small-diameter Aδand C fibres, we investigated if this property could be applied to preferentially reduce nociceptive signalling.Approach.We applied a DC waveform to the sciatic nerve in rats of both sexes and recorded multi-unit spinal activity evoked at the hindpaw using various natural stimuli corresponding to different sensory modalities rather than broad-spectrum electrical stimulus. To determine if DC neuromodulation is effective across different types of chronic pain, tests were performed in models of neuropathic and inflammatory pain.Main results.We found that in both pain models tested, DC application reduced responses evoked by noxious stimuli, as well as tactile-evoked responses which we suggest may be involved in allodynia. Different spinal activity of different modalities were reduced in naïve animals compared to the pain models, indicating that physiological changes such as those mediated by disease states could play a larger role than previously thought in determining neuromodulation outcomes.Significance.Our findings support the continued development of DC neuromodulation as a method for reduction of nociceptive signalling, and suggests that it may be effective at treating a broader range of aberrant pain conditions than existing devices.
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Affiliation(s)
- Tom F Su
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Jack D Hamilton
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Yiru Guo
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason R Potas
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Eccles Institute, John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mohit N Shivdasani
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Gila Moalem-Taylor
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Gene Y Fridman
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Felix P Aplin
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Li YD, Luo YJ, Su WK, Ge J, Crowther A, Chen ZK, Wang L, Lazarus M, Liu ZL, Qu WM, Huang ZL. Anterior cingulate cortex projections to the dorsal medial striatum underlie insomnia associated with chronic pain. Neuron 2024; 112:1328-1341.e4. [PMID: 38354737 DOI: 10.1016/j.neuron.2024.01.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/29/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
Chronic pain often leads to the development of sleep disturbances. However, the precise neural circuit mechanisms responsible for sleep disorders in chronic pain have remained largely unknown. Here, we present compelling evidence that hyperactivity of pyramidal neurons (PNs) in the anterior cingulate cortex (ACC) drives insomnia in a mouse model of nerve-injury-induced chronic pain. After nerve injury, ACC PNs displayed spontaneous hyperactivity selectively in periods of insomnia. We then show that ACC PNs were both necessary for developing chronic-pain-induced insomnia and sufficient to mimic sleep loss in naive mice. Importantly, combining optogenetics and electrophysiological recordings, we found that the ACC projection to the dorsal medial striatum (DMS) underlies chronic-pain-induced insomnia through enhanced activity and plasticity of ACC-DMS dopamine D1R neuron synapses. Our findings shed light on the pivotal role of ACC PNs in developing chronic-pain-induced sleep disorders.
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Affiliation(s)
- Ya-Dong Li
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Songjiang Research Institute, Songjiang Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Emotions and Affective Disorders (LEAD), Shanghai 201699, China.
| | - Yan-Jia Luo
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wei-Kun Su
- Songjiang Research Institute, Songjiang Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Emotions and Affective Disorders (LEAD), Shanghai 201699, China
| | - Jing Ge
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Andrew Crowther
- Department of Anatomy, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ze-Ka Chen
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lu Wang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Michael Lazarus
- International Institute for Integrative Sleep Medicine (WPI-IIIS) and Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Zi-Long Liu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Wei-Min Qu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, and Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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10
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Sucu Çakmak NC, Çalışkan N, Koğar H. Validity and reliability study in undergraduate healthcare students towards the solution of a neglected problem in working life: Attitude scale towards patients with chronic pain. Work 2024:WOR230512. [PMID: 38640186 DOI: 10.3233/wor-230512] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Chronic pain is the type of pain that healthcare professionals frequently encounter. Health care students' attitudes towards pain management are not sufficient and this negatively affects their chronic pain management. When students cannot manage the chronic pain they will experience professional burnout, depersonalization, and a decrease in compassion and empathy in patient care. Therefore, the first step in improving health care students' attitudes towards patients with chronic pain is to determine their attitudes. OBJECTIVE This study aims to test the validity and reliability of the Scale for Healthcare Professionals' Attitudes towards Patients with Chronic Pain (HCPAPCP Scale) in healthcare students. METHOD This quantitative study was conducted with 205 health care students in January-February 2022. Data were collected online with Personal Information Form and the HCPAPCP Scale. To determine the reliability of the scale, internal consistency and test-retest, and for construct validity, exploratory factor analysis and confirmatory factor analysis were performed. RESULTS The results of the exploratory factor analysis showed that the two-factor scale consisting of 18 items, the factor structure, and the distribution of factors in items were the same as the findings of the original scale. The Cronbach's Alpha coefficient was 0.88 for the first factor and 0.74 for the second factor. Test-retest reliability was 0.60. In confirmatory factor analysis, the model had a good and acceptable fit. CONCLUSION We found that the HCPAPCP Scale was valid and reliable in healthcare students.
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Affiliation(s)
- Nefise Cevriye Sucu Çakmak
- Çankırı Karatekin University, Eldivan Vocational School of Health Services, Department of Medical Services and Techniques, Çankırı, Türkiye
| | - Nurcan Çalışkan
- Gazi University Faculty of Nursing, Department of Nursing. Ankara, Türkiye
| | - Hakan Koğar
- Akdeniz University, Faculty of Education, Educational Sciences, Department of Educational Measurement and Assesment, Antalya, Türkiye
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Greer M, Kamma S, Tran H, Etumuse B, Shah JD, El-Abed Y, Onyemachi JO, Hussain N, Pittelkow TP, D’Souza RS. Misinformation Persists in Complementary Health: Evaluating the Reliability and Quality of YouTube-Based Information on the Use of Acupuncture for Chronic Pain. J Pain Res 2024; 17:1509-1518. [PMID: 38646592 PMCID: PMC11032134 DOI: 10.2147/jpr.s459475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Acupuncture is commonly used to treat chronic pain. Patients often access public social media platforms for healthcare information when querying acupuncture. Our study aims to appraise the utility, accuracy, and quality of information available on YouTube, a popular social media platform, on acupuncture for chronic pain treatment. Methods Using search terms such as "acupuncture for chronic pain" and "acupuncture pain relief", the top 54 videos by view count were selected. Included videos were >1 minute duration, contained audio in English, had >7000 views, and was related to acupuncture. One primary outcome of interest was categorizing each video's usefulness as useful, misleading, or neither. Another primary outcome of interest was the quality and reliability of each video using validated instruments, including the modified DISCERN (mDISCERN) tool and the Global Quality Scale (GQS). The means were calculated for the video production characteristics, production sources, and mDISCERN and GQS scores. Continuous and categorical outcomes were compared using Student's t-test and chi-square test, respectively. Results Of the 54 videos, 57.4% were categorized as useful, 14.8% were misleading, and 27.8% were neither. Useful videos had a mean GQS and mDISCERN score of 3.77±0.67 and 3.48±0.63, respectively, while misleading videos had mean GQS and mDISCERN score of 2.50±0.53 and 2.38±0.52, respectively. 41.8% of the useful videos were produced by a healthcare institution while none of the misleading videos were produced by a healthcare institution. However, 87.5% of the misleading videos were produced by health media compared to only 25.8% of useful videos from health media. Discussion As patients increasingly depend on platforms like YouTube for trustworthy information on complementary health practices such as acupuncture, our study emphasizes the critical need for more higher-quality videos from unbiased healthcare institutions and physicians to ensure patients are receiving reliable information regarding this topic.
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Affiliation(s)
- Majesty Greer
- Howard University College of Medicine, Washington, DC, USA
| | - Sai Kamma
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Henry Tran
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Bright Etumuse
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Jay D Shah
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Youshaa El-Abed
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Jane O Onyemachi
- University of Texas Medical Branch School of Medicine, Galveston, TX, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas P Pittelkow
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Nah S, Martire LM, Felt JM. Effects of Receiving Pain-Related Support on Psychological Well-Being: The Moderating Roles of Emotional Responses to Support. J Aging Health 2024:8982643241247248. [PMID: 38619011 DOI: 10.1177/08982643241247248] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We investigated whether receiving greater pain-related instrumental support is associated with poorer psychological well-being among chronic pain patients who report less positive (e.g., grateful) or more negative (e.g., angry) emotional responses to support. METHODS We conducted regression analyses, utilizing data from two waves of interviews with 152 knee osteoarthritis patients. Three indicators of psychological well-being were examined: depressive symptoms, positive affect, and negative affect. RESULTS Receiving greater support was associated with poorer psychological well-being at baseline, as well as higher depressive symptoms and negative affect at the 18-month follow-up, only among patients with low positive emotional responses to support. Furthermore, receiving greater support was related to poorer psychological well-being at baseline only among patients with high negative emotional responses to support. DISCUSSION Care recipients' less positive emotional responses to support may be a risk factor for poorer psychological well-being in both the short- and long-term, when receiving greater support.
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Affiliation(s)
- Suyoung Nah
- Center for Gerontology, Virginia Tech, Blacksburg, VA, USA
| | - Lynn M Martire
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - John M Felt
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA
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13
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Rogers AH, Neighbors C, Derrick JL, Zvolensky MJ. Development of a Personalized Feedback Intervention Targeting Pain-Related Anxiety for Adults Reporting Hazardous Drinking and Chronic Pain: A Randomized Controlled Trial. J Stud Alcohol Drugs 2024. [PMID: 38619311 DOI: 10.15288/jsad.23-00359] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
OBJECTIVE Among individuals with chronic pain, the rate of hazardous alcohol use is elevated compared to the general population. Yet, hazardous drinkers with chronic pain remain an underserved group. There is a need to develop and test alternative and complementary interventions to reduce hazardous alcohol use among this high-risk segment of the general population; targeting pain-related anxiety, a candidate mechanism, is one theoretically-informed route. METHOD Our approach followed a staged model (1a/1b) to develop and test a novel personalized feedback intervention (PFI). Phase 1A collected qualitative feedback from (N = 9; 77.8% female, Mage = 33.86, SD = 8.75) participants to refine intervention content and evaluate treatment acceptability and feasibility. For phase 1B, individuals (N=118; 57.3% male, Mage = 35.24, SD = 11.90) participated in a pilot randomized clinical trial for our novel PFI compared to a health information control condition on alcohol use, intention/motivation to reduce drinking, pain-related anxiety, and expectancies for alcohol analgesia/pain coping for hazardous drinkers with chronic pain. RESULTS Phase 1a results provided support for the feasibility of using a PFI to target pain-related anxiety, and results from Phase 1b indicated that participants reduced drinking and primary outcomes changed in the expected directions, but there were no differential effects of the intervention. CONCLUSIONS The current data provide preliminary evidence for the utility of computer-based brief interventions to encourage behavior change. However, further refinement of the intervention to target pain-related anxiety is warranted.
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Affiliation(s)
- Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA
| | | | - Jaye L Derrick
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Sayed D, Deer TR, Hagedorn JM, Sayed A, D’Souza RS, Lam CM, Khatri N, Hussaini Z, Pritzlaff SG, Abdullah NM, Tieppo Francio V, Falowski SM, Ibrahim YM, Malinowski MN, Budwany RR, Strand NH, Sochacki KM, Shah A, Dunn TM, Nasseri M, Lee DW, Kapural L, Bedder MD, Petersen EA, Amirdelfan K, Schatman ME, Grider JS. A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET. J Pain Res 2024; 17:1461-1501. [PMID: 38633823 PMCID: PMC11022879 DOI: 10.2147/jpr.s451006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN. Objective The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process. Results After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria. Conclusion The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Ray Deer
- Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Asim Sayed
- Podiatry/Surgery, Susan B. Allen Memorial Hospital, El Dorado, KS, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Nasir Khatri
- Interventional Pain Medicine, Novant Spine Specialists, Charlotte, NC, USA
| | - Zohra Hussaini
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Scott G Pritzlaff
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA
| | | | - Vinicius Tieppo Francio
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Yussr M Ibrahim
- Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | | | - Ryan R Budwany
- Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | - Kamil M Sochacki
- Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA
| | - Anuj Shah
- Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA
| | - Tyler M Dunn
- Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Morad Nasseri
- Interventional Pain Medicine / Neurology, Boomerang Healthcare, Walnut Creek, CA, USA
| | - David W Lee
- Pain Management Specialist, Fullerton Orthopedic, Fullerton, CA, USA
| | | | - Marshall David Bedder
- Chief of Pain Medicine Service, Augusta VAMC, Augusta, GA, USA
- Associate Professor and Director, Addiction Medicine Fellowship Program, Department Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kasra Amirdelfan
- Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Jay Samuel Grider
- Anesthesiology, Division of Pain Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
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15
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Licciardone JC, Van Alfen B, Digilio MN, Fowers R, Ballout B, Bibi Y, Aryal S. Impact of Shared Decision-Making on Opioid Prescribing Among Patients with Chronic Pain: A Retrospective Cohort Study. J Pain 2024:S1526-5900(24)00441-3. [PMID: 38615802 DOI: 10.1016/j.jpain.2024.03.018] [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] [Received: 01/08/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
Shared decision-making (SDM) involving patient and physician is a desirable goal that is recommended in chronic pain management guidelines. This study measured whether SDM affects opioid prescribing frequency for chronic low back pain. A retrospective cohort study involving 1478 participants was conducted within a national pain research registry. The patient participation and patient orientation (PPPO) scale of the Communication Behavior Questionnaire was used to measure SDM, including classification of greater SDM (PPPO scale score≥80) or lesser SDM (PPPO scale score<80). Opioid prescribing frequency was measured at quarterly intervals from enrollment through 12 months. Baseline and longitudinal covariates were collected to adjust for potential confounding using generalized estimating equations. The mean age of participants was 53.1 (SD, 13.2) years and 1098 (74.3%) were female. A total of 473 (32.0%) participants were prescribed opioids at baseline. Participants completed 5968 encounters wherein multivariable analyses demonstrated that PPPO scale scores were associated with more frequent opioid prescribing (β=0.013; 95% CI, 0.005 to 0.021; P<0.001). Greater SDM was associated with more frequent opioid prescribing than lesser SDM (β=0.441; 95% CI, 0.160 to 0.722; P=0.002). Opioids were prescribed in 34.3% vs. 25.2% of encounters with greater vs. lesser SDM (OR, 1.55; 95% CI, 1.17-2.06). SDM remained associated with more frequent opioid prescribing in a series of sensitivity analyses. Although SDM is desirable in chronic pain management, complex issues and challenging patient conversations may arise during serial assessments of the appropriateness of opioid therapy. Physicians need better education and training to address such difficult situations. PERSPECTIVE: The more frequent use of opioid therapy among patients who reported greater shared decision-making with their physicians underscores the need for better medical education and training in dealing with the complex issues and challenges pertaining to serial assessments of the appropriateness of opioid therapy for chronic pain.
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Affiliation(s)
| | | | | | | | | | - Yasser Bibi
- University of North Texas Health Science Center
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16
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Pahapill PA, Arocho-Quinones EV, Chen G, Swearingen B, Tomas CW, Koch KM, Nencka AS. Distinct Functional Connectivity Patterns for Intermittent Vs Constant Neuropathic Pain Phenotypes in Persistent Spinal Pain Syndrome Type 2 Patients. J Pain Res 2024; 17:1453-1460. [PMID: 38628431 PMCID: PMC11020324 DOI: 10.2147/jpr.s426640] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Background Chronic low back pain (cLBP) has been associated with alterations in brain functional connectivity (FC) but based upon heterogeneous populations and single network analyses. Our goal is to study a more homogeneous cLBP population and focus on multiple cross-network (CN) connectivity analysis. We hypothesize that within this population: 1) altered CN FC, involving emotion and reward/aversion functions are related to their pain levels and 2) altered relationships are dependent upon pain phenotype (constant neuropathic vs intermittent pain). Methods In this case series, resting state fcMRI scans were obtained over a study duration of 60 months from 23 patients (13 constant neuropathic and 10 intermittent pain) with Persistent Spinal Pain Syndrome (PSPS Type 2) being considered for spinal cord stimulation (SCS) therapy at a single academic center. Images were acquired using a Discovery MR750 GE scanner. During the resting state acquisitions, they were asked to close their eyes and relax. The CN analysis was performed on 7 brain networks and compared to age-matched controls. Linear regression was used to test the correlation between CN connectivity and pain scores. Results CN FC involving emotion networks (STM: striatum network index) was significantly lower than controls in all patients, regardless of pain phenotype (P < 0.003). Pain levels were positively correlated with emotional FC for intermittent pain but negatively correlated for constant pain. Conclusion This is the first report of 1) altered CN FC involving emotion/reward brain circuitry in 2) a homogeneous population of cLBP patients with 3) two different pain phenotypes (constant vs intermittent) in PSPS Type 2 patients being considered for SCS. FC patterns were altered in cLBP patients as compared to controls and were characteristic for each pain phenotype. These data support fcMRI as a potential and objective tool in assessing pain levels in cLBP patients with different pain phenotypes.
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Affiliation(s)
- Peter A Pahapill
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Guangyu Chen
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brad Swearingen
- Center for Neuroimaging, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carissa W Tomas
- Center for Neuroimaging, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin M Koch
- Center for Neuroimaging, Medical College of Wisconsin, Milwaukee, WI, USA
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17
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Bhowmick S, Graham RD, Verma N, Trevathan JK, Franke M, Nieuwoudt S, Fisher LE, Shoffstall AJ, Weber DJ, Ludwig KA, Lempka SF. Computational modeling of dorsal root ganglion stimulation using an Injectrode. J Neural Eng 2024; 21:026039. [PMID: 38502956 PMCID: PMC11007586 DOI: 10.1088/1741-2552/ad357f] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 03/21/2024]
Abstract
Objective.Minimally invasive neuromodulation therapies like the Injectrode, which is composed of a tightly wound polymer-coated Platinum/Iridium microcoil, offer a low-risk approach for administering electrical stimulation to the dorsal root ganglion (DRG). This flexible electrode is aimed to conform to the DRG. The stimulation occurs through a transcutaneous electrical stimulation (TES) patch, which subsequently transmits the stimulation to the Injectrode via a subcutaneous metal collector. However, it is important to note that the effectiveness of stimulation through TES relies on the specific geometrical configurations of the Injectrode-collector-patch system. Hence, there is a need to investigate which design parameters influence the activation of targeted neural structures.Approach.We employed a hybrid computational modeling approach to analyze the impact of Injectrode system design parameters on charge delivery and neural response to stimulation. We constructed multiple finite element method models of DRG stimulation, followed by the implementation of multi-compartment models of DRG neurons. By calculating potential distribution during monopolar stimulation, we simulated neural responses using various parameters based on prior acute experiments. Additionally, we developed a canonical monopolar stimulation and full-scale model of bipolar bilateral L5 DRG stimulation, allowing us to investigate how design parameters like Injectrode size and orientation influenced neural activation thresholds.Main results.Our findings were in accordance with acute experimental measurements and indicate that the minimally invasive Injectrode system predominantly engages large-diameter afferents (Aβ-fibers). These activation thresholds were contingent upon the surface area of the Injectrode. As the charge density decreased due to increasing surface area, there was a corresponding expansion in the stimulation amplitude range before triggering any pain-related mechanoreceptor (Aδ-fibers) activity.Significance.The Injectrode demonstrates potential as a viable technology for minimally invasive stimulation of the DRG. Our findings indicate that utilizing a larger surface area Injectrode enhances the therapeutic margin, effectively distinguishing the desired Aβactivation from the undesired Aδ-fiber activation.
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Affiliation(s)
- Sauradeep Bhowmick
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Robert D Graham
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Nishant Verma
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe)–Madison, Madison, WI, United States of America
| | - James K Trevathan
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe)–Madison, Madison, WI, United States of America
| | | | | | - Lee E Fisher
- Rehab Neural Engineering Labs (RNEL), Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Andrew J Shoffstall
- Neuronoff Inc., Cleveland, OH, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
| | - Douglas J Weber
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, United States of America
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Kip A Ludwig
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States of America
- Wisconsin Institute for Translational Neuroengineering (WITNe)–Madison, Madison, WI, United States of America
- Department of Neurosurgery, University of Wisconsin–Madison, Madison, WI, United States of America
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
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18
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de Andrés Ares J, Eldabe S, Helsen N, Baranidharan G, Barat JL, Bhaskar A, Cassini F, Gillner S, Kallewaard JW, Klessinger S, Mavrocordatos P, Occhigrossi F, Van Zundert J, Huygen F, Stoevelaar H. Radiofrequency for chronic lumbosacral and cervical pain: Results of a consensus study using the RAND/UCLA appropriateness method. Pain Pract 2024. [PMID: 38597223 DOI: 10.1111/papr.13378] [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: 04/11/2024]
Abstract
BACKGROUND Despite the routine use of radiofrequency (RF) for the treatment of chronic pain in the lumbosacral and cervical region, there remains uncertainty on the most appropriate patient selection criteria. This study aimed to develop appropriateness criteria for RF in relation to relevant patient characteristics, considering RF ablation (RFA) for the treatment of chronic axial pain and pulsed RF (PRF) for the treatment of chronic radicular pain. METHODS The RAND/UCLA Appropriateness Method (RUAM) was used to explore the opinions of a multidisciplinary European panel on the appropriateness of RFA and PRF for a variety of clinical scenarios. Depending on the type of pain (axial or radicular), the expert panel rated the appropriateness of RFA and PRF for a total of 219 clinical scenarios. RESULTS For axial pain in the lumbosacral or cervical region, appropriateness of RFA was determined by the dominant pain trigger and location of tenderness on palpation with higher appropriateness scores if these variables were suggestive of the diagnosis of facet or sacroiliac joint pain. Although the opinions on the appropriateness of PRF for lumbosacral and cervical radicular pain were fairly dispersed, there was agreement that PRF is an appropriate option for well-selected patients with radicular pain due to herniated disc or foraminal stenosis, particularly in the absence of motor deficits. The panel outcomes were embedded in an educational e-health tool that also covers the psychosocial aspects of chronic pain, providing integrated recommendations on the appropriate use of (P)RF interventions for the treatment of chronic axial and radicular pain in the lumbosacral and cervical region. CONCLUSIONS A multidisciplinary European expert panel established patient-specific recommendations that may support the (pre)selection of patients with chronic axial and radicular pain in the lumbosacral and cervical region for either RFA or PRF (accessible via https://rftool.org). Future studies should validate these recommendations by determining their predictive value for the outcomes of (P)RF interventions.
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Affiliation(s)
- Javier de Andrés Ares
- Department of Anesthesiology-Pain Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Nicky Helsen
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
| | | | - Jean-Luc Barat
- Service de Neurochirurgie, Hôpital privé Clairval - Ramsay santé, Marseille, France
| | - Arun Bhaskar
- Pain Management Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Fabrizio Cassini
- SS. Antonio e Biagio e C. Arrigo Hospital, Allesandria, Piedmont, Italy
| | - Sebastian Gillner
- Department of Neurosurgery, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Willem Kallewaard
- Department of Anaesthesiology and Pain Management, Rijnstate Hospital, Velp, The Netherlands
- Department of Anaesthesiology and Pain Treatment, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Huygen
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Herman Stoevelaar
- Centre for Decision Analysis and Support, Ismar Healthcare, Lier, Belgium
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Lumley S, Yu D, Wilkie R, Jordan KP, Peat G. Chronic pain-mental health comorbidity and excess prevalence of health risk behaviours: a cross-sectional study. Prim Health Care Res Dev 2024; 25:e15. [PMID: 38587013 PMCID: PMC11022513 DOI: 10.1017/s1463423624000070] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain and anxiety/depression are significant public health problems. We hypothesised that adults with both conditions constitute a group at especially high risk of future cardiovascular health outcomes. AIM To determine whether having comorbid chronic musculoskeletal pain and anxiety/depression is associated with the excess prevalence of selected known cardiovascular health risk behaviours. METHOD A cross-sectional survey of adults aged 35+ years randomly sampled from 26 GP practice registers in West Midlands, England. Respondents were classified into four groups based on self-reported presence/absence of chronic musculoskeletal pain (pain present on most days for six months) and anxiety or depression (Hospital Anxiety and Depression Score 11+). Standardised binomial models were used to estimate standardised prevalence ratios and prevalence differences between the four groups in self-reported obesity, tobacco smoking, physical inactivity, and unhealthy alcohol consumption after controlling for age, sex, ethnicity, deprivation, employment status and educational attainment. The excess prevalence of each risk factor in the group with chronic musculoskeletal pain-anxiety/depression comorbidity was estimated. FINDINGS Totally, 14 519 respondents were included, of whom 1329 (9%) reported comorbid chronic musculoskeletal pain-anxiety/depression, 3612 (25%) chronic musculoskeletal pain only, 964 (7%) anxiety or depression only, and 8614 (59%) neither. Those with comorbid chronic musculoskeletal pain-anxiety/depression had the highest crude prevalence of obesity (41%), smoking (16%) and physical inactivity (83%) but the lowest for unhealthy alcohol consumption (18%). After controlling for covariates, the standardised prevalence ratios and differences for the comorbid group compared with those with neither chronic musculoskeletal pain nor anxiety/depression were as follows: current smoking [1.86 (95% CI 1.58, 2.18); 6.8%], obesity [1.93 (1.76, 2.10); 18.9%], physical inactivity [1.21 (1.17, 1.24); 14.3%] and unhealthy alcohol consumption [0.81 (0.71, 0.92); -5.0%]. The standardised prevalences of smoking and obesity in the comorbid group exceeded those expected from simple additive interaction.
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Affiliation(s)
- Sophie Lumley
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ross Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Kelvin P. Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
- Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, South Yorkshire, UK
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20
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Hemberg A, Landén J, Montgomery A, Holmberg H, Nordin P. Management of groin hernia repair in Sweden: A register-based comparative analysis of public and private healthcare providers. Scand J Surg 2024:14574969241242312. [PMID: 38590013 DOI: 10.1177/14574969241242312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Swedish healthcare is in a period of transition with an expanding private sector. This study compares quality of outcome after groin hernia repair performed in a public or private healthcare setting. METHODS A cohort study based on data from the Swedish National Hernia Register combined with Patient-Reported Outcome Measures (PROMs) 1 year after groin hernia repair. Between September 2012 and December 2018, a questionnaire was sent to all patients registered in the hernia register 1 year after surgery. Endpoints were reoperation for recurrence, chronic pain, and patient satisfaction. RESULTS From a total of 87,650 patients with unilateral groin hernia repair, 61,337 PROM answers (70%) were received from 71 public and 28 private healthcare providers. More females, acute and recurrent cases, and patients with high American Society of Anesthesiology (ASA) scores were operated under the national healthcare system. The private sector had more experience surgeons with higher annual volume per surgeon, shorter time on waiting lists, and shorter operation times. No difference was seen in patient satisfaction. Groin hernia repair performed in a private clinic was associated with less postoperative chronic pain (OR 0.85, 95% CI 0.8-0.91) but a higher recurrence rate (HR 1.41; 95% CI 1.26-1.59) in a multivariable logistic regression analysis. CONCLUSION Despite private clinics having a higher proportion of experienced surgeons and fewer complex cases, the recurrence rate was higher, whereas the risk for chronic postoperative pain was higher among patients treated in the public sector.
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Affiliation(s)
- Anders Hemberg
- Helsingborgs lasarett Kirurgen Charlotte Yhlens gata 10 251 87 Helsingborg Sweden
| | - Jakob Landén
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Henrik Holmberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Pär Nordin
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
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21
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Robinson-Papp J, Lawrence S, Wadley A, Scott W, George MC, Josh J, O'Brien KK, Price C, Uebelacker L, Edelman EJ, Evangeli M, Goodin BR, Harding R, Nkhoma K, Parker R, Sabin C, Slawek D, Tsui JI, Merlin JS. Priorities for HIV and chronic pain research: results from a survey of individuals with lived experience. AIDS Care 2024:1-11. [PMID: 38588701 DOI: 10.1080/09540121.2024.2334358] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
The Global Task Force on Chronic Pain in HIV published seven research priorities in the field of HIV-associated chronic pain in 2019: (1) causes; (2) management; (3) treatment individualization and integration with addiction treatment; (4) mental and social health factors; (5) prevalence; (6) treatment cost effectiveness; and (7) prevention. The current study used a web-based survey to determine whether the research topics were aligned with the priorities of adults with lived experiences of HIV and chronic pain. We also collected information about respondents' own pain and treatment experiences. We received 311 survey responses from mostly US-based respondents. Most respondents reported longstanding, moderate to severe, multisite pain, commonly accompanied by symptoms of anxiety and/or depression. The median number of pain treatments tried was 10 (IQR = 8, 13), with medications and exercise being the most common modalities, and opioids being viewed as the most helpful. Over 80% of respondents considered all research topics either "extremely important" or "very important". Research topic #2, which focused on optimizing management of pain in people with HIV, was accorded the greatest importance by respondents. These findings suggest good alignment between the priorities of researchers and US-based people with lived experience of HIV-associated chronic pain.
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Affiliation(s)
| | - Steven Lawrence
- Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY, USA
| | - Antonia Wadley
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- INPUT Pain Unit, Guy's & St Thomas' NHS Foundation Trust
| | | | - Jo Josh
- British HIV Association (BHIVA), London, UK
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute (RSI), University of Toronto
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health University of Toronto, Toronto, Canada
| | - Collen Price
- Canadian HIV/AIDS and Chronic Pain Society, Ottawa, Canada
| | | | | | - Michael Evangeli
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Burel R Goodin
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
| | - Deepika Slawek
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Judith I Tsui
- University of Washington School of Medicine, Seattle, WA, USA
| | - Jessica S Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) Clinical Research Center, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh
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22
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Hanley AW, Lingard A, Garland EL. A Single-Session, 2-Hour Version of Mindfulness-Oriented Recovery Enhancement (One MORE) Improves Chronic Pain Patients' Pain-Related Outcomes Through 3-Month Follow-Up in a Randomized Controlled Trial. J Integr Complement Med 2024. [PMID: 38588552 DOI: 10.1089/jicm.2023.0501] [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: 04/10/2024]
Abstract
Introduction: Traditional, 8-week, mindfulness-based interventions can effectively treat chronic pain, but require a time and resource investment too burdensome for many patients and providers. The solution to this logistical challenge may be to distill the core, therapeutic elements of an efficacious 8-week, mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), into a 2-h, single-session intervention. Methods: In this study, the authors conducted a waitlist-controlled, randomized clinical trial to assess the impact of a 2-h, single-session adaptation of MORE (i.e., One MORE) on chronic pain patients' (N = 40) pain-related outcomes through 3-month follow-up. Results: Results indicated that One MORE significantly improved chronic pain patients' pain catastrophizing (i.e., primary outcome; F = 9.97, p = 0.002), pain intensity (F = 26.58, p < 0.001), pain interference (F = 39.43, p < 0.001), physical function (F = 16.29, p < 0.001), sleep (F = 16.66, p < 0.001), anxiety (F = 12.54, p < 0.001), and depression (F = 17.48, p < 0.001). One MORE also significantly increased theoretically indicated therapeutic mechanisms through the 3-month follow-up: mindfulness, positive reappraisal, savoring, self-transcendence. Discussion: Study results are promising, and if replicated, would suggest that One MORE is a highly scalable, low-cost (e.g., sustainable), nonpharmacologic treatment for chronic pain. Clinical Trial Registration: NCT05194241.
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Affiliation(s)
- Adam W Hanley
- Brain Science and Symptom Management Center, College of Nursing, Florida State University, Tallahassee, FL, USA
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
| | - Ayaka Lingard
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, USA
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT, USA
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23
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Elma Ö, Tümkaya Yılmaz S, Nijs J, Clarys P, Coppieters I, Mertens E, Malfliet A, Deliens T. Impaired Carbohydrate Metabolism among Women with Chronic Low Back Pain and the Role of Dietary Carbohydrates: A Randomized Controlled Cross-Over Experiment. J Clin Med 2024; 13:2155. [PMID: 38610920 PMCID: PMC11012557 DOI: 10.3390/jcm13072155] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Impaired glucose regulation is suggested to be related to chronic low back pain (CLBP), although it is not clear how they interact with each other. Thus, the primary aim of this study was to investigate differences in postprandial glycemic responses (PPGRs) (the first sign of impaired glucose metabolism) to high- (sucrose) and low-glycemic index (GI) (isomaltulose) beverages in normoglycemic women with CLBP and healthy controls (HCs) and explore whether any group that showed greater PPGRs to high-GI beverage intake would benefit when the high-GI beverage was replaced with a low-GI beverage. Secondly, this study aimed to explore the association between PPGR and pain in patients with CLBP. Methods: This study was registered at clinicaltrials.org (NCT04459104) before the start of the study. In this study, 53 CLBP patients and 53 HCs were recruited. After 11-12 h of fasting, each participant randomly received isomaltulose or sucrose. Blood glucose levels were measured during the fasting state and 15, 30, 45, 60, 90, and 120 min after the beverage intake, and each participant underwent experimental pain measures. Results: Compared to the HCs, the CLBP group showed significantly higher PPGRs to sucrose (p < 0.021). Additionally, the CLBP group showed a significantly higher decrease in PPGR (p = 0.045) when comparing PPGR to sucrose with PPGR to isomaltulose. Correlation analysis revealed a positive association between self-reported pain sensitivity and PPGR to sucrose, while there was no association found between any experimental pain measures and glycemic responses. Conclusions: Overall, these findings suggest that normoglycemic CLBP patients might have a higher risk of developing impaired glucose tolerance than the HCs and might benefit more when high-GI foods are replaced with low-GI ones.
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Affiliation(s)
- Ömer Elma
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Physiotherapy Unit, Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Sevilay Tümkaya Yılmaz
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
| | - Jo Nijs
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussel, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Peter Clarys
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
| | - Iris Coppieters
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussel, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Evelien Mertens
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
- Nutrition and Dietetics Program, Department of Health Care, Design and Technology, Erasmushogeschool Brussel, 1090 Brussels, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (S.T.Y.); (J.N.); (I.C.); (A.M.)
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
| | - Tom Deliens
- Movement and Nutrition for Health and Performance (MOVE) Research Group, Department of Movement and Sport Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (P.C.); (E.M.); (T.D.)
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24
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Ma KSK, Chan SY, Van Dyke TE, Wang SI, Wei JCC, Ashina S. Tooth Loss and Chronic Pain: A Population-based Analysis of the National Health and Nutrition Examination Survey. J Pain 2024:104529. [PMID: 38588761 DOI: 10.1016/j.jpain.2024.104529] [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] [Received: 08/21/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
Poor oral health conditions in adults are associated to chronic pain. A nationwide cross-sectional study was conducted to investigate the link between tooth loss and chronic pain. The study involved 8,662 participants from the National Health and Nutrition Examination Survey (NHANES). Tooth count was categorized into four groups and chronic pain was defined as persistent pain lasting over three months despite treatment. Location of the chronic pain, demographics, comorbidities, lifestyle determinants, and dietary intake were retrieved. Univariate and multivariate logistic regression were used to explore cross-sectional associations between tooth count and chronic pain. Compared to participants with more than 20 teeth, those with severe tooth loss presented with greater odds of chronic pain (adjusted odds ratio (aOR)=2.111, 95%CI=1.213-3.676 f for patients with 1-8 teeth). Edentulous participants presented with significant higher odds of chronic pain in lower extremities (78.4%) and buttocks (49.5%). In the multivariate model, apart from rheumatic arthritis (aOR=4.004, 95%CI=2.766-5.798), variables of higher chronic pain included smoking (aOR=1.518, 95%CI=1.228-1.878), and hypertension (aOR=1.463, 95%CI=1.013-2.112). On the contrary, being Mexican American (aOR=0.603, 95%CI=0.414-0.880) was associated with lower odds of chronic pain. The findings suggested a significant link between chronic pain and tooth loss, independent of ethnicity, lifestyle determinants, and immune-mediated inflammatory diseases including rheumatoid arthritis. PERSPECTIVE: A US nationwide study examined tooth loss and chronic pain. Those with severe tooth loss had increased odds of chronic pain. Edentulous individuals presented higher odds of pain in lower extremities and buttocks. This study highlighted the link between tooth loss and chronic pain, independent of comorbidities and lifestyle factors.
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Affiliation(s)
- Kevin Sheng-Kai Ma
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Shu-Yen Chan
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Thomas E Van Dyke
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Clinical and Translational Research, Forsyth Institute, Cambridge, MA, USA; Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Shiow-Ing Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Sait Ashina
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; Beth Israel Deaconess Medical Center Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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25
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Faig CA, Kim GHK, Do AD, Dworsky-Fried Z, Jackson J, Taylor AMW. Claustrum projections to the anterior cingulate modulate nociceptive and pain-associated behavior. Curr Biol 2024:S0960-9822(24)00384-1. [PMID: 38614081 DOI: 10.1016/j.cub.2024.03.044] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/08/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
The anterior cingulate cortex (ACC) is critical for the perception and unpleasantness of pain.1,2,3,4,5,6 It receives nociceptive information from regions such as the thalamus and amygdala and projects to several cortical and subcortical regions of the pain neuromatrix.7,8 ACC hyperexcitability is one of many functional changes associated with chronic pain, and experimental activation of ACC pyramidal cells produces hypersensitivity to innocuous stimuli (i.e., allodynia).9,10,11,12,13,14 A less-well-studied projection to the ACC arises from a small forebrain region, the claustrum.15,16,17,18,19,20 Stimulation of excitatory claustrum projection neurons preferentially activates GABAergic interneurons, generating feed-forward inhibition onto excitatory cortical networks.21,22,23,24 Previous work has shown that claustrocingulate projections display altered activity in prolonged pain25,26,27; however, it remains unclear whether and how the claustrum participates in nociceptive processing and high-order pain behaviors. Inhibition of ACC activity reverses mechanical allodynia in animal models of persistent and neuropathic pain,1,9,28 suggesting claustrum inputs may function to attenuate pain processing. In this study, we sought to define claustrum function in acute and chronic pain. We found enhanced claustrum activity after a painful stimulus that was attenuated in chronic inflammatory pain. Selective inhibition of claustrocingulate projection neurons enhanced acute nociception but blocked pain learning. Inversely, chemogenetic activation of claustrocingulate neurons had no effect on basal nociception but rescued inflammation-induced mechanical allodynia. Together, these results suggest that claustrocingulate neurons are a critical component of the pain neuromatrix, and dysregulation of this connection may contribute to chronic pain.
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Affiliation(s)
- Christian A Faig
- Department of Pharmacology, University of Alberta, 8613 114 Street NW, Edmonton, AB T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, 11315 87 Avenue NW, Edmonton, AB T6G 2E1, Canada
| | - Gloria H K Kim
- Neuroscience and Mental Health Institute, University of Alberta, 11315 87 Avenue NW, Edmonton, AB T6G 2E1, Canada
| | - Alison D Do
- Department of Physiology, University of Alberta, 8613 114 Street NW, Edmonton, AB T6G 2R3, Canada
| | - Zoë Dworsky-Fried
- Department of Pharmacology, University of Alberta, 8613 114 Street NW, Edmonton, AB T6G 2R3, Canada
| | - Jesse Jackson
- Neuroscience and Mental Health Institute, University of Alberta, 11315 87 Avenue NW, Edmonton, AB T6G 2E1, Canada; Department of Physiology, University of Alberta, 8613 114 Street NW, Edmonton, AB T6G 2R3, Canada.
| | - Anna M W Taylor
- Department of Pharmacology, University of Alberta, 8613 114 Street NW, Edmonton, AB T6G 2R3, Canada; Neuroscience and Mental Health Institute, University of Alberta, 11315 87 Avenue NW, Edmonton, AB T6G 2E1, Canada; Cancer Research Institute of Northern Alberta, University of Alberta, 11315 87 Avenue NW, Edmonton, AB T6G 2E1, Canada; Department of Anesthesiology and Pain Medicine, University of Alberta, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada.
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26
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Joseph K, Mills J. Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months. Aust N Z J Obstet Gynaecol 2024. [PMID: 38581105 DOI: 10.1111/ajo.13817] [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] [Received: 01/29/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. AIMS This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. MATERIALS AND METHODS Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. RESULTS At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. CONCLUSIONS Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.
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Affiliation(s)
- Karen Joseph
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
| | - Jessica Mills
- Pelvic Pain NZ, Christchurch, New Zealand
- University of Otago, Christchurch, New Zealand
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27
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Getachew M, Tesfaye H, Yihunie W, Ayenew T, Alemu S, Dagnew EM, Biyazin Y, Abebe D, Degefu N, Abebaw A. Sustained release local anesthetics for pain management: relevance and formulation approaches. Front Pain Res (Lausanne) 2024; 5:1383461. [PMID: 38645568 PMCID: PMC11026556 DOI: 10.3389/fpain.2024.1383461] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
This review attempted to ascertain the rationale for the formulation of sustained-release local anesthetics and summarize the various formulation approaches designed to date to achieve sustained and localized local analgesic effects. The incidence of pain, which is the concern of patients as well as health care professionals, is increasing due to accidents, surgical procedures, and other diseases. Local anesthetics can be used for the management of moderate to severe acute and chronic pain. They also allow regional analgesia, in situations where the cause and source of the pain are limited to a particular site or region, without the need for loss of consciousness or systemic administration of other analgesics thereby decreasing the risk of potential toxicities. Though they have an interesting antipain efficacy, the short duration of action of local anesthetics makes the need for their multiple injections or opioid adjuvants mandatory. To overcome this problem, different formulations are being designed that help achieve prolonged analgesia with a single dose of administration. Combination with adjuvants, liposomal formulations, lipid-based nanoparticles, thermo-responsive nanogels, microspheres, microcapsules, complexation with multivalent counterions and HP-β-CD, lipid-based nanoparticles, and bio-adhesive films, and polymeric matrices are among the approaches. Further safety studies are required to ensure the safe and effective utilization of sustained-release local anesthetics. Moreover, the release kinetics of the various formulations should be adequately established.
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Affiliation(s)
- Melese Getachew
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Hana Tesfaye
- School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubetu Yihunie
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfahun Ayenew
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Alemu
- Department of Pharmaceutics, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ephrem Mebratu Dagnew
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Department of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Natanim Degefu
- Department of Pharmaceutics, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abtie Abebaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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28
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Eden C, Kang RS, Patel AA, Gulati A. Case Series of Multicontact Peripheral Nerve Stimulation in the Transversus Abdominis Plane for Chronic Abdominal Wall Pain. Neuromodulation 2024:S1094-7159(24)00061-8. [PMID: 38583173 DOI: 10.1016/j.neurom.2024.02.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Managing abdominal pain can be difficult. This is due to the nonspecific nature of the pain, the multiple etiologies, and the different mechanisms underlying this type of pain. Abdominal wall pain in particular poses its own challenges. Traditionally, chronic abdominal wall pain has been managed with nonopioid analgesics, and in severe cases, opioid therapy has been considered. For patients with chronic abdominal wall pain refractory to medication management, peripheral nerve blocks and spinal cord stimulation also have been trialed with some success. In this study, we present a case series in patients with chronic abdominal wall pain who were treated with a multicontact peripheral nerve stimulation (PNS) system in the transversus abdominis plane (TAP). MATERIALS AND METHODS This was a single-center, retrospective case series. Data were included from adults with chronic abdominal wall pain whose symptoms were refractory to standard medical management and who underwent a multicontact PNS system placement in the TAP. RESULTS Four patients met the inclusion criteria. All four patients underwent a multicontact PNS trial lead placement in the TAP. One patient reported no benefit from the trial. The remaining three patients underwent a permanent multicontact PNS system placement in the TAP. CONCLUSIONS In patients with chronic abdominal wall pain whose symptoms are refractory to conservative medical management, PNS may be an alternative treatment option. As the use of PNS for chronic abdominal wall pain and other fascial planes continues to develop, additional research is necessary to determine optimal placements and specific stimulation parameters.
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Affiliation(s)
- Caroline Eden
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramanjot S Kang
- North Texas Orthopedics & Spine Center, Dallas-Fort Worth, TX, USA
| | - Ankur A Patel
- Novant Health Spine Specialists, Winston Salem, NC, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Barr A, Moore K, Flegge LG, Atsaphanthong E, Kirby KE, Craner JR. Predictors of sexual satisfaction among patients with chronic pain. Front Pain Res (Lausanne) 2024; 5:1375546. [PMID: 38638533 PMCID: PMC11024270 DOI: 10.3389/fpain.2024.1375546] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Objectives Sexual satisfaction is an important aspect of quality of life. Chronic pain, depression and anxiety, and relational problems correspond with higher risk for sexual difficulties. Less is known about how risk factors for sexual dysfunction and other problems-such as medical conditions, pain severity, and medication side effects-affect the sexual satisfaction of people with chronic pain. Using a biopsychosocial framework, this study explored factors related to sexual satisfaction among patients presenting for evaluation of chronic pain. Methods Researchers used a hierarchical multiple regression analysis to model potential predictors of sexual satisfaction. Variables analyzed were demographic features, medical history, average pain severity, depressed mood, anxiety, and perceived significant other support. Data collection involved administration of retrospective questionnaires and chart review. The sample included male and female participants (N = 134) presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Results Medical history (i.e., medical conditions, surgical history, and medications) and clinical self-report variables (i.e., pain severity, depressed mood, anxiety, and perceived significant other support) were associated with sexual satisfaction. In this sample, antidepressant use and higher pain severity were unique predictors of lower sexual satisfaction. Married marital status and higher levels of perceived significant other support were predictive of greater sexual satisfaction. Discussion Findings highlight the importance of understanding the unique impact of biopsychosocial variables on the sexual satisfaction of patients presenting for evaluation at a multidisciplinary pain rehabilitation clinic. Further exploration of protective factors that account for sexual satisfaction among individuals with chronic pain may help inform screening, referrals, and treatment.
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Affiliation(s)
- Aex Barr
- Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Kayla Moore
- Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States
| | - Lindsay G. Flegge
- Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Emily Atsaphanthong
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Krissa E. Kirby
- Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States
| | - Julia R. Craner
- Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States
- College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
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Witkin LR, Kasubhai A, Jiang SY, Gotian R. Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study. Pain Manag 2024. [PMID: 38573070 DOI: 10.2217/pmt-2023-0084] [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: 04/05/2024] Open
Abstract
Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations. Conclusion: Despite the importance of measuring the impact of chronic pain on quality of life, there are significant limitations to the real-world use of PRO that may limit the patient's assessment and care.
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Affiliation(s)
- Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Abha Kasubhai
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Ruth Gotian
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
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Malkani R, Paramasivam S, Wolfensohn S. How does chronic pain impact the lives of dogs: an investigation of factors that are associated with pain using the Animal Welfare Assessment Grid. Front Vet Sci 2024; 11:1374858. [PMID: 38638643 PMCID: PMC11025458 DOI: 10.3389/fvets.2024.1374858] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Chronic pain can profoundly affect the wellbeing of dogs and our understanding is limited regarding the multidimensional impact it has on dog quality of life. This study aimed to assess the factors that are significant and predictive of behavior problems in dogs using the Animal Welfare Assessment Grid (AWAG) to further understand what factors influence their welfare. Methods Seventy six AWAG assessments were undertaken across 46 dogs that clinicians diagnosed as having musculoskeletal conditions that caused chronic pain. Wilcoxon-rank sum tests were used to assess the difference in scores between dogs with behavior disorders and a cohort of healthy dogs (n = 143). Results All physical factors besides body condition, and all psychological, environmental, and procedural factors were significantly different between healthy dogs and dogs with chronic pain, evidencing how chronic pain impacts all domains of a dog's life. Spearman Rank Correlation Coefficient (RS) revealed several significant strong positive correlations such as the association between the severity of clinical symptoms with poorer mobility and the frequency at which the dog experienced fearful stimuli. Logistic regression showed that fears and anxieties frequency, the dog's reaction to stressors, engagement with enrichment, and social interactions were significant predictors of chronic pain in dogs. Discussion This highlights that typical signs of musculoskeletal disorders such as gait changes, stiffness, lameness might manifest after behavioral changes such as increased fearfulness, prolonged recovery from a stressful event, a reduced interested in social interactions, toys or play. Owners only seeking veterinary attention when the presence of physical signs of disease are evident may result in a delayed veterinary attention resulting in reduced welfare. Regular veterinary assessments combined with use of the AWAG can proactively identify these behavioral indicators and result in prompt treatment and improved quality of life.
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Affiliation(s)
- Rachel Malkani
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
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Baydoun M, Gajtani Z, Patton M, McLennan A, Cartwright S, Carlson LE. Virtual reality-guided mindfulness for chronic pain in cancer survivors: protocol for the virtual mind study-a single-group feasibility trial. Front Pain Res (Lausanne) 2024; 5:1291374. [PMID: 38638535 PMCID: PMC11024301 DOI: 10.3389/fpain.2024.1291374] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Background Chronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer. Objective The aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP. Methods This mixed methods feasibility study will employ a single-arm, pretest-posttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10-15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants' experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411). Conclusions This novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms.
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Affiliation(s)
- Mohamad Baydoun
- Faculty of Nursing, University of Regina, Regina, SK, Canada
| | - Zen Gajtani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Andrew McLennan
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Stephen Cartwright
- Centre for Simulation and Visualization, University of Calgary, Calgary, AB, Canada
| | - Linda E. Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Lund T, Bernier E, Roman-Juan J, Kopala-Sibley D, Soltani S, Noyek S, Nania C, Beveridge J, Hoppe T, O'Connor R, O'Connor C, Clemens J, Mychasiuk R, Asmundson G, Stinson J, Noel M. Pain and Post-traumatic Stress Disorder Symptoms: Dyadic Relationships Between Canadian Armed Forces Members/Veterans with Chronic Pain and their Offspring. J Pain 2024:S1526-5900(24)00436-X. [PMID: 38580101 DOI: 10.1016/j.jpain.2024.03.012] [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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/29/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024]
Abstract
Chronic pain and mental health issues occur at higher rates in Veterans than the general population. One widely recognized mental health issue faced by Veterans is post-traumatic stress disorder (PTSD). Trauma symptoms and pain frequently co-occur and are mutually maintained due to shared mechanisms. Many Veterans are also parents. Parental physical and mental health issues significantly predict children's chronic pain and related functioning, which can continue into adulthood. Only one US-based study has examined pain in the offspring of Veterans, suggesting heightened risk for pain. Research to date has not examined the associations between trauma and pain, and the dyadic influences of these symptoms, among Veterans and their children. The current study aimed to describe pain characteristics in Canadian Armed Forces (CAF) Members/Veterans with chronic pain and their offspring (youth and adult children aged 9-38). Cross-lagged Panel Models (CLPM) were conducted to examine dyadic relationships between pain interference and trauma symptoms of CAF Members/Veterans and their offspring. Over half of adult offspring and over one quarter of youth offspring reported chronic pain. Results revealed effects between one's own symptoms of PTSD and pain interference. No significant effects of parents on offspring or offspring on parents were found. The findings highlight the interconnection between pain and PTSD consistent with mutual maintenance models, and a lack of significant interpersonal findings suggestive of resiliency in this unique population. PERSPECTIVE: We characterized chronic pain in offspring of Canadian Armed Forces Members/Veterans with chronic pain and examined dyadic relationships between PTSD symptoms and chronic pain interference. Findings revealed that PTSD symptoms and pain interference were related within Veterans and offspring, but no dyadic relationships were found, which could reflect resiliency.
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Affiliation(s)
- Tatiana Lund
- Department of Psychology, University of Calgary, Canada.
| | - Emily Bernier
- Department of Psychology, University of Calgary, Canada
| | - Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | | | | | | | - Cara Nania
- Department of Psychology, University of Calgary, Canada
| | | | - Tom Hoppe
- The Chronic Pain Centre of Excellence for Canadian Veterans.
| | - Robert O'Connor
- Department of Psychology, University of Calgary, Canada; Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain; Department of Psychiatry, University of Calgary, Canada; The Chronic Pain Centre of Excellence for Canadian Veterans; Department of Neuroscience, Monash University, Australia; Department of Psychology, University of Regina, Canada; The Hospital for Sick Children, Canada
| | - Christine O'Connor
- Department of Psychology, University of Calgary, Canada; Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain; Department of Psychiatry, University of Calgary, Canada; The Chronic Pain Centre of Excellence for Canadian Veterans; Department of Neuroscience, Monash University, Australia; Department of Psychology, University of Regina, Canada; The Hospital for Sick Children, Canada
| | - Jessica Clemens
- Department of Psychology, University of Calgary, Canada; Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain; Department of Psychiatry, University of Calgary, Canada; The Chronic Pain Centre of Excellence for Canadian Veterans; Department of Neuroscience, Monash University, Australia; Department of Psychology, University of Regina, Canada; The Hospital for Sick Children, Canada
| | | | | | | | - Melanie Noel
- Department of Psychology, University of Calgary, Canada
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Vu PD, Gul F, Robinson CL, Chen GH, Hasoon J. Peripheral Nerve Stimulation After Total Knee Arthroplasty and Non-Operable Patella Fracture. Orthop Rev (Pavia) 2024; 16:115599. [PMID: 38586247 PMCID: PMC10994825 DOI: 10.52965/001c.115599] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/01/2024] [Indexed: 04/09/2024] Open
Abstract
Chronic knee pain, affecting over 25% of adults in the United States, has surged by 65% over the past two decades leading to rising functional deficits, mobility problems, and a diminished quality of life. While conservative management with pharmacologic and minimally invasive injections are pursued early in the disease process, total knee arthroplasty for refractory osteoarthritis of the knee is often considered. This procedure usually improves pain and functionality within the first three months. However, a significant portion of patients often suffer from postoperative pain that can become chronic and debilitating. We detail the case of a patient with a previous TKA as well as a non-operable patella fracture who obtained significant relief with PNS despite prior conservative and minimally invasive management.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine & Rehabilitation The University of Texas Health Science Center at Houston
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center
| | - Grant H Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
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Seng EC, Mehdipour S, Simpson S, Gabriel RA. Tracking persistent postoperative opioid use: a proof-of-concept study demonstrating a use case for natural language processing. Reg Anesth Pain Med 2024; 49:241-247. [PMID: 37419509 DOI: 10.1136/rapm-2023-104629] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Large language models have been gaining tremendous popularity since the introduction of ChatGPT in late 2022. Perioperative pain providers should leverage natural language processing (NLP) technology and explore pertinent use cases to improve patient care. One example is tracking persistent postoperative opioid use after surgery. Since much of the relevant data may be 'hidden' within unstructured clinical text, NLP models may prove to be advantageous. The primary objective of this proof-of-concept study was to demonstrate the ability of an NLP engine to review clinical notes and accurately identify patients who had persistent postoperative opioid use after major spine surgery. METHODS Clinical documents from all patients that underwent major spine surgery during July 2015-August 2021 were extracted from the electronic health record. The primary outcome was persistent postoperative opioid use, defined as continued use of opioids greater than or equal to 3 months after surgery. This outcome was ascertained via manual clinician review from outpatient spine surgery follow-up notes. An NLP engine was applied to these notes to ascertain the presence of persistent opioid use-this was then compared with results from clinician manual review. RESULTS The final study sample consisted of 965 patients, in which 705 (73.1%) were determined to have persistent opioid use following surgery. The NLP engine correctly determined the patients' opioid use status in 92.9% of cases, in which it correctly identified persistent opioid use in 95.6% of cases and no persistent opioid use in 86.1% of cases. DISCUSSION Access to unstructured data within the perioperative history can contextualize patients' opioid use and provide further insight into the opioid crisis, while at the same time improve care directly at the patient level. While these goals are in reach, future work is needed to evaluate how to best implement NLP within different healthcare systems for use in clinical decision support.
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Affiliation(s)
- Eri C Seng
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Soraya Mehdipour
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Sierra Simpson
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Rodney A Gabriel
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
- Division of Regional Anesthesia, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
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Kapural L, Mekhail NA, Costandi S, Gilmore C, Pope JE, Li S, Hunter CW, Poree L, Staats PS, Taylor RS, Eldabe S, Kallewaard JW, Thomson S, Petersen EA, Sayed D, Deer TR, Antony A, Budwany R, Leitner A, Soliday N, Duarte RV, Levy RM. Durable multimodal and holistic response for physiologic closed-loop spinal cord stimulation supported by objective evidence from the EVOKE double-blind randomized controlled trial. Reg Anesth Pain Med 2024; 49:233-240. [PMID: 37491149 DOI: 10.1136/rapm-2023-104639] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Chronic pain patients may experience impairments in multiple health-related domains. The design and interpretation of clinical trials of chronic pain interventions, however, remains primarily focused on treatment effects on pain intensity. This study investigates a novel, multidimensional holistic treatment response to evoked compound action potential-controlled closed-loop versus open-loop spinal cord stimulation as well as the degree of neural activation that produced that treatment response. METHODS Outcome data for pain intensity, physical function, health-related quality of life, sleep quality and emotional function were derived from individual patient level data from the EVOKE multicenter, participant, investigator, and outcome assessor-blinded, parallel-arm randomized controlled trial with 24 month follow-up. Evaluation of holistic treatment response considered whether the baseline score was worse than normative values and whether minimal clinical important differences were reached in each of the domains that were impaired at baseline. A cumulative responder score was calculated to reflect the total minimal clinical important differences accumulated across all domains. Objective neurophysiological data, including spinal cord activation were measured. RESULTS Patients were randomized to closed-loop (n=67) or open-loop (n=67). A greater proportion of patients with closed-loop spinal cord stimulation (49.3% vs 26.9%) were holistic responders at 24-month follow-up, with at least one minimal clinical important difference in all impaired domains (absolute risk difference: 22.4%, 95% CI 6.4% to 38.4%, p=0.012). The cumulative responder score was significantly greater for closed-loop patients at all time points and resulted in the achievement of more than three additional minimal clinical important differences at 24-month follow-up (mean difference 3.4, 95% CI 1.3 to 5.5, p=0.002). Neural activation was three times more accurate in closed-loop spinal cord stimulation (p<0.001 at all time points). CONCLUSION The results of this study suggest that closed-loop spinal cord stimulation can provide sustained clinically meaningful improvements in multiple domains and provide holistic improvement in the long-term for patients with chronic refractory pain. TRIAL REGISTRATION NUMBER NCT02924129.
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Affiliation(s)
- Leonardo Kapural
- Carolinas Pain Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, California, USA
| | - Sean Li
- Premier Pain Centers, Shrewsbury, New Jersey, USA
| | - Corey W Hunter
- Ainsworth Institute of Pain Management, New York, New York, USA
| | - Lawrence Poree
- University of California at San Francisco, San Francisco, California, USA
| | | | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Sam Eldabe
- Pain Medicine, James Cook Univesity Hospital, Middlesbrough, UK
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Simon Thomson
- Pain Medicine and Neuromodulation, Mid & South Essex University Hospitals, Essex, UK
| | - Erika A Petersen
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy R Deer
- Spine and Nerve Center of the Virginias, West Virginia University - Health Sciences Campus, Morgantown, West Virginia, USA
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, Florida, USA
| | - Ryan Budwany
- West Virginia University, Morgantown, West Virginia, USA
| | - Angela Leitner
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
| | - Nicole Soliday
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
| | - Rui V Duarte
- Saluda Medical Pty Ltd, Artarmon, New South Wales, Australia
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Robert M Levy
- Anesthesia Pain Care Consultants, Boca Raton, Florida, USA
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Kalbfuss J, Odermatt R, Stutzer A. Medical marijuana laws and mental health in the United States. Health Econ Policy Law 2024:1-16. [PMID: 38562089 DOI: 10.1017/s1744133124000033] [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] [Indexed: 04/04/2024]
Abstract
The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.
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Affiliation(s)
- Jörg Kalbfuss
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Reto Odermatt
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
| | - Alois Stutzer
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
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Eldabe S, Nevitt S, Copley S, Maden M, Goudman L, Hayek S, Mekhail N, Moens M, Rigoard P, Duarte R. Does industry funding and study location impact findings from randomized controlled trials of spinal cord stimulation? A systematic review and meta-analysis. Reg Anesth Pain Med 2024; 49:272-284. [PMID: 37611944 DOI: 10.1136/rapm-2023-104674] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/13/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND/IMPORTANCE Concerns have been raised that effects observed in studies of spinal cord stimulation (SCS) funded by industry have not been replicated in non-industry-funded studies and that findings may differ based on geographical location where the study was conducted. OBJECTIVE To investigate the impact of industry funding and geographical location on pain intensity, function, health-related quality of life and adverse events reported in randomized controlled trials (RCTs) of SCS. EVIDENCE REVIEW Systematic review conducted using MEDLINE, CENTRAL, EMBASE and WikiStim databases until September 2022. Parallel-group RCTs evaluating SCS for patients with neuropathic pain were included. Results of studies were combined in random-effects meta-analysis using the generic-inverse variance method. Subgroup meta-analyses were conducted according to funding source and study location. Risk of bias was assessed using Cochrane RoB 2.0 tool. FINDINGS Twenty-nine reports of 17 RCTs (1823 participants) were included. For the comparison of SCS with usual care, test for subgroup differences indicate no significant differences (p=0.48, moderate certainty evidence) in pain intensity score at 6 months for studies with no funding or funding not disclosed (pooled mean difference (MD) -1.96 (95% CI -3.23 to -0.69; 95% prediction interval (PI) not estimable, I2=0%, τ2=0)), industry funding (pooled MD -2.70 (95% CI -4.29 to -1.11; 95% PI -8.75 to 3.35, I2=97%, τ2=2.96) or non-industry funding (MD -3.09 (95% CI -4.47 to -1.72); 95% PI, I2 and τ2 not applicable). Studies with industry funding for the comparison of high-frequency SCS (HF-SCS) with low-frequency SCS (LF-SCS) showed statistically significant advantages for HF-SCS compared to LF-SCS while studies with no funding showed no differences between HF-SCS and LF-SCS (low certainty evidence). CONCLUSION All outcomes of SCS versus usual care were not significantly different between studies funded by industry and those independent from industry. Pain intensity score and change in pain intensity from baseline for comparisons of HF-SCS to LF-SCS seem to be impacted by industry funding.
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Affiliation(s)
- Sam Eldabe
- Department of Pain Medicine, The James Cook University Hospital, Middlesbrough, UK
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sue Copley
- Anaesthesia and Pain Management, James Cook University Hospital, Middlesbrough, UK
| | - Michelle Maden
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Lisa Goudman
- Department of Neurosurgery, UZ Brussel, Brussel, Belgium
| | - Salim Hayek
- Anesthesiology, Case Western Reserve University, Unviersity Hospitals, Cleveland, Ohio, USA
| | | | - Maarten Moens
- Department of Neurosurgery, UZ Brussel, Brussel, Belgium
| | - Phillipe Rigoard
- PRISMATICS Lab, Poitiers, France
- Department of Neurosurgery, Poitiers University Hospital, Poitiers, France
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Kumar A, Soliman N, Gan Z, Cullinan P, Vollert J, Rice AS, Kemp H. A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel. Pain 2024; 165:727-740. [PMID: 38112578 PMCID: PMC10949216 DOI: 10.1097/j.pain.0000000000003094] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Combat trauma can lead to widespread tissue damage and limb loss. This may result in chronic neuropathic and post amputation pain, including phantom limb pain (PLP) and residual limb pain (RLP). The military population is distinct with respect to demographic, injury, and social characteristics compared with other amputation and trauma cohorts. We undertook a systematic review of studies of military personnel, with a history of combat injury, that reported a prevalence of any type of postamputation pain or chronic neuropathic pain, identified from Embase and MEDLINE databases.Using the inverse variance method with a random-effects model, we undertook a meta-analysis to determine an overall prevalence and performed exploratory analyses to identify the effect of the type of pain, conflict, and time since injury on prevalence. Pain definitions and types of pain measurement tools used in studies were recorded. Thirty-one studies (14,738 participants) were included. The pooled prevalence of PLP, RLP, and chronic neuropathic pain were 57% (95% CI: 46-68), 61% (95% CI: 50-71), and 26% (95% CI: 10-54), respectively. Between-study heterogeneity was high (I 2 : 94%-98%). Characterisation of duration, frequency, and impact of pain was limited. Factors reported by included studies as being associated with PLP included the presence of RLP and psychological comorbidity. The prevalence of postamputation pain and chronic neuropathic pain after combat trauma is high. We highlight inconsistency of case definitions and terminology for pain and the need for consensus in future research of traumatic injury.
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Affiliation(s)
- Alexander Kumar
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
- Academic Department of Military Anaesthesia, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Nadia Soliman
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Zoe Gan
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jan Vollert
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Andrew S.C. Rice
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
| | - Harriet Kemp
- Department of Surgery and Cancer, Pain Research Group, Imperial College, London, United Kingdom
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Duan W, Huang J, Huang Q, Dong B. Relationship between Pain and Dementia: The Mediating Effect of Depression among Chinese Elderly. Actas Esp Psiquiatr 2024; 52:114-121. [PMID: 38622013 PMCID: PMC11015815 DOI: 10.62641/aep.v52i2.1530] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Chronic pain poses a significant problem for older adults and may potentially impact cognitive function. This study aimed to examine the cross-sectional relationship between pain severity and cognitive function in elderly individuals residing in the community. Additionally, this study sought to examine the mediating effect of depression on the relationship between pain and dementia. METHODS The study sample was derived from the 2018 China Health and Aging Longitudinal Study (CHARLS), comprising cross-sectional data from 4559 community residents aged 65 years or older. The primary outcome assessed was the occurrence of dementia, while the main independent variable was pain severity (none, little, somewhat, quite a bit, very). Depression score served as the mediating factor. Chi-square and binary logistic regression analyses were performed to examine the relationship between depression and the occurrence of pain and dementia. An intermediate model was constructed by stepwise regression. RESULTS The study indicates a significant association between cognitive impairment and both chronic pain and depressive symptoms in older adults living in China. Individuals who frequently report experiencing pain exhibit a higher likelihood of developing dementia when compared to those who do not report any pain (odds ratio (OR) = 1.72, p < 0.001). Moreover, depressive symptoms significantly mediate the relationship between pain and dementia, with the mediating effect accounting for 65.25%. CONCLUSIONS Chronic pain not only directly impacts patients' cognitive function but also indirectly exacerbates cognitive impairment through depressive symptoms as a mediating variable. For elderly individuals experiencing depressive symptoms, it is important to provide appropriate psychological treatment in conjunction with pain management strategies.
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Affiliation(s)
- Wenrong Duan
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
- Department of Geriatrics, No.2 People’s Hospital, 644000 Yibin, Sichuan, China
| | - Jian Huang
- Department of Geriatrics, No.2 People’s Hospital, 644000 Yibin, Sichuan, China
| | - Qiuling Huang
- Department of Geriatrics, No.2 People’s Hospital, 644000 Yibin, Sichuan, China
| | - Birong Dong
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China
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Onyeakazi UM, Columb MO, Rosalind A, Kanakarajan S, Galley HF. Melatonin treatment has consistent but transient beneficial effects on sleep measures and pain in patients with severe chronic pain: the DREAM-CP randomised controlled trial. Br J Anaesth 2024; 132:725-734. [PMID: 38355388 PMCID: PMC10925889 DOI: 10.1016/j.bja.2024.01.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Sleep disturbance is a major issue for patients with chronic pain. Melatonin has been shown to improve symptoms of fibromyalgia, but its efficacy in other chronic non-malignant pain conditions is not fully known. Hence, we determined the effect of melatonin in patients with severe noncancer chronic pain. METHODS This was a randomised double-blinded crossover trial of modified-release melatonin as Circadin™ compared with placebo. Sixty male and female subjects with chronic severe pain were randomised to receive either 2 mg of Circadin™ or placebo before sleep for 6 weeks, followed by a >4 week washout, then crossing over to the other treatment. Sleep disturbance, quality, and latency were measured using three different validated sleep assessment tools. The primary outcome measure was self-reported sleep disturbance after 6 weeks of treatment. Adverse events were also recorded. RESULTS Sleep disturbance after 6 weeks was not significantly altered by melatonin treatment, but differences between melatonin and placebo treatment periods after 3 weeks were seen: sleep disturbance (P=0.014), latency (P=0.04), overall sleep quality (P=0.004), and effect of pain on sleep (P=0.032). Pain intensity scores improved during both treatment periods (both P<0.001). There were no differences in adverse events between treatment periods. CONCLUSIONS Circadin™ treatment did not improve sleep disturbance in patients with severe chronic pain compared with placebo at 6 weeks, but there were consistent improvements in aspects of sleep in the shorter term. Given its favourable safety profile, it could be beneficial for some patients with chronic pain. CLINICAL TRIAL REGISTRATION ISRCTN12861060.
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Affiliation(s)
- Uzunma M Onyeakazi
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Malachy O Columb
- Manchester University Hospitals NHS Foundation Trust, Wythenshawe, UK
| | - Adam Rosalind
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Helen F Galley
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
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Newlands AF, Kramer M, Roberts L, Maxwell K, Price JL, Finlay KA. Evaluating the quality of life impact of recurrent urinary tract infection: Validation and refinement of the Recurrent UTI Impact Questionnaire (RUTIIQ). Neurourol Urodyn 2024; 43:902-914. [PMID: 38385648 DOI: 10.1002/nau.25426] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/08/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND AIMS Recurrent urinary tract infection (rUTI) has significant negative consequences for a wide variety of quality of life (QoL) domains. Without adequate validation and assessment of the unique insights of people living with rUTI, clinical results cannot be fully understood. The Recurrent UTI Impact Questionnaire (RUTIIQ), a novel patient-reported outcome measure of rUTI psychosocial impact, has been robustly developed with extensive patient and clinician input to facilitate enhanced rUTI management and research. This study aimed to confirm the structural validity of the RUTIIQ, assessing its strength and bifactor model fit. METHODS A sample of 389 adults experiencing rUTI (96.9% female, aged 18-87 years) completed an online cross-sectional survey comprising a demographic questionnaire and the RUTIIQ. A bifactor graded response model was fitted to the data, optimizing the questionnaire structure based on item fit, discrimination capability, local dependence, and differential item functioning. RESULTS The final RUTIIQ demonstrated excellent bifactor model fit (RMSEA = 0.054, CFI = 0.99, SRMSR = 0.052), and mean-square fit indices indicated that all included items were productive for measurement (MNSQ = 0.52-1.41). The final questionnaire comprised an 18-item general "rUTI QoL impact" factor, and five subfactor domains measuring "personal wellbeing" (three items), "social wellbeing" (four items), "work and activity interference" (four items), "patient satisfaction" (four items), and "sexual wellbeing" (three items). Together, the general factor and five subfactors explained 81.6% of the common model variance. All factor loadings were greater than 0.30 and communalities greater than 0.60, indicating good model fit and structural validity. CONCLUSIONS The 18-item RUTIIQ is a robust, patient-tested questionnaire with excellent psychometric properties, which capably assesses the patient experience of rUTI-related impact to QoL and healthcare satisfaction. Facilitating standardized patient monitoring and improved shared decision-making, the RUTIIQ delivers the unique opportunity to improve patient-centered care.
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Affiliation(s)
- Abigail F Newlands
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Lindsey Roberts
- School of Psychology, University of Buckingham, Buckingham, UK
| | - Kayleigh Maxwell
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Katherine A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Bell AD, MacCallum C, Margolese S, Walsh Z, Wright P, Daeninck PJ, Mandarino E, Lacasse G, Kaur Deol J, de Freitas L, St. Pierre M, Belle-Isle L, Gagnon M, Bevan S, Sanchez T, Arlt S, Monahan-Ellison M, O'Hara J, Boivin M, Costiniuk C. Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions. Cannabis Cannabinoid Res 2024; 9:669-687. [PMID: 36971587 PMCID: PMC10998028 DOI: 10.1089/can.2021.0156] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.
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Affiliation(s)
- Alan D. Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Caroline MacCallum
- Faculty of Medicine, Department of Internal Medicine, University of British Columbia, Vancouver, Canada
| | - Shari Margolese
- Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | | | - Paul J. Daeninck
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- CancerCare Manitoba, Winnipeg, Canada
| | - Enrico Mandarino
- Canadian HIV Trials Network, University of British Columbia, Vancouver, Canada
- MJardin Group Canada, Toronto, Canada
| | | | - Jagpaul Kaur Deol
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lauren de Freitas
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | | | | | - Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | | | - Tatiana Sanchez
- Department of Psychology, University of British Columbia, Kelowna, Canada
| | - Stephanie Arlt
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | | | | | | | - Cecilia Costiniuk
- Chronic Viral Illness Service/Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
- McGill Cannabis Research Centre, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
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Kim HS, Lee D, Shen S. Endoplasmic reticular stress as an emerging therapeutic target for chronic pain: a narrative review. Br J Anaesth 2024; 132:707-724. [PMID: 38378384 PMCID: PMC10925894 DOI: 10.1016/j.bja.2024.01.007] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/11/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024] Open
Abstract
Chronic pain is a severely debilitating condition with enormous socioeconomic costs. Current treatment regimens with nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or opioids have been largely unsatisfactory with uncertain benefits or severe long-term side effects. This is mainly because chronic pain has a multifactorial aetiology. Although conventional pain medications can alleviate pain by keeping several dysfunctional pathways under control, they can mask other underlying pathological causes, ultimately worsening nerve pathologies and pain outcome. Recent preclinical studies have shown that endoplasmic reticulum (ER) stress could be a central hub for triggering multiple molecular cascades involved in the development of chronic pain. Several ER stress inhibitors and unfolded protein response modulators, which have been tested in randomised clinical trials or apprpoved by the US Food and Drug Administration for other chronic diseases, significantly alleviated hyperalgesia in multiple preclinical pain models. Although the role of ER stress in neurodegenerative disorders, metabolic disorders, and cancer has been well established, research on ER stress and chronic pain is still in its infancy. Here, we critically analyse preclinical studies and explore how ER stress can mechanistically act as a central node to drive development and progression of chronic pain. We also discuss therapeutic prospects, benefits, and pitfalls of using ER stress inhibitors and unfolded protein response modulators for managing intractable chronic pain. In the future, targeting ER stress to impact multiple molecular networks might be an attractive therapeutic strategy against chronic pain refractory to steroids, NSAIDs, or opioids. This novel therapeutic strategy could provide solutions for the opioid crisis and public health challenge.
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Affiliation(s)
- Harper S Kim
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donghwan Lee
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shiqian Shen
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Steele LA, Mooney SS, Gilbee ES, Grover SR. When you see nothing at all: Outcomes following a negative laparoscopy. A systematic review. Aust N Z J Obstet Gynaecol 2024; 64:95-103. [PMID: 37737451 DOI: 10.1111/ajo.13749] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Persistent pelvic pain (PPP) is a complex and often debilitating condition. While widely accepted to be multifactorial in nature, the precise aetiology of PPP remains elusive. In many cases, women who undergo laparoscopy for PPP will have no visible pathology identified (a 'negative' laparoscopy). Currently, there are no consensus guidelines which outline the recommended management following a negative laparoscopy, and the woman's experiences and outcomes are not widely known. AIMS This review aims to identify and summarise the literature surrounding the experiences of women with PPP who have a negative laparoscopy; specifically, their outcomes of pain, quality of life (QoL), satisfaction with care, and their overall management. MATERIALS AND METHODS A systematic search of the electronic databases Ovid Medline, PubMed and Embase was performed. Studies in English exploring the outcomes of women with PPP following a negative laparoscopy were included. RESULTS Four studies consisting of a total of 200 women were included. Results were inconsistent. Three studies concluded that the majority of women with PPP had persistent pain following a negative laparoscopy. A single study found that pain significantly improved after negative laparoscopy. QoL outcomes varied, with two studies reporting a positive impact and two studies reporting a deleterious impact on QoL following a negative laparoscopy. CONCLUSIONS The impact on pain outcomes and QoL following a laparoscopy that does not diagnose pathology remains unknown, and the available evidence is insufficient to guide evidence-based practice. This review highlights a significant gap in our understanding of surgical management for PPP.
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Affiliation(s)
- Lucy A Steele
- School of Medicine, Austin Hospital Clinical School, Victoria, Melbourne, Australia
| | - Samantha S Mooney
- Department of Endosurgery, Mercy Hospital for Women, Victoria, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ebony S Gilbee
- Department of Endosurgery, Mercy Hospital for Women, Victoria, Melbourne, Australia
| | - Sonia R Grover
- Department of Endosurgery, Mercy Hospital for Women, Victoria, Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Van Houtven CH, Smith VA, Miller KEM, Berkowitz TSZ, Shepherd-Banigan M, Hein T, Penney LS, Allen KD, Kabat M, Jobin T, Hastings SN. Comprehensive Caregiver Supports and Ascertainment and Treatment of Veteran Pain. Med Care Res Rev 2024; 81:107-121. [PMID: 38062735 DOI: 10.1177/10775587231210026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Disabled Veterans commonly experience pain. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides training, a stipend, and services to family caregivers of eligible Veterans to support their caregiving role. We compared ascertainment of veteran pain and pain treatment through health care encounters and medications (pain indicators) of participants (treated group) and non-participants (comparison group) using inverse probability treatment weights. Modeled results show that the proportion of Veterans with a pain indicator in the first year post-application was higher than that pre-application for both groups. However, the proportion of Veterans with a pain indicator was substantially higher in the treatment group: 76.1% versus 63.9% in the comparison group (p < .001). Over time, the proportion of Veterans with any pain indicator fell and group differences lessened. However, differences persisted through 8 years post-application (p < .001). PCAFC caregivers appear to help Veterans engage in pain treatment at higher rates than caregivers not in PCAFC.
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Affiliation(s)
- Courtney H Van Houtven
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Duke Margolis Center for Health Policy, Duke University
| | - Valerie A Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Department of General Internal Medicine, Duke University
| | - Katherine E M Miller
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Medical Ethics and Health Policy, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Theodore S Z Berkowitz
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
| | - Megan Shepherd-Banigan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
| | - Tyler Hein
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs
| | - Lauren S Penney
- The Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio
| | - Kelli D Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Margaret Kabat
- Office of the Secretary US Department of Veterans Affairs
| | - Timothy Jobin
- Caregiver Support Program, Veterans Health Administration, US Department of Veterans Affairs
| | - S Nicole Hastings
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine
- Center for the Study of Aging and Human Development, Duke University School of Medicine
- Geriatrics Research, Education and Clinical Center, Durham VA Health Care System
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Soreau A, Ferey C, Hardouin JB, Draper-Rodi J, Sarzeaud R, Benoist H, Ostelo RW, Merdy O. Translation, validity and reliability of the pain attitudes and beliefs scale for physiotherapists in French. Physiother Res Int 2024; 29:e2078. [PMID: 38430539 DOI: 10.1002/pri.2078] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/04/2024]
Abstract
BACKGROUND The Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) questionnaire evaluates manual therapists' biomedical and biopsychosocial beliefs regarding the management of chronic low back pain. Its usage in clinical settings is an important step in the implementation of national guidelines and policies to improve patient management. OBJECTIVES The objective of this study was to translate the PABS-PT questionnaire into French, to adapt it culturally, and to conduct a psychometric analysis. DESIGN Qualitative and cross-sectional study. METHOD The translation process followed published guidelines with cross-cultural validation by an expert committee. We followed a forward and backward translation procedure and an expert committee, including the original author of the questionnaire and a linguistics expert ensuring good cultural adaptation, issued a finalised version. Psychometric analysis of the French version of the questionnaire was conducted among 390 French manual therapists in two phases. The first phase evaluated structural validity as well as external validity compared with the TSK and BBQ questionnaires. Then, reliability and scalability were analysed. The second phase evaluated test-retest reproducibility by sending the same questionnaire 3 months later. RESULTS The validity study revealed three subscales: the classic biomedical subscale and two subscales for biopsychosocial beliefs (aetiology of pain and physical activity). With 21 items in total for the PABS-PT-FR, the structural validity scores were good (BM: alpha = 0.82, H = 0.38; Physical Activity: alpha = 0.62, H = 0.32; Aetiology of Pain: alpha = 0.55, H = 0.29). CONCLUSIONS This study provides a validated tool to assess French physiotherapists' and, more generally, healthcare providers' beliefs about chronic low back pain, with a new insight into the BPS subscale internal construct.
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Affiliation(s)
- Alexis Soreau
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
| | - Cassandre Ferey
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
- UMR INSERM 1246 - SPHERE, Nantes Université, Université de Tours, Tours, France
| | - Jean-Benoit Hardouin
- UMR INSERM 1246 - SPHERE, Nantes Université, Université de Tours, Tours, France
- Service de santé publique - Plateforme de Méthodologie et de Biostatistique - CHU de Nantes, Nantes, France
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
| | - Robert Sarzeaud
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
| | - Hélène Benoist
- Freelance Translator (English and Spanish into French), Finistère, France
| | - Raymond W Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Olivier Merdy
- Institut des Hautes Études Ostéopathiques (IdHEO), St-Herblain, France
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Sousa APD, Almeida LA, Lourenço BP, Alvares LD, Avila MA. Pain neuroscience education improves quality of life when added to aquatic exercise therapy for women with fibromyalgia: randomized controlled clinical trial. Disabil Rehabil 2024; 46:1559-1569. [PMID: 37070715 DOI: 10.1080/09638288.2023.2201510] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The aim of the present study was to investigate the effects of adding Pain Neuroscience Education (PNE) to an aquatic therapy protocol on pain, fibromyalgia (FMS) impact, quality of life and sleep. MATERIALS AND METHODS Seventy-five women were randomly allocated into two groups: aquatic exercises (AEG, n = 36) and aquatic exercises + PNE (PNG, n = 39). The primary outcome was pain, and the secondary outcomes were FMS impact, quality of life, sleep and pain sensitivity (pressure pain thresholds - PPTs). Participants performed 45-min sessions of aquatic exercises, twice a week, for 12 weeks. PNG also received 4 PNE sessions during this period. Participants were assessed four times: initial (before treatment), after 6 weeks (intermediate) and 12 weeks (final) of treatment and after 12 weeks after the end of treatment (follow-up). RESULTS Both groups improved pain after treatment, with no difference between them (p > 0.05, partial ƞ2 0.10). FMS impact and PPTs improved after treatment with no difference between groups, and sleep did not change. Quality of life improved several domains for both groups, with slightly better results for the PNG, with low effect sizes between groups. CONCLUSIONS The present results show that the addition of PNE to an aquatic exercise intervention did not provide larger effects than aquatic exercises alone for people with FMS concerning pain intensity, but provided benefit for health-related quality of life for this population. TRIAL REGISTRATION ClinicalTrials.gov (NCT03073642, version 2, April 1st, 2019). PERSPECTIVE The addition of 4 Pain Neuroscience Education sessions to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome on pain, fibromyalgia impact, and sleep, but improved quality of life and pain sensitivity.IMPLICATIONS FOR REHABILITATIONAquatic exercises are commonly prescribed, but patient education is crucial for the treatment.The addition of Pain Neuroscience Education to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome.The positive changes on quality of life and pain sensitivity that this combination led to had small effect sizes and did not achieve minimal important clinical difference.
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Affiliation(s)
- Ana Paula de Sousa
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Lucas Araújo Almeida
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
| | | | - Luiza Duarte Alvares
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Mariana Arias Avila
- Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, Brazil
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
- Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
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Tieppo Francio V, Alm J, Leavitt L, Mok D, Yoon BV, Nazir N, Lam C, Latif U, Sowder T, Braun E, Sack A, Khan T, Sayed D. Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation. Pain Pract 2024; 24:584-599. [PMID: 38078593 DOI: 10.1111/papr.13328] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
INTRODUCTION The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention. MATERIALS AND METHODS This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences. RESULTS The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant. CONCLUSION Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John Alm
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Logan Leavitt
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Daniel Mok
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - B Victor Yoon
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Christopher Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Timothy Sowder
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward Braun
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Talal Khan
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Burke L, Desai MJ. Pocket pain following spinal cord stimulator generator implantation: A narrative review of this under-reported risk. Pain Pract 2024; 24:659-669. [PMID: 38102862 DOI: 10.1111/papr.13336] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Spinal cord stimulation (SCS) is a well-established treatment option for chronic pain. Pain over the implantable pulse generator, or pocket pain, is an incompletely understood risk of SCS implantation which may limit the efficacy of treatment and patient quality of life. The goal of this narrative review is to analyze the literature to gain a more thorough understanding of the incidence and risk factors for the development of pocket pain to help guide treatment options and minimize its occurrence in the future. METHODS A literature review was conducted investigating the development of pocket pain in patients with SCS for the management of a variety of pain conditions. RESULTS In total, 305 articles were included in the original database search and 50 met the criteria for inclusion. The highest level of evidence for papers that specifically investigated pocket pain was level III. Four retrospective, observational analyses included pocket pain as a primary outcome. The remainder of the included studies listed pocket pain as an adverse event of SCS implantation. CONCLUSIONS There is a relative dearth of primary literature that examines the incidence, characteristics, and health economic implications of pocket pain in patients with SCS. This highlights the need for large-scale, high-quality prospective or randomized controlled trials examining pocket pain. This may ultimately help prevent and reduce pocket pain leading to improved efficacy of treatment and greater patient quality of life.
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Affiliation(s)
- Lindsay Burke
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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