1
|
Cullens M, James C, Liu M, Vydyanathan A, Shaparin N, Schatman M, Hascalovici J. Defining Personas of People Living with Chronic Pain: An Ethnographic Research Study. J Pain Res 2023; 16:2803-2816. [PMID: 37600078 PMCID: PMC10438436 DOI: 10.2147/jpr.s420742] [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: 06/15/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Pain is the leading reason for which people seek medical care in the United States, and chronic pain (CP) affects approximately 50 million people in the US Pain perception is deeply personal, is highly correlated with behavioral and emotional disorders, and is greatly influenced by physiological and environmental factors. The patient-provider relationship can have profound implications for clinical outcomes within the context of treating CP. However, limited access to pain specialists, the complex nature of many CP-causing conditions, the absence of instruments for objective pain measurement, and the need to foster a trust-based patient-provider relationship throughout treatment pose unique challenges. Objective To support a more optimal CP care delivery system that leverages a healthy therapeutic patient-provider relationship, we systematically gathered deeper knowledge of the behaviors, interpersonal dynamics, home environment, values, and mindsets of people who experience CP. Methods We employed ethnographic research methods to collect and analyze data on views, habits, strategies, attitudes, and life circumstances of a range of participants living with CP. We aggregated, analyzed, and summarized participant data to identify trends and similarities. Results Our findings suggest that patients can be broadly categorized into five predominant pain typologies, or "personas", which are characterized by respective symptom durations, care management preferences, values, communication styles, and behaviors. Conclusion Identifying CP personas may enhance the ability to personalize CP care and help foster more robust therapeutic relationships, which may lead to greater trust, improved patient satisfaction, and better clinical outcomes.
Collapse
Affiliation(s)
| | - Cyan James
- Clearing Relief Labs Inc., New York City, NY, USA
| | - Meran Liu
- Clearing Relief Labs Inc., New York City, NY, USA
| | - Amaresh Vydyanathan
- Relief Medical Group P.A, New York City, NY, USA
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York City, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York City, NY, USA
| | - Jacob Hascalovici
- Relief Medical Group P.A, New York City, NY, USA
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
- The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
2
|
Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity and equity in pain science. Eur J Pain 2023; 27:451-456. [PMID: 36815603 DOI: 10.1002/ejp.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Washington, USA
| | - Karen D Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Joel D Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, North, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine and Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Washington, USA
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| |
Collapse
|
3
|
Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity, and equity in pain science. Pain 2023; 164:217-220. [PMID: 36626235 PMCID: PMC9833109 DOI: 10.1097/j.pain.0000000000002847] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Karen Deborah Davis
- Division of Brain, Imaging, and Behaviour, Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W. Hurley
- Department of Anesthesiology, and Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Joel D. Katz
- Department of Psychology, York University, Toronto, ON, Canada
| | - Francis J. Keefe
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| |
Collapse
|
4
|
Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting Inclusion, Diversity, and Equity in Pain Science. Clin J Pain 2023; 39:55-59. [PMID: 36650601 PMCID: PMC9844988 DOI: 10.1097/ajp.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W. Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joel D. Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York
- Division of Medical Ethics, Department of Population Health NYU Grossman School of Medicine, New York, New York
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| |
Collapse
|
5
|
Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting Inclusion, Diversity, and Equity in Pain Science. Pain Med 2023; 24:105-109. [PMID: 36622210 PMCID: PMC9890303 DOI: 10.1093/pm/pnac204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Tonya M Palermo
- Corresponding author: Tonya M. Palermo, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children’s Research Institute, M/S BC-3, P.O. Box 5371, Seattle, WA 98145-5005, USA.
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, United States; Editor-in-Chief, Pain
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France; Editor-in-Chief, European Journal of Pain
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Editor-in-Chief, Pain Medicine
| | - Joel D Katz
- Department of Psychology, York University, Toronto, ON, Canada; Editor-in-Chief, Canadian Journal of Pain
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States; Former Editor-in-Chief, Pain
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, United States; Editor-in-Chief, Journal of Pain Research,Department of Population Health—Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, United States
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States; Editor-in-Chief, Journal of Pain,Editor-in-Chief, Clinical Journal of Pain
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel; Editor-in-Chief, Pain Reports
| |
Collapse
|
6
|
Palermo TM, Davis KD, Bouhassira D, Hurley RW, Katz JD, Keefe FJ, Schatman M, Turk DC, Yarnitsky D. Promoting inclusion, diversity, and equity in pain science. Can J Pain 2023; 7:2161272. [PMID: 36874230 PMCID: PMC9980601 DOI: 10.1080/24740527.2022.2161272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Karen Deborah Davis
- Department of Surgery and Institute of Medical Science, Krembil Brain Institute, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Didier Bouhassira
- Inserm U987, APHP, UVSQ, Paris-Saclay University, Ambroise Pare Hospital, Boulogne-Billancourt, France
| | - Robert W Hurley
- Department of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Joel D Katz
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USADepartment of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USADepartment of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| | - David Yarnitsky
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, Rambam Medical Center, and Laboratory of Clinical Neurophysiology, Technion Faculty of Medicine, Haifa, Israel
| |
Collapse
|
7
|
Lo Bianco G, Papa A, Gazzerro G, Rispoli M, Tammaro D, Di Dato MT, Vernuccio F, Schatman M. Dorsal Root Ganglion Stimulation for Chronic Postoperative Pain Following Thoracic Surgery: A Pilot Study. Neuromodulation 2020; 24:774-778. [PMID: 32909359 DOI: 10.1111/ner.13265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/13/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Post-thoracotomy pain syndrome (PTPS) is defined as persistent pain following a thoracotomy and has an incidence of 21-61%. Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation that modulates pain signal transmission to the spinal cord. The aims of this study were to investigate the efficacy of DRG-S for the management of PTPS and to assess the role of thoracic paravertebral blocks (t-PVB) as a tool for prediction of success of DRG-S. MATERIALS AND METHODS In this prospective study, we included all patients undergoing thoracic surgery, with PTPS not responding to pharmacotherapy and treated with DRG-S from September 2018 to February 2019. t-PVB followed by a percutaneous DRG-S trial was performed on all patients. Pain intensity was assessed through a numeric rating scale (NRS) and Douleur Neuropathique en 4 Questions (DN4) at baseline, post-trial, at 14 days, 90 days, and at one year after DRG-S implantation. Data summarized as continuous variables were expressed as means and standard deviations (SDs), and categorical variables were expressed as raw numbers and percentages. RESULTS Four patients out of 51 who underwent thoracic surgery at our institution surveyed were included (mean age ± SD, 56 ± 16 years old). Mean NRS and DN4 were, respectively, 7.2 ± 0.96 SD and 8.2 ± 0.5 SD at baseline, 2.5 ± 0.6 SD and 3.2 ± 0.5 SD after t-PVB, 2.2 ± 0.5 SD and 2.2 ± 0.5 SD at 14 days, 90 days, and at one year after DRG-S implantation. No complications or side effects were reported. CONCLUSIONS Our preliminary results show that DRG-S is an effective therapy for PTPS after thoracic surgery. In addition, thoracic paravertebral blocks performed prior to DRG-S correlated with a positive outcome with treatment.
Collapse
Affiliation(s)
- Giuliano Lo Bianco
- Pain Department, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy.,Università di Catania, Dipartimento di Scienze Biomediche e Biotecnologiche (BIOMETEC), Catania, Italy.,Anesthesiology and Pain Department, Fondazione Istituto G. Giglio, Cefalù, Italy.,Pain Management and Neuromodulation, Basildon and Thurrock University Hospitals NHSFT, Orsett Hospital, London, UK
| | - Alfonso Papa
- Pain Department, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy
| | - Giuseppe Gazzerro
- Pain Department, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy
| | - Marco Rispoli
- Anesthesiology Department, Thoracic Surgery, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy
| | - Dario Tammaro
- Pain Department, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy.,Anesthesiology Department, Thoracic Surgery, A.O. Dei Colli - V. Monaldi Hospital, Napoli, Italy
| | | | - Federica Vernuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Michael Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
8
|
Affiliation(s)
- Daniel Carr
- Daniel Carr and Michael Schatman are with the Program on Pain Research, Education and Policy, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA. Daniel Carr is a guest editor for this special section
| | - Michael Schatman
- Daniel Carr and Michael Schatman are with the Program on Pain Research, Education and Policy, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA. Daniel Carr is a guest editor for this special section
| |
Collapse
|
9
|
Savage SR, Romero-Sandoval A, Schatman M, Wallace M, Fanciullo G, McCarberg B, Ware M. Cannabis in Pain Treatment: Clinical and Research Considerations. The Journal of Pain 2016; 17:654-68. [DOI: 10.1016/j.jpain.2016.02.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/27/2016] [Accepted: 02/09/2016] [Indexed: 12/21/2022]
|
10
|
Campbell LC, Robinson K, Meghani SH, Vallerand A, Schatman M, Sonty N. Challenges and opportunities in pain management disparities research: implications for clinical practice, advocacy, and policy. J Pain 2012; 13:611-9. [PMID: 22560002 PMCID: PMC3958966 DOI: 10.1016/j.jpain.2012.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/07/2012] [Accepted: 02/17/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED Due to high profile initiatives at the national level, awareness of inadequate pain care affecting many groups in our society has never been greater. Nevertheless, increased awareness of pain disparities and the initiatives to address these disparities have yielded only modest progress, most notably in the form of growing appreciation that pain disparities likely result from multiple factors, including biological, psychological, environmental, health system, and cultural factors. Much less progress has been made in developing interventions that target these multiple determinants to reduce pain management disparities. In this paper we discuss key ethical and methodological challenges that undermine our capacity to investigate and develop meaningful interventions to improve pain outcomes among vulnerable populations. Key challenges in the areas of research engagement, recruitment, design, and measurement are discussed from both scientific and normative standpoints. Specific opportunities within emerging research paradigms to improve designs and measures are also discussed. Finally, we conclude with identifying potential synergies between the pain management disparities research agenda and the broader areas of clinical practice, advocacy, and policy that could help to move the field forward. PERSPECTIVE Researchers studying disparities in pain care face a number of ethical and methodological challenges that must be addressed to advance the field towards eliminating disparities. We discuss these ethical and methodological challenges and propose opportunities for paradigmatic revisions in areas of research engagement, design, measurement, advocacy, and policy.
Collapse
Affiliation(s)
- Lisa C Campbell
- Department of Psychology, East Carolina University, Greenville, North Carolina 27858, USA.
| | | | | | | | | | | |
Collapse
|