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Crul TC, Hacking EC, Visser-Meily JMA, Post MWM, Stolwijk-Swüste JM. Choosing non-pharmacological treatments for neuropathic pain in spinal cord injury: a qualitative study. Disabil Rehabil 2024:1-7. [PMID: 38840332 DOI: 10.1080/09638288.2024.2362402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The aims of this study were to explore (1) the considerations of people with spinal cord injury (SCI) in choosing to use non-pharmacological treatments (N-PTs) for neuropathic pain (NP), (2) which factors influence their decision and who is involved in this choice. MATERIALS AND METHODS Eleven individuals with SCI and NP were interviewed. Interviews were transcribed verbatim, transcripts were analysed through thematic coding, following an inductive content analysis approach. RESULTS A journey towards finding and choosing N-PTs emerged. Key phases in this journey were: motives, strategy and practical considerations. Pain and its impact on their life led participants to consider N-PTs. Motives were participants' negative attitudes towards regular medication, willingness to try everything and disappointment and frustration with the guidance from their health care provider (HCP). The search strategies often involved third parties and the internet. This led them to choose a specific N-PT. The journey was influenced by one's attitude, previous personal experience, experience of HCPs, financial considerations, availability and convenience of the treatment. CONCLUSIONS The journey individuals with SCI and NP go through to find N-PTs to manage pain is difficult and often lonely. Findings highlight the importance of HCPs accompanying people with SCI in finding N-PTs.
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Affiliation(s)
- T C Crul
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - E C Hacking
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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Flores MW, Sharp A, Lu F, Cook BL. Examining Racial/Ethnic Differences in Patterns of Opioid Prescribing: Results from an Urban Safety-Net Healthcare System. J Racial Ethn Health Disparities 2024; 11:719-729. [PMID: 36892815 PMCID: PMC9997438 DOI: 10.1007/s40615-023-01555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
Prescription opioids still account for a large proportion of overdose deaths and contribute to opioid use dependence (OUD). Studies earlier in the epidemic suggest clinicians were less likely to prescribe opioids to racial/ethnic minorities. As OUD-related deaths have increased disproportionately amongst minority populations, it is essential to understand racial/ethnic differences in opioid prescribing patterns to inform culturally sensitive mitigation efforts. The purpose of this study is to estimate racial/ethnic differences in opioid medication use among patients prescribed opioids. Using electronic health records and a retrospective cohort study design, we estimated multivariable hazard models and generalized linear models, assessing racial/ethnic differences in OUD diagnosis, number of opioid prescriptions, receiving only one opioid prescription, and receiving ≥18 opioid prescriptions. Study population (N=22,201) consisted of adult patients (≥18years), with ≥3 primary care visits (ensuring healthcare system linkage), ≥1 opioid prescription, who did not have an OUD diagnoses prior to the first opioid prescription during the 32-month study period. Relative to racial/ethnic minority patients, White patients, in both unadjusted and adjusted analyses, had a greater number of opioid prescriptions filled, a higher proportion received ≥18 opioid prescriptions, and a greater hazard of having an OUD diagnosis subsequent to receiving an opioid prescription (all groups p<0.001). Although opioid prescribing rates have declined nationally, our findings suggest White patients still experience a high volume of opioid prescriptions and greater risk of OUD diagnosis. Racial/ethnic minorities are less likely to receive follow-up pain medications, which may signal low care quality. Identifying provider bias in pain management of racial/ethnic minorities could inform interventions seeking balance between adequate pain treatment and risk of opioid misuse/abuse.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Frederick Lu
- Boston University School of Medicine, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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3
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Kim K, Yang Y, Wang Z, Chen J, Barandouzi ZA, Hong H, Han HR, Starkweather A. A systematic review of the association between health literacy and pain self-management. PATIENT EDUCATION AND COUNSELING 2022; 105:1427-1440. [PMID: 34629232 DOI: 10.1016/j.pec.2021.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/03/2021] [Accepted: 09/28/2021] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes. METHODS This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies. RESULTS Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education. CONCLUSIONS Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation. PRACTICE IMPLICATIONS Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients' literacy levels helps clinicians personalize education, which then promotes patients' knowledge of pain, medication regimen adherence, and pain control.
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Affiliation(s)
- Kyounghae Kim
- College of Nursing, Korea University, Seoul, South Korea; Institute of Nursing Research, Korea University, Seoul, South Korea; Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, South Korea.
| | - Yuxuan Yang
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | - Zequan Wang
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | - Jie Chen
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
| | | | - Hyejeong Hong
- School of Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Angela Starkweather
- School of Nursing, University of Connecticut, Storrs, CT, USA; Center for Advancement in Managing Pain, University of Connecticut, Storrs, CT, USA
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4
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Gilmartin-Thomas JFM, Forbes A, Liew D, McNeil JJ, Cicuttini FM, Owen AJ, Ernst ME, Nelson MR, Lockery J, Ward SA, Busija L. Evaluation of the Pain Impact Index for Community-Dwelling Older Adults Through the Application of Rasch Modelling. Pain Pract 2021; 21:501-512. [PMID: 33295122 PMCID: PMC8187294 DOI: 10.1111/papr.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the Pain Impact Index, a simple, brief, easy-to-use, and novel tool to assess the impact of chronic pain in community-dwelling older adults. METHODS A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert-type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. RESULTS The four-item Pain Impact Index was self-completed by 6454 community-dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced sample size to mitigate the potential for overpowering: n = 377, P > 0.0125, power > 77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study sample. Both convergent and discriminant validity of the Index were supported. CONCLUSION The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
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Affiliation(s)
- Julia F-M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, U.S.A
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, U.S.A
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Powers MB, Pogue JR, Curcio NE, Patel S, Wierzchowski A, Thomas EV, Warren AM, Adams M, Turner E, Carl E, Froehlich-Grobe K, Sikka S, Foreman M, Leonard K, Douglas M, Bennett M, Driver S. Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2021; 22:100763. [PMID: 34013091 PMCID: PMC8113811 DOI: 10.1016/j.conctc.2021.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/28/2021] [Accepted: 03/26/2021] [Indexed: 10/28/2022] Open
Abstract
The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (N = 60) will be randomly assigned to either: (1) 12-sessions of PE (2-3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.
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Affiliation(s)
- Mark B Powers
- Baylor University Medical Center, Dallas, TX, United States
| | - Jamie R Pogue
- Baylor University Medical Center, Dallas, TX, United States
| | | | - Sarita Patel
- Baylor University Medical Center, Dallas, TX, United States
| | | | | | | | - Maris Adams
- Baylor University Medical Center, Dallas, TX, United States
| | - Emma Turner
- Baylor University Medical Center, Dallas, TX, United States
| | - Emily Carl
- The University of Texas at Austin, Austin, TX, United States
| | | | - Seema Sikka
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | | | - Kiara Leonard
- Baylor University Medical Center, Dallas, TX, United States
| | - Megan Douglas
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | - Monica Bennett
- Baylor University Medical Center, Dallas, TX, United States
| | - Simon Driver
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
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6
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Campos JH, Seering M. Does Liposomal Bupivacaine Have Any Advantage Over Bupivacaine Hydrochloride for Intercostal Nerve Blocks in Minimally Invasive Thoracic Surgery? J Cardiothorac Vasc Anesth 2021; 35:1399-1403. [PMID: 33563528 DOI: 10.1053/j.jvca.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Melinda Seering
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
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7
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Jaaniste T, Noel M, Yee RD, Bang J, Tan AC, Champion GD. Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer. CHILDREN-BASEL 2019; 6:children6120132. [PMID: 31810283 PMCID: PMC6956370 DOI: 10.3390/children6120132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child’s pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children’s self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
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Affiliation(s)
- Tiina Jaaniste
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
- Correspondence:
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Hotchkiss Brain Institute, Calgary, AB T2N 1N4, Canada
| | - Renee D. Yee
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Joseph Bang
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | | | - G. David Champion
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
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8
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Findley G, Ryan C, Cartwright A, Martin D. Study protocol for an investigation of the effectiveness of the pain toolkit for people with low back pain: double-blind randomised controlled trial. BMJ Open 2019; 9:e031266. [PMID: 31712337 PMCID: PMC6858217 DOI: 10.1136/bmjopen-2019-031266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Pain Toolkit is a self-management tool for people with persistent pain. It is available for use worldwide in multiple formats. To date, no studies have investigated the effectiveness of this intervention. This study aims to investigate the effectiveness of the Pain Toolkit in comparison with a simple education control for people with low back pain. METHODS AND ANALYSIS Participants who have been discharged from the North of England Regional Back Pain Pathway will be randomised using sealed, consecutively numbered opaque envelopes to receive either the Pain Toolkit and the Back Book (intervention group) or the Back Book only (control group). Both the therapist and the participant will be blind to group allocation. The primary outcome measure will be disability (Oswestry Disability Index (ODI)). Secondary outcome measures will be pain (0-10 numerical scale), healthcare use (number of healthcare professional visits) and quality of life (EuroQol-5D). Outcome measures will be completed at baseline and at 6 and 12 months. Data will be analysed using analysis of covariance, adjusting for baseline values. A change of 10 points in the ODI will be considered a clinically important change. Additionally, a subsample of participants from the intervention group will undergo semistructured interviews to explore individuals' experience of the Pain Toolkit. Participants will be asked questions about the ease of use and acceptability of the Pain Toolkit and also for how long they used the Toolkit. The qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION Approval for the study was given by the Health Research Authority and the North East Newcastle, North Tyneside 2 Regional Ethics Committee (reference 18/NE/0144) and Teesside University (reference 176/17). Findings will be disseminated through peer-reviewed journals and presentation at relevant patient groups, and local, national and international conferences. TRIAL REGISTRATION NUMBER NCT03791164; Pre -results.
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Affiliation(s)
- Gillian Findley
- NHS Durham Dales Easington and Sedgefield Clinical Commissioning Group, Sedgefield, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Amy Cartwright
- NHS Durham Dales Easington and Sedgefield Clinical Commissioning Group, Sedgefield, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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9
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Wang WY, Chu CM, Wu YS, Sung CS, Ho ST, Pan HH, Wang KY. Evaluation of the pain intensity differences among hospitalized cancer patients based on a nursing information system. PLoS One 2019; 14:e0222516. [PMID: 31553746 PMCID: PMC6760775 DOI: 10.1371/journal.pone.0222516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/30/2019] [Indexed: 11/19/2022] Open
Abstract
Evaluating the absolute difference in pain intensity and the percentage difference in pain intensity could facilitate an understanding of pain reduction among cancer patients during repeated hospitalizations. Examinations of the absolute differences in pain intensity and the percentage differences in pain intensity according to the worst pain intensity and last evaluated pain intensity before discharge are lacking. The aim of this study was to evaluate the absolute and percentage difference in pain intensities among cancer patients with moderate or severe pain from their 1st to 18th hospitalizations from 2011–2013. A population-based retrospective cohort study was conducted. Pain intensity was assessed using scales and was recorded in a nursing information system. The absolute and percentage difference in pain intensities were examined via the one-sample Kolmogorov-Smirnov test, and group differences in moderate or severe pain were evaluated with the Mann-Whitney U test. For moderate pain patients, the mean absolute difference in pain intensity was 1.52, and the percentage difference in pain intensity was 29.0%; both these values were significant. More significant changes in the absolute and percentage difference in pain intensities were associated with severe pain patients. Both the average absolute difference in pain intensity (3.09) and the percentage difference in pain intensity (38.5%) in patients with severe pain were significantly higher than the average absolute difference in pain intensity (1.52) and the percentage difference in pain intensity (29.0%) in patients with moderate pain. Cancer patients with moderate and severe pain experienced pain reductions of approximately 30% and 40%, respectively. Early pain management intervention in patients with severe pain is necessary to achieve an obvious analgesic effect, and the formula of the percentage difference in pain intensity should be incorporated into the nursing information system to alert clinicians for early detection of the effectiveness of cancer pain management.
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Affiliation(s)
- Wei-Yun Wang
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Syuan Wu
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Sung Sung
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsueh-Hsing Pan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kwua-Yun Wang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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10
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Malfliet A, Ickmans K, Huysmans E, Coppieters I, Willaert W, Bogaert WV, Rheel E, Bilterys T, Wilgen PV, Nijs J. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J Clin Med 2019; 8:jcm8071063. [PMID: 31331087 PMCID: PMC6679058 DOI: 10.3390/jcm8071063] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient’s preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time.
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Affiliation(s)
- Anneleen Malfliet
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium.
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- Pain in Motion International Research Group, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium.
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium.
| | - Kelly Ickmans
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
| | - Eva Huysmans
- Research Foundation-Flanders (FWO), 1090 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Iris Coppieters
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
| | - Ward Willaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
| | - Wouter Van Bogaert
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
| | - Emma Rheel
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, 9000 Ghent, Belgium
| | - Thomas Bilterys
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
| | - Paul Van Wilgen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Transcare, Transdisciplinary Pain Management Centre, 9728 EE Groningen, The Netherlands
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- Pain in Motion International Research Group, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussel, Belgium.
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11
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Bhattarai P, Newton-John TRO, Phillips JL. Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review. PAIN MEDICINE 2019; 19:471-484. [PMID: 28541464 DOI: 10.1093/pm/pnx090] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain. Methods A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Results Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Conclusions Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.
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Affiliation(s)
- Priyanka Bhattarai
- The University of Notre Dame Australia, School of Nursing, Darlinghurst, NSW, Australia
| | | | - Jane L Phillips
- Center for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia
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12
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Papini S, Pisner D, Shumake J, Powers MB, Beevers CG, Rainey EE, Smits JA, Warren AM. Ensemble machine learning prediction of posttraumatic stress disorder screening status after emergency room hospitalization. J Anxiety Disord 2018; 60:35-42. [PMID: 30419537 PMCID: PMC6777842 DOI: 10.1016/j.janxdis.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/23/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
Posttraumatic stress disorder (PTSD) develops in a substantial minority of emergency room admits. Inexpensive and accurate person-level assessment of PTSD risk after trauma exposure is a critical precursor to large-scale deployment of early interventions that may reduce individual suffering and societal costs. Toward this aim, we applied ensemble machine learning to predict PTSD screening status three months after severe injury using cost-effective and minimally invasive data. Participants (N = 271) were recruited at a Level 1 Trauma Center where they provided variables routinely collected at the hospital, including pulse, injury severity, and demographics, as well as psychological variables, including self-reported current depression, psychiatric history, and social support. Participant zip codes were used to extract contextual variables including population total and density, average annual income, and health insurance coverage rates from publicly available U.S. Census data. Machine learning yielded good prediction of PTSD screening status 3 months post-hospitalization, AUC = 0.85 95% CI [0.83, 0.86], and significantly outperformed all benchmark comparison models in a cross-validation procedure designed to yield an unbiased estimate of performance. These results demonstrate that good prediction can be attained from variables that individually have relatively weak predictive value, pointing to the promise of ensemble machine learning approaches that do not rely on strong isolated risk factors.
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Affiliation(s)
- Santiago Papini
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States.
| | - Derek Pisner
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | - Jason Shumake
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | - Mark B. Powers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin,Baylor University Medical Center
| | - Christopher G. Beevers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
| | | | - Jasper A.J. Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
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13
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Makris UE, Higashi RT, Marks EG, Fraenkel L, Gill TM, Friedly JL, Reid MC. Physical, Emotional, and Social Impacts of Restricting Back Pain in Older Adults: A Qualitative Study. PAIN MEDICINE 2018; 18:1225-1235. [PMID: 27516362 DOI: 10.1093/pm/pnw196] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Back pain is the most common type of pain reported by older adults, yet current management strategies often do not address the multi-dimensional impacts on older adults who face unique challenges as compared with younger populations. The objective of this qualitative study was to assess the physical, psychological, and social impacts of back pain (severe enough to restrict activity, hereafter referred to as restricting back pain) on older adults. Design This was a qualitative study using semi-structured interviews and focus groups. Setting and Patients This study was comprised of a diverse sample of 93 community-living older adults (median age 83) with restricting back pain. Methods We used a semi-structured guide in 23 interviews and 16 focus groups to discuss the various ways that restricting back pain impacted participants. Transcripts were analyzed in an iterative process to develop thematic categories. Results Restricting back pain affected participants physically (inability to execute routine tasks, disruption of sleep and exercise), psychologically (feelings of sadness and irritability, fears about worsening health, loss of hope towards recovery or pain relief), and socially (experiences of isolation, inability to pursue hobbies). Conclusions These data inform which outcomes should be measured in studies evaluating treatments for older adults with restricting back pain.
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Affiliation(s)
- Una E Makris
- Departments of Internal Medicine.,Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.,Department of Medicine, Division of Rheumatology, VA North Texas Health Care System, Dallas, Texas
| | - Robin T Higashi
- Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Emily G Marks
- Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Liana Fraenkel
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Medicine, VA Connecticut Health Care System, West Haven, Connecticut
| | - Thomas M Gill
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janna L Friedly
- Department of Rehabilitation Medicine.,Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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14
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Abstract
The incidence and prevalence of rheumatologic conditions are increasing and the rheumatology workforce must be aware of aging-specific issues. This article reviews specific barriers to understanding the biology of aging and aging-related mechanisms that may underlie development of rheumatologic diseases in older adults. It summarizes gaps in the assessment, outcomes measurement, and treatment of these diseases in this unique population. It also highlights potential solutions to these barriers and suggests possible ways to bridge the gap, from a research and education standpoint, so that clinicians can be better prepared to effectively manage older adults with rheumatologic conditions.
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15
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Green SM, Krauss BS. The Numeric Scoring of Pain: This Practice Rates a Zero Out of Ten. Ann Emerg Med 2016; 67:573-5. [DOI: 10.1016/j.annemergmed.2015.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Indexed: 11/28/2022]
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16
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Becker WC, Fiellin DA, Black AC, Kostovich CT, Kerns RD, Fraenkel L. Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy. ACTA ACUST UNITED AC 2016; 53:127-36. [PMID: 27006339 DOI: 10.1682/jrrd.2014.11.0285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 09/11/2015] [Indexed: 11/05/2022]
Abstract
Guidelines on long-term opioid therapy recommend frequent reassessment of harm, efficacy, and misuse of these potentially harmful and sometimes ineffective medications. In primary care, there is a need for a brief, patient-reported instrument. This report details the initial steps in the development of such an instrument. An interdisciplinary team of clinician-scientists performed four discrete steps in this study: (1) conceptualization of the purpose and function of the instrument, (2) assembly of an item pool, (3) expert rating on which items were most important to include in the instrument, and (4) modification of expert-selected items based on a reading level check and cognitive interviews with patients. A diverse panel of 47 subject matter experts was presented with 69 items to rate on a 1-9 scale in terms of importance for inclusion in the instrument. The panel highly rated 37 items: 8 related to harm, 4 related to efficacy, and 25 related to misuse. These 37 items were then tested for patient comprehension and modified as needed. Next steps in development will include further item reduction, testing against a gold standard, and assessment of the instrument's effect on clinical outcomes.
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Affiliation(s)
- William C Becker
- Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT
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17
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Dunn LK, Durieux ME, Nemergut EC. Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery. Best Pract Res Clin Anaesthesiol 2016; 30:79-89. [DOI: 10.1016/j.bpa.2015.11.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/27/2015] [Accepted: 11/16/2015] [Indexed: 01/07/2023]
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18
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19
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Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci 2015; 22:930-8. [DOI: 10.1016/j.jocn.2015.01.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/16/2015] [Indexed: 01/05/2023]
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20
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Kulich K, Keininger DL, Tiplady B, Banerji D. Symptoms and impact of COPD assessed by an electronic diary in patients with moderate-to-severe COPD: psychometric results from the SHINE study. Int J Chron Obstruct Pulmon Dis 2015; 10:79-94. [PMID: 25609942 PMCID: PMC4293297 DOI: 10.2147/copd.s73092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Symptoms, particularly dyspnea, and activity limitation, have an impact on the health status and the ability to function normally in patients with chronic obstructive pulmonary disease (COPD). METHODS To develop an electronic patient diary (eDiary), qualitative patient interviews were conducted from 2009 to 2010 to identify relevant symptoms and degree of bother due to symptoms. The eDiary was completed by a subset of 209 patients with moderate-to-severe COPD in the 26-week QVA149 SHINE study. Two morning assessments (since awakening and since the last assessment) and one evening assessment were made each day. Assessments covered five symptoms ("shortness of breath," "phlegm/mucus," "chest tightness," "wheezing," and "coughing") and two impact items ("bothered by COPD" and "difficulty with activities") and were scored on a 10-point numeric scale. RESULTS Patient compliance with the eDiary was 90.4% at baseline and 81.3% at week 26. Correlations between shortness of breath and impact items were >0.95. Regression analysis showed that shortness of breath was a highly significant (P<0.0001) predictor of impact items. Exploratory factor analysis gave a single factor comprising all eDiary items, including both symptoms and impact items. Shortness of breath, the total score (including five symptoms and two impact items), and the five-item symptom score from the eDiary performed well, with good consistency and reliability. The eDiary showed good sensitivity to change, with a 0.6 points reduction in the symptoms scores (on a 0-10 point scale) representing a meaningful change. CONCLUSION The eDiary was found to be valid, reliable, and responsive. The high correlations obtained between "shortness of breath" and the ratings of "bother" and "difficulty with activities" confirmed the relevance of this symptom in patients with COPD. Future studies will be required to explore further psychometric properties and their ability to differentiate between COPD treatments.
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Affiliation(s)
| | | | | | - Donald Banerji
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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21
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Voepel-Lewis T. How reliable are 'valid and reliable' pain scores in the pediatric clinical setting? Pain Manag 2014; 3:343-50. [PMID: 24654867 DOI: 10.2217/pmt.13.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Over the past decade, growing clinician skepticism and inconsistent use of self-report pain scales have raised important questions regarding the clinical meaning and interpretation of pain scores. The appropriate use of pain scores at the bedside requires an understanding of what they may mean to the child who is providing them. This article summarizes the evidence regarding pain score meaning, showing that despite the established psychometric properties of pain scales, pain score numbers mean different things to different children, complicating the clinical interpretation. The evidence suggests that it is inappropriate to use standardized pain score thresholds for treatment or evaluation, and suggests an individualized approach to the interpretation and use of pain scores is needed.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, Section of Pediatrics, Room 4917 CS Mott Children's Hospital, University of Michigan, Box 4245, 1540 E Hospital Drive, Ann Arbor, MI 48109 4245, USA.
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22
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Powers MB, Warren AM, Rosenfield D, Roden-Foreman K, Bennett M, Reynolds MC, Davis ML, Foreman ML, Petrey LB, Smits JAJ. Predictors of PTSD symptoms in adults admitted to a Level I trauma center: a prospective analysis. J Anxiety Disord 2014; 28:301-9. [PMID: 24632075 PMCID: PMC4004712 DOI: 10.1016/j.janxdis.2014.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 01/10/2014] [Accepted: 01/25/2014] [Indexed: 11/26/2022]
Abstract
Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again 3 months later (N=227). Participants were classified as symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian injury, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.
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23
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Fraenkel L, Cunningham M. High disease activity may not be sufficient to escalate care. Arthritis Care Res (Hoboken) 2014; 66:197-203. [PMID: 23926094 DOI: 10.1002/acr.22098] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/30/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) treatment regimens are not adjusted in response to active disease as frequently as indicated. The objective of this study was to examine how disease activity and patients' illness beliefs combine to predict future treatment changes in patients who are currently under the care of a rheumatologist. METHODS We interviewed RA patients at baseline and at 2, 4, and 6 months. We examined the association of disease activity (Routine Assessment of Patient Index Data 4) and 5 specific illness beliefs (consequences, treatment control, symptom burden, concern, and emotional impact) with future escalation of treatment using logistic regression. Analyses were adjusted for age, current biologic agent use, and disease duration. Disease activity and illness beliefs were dichotomized at the median to create 4 dummy variables (e.g., low disease activity + high illness belief) in order to examine the combined impact of disease activity and illness beliefs on escalation. RESULTS Twenty-nine percent of the participants (n = 41 of 142) had an escalation of treatment during the followup period. When examined separately, disease activity and 4 of the illness beliefs (consequences, symptom burden, concern, and emotional impact) were associated with future escalation. High disease activity was predictive of future escalation only when combined with high levels of consequences, concern, and emotional impact. The combinations of high disease activity and high consequences, concern, and emotional impact were much stronger predictors of future escalation than either factor in isolation. CONCLUSION The findings suggest that patients' illness beliefs are an important determinant of treatment decisions, which are not fully captured by disease activity measures alone.
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Affiliation(s)
- Liana Fraenkel
- Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Connecticut
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24
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Makris UE, Melhado T, Lee SC, Hamann HA, Walke LM, Gill TM, Fraenkel L. Illness representations of restricting back pain: the older Person’s perspective. PAIN MEDICINE 2014; 15:938-46. [PMID: 25075398 DOI: 10.1111/pme.12397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Back pain is the most common type of pain reported by older adults, leading to considerable morbidity and cost. Yet little is known about the segment of the population ≥80 years old that can be used to guide care in this age group. Illness representations provide a useful framework to understand older adults' beliefs and perceptions of their back pain. The objective of this study was to understand illness representations of back pain, severe enough to restrict activity (restricting back pain). DESIGN Qualitative research using semi-structured interviews. SUBJECTS Twenty-three community-living older adults ≥80 years old with restricting back pain. METHODS We used an interview guide to stimulate discussion about how older adults understand and perceive living with restricting back pain. Thematic codes were created to categorize the nuances of participants' restricting back pain experiences. RESULTS Participants reported five important components of illness representation: 1) identity,the label and symptoms individuals assign to the illness; 2) timeline, the individual's perceived clinical course of the illness; 3) cause, the individual's perceived etiology of the illness; 4) consequences,the perceived impact of the illness; and 5) cure control,the perceived degree to which cure or management is possible/likely. CONCLUSIONS Thematic analysis revealed that restricting back pain in older adults has variable and noteworthy physical, psychological and social consequences.There are several components of the illness representation of restricting back pain, specifically,the perceptions of consequences and control that may offer potential targets for clinical intervention.
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Affiliation(s)
- Una E Makris
- Departments of Internal Medicine and Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas; Deparment of Veterans Affairs, VA North Texas Health Care System, Dallas, Texas.
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Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Tulipan NB, McGirt MJ. Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation Type I. J Neurosurg 2013; 119:1159-65. [DOI: 10.3171/2013.8.jns122106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CMI). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I.
Methods
The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele.
Results
A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05).
Conclusions
Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, and it significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms. Further research is needed to accurately predict which patients may benefit from decompression alone without duraplasty.
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Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Wells JA, Shau DN, McGirt MJ. Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults. Neurosurgery 2013; 73:569-81; discussion 581. [DOI: 10.1227/neu.0000000000000032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P < .05). Of the 38 patients (76%) employed preoperatively, 29 (76%) returned to work postoperatively at a median time of 6 weeks (interquartile range, 4-12 weeks). Minimum clinically important difference thresholds after SOC for CMI were 4.4 points for numeric rating scale for headache, 0.7 points for numeric rating scale for neck pain, 13.8 percentage points for Headache Disability Index, 14.2 percentage points for Neck Disability Index, 7.0 points for Short Form-12 Physical Component Summary, 6.1 points for Short Form-12 Mental Component Summary, 4.5 points for Zung depression, 1.7 points for modified Japanese Orthopaedic Association, and 0.34 quality-adjusted life-years for Euro-Qol-5D.
CONCLUSION:
Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.
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Affiliation(s)
- Scott L. Parker
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Saniya S. Godil
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Scott L. Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Stephen K. Mendenhall
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - John A. Wells
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - David N. Shau
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
| | - Matthew J. McGirt
- Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt Spinal Column Surgical Outcomes and Quality Research Laboratory, Nashville, Tennessee
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