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Vanneman MW, Kiwakyou LM, Harrison TK, Mariano ER. Heartfelt Healing: Charting New Trajectories in Postsurgical Pain. Anesth Analg 2024; 138:1187-1191. [PMID: 38771601 DOI: 10.1213/ane.0000000000006871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Matthew W Vanneman
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Larissa M Kiwakyou
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - T Kyle Harrison
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Department of Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Edward R Mariano
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Department of Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
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He J, Wilson JM, Fields KG, Mikayla Flowers Zachos K, Franqueiro AR, Reale SC, Farber MK, Bateman BT, Edwards RR, Rathmell JP, Soens M, Schreiber KL. Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires. Anesthesiology 2024; 140:701-714. [PMID: 38207329 PMCID: PMC10939890 DOI: 10.1097/aln.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models. METHODS In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery. RESULTS A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain. CONCLUSIONS The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Jenna M. Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kara G. Fields
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - K. Mikayla Flowers Zachos
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Angelina R. Franqueiro
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Sharon C. Reale
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Michaela K. Farber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - James P. Rathmell
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
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Haenen V, Dams L, Meeus M, Devoogdt N, Morlion B, De Groote A, De Groef A. Continuum of somatosensory profiles in breast cancer survivors with and without pain, compared to healthy controls and patients with fibromyalgia. Eur J Pain 2024. [PMID: 38440910 DOI: 10.1002/ejp.2257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/06/2024]
Abstract
CONTEXT The prevalence of persistent pain among breast cancer survivors (BCS) is high, and it is unclear what distinguishes those with persistent pain from those without. Research suggests that differences in somatosensory function evaluated by quantitative sensory testing (QST) may be responsible. OBJECTIVES This study aimed to describe somatosensory profiles in terms of hyper- and hypoesthesia in BCS with and without persistent pain using reference data from healthy controls. Second, QST parameters of BCS with and without pain were compared with those of healthy controls (i.e., a negative control group) and patients with fibromyalgia (i.e., a positive control group). METHODS Participants (n = 128) were divided into four equal groups: healthy controls, BCS with persistent pain, BCS without persistent pain, and patients with fibromyalgia. Nine QST parameters were evaluated at the trunk and at a remote location. Somatosensory profiles were determined by Z-score transformation of QST data using normative data from healthy controls. RESULTS At the trunk, compared to healthy controls, BCS with persistent pain exhibited sensory aberrations across five out of seven QST parameters: pressure pain threshold, mechanical detection, and thermal thresholds. Pain-free BCS showed similar sensory aberrations across the four QST parameters compared to healthy controls: mechanical detection and thermal thresholds. Temporal summation and conditioned pain modulation were not significantly different between groups. CONCLUSION BCS with persistent pain exert aberrations in peripheral processing of nociceptive signals, heightened facilitation of nociceptive signals, and higher psychosocial burden when compared to pain-free BCS, healthy controls, and patients with fibromyalgia. SIGNIFICANCE This study investigates the somatosensory function of breast cancer survivors with and without persistent pain using quantitative sensory testing and two control group (i.e., patients with fibromyalgia and healthy controls). Our results indicate somatosensory aberrations within the peripheral, but not central pathways in breast cancer survivors with persistent pain. Our findings contribute to a better understanding of the somatosensory mechanisms underlying persistent pain, which may inform future interventions to prevent the development of persistent pain, and improve treatment modalities.
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Affiliation(s)
- Vincent Haenen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research Group Rehabilitation in Internal Disorders (GRID), Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Wilrijk, Belgium
| | - Lore Dams
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Wilrijk, Belgium
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Wilrijk, Belgium
| | - Nele Devoogdt
- Research Group Rehabilitation in Internal Disorders (GRID), Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Center for Lymphoedema, Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- Lymphovenous Center, Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- Department of Cardiovascular Sciences, Section Anesthesiology & Algology, KU Leuven, University of Leuven, Leuven, Belgium
- The Leuven Center for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Amber De Groote
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group, Wilrijk, Belgium
| | - An De Groef
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research Group Rehabilitation in Internal Disorders (GRID), Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Wilrijk, Belgium
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Lirk P, Schreiber KL. Lessons learnt in evidence-based perioperative pain medicine: changing the focus from the medication and procedure to the patient. Reg Anesth Pain Med 2024:rapm-2023-105235. [PMID: 38355216 DOI: 10.1136/rapm-2023-105235] [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: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
Over time, the focus of evidence-based acute pain medicine has shifted, from a focus on drugs and interventions (characterized by numbers needed to treat), to an appreciation of procedure-specific factors (characterized by guidelines and meta-analyses), and now anesthesiologists face the challenge to integrate our current approach with the concept of precision medicine. Psychometric and biopsychosocial markers can potentially guide clinicians on who may need more aggressive perioperative pain management, or who would respond particularly well to a given analgesic intervention. The challenge will be to identify an easily assessable set of parameters that will guide perioperative physicians in tailoring the analgesic strategy to procedure and patient.
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Affiliation(s)
- Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Langford L, Latchford G, Mulvey M. Can illness representations be used to understand pain experienced in breast cancer survivorship-a cross-sectional study. J Cancer Surviv 2024:10.1007/s11764-024-01533-2. [PMID: 38285112 DOI: 10.1007/s11764-024-01533-2] [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: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Chronic pain is a recognised long-term consequence associated with breast cancer and its treatment; however, it is often underdiagnosed and undertreated. This study aims to explore the associations between illness representations, chronic cancer pain, and HRQoL in women who have survived breast cancer. DESIGN AND METHODS A cross-sectional online survey design was used. Data from 182 women who participated in the survey were analysed. RESULTS Chronic cancer pain was reported by 66% of respondents. Using the BPI-SF (score 0-10), participants were categorised into one of four pain categories: no chronic pain (BPI score 0; 34.1%), mild pain (BPI score 1-3; 35.7%), moderate pain (BPI score 4-6; 25.3%), and severe pain (BPI score 7 + ; 4.9%). The main findings were that having a strong illness identity (IPQ-R subscale which assesses the number of symptoms an individual attributes to their illness) was found to be a significant predictor of pain severity (OR 1.21 (95% CI 1.07-1.37), p = 0.003). Furthermore, HRQoL was significantly associated and predictive of pain severity (OR 0.97 (95% CI 0.95-0.99), p < 0.001). An additional finding was that not being in paid work was strongly associated with being in a higher pain category (OR 5.92 (95% CI 1.84-19.05), p = 0.003). CONCLUSIONS The findings of this study highlight the high prevalence of chronic cancer pain experienced by this population. Results show that dimensions of illness representations are associated with chronic cancer pain experienced by breast cancer survivors. Furthermore, having a strong illness identity and HRQoL were found to be independent, significant predictors of pain severity. IMPLICATIONS FOR CANCER SURVIVORS These findings demonstrate that chronic pain is an unmet clinical need experienced by breast cancer survivors, which is associated with reduced overall HRQoL. Therefore, consideration is needed regarding the assessment and management of chronic pain experienced by this population.
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Affiliation(s)
- Lewis Langford
- Clinical Neuropsychology, Salford Royal Hospital, Salford, M6 8HD, UK.
- Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Gary Latchford
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Mulvey
- Institute of Health Sciences, University of Leeds, Leeds, UK
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Beck M, Schreiber KL, Wilson JM, Flowers KM, Edwards RR, Chai PR, Azizoddin DR. A secondary analysis: the impact of pre-existing chronic pain among patients with cancer presenting to the emergency department with acute pain. Support Care Cancer 2024; 32:129. [PMID: 38270721 PMCID: PMC11069411 DOI: 10.1007/s00520-024-08314-8] [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: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Patients with cancer may experience pain from cancer itself or its treatment. Additionally, chronic pain (CP) predating a patient's cancer diagnosis may make the etiology of pain less clear and the management of pain more complex. In this brief report, we investigated differences in biopsychosocial characteristics, pain severity, and opioid consumption, comparing groups of cancer patients with and without a history of CP who presented to the emergency department (ED) with a complaint of cancer-related pain. METHODS This secondary analysis of a prospective cohort study included patients with cancer who presented to the ED with a complaint of pain (≥ 4/10). Sociodemographic, clinical, psychological, and pain characteristics were assessed in the ED and subsequent hospitalization. Mann-Whitney U-, T-, and Chi-square tests were used to compare differences between patients with and without pre-existing CP before cancer. RESULTS Patients with pre-existing CP had lower income (p = 0.21) and less formal education (p = 0.25) and were more likely to have a diagnosis of depression or substance use disorder (p < 0.01). Patients with pre-existing CP reported significantly greater pain severity in the ED and during hospitalization compared to those without pre-existing CP (p < 0.05), despite receiving greater amounts of opioid analgesics (p = 0.036). CONCLUSION Identifying a history of pre-existing CP during intake may help identify patients with cancer with difficult to manage pain, who may particularly benefit from multimodal interventions and supportive care. In addition, referral of these patients for the management of co-occurring pain disorders may help decrease the usage of the ED for undertreated pain.
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Affiliation(s)
- Meghan Beck
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Desiree R Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Yu L, Shen XJ, Liu H, Zhou YT, Zhang Q, Zhang ZD, Shen SM. Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer: study protocol for a randomised controlled trial. Trials 2024; 25:51. [PMID: 38225606 PMCID: PMC10788999 DOI: 10.1186/s13063-023-07777-0] [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: 04/21/2023] [Accepted: 11/06/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND A single injection of local anaesthetic (LA) in the erector spinae plane block (ESPB) can reduce pain after modified radical mastectomy (MRM) surgery, but the duration of analgesia is affected by the duration of the LA. The aim of this study is to investigate the effect of continuous ESPB on acute and chronic pain and inflammatory response after MRM surgery. METHODS In this prospective, randomised, controlled trial, we will recruit 160 patients, aged 18-80 years, scheduled for elective MRM surgery under general anaesthesia. They will be randomly assigned to two groups: a continuous ESPB group (group E) and a sham block group (group C). Both groups of patients will have a nerve block (group C pretended to puncture) and an indwelling catheter fixed prior to surgery. Electronic pumps containing LA are shielded. The primary outcome is the total consumption of analgesic agents. The secondary outcomes include the levels of inflammation-related cytokines; the occurrence of chronic pain (post-mastectomy pain syndrome, PMPS); static and dynamic pain scores at 2, 6, 12, 24 and 48 h postoperatively; and post-operative and post-puncture adverse reactions. DISCUSSION Analgesia after MRM surgery is important and chronic pain can develop when acute pain is prolonged, but the analgesic effect of a nerve block with a single injection of LA is limited by the duration of drug action. The aim of this trial is to investigate whether continuous ESPB can reduce acute pain after MRM surgery and reduce the incidence of chronic pain (PMPS), with fewer postoperative analgesic drug-related complications and less inflammatory response. Continuous ESPB and up to 12 months of follow-up are two innovations of this trial. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ) ChiCTR2200061935. Registered on 11 July 2022. This trial is a prospective registry with the following registry names: Effect of ultrasound-guided continuous erector spinae plane block on postoperative pain and inflammatory response in patients undergoing modified radical mastectomy for breast cancer.
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Affiliation(s)
- Liang Yu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Xiao-Juan Shen
- Department of 706A Ward Nursing, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China.
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Yu-Ting Zhou
- Department of Breast Surgery, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Qin Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Zhen-Duo Zhang
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
| | - Shu-Min Shen
- Department of Anesthesiology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Affiliated Central Hospital, Huzhou University, No. 1558 Sanhuan North Road, Huzhou, 313000, Zhejiang, China
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Aglio LS, Mezzalira E, Corey SM, Fields KG, Hauser BM, Susano MJ, Culley DJ, Schreiber KL, Kelly-Aglio NJ, Patton ME, Mekary RA, Edwards RR. Does the Association Between Psychosocial Factors and Opioid Use After Elective Spine Surgery Differ by Sex in Older Adults? J Pain Res 2023; 16:3477-3489. [PMID: 37873025 PMCID: PMC10590566 DOI: 10.2147/jpr.s415714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/01/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose Psychosocial disorders have been linked to chronic postoperative opioid use and the development of postoperative pain. The potential interaction between sex and psychosocial factors with respect to opioid use after elective spine surgery in the elderly has not yet been evaluated. Our aim was to assess whether any observed association of anxiety or depression indicators with opioid consumption in the first 72 hours after elective spine surgery varies by sex in adults ≥65 years. Patients and Methods Secondary analysis of a retrospective cohort of 647 elective spine surgeries performed at Brigham and Women's Hospital, July 1, 2015-March 15, 2017, in patients ≥65. Linear mixed-effects models were used to test whether history of anxiety, anxiolytic use, history of depression, and antidepressant use were associated with opioid consumption 0-24, 24-48, and 48-72 post surgery, and whether these potential associations differed by sex. Results History of anxiety, anxiolytic use, history of depression, and antidepressant use were more common among women (51.3% of the sample). During the first 24 hours after surgery, men with a preoperative history of anxiety consumed an adjusted mean of 19.5 morphine milligram equivalents (MME) (99.6% CI: 8.1, 31.0) more than men without a history of anxiety; women with a history of anxiety only consumed an adjusted mean 2.9 MME (99.6% CI: -3.1, 8.9) more than women without a history of anxiety (P value for interaction between sex and history of anxiety <0.001). No other interactions were detected between sex and psychosocial factors with respect to opioid use after surgery. Conclusion Secondary analysis of this retrospective cohort study found minimal evidence that the association between psychosocial factors and opioid consumption after elective spine surgery differs by sex in adults ≥65.
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Affiliation(s)
- Linda S Aglio
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elisabetta Mezzalira
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Sarah M Corey
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Blake M Hauser
- Harvard-Massachusetts Institute of Technology Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Maria J Susano
- Department of Anesthesiology, Emergency and Critical Care, Centro Hospitalar do Porto, Porto, Portugal
| | - Deborah J Culley
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nicole J Kelly-Aglio
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rania A Mekary
- Computational Neurosurgical Outcome Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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9
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Nishigami T, Manfuku M, Lahousse A. Central Sensitization in Cancer Survivors and Its Clinical Implications: State of the Art. J Clin Med 2023; 12:4606. [PMID: 37510721 PMCID: PMC10380903 DOI: 10.3390/jcm12144606] [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: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Although the prevalence of cancer pain is 47% after treatment, cancer pain is often underestimated, and many patients are undertreated. The complexity of cancer pain contributes to the lack of its management. Recently, as the mechanism of cancer pain, it has become clear that central sensitization (CS) influences chronic pain conditions and the transition from acute to chronic pain. In this state-of-the-art review, we summarized the association of CS or central sensitivity syndrome with pain and the treatment for pain targeting CS in cancer survivors. The management of patients with CS should not only focus on tissue damage in either the affected body regions or within the central nervous system; rather, it should aim to target the underlying factors that sustain the CS process. Pain neuroscience education (PNE) is gaining popularity for managing chronic musculoskeletal pain and could be effective for pain and CS in breast cancer survivors. However, there is a study that did not demonstrate significant improvements after PNE, so further research is needed. Precision medicine involves the classification of patients into subgroups based on a multifaceted evaluation of disease and the implementation of treatment tailored to the characteristics of each patient, which may play a central role in the treatment of CS.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
| | - Masahiro Manfuku
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka 596-0076, Japan
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
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10
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Colebaugh CA, Wilson JM, Flowers KM, Overstreet D, Wang D, Edwards RR, Chai PR, Schreiber KL. The Impact of Varied Music Applications on Pain Perception and Situational Pain Catastrophizing. THE JOURNAL OF PAIN 2023; 24:1181-1192. [PMID: 36646399 PMCID: PMC10329987 DOI: 10.1016/j.jpain.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
We evaluated how pain processing and situational pain catastrophizing differed between 2 music interventions (Unwind and favorite music) and a control condition (white noise). Healthy adults (n = 70) completed quantitative sensory testing (QST) measuring pressure pain threshold (PPTh) and tolerance (PPTol), heat pain threshold (HPTh), offset analgesia (OA), temporal summation of pain (TSP), and conditioned pain modulation (CPM). Participants completed 3 QST rounds with the presence of white noise (control condition), a relaxing music app (Unwind), and their favorite music, which were presented in a randomized order. The Situational Pain Catastrophizing Scale was completed after each round. Friedman tests and post hoc Wilcoxon signed-rank tests were used to compare pain processing and catastrophizing across the 3 conditions. Participants' PPTh, PPTol, and HPTh were significantly higher during the favorite music condition compared to the other 2 conditions, indicating lower pain sensitivity when listening to favorite music. In contrast, OA was lower in the favorite music condition. Although TSP and CPM were induced by the QST paradigm, these did not differ across the 3 conditions. Situational pain catastrophizing was also significantly lower during the favorite music condition. Several measures of pain sensitivity and situational pain catastrophizing were lower when listening to favorite music compared to relaxing music or white noise. More research is necessary to determine the mechanism(s) by which music modulates pain processing. PERSPECTIVE: This article presents evidence that participant-chosen favorite music can alter several aspects of nociceptive processing, including catastrophic thinking about pain, compared to white noise or relaxing music. Employing an individual's favorite music during episodic or procedural pain might represent a cost effective adjunctive analgesic strategy.
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Affiliation(s)
- Carin A Colebaugh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Demario Overstreet
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dan Wang
- Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts; The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, Massachusetts; The Fenway Institute, Boston, Massachusetts
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Komenaka IK, Hsu CH, Ramos GM, Nodora J, Martinez ME. Post Treatment Mastalgia is a Common Complaint but not an Indication of Recurrence or Second Primary Breast Cancer. Clin Breast Cancer 2023; 23:330-337. [PMID: 36641323 DOI: 10.1016/j.clbc.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-treatment mastalgia is a common complaint in up to 68% of patients after treatment. This symptom is worrisome to patients as many believe it is a sign of recurrence. The current study was performed to evaluate if post-treatment mastalgia is associated with a second breast cancer diagnosis. MATERIALS AND METHODS Patients included were seen from January 1, 2000 to December 31, 2020. All patients who were treated for breast cancer and then presented with breast pain during follow up were considered to have post-treatment mastalgia. All patients who were diagnosed with a second breast cancer but did not experience post-treatment mastalagia were also evaluated. RESULTS 1799 patients had a mean age 52.9 years. 36% of patients experienced post-treatment mastalgia. Of patients who complained of post-treatment mastalgia, 19 were diagnosed with a chest wall recurrence (CW), ipsilateral breast tumor recurrence (IBTR), or contralateral breast cancer (CBC). 17 of the 19 patients had breast pain after the second diagnosis and treatment were completed. The average duration between their second diagnosis and initial complaint of breast pain was 6.2 years. The two patients who complained of breast pain prior to their second diagnosis did not have mastalgia at the time of their second diagnosis. Local recurrence or contralateral breast cancer were more common in patients without post treatment mastalgia (10.1% vs 0.3%, p < 0.0001) during follow up. CONCLUSION Post treatment mastalgia is not associated with recurrence. Interval or repeat imaging does not appear necessary and instead patient education and reassurance are important in its management.
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Affiliation(s)
- Ian K Komenaka
- Ironwood Cancer and Research Centers, Chandler, AZ; Arizona Cancer Center, University of Arizona, Tucson, AZ.
| | - Chiu-Hsieh Hsu
- Arizona Cancer Center, University of Arizona, Tucson, AZ; Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ
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12
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Buskbjerg C, O'Toole MS, Zachariae R, Jensen AB, Frederiksen Y, Johansen C, von Heymann A, Speckens A, Johannsen M. Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark. BMJ Open 2023; 13:e066505. [PMID: 36948567 PMCID: PMC10040060 DOI: 10.1136/bmjopen-2022-066505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05444101).
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Affiliation(s)
- Cecilie Buskbjerg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Yoon Frederiksen
- Deparment of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- The Sexology Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Christoffer Johansen
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE Cancer Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Speckens
- Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maja Johannsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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13
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Azizoddin DR, Soens MA, Beck MR, Flowers KM, Edwards RR, Schreiber KL. Perioperative Sleep Disturbance Following Mastectomy: A Longitudinal Investigation of the Relationship to Pain, Opioid Use, Treatment, and Psychosocial Symptoms. Clin J Pain 2023; 39:76-84. [PMID: 36650603 PMCID: PMC9968504 DOI: 10.1097/ajp.0000000000001090] [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: 06/02/2021] [Accepted: 10/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery. METHODS In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery. RESULTS Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=-0.09, P =0.006), opioid use (B=3.09, P =0.02), and higher pain (B=0.19, P =<0.001) and anxiety (B=0.45, P =<0.001) at baseline. In addition, higher baseline positive affect (B=-0.14, P =<0.012) and the surgical category total mastectomy without reconstruction (B=-2.81, P =<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep. DISCUSSION Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.
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Affiliation(s)
- Desiree R Azizoddin
- Department of Emergency Medicine
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Mieke A Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital
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14
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Nijs J, Lahousse A, Fernández-de-Las-Peñas C, Madeleine P, Fontaine C, Nishigami T, Desmedt C, Vanhoeij M, Mostaqim K, Cuesta-Vargas AI, Kapreli E, Bilika P, Polli A, Leysen L, Elma Ö, Roose E, Rheel E, Yılmaz ST, De Baets L, Huysmans E, Turk A, Saraçoğlu İ. Towards precision pain medicine for pain after cancer: the Cancer Pain Phenotyping Network multidisciplinary international guidelines for pain phenotyping using nociplastic pain criteria. Br J Anaesth 2023; 130:611-621. [PMID: 36702650 DOI: 10.1016/j.bja.2022.12.013] [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: 09/01/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 01/26/2023] Open
Abstract
Pain after cancer remains underestimated and undertreated. Precision medicine is a recent concept that refers to the ability to classify patients into subgroups that differ in their susceptibility to, biology, or prognosis of a particular disease, or in their response to a specific treatment, and thus to tailor treatment to the individual patient characteristics. Applying this to pain after cancer, the ability to classify post-cancer pain into the three major pain phenotypes (i.e. nociceptive, neuropathic, and nociplastic pain) and tailor pain treatment accordingly, is an emerging issue. This is especially relevant because available evidence suggests that nociplastic pain is present in an important subgroup of those patients experiencing post-cancer pain. The 2021 International Association for the Study of Pain (IASP) clinical criteria and grading system for nociplastic pain account for the need to identify and correctly classify patients according to the pain phenotype early in their treatment. These criteria are an important step towards precision pain medicine with great potential for the field of clinical oncology. Within this framework, the Cancer Pain Phenotyping (CANPPHE) Network, an international and interdisciplinary group of oncology clinicians and researchers from seven countries, applied the 2021 IASP clinical criteria for nociplastic pain to the growing population of those experiencing post-cancer pain. A manual is provided to allow clinicians to differentiate between predominant nociceptive, neuropathic, or nociplastic pain after cancer. A seven-step diagnostic approach is presented and illustrated using cases to enhance understanding and encourage effective implementation of this approach in clinical practice.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium; Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
| | - Pascal Madeleine
- Sport Sciences - Performance & Technology, Department of Health Science & Technology, Aalborg University, Aalborg, Denmark
| | | | | | | | - Marian Vanhoeij
- Breast Clinic, University Hospital Brussels, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium
| | - Kenza Mostaqim
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Antonio I Cuesta-Vargas
- Cátedra de Fisioterapia, Universidad de Malaga, Andalucia Tech, Instituto de Investigacion Biomédica de Malaga (IBIMA) Grupo de Clinimetria (F-14), Malaga, Spain
| | - Eleni Kapreli
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Paraskevi Bilika
- Clinical Exercise Physiology & Rehabilitation Research Laboratory, Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium; Laboratory of Clinical Epigenetics, Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Leuven, Belgium
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Ömer Elma
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium; Universiteit Hasselt, REVAL, Agoralaan-gebouw A, 3590 Diepenbeek, Belgium
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sevilay Tümkaya Yılmaz
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Ali Turk
- Kutahya Health Sciences University, Faculty of Medicine, Department of Radiation Oncology, Kütahya, Turkey
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15
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Wilson JM, Haliwa I, Lee J, Shook NJ. The role of dispositional mindfulness in the fear-avoidance model of pain. PLoS One 2023; 18:e0280740. [PMID: 36706069 PMCID: PMC9882899 DOI: 10.1371/journal.pone.0280740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The fear-avoidance model of pain posits that a painful stimulus is interpreted through pain catastrophizing, which leads to negative downstream cognitions, emotions, and behaviors that shape the experience of pain. As dispositional mindfulness is associated with less catastrophizing and pain, some researchers have suggested incorporating mindfulness into the fear-avoidance model. Across two studies, we empirically tested dispositional mindfulness as a stand-alone component within the fear-avoidance model of pain. METHODS Two independent, online cross-sectional surveys (Ns = 362 and 580 U.S. adults) were conducted. Participants completed validated assessments of mindfulness, pain catastrophizing, fear of pain, pain vigilance, depression, pain intensity, and pain sensitivity. Using structural equation modeling, we tested the inclusion of dispositional mindfulness in the fear-avoidance model of pain. We proposed that greater mindfulness would be associated with less pain catastrophizing, which in turn would be associated with less fear of pain, leading to less depression, and then ultimately less pain intensity and pain sensitivity. RESULTS Across both studies, the fear-avoidance model of pain did not fit the data well, with or without mindfulness included. We found that a simplified model fit the data best (Study 1: χ2/df = 1.83; CFI = .981; RMSEA = .049, 90% CI [0.019, 0.076]; SRMR = 0.031; Study 2: χ2/df = 2.23; CFI = .976; RMSEA = .046, 90% CI [0.026, 0.067]; SRMR = .031), such that greater mindfulness was significantly associated with less pain catastrophizing and, in turn, lower levels of pain intensity and pain sensitivity. CONCLUSION Our findings suggest that a simplified model, compared to the traditional fear-avoidance model, may partly explain the experience of pain among individuals without chronic pain. Future work should examine the temporal associations among these variables to inform the employment of future empirically supported interventions for pain management.
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Affiliation(s)
- Jenna M. Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Ilana Haliwa
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
| | - Jerin Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Natalie J. Shook
- Department of Psychology, Salve Regina University, Newport, RI, United States of America
- School of Nursing, University of Connecticut, Storrs, CT, United States of America
- * E-mail:
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16
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Wilson JM, Colebaugh CA, Flowers KM, Overstreet D, Edwards RR, Maixner W, Smith SB, Schreiber KL. Applying the Rapid OPPERA Algorithm to Predict Persistent Pain Outcomes Among a Cohort of Women Undergoing Breast Cancer Surgery. THE JOURNAL OF PAIN 2022; 23:2003-2012. [PMID: 35963491 PMCID: PMC9729400 DOI: 10.1016/j.jpain.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
Persistent postmastectomy pain after breast surgery is variable in duration and severity across patients, due in part to interindividual variability in pain processing. The Rapid OPPERA Algorithm (ROPA) empirically identified 3 clusters of patients with different risk of chronic pain based on 4 key psychophysical and psychosocial characteristics. We aimed to test this type of group-based clustering within in a perioperative cohort undergoing breast surgery to investigate differences in postsurgical pain outcomes. Women (N = 228) scheduled for breast cancer surgery were prospectively enrolled in a longitudinal observational study. Pressure pain threshold (PPT), anxiety, depression, and somatization were assessed preoperatively. At 2-weeks, 3, 6, and 12-months after surgery, patients reported surgical area pain severity, impact of pain on cognitive/emotional and physical functioning, and pain catastrophizing. The ROPA clustering, which used patients' preoperative anxiety, depression, somatization, and PPT scores, assigned patients to 3 groups: Adaptive (low psychosocial scores, high PPT), Pain Sensitive (moderate psychosocial scores, low PPT), and Global Symptoms (high psychosocial scores, moderate PPT). The Global Symptoms cluster, compared to other clusters, reported significantly worse persistent pain outcomes following surgery. Findings suggest that patient characteristic-based clustering algorithms, like ROPA, may generalize across diverse diagnoses and clinical settings, indicating the importance of "person type" in understanding pain variability. PERSPECTIVE: This article presents the practical translation of a previously developed patient clustering solution, based within a chronic pain cohort, to a perioperative cohort of women undergoing breast cancer surgery. Such preoperative characterization could potentially help clinicians apply personalized interventions based on predictions concerning postsurgical pain.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Carin A Colebaugh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Demario Overstreet
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William Maixner
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Shad B Smith
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Zhu Y, Loggia ML, Edwards RR, Flowers KM, Muñoz-Vergara DW, Partridge AH, Schreiber KL. Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy. Clin J Pain 2022; 38:721-729. [PMID: 36136765 PMCID: PMC9649865 DOI: 10.1097/ajp.0000000000001073] [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: 09/20/2021] [Accepted: 09/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Aromatase inhibitors (AIs), which potently inhibit estrogen biosynthesis, are a standard treatment for hormone sensitive early-stage breast cancer. AIs have been associated with substantial joint pain and muscle stiffness (aromatase inhibitor-associated musculoskeletal syndrome). However, the link between AIs and number of clinical pain locations and pain sensitivity are less well understood. The aim of this study was to compare longitudinal changes in clinical pain and quantitative pain sensitivity between women who did or did not receive AI therapy. METHODS Women with early-stage breast cancer were prospectively enrolled and assessed for clinical pain in surgical and nonsurgical body areas using the Brief Pain Inventory and Breast Cancer Pain Questionnaire, and for pain sensitivity using quantitative sensory testing preoperatively and at 1 year postoperatively. Pain outcomes between participants who did and did not begin adjuvant AI therapy were compared using Wilcoxon Signed-Ranks and generalized estimating equation linear regression analyses. RESULTS Clinical pain and pain sensitivity were comparable between AI (n=49) and no-AI (n=106) groups preoperatively. After adjusting for body mass index, AI therapy was associated with a greater increase in the number of painful nonsurgical body sites (significant time by treatment interaction, P =0.024). Pain location was most frequent in knees (28%), lower back (26%), and ankles/feet (17%). Quantitative sensory testing revealed a significant decrease in pain sensitivity (increased pressure pain threshold) in the no-AI group over time, but not in the AI group. CONCLUSIONS AI therapy was associated with increased diffuse joint-related pain and greater post-treatment pain sensitivity, potentially implicating central sensitization as a contributing pain mechanism of aromatase inhibitor-associated musculoskeletal syndrome worthy of future investigation.
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Affiliation(s)
- Yehui Zhu
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco L. Loggia
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey M. Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis W. Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Stalls JM, Bovbjerg DH, Somers TJ, Plumb Vilardaga JC, Kimmick GG, McAuliffe PF, Keefe FJ, Posluszny DM, Sullivan MJL, Erkanli A, Reed SD, Sutton L, Owen L, Massa L, Shelby RA. Improving well-being for individuals with persistent pain after surgery for breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ: A randomized clinical trial. Contemp Clin Trials 2022; 122:106934. [PMID: 36152791 PMCID: PMC10001426 DOI: 10.1016/j.cct.2022.106934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/27/2023]
Abstract
>276,000 Americans will be diagnosed with invasive breast cancer, lobular carcinoma in situ, or ductal carcinoma in situ this year and most will undergo breast surgery as part of their care. Although prognosis is excellent, many patients experience persistent post-surgical pain (PSP), which has no satisfactory pharmacological treatment. The causal contributions of pain-associated psychological factors (e.g., catastrophic thoughts about pain, psychological flexibility, self-efficacy) to the continuing burden of PSP have not yet been determined and may be opportune intervention targets. The randomized trial described here will compare the benefits of three manualized behavioral interventions for individuals with PSP. Participants will receive either: 1) self-guided health education (SGHE); 2) interventionist-guided health education (IGHE); or 3) interventionist-guided pain coping skills training with elements of acceptance and commitment therapy that specially target catastrophic thoughts about pain, self-efficacy, and psychological flexibility (CST-PSP). Participants will prospectively complete validated assessments of primary outcomes (PSP severity and interference) at baseline (pre-intervention) and 3-, 6-, and 12-months later. Validated measures of emotional distress and cancer-specific distress will be assessed as secondary outcomes. To test their roles as drivers of PSP, catastrophic thoughts about pain, self-efficacy, and psychological flexibility, will be assessed and statistically analyzed as mediators of hypothesized beneficial effects. The interventions' impacts on pain sensitivity and central sensitization will be investigated to test these physiological pathways as proximal drivers of PSP. To better characterize the patient experience, additional validated measures will be explored for associations with PSP, along with demographic and clinical factors. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04225585, registered January 13, 2020.
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Affiliation(s)
- Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America.
| | - Dana H Bovbjerg
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
| | | | - Gretchen G Kimmick
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States of America
| | - Priscilla F McAuliffe
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
| | - Donna M Posluszny
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | - Alaattin Erkanli
- Department of Biostatistics, Duke University, Durham, NC, United States of America
| | - Shelby D Reed
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States of America
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States of America
| | - Lisa Massa
- Department of Physical and Occupational Therapy, Duke University, Durham, NC, United States of America
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States of America
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19
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Rogowsky L, Illmann CF, Macadam SA, Lennox PA, Van Laeken N, Bovill ES, Doherty C, Isaac KV. Prevalence and Severity of Chronic Pain in Patients Receiving Mastectomy with Alloplastic Immediate Breast Reconstruction: A Survey Study. Plast Surg (Oakv) 2022. [DOI: 10.1177/22925503221128985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Breast cancer is the most frequently diagnosed cancer worldwide. For those undergoing mastectomy, the choice of alloplastic immediate breast reconstruction (IBR) is increasingly favored. Post-operative chronic pain is an important consideration in this decision, but there is a paucity of data for those undergoing alloplastic IBR. We sought to examine the prevalence, severity, and risk factors for the development of chronic pain in this cohort using validated patient-reported outcome measures. Methods: A cross-sectional survey study was conducted among patients receiving mastectomy with alloplastic IBR. Participants completed 3 surveys querying chronic pain, specifically the Breast Cancer Pain Questionnaire (BCPQ), Brief Pain Inventory (BPI), and BREAST-Q. Participant medical records were reviewed for demographic and surgical variables. Results: A total of 118 patients participated in the study—a response rate of 33.6%. Chronic pain prevalence was high (52.5%), and only 29.0% of these patients had consulted a physician regarding their pain. Among those reporting chronic pain ( n = 62), the median severity of pain was 3.1 on an 11-point scale. Chronic pain was associated with radiation ( p = .018), bilateral reconstruction ( p = .05), worse emotional health ( p = .0003), less self ( p = .022), and sexual confidence ( p = .044). Inter-tool reliability was high, with no significant difference in responses between the 3 surveys. Conclusion: In this cohort, chronic pain is supported as a significant concern among patients who have undergone mastectomy with alloplastic IBR. Given the burden of chronic pain, there is an opportunity to intervene with preventative measures and support for its management.
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Affiliation(s)
- Larissa Rogowsky
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline F. Illmann
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter A. Lennox
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Wilson JM, Schreiber KL, Mackey S, Flowers KM, Darnall BD, Edwards RR, Azizoddin DR. Increased pain catastrophizing longitudinally predicts worsened pain severity and interference in patients with chronic pain and cancer: A collaborative health outcomes information registry study (CHOIR). Psychooncology 2022; 31:1753-1761. [PMID: 35988161 PMCID: PMC9910323 DOI: 10.1002/pon.6020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Little is known about how changes in psychosocial factors impact changes in pain outcomes among patients with cancer and chronic pain. This longitudinal cohort study of cancer patients investigated the relationships between changes in psychosocial factors and changes in pain severity and interference over time. METHODS Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their baseline visit (Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at a follow-up visit (Time 2), on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time. RESULTS Participants were an average age of 59 years, were 61% female, and 69% White. Overall, a decrease in pain severity (p ≤ 0.001), but not pain interference, was observed among the group over time. In multivariable analyses, increased pain catastrophizing was significantly associated with increased pain severity over time (β = 0.24, p ≤ 0.001). Similarly, increased pain catastrophizing (β = 0.21, p ≤ 0.001) and increased depression (β = 0.20, p ≤ 0.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes. CONCLUSIONS Increased pain catastrophizing was uniquely associated with increased chronic pain severity and interference. Our findings indicate that cancer patients with chronic pain would likely benefit from the incorporation of nonpharmacological interventions, simultaneously addressing pain and psychological symptoms.
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Affiliation(s)
- Jenna M. Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - K. Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Beth D. Darnall
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, California, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Desiree R. Azizoddin
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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21
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Kristin Schreiber, M.D., Ph.D., a Recipient of the 2022 James E. Cottrell, M.D., Presidential Scholar Award. Anesthesiology 2022. [DOI: 10.1097/aln.0000000000004359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Shiraishi M, Sowa Y, Tsuge I, Shiraishi A, Inafuku N, Nakayama I, Morimoto N. Risk factors associated with chronic pain after mastectomy: a prospective study with a 5-year follow-up in Japan. Breast Cancer 2022; 29:1133-1139. [PMID: 36018439 DOI: 10.1007/s12282-022-01392-8] [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: 06/17/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic pain is a major complication following breast surgery including breast reconstruction. We previously examined prospective patient-specific and medical/surgical factors that predict chronic pain a year after breast surgery in the Japanese population. Five-year survivorship is essential for breast cancer patients. This report is a 4-year follow-up study following the previous research. METHODS A follow-up observation study was performed 5 years after breast operations. The subjects were patients who underwent breast surgery, including tissue expander/implant (TE/implant), DIEP procedures and mastectomy only. Pain at 5 years was assessed using the Japanese Version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with chronic pain. RESULTS Questionnaires were completed by 132 subjects. No factor related to chronic pain was significantly related to the MPQ pain ratings. Among patient characteristics, a psychotic or neurological medical history was related to significantly lower visual analog scale (p = 0.02) and present pain index (p = 0.04) scores. A history of chemotherapy and/or hormone therapy was significantly associated with the frequency of use of pain medication postoperatively (p = 0.05) and effect on the social life of the patients (p = 0.02). CONCLUSIONS A psychotic or neurological history and a history of chemotherapy and/or hormone therapy were identified as risk factors for chronic pain after breast surgery, but the type of operation was not associated with chronic pain.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan.,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan. .,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan.
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Akiko Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Naoki Inafuku
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Ichiro Nakayama
- Department of Breast Surgery, Kyoto Miniren Chuo Hospital, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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23
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Lukas A, Theunissen M, Boer DDKD, van Kuijk S, Van Noyen L, Magerl W, Mess W, Buhre W, Peters M. AMAZONE: prevention of persistent pain after breast cancer treatment by online cognitive behavioral therapy-study protocol of a randomized controlled multicenter trial. Trials 2022; 23:595. [PMID: 35879728 PMCID: PMC9310687 DOI: 10.1186/s13063-022-06549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Surviving breast cancer does not necessarily mean complete recovery to a premorbid state of health. Among the multiple psychological and somatic symptoms that reduce the quality of life of breast cancer survivors, persistent pain after breast cancer treatment (PPBCT) with a prevalence of 15–65% is probably the most invalidating. Once chronic, PPBCT is difficult to treat and requires an individualized multidisciplinary approach. In the past decades, several somatic and psychological risk factors for PPBCT have been identified. Studies aiming to prevent PPBCT by reducing perioperative pain intensity have not yet shown a significant reduction of PPBCT prevalence. Only few studies have been performed to modify psychological distress around breast cancer surgery. The AMAZONE study aims to investigate the effect of online cognitive behavioral therapy (e-CBT) on the prevalence of PPBCT. Methods The AMAZONE study is a multicenter randomized controlled trial, with an additional control arm. Patients (n=138) scheduled for unilateral breast cancer surgery scoring high for surgical or cancer-related fears, general anxiety or pain catastrophizing are randomized to receive either five sessions of e-CBT or online education consisting of information about surgery and a healthy lifestyle (EDU). The first session is scheduled before surgery. In addition to the online sessions, patients have three online appointments with a psychotherapist. Patients with low anxiety or catastrophizing scores (n=322) receive treatment as usual (TAU, additional control arm). Primary endpoint is PPBCT prevalence 6 months after surgery. Secondary endpoints are PPBCT intensity, the intensity of acute postoperative pain during the first week after surgery, cessation of postoperative opioid use, PPBCT prevalence at 12 months, pain interference, the sensitivity of the nociceptive and non-nociceptive somatosensory system as measured by quantitative sensory testing (QST), the efficiency of endogenous pain modulation assessed by conditioned pain modulation (CPM) and quality of life, anxiety, depression, catastrophizing, and fear of recurrence until 12 months post-surgery. Discussion With perioperative e-CBT targeting preoperative anxiety and pain catastrophizing, we expect to reduce the prevalence and intensity of PPBCT. By means of QST and CPM, we aim to unravel underlying pathophysiological mechanisms. The online application facilitates accessibility and feasibility in a for breast cancer patients emotionally and physically burdened time period. Trial registration NTR NL9132, registered December 16 2020.
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Affiliation(s)
- Anne Lukas
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Maurice Theunissen
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Dianne de Korte-de Boer
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lotte Van Noyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Walter Magerl
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Ruprecht-Karls-University Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
| | - Werner Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang Buhre
- Department of Anesthesiology & Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Madelon Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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24
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Rodriguez DA, Galor A, Felix ER. Self-Report of Severity of Ocular Pain Due to Light as a Predictor of Altered Central Nociceptive System Processing in Individuals With Symptoms of Dry Eye Disease. THE JOURNAL OF PAIN 2022; 23:784-795. [PMID: 34890797 DOI: 10.1016/j.jpain.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/06/2021] [Accepted: 11/24/2021] [Indexed: 06/13/2023]
Abstract
Dry eye disease (DED) is a diagnosis given to individuals with a heterogeneous combination of symptoms and/or signs, including spontaneous and evoked ocular pain. Our current study evaluated whether and which ocular pain assessments could serve as screening tools for central sensitization in individuals with DED. A cohort of individuals with DED symptoms (n = 235) were evaluated for ocular pain, DED signs (tear production, evaporation), evoked sensitivity to mechanical stimulation at the cornea, and evidence of central sensitization. Central sensitization was defined for this study as the presence of pain 30 seconds after termination of a thermal noxious temporal summation protocol (ie, aftersensations) presented at a site remote from the eye (ventral forearm). We found that combining ratings of average intensity of ocular pain, ratings of average intensity of pain due to light, response to topical anesthetic eye drops, and corneal mechanical pain thresholds produced the best predictive model for central sensitization (area under the curve of .73). When examining ratings of intensity of ocular pain due to light alone (0-10 numerical rating), a cutoff score of 2 maximized sensitivity (85%) and specificity (48%) for the presence of painful aftersensations at the forearm. Self-reported rating of pain sensitivity to light may serve as a quick screening tool indicating the involvement of central nociceptive system dysfunction in individuals with DED. PERSPECTIVE: This study reveals that clinically-relevant variables, including a simple 0 to 10 rating of ocular pain due to light, can be used to predict the contribution of central sensitization mechanisms in a subgroup of individuals with DED symptoms. These findings can potentially improve patient stratification and management for this complex and painful disease.
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Affiliation(s)
- Daniel A Rodriguez
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida; Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida; Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Elizabeth R Felix
- Research Service, Miami Veterans Affairs Medical Center, Miami, Florida; Physical Medicine and Rehabilitation, University of Miami, Miami, Florida.
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25
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Sieberg CB, Karunakaran KD, Kussman B, Borsook D. Preventing Pediatric Chronic Postsurgical Pain: Time for Increased Rigor. Can J Pain 2022; 6:73-84. [PMID: 35528039 PMCID: PMC9067470 DOI: 10.1080/24740527.2021.2019576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous systems following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient’s risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the perisurgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an eight-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.
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Affiliation(s)
- Christine B. Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA USA
- Pain and Affective Neuroscience Center, Department of, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Keerthana Deepti Karunakaran
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA USA
- Pain and Affective Neuroscience Center, Department of, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Barry Kussman
- Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA USA
| | - David Borsook
- Department of Anesthesiology, Harvard Medical School, Boston, MA USA
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Hospital, Harvard Medical School, Boston, USA
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26
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Lahousse A, Ivakhnov S, Nijs J, Beckwée D, Cools W, Fernandez de Las Penas C, Roose E, Leysen L. The Mediating Effect of Perceived Injustice and Pain Catastrophizing in the Relationship of Pain on Fatigue and Sleep in Breast Cancer Survivors: A Cross-Sectional Study. PAIN MEDICINE 2022; 23:1299-1310. [PMID: 35020939 DOI: 10.1093/pm/pnac006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Multidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that they play an important role in patients' pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep. METHODS Cross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep. RESULTS The indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < 0.01 and VAS*PI = 1.19; P < 0.01) and sleep (CSI*PI = 0.31; P < 0.01 and VAS*PI = 1.74; P < 0.01) were found significant for both pain measures (Central Sensitization Inventory (CSI) and Visual Analogue Scale (VAS)). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = 0.03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems. CONCLUSION PI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.
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Affiliation(s)
- Astrid Lahousse
- Research Foundation-Flanders (FWO), Brussels, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - Sergei Ivakhnov
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, University of Gothenburg, Gothenburg, Sweden
| | - David Beckwée
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Wilfried Cools
- Interfaculty Center Data processing and Statistics, Brussels Health Campus
| | - César Fernandez de Las Penas
- Department of Physical Therapy Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
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27
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Quixadá AP, Miranda JGV, Osypiuk K, Bonato P, Vergara-Diaz G, Ligibel JA, Mehling W, Thompson ET, Wayne PM. Qigong Training Positively Impacts Both Posture and Mood in Breast Cancer Survivors With Persistent Post-surgical Pain: Support for an Embodied Cognition Paradigm. Front Psychol 2022; 13:800727. [PMID: 35265005 PMCID: PMC8900705 DOI: 10.3389/fpsyg.2022.800727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors (BCS) with persistent postsurgical pain (PPSP) over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open (EO), eyes open relaxed (EOR) and eyes closed (EC). Assessments were made before and after the Qigong training. The association between categorical variables (angle and mood) was measured by Cramer's V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs.
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Affiliation(s)
- Ana Paula Quixadá
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
- *Correspondence: Ana Paula Quixadá,
| | - Jose G. V. Miranda
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
| | - Kamila Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Jennifer A. Ligibel
- Zakim Center for Integrative Therapies and Healthy Living, Harvard Medical School, Dana Farber Cancer Institute, Boston, MA, United States
| | - Wolf Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Evan T. Thompson
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
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Dams L, Haenen V, Van der Gucht E, Devoogdt N, Smeets A, Bernar K, De Vrieze T, De Groef A, Meeus M. Absolute and relative reliability of a comprehensive quantitative sensory testing protocol in women treated for breast cancer. PAIN MEDICINE 2021; 23:1162-1175. [PMID: 34908144 DOI: 10.1093/pm/pnab343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Quantitative sensory testing (QST) are non-invasive psychophysical assessment techniques to evaluate functioning of the somatosensory nervous system. Despite the importance of reliability for correct use of QST results in research and clinical practice, the relative and absolute intra-and inter-rater reliability of a comprehensive QST protocol to evaluate the functioning of both peripheral and central somatosensory nervous system in a breast cancer population, has not yet been investigated. SETTING University Hospitals, Leuven, Belgium. SUBJECTS Thirty women at least six months after unilateral breast cancer surgery. METHODS The protocol included nine static and dynamic QST methods (mechanical detection-pain thresholds, pressure pain thresholds, thermal detection-pain thresholds for heat and cold, temporal summation and conditioned pain modulation (CPM)) performed in the surgical area and more distant regions. Absolute and relative intra (60-minutes interval) and inter-rater (one-week interval) reliability was evaluated using intraclass correlation coefficients, standard error of measurement and Bland-Altman plots. RESULTS A moderate to excellent relative intra- and inter-rater reliability was found for the evaluation of mechanical thresholds, pressure pain thresholds and temporal summation. Reliability of the CPM paradigm was considered weak. Systematic bias between raters was noticed for detection of mechanical and cold stimuli at the non-affected trunk and CPM. CONCLUSIONS Except for the evaluation of CPM, the QST protocol was found suitable for identifying differences between subjects (relative reliability) and individual follow-up after breast cancer surgery (limited systematic bias) during a one-week timeframe. Additional research is required to determine measurement properties that influence CPM test stability in order to establish a more reliable CPM test paradigm.
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Affiliation(s)
- Lore Dams
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium.,KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.,Pain In Motion International research group, www.paininmotion.be
| | - Vincent Haenen
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium.,KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Elien Van der Gucht
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium.,KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.,Pain In Motion International research group, www.paininmotion.be
| | - Nele Devoogdt
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - An De Groef
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium.,KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.,Pain In Motion International research group, www.paininmotion.be
| | - Mira Meeus
- University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, Antwerp, Belgium.,Pain In Motion International research group, www.paininmotion.be.,Ghent University, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium
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Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery. Pain Rep 2021; 6:e976. [PMID: 34841183 PMCID: PMC8613357 DOI: 10.1097/pr9.0000000000000976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Examining the divergence of prevalence and predictors of postsurgical numbness vs positive neuropathic symptoms gives insights into variation in clinical postoperative pain experienced by patients. Introduction: Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). Objectives: In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Methods: Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Results: Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Conclusions: Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.
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Mi X, Zou B, Rashidi P, Baharloo R, Fillingim RB, Wallace MR, Crispen PL, Parvataneni HK, Prieto HA, Gray CF, Machuca TN, Hughes SJ, Murad GJA, Thomas E, Iqbal A, Tighe PJ. Effects of Patient and Surgery Characteristics on Persistent Postoperative Pain: A Mediation Analysis. Clin J Pain 2021; 37:803-811. [PMID: 34475340 PMCID: PMC8511273 DOI: 10.1097/ajp.0000000000000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Acute postoperative pain intensity is associated with persistent postsurgical pain (PPP) risk. However, it remains unclear whether acute postoperative pain intensity mediates the relationship between clinical factors and persistent pain. MATERIALS AND METHODS Participants from a mixed surgical population completed the Brief Pain Inventory and Pain Catastrophizing Scale before surgery, and the Brief Pain Inventory daily after surgery for 7 days and at 30 and 90 days after surgery. We considered mediation models using the mean of the worst pain intensities collected daily on each of postoperative days (PODs) 1 to 7 against outcomes of worst pain intensity at the surgical site endpoints reflecting PPP (POD 90) and subacute pain (POD 30). RESULTS The analyzed cohort included 284 participants for the POD 90 outcome. For every unit increase of maximum acute postoperative pain intensity through PODs 1 to 7, there was a statistically significant increase of mean POD 90 pain intensity by 0.287 after controlling for confounding effects. The effects of female versus male sex (m=0.212, P=0.034), pancreatic/biliary versus colorectal surgery (m=0.459, P=0.012), thoracic cardiovascular versus colorectal surgery (m=0.31, P=0.038), every minute increase of anesthesia time (m=0.001, P=0.038), every unit increase of preoperative average pain score (m=0.012, P=0.015), and every unit increase of catastrophizing (m=0.044, P=0.042) on POD 90 pain intensity were mediated through acute PODs 1 to 7 postoperative pain intensity. DISCUSSION Our results suggest the mediating relationship of acute postoperative pain on PPP may be predicated on select patient and surgical factors.
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Affiliation(s)
- Xinlei Mi
- Department of Biostatistics, Columbia University, New York, NY
| | - Baiming Zou
- Department of Biostatistics, Columbia University, New York, NY
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Parisa Rashidi
- Department of Biomedical Engineering
- Electrical and Computer Engineering
| | | | | | | | | | | | | | | | | | | | - Gregory J A Murad
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL
| | - Elizabeth Thomas
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio
| | - Atif Iqbal
- Division of General Surgery, Baylor College of Medicine, Houston, TX
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Guliyeva G, Torres RA, Avila FR, Kaplan JL, Lu X, Forte AJ. The Impact of implant-based reconstruction on persistent pain after breast cancer surgery: A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:519-527. [PMID: 34801428 DOI: 10.1016/j.bjps.2021.09.079] [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: 02/06/2021] [Revised: 06/16/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION With the increasing number of breast cancer survivors and reconstruction operations, persistent pain following breast cancer surgery (PPBCT) and its management is becoming a challenge for plastic surgeons. To date, most studies compared the difference in the level of PPBCT in reconstruction versus nonreconstruction groups. We systematically reviewed the literature to assess the impact of implant-based reconstruction on PPBCT levels. MATERIALS AND METHODS PubMed, Embase, CINAHL, and Scopus databases were searched for relevant articles. We used five search strategies: (persistent pain after breast cancer surgery AND reconstruction), (chronic postsurgical pain AND breast reconstruction), (Breast Implantation [MeSH Terms] AND "Chronic Pain" [MeSH Terms]), (breast reconstruction AND chronic pain), and (postmastectomy pain syndrome AND breast reconstruction). RESULTS A total of 2281 articles were detected. After scanning for the title and abstract, full-text articles were reviewed to identify the eligible articles. Eleven articles were included in the final review, with seven of these reporting no increased chance of PPBCT following reconstruction with implants, whereas two articles described lower chances of PPBCT following implant-based reconstruction. CONCLUSION We discovered that implant-based reconstruction does not increase the risk of PPBCT in comparison to other surgical techniques or mastectomy alone. This relationship may facilitate doctors and their patients in the decision-making of the appropriate reconstruction technique to use. In addition, our results should prompt plastic surgeons to prescribe the same dosage and frequency of analgesics to patients undergoing implant reconstruction as they would to their patients not undergoing reconstruction.
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Affiliation(s)
- Gunel Guliyeva
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Ricardo A Torres
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Jamie L Kaplan
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Xiaona Lu
- Section of Plastic Surgery, Yale University, New Haven, CT, United States
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, United States.
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Chadwick A, Frazier A, Khan TW, Young E. Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review. J Pain Res 2021; 14:3145-3161. [PMID: 34675643 PMCID: PMC8517910 DOI: 10.2147/jpr.s320863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine. METHODS Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological. RESULTS Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors. CONCLUSION Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.
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Affiliation(s)
- Andrea Chadwick
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Frazier
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Young
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers. Life (Basel) 2021; 11:life11101026. [PMID: 34685397 PMCID: PMC8540201 DOI: 10.3390/life11101026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 12/29/2022] Open
Abstract
After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.
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Zhan H, Quinn M, Tian W, Yan L, Khoury T. Significance of Removing Comedonecrosis as an Exclusion Criterion in Mammary Low-Risk Ductal Carcinoma In Situ Managed in an Active Surveillance Clinical Trial. Am J Clin Pathol 2021; 156:596-606. [PMID: 33769445 DOI: 10.1093/ajcp/aqaa276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aims to investigate the consequences of comedonecrosis omission as an exclusion criterion of the Comparison of Operative vs Monitoring and Endocrine Therapy (COMET) trial. METHODS The clinical inclusion criteria of the COMET trial were applied on women who were mammographically screened between 2007 and 2017 and had a diagnosis of low- or intermediate-grade ductal carcinoma in situ (DCIS). The percentage of ductal diameter occupied by necrosis was calculated. RESULTS Twenty-six of 129 (20.2%) cases were upgraded. Larger calcification span correlated with upgrade (P = .02), with the best cutoff of 1.1 cm, and negative predictive value of 86%. When solely analyzing cases with no comedonecrosis (n = 76), none of the variables correlated with upgrade. Comedonecrosis was significantly correlated with upgrade to invasive carcinoma (P = .041), with the best cutoff of 53% of ductal diameter occupied by necrosis. CONCLUSIONS Results indicate that comedonecrosis and span of mammographic calcifications could be risk factors in women managed with active surveillance.
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Affiliation(s)
- Haiying Zhan
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Marie Quinn
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Wanqing Tian
- Department of Biostatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Li Yan
- Department of Biostatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Azizoddin DR, Schreiber K, Beck MR, Enzinger AC, Hruschak V, Darnall BD, Edwards RR, Allsop MJ, Tulsky JA, Boyer E, Mackey S. Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system. Cancer 2021; 127:3254-3263. [PMID: 34061975 PMCID: PMC9981278 DOI: 10.1002/cncr.33645] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/21/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite the biopsychosocial underpinnings of chronic noncancer pain, relatively little is known about the contribution of psychosocial factors to chronic cancer pain. The authors aimed to characterize associations between biopsychosocial factors and pain and opioid use among individuals with chronic pain and cancer. METHODS The authors conducted a retrospective, cross-sectional study of 700 patients with chronic pain and cancer seeking treatment at an academic tertiary pain clinic. Patients completed demographic questionnaires and validated psychosocial and pain measures. Multivariable, hierarchical linear and logistic regressions assessed the relative contributions of biopsychosocial factors to the primary dependent variables of pain severity, pain interference, and opioid use. RESULTS Participants were 62% female and 66% White with a mean age of 59 ± 15 years, and 55% held a college degree or higher. Older age, African American or "other" race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity (F(5,657) = 22.45; P ≤ .001; R2 = 0.22). Depression, sleep disturbance, pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference (F(5,653) = 9.47; P ≤ .001; R2 = 0.44). Lastly, a poor cancer prognosis (Exp(B) = 1.62) and sleep disturbance (Exp(B) = 1.02) were associated with taking opioids, whereas identifying as Asian (Exp(B) = 0.48) or Hispanic (Exp(B) = 0.47) was associated with lower odds of using opioids. CONCLUSIONS Modifiable psychological factors-specifically sleep disturbance, depression, and pain catastrophizing-were uniquely associated with pain and opioid use in patients with chronic pain and diverse cancer diagnoses. Future behavioral pain interventions that concurrently target sleep may improve pain among patients with cancer. LAY SUMMARY Feeling depressed, worrying about pain, and bad sleep are related to higher pain symptoms in individuals with chronic pain and cancer. Specifically, those who struggle to sleep have worse pain and use more opioids. Also, individuals who have a bad prognosis for their cancer are more likely to be using opioid pain medications. Although race and cancer are related to chronic pain in patients, psychological well-being is also strongly related to this same pain.
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Affiliation(s)
- Desiree R. Azizoddin
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Kristin Schreiber
- Harvard Medical School, Boston, Massachusetts,Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Andrea C. Enzinger
- Harvard Medical School, Boston, Massachusetts,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Valerie Hruschak
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Beth D. Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative Medicine, and Pain Medicine, Stanford University, Stanford, California
| | - Robert R. Edwards
- Harvard Medical School, Boston, Massachusetts,Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Matthew J. Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts,Division of Palliative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative Medicine, and Pain Medicine, Stanford University, Stanford, California
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Khoury T, Quinn M, Tian W, Yan L, Zhan H. Touching Tumor-Infiltrating Lymphocytes in Low Risk Ductal Carcinoma in Situ Correlates with Upgrade to High Grade DCIS. Histopathology 2021; 80:291-303. [PMID: 34379814 DOI: 10.1111/his.14539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022]
Abstract
AIMS To examine our hypothesis that higher number of touching TILs in a low risk DCIS detected in a setting like active surveillance clinical trial correlates with upgrade to HG-DCIS in the subsequent excisional biopsy. METHODS AND RESULTS The clinical inclusion criteria of the COMET clinical trial were applied on women who were mammographically screened between 2007 and 2017. In the core needle biopsy, touching TILs were assessed by counting the number of TILs touching the ductal basement membrane or away from it by one lymphocyte thickness. The highest number of TILs around a single involved duct and the average number among involved ducts were recorded. DCIS was graded as low or intermediate. Twenty-six of 129 (20.2%) cases had upgrade [14 (10.9%) to pure HG-DCIS, and 12 (9.3%) to invasive carcinoma, 2 of which with concurrent HG-DCIS]. Increased average touching TILs and intermediate grade DCIS correlated with upgrade to HG-DCIS in 11 of 16 (68.8%) cases and decreased average touching TILs and low-grade DCIS correlated with no upgrade in 89 of 113 (78.8%) [accuracy 0.775; AUC 0.746]. Increased highest touching TILs and intermediate-grade DCIS correlated with upgrade to HG-DCIS in 12 of 16 (75%) cases and decreased highest touching TILs and low-grade DCIS correlated with no upgrade in 82 of 113 (72.6%) [accuracy 0.7287; AUC 0.734]. Highest touching TILs ≥ 10 cells correlated with upgrade to invasive carcinoma and/or HG-DCIS (p=0.018). CONCLUSIONS Intermediate-grade and touching TILs may be good variables to examine in the COMET clinical trial and correlate with the risk of upgrade.
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Affiliation(s)
- Thaer Khoury
- Department of Pathology, Roswell Park Comprehensive Cancer Center, USA
| | - Marie Quinn
- Department of Radiology, Roswell Park Comprehensive Cancer Center, USA
| | - Wanqing Tian
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, USA
| | - Li Yan
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, USA
| | - Haiying Zhan
- Department of Pathology, Roswell Park Comprehensive Cancer Center, USA
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Zinboonyahgoon N, Patton ME, Chen YYK, Edwards RR, Schreiber KL. Persistent Post-Mastectomy Pain: The Impact of Regional Anesthesia Among Patients with High vs Low Baseline Catastrophizing. PAIN MEDICINE 2021; 22:1767-1775. [PMID: 33560352 DOI: 10.1093/pm/pnab039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Persistent post-mastectomy pain (PPMP) varies both in its severity and impact, with psychosocial factors such as catastrophizing conferring greater risk. Preoperative regional anesthesia (RA) is an important nonopioid therapy, but with variable success at preventing PPMP in previous reports. We previously reported that RA was associated with lower acute post-mastectomy pain and opioid use, but more prominently among patients with higher baseline catastrophizing. The current longitudinal investigation at 3, 6, and 12 months postop aimed to detect differential long-term impact of RA on PPMP among patients with high vs low catastrophizing. METHODS In this prospective observational study, patients (n = 123) completed preoperative psychosocial assessment and underwent mastectomy either with (n = 56) or without (n = 67) preoperative RA. Generalized estimating equation (GEE) regression analysis assessed impact of baseline catastrophizing, RA, and their interaction, on the primary outcome of pain severity index, as well as secondary outcomes including cognitive and emotional impact of pain, and persistent opioid use. RESULTS We observed a significant interaction between the effect of catastrophizing and RA on PPMP. Specifically, RA was associated with reduced pain severity and pain impact 3, 6, and 12 months postoperatively, but only among those with high baseline catastrophizing scores. In addition, both RA and lower catastrophizing scores were associated with lower incidence of persistent opioid use. CONCLUSIONS The efficacy of therapies to prevent PPMP may be importantly influenced by pain-modulatory psychosocial characteristics. These findings underscore the importance of considering individual patient factors when applying preventive treatments, and of including their assessment in future trials.
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Affiliation(s)
- Nantthasorn Zinboonyahgoon
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts, USA.,Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts, USA
| | - Yun-Yun K Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts, USA
| | - Rob R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, Massachusetts, USA
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38
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Post-Breast Surgery Pain Syndrome: Shifting a Surgical Paradigm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3720. [PMID: 34316427 PMCID: PMC8301281 DOI: 10.1097/gox.0000000000003720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
Post-mastectomy pain syndrome and the less well-described post-breast surgery pain syndrome are long-term neuropathic pain conditions that may affect more than 50% of patients after mastectomy and breast surgery. While the etiology, risk factors, and management have been reviewed in our literature, we offer here a focused outline that will gear the plastic surgeon with tools to lead a multidisciplinary, algorithmic approach to the care of patients with post-mastectomy pain syndrome/post-breast surgery pain syndrome. After reading this article, we hope the reader will have improved awareness of post-mastectomy pain syndrome/post-breast surgery pain syndrome, and thus be able to incorporate appropriate treatments and preventative steps into their primary surgical routine.
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Panzenbeck P, von Keudell A, Joshi GP, Xu CX, Vlassakov K, Schreiber KL, Rathmell JP, Lirk P. Procedure-specific acute pain trajectory after elective total hip arthroplasty: systematic review and data synthesis. Br J Anaesth 2021; 127:110-132. [PMID: 34147158 DOI: 10.1016/j.bja.2021.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND For most procedures, there is insufficient evidence to guide clinicians in the optimal timing of advanced analgesic methods, which should be based on the expected time course of acute postoperative pain severity and aimed at time points where basic analgesia has proven insufficient. METHODS We conducted a systematic search of the literature of analgesic trials for total hip arthroplasty (THA), extracting and pooling pain scores across studies, weighted for study size. Patients were grouped according to basic anaesthetic method used (general, spinal), and adjuvant analgesic interventions such as nerve blocks, local infiltration analgesia, and multimodal analgesia. Special consideration was given to high-risk populations such as chronic pain or opioid-dependent patients. RESULTS We identified and analysed 71 trials with 5973 patients and constructed pain trajectories from the available pain scores. In most patients undergoing THA under general anaesthesia on a basic analgesic regimen, postoperative acute pain recedes to a mild level (<4/10) by 4 h after surgery. We note substantial variability in pain intensity even in patients subjected to similar analgesic regimens. Chronic pain or opioid-dependent patients were most often actively excluded from studies, and never analysed separately. CONCLUSIONS We have demonstrated that it is feasible to construct procedure-specific pain curves to guide clinicians on the timing of advanced analgesic measures. Acute intense postoperative pain after THA should have resolved by 4-6 h after surgery in most patients. However, there is a substantial gap in knowledge on the management of patients with chronic pain and opioid-dependent patients.
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Affiliation(s)
- Paul Panzenbeck
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvind von Keudell
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, RX, USA
| | - Claire X Xu
- Department of Anesthesiology, Pain and Critical Care Medicine, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Kamen Vlassakov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James P Rathmell
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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40
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Dams L, Van der Gucht E, Meeus M, Devoogdt N, Smeets A, Penen F, De Baerdemaecker T, Haenen V, Bernar K, De Vrieze T, De Groef A. Quantitative Sensory Testing in Women After Surgery for Breast Cancer: A Systematic Review and Narrative Synthesis. Clin J Pain 2021; 37:538-564. [PMID: 33883413 DOI: 10.1097/ajp.0000000000000940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Quantitative sensory testing (QST) is a noninvasive technique to evaluate functioning of the somatosensory system. In many women surgically treated for breast cancer (BC), somatosensory functioning is disturbed with high prevalence of sensory loss and/or pain. The aims of this systematic review were (1) to summarize literature about QST methods; (2) to summarize the results within women surgically treated for BC (patients and survivors); (3) to compare QST results between women surgically treated for BC with and without pain; and (4) to compare the results between women surgically treated for BC and women without history of BC. METHODS A systematic literature search was conducted up to February 2020. Included studies had to report on QST methods (mechanical or thermal detection-pain thresholds, pressure pain thresholds [PPT], temporal summation [TS], or conditioned pain modulation [CPM]) in women over 18 years with-without pain, who had undergone unilateral surgery for BC. RESULTS Twenty-eight studies were included. Discrepancies in QST methods were greatest for TS and CPM. A local disturbance in thermal detection and an increased pain facilitation were found in BC survivors with pain in the surgical area. BC survivors with upper limb pain had significantly lower PPT at the surgical area and PPT were also significantly lower compared with women without history of BC, at affected and nonaffected sides for both local and remote body regions. DISCUSSION Standardized QST incorporating assessments of CPM is warranted in order to draw conclusions about neurobiological mechanisms of pain and somatosensory disturbances after surgical treatment for BC and to enhance mechanism-based management of these sequelae.
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Affiliation(s)
- Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Pain in Motion International Research Group, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Pain in Motion International Research Group, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Pain in Motion International Research Group, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent
| | - Nele Devoogdt
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven-University Hospitals Leuven
| | | | - Frauke Penen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
| | | | - Vincent Haenen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
| | - An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, MOVANT, Antwerp
- Pain in Motion International Research Group, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven
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Flowers KM, Patton ME, Hruschak VJ, Fields KG, Schwartz E, Zeballos J, Kang JD, Edwards RR, Kaptchuk TJ, Schreiber KL. Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial. Pain 2021; 162:1828-1839. [PMID: 33449503 PMCID: PMC8378225 DOI: 10.1097/j.pain.0000000000002185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as "open-label placebos" (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (-14.5 daily morphine milligram equivalents; 95% CI: [-26.8, -2.2]). Daily worst pain scores were also lower in the COLP group (-1.0 point on the 10-point scale; 95% CI: [-2.0, -0.1]), although a significant difference was not detected in average daily pain between the groups (-0.8 point; 95% CI: [-1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
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Affiliation(s)
- Kelsey M. Flowers
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Megan E. Patton
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Valerie J. Hruschak
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kara G. Fields
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily Schwartz
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jose Zeballos
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - James D. Kang
- Departments of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Rob R. Edwards
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristin L. Schreiber
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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42
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Tola YO, Chow KM, Liang W. Effects of non-pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review. J Clin Nurs 2021; 30:3369-3384. [PMID: 33942405 DOI: 10.1111/jocn.15827] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poorly managed preoperative anxiety and pain were reported to slow the postoperative recovery of breast cancer patients. Thus, proactive management using non-pharmacological interventions becomes essential for decreasing opioid or anxiolytics consumption, anxiety level, pain intensity, postoperative complications and improving patients' haemodynamics and satisfaction with care. PURPOSE To identify, analyse and synthesise the effects of non-pharmacological interventions on preoperative anxiety and acute postoperative pain in women undergoing breast cancer surgery. METHOD For this systematic review, 12 databases including Ovid Nursing, PsycInfo, British Nursing Index, CINAHL, Cochrane Library were searched to identify relevant studies. A total of 6,012 articles were identified from the search, six RCTs and one quasi-experimental study that met the inclusion criteria were included after eligibility screening. Narrative synthesis was used to analyse data extracted from the included articles. The review adhered to the PRISMA guideline. RESULTS Twelve outcomes were measured in the included studies, including preoperative anxiety, and acute postoperative pain. Music, massage, aromatherapy and acupuncture were the interventions delivered. Music had a small-to-large effect size and aromatherapy had a small effect size on reducing preoperative anxiety. Also, music had a large effect size whilst acupuncture had a medium effect size on minimising postoperative pain in women undergoing breast cancer surgery. CONCLUSION Music, aromatherapy and acupuncture appeared to be effective for reducing preoperative anxiety and postoperative pain in women undergoing breast cancer surgery. However, the small number of studies available for each intervention prevents conclusive statements about which the most effective method. IMPLICATION FOR CLINICAL PRACTICE A nursing care pathway that standardises the use of non-pharmacological interventions for the management of both preoperative anxiety and postoperative pain in breast cancer surgery patients should be developed.
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Affiliation(s)
- Yetunde Oluwafunmilayo Tola
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Nursing Research, Osogbo, Nigeria
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Liang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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43
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Calapai F, Mondello E, Mannucci C, Sorbara EE, Gangemi S, Quattrone D, Calapai G, Cardia L. Pain Biomarkers in Cancer: An Overview. Curr Pharm Des 2021; 27:293-304. [PMID: 33138755 DOI: 10.2174/1381612826666201102103520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pain is a common symptom in oncologic patients and its management is generally guided with reference to pain individually perceived by patients and expressed through self-reported scales. However, the utility of these tools is limited as it strongly depends on patients' opinions. For this reason, more objective instruments are desirable. OBJECTIVE In this overview, scientific articles indicating potential markers to be used for pain management in cancer were collected and discussed. METHODS Research was performed on principal electronic scientific databases by using the words "pain", "cancer", "markers" and "biomarkers" as the main keywords, and findings describing potential biomarkers for the management of cancer pain were reported. RESULTS Studies on pain markers not specific for cancer typology (inflammatory, genetic markers predicting response to analgesic drugs, neuroimaging markers) and pain markers for specific types of cancer (bone cancer, breast cancer, lung cancer, head and neck cancer, prostate cancer, cancer in pediatrics) have been presented and commented on. CONCLUSION This overview supports the view of the involvement of inflammatory mediators in the mechanisms underlying cancer pain. Only a small amount of data from research up till today is available on markers that can help in the management of pain, except for pro-inflammatory cytokines and other inflammatory indexes such as C-reactive protein (CRP). However, biomarkers are a promising strategy useful to predict pain intensity and to objectively quantify analgesic response in guiding decisions regarding individual-tailored treatments for cancer patients.
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Affiliation(s)
- Fabrizio Calapai
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging - University of Messina, Messina, Italy
| | - Epifanio Mondello
- Anesthesia, Intensive Care and Pain Therapy, Policlinico "G. Martino" - University of Messina, Messina, Italy
| | - Carmen Mannucci
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging - University of Messina, Messina, Italy
| | - Emanuela E Sorbara
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging - University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- School and Division of Allergy and Clinical Immunology, Department of Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Quattrone
- Pain Therapy Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli" - Reggio Calabria, Italy
| | - Gioacchino Calapai
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging - University of Messina, Messina, Italy
| | - Luigi Cardia
- IRCCS Centro Neurolesi Bonino- Pulejo, Messina, Italy
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44
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Osypiuk K, Kilgore K, Ligibel J, Vergara-Diaz G, Bonato P, Wayne PM. "Making Peace with Our Bodies": A Qualitative Analysis of Breast Cancer Survivors' Experiences with Qigong Mind-Body Exercise. J Altern Complement Med 2021; 26:825-832. [PMID: 32924562 DOI: 10.1089/acm.2019.0406] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives: Breast cancer treatment leaves breast cancer survivors (BCS) with an array of lasting side effects, including persistent postsurgical pain (PPSP). In this study, we explored the perceptions of BCS with PPSP as they learned Qigong mind-body exercise (QMBE), a multimodal practice rooted in Traditional Chinese Medicine. Methods: Participants included 18 female BCS treated for stage 0-III breast cancer and experiencing PPSP. Participants were taught QMBE over 12 weeks. Semi-structured interviews were conducted before and after the intervention. Results: BCS disclosed a disconnect between mind and body that emerged during treatment. They perceived QMBE as moving meditation, which enabled them to reconnect mind and body, lessen their pain, and make peace with their bodies. Conclusion: These women's experiences both inform the promise of integrating QMBE and related mind-body exercise into PPSP clinical practice guidelines and suggest new areas of research regarding the role of multimodal interventions for holistic healing in BCS.
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Affiliation(s)
- Kamila Osypiuk
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Kilgore
- College of Education, University of Florida, Gainesville, FL, USA
| | - Jennifer Ligibel
- Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Smith CR, Baharloo R, Nickerson P, Wallace M, Zou B, Fillingim RB, Crispen P, Parvataneni H, Gray C, Prieto H, Machuca T, Hughes S, Murad G, Rashidi P, Tighe PJ. Predicting long-term postsurgical pain by examining the evolution of acute pain. Eur J Pain 2021; 25:624-636. [PMID: 33171546 PMCID: PMC8628519 DOI: 10.1002/ejp.1698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/08/2020] [Indexed: 09/13/2023]
Abstract
BACKGROUND Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. METHODS We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. RESULTS This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. CONCLUSIONS Clinically, these results suggest that individual pain-state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient- and surgery-specific factors may help indicate which patients are at increased risk of PPP. SIGNIFICANCE Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
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Affiliation(s)
- Cameron R Smith
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Raheleh Baharloo
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Paul Nickerson
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Margaret Wallace
- Center for NeuroGenetics, University of Florida, Gainesville, FL, USA
| | - Baiming Zou
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Paul Crispen
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hari Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Chancellor Gray
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hernan Prieto
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tiago Machuca
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gregory Murad
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Parisa Rashidi
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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46
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Leysen L, Cools W, Nijs J, Adriaenssens N, Pas R, van Wilgen CP, Bults R, Roose E, Lahousse A, Beckwée D. The mediating effect of pain catastrophizing and perceived injustice in the relationship of pain on health-related quality of life in breast cancer survivors. Support Care Cancer 2021; 29:5653-5661. [PMID: 33569674 DOI: 10.1007/s00520-021-06011-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The importance of cognitive appraisals in the effectiveness of pain coping is well established. Two key variables in these appraisal processes are pain catastrophizing (PC) and perceived injustice (PI), which are known to increase the risk of long-term disability and aggravate the pain-related distress through maladaptive behavioral responses. However, to date, the mediating effects of these appraisals have not been examined concurrently in the breast cancer survivor (BCS) population, nor have they been related to health-related quality of life (HRQoL). METHODS Using cross-sectional data from 110 BCS, structural path analyses were used to examine the mediating effects of PC and PI in the relationship of pain on the HRQoL in BCS. RESULTS Results demonstrated a significant direct effect of pain and PI on HRQoL combined with a significant indirect effect through PI, but not through PC. An increase in pain is suggested to result in a decrease in quality of life. On the other hand, an increase in pain also is suggested to increase the PI. A similar relation with PC was not retained as significant. CONCLUSION The relative salience of PI as a mediator of HRQoL underscores the fact that PI is not only understudied but also underappreciated and undertreated in the BCS population. The results of our study warrant replication across longitudinal studies but continue to expand upon the evidence of the multifactorial nature of pain coping in BCS.
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Affiliation(s)
- Laurence Leysen
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium. .,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.
| | - Wilfried Cools
- Interfaculty Center Data Processing and Statistics, Brussels Health Campus, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
| | - Nele Adriaenssens
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Oncology, University Hospital Brussels, Brussels, Belgium
| | - Roselien Pas
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - C Paul van Wilgen
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Transcare Pijn - Transdisciplinary Pain Center, Groningen, the Netherlands
| | - Rinske Bults
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Transcare Pijn - Transdisciplinary Pain Center, Groningen, the Netherlands.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussels, Brussels, Belgium
| | - Eva Roose
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - Astrid Lahousse
- Pain in Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Building F-kine, Laarbeeklaan 103, BE-1090, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Schreiber KL, Zinboonyahgoon N, Flowers KM, Hruschak V, Fields KG, Patton ME, Schwartz E, Azizoddin D, Soens M, King T, Partridge A, Pusic A, Golshan M, Edwards RR. Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators. Ann Surg Oncol 2021; 28:5015-5038. [PMID: 33452600 DOI: 10.1245/s10434-020-09479-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/27/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Persistent post-mastectomy pain (PPMP) is a significant negative outcome occurring after breast surgery, and understanding which individual women are most at risk is essential to targeting of preventive efforts. The biopsychosocial model of pain suggests that factors from many domains may importantly modulate pain processing and predict the progression to pain persistence. METHODS This prospective longitudinal observational cohort study used detailed and comprehensive psychosocial and psychophysical assessment to characterize individual pain-processing phenotypes in 259 women preoperatively. Pain severity and functional impact then were longitudinally assessed using both validated surgery-specific and general pain questionnaires to survey patients who underwent lumpectomy, mastectomy, or mastectomy with reconstruction in the first postsurgical year. An agnostic, multivariable modeling strategy identified consistent predictors of several pain outcomes at 12 months. RESULTS The preoperative characteristics most consistently associated with PPMP outcomes were preexisting surgical area pain, less education, increased somatization, and baseline sleep disturbance, with axillary dissection emerging as the only consistent surgical variable to predict worse pain. Greater pain catastrophizing, negative affect, younger age, higher body mass index (BMI), and chemotherapy also were independently predictive of pain impact, but not severity. Sensory disturbance in the surgical area was predicted by a slightly different subset of factors, including higher preoperative temporal summation of pain. CONCLUSIONS This comprehensive approach assessing consistent predictors of pain severity, functional impact, and sensory disturbance may inform personalized prevention of PPMP and also may allow stratification and enrichment in future preventive studies of women at higher risk of this outcome, including pharmacologic and behavioral interventions and regional anesthesia.
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Affiliation(s)
- Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Megan E Patton
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Schwartz
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Desiree Azizoddin
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mieke Soens
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Pusic
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Mehra Golshan
- Department of Surgery, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Rob R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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48
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Levitt AE, Galor A, Small L, Feuer W, Felix ER. Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK. Ocul Surf 2021; 19:275-281. [PMID: 33096271 PMCID: PMC7867610 DOI: 10.1016/j.jtos.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain. METHODS Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest. RESULTS 43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009). CONCLUSIONS Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK. TRIAL REGISTRATION NCT02701764.
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Affiliation(s)
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA.
| | - Leslie Small
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Department of Physical Medicine & Rehabilitation, University of Miami, Miami, FL, USA; Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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49
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Chai PR, Gale JY, Patton ME, Schwartz E, Jambaulikar GD, Wade Taylor S, Edwards RR, Boyer EW, Schreiber KL. The Impact of Music on Nociceptive Processing. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:3047-3054. [PMID: 32337605 PMCID: PMC7685689 DOI: 10.1093/pm/pnaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Music has been shown to modulate pain, although the impact of music on specific aspects of nociceptive processing is less well understood. Using quantitative sensory testing (QST), we assessed the impact of a novel music app on specific aspects of nociceptive processing. DESIGN Within-subjects paired comparison of pain processing in control vs music condition. SETTING Human psychophysical laboratory. SUBJECTS Sixty healthy adult volunteers. METHODS Subjects were assessed for baseline anxiety, depression, and catastrophizing using validated questionnaires. QSTs measured included 1) pain threshold and tolerance to deep muscle pressure, 2) pain with mechanical pinprick, 3) temporal summation of pain (TSP) with a repeated pain stimulus, and 4) conditioned pain modulation (CPM) with a second painful stimulus. QSTs were performed in the absence and presence of music delivered through a music app. RESULTS We found an increase in pressure pain thresholds in both the forearm (P = 0.007) and trapezius (P = 0.002) with music, as well as a decrease in the amount of pinprick pain (P < 0.001) and TSP (P = 0.01) with music. Interestingly, CPM was also significantly diminished (P < 0.001) in the music condition. No significant difference in cold pain, anxiety, or situational catastrophizing was observed with music. Higher baseline pain catastrophizing scores were associated with less music-induced pressure pain reduction. CONCLUSIONS Several measures of mechanical pain sensitivity were reduced with music. TSP, a measure of central sensitization, also decreased with music, but CPM, a measure of descending modulation of pain, was not further augmented by music.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
| | - Jasmine Y Gale
- Department of Emergency Medicine, Brigham and Women’s Hospital
- Tufts University School of Medicine
| | - Megan E Patton
- Department of Anesthesiology, Brigham and Women’s Hospital
| | - Emily Schwartz
- Department of Anesthesiology, Brigham and Women’s Hospital
| | | | - S Wade Taylor
- The Fenway Institute
- Boston University, Boston, Massachusetts, USA
| | | | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women’s Hospital
- The Fenway Institute
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50
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Dominici LS, Rosenberg SM. Ductal carcinoma in situ (DCIS): The importance of patient-reported outcomes (PRO). CURRENT BREAST CANCER REPORTS 2020; 12:90-97. [PMID: 32747864 DOI: 10.1007/s12609-020-00363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose Patient reported outcomes (PROs) are an optimal method for assessing quality of life (QOL), including physical and psychosocial health. This review summarizes PROs frequently assessed in the setting of a DCIS diagnosis. Recent findings Health-related QOL has generally been found to be modestly affected in women with DCIS and similar to women with invasive breast cancer. Several studies reported a substantial negative impact on sexual health and body image, including some differences based on surgery type. Some patients experience pain after treatment, although many physical symptoms resolve. The prevalence of anxiety and depression varied based on assessment timing, with symptoms improving over time. Women with DCIS often overestimate the risks associated both with DCIS and invasive cancer. Summary PROs provide critical information regarding the experiences of women following a DCIS diagnosis. Continued inclusion of PROs in clinical trials is warranted, further informing treatment decisions and adequately preparing patients for what to expect following treatment.
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Affiliation(s)
- Laura S Dominici
- Brigham and Women's Hospital, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
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