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Keefer L, Hashash JG, Szigethy E, Mayer EA. AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary. Gastroenterology 2024; 166:1182-1189. [PMID: 38639677 DOI: 10.1053/j.gastro.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
DESCRIPTION Pain is a common symptom among patients with inflammatory bowel disease (IBD). Although pain typically occurs during episodes of inflammation, it is also commonly experienced when intestinal inflammation is quiescent. Many gastroenterologists are at a loss how to approach pain symptoms when they occur in the absence of gut inflammation. We provide guidance in this area as to the evaluation, diagnosis, and treatment of pain among patients with IBD. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors. Formal ratings regarding the quality of evidence or strength of the presented considerations were not included because systematic reviews were not performed.
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Affiliation(s)
- Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Eva Szigethy
- Department of Pediatric Psychiatry, Akron Children's Hospital, Akron, Ohio; Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emeran A Mayer
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California at Los Angeles, Los Angeles, California.
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Tsai PF, Edison JL, Wang CH, Gramlich MW, Manning KQ, Deshpande G, Bashir A, Sefton J. Characteristics of patients with myofascial pain syndrome of the low back. Sci Rep 2024; 14:11912. [PMID: 38789439 PMCID: PMC11126576 DOI: 10.1038/s41598-024-61319-5] [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: 10/17/2023] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
The objective of this study is to determine characteristics of patients with myofascial pain syndrome (MPS) of the low back and the degree to which the low back pain in the patients examined can be attributed to MPS. Twenty-five subjects with myofascial trigger point(s) [MTrP(s)] on the low back participated in this cross-sectional study. The location, number, and type of selected MTrPs were identified by palpation and verified by ultrasound. Pain pressure threshold, physical function, and other self-reported outcomes were measured. Significant differences were found in Group 1 (Active), 2 (Latent), 3 (Atypical, no twitching but with spontaneous pain), and 4 (Atypical, no twitching and no spontaneous pain) of participants in the number of MTrPs, current pain, and worst pain in the past 24 h (p = .001-.01). There were interaction effects between spontaneous pain and twitching response on reports of physical function, current pain, and worst pain (p = .002-.04). Participants in Group 3 reported lower levels of physical function, and higher levels of current pain and worst pain compared to those in Group 4. Participants in Group 1 and 2 had similar levels of physical function, current pain, and worst pain. The number of MTrPs is most closely associated with the level of pain. Spontaneous pain report seems to be a decisive factor associated with poor physical function; however, twitching response is not.
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Affiliation(s)
- Pao-Feng Tsai
- College of Nursing, Auburn University, 710 S Donahue Dr, Auburn, AL, 36849, USA.
| | | | | | | | | | - Gopikrishna Deshpande
- Auburn University Neuroimaging Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, United States
- Department of Psychological Sciences, Auburn University, Auburn, AL, United States
- Alabama Advanced Imaging Consortium, Birmingham, AL, United States
- Center for Neuroscience, Auburn University, Auburn, AL, United States
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
- Department of Heritage Science and Technology, Indian Institute of Technology, Hyderabad, India
| | - Adil Bashir
- Samuel Ginn College of Engineering, Auburn University, Auburn, AL, USA
| | - JoEllen Sefton
- School of Kinesiology, Auburn University, Auburn, AL, USA
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Kissi A, Vorensky M, Sturgeon JA, Vervoort T, van Alboom I, Guck A, Perera RA, Rao S, Trost Z. Racial Differences in Movement-Related Appraisals and Pain Behaviors Among Adults With Chronic Low Back Pain. THE JOURNAL OF PAIN 2024; 25:104438. [PMID: 38065466 PMCID: PMC11058036 DOI: 10.1016/j.jpain.2023.11.021] [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: 05/15/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Research documents racial disparities in chronic low back pain (CLBP). Few studies have examined racial disparities in movement-related appraisals and no studies have examined anticipatory appraisals prior to or pain behaviors during functional activities among individuals with CLBP. This cross-sectional study examined racial differences in anticipatory appraisals of pain, concerns about harm, and anxiety, appraisals of pain and anxiety during movement, and observed pain behaviors during 3 activities of daily living (supine-to-standing bed task, sitting-to-standing chair task, floor-to-waist lifting task) in a sample (N = 126) of non-Hispanic Black (31.0%), Hispanic (30.2%), and non-Hispanic White (38.9%) individuals with CLBP. Hispanic participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed and chair tasks compared to non-Hispanic White participants. Hispanic participants reported more pain during the bed task and more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants reported more expected pain, concerns about harm, and pre-movement anxiety prior to the bed task and more pre-movement anxiety prior to the chair task compared to non-Hispanic White participants. Non-Hispanic Black participants reported more anxiety during the bed and chair tasks compared to non-Hispanic White participants. Non-Hispanic Black participants were observed to have significantly more verbalizations of pain during the bed task compared to non-Hispanic White participants. Current findings identify racial disparities in important cognitive-behavioral and fear-avoidance mechanisms of pain. Results indicate a need to revisit traditional theoretical and treatment models in CLBP, ensuring racial disparities in pain cognitions are considered. PERSPECTIVE: This study examined racial disparities in anticipatory and movement-related appraisals, and pain behaviors during activities of daily living among Non-Hispanic Black, Non-Hispanic White, and Hispanic individuals with CLBP. Racial disparities identified in the current study have potentially important theoretical implications surrounding cognitive-behavioral and fear-avoidance mechanisms of pain.
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Affiliation(s)
- Ama Kissi
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Mark Vorensky
- Rusk Rehabilitation, NYU Langone Health, 333 East 38 Street, New York, NY 10016, United States of America
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
- Department of Physical Therapy, Touro University, 3 Times Square, New York, NY 10036, United States of America
| | - John A. Sturgeon
- Department of Anesthesiology, University of Michigan, 24 Frank Lloyd Wright Dr, Ann Arbor, MI 48105, United States of America
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ischa van Alboom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Adam Guck
- Department of Family Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, United States of America
| | - Robert A. Perera
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
| | - Smita Rao
- Department of Physical Therapy, New York University, 380 2 Ave, New York, NY 10010, United States of America
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 1223 E Marshall St, Richmond, VA 23298, United States of America
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Richardson EJ, McKinley EC, Richards JS. Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator. Rehabil Psychol 2024; 69:85-93. [PMID: 38127538 PMCID: PMC11058032 DOI: 10.1037/rep0000532] [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] [Indexed: 12/23/2023]
Abstract
PURPOSE/OBJECTIVE Higher levels of resilience is associated with improved pain outcomes in chronic pain and other neurological populations, but the role of resilience in pain following spinal cord injury (SCI) remains unclear. This study examined resilience as a moderator in the relationship between perceived stress and both pain intensity and interference during acute rehabilitation for SCI. RESEARCH METHOD/DESIGN Individuals admitted to inpatient rehabilitation acutely following SCI (N = 57) completed measures of perceived stress, resilience, pain intensity, and interference. The Johnson-Neyman procedure was used to examine significance of conditional relationships that emerged. RESULTS Resilience was found to moderate the relationship between perceived stress and pain interference, but not pain intensity, during inpatient rehabilitation. CONCLUSIONS/IMPLICATIONS When resilience is low, perceived stress has a more profound and adverse impact on pain interference during inpatient rehabilitation, suggesting therapeutic strategies that build components of resilience are needed during acute rehabilitation following SCI. The relationship between stress, resilience, and pain may differ postinpatient rehabilitation for SCI and warrants further investigation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Elizabeth J. Richardson
- Department of Behavioral and Social Sciences, University of Montevallo
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
| | | | - J. Scott Richards
- Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham
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Roseen EJ, Patel KV, Ward R, de Grauw X, Atlas SJ, Bartels S, Keysor JJ, Bean JF. Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018. J Gen Intern Med 2024; 39:578-586. [PMID: 37856007 PMCID: PMC10973298 DOI: 10.1007/s11606-023-08438-3] [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] [Received: 04/12/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable. OBJECTIVE Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP. DESIGN/SETTING Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018. PARTICIPANTS 146,087 adults reporting LBP in prior 3 months. METHODS We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents. RESULTS Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016-2018 vs 2002-2015, OR = 1.15; 95% CI: 1.10-1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions > 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR = 0.62, 95% CI: 0.65-0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR = 0.98; 95% CI: 0.94-1.03) but lower for chiropractic care use (OR = 0.50; 95% CI: 0.47-0.53). CONCLUSIONS Although use of chiropractic care or OT/PT for LBP increased after the introduction of clinical guidelines in 2016, only about a third of US adults with LBP reported using these services between 2016 and 2018 and disparities in use have not improved.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA.
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA.
- Department of Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA.
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Rachel Ward
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Xinyao de Grauw
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Steven J Atlas
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen Bartels
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie J Keysor
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
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Gombatto SP, Bailey B, Bari M, Bouchekara J, Holmes A, Lenz S, Simmonds K, Vonarb A, Whelehon K, Batalla CR, Monroe KS. Identifying Clinical Phenotypes in People Who Are Hispanic/Latino With Chronic Low Back Pain: Use of Sensor-Based Measures of Posture and Movement, Pain, and Psychological Factors. Phys Ther 2024; 104:pzad185. [PMID: 38169435 PMCID: PMC10851858 DOI: 10.1093/ptj/pzad185] [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] [Received: 01/15/2023] [Revised: 08/22/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE The aim of this study was to identify clinical phenotypes using sensor-based measures of posture and movement, pain behavior, and psychological factors in Hispanic/Latino people with chronic low back pain (CLBP). METHODS Baseline measures from an ongoing clinical trial were analyzed for 81 Hispanic/Latino people with CLBP. Low back posture and movement were measured using commercial sensors during in-person testing and 8 hours of ecological monitoring. Magnitude, frequency, and duration of lumbar movements, sitting and standing postures were measured. Movement-evoked pain was assessed during in-person movement testing. Psychological measures included the Pain Catastrophizing Scale and the Fear Avoidance Beliefs Questionnaire. Random forest analysis was conducted to generate 2 groups and identify important variables that distinguish groups. Group differences in demographics, pain, psychological, and posture and movement variables were examined using t-tests and chi-square analyses. RESULTS Two subgroups of Hispanic/Latino people with CLBP were identified with minimal error (7.4% misclassification ["out-of-bag" error]). Ecological posture and movement measures best distinguished groups, although most movement-evoked pain and psychological measures did not. Group 1 had greater height and weight, lower movement frequency, more time in sitting, and less time in standing. Group 2 had a greater proportion of women than men, longer low back pain duration, higher movement frequency, more time in standing, and less time in sitting. CONCLUSION Two distinct clinical phenotypes of Hispanic/Latino people with CLBP were identified. One group was distinguished by greater height and weight and more sedentary posture and movement behavior; the second group had more women, longer duration of low back pain, higher lumbar spine movement frequency, and longer duration of standing postures. IMPACT Ecological measures of posture and movement are important for identifying 2 clinical phenotypes in Hispanic/Latino people with CLBP and may provide a basis for a more personalized plan of care. LAY SUMMARY Wearable sensors were used to measure low back posture and movement in Hispanic/Latino people with chronic low back pain. These posture and movement measures helped to identify 2 different clinical subgroups that will give physical therapists more information to better personalize treatment for chronic low back pain in Hispanic/Latino patients.
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Affiliation(s)
- Sara P Gombatto
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
| | - Barbara Bailey
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Monica Bari
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Juna Bouchekara
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Alyssa Holmes
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Stephanie Lenz
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Kerry Simmonds
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Alexandra Vonarb
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Kim Whelehon
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
| | - Cristina Rangel Batalla
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
| | - Katrina S Monroe
- Doctor of Physical Therapy Program, Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
- SDSU HealthLINK Center for Transdisciplinary Health Disparities Research, San Diego, California, USA
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Peace J, Pooleri A, Frech A, Tumin D. Socioeconomic Characteristics Associated With the Development of Chronic Pain After Pain Interference Experienced in Early Adulthood. Clin J Pain 2023; 39:628-633. [PMID: 37440352 DOI: 10.1097/ajp.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Predictors of pain persistence have been identified among patients undergoing treatment for chronic pain or related conditions, but correlates of pain persistence in the general population remain underexplored. We identify socioeconomic variables associated with pain onset or persistence over a 6 to 10 year period in a nationally representative cohort. METHODS Using panel data from the National Longitudinal Survey of Youth-1997, we examined the presence of pain interference at age 29 and chronic pain at ages 35 to 39. Persistent pain was defined as pain present at both interview time points; new-onset pain was defined as pain not reported at age 29, but present at ages 35 to 39; and transient pain was defined as experiencing pain interference at age 29 with no report of chronic pain at ages 35 to 39. RESULTS Based on a sample of 6188 participants, we estimated that 4% experienced persistent pain, 11% experienced transient pain, and 7% experienced new-onset pain. Pain persistence was less likely among non-Hispanic Black respondents but more likely among formerly married respondents and those with poor health, health-related work limitation, or greater pain interference at the age 29 baseline. New-onset pain was most likely among female respondents, respondents with some college education, and respondents with poor self-rated health or obesity at baseline. DISCUSSION Development of chronic pain by the mid-late 30s was common among young adults experiencing pain interference at age 29. Race/ethnicity, gender, and educational attainment exhibited different associations with persistence as compared with new onset of pain problems.
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Affiliation(s)
- Jordan Peace
- Brody School of Medicine at East Carolina University
| | - Anand Pooleri
- ECU Health
- Department of Physical Medicine and Rehabilitation, Brody School of Medicine at East Carolina University
| | | | - Dmitry Tumin
- Department of Academic Affairs Brody School of Medicine at East Carolina University, Greenville NC
- Department of Social Medicine, Heritage College of Medicine at Ohio University-Cleveland campus, Cleveland OH
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Franqueiro AR, Yoon J, Crago MA, Curiel M, Wilson JM. The Interconnection Between Social Support and Emotional Distress Among Individuals with Chronic Pain: A Narrative Review. Psychol Res Behav Manag 2023; 16:4389-4399. [PMID: 37915959 PMCID: PMC10617401 DOI: 10.2147/prbm.s410606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic pain is a public health concern affecting over 100 million U.S. adults. Because chronic pain is multifactorial, it requires a biopsychosocial approach to understand how biological, psychological, and social factors contribute to both the development and maintenance of pain. On average, individuals with chronic pain report higher levels of emotional distress compared to pain-free individuals. Research has demonstrated that social support is associated with better pain outcomes and less emotional distress. It has been proposed that social support may improve pain outcomes by reducing the influence of stressors. However, the majority of research exploring the relationships between social support and pain-related outcomes has focused on the direct relationship between these variables, largely overlooking the process by which social support has a positive influence on pain. This narrative review synthesizes research on how chronic pain, emotional distress, and social support are highly interconnected, yet research investigating chronic pain and emotional distress within a social context is limited. We then highlight disparities in chronic pain, such that the burden of chronic pain is unequal between demographic groups. Next, we discuss existing evidence for the use of group-based interventions to address pain-related outcomes. Lastly, we summarize limitations of prior research studies and highlight gaps in the current literature. Overall, longitudinal research comprehensively investigating the distinct nuances in the measurement of social support and how these nuances relate to emotional distress and pain outcomes is needed and may provide insight into the unique needs of individuals or subgroups. Further, demographically diverse randomized controlled trials are needed to identify the process by which group-based interventions improve pain outcomes and whether these interventions are more effective for particular groups in order to personalize treatment approaches and address inequities in pain care.
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Affiliation(s)
- Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - JiHee Yoon
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Madelyn A Crago
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Marie Curiel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
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Schaar AN, Finneran JJ, Gabriel RA. Association of race and receipt of regional anesthesia for hip fracture surgery. Reg Anesth Pain Med 2023; 48:392-398. [PMID: 36737100 DOI: 10.1136/rapm-2022-104055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is evidence suggesting clinical benefits of regional anesthesia use in the setting of hip fracture repair, including reduced risk of death, deep vein thrombosis, pulmonary complications and myocardial infarction. Thought the literature is mixed, the use of regional anesthesia in hip fracture surgery has not been studied for racial differences. We examined the association of race with neuraxial anesthesia and regional blocks in patients undergoing hip fracture surgery. METHODS Using American College of Surgeons National Surgical Quality Improvement Program, we identified patients ≥18 years old who were either white, black or Asian and underwent hip fracture surgery from 2014 to 2020. We reported unadjusted estimates of both regional and neuraxial anesthesia use by race and examined sociodemographic characteristics and health status differences. Two separate multivariable logistic regression models were employed to investigate the association of race with the receipt of (1) neuraxial anesthesia and (2) regional block (ie, peripheral nerve blocks, fascial plane blocks). RESULTS There were 104,949 patients who underwent hip fracture surgery, of whom 16,400 (15.6%) received a neuraxial anesthetic and 6264 (5.9%) received a regional block. On multivariable logistic regression analysis, compared with white patients, black patients (OR 0.67, 99% CI 0.59 to 0.75, p<0.001) had decreased odds, while Asian patients (OR 2.04, 99% CI 1.84 to 2.26, p<0.001) had increased odds for receipt of neuraxial anesthesia as a primary anesthetic. Black race (OR 1.35, 99% CI 1.17 to 1.55, p<0.001) was associated with increased odds for receiving a regional block compared with white patients. CONCLUSIONS The study suggests that racial differences exist with the utilization of regional anesthesia for hip fracture surgery. While the results of this study should not be taken as evidence for healthcare disparities, it could be used to support hypotheses for future studies that aim to investigate causes of disparities and corresponding patient outcomes.
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Affiliation(s)
- Adam N Schaar
- Anesthesiology, University of California Health Sciences, La Jolla, California, USA
| | - John J Finneran
- Department of Anesthesiology, University of California, San Diego, California, USA
| | - Rodney A Gabriel
- Anesthesiology, University of California, La Jolla, California, USA
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