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Huisman D, Fernhout F, Moxham F, Norton C, Bannister K, Moss-Morris R. Managing patients' reports of abdominal pain and irritable bowel syndrome-like symptoms during quiescent inflammatory bowel disease: a role for shared sensemaking. Br J Pain 2024; 18:325-336. [PMID: 39092211 PMCID: PMC11289903 DOI: 10.1177/20494637241230807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) are often faced with distressing and confusing abdominal pain during remission. Some people respond adversely to healthcare professionals' (HCPs) suggestions that this pain and related symptoms are due to secondary irritable bowel syndrome (IBS). Exploring how HCPs view, manage, and explain pain during quiescent disease may provide insights into how communication can be improved to increase understanding and mitigate negative responses. Methods In-depth semi-structured interviews were conducted with 12 IBD-nurses (n = 4) and gastroenterologists (n = 8) working in the United Kingdom or the Netherlands. Reflexive thematic analysis was used to analyse interviews. Results Findings suggest that HCPs pay relatively little attention to pain when there is no underlying pathology and prefer to concentrate on objectifiable causes of symptoms and treating disease activity (Theme 1: Focus on disease activity, not pain and associated symptoms). Explanations of abdominal pain and IBS-like symptoms during remission were not standardised (Theme 2: Idiosyncratic and uncertain explanations for pain during remission). Processes of shared decision-making were outlined and shared sensemaking was reported as a strategy to enhance acceptance of IBS explanations (Theme 3: Shared decision making versus shared sensemaking). Conclusion Future work should focus on establishing how pain during remission may be best defined, when to diagnose IBS in the context of IBD, and how to explain both to patients. The formulation of standardised explanations is recommended as they might help HCPs to adopt practices of shared sensemaking and shared decision-making. Explanations should be adaptable to specific symptom presentations and different health literacy levels.
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Affiliation(s)
- Danielle Huisman
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Felice Fernhout
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Faye Moxham
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Montag LT, Bisson EJ, Duggan S, Gregory T, Murphy G, Gilron I, Wilson R, Salomons TV. Patient Expectations and Therapeutic Alliance Affect Pain Reduction Following Lidocaine Infusion in an Interdisciplinary Chronic Pain Clinic. THE JOURNAL OF PAIN 2024; 25:104443. [PMID: 38056545 DOI: 10.1016/j.jpain.2023.11.026] [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: 08/07/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
Pain experience is affected by both ascending nociceptive signals and descending modulation. Expectations can affect pain experience and augment treatment-induced analgesia through descending inhibitory modulation of pain. This open-label, prospective cohort study examined the association between participant expectation ratings and pain reduction in adult participants with chronic pain receiving an intravenous lidocaine infusion. We aimed to explore whether: 1) participants' expectations of treatment efficacy were associated with pain reduction over 8 weeks after infusion; and 2) participants' therapeutic alliance was associated with expectations and/or pain reduction. We recruited 70 participants with chronic pain scheduled for lidocaine infusion. Study measures included pain intensity (pre-treatment, post-treatment, and daily for 8 weeks), treatment expectations (EXPECT), and therapeutic alliance (Trust in Physician and Working Alliance Inventory-Short Revised). Baseline treatment expectations were significantly correlated with pain reduction (r = .42, P < .01). Therapeutic alliance was significantly correlated with expectations (r = .27, P < .05) and pain reduction (r = .38, P < .01). This study quantifies the contribution of: 1) treatment expectations; and 2) therapeutic alliance to the magnitude of lidocaine-induced pain reduction. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes. PERSPECTIVE: This study evaluates the relationship between pain reduction and ratings of: 1) treatment expectations; and 2) therapeutic alliance following an intravenous lidocaine infusion. Results generate the hypothesis that focused efforts to augment treatment expectations and therapeutic alliance could serve to improve pain treatment outcomes.
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Affiliation(s)
- Landon T Montag
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| | - Etienne J Bisson
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Scott Duggan
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| | - Thomas Gregory
- Kingston Orthopaedic Pain Institute, Kingston, Canada; Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
| | - Greg Murphy
- Kingston Orthopaedic Pain Institute, Kingston, Canada
| | - Ian Gilron
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada; School of Policy Studies, Queen's University, Kingston, Canada; Providence Care Hospital, Kingston, Canada
| | - Rosemary Wilson
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada; School of Nursing, Queen's University, Kingston, Canada
| | - Tim V Salomons
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Department of Psychology, Queen's University, Kingston, Canada
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3
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Sheridan K, O’Connor S, Whyte E. An investigation into perceived autonomy support, motivation and competence in chronic pain patients in Ireland: A cross-sectional study. PLoS One 2024; 19:e0301861. [PMID: 38709725 PMCID: PMC11073679 DOI: 10.1371/journal.pone.0301861] [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: 10/11/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Autonomy supportive healthcare settings are associated with enhanced behaviour change and self-management strategies in individuals living with chronic disease. The level of autonomy support provided by healthcare professionals to individuals living with chronic pain in Ireland is unknown. A cross-sectional study was completed on participants living with chronic pain (>3 months) in Ireland. Participants (n = 389) completed an anonymous survey constructed of patient reported outcome measures relating to autonomy support (HCCQ), motivation (TSRQ), competence in physical activity (PCS), pain interference (BPI) and psychological factors (PHQ-9, GAD-7). Results showed the median HCCQ (H = 39.287, p < .001), Autonomous Motivation (H = 13.568, p = 0.019) and PCS (H = 30.701, p < .001) scores were significantly different when patients received care from different healthcare professionals. There was a negative correlation between PCS and pain severity (r = -0.32, <0.01), pain interference (r = -0.44, p = <0.01), PHQ-9 (r = -0.50, p = <0.01) and GAD-7 (r = -0.34, p = <0.01). This study has identified that perceived healthcare support in Ireland varies according to the healthcare professional leading pain care. Furthermore, higher levels of self-determination were associated with decreased depression and anxiety in individuals with chronic pain. Given the limited number of multidisciplinary team clinics to provide pain management programs, an alternative cost-effective community led solution is required. The results of this study indicate that allied health professionals may be well placed to fill this void. Future research exploring the barriers to providing healthcare supportive settings is required.
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Affiliation(s)
- Kate Sheridan
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin City, Ireland
| | - Siobhan O’Connor
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin City, Ireland
| | - Enda Whyte
- Centre for Injury Prevention and Performance, School of Health and Human Performance, Dublin City University, Dublin City, Ireland
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4
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Zhang Q, Sun H, Xin Y, Li X, Shao X. Studies on Pain Associated with Anxiety or Depression in the Last 10 Years: A Bibliometric Analysis. J Pain Res 2024; 17:133-149. [PMID: 38196966 PMCID: PMC10775703 DOI: 10.2147/jpr.s436500] [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: 08/28/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
Background The prevalence of pain comorbid and anxiety/depression in clinical observations has been high, and the number of related publications has increased in recent years. Nevertheless, few studies have used bibliometric methods to analyze the scientific research on comorbid pain and depression/anxiety. The aim of this study was to systematically examine the trends in global scientific research on comorbid pain and depression/anxiety from 2012 to 2022. Methods Papers published between 2012 and 2022 were identified in the Web of Science database. Publications that examined comorbid pain and depression/anxiety were included. The language was limited to English. CiteSpace, Excel and VOSviewer were used to analyze the volume of publications, countries, institutions, authors, cocited authors, and keywords. Results A total of 30,290 papers met the inclusion criteria of the study. Using CiteSpace, VOSviewer and Excel, the results showed that the United States (10,614 publications), Harvard University (1195 publications), and Jensen, Mark P. (77 publications) were the most productive country, institution, and author, respectively. The hotspots and frontiers were "relationship between depression and pain", "gender differences in pain and depression/anxiety domains", "study of specific pain types with depression/anxiety", "treatment of pain combined with anxiety/depression", and "effects of COVID-19 on patients with pain combined with depression/anxiety". Conclusion These findings indicate a growing interest in the field of comorbid pain and depression/anxiety. The research has been broad and deep, but there is still much room for growth. Furthermore, there is a need for more mature global collaborative networks as well as more high-quality research results in the future.
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Affiliation(s)
- Qianyuan Zhang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Haiju Sun
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yinuo Xin
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Xiaoyu Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Xiaomei Shao
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
- Key Laboratory for Research of Acupuncture Treatment and Transformation of Emotional Diseases, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310009, People’s Republic of China
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5
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Docherty C, McPeake J, Quasim T, MacTavish P, Devine H, O'Brien P, Strachan L, Lucie P, Hogg L, Sim M, Shaw M. The relationship between pain, anxiety and depression in patients with post-intensive care syndrome. J Crit Care 2023; 78:154359. [PMID: 37356416 DOI: 10.1016/j.jcrc.2023.154359] [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: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Survivors of critical illness frequently experience long-term symptoms including physical symptoms such as pain and emotional symptoms such as anxiety and depression. These symptoms frequently co-exist, however, at present there is limited understanding of these relationships. The aim of this study was to quantify the relationship between pain, anxiety and depression across the recovery trajectory. METHODS This study is a secondary analysis of data from a multi-centre, prospective, cohort study which followed-up patients recovering from critical illness. Data was available at multiple time points and for 3 distinct cohorts. Structural equation modelling was used to investigate the relationship between outcome measures of pain, anxiety and depression. RESULTS Data from 414 patients was analysed. Pain was significantly associated with both anxiety and depression in all cohorts and at all time points sampled. Path coefficients for the covariances between pain and depression ranged between 0.39 and 0.72 (p < 0.01). Path coefficients for the covariances between pain and anxiety ranged between 0.39 and 0.65 (p < 0.01). CONCLUSIONS Pain, anxiety and depression are highly correlated in survivors of critical illness. Pharmacological treatments for pain management may be ineffective alone and further research is required to assess interventions targeting these symptoms in combination.
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Affiliation(s)
- Christie Docherty
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK.
| | - Tara Quasim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK.
| | | | - Helen Devine
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK.
| | - Peter O'Brien
- Intensive Care Unit, University Hospital Crosshouse, Kilmarnock, UK. peter.o'
| | - Laura Strachan
- Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Phil Lucie
- Intensive Care Unit, University Hospital Wishaw, North Lanarkshire, UK.
| | - Lucy Hogg
- Intensive Care Unit, Victoria Hospital, Kirkcaldy, UK.
| | - Malcolm Sim
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Intensive Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Martin Shaw
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK.
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6
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Li Q, Mathena RP, Li F, Dong X, Guan Y, Mintz CD. Effects of Early Exposure to Isoflurane on Susceptibility to Chronic Pain Are Mediated by Increased Neural Activity Due to Actions of the Mammalian Target of the Rapamycin Pathway. Int J Mol Sci 2023; 24:13760. [PMID: 37762067 PMCID: PMC10530853 DOI: 10.3390/ijms241813760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Patients who have undergone surgery in early life may be at elevated risk for suffering neuropathic pain in later life. The risk factors for this susceptibility are not fully understood. Here, we used a mouse chronic pain model to test the hypothesis that early exposure to the general anesthetic (GA) Isoflurane causes cellular and molecular alterations in dorsal spinal cord (DSC) and dorsal root ganglion (DRG) that produces a predisposition to neuropathic pain via an upregulation of the mammalian target of the rapamycin (mTOR) signaling pathway. Mice were exposed to isoflurane at postnatal day 7 (P7) and underwent spared nerve injury at P28 which causes chronic pain. Selected groups were treated with rapamycin, an mTOR inhibitor, for eight weeks. Behavioral tests showed that early isoflurane exposure enhanced susceptibility to chronic pain, and rapamycin treatment improved outcomes. Immunohistochemistry, Western blotting, and q-PCR indicated that isoflurane upregulated mTOR expression and neural activity in DSC and DRG. Accompanying upregulation of mTOR and rapamycin-reversible changes in chronic pain-associated markers, including N-cadherin, cAMP response element-binding protein (CREB), purinergic P2Y12 receptor, glial fibrillary acidic protein (GFAP) in DSC; and connexin 43, phospho-extracellular signal-regulated kinase (p-ERK), GFAP, Iba1 in DRG, were observed. We concluded that early GA exposure, at least with isoflurane, alters the development of pain circuits such that mice are subsequently more vulnerable to chronic neuropathic pain states.
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Affiliation(s)
- Qun Li
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.P.M.); (F.L.); (Y.G.)
| | - Reilley Paige Mathena
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.P.M.); (F.L.); (Y.G.)
| | - Fengying Li
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.P.M.); (F.L.); (Y.G.)
| | - Xinzhong Dong
- Solomon H. Snyder Department of Neuroscience and Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.P.M.); (F.L.); (Y.G.)
| | - Cyrus David Mintz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (R.P.M.); (F.L.); (Y.G.)
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7
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Abbas N, Virdee T, Basu M, Iles D, Kanitkar S, Kearney R, Khan H, Ward K, Reid F. Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence. Neurourol Urodyn 2023; 42:785-793. [PMID: 36825383 DOI: 10.1002/nau.25155] [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: 11/22/2022] [Revised: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017. Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center. METHODS All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected using patient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25. RESULTS Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3-60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of "very much improved" regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an additional complication (37% vs. 5.55%). Overall, 62.2% women felt "better" after their excision, 17.8% felt "worse." DISCUSSION After TETOT, 62% of women felt better. Improvement in pain was reported by 58%-those with chronic pain without another complication reported improvement in pain less frequently (48% vs. 72%) and worsening pain more frequently (37% vs. 6%). Existing SUI worsened in 65% of women and 75% developed new SUI. There appears to be discordance between reporting global improvement with worsening of commonly measured clinical outcomes. CONCLUSION Outcome data are important for counseling women about the risks and benefits of TETOT. Women and clinicians may have different attitudes to the possible benefits of TETOT, as evidenced by women reporting feeling better despite continuing pain or SUI. Conventional outcome measures do not adequately capture all outcomes that are important to patients.
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Affiliation(s)
- Nazish Abbas
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tonicka Virdee
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - Maya Basu
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David Iles
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Surya Kanitkar
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rohna Kearney
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hamayun Khan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Ward
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Reid
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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8
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Understanding Nociplastic Pain: Building a Bridge between Clinical Psychology and Medicine. J Pers Med 2023; 13:jpm13020310. [PMID: 36836544 PMCID: PMC9968114 DOI: 10.3390/jpm13020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
Chronic pain (CP), defined as pain lasting more than three months, is a significant healthcare challenge with considerable economic costs [...].
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9
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Hood AM, Morais CA, Fields LN, Merriwether EN, Brooks AK, Clark JF, McGill LS, Janevic MR, Letzen JE, Campbell LC. Racism exposure and trauma accumulation perpetuate pain inequities-advocating for change (RESTORATIVE): A conceptual model. AMERICAN PSYCHOLOGIST 2023; 78:143-159. [PMID: 37011166 PMCID: PMC10071409 DOI: 10.1037/amp0001042] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Experiences of racism occur across a continuum from denial of services to more subtle forms of discrimination and exact a significant toll. These multilevel systems of oppression accumulate as chronic stressors that cause psychological injury conceptualized as racism-based traumatic stress (RBTS). RBTS has overlapping symptoms with posttraumatic stress disorder (PTSD) with the added burden that threats are constantly present. Chronic pain is a public health crisis that is exacerbated by the intersection of racism and health inequities. However, the relationship between RBTS and pain has not yet been explored. To highlight how these phenomena are interlinked, we present Racism ExpoSure and Trauma AccumulatiOn PeRpetuate PAin InequiTIes-AdVocating for ChangE (RESTORATIVE); a novel conceptual model that integrates the models of racism and pain and demonstrates how the shared contribution of trauma symptoms (e.g., RBTS and PTSD) maintains and perpetuates chronic pain for racialized groups in the United States. Visualizing racism and pain as "two halves of the same coin," in which the accumulative effects of numerous events may moderate the severity of RBTS and pain, we emphasize the importance of within-group distinctiveness and intersectionality (overlapping identities). We call on psychologists to lead efforts in applying the RESTORATIVE model, acting as facilitators and advocates for the patient's lived experience with RBTS in clinical pain care teams. To assist with this goal, we offer suggestions for provider and researcher antiracism education, assessment of RBTS in pain populations, and discuss how cultural humility is a central component in implementing the RESTORATIVE model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Anna M. Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health
| | - Calia A. Morais
- Department of Hematology and Oncology, The University of Alabama at Birmingham
| | | | - Ericka N. Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development
- Department of Medicine, NYU Grossman School of Medicine, New York University
| | - Amber K. Brooks
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Jaylyn F. Clark
- Department of Anesthesiology, Wake Forest School of Medicine
| | - Lakeya S. McGill
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Mary R. Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Janelle E. Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine
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10
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Zhang Z, Liu L, Zhang H, Li C, Chen Y, Zhang J, Pan C, Cheng S, Yang X, Meng P, Yao Y, Jia Y, Wen Y, Zhang F. The genetic structure of pain in depression patients: A genome-wide association study and proteome-wide association study. J Psychiatr Res 2022; 156:547-556. [PMID: 36368244 DOI: 10.1016/j.jpsychires.2022.10.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Comparing with the general population, the pain in depression patients has more complex biological mechanism. We aim to explore the etiological mechanism of pain in depression patients from the perspective of genetics. METHODS Utilizing the UK Biobank samples with self-reported depression status or PHQ score ≥10, we conducted genome-wide association studies (GWAS) of seven pain traits (N = 1,133-58,349). Additionally, we used FUSION pipeline to perform proteome-wide association study (PWAS) and transcriptome-wide association study (TWAS) by integrating GWAS summary data with two different proteome reference weights (ROS/MAP and Banner) and Rnaseq gene expression reference weights, respectively. RESULTS GWAS identified 3 significant genes associated with different pain traits in depression patients, including TRIOBP (PGWAS = 4.48 × 10-8) for stomach or abdominal pain, SLC9A9(PGWAS = 2.77 × 10-8) for multisite chronic pain (MCP) and ADGRF1 (PGWAS = 1.51 × 10-8) for neck or shoulder pain. In addition, PWAS and TWAS analysis also identified multiple candidate genes associated with different pain traits in depression patients, such as TPRG1L (PPWAS-Banner = 3.38 × 10-2) and SIRPA (PPWAS-Banner = 3.65 × 10-2) for MCP, etc. Notably, when comparing the results of PWAS and TWAS analysis, we found overlapping candidate genes in these pain traits, such as GSTM3 (PPWAS-Banner = 3.38 × 10-2, PTWAS = 6.92 × 10-3) in the stomach or abdominal pain phenotype, ATG7 (PPWAS-Rosmap = 3.15 × 10-2, PTWAS = 2.98 × 10-2) in the MCP, etc. CONCLUSIONS: We identified multiple novel candidate genes for pain traits in depression patients from different perspectives of genetics, which provided novel clues for understanding the genetic mechanisms underlying the pain in depression patients.
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Affiliation(s)
- Zhen Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Li Liu
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Huijie Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chun'e Li
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yujing Chen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Jingxi Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Chuyu Pan
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Shiqiang Cheng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Xuena Yang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Peilin Meng
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yao Yao
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yumeng Jia
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
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11
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Mayoral Rojals V, Canós Verdecho Á, Soler López B. Assessment of the Management of Patients with Chronic Pain Referred to a Specialized Pain Unit: A Cross-Sectional Multicenter Study (the DUO Project). J Clin Med 2022; 11:jcm11133586. [PMID: 35806871 PMCID: PMC9267154 DOI: 10.3390/jcm11133586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023] Open
Abstract
A multicenter cross-sectional study was designed to assess the quality of treatment of 1190 patients with chronic pain at the time of referral to a specialized pain unit. A total of 119 physicians from 77 pain units throughout Spain collected 23 indicators of the quality of care from 10 consecutive clinical records of chronic pain patients (5 men, 5 women). Degenerative spinal diseases (38.6%) and lumbosciatic pain (29.8%) were the most common etiologies. At the time of referral to the pain unit, 9.8% of patients were not receiving any analgesic treatment. Treatment was modified in 88.1% of the patients by adding adjuvant drugs, adding opioids or increasing the doses of analgesic medications, and using analgesic techniques. Women had higher percentages of osteoarthritis, headache and fibromyalgia as the cause of pain, longer duration of pain and severe pain intensity, and a higher proportion of changes in the diagnosis of the underlying condition with which they had been referred to the pain unit. Improvements should be made in the patient management and referral protocols not only in the clinics prior to patient referral to the pain unit, but also in the pain units themselves.
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Affiliation(s)
- Víctor Mayoral Rojals
- Pain Unit, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | | | - Begoña Soler López
- Medical Department, E-C-BIO, S.L., Las Rozas, 28230 Madrid, Spain
- Correspondence:
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12
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Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative. J Addict Nurs 2022; 33:70-79. [PMID: 35640210 DOI: 10.1097/jan.0000000000000455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings. METHODS From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative-a national program intending to implement MOUD in general medical settings-to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes. RESULTS Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care. CONCLUSIONS In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.
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13
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Perspectives on record-keeping practices in MDT meetings and meeting record utility. Int J Med Inform 2022; 161:104711. [DOI: 10.1016/j.ijmedinf.2022.104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
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14
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Olliges E, Bobinger A, Weber A, Hoffmann V, Schmitz T, Popovici RM, Meissner K. The Physical, Psychological, and Social Day-to-Day Experience of Women Living With Endometriosis Compared to Healthy Age-Matched Controls-A Mixed-Methods Study. Front Glob Womens Health 2022; 2:767114. [PMID: 34977863 PMCID: PMC8714740 DOI: 10.3389/fgwh.2021.767114] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Endometriosis is characterized by lesions of endometrial tissue outside the uterus. Chronic pain is considered as main symptom, but challenges can relate to various physical, mental, and social aspects of the women's lives. The aim of our study was to gain a holistic understanding of the everyday reality of women with endometriosis compared to healthy controls. Methods: The total sample comprised 12 hormone-free endometriosis patients (EP) and 11 age-matched healthy women (HC). A mixed-methods design was used comprising semi-structured interviews, standardized questionnaires and a comprehensive diary to assess pain ratings and various mental and physical symptoms over the course of a menstrual cycle. Interviews were recorded, transcribed, and evaluated according to phenomenological analysis using the MAXQDA software. Results: Interviews showed that living with endometriosis was associated with an impairment in everyday life. Physical strains, especially pain, high levels of psychological distress, and social limitations have been reported. Living with endometriosis affected the patients' personality and they “no longer felt like themselves.” Physical and psychological symptoms were reported to interfere with social interaction and participation. Evaluation of the standardized questionnaires revealed significant impairments in EP compared to HC in regard to anxiety and depression scores (both p < 0.001; Hospital Anxiety and Depression Scale), mental and physical quality of life (both p < 0.001; Short-Form Health Survey-12), stress ratings (p < 0.001; Patient Health Questionnaire-15) and functional well-being (p < 0.001; Functional Well-being-7). The highest levels of mean pelvic pain and dyschezia were observed in EP during menstruation, but mean pain ratings and dyschezia were increased in EPs compared to HP during the whole cycle. EP reported mental symptoms (e.g., depressed mood or anxiety) mainly during menstruation, while HC did not show any mental symptoms during the cycle. In addition, physical symptoms were elevated during the entire cycle in EPs (all p < 0.01). Discussion: The mixed-methods approach enabled to interpret the interviews, the standardized questionnaires, and the symptom diary in a broader context of everyday life. The symptoms do not appear to act independently, but rather influence each other. This leads to a complex interplay of physical, mental, and social impairments, with pain often being the starting point.
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Affiliation(s)
- Elisabeth Olliges
- Faculty of Medicine, Institute of Medical Psychology, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Barmelweid, Switzerland
| | - Alina Bobinger
- Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Annemarie Weber
- Faculty of Medicine, Institute of Medical Psychology, LMU Munich, Munich, Germany
| | - Verena Hoffmann
- Faculty of Medicine, Institute of Medical Psychology, LMU Munich, Munich, Germany
| | - Timo Schmitz
- Faculty of Medicine, Institute of Medical Psychology, LMU Munich, Munich, Germany.,Chair of Epidemiology, University of Augsburg, Augsburg, Germany
| | - Roxana M Popovici
- Kïz, Munich, Germany.,Department of Gynecologic Endocrinology and Fertility Disorders, Heidelberg University Women's Hospital, Heidelberg, Germany
| | - Karin Meissner
- Faculty of Medicine, Institute of Medical Psychology, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
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15
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Pandey M, Marwah R, McLean M, Paluck E, Oliver AM, Maierhoffer S, Rude D, Oakes L. Patient perspectives from the multi-disciplinary chronic pain clinic: a qualitative study. Pain Manag 2021; 12:383-396. [PMID: 34809470 DOI: 10.2217/pmt-2021-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.
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Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Radhika Marwah
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada.,Department of Academic Family Medicine, College of Medicine, University of Saskatchewan, Regina, SK, S4P 2S5, Canada
| | - Maeve McLean
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Elan Paluck
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Amanda M Oliver
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Shelly Maierhoffer
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, S4S 0A5, Canada
| | - Darlene Rude
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; from 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
| | - Larry Oakes
- Former: Eagle Moon Health Office of the Regina Qu'Appelle Health Region; from 2019: Grey Wolf Lodge of First Nations Métis Relations, Saskatchewan Health Authority, Regina, SK, S4R 1X3, Canada
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16
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Glavare M, Stålnacke BM, Häger CK, Löfgren M. Virtual Reality Exercises in an Interdisciplinary Rehabilitation Programme for Persons with Chronic Neck Pain: a Feasibility Study. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000067. [PMID: 34527201 PMCID: PMC8404524 DOI: 10.2340/20030711-1000067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
Objective To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed. Methods Nine women and 3 men participated in a 6-week virtual reality exercise intervention during an interdisciplinary rehabilitation programme. Symptom severity was rated before and after each session of virtual reality exercise, using questionnaires before and after the interdisciplinary rehabilitation programme, and questions about participants' experiences. Results Neck pain symptoms increased temporarily during the exercises, but no lasting deterioration was found after the interdisciplinary rehabilitation programme. Depression, pain interference, pain control, sleep and kinesiophobia improved significantly after the programme. Participants experienced that the virtual reality exercises increased motivation to exercise and provided a focus other than pain. However, the equipment was heavy; and exercising was tiring and reminded them of their challenges. Conclusion This study indicates that virtual reality exercises as part of an interdisciplinary rehabilitation programme are feasible and safe for patients with chronic neck pain. Pain symptoms may increase temporarily during the exercises. Virtual reality exercises may support participants by increasing motivation to exercise and providing helpful feedback. Further research into the added value of virtual reality exercises in an interdisciplinary rehabilitation programme for patients with chronic neck pain is warranted.
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Affiliation(s)
- Maria Glavare
- Department of Rehabilitation Medicine, Danderyd University Hospital
| | - Britt-Marie Stålnacke
- Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Department of Rehabilitation Medicine, Danderyd University Hospital.,Karolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm
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17
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Yamamoto K, Elias GJB, Beyn ME, Zemmar A, Loh A, Sarica C, Germann J, Parmar R, Wong EHY, Boutet A, Kalia S, Hodaie M, Lozano AM. Neuromodulation for Pain: A Comprehensive Survey and Systematic Review of Clinical Trials and Connectomic Analysis of Brain Targets. Stereotact Funct Neurosurg 2021; 100:14-25. [PMID: 34380132 DOI: 10.1159/000517873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain is a debilitating condition that imposes a tremendous burden on health-care systems around the world. While frontline treatments for chronic pain involve pharmacological and psychological approaches, neuromodulation can be considered for treatment-resistant cases. Neuromodulatory approaches for pain are diverse in both modality and target and their mechanism of action is incompletely understood. OBJECTIVES The objectives of this study were to (i) understand the current landscape of pain neuromodulation research through a comprehensive survey of past and current registered clinical trials (ii) investigate the network underpinnings of these neuromodulatory treatments by performing a connectomic mapping analysis of cortical and subcortical brain targets that have been stimulated for pain relief. METHODS A search for clinical trials involving pain neuromodulation was conducted using 2 major trial databases (ClinicalTrials.gov and the International Clinical Trials Registry Platform). Trials were categorized by variables and analyzed to gain an overview of the contemporary research landscape. Additionally, a connectomic mapping analysis was performed to investigate the network connectivity patterns of analgesic brain stimulation targets using a normative connectome based on a functional magnetic resonance imaging dataset. RESULTS In total, 487 relevant clinical trials were identified. Noninvasive cortical stimulation and spinal cord stimulation trials represented 49.3 and 43.7% of this count, respectively, while deep brain stimulation trials accounted for <3%. The mapping analysis revealed that superficial target connectomics overlapped with deep target connectomics, suggesting a common pain network across the targets. CONCLUSIONS Research for pain neuromodulation is a rapidly growing field. Our connectomic network analysis reinforced existing knowledge of the pain matrix, identifying both well-described hubs and more obscure structures. Further studies are needed to decode the circuits underlying pain relief and determine the most effective targets for neuromodulatory treatment.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada,
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Suneil Kalia
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Pollard KJ, Bowser DA, Anderson WA, Meselhe M, Moore MJ. Morphine-sensitive synaptic transmission emerges in embryonic rat microphysiological model of lower afferent nociceptive signaling. SCIENCE ADVANCES 2021; 7:7/35/eabj2899. [PMID: 34452921 PMCID: PMC8397270 DOI: 10.1126/sciadv.abj2899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 05/12/2023]
Abstract
Debilitating chronic pain resulting from genetic predisposition, injury, or acquired neuropathy is becoming increasingly pervasive. Opioid analgesics remain the gold standard for intractable pain, but overprescription of increasingly powerful and addictive opioids has contributed to the current prescription drug abuse epidemic. There is a pressing need to screen experimental compounds more efficiently for analgesic potential that remains unmet by conventional research models. The spinal cord dorsal horn is a common target for analgesic intervention, where peripheral nociceptive signals are relayed to the central nervous system through synaptic transmission. Here, we demonstrate that coculturing peripheral and dorsal spinal cord nerve cells in a novel bioengineered microphysiological system facilitates self-directed emergence of native nerve tissue macrostructure and concerted synaptic function. The mechanistically distinct analgesics-morphine, lidocaine, and clonidine-differentially and predictably modulate this microphysiological synaptic transmission. Screening drug candidates for similar microphysiological profiles will efficiently identify therapeutics with analgesic potential.
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Affiliation(s)
- Kevin J Pollard
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
| | - Devon A Bowser
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
- Bioinnovation Program, Tulane University, New Orleans, LA 70118, USA
| | - Wesley A Anderson
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
- AxoSim Inc., New Orleans, LA 70112, USA
| | - Mostafa Meselhe
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA 70118, USA
| | - Michael J Moore
- Department of Biomedical Engineering, Tulane University, New Orleans, LA 70118, USA.
- AxoSim Inc., New Orleans, LA 70112, USA
- Tulane Brain Institute, Tulane University, New Orleans, LA 70118, USA
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Jess MA, Hamilton S, Ryan C, Wellburn S, Alexanders J, Spence D, Martin D. Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review. JBI Evid Synth 2021; 19:308-340. [PMID: 32881730 DOI: 10.11124/jbisrir-d-19-00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. INTRODUCTION From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. INCLUSION CRITERIA Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. METHODS The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. RESULTS Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. CONCLUSIONS This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel Spence
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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A Systematic Review of Self-Compassion in Chronic Pain: From Correlation to Efficacy. SPANISH JOURNAL OF PSYCHOLOGY 2021; 24:e26. [PMID: 33840398 DOI: 10.1017/sjp.2021.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic pain (CP) is a common condition affecting millions of people worldwide. Compassion-related interventions are proving to be advantageous in CP, and self-compassion (SC) is hypothesized to be related with pain regulation physiological processes, as well as with psychological benefits in CP. We aimed to review scientific literature on: 1) Compassion-based psychological interventions and their changes in pain outcomes; and 2) associations between SC and pain-related outcomes. We performed a systematic research in four electronic databases: MEDLINE, EMBASE, PsycINFO and the Cochrane Library from inception until April 2020. In Question 1, we included studies involving adult patients with CP who participated in compassion-based psychological interventions. In Question 2, we included studies that examined the associations between SC and pain outcomes in adults with CP. We identified 16 studies. For Question 1, we included seven studies focused on different compassion-based interventions that assessed at least one pain outcome, in a total of 253 participants with CP associated with multiple conditions. For Question 2, we included nine studies, in a total of 1,430 participants, with eight different pain outcomes: Intensity, acceptance, catastrophizing, self-efficacy, disability, distress, pain related coping and anxiety. Considering the high heterogeneity between studies and the poor-quality assessment, we could not draw definitive conclusions on the efficacy of compassion-based interventions nor on the association between SC and pain outcomes. Studies are further discussed in detail. This review can be a starting point for large-scale and high-quality trials in this area as it provides an organized overview of the current literature on this topic.
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21
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Gao Z, Zhang J, Liu GF, Ji LX. Research Trends from 2010 to 2020 for Pain Treatment with Acupuncture: A Bibliometric Analysis. J Pain Res 2021; 14:941-952. [PMID: 33859495 PMCID: PMC8043846 DOI: 10.2147/jpr.s300911] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/03/2021] [Indexed: 12/11/2022] Open
Abstract
Background Given that acupuncture treatment for pain has gradually been accepted by researchers from various countries. However, few bibliometric analyses have been performed on the published articles. The objective of this research was to review its application for pain in recent 10 years and analyze, demonstrate and evaluate the trends, major research hotspots and frontier areas. Methods The Web of Science retrieved literature from 2010 to 2020 on acupuncture for pain. The CiteSpace and Excel were used to analyze annual volumes of publications, journals, cited journals, countries, institutions, authors, cited authors, references and keywords and to draw collaborative networks and reference co-citation network maps. Results The search finally included 4227 related studies. Results show that the number of annual publications has been increasing gradually. Evid Based Complement Alternat Med (366) was the most productive journal, while Pain (2270/0.04) ranked first in terms of frequency and centrality of cited journals, respectively. Among countries/institutions, the China (1252) and the Kyung Hee University (228) ranked first. Lee MS (51 articles) was the most effective author while MacPherson H (577) was the most cited author. The most frequently cited reference was a systematic review of individual patient data on acupuncture for chronic pain (322). “Burden” was identified as a frontier research item for 2017–2020. Conclusion This study provides a new and in-depth understanding of current acupuncture used for the treatment of pain. We anticipate that this study will stimulate international cooperation among research teams to advance the field.
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Affiliation(s)
- Zhen Gao
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jing Zhang
- Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, People's Republic of China
| | - Gao-Feng Liu
- Graduate Faculty, Tianjin University of Traditional Chinese Medicine, Tianjin, People's Republic of China
| | - Lai-Xi Ji
- Graduate Faculty, Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, People's Republic of China
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22
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Mohamad SA, Alaaeldin E, Abdallah RMA, Mansour HF. A New Approach for Dry Eye Management By Mucoadhesive In situ Gel of Vitamin B12: Formulation, In vitro and In vivo Assessment. AAPS PharmSciTech 2021; 22:87. [PMID: 33665761 DOI: 10.1208/s12249-021-01957-4] [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: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
The commitment of the existent study was to develop a mucoadhesive in situ gel systems of vitamin B12 for the management of dry eye disease. The gels were prepared using pluronic F-127 and either of chitosan, carbapol 971P, sodium alginate, or hydroxy propyl methyl cellulose. Drug-excipients compatibility was investigated by means of differential scanning calorimetry and Fourier transform infrared spectroscopy. The gels were characterized for pH, clarity, gelling capacity, viscosity, and adhesion. In vitro release of vitamin B12 from the selected gels was investigated. In vivo effectiveness of the selected gel was determined in rabbit models using Schirmer's and fluorescein tests. The compatibility studies revealed the possibility of incidence of drug/polymer interaction in some formulations. F2-containing pluronic F127 and hydroxypropyl methyl cellulose showed the most appropriate physical characterization and in vitro release profile. The prepared gels showed prolonged drug release with drug release mechanism of combined diffusion and erosion. The in vivo study revealed good effectiveness of the prepared mucoadhesive in situ gel system of vitamin B12 in the treatment of dry eye disease that was comparable to that of the marketed drops.
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Abstract
Abstract
Objective
The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management.
Methods
A scoping review was guided by Arksey and O'Malley's (2005)1 five-stage framework, investigated contemporary patient education programs (2007–2018) for chronic pain management in education content, formats of delivery, and tools used for evaluation. Content analysis and description were used for the outcome report.
Results
Seven quantitative studies were included. Education content consisted of General information, Cognitive behavior therapy (CBT), Self-management, and Pain neurophysiology (PN). Education delivery formats varied from workbook to workbook, face-to-face, online, when given for a group or individual or in a combined way. In total, 19 tools were reported for the evaluation of the education programs.
Conclusions
There is a variety in the education content and the delivery formats. The majority of programs showed effectiveness in patients’ chronic pain management based on their selected evaluation tools. This review showed that patient education programs can be useful in chronic pain management. The effectiveness of patient education programs focuses on the improved patients’ physical function and quality of life rather than the cessation of pain only.
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Romero-Morelos P, Ruvalcaba-Paredes E, Garciadiego-Cázares D, Pérez-Santos M, Reyes-Long S, Alfaro-Rodriguez A, Salcedo M, Mancilla-Ramírez J, Bandala C. Neurophysiological Mechanisms Related to Pain Management in Bone Tumors. Curr Neuropharmacol 2021; 19:308-319. [PMID: 33176655 PMCID: PMC8033964 DOI: 10.2174/1570159x18666201111112748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/24/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary and metastatic bone tumor incidence has increased in the previous years. Pain is a common symptom and is one of the most important related factors to the decrease of quality of life in patients with bone tumor. Different pain management strategies are not completely effective and many patients afflicted by cancer pain cannot be controlled properly. In this sense, we need to elucidate the neurophysiology of cancer-induced pain, contemplating other components such as inflammation, neuropathies and cognitive components regarding bone tumors, and thus pave the way for novel therapeutic approaches in this field. AIM This study aims to identify the neurophysiology of the mechanisms related to pain management in bone tumors. METHODS Advanced searches were performed in scientific databases: PubMed, ProQuest, EBSCO, and the Science Citation index to get information about the neurophysiology mechanisms related to pain management in bone tumors. RESULTS The central and peripheral mechanisms that promote bone cancer pain are poorly understood. Studies have shown that bone cancer could be related to neurochemicals produced by tumor and inflammatory cells, coupled with peripheral sensitization due to nerve compression and injury caused by tumor growth. The activity of mesolimbic dopaminergic neurons, substance P, cysteine/ glutamate antiporter, and other neurochemical dynamics brings us putative strategies to suggest better and efficient treatments against pain in cancer patients. CONCLUSION Cancer-induced bone pain could include neuropathic and inflammatory pain, but with different modifications to the periphery tissue, nerves and neurochemical changes in different neurological levels. In this sense, we explore opportunity areas in pharmacological and nonpharmacological pain management, according to pain-involved mechanisms in this study.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cindy Bandala
- Address correspondence to this author at the Departament of Neurosciences, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Calzada México-Xochimilco 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389 Ciudad de México, México; Tel: (+52) (55) 5999 1000, ext. 19303; E-mail:
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Karra R, Holten-Rossing S, Mohammed D, Parmeggiani L, Heine M, Namnún OC. Unmet needs in the management of functional impairment in patients with chronic pain: a multinational survey. Pain Manag 2020; 11:303-314. [PMID: 33353407 DOI: 10.2217/pmt-2020-0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: A survey of European Pain Federation 2019 attendees was conducted to identify unmet needs in chronic pain patients. Materials & methods: Four questions were asked focusing on functional impairment in chronic pain, including who are at increased risk and ways to better identify and manage these patients. Results: In total 143 respondents indicated that key issues were lack of knowledge, lack of resources/time to assess and manage chronic pain and lack of sufficient tools to identify patients at risk for functional impairment. Education and training of primary care physicians, simplified guidelines and practical tools for assessment and use of multidisciplinary teams to treat chronic pain were recommended. Conclusion: There are many unmet needs in the management of functional impairment in chronic pain patients.
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Affiliation(s)
- Ravi Karra
- Medical Affairs, Grünenthal GmbH, Aachen 52078, Germany
| | | | - Diar Mohammed
- Medical Affairs, Grünenthal Ltd, Stokenchurch HP14 3FE, UK
| | | | - Myriam Heine
- Medical Affairs, Grünenthal GmbH, Stolberg 52222, Germany
| | - Olga Carrón Namnún
- Medical Affairs, Grunenthal Pharma, S.A., Punta PaitillaCiudad de Panamá - Panamá
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Mishriky J, Stupans I, Chan V. An Investigation of the Practices of Australian Adults Experiencing Pain and Their Views of Australian Community Pharmacy Pain Management Services. PHARMACY 2020; 8:E187. [PMID: 33066149 PMCID: PMC7711846 DOI: 10.3390/pharmacy8040187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 11/23/2022] Open
Abstract
Pain is a common and debilitating condition requiring appropriate assessment and management. The consequences of inadequate treatment of pain is well known; however, research investigating pain management practices and the benefits Australian community pharmacies offer in pain management are more limited. This study investigated the knowledge and practices of Australian adults experiencing pain, and their views of community pharmacy pain management services. A cross-sectional study was conducted using a pre-tested anonymous self-administered questionnaire. Participants were recruited from ten community pharmacies across metropolitan Melbourne, Australia. A total of 120 participants completed the questionnaire. Most reported that their pain interfered with their quality/functionality-of-life. Paracetamol was the pharmacological preference irrespective of pain severity experienced. Approximately 30% did not believe that visiting a community pharmacy is helpful in pain management, but many reported their pain management knowledge could be improved, yet more than 60% disagreed when asked whether they would rather visit a supermarket than their pharmacy to purchase analgesics. More than half believed that community pharmacies can and should offer more pain management services. This suggests that enhancing the involvement of community pharmacists can help bridge gaps in pain management knowledge, which may provide greater positive outcomes for patients experiencing pain symptoms.
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Affiliation(s)
| | | | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia; (J.M.); (I.S.)
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Metzger CS, Hammond MB, Pyles ST, Washabaugh EP, Waghmarae R, Berg AP, North JM, Pei Y, Jain R. Pain relief outcomes using an SCS device capable of delivering combination therapy with advanced waveforms and field shapes. Expert Rev Med Devices 2020; 17:951-957. [PMID: 32883126 DOI: 10.1080/17434440.2020.1812383] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given the range of subjective experiences reported by patients with chronic pain, Spinal Cord Stimulation (SCS) systems designed for tailored delivery of analgesic therapy may help improve treatment effectiveness and satisfaction. RESEARCH DESIGN AND METHODS This case-series evaluated 420 patients with chronic back and/or leg pain implanted with an SCS device capable of sequential or simultaneous delivery of neurostimulation (i.e. combination therapy) as well as multiple waveforms and/or field shapes. Following implantation, an array of standard programs (e.g. paresthesia-based SCS), and a custom set of sub-perception programs were provided per patient feedback. Pain scores (Numeric Rating Scale, NRS) were collected at baseline and during follow-up. RESULTS In this multicenter, observational series (n = 420, 53.1% female; Age: 64.2 ± 13.4 years), a mean overall pain score of 7.2 ± 1.8 (SD) was reported pre-trial (Baseline). At a mean follow-up duration of 208 ± 200 (SD) days, the mean overall pain score reduced to 2.4 (p < 0.0001). Overall pain was reduced by 5.1 ± 2.4 and 4.5 ± 2.4 points (NRS) at 3-months (N = 256) and at 12-months post-implant (N = 122) respectively (p < 0.0001). CONCLUSIONS These results suggest that highly 'customizable' SCS approaches may allow for highly effective pain relief within the real-world clinical setting.
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Affiliation(s)
| | | | | | | | | | | | - James M North
- The Center for Clinical Research, LLC , Winston-Salem, NC, USA
| | - Yu Pei
- Division of Neuromodulation, Boston Scientific , Valencia, CA, USA
| | - Roshini Jain
- Division of Neuromodulation, Boston Scientific , Valencia, CA, USA
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Abstract
Ocular surface pain is a frequent cause of visits to an eye care provider and has a substantial impact on healthcare cost, yet a complete understanding of its causative factors and tools for diagnostic workup are notably missing in many eye clinics. The cornea has the densest sensory innervation in the human body and has the potential to be a powerful producer of pain. Pain can manifest as a result of a noxious stimulus or disruption in the ocular surface anatomy (nociceptive pain), or it can result from abnormalities in the ocular surface neurosensory apparatus itself (neuropathic pain). Novel advances in neurobiology have sought to differentiate the two entities, particularly to identify when chronic dry eye symptomatology is driven by neuropathic ocular pain. In this review, we seek to provide an overview of the prevalence, physiologic factors, and management of ocular surface pain complaints.
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Affiliation(s)
- Divy Mehra
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Noah K Cohen
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA.
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
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Romeyke T, Noehammer E, Stummer H. Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases. Glob Adv Health Med 2020; 9:2164956120948811. [PMID: 32913669 PMCID: PMC7444101 DOI: 10.1177/2164956120948811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Musculoskeletal disorders may cause chronic pain, which is associated with deterioration in physical well-being, functions, and quality of life. There are worldwide shortfalls in the care that is provided to the affected patients. Holistic, interdisciplinary care is rare. Monomodal therapeutic approaches dominate when health-care resources are scarce. In this study, we test the patient-relevant outcomes of multimodal treatment for rheumatic diseases that are associated with pain and check for remuneration. Methods We performed a retrospective data analysis of an inpatient multimodal treatment. The target parameter was the patient perspective, which we assessed by means of Patient-Reported Outcomes (PRO). We applied the Visual Analogue Scale (mental and physical condition), the Heidelberg Short Early Risk Assessment Questionnaire, the Pain Disability Index, and the pain grading according to Kohlmann/Raspe (N = 375 patients). We also investigated compensation for inpatient treatments with and without multimodal treatments. Moreover, we compared Diagnosis-Related Group remuneration with and without complex treatment. Results After implementing a multimodal treatment, improved mental (mood) status was significantly better (Wilcoxon signed-rank test, P < . 001), despite high levels of pain (Kohlmann/Raspe) reported on admission. Apart from the underlying rheumatic disease, 111 patients also reported chronic back pain, which was improved following the treatment (t test, P < . 001). Subjective impairments associated with pain were significantly lower at the end of the hospital stay (Wilcoxon signed-rank test, P < . 001). Compensation for inpatient treatments with multimodal treatments increased noticeably in German hospitals in 2016 to 2019, while remunerations for monomodal treatments show mixed results. Conclusion PROs regarding mood, pain, and perceived impairments improved following the multimodal complex treatment. Compensation of hospitals should take into account additional performance requirements of holistic treatments, whereby the promotion and further studies of PROs are recommended.
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Affiliation(s)
- Tobias Romeyke
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Waldhausklinik, Acute Hospital for Internal Medicine, Pain Therapy, Complementary and Individualized Patient Centred Medicine, Deuringen, Germany
| | - Elisabeth Noehammer
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT-Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Rekatsina M, Paladini A, Piroli A, Zis P, Pergolizzi JV, Varrassi G. Pathophysiologic Approach to Pain Therapy for Complex Pain Entities: A Narrative Review. Pain Ther 2020; 9:7-21. [PMID: 31902121 PMCID: PMC7203327 DOI: 10.1007/s40122-019-00147-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 12/14/2022] Open
Abstract
Pain management is challenging for both clinicians and patients. In fact, pain patients are frequently undertreated or even completely untreated. Optimal treatment is based on targeting the underlying mechanisms of pain and tailoring the management modality for each patient using a personalized approach. This narrative review deals with pain conditions that have a complex underlying mechanism and need an individualized and frequently multifactorial approach to pain management. The research is based on previously conducted studies, and does not contain any studies with human participants or animals performed by any of the authors. This is not an exhaustive review of the current evidence. However, it provides the clinician with a perspective on pain therapy targeting the underlying pain mechanism(s). When dealing with complex pain conditions, the prudent physician benefits from having a deep knowledge of various underlying pain mechanisms in order to provide a plan for optimal pharmacological pain relief to patients.
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Affiliation(s)
- Martina Rekatsina
- Department of Anaesthesia and Pain Management, King's College Hospital, London, UK
| | | | - Alba Piroli
- Department of MESVA, University of L'Aquila, 67100, L'Aquila, Italy
| | - Panagiotis Zis
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Joseph V Pergolizzi
- Director of Analgesic Research Fellowship and COO, NEMA Research Inc., Naples, FL, 34108, USA
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Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study. Int J Impot Res 2020; 33:339-347. [PMID: 32382105 DOI: 10.1038/s41443-020-0294-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/24/2020] [Accepted: 04/16/2020] [Indexed: 11/08/2022]
Abstract
The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.
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Jeong Y, Wagner MA, Ploutz-Snyder RJ, Holden JE. Pain condition and sex differences in the descending noradrenergic system following lateral hypothalamic stimulation. IBRO Rep 2020; 8:11-17. [PMID: 31890982 PMCID: PMC6931064 DOI: 10.1016/j.ibror.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 01/28/2023] Open
Abstract
LH stimulation produced pronociceptive and antinociceptive effects from alpha-adrenoceptors in naïve male and female rats. LH stimulation produced pronociceptive and antinociceptive effects from alpha-adrenoceptors in male CCI rats. LH stimulation produced alpha-adrenoceptor-mediated pronociception, but not antinociception in female CCI rats.
The lateral hypothalamus (LH) is known to modulate nociception via the descending noradrenergic system in acute nociception, but less is known about its role in neuropathic pain states. In naïve females, LH stimulation produces opposing effects of α-adrenoceptors, with α2-adrenoceptors mediating antinociception, while pronociceptive α1-adrenoceptors attenuate the effect. Whether this opposing response is seen in neuropathic conditions or in naïve males is unknown. We used a mixed factorial design to compare male and female rats with chronic constriction injury (CCI) to naïve rats, measured by Total Paw Withdrawal (TPW) responses to a thermal stimulus. Rats received one of three doses of carbachol to stimulate the LH followed by intrathecal injection of either an α1- or an α2-adrenoceptor antagonist (WB4101 or yohimbine, resp.) or saline for control. Overall, naïve rats showed a more pronounced opposing alpha-adrenergic response than CCI rats (p < 0.04). Naïve male and female rats demonstrated antinociception following α1-adrenoceptor blockade and hyperalgesia following α2-adrenoceptor blockade. Male CCI rats also showed dose dependent effects from either WB4101 or yohimbine (p < 0.05), while female CCI rats had significant antinociception from WB4101 (p < 0.05), but no effect from yohimbine. These results support the idea that peripheral nerve damage differentially alters the descending noradrenergic modulatory system in male and female rats, and notably, that female CCI rats do not show antinociception from descending noradrenergic input. These findings are suggestive that clinical therapies that recruit the descending noradrenergic system may require a different approach based on patient gender.
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Affiliation(s)
- Younhee Jeong
- College of Nursing Science, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Monica A Wagner
- The University of Pittsburgh School of Nursing, 3500 Victoria Street, Victoria Bldg, Pittsburgh, PA 15261, United States
| | - Robert J Ploutz-Snyder
- The University of Michigan School of Nursing, 400 N. Ingalls Bldg, Ann Arbor, MI 48109-5482, United States
| | - Janean E Holden
- The University of Michigan School of Nursing, 400 N. Ingalls Bldg, Ann Arbor, MI 48109-5482, United States
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Chronic dry eye induced corneal hypersensitivity, neuroinflammatory responses, and synaptic plasticity in the mouse trigeminal brainstem. J Neuroinflammation 2019; 16:268. [PMID: 31847868 PMCID: PMC6918709 DOI: 10.1186/s12974-019-1656-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background Dry eye disease (DED) is a multifactorial disease associated with ocular surface inflammation, pain, and nerve abnormalities. We studied the peripheral and central neuroinflammatory responses that occur during persistent DED using molecular, cellular, behavioral, and electrophysiological approaches. Methods A mouse model of DED was obtained by unilateral excision of the extraorbital lachrymal gland (ELG) and Harderian gland (HG) of adult female C57BL/6 mice. In vivo tests were conducted at 7, 14, and 21 days (d) after surgery. Tear production was measured by a phenol red test and corneal alterations and inflammation were assessed by fluorescein staining and in vivo confocal microscopy. Corneal nerve morphology was evaluated by nerve staining. Mechanical corneal sensitivity was monitored using von Frey filaments. Multi-unit extracellular recording of ciliary nerve fiber activity was used to monitor spontaneous corneal nerve activity. RT-qPCR and immunostaining were used to determine RNA and protein levels at d21. Results We observed a marked reduction of tear production and the development of corneal inflammation at d7, d14, and d21 post-surgery in DED animals. Chronic DE induced a reduction of intraepithelial corneal nerve terminals. Behavioral and electrophysiological studies showed that the DED animals developed time-dependent mechanical corneal hypersensitivity accompanied by increased spontaneous ciliary nerve fiber electrical activity. Consistent with these findings, DED mice exhibited central presynaptic plasticity, demonstrated by a higher Piccolo immunoreactivity in the ipsilateral trigeminal brainstem sensory complex (TBSC). At d21 post-surgery, mRNA levels of pro-inflammatory (IL-6 and IL-1β), astrocyte (GFAP), and oxidative (iNOS2 and NOX4) markers increased significantly in the ipsilateral trigeminal ganglion (TG). This correlated with an increase in Iba1, GFAP, and ATF3 immunostaining in the ipsilateral TG of DED animals. Furthermore, pro-inflammatory cytokines (IL-6, TNFα, IL-1β, and CCL2), iNOS2, neuronal (ATF3 and FOS), and microglial (CD68 and Itgam) markers were also upregulated in the TBSC of DED animals at d21, along with increased immunoreactivity against GFAP and Iba1. Conclusions Overall, these data highlight peripheral sensitization and neuroinflammatory responses that participate in the development and maintenance of dry eye-related pain. This model may be useful to identify new analgesic molecules to alleviate ocular pain.
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10 kHz SCS therapy for chronic pain, effects on opioid usage: Post hoc analysis of data from two prospective studies. Sci Rep 2019; 9:11441. [PMID: 31391503 PMCID: PMC6686020 DOI: 10.1038/s41598-019-47792-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/24/2019] [Indexed: 12/29/2022] Open
Abstract
Chronic pain, including chronic low back and leg pain are prominent causes of disability worldwide. While patient management aims to reduce pain and improve daily function, prescription of opioids remains widespread despite significant adverse effects. This study pooled data from two large prospective trials on 10 kHz spinal cord stimulation (10 kHz SCS) in subjects with chronic low back pain and/or leg pain and performed post hoc analysis on changes in opioid dosage 12 months post 10 kHz SCS treatment. Patient-reported back and leg pain using the visual analog scale (VAS) and opioid dose (milligrams morphine equivalent/day, MME/day) were compared at 12 months post-10 kHz SCS therapy to baseline. Results showed that in the combined dataset, 39.3% of subjects were taking >90 MME dose of opioids at baseline compared to 23.0% at 12 months post-10 kHz SCS therapy (p = 0.007). The average dose of opioids in >90 MME group was significantly reduced by 46% following 10 kHz SCS therapy (p < 0.001), which was paralleled by significant pain relief (P < 0.001). In conclusion, current analysis demonstrates the benefits of 10 kHz SCS therapy and offers an evidence-based, non-pharmaceutical alternative to opioid therapy and/or an adjunctive therapy to facilitate opioid dose reduction whilst delivering significant pain relief. Healthcare providers involved in management of chronic non-cancer pain can include reduction or elimination of opioid use as part of treatment plan when contemplating 10 kHz SCS.
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Abraham ME, Potdar A, Ward M, Herschman Y, Mammis A. Risk Factors Associated with Lead Migration Requiring Revision in Dorsal Root Ganglion Stimulation. World Neurosurg 2019; 128:e649-e652. [DOI: 10.1016/j.wneu.2019.04.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
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Mishriky J, Stupans I, Chan V. An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines. Pharm Pract (Granada) 2019; 17:1436. [PMID: 31275495 PMCID: PMC6594427 DOI: 10.18549/pharmpract.2019.2.1436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/09/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Fever and pain are common conditions in the Australian healthcare setting.
Whilst clinical guidelines provide important therapeutic recommendations,
evidence suggests they are not always followed. Given that community
pharmacy is one of the most frequently accessed primary healthcare services,
it is important to understand the views and practices of community
pharmacists in pain and fever. Objectives: To investigate the views and practices of Australian community pharmacists in
pain and fever management, and their views on relevant clinical
guidelines. Methods: A cross-sectional study of community pharmacists in Australia was conducted
using a customised, anonymous, self-administered, online questionnaire
between March and May 2018. To capture a broad range of demographics,
pharmacists were recruited via local industry contacts and the
Pharmaceutical Society newsletter, with further recruitment through snowball
sampling. The main outcomes measured were pharmacists’ views,
practices and treatment recommendation of choice in pain and fever
management, as well as views on clinical guidelines and training. Results: A total of 113 pharmacists completed the survey. In general, paracetamol
(72%) was preferred as a recommendation over ibuprofen, and was the
drug of choice for most mild to moderate pain and fever scenarios. Majority
of pharmacists reported good knowledge of pain and fever management,
however, only approximately half reported recent pain management training.
Greater than 87% of pharmacists believe that clinical guidelines are
useful in fever management, and 79% of pharmacists believe that
following clinical guidelines is important in pain management. Conclusions: While most pharmacists recognise the importance of guidelines and
demonstrated good pain and fever management, results suggests opportunities
to promote additional education, upskilling, and research in this space to
further optimise pain and fever management in the community.
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Affiliation(s)
- John Mishriky
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC, (Australia).
| | - Ieva Stupans
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC, (Australia).
| | - Vincent Chan
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora VIC (Australia).
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Edgerton K, Hall J, Bland MK, Marshall B, Hulla R, Gatchel RJ. A physical therapist’s role in pain management: A biopsychosocial perspective. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Jarod Hall
- Greater Therapy Centers Lewisville Texas
| | - Michelle K. Bland
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Blaine Marshall
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Ryan Hulla
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Robert J. Gatchel
- Department of Psychology University of Texas at Arlington Arlington Texas
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Ooijevaar RE, Felt-Bersma RJF, Han-Geurts IJ, van Reijn D, Vollebregt PF, Molenaar CBH. Botox treatment in patients with chronic functional anorectal pain: experiences of a tertiary referral proctology clinic. Tech Coloproctol 2019; 23:239-244. [PMID: 30778784 PMCID: PMC6511340 DOI: 10.1007/s10151-019-01945-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anorectal pain is a symptom which may have both structural and functional causes, and can, sometimes, develop into a chronic pain syndrome. Functional causes in particular are challenging to treat when conservative treatment measures fail. Botulinum toxin A (BTX-A) can be applied to relax the anal sphincter and/or levator ani muscle to break the vicious circle of pain and contraction. In our tertiary referral proctology clinic, we evaluated the outcome of patients treated with BTX-A for chronic functional anorectal pain. METHODS Our electronic database was searched for patients who had BTX-A treatment for chronic functional anorectal pain from 2011 to 2016. All medical data concerning history, treatments, and clinical outcome were retrieved. The clinical outcome (resolution of pain) was scored as good, temporary, or poor. RESULTS A total of 113 patients [47 (42%) males; age 51years, SD 13 years, range 18-88 years] with chronic functional anorectal pain were included. The outcome of BTX-A treatment was good in 53 (47%), temporary in 23 (20%), and poor in 37 (33%). To achieve this outcome, 29 (45%) patients needed a single treatment, 11 (44%) a second treatment, and 13 (54%) ≥ 3 treatments. CONCLUSIONS Chronic functional anorectal pain can be treated successfully with BTX-A in 47% of patients who fail conservative management. Repeated injections may be needed to ensure complete cure in a subgroup of patients.
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Affiliation(s)
- R E Ooijevaar
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location VU University Medical Centre, PO Box 7057, Amsterdam, 1081 HZ, The Netherlands.
| | - R J F Felt-Bersma
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location VU University Medical Centre, PO Box 7057, Amsterdam, 1081 HZ, The Netherlands
- Department of Anorectal Surgery, Proctos Clinic, Bilthoven, The Netherlands
| | - I J Han-Geurts
- Department of Anorectal Surgery, Proctos Clinic, Bilthoven, The Netherlands
| | - D van Reijn
- Department of Anorectal Surgery, Proctos Clinic, Bilthoven, The Netherlands
| | - P F Vollebregt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location VU University Medical Centre, PO Box 7057, Amsterdam, 1081 HZ, The Netherlands
| | - C B H Molenaar
- Department of Anorectal Surgery, Proctos Clinic, Bilthoven, The Netherlands
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Mishriky J, Stupans I, Chan V. Expanding the role of Australian pharmacists in community pharmacies in chronic pain management - a narrative review. Pharm Pract (Granada) 2019; 17:1410. [PMID: 31015881 PMCID: PMC6463420 DOI: 10.18549/pharmpract.2019.1.1410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/03/2019] [Indexed: 01/12/2023] Open
Abstract
Chronic pain is a condition where patients continuously experience pain symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage chronic pain often results in additional health concerns that may directly contribute to the worsening symptoms of pain. Community pharmacists are an important healthcare resource that contributes to patient care, yet their roles in chronic pain management are often not fully utilised. This review aimed to investigate and explore pharmacist-driven chronic pain educational and medication management interventions in community pharmacies on an international level, and thereby identify if there are potential benefits in modelling and incorporating these interventions in the Australian community. We found a number of studies conducted in Europe and the United States investigated the benefits of pharmacist-driven educational and medication management interventions in the context of chronic pain management. Results demonstrated that there were improvements in the pain scores, depression/anxiety scales and physical functionality in patient groups receiving the pharmacist driven-interventions, thereby highlighting the clinical benefit of these interventions in chronic pain. In conclusion, pharmacists are trustworthy and responsible advocates for medication reviews and patient education. There are currently very limited formal nationally recognised pharmacist-driven intervention programs dedicated to chronic pain management in Australian community pharmacies. International studies have shown that pharmacist-driven chronic pain interventions undertaken in community pharmacies are of benefit with regards to alleviating pain symptoms and adverse events. Furthermore, it is also clear that research around the application of pharmacist-led chronic pain interventions in Australia is lacking. Modelling interventions that have been conducted overseas may be worth exploring in Australia. The implementation of similar intervention programs for Australian pharmacists in community pharmacies may provide enhanced clinical outcomes for patients suffering from chronic pain. The recently implemented Chronic Pain MedsCheck Trial may provide some answers.
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Affiliation(s)
- John Mishriky
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- Professor and Discipline Head of Pharmacy. School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora, VIC (Australia).
| | - Vincent Chan
- School of Health and Biomedical Sciences, Discipline of Pharmacy, RMIT University. Bundoora, VIC (Australia).
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Multimodal pain therapy in chronic noncancer pain-gold standard or need for further clarification? Pain 2019; 158:1853-1859. [PMID: 28328572 DOI: 10.1097/j.pain.0000000000000902] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chaudhury S, Jawdekar A, Patel V, Saldanha D. Prevalence and correlates of psychiatric comorbidity in chronic pain patients: A hospital-based study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2019. [DOI: 10.4103/mjdrdypu.mjdrdypu_57_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jodoin M, Rouleau D, Larson-Dupuis C, Gosselin N, De Beaumont L. The clinical utility of repetitive transcranial magnetic stimulation in reducing the risks of transitioning from acute to chronic pain in traumatically injured patients. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:322-331. [PMID: 28694022 DOI: 10.1016/j.pnpbp.2017.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 01/01/2023]
Abstract
Pain is a multifaceted condition and a major ongoing challenge for healthcare professionals having to treat patients in whom pain put them at risk of developing other conditions. Significant efforts have been invested in both clinical and research settings in an attempt to demystify the mechanisms at stake and develop optimal treatments as well as to reduce individual and societal costs. It is now universally accepted that neuroinflammation and central sensitization are two key underlying factors causing pain chronification as they result from maladaptive central nervous system plasticity. Recent research has shown that the mechanisms of action of repetitive transcranial magnetic stimulation (rTMS) make it a particularly promising avenue in treating various pain conditions. This review will first discuss the contribution of neuroinflammation and central sensitization in the transition from acute to chronic pain in traumatically injured patients. A detailed discussion on how rTMS may allow the restoration from maladaptive plasticity in addition to breaking down the chain of events leading to pain chronification will follow. Lastly, this review will provide a theoretical framework of what might constitute optimal rTMS modalities in dealing with pain symptoms in traumatically injured patients based on an integrated perspective of the physiopathological mechanisms underlying pain.
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Affiliation(s)
- Marianne Jodoin
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Dominique Rouleau
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Camille Larson-Dupuis
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada.
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Campos WK, Linhares MN, Sarda J, Santos ARS, Licinio J, Quevedo J, Lin K, Walz R. Determinants for Meaningful Clinical Improvement of Pain and Health‐Related Quality of Life After Spinal Cord Stimulation for Chronic Intractable Pain. Neuromodulation 2018; 22:280-289. [DOI: 10.1111/ner.12891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/18/2018] [Accepted: 10/07/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Wuilker Knoner Campos
- Functional Neurosurgery Division, Department of NeurosurgeryBaia Sul Medical Center Florianópolis SC Brazil
- Neuron Institute, Baia Sul Medical Center Florianópolis SC Brazil
- Neurosurgery DivisionHospital Governador Celso Ramos Florianópolis SC Brazil
- Center for Applied Neuroscience (CeNAp)University Hospital (HU), Federal University of Santa Catarina State (UFSC) Florianópolis SC Brazil
| | - Marcelo Neves Linhares
- Functional Neurosurgery Division, Department of NeurosurgeryBaia Sul Medical Center Florianópolis SC Brazil
- Neuron Institute, Baia Sul Medical Center Florianópolis SC Brazil
- Neurosurgery DivisionHospital Governador Celso Ramos Florianópolis SC Brazil
- Center for Applied Neuroscience (CeNAp)University Hospital (HU), Federal University of Santa Catarina State (UFSC) Florianópolis SC Brazil
- Department of SurgeryNeurosurgery Division, HU, UFSC Florianópolis SC Brazil
| | - Jamir Sarda
- Psychology DepartmentUniversidade do Vale do Itajaí (UNIVALI) Itajaí SC Brazil
| | | | - Júlio Licinio
- Department of Psychiatry, College of MedicineState University of New York, Upstate Medical University Syracuse NY USA
| | - João Quevedo
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral SciencesMcGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth) Houston TX USA
| | - Kátia Lin
- Center for Applied Neuroscience (CeNAp)University Hospital (HU), Federal University of Santa Catarina State (UFSC) Florianópolis SC Brazil
- Department of Internal MedicineNeurology Division, HU, UFSC Florianópolis SC Brazil
| | - Roger Walz
- Center for Applied Neuroscience (CeNAp)University Hospital (HU), Federal University of Santa Catarina State (UFSC) Florianópolis SC Brazil
- Department of Internal MedicineNeurology Division, HU, UFSC Florianópolis SC Brazil
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Söderlund A, Löfgren M, Stålnacke BM. Predictors before and after multimodal rehabilitation for pain acceptance and engagement in activities at a 1-year follow-up for patients with whiplash-associated disorders (WAD)-a study based on the Swedish Quality Registry for Pain Rehabilitation (SQRP). Spine J 2018; 18:1475-1482. [PMID: 29155342 DOI: 10.1016/j.spinee.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/03/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD). PURPOSE The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR). STUDY DESIGN The design of this investigation was a cohort study with 1-year postrehabilitation follow-up. STUDY SETTING The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015. PATIENT SAMPLE The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177 were followed up at 1 year after MMR. OUTCOME MEASURES Demographic variables, pain intensity, fear of movement, perceived responses from significant others, and outcome expectations were measured at the start and after MMR. Chronic pain acceptance and engagement in activities were measured at follow-up. METHODS The data were obtained from a Swedish Quality Registry for Pain Rehabilitation (SQRPR). RESULTS Outcome expectancies of recovery, supporting and distracting responses of significant others, and fear of (re)injury and movement before MMR were significant predictors of engagement in activities at follow-up. Pain intensity and fear of (re)injury and movement after MMR significantly predicted engagement in activities at follow-up. Supporting responses of significant others and fear of (re)injury and movement before MMR were significant predictors of pain acceptance at the 1-year follow-up. Solicitous responses of significant others and fear of (re)injury and movement at postrehabilitation significantly predicted pain acceptance at follow-up. CONCLUSION For engagement in activities and pain acceptance, the fear of movement appears to emerge as the strongest predictor, but patients' perceived reactions from their spouses need to be considered in planning the management of WAD.
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Affiliation(s)
- Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden.
| | - Monika Löfgren
- Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital AB, Mörbygårdsvägen, SE 182 88 Stockholm, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Vårdvetarhuset, Umeå University, SE-901 87 Umeå, Sweden
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Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin 2018. [PMID: 29513044 DOI: 10.1080/03007995.2018.1449738] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pain is one of the most common reasons for an individual to consult their primary care physician, with most chronic pain being treated in the primary care setting. However, many primary care physicians/non-pain medicine specialists lack enough awareness, education and skills to manage pain patients appropriately, and there is currently no clear, common consensus/formal definition of "pain chronification". METHODS This article, based on an international Change Pain Chronic Advisory Board meeting which was held in Wiesbaden, Germany, in October 2016, provides primary care physicians/non-pain medicine specialists with a narrative overview of pain chronification, including underlying physiological and psychosocial processes, predictive factors for pain chronification, a brief summary of preventive strategies, and the role of primary care physicians and non-pain medicine specialists in the holistic management of pain chronification. RESULTS Based on currently available evidence, we propose the following consensus-based definition of pain chronification which provides a common framework to raise awareness among non-pain medicine specialists: "Pain chronification describes the process of transient pain progressing into persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental and biopsychosocial factors determine the risk, the degree, and time-course of chronification." CONCLUSIONS Early intervention plays an important role in preventing pain chronification and, as key influencers in the management of patients with acute pain, it is critical that primary care physicians are equipped with the necessary awareness, education and skills to manage pain patients appropriately.
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Affiliation(s)
- Bart Morlion
- a Leuven Centre for Algology & Pain Management , University Hospitals Leuven , KU Leuven , Belgium
| | - Flaminia Coluzzi
- b Department of Medical and Surgical Sciences and Biotechnologies Unit of Anaesthesia, Intensive Care and Pain Medicine , Sapienza University of Rome , Rome , Italy
| | | | - Magdalena Kocot-Kepska
- d Department of Pain Research and Treatment , Jagiellonian University Medical College , Kraków , Poland
| | - Joseph Pergolizzi
- e Global Pain Initiative, Golden, CO, USA and Naples Anesthesia and Pain Associates , Naples , FL , USA
| | | | | | - Eija Kalso
- h Pain Clinic, Departments of Anaesthesiology , Intensive Care, and Pain Medicine, Helsinki University Central Hospital , Helsinki , Finland
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Aykut V, Elbay A, Çigdem Uçar I, Esen F, Durmus A, Karadag R, Oguz H. Corneal sensitivity and subjective complaints of ocular pain in patients with fibromyalgia. Eye (Lond) 2018; 32:763-767. [PMID: 29386615 PMCID: PMC5898857 DOI: 10.1038/eye.2017.275] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/22/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeFibromyalgia (FM) is a chronic pain disorder associated with pain and hypersensitivity in various parts of the body. The aim of this study was to understand whether changes in corneal sensitivity were associated with the subjective complaints of these patients.Patients and methodsIn this study, we included 36 patients with FM (30 female, 6 male, mean age: 46.7±9.2 years) and 39 healthy control subjects (33 females, 6 males, mean age: 44.3±7.6 years). We performed a detailed ophthalmological examination, measured tear film breakup time (TBUT), and performed Schirmer I test without anesthetic (SIT). Only patients that did not have any eye disease were included in this study. Subjective complaints of the patients were evaluated with ocular surface disease index (OSDI) scores and the corneal sensation was evaluated with Cochet-Bonnet esthesiometer.ResultsThere was no significant difference between the groups for age, sex, and visual acuity. Both SIT (16.1 mm vs 15.3 mm, P=0.36) and TBUT results (17.8 s vs 18.8 s, P=0.40) were similar in FM group and the controls subjects. However, corneal sensations in central (60.0 mm vs 55.0 mm, P=0.03), superior (57.5 mm vs 50.0 mm, P=0.005), and inferior (53.89 mm vs 46.03 mm, P<0.001) regions were significantly increased in FM patients. There was a significant positive correlation between corneal sensation and OSDI scores.ConclusionIn this study, we have demonstrated that the patients with FM have increased corneal sensitivity and have related ocular surface complaints similar to dry eye disease in the absence of it.
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Affiliation(s)
- V Aykut
- Department of Ophthalmology, Goztepe Education and Research Hospital, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - A Elbay
- Department of Ophthalmology, Bezmialem University School of Medicine, Istanbul, Turkey
| | - I Çigdem Uçar
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - F Esen
- Department of Ophthalmology, Goztepe Education and Research Hospital, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - A Durmus
- Department of Ophthalmology, Istanbul Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey
| | - R Karadag
- Department of Ophthalmology, Goztepe Education and Research Hospital, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - H Oguz
- Department of Ophthalmology, Goztepe Education and Research Hospital, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature. RECENT FINDINGS Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible. Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.
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54. The development and analysis of feedback from a pilot Chronic Pain group at The Royal Manchester Children’s Hospital. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Objective Physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs. Methods Narrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain. Results The specific roles and responsibilities of PAs, NPs, and RNs in the management of patients receiving IT therapy vary by practice. In many pain treatment centers, PAs, NPs, and RNs are responsible for patient education, postimplant maintenance, and ongoing supportive care of patients receiving IT therapy. Topics that we address include patient selection, patient expectations and goal setting, medication selection, outcome assessment, and treatment adjustment. Currently, morphine and ziconotide (a nonopioid, selective N-type calcium channel blocker) are the only agents approved by the US Food and Drug Administration for IT analgesia. We provide relevant information on the dosing, titration, and adverse effect management of these medications for PAs, NPs, and RNs responsible for administering IT therapy. Conclusion PAs, NPs, and RNs are valuable members of IT pain management teams. Treatment success requires ongoing monitoring of efficacy and adverse effects, with corresponding adjustments to medication selection and dosing, in addition to good communication among the health care professionals involved in patient care.
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Affiliation(s)
| | - Neona M Lotz
- Cypress Ambulatory Surgery Center, Santa Maria, CA, USA
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