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Chen YT, Hassett AL, Huang S, Khanna D, Murphy SL. Peer-Led Symptom Management Intervention to Enhance Resilience in People with Systemic Sclerosis: Mediation Analysis from a Randomized Clinical Trial. Arthritis Care Res (Hoboken) 2024. [PMID: 38622109 DOI: 10.1002/acr.25352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Facilitated self-management interventions have the potential to enhance resilience and well-being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12-week online peer-led symptom management intervention. METHODS We conducted a secondary data analysis from a randomized control trial comparing a peer health coached intervention to a waitlist control. Participants completed the Connor-Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12. RESULTS One hundred and seventy-three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (p < .001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of -1.41 (95% Confidence Interval [CI], -2.41 to -0.41), pain interference of -0.86 (95% CI, -1.65 to -0.08), and depressive symptoms of -1.99 (95% CI, -3.16 to -0.81). CONCLUSION For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions.
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Affiliation(s)
- Yen T Chen
- University of Michigan, Ann Arbor, Michigan
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Weston EB, Hassett AL, Khan SN, Weaver TE, Marras WS. The Potential Relationship Between a Cognitive Dissonance State and Musculoskeletal Injury: A Systematic Review. Hum Factors 2024; 66:1152-1169. [PMID: 36059264 DOI: 10.1177/00187208221120459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of this systematic review was to investigate the potential link between cognitive dissonance or its related constructs (emotional dissonance, emotional labor) and musculoskeletal disorders. BACKGROUND The etiology of musculoskeletal disorders is complex, as pain arises from complex interactions among physical, social, and psychological stressors. It is possible that the psychological factor of cognitive dissonance may contribute to the etiology and/or maintenance of musculoskeletal disorders. METHOD MEDLINE, APA PsycInfo, and CINAHL Plus databases were searched for studies investigating cognitive dissonance or its related constructs as exposure(s) of interest and outcomes related to physical health (including, but not limited to, musculoskeletal pain). Risk of bias was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. RESULTS The literature search yielded 7 studies eligible for inclusion. None of the included studies investigated cognitive dissonance directly but instead investigated dissonance-related constructs of emotional dissonance and emotional labor, in which a mismatch between required and felt emotions might elicit a psychological response consistent with the cognitive dissonance state. Moderate effect sizes between dissonance-related constructs and musculoskeletal disorders were noted (OR 1.25-2.22). CONCLUSION There is likely a relationship between the two factors studied. However, as the included studies were cross-sectional in nature, a causal relationship between cognitive dissonance-related constructs and musculoskeletal disorders cannot be inferred. Therefore, future study proposing and validating a causal pathway between these variables is warranted. APPLICATION Cognitive dissonance and its related constructs may serve as risk factors for musculoskeletal disorders that have not been considered previously.
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Affiliation(s)
- Eric B Weston
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, MI, USA
| | - Safdar N Khan
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
| | - Tristan E Weaver
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
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Sturgeon JA, Zubieta C, Kaplan CM, Pierce J, Arewasikporn A, Slepian PM, Hassett AL, Trost Z. Broadening the Scope of Resilience in Chronic Pain: Methods, Social Context, and Development. Curr Rheumatol Rep 2024; 26:112-123. [PMID: 38270842 DOI: 10.1007/s11926-024-01133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience. RECENT FINDINGS Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Caroline Zubieta
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chelsea M Kaplan
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Pierce
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anne Arewasikporn
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - P Maxwell Slepian
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, CA, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zina Trost
- Department of Psychology, Texas A&M University, College Station, TX, USA
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4
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Murphy SL, Chen YT, Alore M, Hicks S, Pape A, Hassett AL, Kratz AL, Whibley D, Harper AE, Huang S, Jay G, Bolde S, Khanna D. Effects of a Resilience-Building Energy Management Program on Fatigue and Other Symptoms in Systemic Sclerosis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2024; 76:318-327. [PMID: 37846437 PMCID: PMC10922781 DOI: 10.1002/acr.25253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Supported self-management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12-week resilience-building energy management program (called RENEW) for fatigue and other patient-reported outcomes. METHODS Participants, who had physician-diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer-led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor-Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three-way interaction with group, time, and SSc duration was examined in each model. RESULTS Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (β = -4.7; 95% confidence interval -6.7 to -2.7; P < 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. CONCLUSION An mHealth supported self-management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yen T. Chen
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Alore
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheri Hicks
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam Pape
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Alexandra E. Harper
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Suiyuan Huang
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gina Jay
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Shannen Bolde
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Mauck MC, Aylward AF, Barton CE, Birckhead B, Carey T, Dalton DM, Fields AJ, Fritz J, Hassett AL, Hoffmeyer A, Jones SB, McLean SA, Mehling WE, O'Neill CW, Schneider MJ, Williams DA, Zheng P, Wasan AD. [Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach : German version]. Schmerz 2024:10.1007/s00482-024-00798-x. [PMID: 38381187 DOI: 10.1007/s00482-024-00798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. OBJECTIVE The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. METHODS A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. CONCLUSION The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.
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Affiliation(s)
- Matthew C Mauck
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA.
| | - Aileen F Aylward
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chloe E Barton
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Brandon Birckhead
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Carey
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane M Dalton
- Department of Physical Therapy, Boston University, College of Health and Rehabilitation Sciences, Sargent, Boston, MA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Hoffmeyer
- University of North Carolina at Chapel Hill, Collaborative Studies Coordinating Center, Chapel Hill, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A McLean
- Department of Anesthesiology, University of North Carolina at Chapel Hill, CB#7011, 27599-7010, Chapel Hill, NC, USA
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, Kalifornien, USA
| | - Conor W O'Neill
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Michael J Schneider
- Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Zheng
- Section of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, Kalifornien, USA
| | - Ajay D Wasan
- Departments of Anesthesiology and Perioperative Medicine and Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Somers EC, Goodrich JM, Wang L, Harlow SD, Marder W, Hassett AL, Zick SM, McCune WJ, Gordon C, Barbour KE, Helmick CG, Strickland FM. Associations between CD70 methylation of T cell DNA and age in adults with systemic lupus erythematosus and population controls: The Michigan Lupus Epidemiology & Surveillance (MILES) Program. J Autoimmun 2024; 142:103137. [PMID: 38064919 PMCID: PMC10957300 DOI: 10.1016/j.jaut.2023.103137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Environmental factors can influence epigenetic regulation, including DNA methylation, potentially contributing to systemic lupus erythematosus (SLE) development and progression. We compared methylation of the B cell costimulatory CD70 gene, in persons with lupus and controls, and characterized associations with age. RESULTS In 297 adults with SLE and 92 controls from the Michigan Lupus Epidemiology and Surveillance (MILES) Cohort, average CD70 methylation of CD4+ T cell DNA across 10 CpG sites based on pyrosequencing of the promoter region was higher for persons with SLE compared to controls, accounting for covariates [β = 2.3, p = 0.011]. Using Infinium MethylationEPIC array data at 18 CD70-annoted loci (CD4+ and CD8+ T cell DNA), sites within the promoter region tended to be hypomethylated in SLE, while those within the gene region were hypermethylated. In SLE but not controls, age was significantly associated with pyrosequencing-based CD70 methylation: for every year increase in age, methylation increased by 0.14 percentage points in SLE, accounting for covariates. Also within SLE, CD70 methylation approached a significantly higher level in Black persons compared to White persons (β = 1.8, p = 0.051). CONCLUSIONS We describe altered CD70 methylation patterns in T lymphocyte subsets in adults with SLE relative to controls, and report associations particular to SLE between methylation of this immune-relevant gene and both age and race, possibly a consequence of "weathering" or accelerated aging which may have implications for SLE pathogenesis and potential intervention strategies.
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Affiliation(s)
- Emily C Somers
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA; University of Michigan, Department of Environmental Health Sciences, Ann Arbor, MI, USA; University of Michigan, Department of Obstetrics & Gynecology, Ann Arbor, MI, USA.
| | - Jaclyn M Goodrich
- University of Michigan, Department of Environmental Health Sciences, Ann Arbor, MI, USA
| | - Lu Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA
| | - Sioban D Harlow
- University of Michigan, Department of Epidemiology, Ann Arbor, MI, USA
| | - Wendy Marder
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA; University of Michigan, Department of Obstetrics & Gynecology, Ann Arbor, MI, USA
| | - Afton L Hassett
- University of Michigan, Department of Anesthesiology, Ann Arbor, MI, USA
| | - Suzanna M Zick
- University of Michigan, Department of Family Medicine, Ann Arbor, MI, USA
| | - W Joseph McCune
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA
| | - Caroline Gordon
- University of Birmingham, Rheumatology Research Group, Institute of Inflammation and Ageing, Birmingham, UK
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Charles G Helmick
- Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Faith M Strickland
- University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA
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Weston EB, Hassett AL, Khan SN, Weaver TE, Marras WS. Cognitive dissonance increases spine loading in the neck and low back. Ergonomics 2023; 66:2133-2147. [PMID: 36861457 DOI: 10.1080/00140139.2023.2186323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Cognitive dissonance refers to a state where two psychologically inconsistent thoughts, behaviours, or attitudes are held at the same time. The objective of this study was to explore the potential role of cognitive dissonance in biomechanical loading in the low back and neck. Seventeen participants underwent a laboratory experiment involving a precision lowering task. To establish a cognitive dissonance state (CDS), study participants were provided negative feedback on their performance running counter to a pre-established expectation that their performance was excellent. Dependent measures of interest were spinal loads in the cervical and lumbar spines, calculated via two electromyography-driven models. The CDS was associated with increases to peak spinal loads in the neck (11.1%, p < .05) and low back (2.2%, p < .05). A greater CDS magnitude was also associated with a greater spinal loading increase. Therefore, cognitive dissonance may represent a risk factor for low back/neck pain that has not been previously identified.Practitioner summary: Upon establishing a cognitive dissonance state in a group of participants, spinal loading in the cervical and lumbar spines were increased proportional to the magnitude of the cognitive dissonance reported. Therefore, cognitive dissonance may represent a risk factor for low back and neck pain that has not been previously identified.
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Affiliation(s)
- Eric B Weston
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
| | - Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Safdar N Khan
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Orthopedics, The Ohio State University, Columbus, OH, USA
| | - Tristan E Weaver
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH, USA
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Wilson L, Denham A, Ionova Y, O'Neill C, Greco CM, Hassett AL, Hanmer J, Shaikh S, Wolf M, Berven S, Williams D, Ma Y, Lotz J, Zheng P. Preferences for risks and benefits of treatment outcomes for chronic low back pain: Choice-based conjoint measure development and discrete choice experiment. PM R 2023. [PMID: 38040670 DOI: 10.1002/pmrj.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/10/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Understanding individual patient preferences for chronic low back pain (cLBP) outcomes is essential for targeting available therapeutic options; yet tools to elicit patient outcome preferences are limited. OBJECTIVE To develop and test a choice-based conjoint (CBC) measure, commonly used in behavioral economics research, to elicit what outcomes patients with cLBP want to achieve and avoid. DESIGN We developed a survey-based CBC measure to allow patients to make risk/benefit trade-off choices between possible treatment outcomes. After extensive literature, clinician, and patient input, our measure included seven attributes: fatigue, anxiety/depression, difficulty thinking/making decisions, pain intensity, physical abilities, change in pain, and ability to enjoy life despite pain. Random-parameters logit models were used to estimate strength of preferences, and latent class analysis was used to identify patient characteristics associated with distinct preference. SETTING Online study using the Sawtooth web-based platform. PARTICIPANTS Two hundred eleven individuals with cLBP recruited from online advertising as well as at clinical sites across multiple academic and private institutions. INTERVENTIONS Not applicable. RESULTS The most valued outcome was the highest level of physical activity (β = 1.6-1.98; p < .001), followed by avoiding cognitive difficulties (β = -1.48; p < .001). Avoidance of severe pain was comparable to avoiding constant fatigue and near-constant depression/anxiety (β = -0.99, -1.02); p < .001). There was an association between preferences and current pain/disability status; patients with higher pain had a stronger preference to avoid severe pain, whereas those with higher disability have stronger preferences for achieving physical activity. The latent class analysis identified two distinct groups: (1) more risk-seeking and willing to accept worse outcomes (56%); and (2) more risk-averse with a stronger preference for achieving maximum benefits (44%). CONCLUSIONS Our study illuminated cLBP patient preferences for treatment outcomes and heterogeneity in these preferences. Patients stressed the importance of reaching high physical activity and avoiding cognitive declines, even over a desire to avoid pain. More work is needed to understand patient preferences to aid informed, shared decisions.
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Affiliation(s)
- Leslie Wilson
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Alina Denham
- Department of Family, Population and Preventive Medicine, Program in Public Health, Stony Brook University, San Francisco, Stony Brook, USA
| | - Yelena Ionova
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Conor O'Neill
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Carol M Greco
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Janel Hanmer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sana Shaikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Mehling Wolf
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Sigurd Berven
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - David Williams
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanlei Ma
- Department of Medicine, Cornell University, Ithaca, New York, USA
| | - Jeffrey Lotz
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Patricia Zheng
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
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Kaplan CM, Schrepf A, Boehnke KF, He Y, Smith T, Williams DA, Bergmans R, Voepel-Lewis T, Hassett AL, Harris RE, Clauw DJ, Beltz AM, Harte SE. Risk Factors for the Development of Multisite Pain in Children. Clin J Pain 2023; 39:588-594. [PMID: 37440345 PMCID: PMC10592500 DOI: 10.1097/ajp.0000000000001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date, no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future. We hypothesized that female sex, sleep problems, and heightened somatic symptoms complaints at baseline would be associated with the risk of developing new multisite pain 1 year later. METHODS Symptom assessments were completed by parents of youth (ages 9 to 10) enrolled in the Adolescent Brain Cognitive Development study. Multivariate logistic regression models focused on children who developed multisite pain 1 year later (n=331) and children who remained pain free (n=3335). RESULTS Female sex (odds ratio [OR]=1.35; 95% CI, 1.07, 1.71; P =0.01), elevated nonpainful somatic symptoms (OR=1.17; 95% CI, 1.06, 1.29; P <0.01), total sleep problems (OR=1.20; 95% CI, 1.07, 1.34; P <0.01), and attentional issues (OR=1.22; 95% CI, 1.10, 1.35; P <0.001) at baseline were associated with new multisite pain 1 year later. Baseline negative affect was not associated with new multisite pain. DISCUSSION Identifying symptom-based risk factors for multisite pain in children is critical for early prevention. Somatic awareness, sleep and attention problems represent actionable targets for early detection, treatment, and possible prevention of multisite pain in youth.
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Affiliation(s)
| | - Andrew Schrepf
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Kevin F Boehnke
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Ying He
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Tristin Smith
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Rachel Bergmans
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Afton L Hassett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Richard E Harris
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Susan Samueli Integrative Health Institute, School of Medicine
- Department of Anesthesiology and Perioperative Care, School of Medicine, University of California at Irvine, Irvine, CA
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Adriene M Beltz
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Steven E Harte
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
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10
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Wilson L, Zheng P, Ionova Y, Denham A, Yoo C, Ma Y, Greco CM, Hanmer J, Williams DA, Hassett AL, Scheffler AW, Valone F, Mehling W, Berven S, Lotz J, O'Neill C. CAPER: patient preferences to inform nonsurgical treatment of chronic low back pain: a discrete-choice experiment. Pain Med 2023; 24:963-973. [PMID: 36975607 DOI: 10.1093/pm/pnad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE We developed and used a discrete-choice measure to study patient preferences with regard to the risks and benefits of nonsurgical treatments when they are making treatment selections for chronic low back pain. METHODS "CAPER TREATMENT" (Leslie Wilson) was developed with standard choice-based conjoint procedures (discrete-choice methodology that mimics an individual's decision-making process). After expert input and pilot testing, our final measure had 7 attributes (chance of pain relief, duration of relief, physical activity changes, treatment method, treatment type, treatment time burden, and risks of treatment) with 3-4 levels each. Using Sawtooth software (Sawtooth Software, Inc., Provo, UT, USA), we created a random, full-profile, balanced-overlap experimental design. Respondents (n = 211) were recruited via an emailed online link and completed 14 choice-based conjoint choice pairs; 2 fixed questions; and demographic, clinical, and quality-of-life questions. Analysis was performed with random-parameters multinomial logit with 1000 Halton draws. RESULTS Patients cared most about the chance of pain relief, followed closely by improving physical activity, even more than duration of pain relief. There was comparatively less concern about time commitment and risks. Gender and socioeconomic status influenced preferences, especially with relation to strength of expectations for outcomes. Patients experiencing a low level of pain (Pain, Enjoyment, and General Activity Scale [PEG], question 1, numeric rating scale score<4) had a stronger desire for maximally improved physical activity, whereas those in a high level of pain (PEG, question 1, numeric rating scale score>6) preferred both maximum and more limited activity. Highly disabled patients (Oswestry Disability Index score>40) demonstrated distinctly different preferences, placing more weight on achieving pain control and less on improving physical activity. CONCLUSIONS Individuals with chronic low back pain were willing to trade risks and inconveniences for better pain control and physical activity. Additionally, different preference phenotypes exist, which suggests a need for clinicians to target treatments to particular patients.
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Affiliation(s)
- Leslie Wilson
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Patricia Zheng
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Yelena Ionova
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Alina Denham
- Harvard Medical School, Boston, MA 02115, United States
| | - Connie Yoo
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Yanlei Ma
- Cornell University, Ithaca, NY 14853, United States
| | - Carol M Greco
- University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Janel Hanmer
- University of Pittsburgh, Pittsburgh, PA 15260, United States
| | | | | | | | - Frank Valone
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Wolf Mehling
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Sigurd Berven
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Jeffrey Lotz
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Conor O'Neill
- University of California San Francisco, San Francisco, CA 94143, United States
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11
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Minhas D, Marder W, Hassett AL, Zick SM, Gordon C, Harlow SD, Wang L, Barbour KE, Helmick CG, McCune WJ, Somers EC. Cost-related prescription non-adherence and patient-reported outcomes in systemic lupus erythematosus: The Michigan Lupus Epidemiology & Surveillance program. Lupus 2023; 32:1075-1083. [PMID: 37378450 PMCID: PMC10585710 DOI: 10.1177/09612033231186113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES Medication access and adherence play key roles in determining patient outcomes. We investigated whether cost-related non-adherence (CRNA) to prescription medications was associated with worse patient-reported outcomes in a population-based systemic lupus erythematosus (SLE) cohort. METHODS Sociodemographic and prescription data were collected by structured interviews in 2014-2015 from patients meeting SLE criteria in the established Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We examined the associations between CRNA and potential confounders such as sociodemographics and health insurance coverage, and outcome measures of SLE activity and damage using multivariable linear regression. RESULTS 462 SLE participants completed the study visit: 430 (93.1%) female, 208 (45%) Black, and mean age 53.3 years. 100 (21.6%) participants with SLE reported CRNA in the preceding 12 months. After adjusting for covariates, CRNA was associated with both higher levels of current SLE disease activity [SLAQ: β coeff 2.7 (95% CI 1.3, 4.1), p < 0.001] and damage [LDIQ β coeff 1.4 (95% CI 0.5, 2.4), p = 0.003]. Race, health insurance status, and fulfilling Fibromyalgia (FM) Survey Criteria were independently associated with both higher (worse) SLAQ and LDIQ scores; female sex was further associated with higher SLAQ scores. CONCLUSION Patients with SLE who reported CRNA in the previous 12 months had significantly worse self-reported current disease activity and damage scores compared to those not reporting CRNA. Raising awareness and addressing barriers or concerns related to financial implications and accessibility issues in care plans may help to improve these outcomes.
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Affiliation(s)
- Deeba Minhas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wendy Marder
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Suzanna M Zick
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sioban D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - W Joseph McCune
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily C Somers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI, USA
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12
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Clauw DJ, Choy EHS, Napadow V, Soni A, Boehnke KF, Naliboff B, Hassett AL, Arewasikporn A, Schrepf A, Kaplan CM, Williams D, Basu N, Bergmans RS, Harris RE, Harte SE, Chadwick A, Macfarlane GJ. Hypothetical model ignores many important pathophysiologic mechanisms in fibromyalgia. Nat Rev Rheumatol 2023; 19:321. [PMID: 36964334 PMCID: PMC10878028 DOI: 10.1038/s41584-023-00951-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Ernest H S Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - Vitaly Napadow
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Anushka Soni
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Naliboff
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Anne Arewasikporn
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Chelsea M Kaplan
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Chadwick
- Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gary J Macfarlane
- Department of Public Health, School of Medicine, University of Aberdeen, Aberdeen, UK
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13
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Mohan N, Zhu G, Hassett AL, Fatabhoy MG, Pierce J. History of abuse is associated with thoughts of harm among patients with pain after accounting for depressive symptoms. Reg Anesth Pain Med 2023; 48:120-126. [PMID: 36396297 DOI: 10.1136/rapm-2022-103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Screening for depressive symptoms is often the first step to understanding risk for thoughts of harm among patients with pain. Pain characteristics and history of abuse are also associated with thoughts of harm; however, little is known about these associations after accounting for depressive symptoms. This study examined the association between pain characteristics and history of abuse with thoughts of harm among pain patients with moderate to severe and low to mild depressive symptoms. METHODS We conducted a cross-sectional analysis of patients (n=7510) who presented to a tertiary-care, outpatient pain clinic. RESULTS Abuse history was significantly associated with increased odds of reporting thoughts of harm for both patients with moderate to severe depressive symptoms as well as low to mild depressive symptoms. Abuse did not modify the association between any of the pain characteristics and thoughts of harm. DISCUSSION Our results highlight the importance of abuse history in assessing thoughts of harm. Although we are unable to infer causality due to the cross-sectional design, this study highlights the importance of screening for abuse history when assessing for suicidal and homicidal ideation.
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Affiliation(s)
- Nitesh Mohan
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Guohao Zhu
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megha G Fatabhoy
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Pierce
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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14
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Hassett AL, Williams DA, Harris RE, Harte SE, Kaplan CM, Schrepf A, Kratz AL, Brummett CM, Kidwell KM, Tsodikov A, Shaikh S, Murphy SL, Lobo R, King A, Favorite T, Fisher L, Golmirzaie GM, Schneiderhan JR, Mawla I, Ichesco E, McAfee J, Wasserman RA, Banner E, Scott KA, Cole C, Clauw DJ. An Interventional Response Phenotyping Study in Chronic Low Back Pain: Protocol for a Mechanistic Randomized Controlled Trial. Pain Med 2023:7008338. [PMID: 36708026 PMCID: PMC10403311 DOI: 10.1093/pm/pnad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
Evidence-based treatments for chronic low back pain (cLBP) typically work well in only a fraction of patients, and at present there is little guidance regarding what treatment should be used in which patients. Our central hypothesis is that an interventional response phenotyping study can identify individuals with different underlying mechanisms for their pain who thus respond differentially to evidence-based treatments for cLBP. Thus, we will conduct a randomized controlled Sequential, Multiple Assessment, Randomized Trial (SMART) design study in cLBP with the following three aims. Aim 1: Perform an interventional response phenotyping study in a cohort of cLBP patients (n = 400), who will receive a sequence of interventions known to be effective in cLBP. For 4 weeks, all cLBP participants will receive a web-based pain self-management program as part of a run-in period, then individuals who report no or minimal improvement will be randomized to: a) mindfulness-based stress reduction, b) physical therapy and exercise, c) acupressure self-management, and d) duloxetine. After 8 weeks, individuals who remain symptomatic will be re-randomized to a different treatment for an additional 8 weeks. Using those data, we will identify the subsets of participants that respond to each treatment. In Aim 2, we will show that currently available, clinically derived measures, can predict differential responsiveness to the treatments. In Aim 3, a subset of participants will receive deeper phenotyping (n = 160), to identify new experimental measures that predict differential responsiveness to the treatments, as well as to infer mechanisms of action. Deep phenotyping will include functional neuroimaging, quantitative sensory testing, measures of inflammation, and measures of autonomic tone.
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Affiliation(s)
- Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Chelsea M Kaplan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kelley M Kidwell
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Alexander Tsodikov
- School of Public Health, Biostatistics, University of Michigan, Ann Arbor, MI
| | - Sana Shaikh
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Remy Lobo
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Anthony King
- Department of Psychiatry, Ohio State University, Columbus, OH
| | - Todd Favorite
- Department of Psychiatry, Ohio State University, Columbus, OH
| | - Laura Fisher
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | | | | | - Ishtiaq Mawla
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Eric Ichesco
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Elizabeth Banner
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kathy A Scott
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Courtney Cole
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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15
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Mauck MC, Lotz J, Psioda MA, Carey TS, Clauw DJ, Majumdar S, Marras WS, Vo N, Aylward A, Hoffmeyer A, Zheng P, Ivanova A, McCumber M, Carson C, Anstrom KJ, Bowden AE, Dalton D, Derr L, Dufour J, Fields AJ, Fritz J, Hassett AL, Harte SE, Hue TF, Krug R, Loggia ML, Mageswaran P, McLean SA, Mitchell UH, O'Neill C, Pedoia V, Quirk DA, Rhon DI, Rieke V, Shah L, Sowa G, Spiegel B, Wasan AD, Wey HYM, LaVange L. The Back Pain Consortium (BACPAC) Research Program: Structure, Research Priorities, and Methods. Pain Med 2023:6978204. [PMID: 36622041 PMCID: PMC10403298 DOI: 10.1093/pm/pnac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
In 2019, the National Health Interview survey found that nearly 59% of adults reported pain some, most, or every day in the past 3 months, with 39% reporting back pain, making back pain the most prevalent source of pain, and a significant issue among adults. Often, identifying a direct, treatable cause for back pain is challenging, especially as it is often attributed to complex, multifaceted issues involving biological, psychological, and social components. Due to the difficulty in treating the true cause of chronic low back pain (cLBP), an over-reliance on opioid pain medications among cLBP patients has developed, which is associated with increased prevalence of opioid use disorder and increased risk of death. To combat the rise of opioid-related deaths, the NIH initiated the Helping to End Addiction Long-TermSM (HEAL) initiative, whose goal is to address the causes and treatment of opioid use disorder while also seeking to better understand, diagnose, and treat chronic pain. The NIH Back Pain Consortium (BACPAC) Research Program, a network of 14 funded entities, was launched as a part of the HEAL initiative to help address limitations surrounding the diagnosis and treatment of cLBP. This paper provides an overview of the BACPAC research program's goals and overall structure, and describes the harmonization efforts across the consortium, define its research agenda, and develop a collaborative project which utilizes the strengths of the network. The purpose of this paper is to serve as a blueprint for other consortia tasked with the advancement of pain related science.
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Affiliation(s)
| | | | | | | | | | | | | | - Nam Vo
- University of Pittsburgh (U Pitt)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roland Krug
- University of California San Francisco (UCSF)
| | | | | | | | | | | | | | | | - Daniel I Rhon
- Uniformed Services University of the Health Sciences, Bethesda, MD
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16
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Pierce J, Presto J, Hinckley E, Hassett AL, Dickens J, Schneiderhan JR, Grace K, McAfee J. Perceived social support partially mediates the association between childhood abuse and pain-related characteristics. Front Pain Res (Lausanne) 2022; 3:1075605. [PMID: 36618580 PMCID: PMC9815443 DOI: 10.3389/fpain.2022.1075605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Higher perceived social support has been shown to buffer the impact of negative stressful events like childhood abuse on health outcomes. Yet, the role of perceived social support as a mediator of the association between childhood abuse and pain-related characteristics is not well understood. The present study explored this premise. Patients (n = 1,542) presenting to a tertiary-care, outpatient pain clinic completed a cross-sectional survey consisting of regularly collected clinical data and validated measures. Path analysis suggested that the impact of childhood abuse on sensory and affective pain-related characteristics was partially explained by perceived emotional support. Survivors of childhood abuse display a more complex clinical pain phenotype and this extends to more negative perceptions of social support. Our findings may reflect processes whereby childhood abuse negatively impacts social relationships across the lifespan, and these negative social perceptions and relationships influence sensory and affective components of pain.
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Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States,Correspondence: Jennifer Pierce
| | - Jacob Presto
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth Hinckley
- Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Dickens
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Jill R. Schneiderhan
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kathryn Grace
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
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17
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Smeallie E, Rosenthal L, Johnson A, Roslin C, Hassett AL, Choi SW. Corrigendum: Enhancing Resilience in Family Caregivers Using an mHealth App. Appl Clin Inform 2022; 13:e1. [PMID: 38499314 PMCID: PMC10948270 DOI: 10.1055/s-0044-1785193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Eleanor Smeallie
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Lindsay Rosenthal
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Amanda Johnson
- Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon, United States
| | - Chloe Roslin
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
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18
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Nguyen SN, Hassett AL, Hu HM, Brummett CM, Bicket MC, Carlozzi NE, Waljee JF. Prospective cohort study on the trajectory and association of perioperative anxiety and postoperative opioid-related outcomes. Reg Anesth Pain Med 2022; 47:637-642. [PMID: 35973779 PMCID: PMC9549960 DOI: 10.1136/rapm-2022-103742] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/18/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Although perioperative anxiety is common, its trajectory and influence on postoperative pain and opioid use are not well understood. We sought to examine the association and trajectory of perioperative anxiety, pain and opioid use following common surgical procedures. METHODS We conducted a prospective cohort study of 1771 patients undergoing elective surgical procedures. Self-reported opioid use, pain (Brief Pain Inventory) and anxiety (Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety) were recorded on the day of surgery and at 1 month, 3 months and 6 months postsurgery. Clinically significant anxiety was defined as a PROMIS Anxiety T-score ≥55. We examined postoperative opioid use in the context of surgical site pain and anxiety using mixed-effects regression models adjusted for covariates, and examined anxiety as a mediator between pain and opioid use. RESULTS In this cohort, 65% of participants completed all follow-ups and 30% reported clinically significant anxiety at baseline. Anxiety and surgical site pain were highest on the day of surgery (anxiety: mean=49.3, SD=9.0; pain: mean=4.3, SD=3.3) and declined in the follow-up period. Those with anxiety reported higher opioid use (OR=1.40; 95% CI 1.0, 1.9) and 1.14-point increase in patient-reported surgical pain (95% CI 1.0, 1.3) compared with those without anxiety. Anxiety had no significant mediation effect on the relationship of pain and opioid use. DISCUSSION Anxiety is an independent risk factor for increased pain and opioid use after surgery. Future studies examining targeted behavioral therapies to reduce anxiety during the perioperative period may positively impact postoperative pain and opioid use.
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Affiliation(s)
- Shay N Nguyen
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Hsou-Mei Hu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network (OPEN), Institute for Health Policy and Evaluations, University of Michigan, Ann Arbor, MI, USA
| | - Noelle E Carlozzi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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19
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Smeallie E, Rosenthal L, Johnson A, Roslin C, Hassett AL, Choi SW. Enhancing Resilience in Family Caregivers Using an mHealth App. Appl Clin Inform 2022; 13:1194-1206. [PMID: 36283418 PMCID: PMC9771688 DOI: 10.1055/a-1967-8721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/19/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We previously developed a mobile health (mHealth) app (Roadmap) to promote the resilience of family caregivers during the acute phases of care in patients undergoing hematopoietic cell transplantation (HCT). OBJECTIVE This study explored users' perspectives on the uptake of Roadmap's multicomponent features and the app's utility in promoting resilience. METHODS Fifteen participants were randomized to the full version of the app that included resilience-building activities and the other 15 were randomized to the control version that included a limited view of the app (i.e., without any resilience-building activities). They were instructed to use the app for 120 days. Semistructured qualitative interviews were then conducted with users as part of an ongoing, larger Roadmap study (NCT04094844). During the interview, caregiver participants were asked about their overall experiences with the app, frequency of use, features used, facilitators of and barriers to use, and their perspectives on its utility in promoting resilience. Data were professionally transcribed, coded, and categorized through content analysis. RESULTS Interviews were conducted with 30 participants, which included 23 females and 7 males. The median age of the population was 58 years (range, 23-82). The four main themes that emerged included app use, ease of use, user experiences, and ability to foster resilience. The subthemes identified related to facilitators (convenience and not harmful), barriers (caregiver burden and being too overwhelmed during the acute phases of HCT care), resilience (optimism/positivity and self-care), and app design improvements (personalization and notifications/reminders). CONCLUSION The qualitative evaluation provided insights into which components were utilized and how one, or a combination of the multicomponent features, may be enhancing users' experiences. Lessons learned suggest that the Roadmap app contributed to promoting resilience during the acute phases of HCT care. Nonetheless, features that provided enhanced personalization may further improve longer-term engagement.
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Affiliation(s)
- Eleanor Smeallie
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Lindsay Rosenthal
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Amanda Johnson
- Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon, United States
| | - Chloe Roslin
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
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20
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Kaplan CM, Schrepf A, Mawla I, Ichesco E, Boehnke KF, Beltz A, Foxen-Craft E, Puglia MP, Tsodikov A, Williams DA, Hassett AL, Clauw DJ, Harte SE, Harris RE. Neurobiological antecedents of multisite pain in children. Pain 2022; 163:e596-e603. [PMID: 34382607 PMCID: PMC8720318 DOI: 10.1097/j.pain.0000000000002431] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Altered brain structure and function is evident in adults with multisite chronic pain. Although many such adults trace their pain back to childhood, it has been difficult to disentangle whether central nervous system alterations precede or are consequences of chronic pain. If the former is true, aberrant brain activity may identify children vulnerable to developing chronic pain later in life. We examined structural and functional brain magnetic resonance imaging metrics in a subset of children from the first 2 assessments of the Adolescent Brain and Cognitive Development Study. Children (aged 9-10) who were pain free at baseline and then developed multisite pain 1 year later (n = 115) were matched to control children who were pain free at both timepoints (n = 230). We analyzed brain structure (cortical thickness and gray matter volume) and function (spontaneous neural activity and functional connectivity). Results were deemed significant at the cluster level P < 0.05 false discovery rate corrected for multiple comparisons. At baseline, children who subsequently developed multisite pain had increased neural activity in superior parietal /primary somatosensory and motor cortices and decreased activity in the medial prefrontal cortex. They also exhibited stronger functional connectivity between the salience network, somatosensory, and default mode network regions. No significant differences in the brain structure were observed. Increased neural activity and functional connectivity between brain regions, consistent to that seen in adults with chronic pain, exist in children before developing multisite pain. These findings may represent a neural vulnerability to developing future chronic pain.
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Affiliation(s)
- Chelsea M Kaplan
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Ishtiaq Mawla
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Eric Ichesco
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin F Boehnke
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Adriene Beltz
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Emily Foxen-Craft
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Michael P Puglia
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alexandre Tsodikov
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - David A Williams
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, United States
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21
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Abstract
BACKGROUND AND OBJECTIVES Experiencing structural racism over the life course contributes to disproportionate pain-related disability among African American older adults. Positive STEPS, delivered by community health workers, is a culturally congruent chronic pain self-management intervention that incorporates positive psychology principles and gives attention to social determinants of pain and pain management. RESEARCH DESIGN AND METHODS We conducted a randomized pilot trial among older adults with chronic musculoskeletal pain in an underserved, primarily African American community (Detroit, Michigan). The 7-week intervention included weekly telephone sessions with a community health worker; web-based videos teaching pain self-management skills; positive activities (e.g., Life Review, Gratitude Jar); and use of wearable activity trackers. Outcomes were measured at baseline and 8-week follow-up. We assessed participant retention, engagement, and satisfaction. RESULTS Study completers (n = 46; 90% retention) were 93% African American, 89% female, mean 72 years, and completed 5.7 of 7 sessions. Intervention participants versus controls showed greater improvement in PROMIS Pain Interference (4.3-point T-score decrease vs. 0.4-point increase; p = .01) and the Pain Self-Efficacy Questionnaire (p = .007). Furthermore, compared with controls, significantly more intervention participants reported "better" or "much better" global functioning (86% vs. 25%; p = .000) and pain (67% vs. 21%; p = .003) since baseline. Improvements in physical functioning, social participation, and resilience were noted, but differences were not significant. Participant feedback on the intervention was overwhelmingly positive. DISCUSSION AND IMPLICATIONS A community health worker-led chronic pain self-management intervention combining positive activities with self-management skills training demonstrated the potential to enhance pain-related functioning among a vulnerable group of older adults. CLINICAL TRIAL NUMBER NCT04321239.
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Affiliation(s)
- Mary Janevic
- Address correspondence to: Mary Janevic, PhD, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. E-mail:
| | - Sheria G Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rebecca Courser
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth Brines
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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22
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Pierce J, Hassett AL, Brummett CM, McAfee J, Sieberg C, Schrepf A, Harte SE. Characterizing Pain and Generalized Sensory Sensitivity According to Trauma History Among Patients With Knee Osteoarthritis. Ann Behav Med 2021; 55:853-869. [PMID: 33377478 PMCID: PMC8382144 DOI: 10.1093/abm/kaaa105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood trauma and adversity have been linked to chronic pain and pain sensitivity, particularly centralized pain. Yet, there remain numerous gaps in our understanding of this link. PURPOSE We explored the association between nonviolent and violent childhood trauma and a component of centralized pain (i.e., generalized sensory sensitivity) and pain sensitivity using self-report measures of centralized pain and quantitative sensory testing (QST). METHODS Patients scheduled for a total knee arthroplasty (n = 129) completed questionnaires and QST prior to surgery. RESULTS We found that self-report measures of centralized pain (i.e., widespread pain, somatic awareness, and sensory sensitivity) displayed a graded relationship across trauma groups, with patients with a history of violent trauma reporting the highest scores. Univariable multinomial logistic regression analyses showed that higher sensory sensitivity was associated with increased risk of being in the nonviolent trauma group compared to the no trauma group. Furthermore, higher widespread pain, higher somatic awareness, and higher sensory sensitivity distinguished the violent trauma group from the no trauma group. In multivariable analyses, sensory sensitivity is uniquely distinguished between the violent trauma group and the no trauma group. QST did not distinguish between groups. CONCLUSIONS The findings highlight the need for future research and interventions that reduce sensory sensitivity for chronic pain patients with a history of violent childhood trauma.
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Affiliation(s)
- Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Jenna McAfee
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Christine Sieberg
- Center for Pain and the Brain, Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Back and Pain Center, Ann Arbor, MI, USA
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23
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Larach DB, Sahara MJ, As-Sanie S, Moser SE, Urquhart AG, Lin J, Hassett AL, Wakeford JA, Clauw DJ, Waljee JF, Brummett CM. Patient Factors Associated With Opioid Consumption in the Month Following Major Surgery. Ann Surg 2021; 273:507-515. [PMID: 31389832 PMCID: PMC7068729 DOI: 10.1097/sla.0000000000003509] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to determine preoperative patient characteristics associated with postoperative outpatient opioid use and assess the frequency of postoperative opioid overprescribing. SUMMARY BACKGROUND DATA Although characteristics associated with inpatient opioid use have been described, data regarding patient factors associated with opioid use after discharge are lacking. This hampers the development of individualized approaches to postoperative prescribing. METHODS We included opioid-naïve patients undergoing hysterectomy, thoracic surgery, and total knee and hip arthroplasty in a single-center prospective observational cohort study. Preoperative phenotyping included self-report measures to assess pain severity, fibromyalgia survey criteria score, pain catastrophizing, depression, anxiety, functional status, fatigue, and sleep disturbance. Our primary outcome measure was self-reported total opioid use in oral morphine equivalents. We constructed multivariable linear-regression models predicting opioids consumed in the first month following surgery. RESULTS We enrolled 1181 patients; 1001 had complete primary outcome data and 913 had complete phenotype data. Younger age, non-white race, lack of a college degree, higher anxiety, greater sleep disturbance, heavy alcohol use, current tobacco use, and larger initial opioid prescription size were significantly associated with increased opioid consumption. Median total oral morphine equivalents prescribed was 600 mg (equivalent to one hundred twenty 5-mg hydrocodone pills), whereas median opioid consumption was 188 mg (38 pills). CONCLUSIONS In this prospective cohort of opioid-naïve patients undergoing major surgery, we found a number of characteristics associated with greater opioid use in the first month after surgery. Future studies should address the use of non-opioid medications and behavioral therapies in the perioperative period for these higher risk patients.
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Affiliation(s)
- Daniel B. Larach
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | | | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Andrew G. Urquhart
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Jules Lin
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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24
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Shin JY, Chaar D, Kedroske J, Vue R, Chappell G, Mazzoli A, Hassett AL, Hanauer DA, Park SY, Debra B, Choi SW. Harnessing mobile health technology to support long-term chronic illness management: exploring family caregiver support needs in the outpatient setting. JAMIA Open 2020; 3:593-601. [PMID: 33758797 PMCID: PMC7969961 DOI: 10.1093/jamiaopen/ooaa053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Family caregiving is an important public health issue, particularly with the aging population. In recent years, mobile health (mHealth) technology has emerged as a potential low-cost, scalable platform to address caregiver support needs, and thereby alleviate the burden on caregivers. This study sought to examine the support needs of family caregivers in their lived experiences of outpatient care to inform the development of a future mHealth intervention. MATERAILS AND METHODS We conducted 20 semi-structured interviews in 2 outpatient hematopoietic cell transplant (HCT) clinics at a large academic medical center in the Midwestern United States. A thematic analysis was performed to define emerging themes. RESULTS Qualitative data analysis identified 5 primary themes that HCT caregivers faced: (I) lifestyle restrictions due to the patient's immunocompromised state; (II) Unmet needs due to limitations in the current resources, including unfamiliar medical tasks without necessary trainings; and (III) caregivers' adaptive strategies, including reformation of social relationships with family and friends. Based on these findings, we suggest 3 design considerations to guide the development of a future mHealth intervention. CONCLUSIONS The findings herein captured the family caregiver's lived experiences during outpatient care. There was broad agreement that caregiving was challenging and stressful. Thus, effective and scalable interventions to support caregivers are needed. This study provided data to guide the content and design of a future mHealth intervention in the outpatient setting.
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Affiliation(s)
- Ji Youn Shin
- Department of Media and Information, College of Communication Arts and Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Dima Chaar
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacob Kedroske
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca Vue
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Grant Chappell
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Mazzoli
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Hanauer
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, Michigan, USA
- Stamps School of Arts and Design, University of Michigan, Ann Arbor, Michigan, USA
| | - Barton Debra
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Won Choi
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
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25
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Hassett AL, Whibley D, Kratz A, Williams DA. Measures for the Assessment of Pain in Adults. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:342-357. [PMID: 33091243 DOI: 10.1002/acr.24222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | - Daniel Whibley
- University of Michigan, Ann Arbor, and University of Aberdeen, Aberdeen, Scotland
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26
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Charoenwoodhipong P, Harlow SD, Marder W, Hassett AL, McCune WJ, Gordon C, Helmick CG, Barbour KE, Wang L, Mancuso P, Somers EC, Zick SM. Dietary Omega Polyunsaturated Fatty Acid Intake and Patient-Reported Outcomes in Systemic Lupus Erythematosus: The Michigan Lupus Epidemiology and Surveillance Program. Arthritis Care Res (Hoboken) 2020; 72:874-881. [PMID: 31074595 PMCID: PMC6842394 DOI: 10.1002/acr.23925] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/07/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine associations between dietary intake of omega-3 (n-3; generally antiinflammatory) and omega-6 (n-6; generally proinflammatory) fatty acids and patient-reported outcomes in systemic lupus erythematosus (SLE). METHODS This study was based on the population-based Michigan Lupus Epidemiology and Surveillance cohort. Estimates of n-3 and n-6 intake were derived from Diet History Questionnaire II items (past year with portion size version). Patient-reported outcomes included self-reported lupus activity (Systemic Lupus Activity Questionnaire [SLAQ]). Multivariable regression, adjusted for age, sex, race, and body mass index, was used to assess associations between absolute intake of n-3 and n-6, as well as the n-6:n-3 ratio, and patient-reported outcomes. RESULTS Among 456 SLE cases, 425 (93.2%) were female, 207 (45.4%) were African American, and the mean ± SD age was 52.9 ± 12.3 years. Controlling for potential confounders, the average SLAQ score was significantly higher by 0.3 points (95% confidence interval [95% CI] 0.1, 0.6; P = 0.013) with each unit increase of the n-6:n-3 ratio. Both lupus activity and Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were lower with each 1-gram/1,000 kcal increase of n-3 fatty acids (SLAQ regression coefficient β = -0.8 [95% CI -1.6, 0.0]; P = 0.055; PROMIS sleep β = -1.1 [95% CI -2.0, -0.2]; P = 0.017). Higher n-3 intakes were nonsignificantly associated with lower levels of depressive symptoms and comorbid fibromyalgia, and with higher quality of life, whereas results for the n6:n3 ratio trended in the opposite direction. CONCLUSION This population-based study suggests that higher dietary intake of n-3 fatty acids and lower n-6:n-3 ratios are favorably associated with patient-reported outcomes in SLE, particularly self-reported lupus activity and sleep quality.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lu Wang
- University of MichiganAnn Arbor
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27
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Rozwadowski M, Dittakavi M, Mazzoli A, Hassett AL, Braun T, Barton DL, Carlozzi N, Sen S, Tewari M, Hanauer DA, Choi SW. Promoting Health and Well-Being Through Mobile Health Technology (Roadmap 2.0) in Family Caregivers and Patients Undergoing Hematopoietic Stem Cell Transplantation: Protocol for the Development of a Mobile Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19288. [PMID: 32945777 PMCID: PMC7532463 DOI: 10.2196/19288] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cancer patients who undergo allogeneic hematopoietic stem cell transplantation are among the most medically fragile patient populations with extreme demands for caregivers. Indeed, with earlier hospital discharges, the demands placed on caregivers continue to intensify. Moreover, an increased number of allogeneic hematopoietic stem cell transplantations are being performed worldwide, and this expensive procedure has significant economic consequences. Thus, the health and well-being of family caregivers have attracted widespread attention. Mobile health technology has been shown to deliver flexible, and time- and cost-sparing interventions to support family caregivers across the care trajectory. Objective This protocol aims to leverage technology to deliver a novel caregiver-facing mobile health intervention named Roadmap 2.0. We will evaluate the effectiveness of Roadmap 2.0 in family caregivers of patients undergoing hematopoietic stem cell transplantation. Methods The Roadmap 2.0 intervention will consist of a mobile randomized trial comparing a positive psychology intervention arm with a control arm in family caregiver-patient dyads. The primary outcome will be caregiver health-related quality of life, as assessed by the PROMIS Global Health scale at day 120 post-transplant. Secondary outcomes will include other PROMIS caregiver- and patient-reported outcomes, including companionship, self-efficacy for managing symptoms, self-efficacy for managing daily activities, positive affect and well-being, sleep disturbance, depression, and anxiety. Semistructured qualitative interviews will be conducted among participants at the completion of the study. We will also measure objective physiological markers (eg, sleep, activity, heart rate) through wearable wrist sensors and health care utilization data through electronic health records. Results We plan to enroll 166 family caregiver-patient dyads for the full data analysis. The study has received Institutional Review Board approval as well as Code Review and Information Assurance approval from our health information technology services. Owing to the COVID-19 pandemic, the study has been briefly put on hold. However, recruitment began in August 2020. We have converted all recruitment, enrollment, and onboarding processes to be conducted remotely through video telehealth. Consent will be obtained electronically through the Roadmap 2.0 app. Conclusions This mobile randomized trial will determine if positive psychology-based activities delivered through mobile health technology can improve caregiver health-related quality of life over a 16-week study period. This study will provide additional data on the effects of wearable wrist sensors on caregiver and patient self-report outcomes. Trial Registration ClinicalTrials.gov NCT04094844; https://www.clinicaltrials.gov/ct2/show/NCT04094844 International Registered Report Identifier (IRRID) PRR1-10.2196/19288
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Affiliation(s)
- Michelle Rozwadowski
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Manasa Dittakavi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesia, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Muneesh Tewari
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David A Hanauer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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28
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Minhas D, Marder W, Harlow S, Hassett AL, Zick SM, Gordon C, Barbour KE, Helmick CG, Wang L, Lee J, Padda A, McCune WJ, Somers EC. Access and cost-related non-adherence to prescription medications among lupus cases and controls: the Michigan Lupus Epidemiology & Surveillance (MILES) Program. Arthritis Care Res (Hoboken) 2020; 73:1561-1567. [PMID: 32741110 PMCID: PMC9219566 DOI: 10.1002/acr.24397] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/21/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Medication access and adherence are important determinants of health outcomes. We investigated factors associated with access and cost-related non-adherence to prescriptions in a population-based cohort of systemic lupus erythematosus (SLE) patients and controls. METHODS Detailed sociodemographic and prescription data were collected by structured interview in 2014-2015 from participants in the Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We compared access between cases and frequency-matched controls and examined associated factors in separate multivariable logistic regression models. RESULTS 654 participants (462 SLE cases, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) black, and mean age was 53 years. SLE cases and controls reported similar frequencies of being unable to access prescribed medications (12.1% vs 9.4%, respectively; p=NS). SLE patients were twice as likely as controls to report cost-related prescription non-adherence in the preceding 12 months to save money (21.7% vs 10.4%; p=0.001), but also more likely to ask their doctor for lower cost alternatives (23.8% vs 15.6%, p=0.02). Disparities were found in association with income, race and health insurance status, but main findings persisted after adjusting for these and other variables in multivariable models. CONCLUSION SLE patients were more likely than controls from the general population to report cost-related prescription non-adherence, including skipping doses, taking less medicine and delaying filling prescriptions, yet less than 1 in 4 patients asked providers for lower cost medications. Consideration of medication costs in patient decision-making could provide a meaningful avenue for improving access and adherence to medications.
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Affiliation(s)
- Deeba Minhas
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Wendy Marder
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Sioban Harlow
- Dept. of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Afton L Hassett
- Dept. of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Suzanna M Zick
- Dept. of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, United States
| | | | - Lu Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI, USA
| | - Jiha Lee
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Amrita Padda
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - W Joseph McCune
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Emily C Somers
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.,University of Michigan, Department of Environmental Health Sciences, Ann Arbor, MI, USA.,University of Michigan, Department of Obstetrics & Gynecology, Ann Arbor, MI, USA
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29
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Pierce J, Hassett AL, Schneiderhan JR, Divers J, Brummett CM, Goesling J. Centralized pain and pain catastrophizing mediate the association between lifetime abuse history and self-reported pain medication side effects. Reg Anesth Pain Med 2020; 45:293-300. [DOI: 10.1136/rapm-2019-101130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 12/12/2022]
Abstract
BackgroundSelf-reported side effects of pain medication are important determinants of treatment course that can affect patient adherence, medication discontinuation and physician decisions. Yet, few studies have investigated patient-level predictors of self-reported pain medication side effects. The present study sought to fill this gap by exploring the impact of physical or sexual abuse history on self-reported pain medication side effects and considered a mediation model in which those effects are transmitted through a centralized pain phenotype and pain catastrophizing.MethodsWe conducted a cross-sectional analysis of 3118 patients presenting to a tertiary-care, outpatient pain clinic.ResultsApproximately 15% of the sample (n=479) reported a lifetime history of abuse. Patients with a lifetime history of abuse, particularly abuse that occurred in both childhood and adulthood, reported more pain medication side effects compared with patients reporting no abuse history. Furthermore, path analysis showed that a centralized pain phenotype and pain catastrophizing mediated the association between lifetime abuse history and the sum of pain medication side effects.ConclusionsThis suggests that individuals who experience abuse may develop a heightened physiological sensitivity to stimuli, as well as a tendency to interpret stimuli negatively, exaggerate the impact of aversive stimuli and undermine their ability to cope with the stressor. This study highlights the need for physicians to understand patient-level predictors of medication tolerance and to consider a history of abuse and trauma in decisions regarding treatment and medication management.
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Hassett AL, Pierce J, Goesling J, Fritsch L, Bakshi RR, Kohns DJ, Brummett CM. Initial validation of the electronic form of the Michigan Body Map. Reg Anesth Pain Med 2019; 45:rapm-2019-101084. [PMID: 31857372 DOI: 10.1136/rapm-2019-101084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Michigan Body Map (MBM) was developed to assess pain location in a reliable and valid manner; however, electronic formats have not been validated. This study had two aims: (1) initial validation of the electronic form of the MBM (eMBM) and (2) preliminary test of assessing pain severity within body zones. METHODS For the first aim, 68 participants with chronic pain completed paper and electronic forms of the MBM, then underwent scripted interviews to assess preferences among body maps and verbal confirmation of pain locations. For the second aim, a subset of the participants (n=40) completed the Brief Pain Inventory (BPI) pain severity subscale, as well as the eMBM again and endorsed pain severity using additional screens showing body zones that contained areas in which pain was endorsed. RESULTS There were few discrepancies between MBM, eMBM and verbal report (1.9% and 1.6%, respectively), and no difference between forms in perceived ability to indicate areas of pain or ease of completion. Patients accurately indicated their bodily pain on both maps, with 84% and 87% reporting one or no errors on MBM and eMBM, respectively. Participants also reported no preference for which version best-depicted areas of pain or best distinguished left from right. Lastly, the most preferred measure was eMBM with pain severity zones, followed by eMBM without zones, followed by the BPI pain severity subscale. CONCLUSIONS These data support the validity of the eMBM for patients with chronic pain. Further, an expanded form of the eMBM that assesses pain severity was preferred by most participants.
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Affiliation(s)
- Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Fritsch
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rishi R Bakshi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - David J Kohns
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Chaar D, Shin JY, Mazzoli A, Vue R, Kedroske J, Chappell G, Hanauer DA, Barton D, Hassett AL, Choi SW. A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations. JMIR Mhealth Uhealth 2019; 7:e15775. [PMID: 31651402 PMCID: PMC6913725 DOI: 10.2196/15775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver–facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants’ homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one’s own needs with the patient’s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a “menu” of positive activities to help support caregiver health and well-being. Conclusions This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.4918
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Affiliation(s)
- Dima Chaar
- University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Ji Youn Shin
- Michigan State University, College of Communication Arts and Sciences, Department of Media and Information, East Lansing, MI, United States
| | - Amanda Mazzoli
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Rebecca Vue
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Jacob Kedroske
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Grant Chappell
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - David A Hanauer
- University of Michigan, Medical School, Michigan Institute for Clinical and Health Research, Ann Arbor, MI, United States
| | - Debra Barton
- University of Michigan, School of Nursing, Ann Arbor, MI, United States
| | - Afton L Hassett
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Sung Won Choi
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
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Somers EC, Lee J, Hassett AL, Zick SM, Harlow SD, Helmick CG, Barbour KE, Gordon C, Brummett CM, Minhas D, Padda A, Wang L, McCune WJ, Marder W. Prescription Opioid Use in Patients With and Without Systemic Lupus Erythematosus - Michigan Lupus Epidemiology and Surveillance Program, 2014-2015. MMWR Morb Mortal Wkly Rep 2019; 68:819-824. [PMID: 31557148 PMCID: PMC6762189 DOI: 10.15585/mmwr.mm6838a2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Frey DP, Bauer ME, Bell CL, Low LK, Hassett AL, Cassidy RB, Boyer KD, Sharar SR. Virtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women. Anesth Analg 2019; 128:e93-e96. [PMID: 31094789 DOI: 10.1213/ane.0000000000003649] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This pilot study investigated the use of virtual reality (VR) in laboring women. Twenty-seven women were observed for equivalent time during unmedicated contractions in the first stage of labor both with and without VR (order balanced and randomized). Numeric rating scale scores were collected after both study conditions. Significant decreases in sensory pain -1.5 (95% CI, -0.8 to -2.2), affective pain -2.5 (95% CI, -1.6 to -3.3), cognitive pain -3.1 (95% CI, -2.4 to -3.8), and anxiety -1.5 (95% CI, -0.8 to -2.3) were observed during VR. Results suggest that VR is a potentially effective technique for improving pain and anxiety during labor.
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Affiliation(s)
| | | | - Carrie L Bell
- Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lisa Kane Low
- School of Nursing, Women's Studies, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Sam R Sharar
- Department of Anesthesiology, University of Washington Harborview Medical Center, Seattle, Washington
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Morffi D, Larach DB, Moser SE, Goesling J, Hassett AL, Brummett CM. Medial branch radiofrequency ablation outcomes in patients with centralized pain. Reg Anesth Pain Med 2019; 44:rapm-2018-100275. [PMID: 31048494 DOI: 10.1136/rapm-2018-100275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES We hypothesized that patients with characteristics of centralized pain (fibromyalgia (FM)-like phenotype) would be less likely to respond to radiofrequency ablation (RFA), which may explain some of the failures of this peripherally directed therapy. METHODS We conducted a prospective, observational study of patients undergoing RFA using a number of validated self-report measures of pain, mood and function. The 2011 Fibromyalgia Survey Criteria were used to assess for symptoms of centralized pain and was the primary predictor of interest. We constructed multivariable linear regression models to evaluate covariates independently associated with change in pain 3 months after RFA. RESULTS 141 patients scheduled for medial branch blocks were enrolled in the study; 55 underwent RFA (51 with complete 3 months' follow-up). Patients with higher FM scores had less improvement in overall body pain; however, this was not statistically significant (adjusted mean change in pain FM+0.41, FM-1.11, p=0.396). In a secondary analysis, the FM score was not associated with change in back pain (p=0.720), with both groups improving equally. This cohort also reported significant improvement in anxiety, physical function, catastrophizing, and sleep disturbance at 3 months after RFA. CONCLUSIONS Although patients with high baseline centralized pain exhibited less improvement in overall pain, this trend was not statistically significant, possibly due to insufficient power. The same trend was not seen with change in spine pain with both groups improving equally. Centralized pain patients may have less improvement in overall pain but may have equal improvement in their site-specific pain levels after localized interventions.
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Affiliation(s)
- Dayaris Morffi
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel B Larach
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jenna Goesling
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Goesling J, Moser SE, Lin LA, Hassett AL, Wasserman RA, Brummett CM. Discrepancies Between Perceived Benefit of Opioids and Self-Reported Patient Outcomes. Pain Med 2019; 19:297-306. [PMID: 28034978 PMCID: PMC5914338 DOI: 10.1093/pm/pnw263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective There is little empirical evidence supporting the long-term use of opioid therapy for chronic pain, suggesting the need to reevaluate the role of opioids in chronic pain management. Few studies have considered opioid use and opioid cessation from the perspective of the patient. Methods This prospective structured interview study included 150 new patients seeking treatment for chronic pain at an outpatient tertiary care pain clinic. Results Of the 150 patients, 56% (N = 84) reported current opioid use. Opioids users reported higher pain severity (t(137) = -3.75, P < 0.001), worse physical functioning (t(136) = -3.82, P < 0.001), and more symptoms of depression (t(136) = -1.98, P = 0.050) than nonusers. Among opioid users, 45.6% reported high pain (>7), 60.8% reported low functioning (>7), and 71.4% reported less than a 30% reduction in pain severity since starting opioids, suggesting that many patients are unlikely to be receiving adequate benefit. Overall, 66.3% of current opioid users reported moderate to high opioid-related difficulties on the prescribed opioids difficulties scale, and patients with depression were more likely to report greater difficulties. There was no association between helpfulness of opioids over the past month and opioid-related difficulties (r(75) = -0.07, P = 0.559), current pain severity (r(72)=0.05, P = 0.705), or current pain interference (r(72) = 0.20, P = 0.095). Conclusions Despite clinical indicators that question the benefit, patients may continue to report that their opioids are helpful. Such discrepancies in patients' perceptions will likely pose significant barriers for implementing opioid cessation guidelines in clinical practice.
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Affiliation(s)
- Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie E Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lewei A Lin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Afton L Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald A Wasserman
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
IMPORTANCE Pain after deployment is a major health care concern. While risk factors have been previously studied, few studies have explored protective factors. OBJECTIVE To examine the prospective association between predeployment optimism and the onset of new pain after deployment in US Army soldiers. DESIGN, SETTING, AND PARTICIPANTS This prospective longitudinal cohort study examined US Army soldiers (active duty, Reserve, and National Guard) who deployed to Afghanistan or Iraq between February 12, 2010, and August 29, 2014, and completed the necessary psychological and health assessments before and after deployment. Analyses were performed in the Person-Event Data Environment between July 2016 and November 2018. This study relied exclusively on existing, secondary Army data. Of the 413 763 Army soldiers who met the specified deployment criteria, 385 925 soldiers were missing 1 or more of the required assessment forms. Of the remaining 27 838 soldiers who were examined for eligibility, 7104 soldiers were excluded because of preexisting back pain, joint pain, or frequent headaches. These exclusions resulted in a final analytic sample of 20 734 eligible soldiers. MAIN OUTCOMES AND MEASURES This study examined new reports of pain after deployment, including new back pain, joint pain, and frequent headaches. RESULTS Among 20 734 US Army soldiers (87.8% male; mean [SD] age, 29.06 [8.42] years), 37.3% reported pain in at least 1 new area of the body after deployment: 25.3% reported new back pain, 23.1% reported new joint pain, and 12.1% reported new frequent headaches. As a continuous measure, each 1-U increase in optimism was associated with 11% lower odds of reporting any new pain after deployment, even while adjusting for demographic, military, and combat factors (odds ratio, 0.89; 95% CI, 0.86-0.93). Tertile analyses revealed that compared with soldiers with high optimism (lowest odds of new pain) soldiers with low optimism had 35% greater odds of reporting new pain in any of the 3 sites evaluated (odds ratio, 1.35; 95% CI, 1.21-1.50). In addition, a larger increase in risk of new pain was observed when comparing the moderate-optimism and low-optimism groups rather than the high-optimism and moderate-optimism groups. CONCLUSIONS AND RELEVANCE Higher levels of optimism were associated with lower odds of reporting new pain after deployment, over and above other common determinants of pain, including demographic and military characteristics and combat experiences. Soldiers with low levels of optimism before deployment could benefit from programs geared toward enhancing optimism.
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Affiliation(s)
- Afton L. Hassett
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
| | - Joseph A. Fisher
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Loryana L. Vie
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Whitney L. Kelley
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
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Affiliation(s)
- Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Harvey WF, Hassett AL, Lakhanpal S. Editorial: Ensuring the Future of Rheumatology: A Multi-Dimensional Challenge and Call to Action. Arthritis Rheumatol 2018; 70:797-800. [DOI: 10.1002/art.40431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Sharad Lakhanpal
- Rheumatology Associates and UT Southwestern Medical Center; Dallas Texas
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Geenen R, Overman CL, Christensen R, Åsenlöf P, Capela S, Huisinga KL, Husebø MEP, Köke AJA, Paskins Z, Pitsillidou IA, Savel C, Austin J, Hassett AL, Severijns G, Stoffer-Marx M, Vlaeyen JWS, Fernández-de-Las-Peñas C, Ryan SJ, Bergman S. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018; 77:797-807. [PMID: 29724726 DOI: 10.1136/annrheumdis-2017-212662] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/21/2018] [Accepted: 03/28/2018] [Indexed: 01/19/2023]
Abstract
Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.
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Affiliation(s)
- Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Cécile L Overman
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Susana Capela
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Faculty of Medicine, Lisbon Academic Medical Centre, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Karen L Huisinga
- Department of Rheumatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Mai Elin P Husebø
- Norwegian National Unit for Rehabilitation for Rheumatic Patients with Special Needs, NBRR, Diakonhjemmet Hospital, Oslo, Norway
| | - Albère J A Köke
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands
| | - Zoe Paskins
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Carine Savel
- Department of Rheumatology, CHU, Clermont Ferrand, Clermont Ferrand, France
| | - Judith Austin
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Afton L Hassett
- Department of Anesthesiology, Division of Pain Research, Chronic Pain & Fatigue Research Center, University of Michigan Medical School, Ann Harbor, Michigan, USA
| | - Guy Severijns
- EULAR Social Leagues Patients' Representative, Leuven, Belgium
| | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Department of Health Sciences, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Johan W S Vlaeyen
- Research group Health Psychology, University of Leuven, Leuven, Belgium.,Behavioral Medicine Research, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - César Fernández-de-Las-Peñas
- Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Sarah J Ryan
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Stefan Bergman
- Department of Public Health and Community Medicine, Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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van der Heijde D, Daikh DI, Betteridge N, Burmester GR, Hassett AL, Matteson EL, van Vollenhoven R, Lakhanpal S. Common Language Description of the Term Rheumatic and Musculoskeletal Diseases (RMDs) for Use in Communication With the Lay Public, Healthcare Providers, and Other Stakeholders Endorsed by the European League Against Rheumatism (EULAR) and the American Co. Arthritis Rheumatol 2018. [DOI: 10.1002/art.40448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | - David I. Daikh
- University of California San Francisco and San Francisco VA Medical Center; San Francisco California
| | | | - Gerd R. Burmester
- Charité-University Medicine Berlin; Free University, and Humboldt University Berlin; Berlin Germany
| | | | | | | | - Sharad Lakhanpal
- Rheumatology Associates and UT Southwestern Medical Center; Dallas Texas
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Scott JR, Hassett AL, Schrepf AD, Brummett CM, Harris RE, Clauw DJ, Harte SE. Moderate Alcohol Consumption Is Associated with Reduced Pain and Fibromyalgia Symptoms in Chronic Pain Patients. Pain Medicine 2018; 19:2515-2527. [DOI: 10.1093/pm/pny032] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- J Ryan Scott
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
| | - Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
| | - Andrew D Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
| | - Chad M Brummett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Chronic Pain and Fatigue Research Center
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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van der Heijde D, Daikh DI, Betteridge N, Burmester GR, Hassett AL, Matteson EL, van Vollenhoven R, Lakhanpal S. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Ann Rheum Dis 2018. [PMID: 29525777 DOI: 10.1136/annrheumdis-2017-212565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A European League Against Rheumatism-American College of Rheumatology working group consisting of practising and academic rheumatologists, a rheumatology researcher and a patient representative created a succinct general statement describing rheumatic and musculoskeletal diseases (RMDs) in adults and children in language that can be used in conversations with the lay public, media, healthcare providers and other stakeholders. Based on the literature review, several elements were deemed important for inclusion in the description of RMDs. First, RMDs encompass many different diseases that can affect individuals at any age, including children. Second, there are various pathophysiological pathways underlying different RMDs. Third, the impact of RMDs on individuals and society should be emphasised. The working group agreed that the language should be comprehensible to the lay public. Thus, the following description of RMDs has been developed: 'Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can affect any organ of the body. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscles and bones. Many of these diseases are long term and worsen over time. They are typically painful and limit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.' This description can be used by rheumatology groups, researchers and those who work in advocacy and education related to RMDs.
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Affiliation(s)
| | - David I Daikh
- Division of Rheumatology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric L Matteson
- Division of Rheumatology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Sharad Lakhanpal
- Rheumatology Associates, UT Southwestern Medical Center, Dallas, Texas, USA
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Hassett AL, Marshall E, Bailey AM, Moser S, Clauw DJ, Hooten WM, Urquhart A, Brummett CM. Changes in Anxiety and Depression Are Mediated by Changes in Pain Severity in Patients Undergoing Lower-Extremity Total Joint Arthroplasty. Reg Anesth Pain Med 2018; 43:14-18. [PMID: 29077589 PMCID: PMC5738285 DOI: 10.1097/aap.0000000000000682] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression and anxiety are common comorbidities in chronic pain including osteoarthritis patients undergoing total joint arthroplasty (TJA). What is not clear is whether psychiatric comorbidity precedes the manifestation of painful states or represents a reaction to living with chronic pain and associated functional impairment. The objective of this research was to explore whether decreases in depressive and anxiety symptoms after lower-extremity TJA could be due to postsurgical reductions in pain. METHODS We conducted a secondary analysis of data from 1448 TJA patients enrolled in the Analgesics Outcome Study. Patients completed measures of pain intensity, functional status, and depressive and anxiety symptoms preoperatively and at 3 and 6 months postoperatively. Data were analyzed using a structural equation modeling approach. RESULTS We found that improvement in pain and physical function from baseline to 6 months postoperatively was associated with improvement in depression and anxiety symptoms. We also found that a change in overall body pain at 3 months after surgery significantly mediated changes in both the depression and anxiety scores at 6 months after surgery even when controlling for age, sex, baseline body pain, education, opioid use, and type of surgery. CONCLUSIONS Presurgical affective symptoms not only have an effect on change in postsurgical pain, whereby lower preoperative scores on depression and anxiety were associated with lower postsurgical pain, but also postsurgical decreases in pain were associated with lower levels of depression and anxiety after surgery. Taking these points into consideration may prove useful in working toward better outcomes for TJA.
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MESH Headings
- Aged
- Anxiety/diagnosis
- Anxiety/psychology
- Arthralgia/diagnosis
- Arthralgia/physiopathology
- Arthralgia/psychology
- Arthralgia/surgery
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/psychology
- Chronic Pain/diagnosis
- Chronic Pain/physiopathology
- Chronic Pain/psychology
- Chronic Pain/surgery
- Depression/diagnosis
- Depression/psychology
- Female
- Health Status
- Humans
- Male
- Mental Health
- Middle Aged
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/psychology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/psychology
- Osteoarthritis, Knee/surgery
- Pain Measurement
- Recovery of Function
- Risk Factors
- Self Report
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Angela M. Bailey
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Stephanie Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - W. Michael Hooten
- Department of Anesthesiology and Pain Medicine, Mayo Clinic, Rochester, MN
| | - Andrew Urquhart
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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Hassett AL, Goesling J, Mathur SN, Moser SE, Brummett CM, Sibille KT. Affect and Low Back Pain: More to Consider Than the Influence of Negative Affect Alone. Clin J Pain 2017; 32:907-14. [PMID: 26889620 DOI: 10.1097/ajp.0000000000000350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Affect balance style, a measure of trait positive affect (PA) and negative affect (NA), is predictive of pain and functioning in fibromyalgia and healthy individuals. The purpose of this study was to evaluate the distribution of affect balance styles and the relationship between these styles and clinical factors in low back pain. METHODS In this cross-sectional study, patients with low back pain (N=443) completed questionnaires and were categorized as having 1 of 4 distinct affect balance styles: Healthy (high levels of PA and low levels of NA), Low (low PA/low NA), Reactive (high PA/high NA), and Depressive (low PA/high NA). Comparisons between groups were made in regard to pain, functioning, and psychiatric comorbidity. RESULTS High NA was observed in 63% (n=281), whereas low PA was present in 81% (n=359). We found that having a Depressive style was associated with greater pain severity, increased odds for comorbid fibromyalgia, and worse functioning compared with having a Healthy or Low style. Yet, those with a Low style were at increased risk for depression compared with a Healthy style, whereas patients with a Reactive style had similar levels of pain, functioning, and depression as those with a Healthy affective style. CONCLUSIONS Our study revealed that there are important differences between trait affect balance styles in regard to pain, mood, and functioning in low back pain. Findings related to Reactive and Low affective styles suggest that relationships between affect, pain, and disability in low back pain extend beyond considering NA alone.
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Affiliation(s)
- Afton L Hassett
- *Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI †NeuroSpinecare Inc., Cleveland, OH ‡Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
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Clauw DJ, Hassett AL. The role of centralised pain in osteoarthritis. Clin Exp Rheumatol 2017; 35 Suppl 107:79-84. [PMID: 28967359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
The mechanisms underlying chronic pain states, including osteoarthritis, differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors often play a particularly prominent role. In many individuals with chronic pain, pain can occur with minimal or no evidence of ongoing nociceptive input. Medical subspecialties have applied a wide-range of labels to these pain conditions including fibromyalgia, irritable bowel syndrome and interstitial cystitis to name just a few. These same CNS processes can augment or magnify pain when there is ongoing nociceptive input, as in conditions such as osteoarthritis or autoimmune disorders. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable though the use of experimental sensory testing, that has been corroborated by functional neuroimaging. Characteristic symptoms of these central pain conditions include multifocal pain, fatigue, poor sleep, memory complaints and frequent co-morbid mood and anxiety disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants. While osteoarthritis is generally considered a peripherally mediated pain state, a subset of these patients also manifests centrally driven pain characteristics. Thus, osteoarthritis can also be thought of as a "mixed" pain state and this requires a more tailored approach to treatment.
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Affiliation(s)
- Daniel J Clauw
- Department of Anesthesiology and Medicine, Rheumatology, Chronic Pain and Fatigue Research Center, the University of Michigan, Ann Arbor, USA.
| | - Afton L Hassett
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, The University of Michigan, Ann Arbor, USA
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Borenstein DG, Hassett AL, Pisetsky D. Pain management in rheumatology research, training, and practice. Clin Exp Rheumatol 2017; 35 Suppl 107:2-7. [PMID: 28967362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
The Pain Management Task Force of the American College of Rheumatology published a report in 2010 highlighting pain management as a fundamental aspect of clinical practice, training and research. In the interim, the consideration of pain as a focus of attention of rheumatologists and rheumatology health professionals has become even more challenging than in 2010 because of the epidemic of opiate addiction and overdose death. The characterisation of categories of pain by mechanism (e.g., inflammation, joint degeneration, abnormalities of central pain processing) can help guide treatment. However, such categorisation can overlook the overlap of these processes and their interaction to create mixed pain states. Further complicating the assessment of pain, outcome measures in rheumatic disease often assess the degree of pain indirectly while concentrating on the quantification of inflammation. Non-inflammatory pain often persists despite treatment, highlighting the need for alternative analgesic therapies. Recommended therapies include acetaminophen, nonsteroidal anti-inflammatory drugs, and stimulators of the pain inhibitory pathway. Each of these non-opioid therapies has incomplete efficacy and potential toxicities that can limit their utility. Non-pharmacologic therapies can show efficacy that rivals or surpasses pharmacologic therapies in the control of pain and improving function in a variety of rheumatic disorders including chronic low back pain and fibromyalgia. A limitation of the use of these therapies is inadequate training and appreciation of their benefits. Furthermore, the supply of trained practitioners to provide non-pharmacological care and support patient efforts for self-management is often limited. Together, these considerations suggest the importance of a renewed effort to implement task force recommendations.
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Affiliation(s)
- David G Borenstein
- The George Washington University Medical Center, Partner, Arthritis and Rheumatism Associates, Washington, DC, USA.
| | - Afton L Hassett
- Department of Anesthesiology, Division of Pain Research, University of Michigan Medical School, Ann Arbor, MI, USA
| | - David Pisetsky
- Duke University Medical Center, Medical Research Service, Durham NC, USA
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Abstract
Background Caffeine’s properties as an analgesic adjuvant with nonsteroidal anti-inflammatory drugs/acetaminophen are well documented. However, little clinical research has explored caffeine’s effects on opioid analgesia. This study assessed the effects of caffeine consumption on pain and other symptoms in opioid-using and nonusing chronic pain patients meeting the survey criteria for fibromyalgia. Materials and methods Patients presenting to a university-based pain clinic completed validated self-report questionnaires assessing symptoms. Patients (N=962) meeting the fibromyalgia survey criteria were stratified by opioid use and further split into groups based on caffeine amount consumed per day (no caffeine, or low, moderate, high caffeine). Analysis of covariance with Dunnett’s post hoc testing compared pain and symptom severity between the no caffeine group and the caffeine consuming groups. Results In opioid users, caffeine consumption had modest but significant effects on pain, catastrophizing, and physical function. Lower levels of pain interference were associated with low and moderate caffeine use compared to no caffeine intake. Lower pain catastrophizing and higher physical function were observed in all caffeine dose groups, relative to the no caffeine group. Lower pain severity and depression were observed only in the moderate caffeine group. In opioid nonusers, low caffeine intake was associated with higher physical function; however, no other significant effects were observed. Conclusion Caffeine consumption was associated with decreased pain and symptom severity in opioid users, but not in opioid nonusers, indicating caffeine may act as an opioid adjuvant in fibromyalgia-like chronic pain patients. These data suggest that caffeine consumption concomitant with opioid analgesics could provide therapeutic benefits not seen with opioids or caffeine alone.
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Affiliation(s)
- J Ryan Scott
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Afton L Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Chad M Brummett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
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Voepel-Lewis T, Caird MS, Tait AR, Malviya S, Farley FA, Li Y, Abbott MD, van Veen T, Hassett AL, Clauw DJ. A High Preoperative Pain and Symptom Profile Predicts Worse Pain Outcomes for Children After Spine Fusion Surgery. Anesth Analg 2017; 124:1594-1602. [DOI: 10.1213/ane.0000000000001963] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wasserman RA, Hassett AL, Harte SE, Goesling J, Malinoff HL, Berland DW, Zollars J, Moser SE, Brummett CM. Pressure sensitivity and phenotypic changes in patients with suspected opioid-induced hyperalgesia being withdrawn from full mu agonists. J Nat Sci 2017; 3:e319. [PMID: 28361126 PMCID: PMC5370173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess changes in phenotype and pressure sensitivity in patients with suspected opioid-induced-hyperalgesia (OIH) after transitioning to buprenorphine. METHODS Twenty patients with suspected OIH were enrolled to transition to buprenorphine therapy. Patients completed validated self-report measures at baseline and at 1, 4, 8 weeks, and 6 months after initiation of buprenorphine along with quantitative sensory testing including measures of pressure pain threshold, pain tolerance and Pain 50 (a pain intensity rating). RESULTS 20 patients were enrolled, 17 were treated with buprenorphine and 11 completed all assessment points. We found that after transitioning to buprenorphine, patients on higher opioid doses (≥100mg oral morphine equivalents) had significant improvements for some measures including decreased pain severity and fibromyalgia survey scores, fewer neuropathic pain features, less catastrophizing, fewer depressive symptoms, and improved functioning 1-week after transitioning to buprenorphine with an eventual return back to baseline. Although not statistically significant, patients on high dose opioids (≥100mg OME) also showed a trend of decreased pressure sensitivity 1-week after transitioning to buprenorphine with a gradual return back to baseline. CONCLUSIONS Our study is the first to look at pressure pain sensitivity in patients who were taking opioids and transitioned to buprenorphine. These results suggest that the patients most likely to benefit from buprenorphine therapy are those on higher doses. In addition, the eventual return back to baseline on measures of pain phenotype and pressure sensitivity suggests that buprenorphine may over time result in a return of the hyperalgesic effects of a full mu agonist.
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Affiliation(s)
- Ronald A. Wasserman
- Corresponding Author: Ronald A. Wasserman, M.D. University of Michigan Back and Pain Center, Burlington Building 1, Floor 1, 325 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA, Tel: 734-647-9983; Fax: 734-936-6585.
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Nicol AL, Sieberg CB, Clauw DJ, Hassett AL, Moser SE, Brummett CM. The Association Between a History of Lifetime Traumatic Events and Pain Severity, Physical Function, and Affective Distress in Patients With Chronic Pain. The Journal of Pain 2016; 17:1334-1348. [DOI: 10.1016/j.jpain.2016.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
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